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Pneumothorax (PTX) and pneumomediastinum (PM) are frequently encountered in patients with Coronavirus disease 2019 (COVID-19) and complicate the management of these patients. In this study, we aimed to evaluate the risk factors that cause PTX/PM complications in patients hospitalized due to COVID-19 pneumonia and the effects of these complications on the course of the disease.A total of 503 patients with COVID-19 hospitalized in the COVID-19 ward or intensive care unit (ICU) between September 2020 and December 2020 were included in the study.The median age of patients was 65 (min-max, 21-99) years. Of the patients 299 (59.4%) were male and 204 (40.6%) were female. Of the cases, 26 (5.2%) developed PTX or PM. The patients who developed PTX/PM were older than patients who did not [58.5 (min-max, 21-96) vs 65 years (min-max, 22-99), p= 0.029]. The percentage of PTX/PM development was significantly higher in male patients [F/M= 4/22 (2/7.4%) vs 200/277 (98/92.6%), p= 0.007]. Hypertension as a comorbidity was more commonly seen in the group without PTX/PM (p= 0.007). Ground-glass opacity was the most common tomographic finding in both groups, it was significantly higher in those who did not develop PTX/PM (p0.001). The length of hospital stay was shorter in patients with PTX/PM (p0.001), but mortality was higher (p= 0.04).PTX/PM were relatively more common in COVID-19 patients. These complications may negatively affect the prognosis of the disease.

Purpose: The treatment of Pulmonary Embolism (PE) which is a life-threatening disease must be planned considering the risk-benefit relationship. In this study, patients with PE given thrombolytic therapy, low-molecular-weight heparin, and warfarin were monitored for 5 years to compare them in terms of hemorrhage side effects due to therapy. Method: A total of 219 patients were included in the study. 50.2% (n=109) of the patient’s were female and 49.8% (n=110) were male, (p=0.20). Clinical findings, radiologic and laboratory parameters, treatments and side effects were recorded. A total of 121 (55.25%) patients were given thrombolytic therapy (Group 1 n=121). Enoxaparin therapy was given to 205 patients (Group 2). During therapy maintenance, warfarin therapy was conducted for 159 patients (Group 3). Results: Cerebral hemorrhage observed in 1 case (0.83%) in group 1, 2 case (0.98%) in group 2 and 1 cases (0.62%) in group 3 (p>0.05). Gastrointestinal system (GI) bleeding happened 2 cases (1.65%) in group 1 and 2 cases (0.98%) in group 2 (p>0.05). Minor bleeding was observed at similar rates due to the treatments. There was no fatality due to hemorrhage. There is no significant difference in terms of death, recurrence, residual chronic thrombus, and chronic PE in the follow-up for five years between the rt-PA group (group1) and non-rt-PA group (p>0.05). Conclusion: According to our results; major hemorrhage was observed similarly in thrombolytic, enoxaparin, and warfarin therapy. Study results about the rate of cerebral hemorrhage related to thrombolytic therapy were low in contrast to the results reported in the literature before.

Introduction The risk of tuberculosis is higher in cases who have used antiTNF treatments. However, it is not clearly known whether there is a relationship between other biologic agents and the risk of developing tuberculosis or not. We aimed to investigate the prevalence of active tuberculosis among patients with rheumatic disease treated with biologic drugs. Materials and methods The study was performed at a tertiary referral center from January 2015 to December 2019. A total of 2000 patients with rheumatic diseases were screened and 461 patients were enrolled in the study due to regular records. They were underwent LTBI screening tests and were followedup at least 1 year after TNF inhibitor treatment initiation. Result The median age of all patients was 48 (min-max: 19-80). 283 patients (61.3%) were female and 178 (38.7%) were male. The most common diseases were ankylosing spondylitis (67.2%), rheumatoid arthritis (26%) and psoriatic arthritis (5.2%). Anti-TNF treatments were given to 85.2% of all cases and other biologic treatments were given to 14.8%. Tuberculin skin test was applied to 429 patients and 70.4% positivity was found. Quantiferon-TB test was applied to 93 patients and 20.4% positivity was found. 320 patients were treated for LTBI due to positive tuberculin skin test and/or positive quantiferon-TB test. TB was developed in only one patient out of 393 patients who were treated with anti-TNF treatments and the the prevalence of TB development was found 255/100.000. Conclusions The incidence of tuberculosis was quite low in our patients with rheumatic disease who were receiving anti-TNF treatment compared to previous studies. Also, in patients who were using other biological treatments, no TB cases were developed.

INTRODUCTION Obstructive sleep apnea (OSA) is an oxidative stress disease, which has been considered to be a notable risk and associated with increased cardiovascular morbidity and mortality. Thiol-disulfide homeostasis is as a novel indicator of oxidative stress. OBJECTIVES We aimed to evaluate thiol-disulfide homeostasis in a large patient population with OSA. METHODS A total of 230 with OSA and 40 healthy controls were included in the study. Inclusion criteria for OSA patients are having apnoea-hypopnoea index of ≥5/hour, being more than 18 years of age and having no previous treatment for OSA. Thiol-disulfide analysis was done for the patients and control group. Blood thiol-disulfide homeostasis was analysed using the new automatic method, developed by Erel and Neselioglu. RESULTS Among all OSA subjects, 149 (64.8%) were males and the mean ages of the patients were 53.38 ± 10.22. Total thiol, native thiol (SH) and disulfide (SS) levels were significantly lower in OSA group compared to the control group (P

Among the various clinical scoring methods used for the prediagnosis of pulmonary embolism (PE), Wells criteria is the most common. It relies on the findings and story of deep venous thrombosis (DVT), PE and malignancy. It is known that atrial fibrillation (AF) is a risk factor for PE like as DVT or malignancy. We aimed to evaluate the possibility of diagnosing more patients with PE by including AF in the Wells criteria. This prospective study included 250 patients admitted to the emergency department with PE findings. Wells scoring and Wells scoring with AF were performed for each patient. Out of 250 patients, 165 patients were diagnosed as PE. Wells score was >4 in 61.8% of patients with PE and 28.2% of patients without PE. Out of false negative 63 patients with PE, 21 of them had AF. According to Wells scoring with AF the score of 148 (89.7%) patients with PE diagnosis was ≥3, whereas the score of 45 (52.9%) patients without PE was ≥3. AF was detected in 15.8% of patients with PE. The sensitivity of Wells score with AF was significantly higher than that of the Wells score (p

INTRODUCTION: We aimed to investigate the relationship between smoking and the general characteristics, symptoms and clinical course of patients diagnosed with COVID-19 who were followed-up in the COVID ward in the first 2 months of the pandemic. METHODS: Patients over the age of 18 and diagnosed with COVID-19 were included retrospectively. The demographic data, symptoms, comorbidities of the patients, tobacco and tobacco-product use, disease severity, the patient's follow-up status in the ward or intensive care unit and the need for supportive treatment, and the relationship between tobacco-use and disease severity were evaluated. RESULTS: A total of 224 patients, 40.6% of whom were female, with a mean age of 57 years were included in the study. 32.6% of the patients were active smokers, 27.6% were quit-smoking, 13.4% passive-smokers and 26.3% never-smoked. Of the patients (n = 62) who quit smoking, 17 (27.4%) patients were quit smoking during the pandemic. The highest smoking rate was found in patients between the ages of 18-49 (44.7%). Dyspnea (45.2%), loss of smelling (31.5%), inability to taste (21.9%), chills-and-shivering (16.9%) were statistically higher in patients with active-smoking. Comparing the need for supportive treatments during the follow-up of the patients, the use of oxygen therapy was found to be significantly higher in patients with active-smoking and quit-tobacco use, while other supportive treatments were similar. When the rates of smoking status and death of the patients were compared, a proportionally higher mortality rate was found in active-tobacco users, but there was no significant difference. DISCUSSION AND CONCLUSION: While no significant difference on the effect of tobacco use on disease severity and mortality in our study, it is observed that the symptom of shortness of breath was higher in smokers in COVID-19 patients. Additionally, the need for oxygen treatment may increase significantly due to tobacco use in their life span.

Behcet's disease is a chronic inflammatory multi-systemic vasculitis. Recurrent oral and genital aphthous ulcers, uveitis, arthritis, arterial aneurysms, venous thrombosis, gastrointestinal system lesions and skin lesions can be seen. Large, medium or small arteries and veins may be involved. While venous lesions cause occlusion, arterial lesions can cause both occlusion and aneurysm. Major forms of pulmonary involvement include pulmonary artery aneurysm, arterial and venous thrombosis, pulmonary infarction, recurrent pneumonia, and pleurisy. In Behcet's disease, pulmonary thromboembolism (PE) is often associated with endothelial damage. Neutrophils play an important role in the pathogenesis of thrombosis. Coagulation components such as fibrinogen, thrombin, factor Xa and factor VIIa activate the inflammatory cascade and induce vascular events. It is important to understand the pathogenesis of vascular events in determining the effective treatment strategy. Here we present a patient with Behcet's disease who was presented with pulmonary embolism and was investigated for the etiology of thrombosis.

Aim: The aim of this study is to develop and explain an easy-to-use severity score calculation tool to predict severe COVID-19 cases that would need intensive care unit (ICU) follow-up.Material method: The study was carried out in patients with laboratory-confirmed COVID-19 hospitalized in Ankara City Hospital between March 15, 2020, and June 15, 2020. The outcome was severe illness that required ICU follow-up. Univariate and binary logistic regression were used to create a prediction model by using potential predictive parameters obtained on the day of hospitalization. Youden’s J index was calculated with receiver-operator characteristic curves analysis in order to evaluate cut-off points, and predicted probability was calculated. The accuracy of the prediction model was tested by calculating the area under curve (AUC). Results: Of the total of 1022 patients, 152 had a severe illness and required ICU follow-up. Among 68 variables, 20 parameters met the potential predictive factor condition for severe illness and were included in the development process for ANKARA CITY HOSPITAL COVID-19 SEVERITY SCORE (ACCSES). The ACCSES calculation tool was created by the final 9 parameters (sex, oxygen saturation, hemoglobin, platelet count, glomerular filtration rate, aspartate transaminase, procalcitonin, ferritin, and D-dimer). AUC was 0.96 (95% CI, 0.95-0.98).Conclusion: We developed a simple, accessible, easy to use calculation tool, ACCSES, with good distinctive power for a severe illness that required ICU follow-up. The clinician can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up simply using available clinical and laboratory values of patients upon admission.

Background Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. Methods Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer–Lemeshow Goodness-of-fit test, and calibration curve analysis. Results Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902–0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899–0.947). Hosmer–Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). Conclusion We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

Amaç: Pasif içicilik sigara içmeyen bireylerin tütündumanına istemsiz olarak maruziyetini tanımlar ve önemli bir halk sağlığıproblemidir. Tüm dünyada, çocukların %40'ı ve sigara içmeyen yetişkinlerin%34'ü sigara dumanına maruz kalmaktadır. Uzun süredir tütün dumanının sigaraiçmeyen kişilerde sağlığa zararlı etkileri olduğu bilinmektedir. Biz de buçalışma ile, hastanemiz Sigara Bırakma ve Göğüs Hastalıkları Polikliniğimizebaşvuran hasta ve yakınlarının pasif içiciliğin sağlık üzerine etkilerihakkında bilgi ve görüşlerini değerlendirmeyi amaçladık. Materyal ve Metot: Çalışmamız, hastanemiz Sigara Bırakma ve GöğüsHastalıkları Polikliniği’ne başvuran, hasta ve hasta yakınlarından gönüllü olankişiler ile yapıldı. Gönüllü olan kişilere, demografik özellikleri ve pasifiçiciliğin sağlık üzerindeki etkileri hakkında bilgi ve görüşlerinideğerlendiren anket uygulandı. Ankette pasif içiciliğin tanımı ve sonuçlarınıiçeren 17 ifade bulunmakta idi. Katılımcılara bu ifadeler için “Katılıyorum”,“Katılmıyorum” ya da “Bilmiyorum” seçenekleri sunuldu. Bulgular: Çalışmaya 520 kişi dahil edildi. Katılımcıların yaş ortalaması42,73 ± 15,40, 328’si (%63,10) erkek ve 192’si (%36,90) kadındı. Katılımcıların%41,70’i halen sigara içmekte, %42,50’si hiç sigara içmemiş, %15,80’i isesigarayı bırakmıştı. Katılımcıların çoğu (%89,10) pasif içiciliğin tanımınıbiliyordu. Pasif içicilik kalp hastalığı, astım, akciğer kanseri, bronşit,zatüre, kalp-damar hastalıkları, KOAH riskini artırdığına yönelik ifadelerekatılım yüksek iken, diabetes mellitus, demans, ani bebek ölümü gibi riskleriartırdığına ait ifadelere katılım ise düşük düzeyde bulundu. “Sigara içenlerinbebeklerinde uykuda ani bebek ölümü daha fazla görülür” ve “Sigara içenlerinçocuklarında öksürük, balgam ve hışıltılı solunum daha fazla görülür” ifadelerinehalen sigara içenlerin katılımı hiç sigara içmemiş ve sigarayı bırakanlara göredaha azdı (sırasıyla p=0,037 ve p=0,005). “Sigara içenlerin çocuklarındaöksürük, balgam ve hışıltılı solunum daha fazla görülür” ifadesinekatılmayanların çoğunluğunu erkekler oluşturmaktaydı (p= 0,033). Sonuç: Çalışmamızda katılımcıların pasif içiciliğin sağlık üzerindekiolumsuz etkilerinin bir kısmı hakkında bilgi sahibiydiler. Her ne kadarülkemizde on yıldır uygulanmakta olan dumansız hava sahası politikası toplumunsigara dumanının etkileri hakkında farkındalığını artırsa da yeterli değildir.Pasif içiciliğin zararlarından korunmak kapalı alanlarda sigara içilmesininönlenmesi ve toplum bilincinin artırılması ile mümkün olabilir. Özellikleçocuklar üzerindeki etkilerin bilinmesi ebeveynlerin çocuklarının sağlığınıkorumaya yönelik tedbirler almasını sağlayacaktır., Objectives: Passive smoking describes the unintended exposure of non-smokers totobacco smoke and is an important public health problem. In all over the world,40% of children and 34% of non-smoker adults are exposed to cigarette smoke. Ithas long been known that tobacco smoke has a detrimental effect on people whodoesn’t smoke. We aimed to evaluate the knowledge of the patients and theirrelatives about the health problems occurred by passive smoking. Materials and Methods: Our study was applied with the volunteers frompatients and their relatives in the outpatient clinics of Smoking Cessation andChest Diseases. A questionnaire was used to evaluate the demographiccharacteristics and the knowledge of the patients and relatives about resultsof passive smoking. The questionnaire included 17 statements that included thedefinition and results of passive smoking. For participants some options werepresented "I agree", ”I disagree“ or "I don’t know". Results: 520 participants were included in the study. The mean age ofthe participants was 42.73 ± 15.40, 328 (63.10%) were male and 192 (36.90%)were female. 41.70% of the participants were smokers, 42.50% had never smoked,15.80% had stopped smoking. Most participants (89.10%) knew the definition ofpassive smoking. Knowledge was high in some statements like passive smokingrelation with heart disease, asthma, lung cancer, bronchitis, pneumonia,cardiovascular diseases and COPD. However, relationship between passive smokingand diabetes mellitus, dementia and sudden infant death were not known well. Tothe statements of “In infants of smokers, sudden infant death in sleep is morecommon” and “in children of smokers cough, sputum and wheezing are more common”,agreement of smokers was less than who never smoked and than those who quitsmoking (p=0.037 and p=0.005, respectively). The majority of those who did notagree in the statement “Cough, sputum and wheezing are more common in thechildren of smokers” were male (p= 0.033). Conclusion: In our study, the participants had known some of theharmless effects of passive smoking on health. Although the smoke-free airspacepolicy, which has been implemented for ten years in our country, has increasedthe public's awareness of the hazards of cigarette smoke; this is not enough.Therefore, people can be protected from the damages of passive smoking with theapplication of laws and increasing public awareness. Especially parents cantake some protective measures for their children by the awareness of allpassive smoking hazards.

Pseudomembranous aspergillus tracheobronchitis is an uncommon form of invasive pulmonary aspergillosis, and it is generally seen in immunocompromised patients. We report about a mildly immunocompromised case with pseudomembranous aspergillus tracheobronchitis, which caused tracheal perforation, and Horner's syndrome. A 44-year-old female with uncontrolled diabetes mellitus, complaining of fever and dyspnea, was admitted to the hospital. She was hospitalized with community-acquired pneumonia and diabetic ketoacidosis. Insulin infusion and empirical antibiotics were firstly commenced. Bronchoscopy showed left vocal cord paralysis with extensive whitish exudative membranes covering the trachea and the main bronchi. Liposomal amphotericin B was added due to the probability of fungal etiology. Mucosal biopsy revealed aspergillus species. Second bronchoscopic examination demonstrated a large perforation in the tracheobronchial system. Despite all treatments, respiratory failure developed on the 25th day and the patient died within 2 days. Pseudomembranous aspergillus tracheobronchitis is fatal in about 78 % of all cases despite appropriate therapy. Early diagnosis and efficient antifungal therapy may improve the prognosis.

Nitrofurantoin is an antimicrobial agent commonly used for urinary tract infections. This drug may cause pulmonary toxicities, the manifestations of which range from acute self-limiting reactions to chronic pathologies. Here, we report the case of a 72-year-old male who was admitted with progressive cough and dyspnea for 4 months. On physical examination, his respiratory rate was 26/min and oxygen saturation was 84% at rest while breathing room air. Chest examination revealed bilaterally fine crackles. His thorax computed tomography showed bilateral widespread ground-glass opacities and interlobular and intralobular septal thickening. His blood test revealed antinuclear antibody positivity. He had been using nitrofurantoin for a long time for urinary tract infection. He had a high score on Naranjo Adverse Drug Reaction Probability Scale. When he was a diagnosed, he had a respiratory failure due to lung damage. Patients using nitrofurantoin should be followed up closely for drug toxicity.

Aim: Clinical features in sarcoidosis are very variable and can present with numerous phenotypes depending on organ involvements, clinical onset (acute, subacute, and chronic) and response to therapy. In this study, we aimed to evaluate the clinical findings, diagnostic methods and treatments of patients with sarcoidosis by 10-years data in our hospital in Turkey.Materials and Methods: The study was carried out between January 2018 and January 2019. The patients were screened retrospectively from the hospital information system. Clinical details were collected using a structured data collection form.Results: 172 patients were included in our study. 122 (70.9%) were female and 50 (29.1%) were male. The mean age at diagnosis was50.18 ± 13.73 years in all patients, while female patients’ mean age was 52.86 ± 13.06, male patients’ was 43.66 ± 13.24 (p

Giriş: Bu çalışmada, obstrüktif uyku apne sendromu (OSAS)'nun değerlendirilmesinde kullanılan antropometrik ölçüm ve oranların ülkemize ait değerlerini belirlemek istedik. Materyal ve Metod: Çok merkezli prospektif olarak planlanan çalışmamıza 13 ilimizde yer alan, akredite olmuş 20 uyku merkezi katıldı. OSAS semptomları olan ve polisomnografik inceleme ile apne-hipopne indeksi (AHİ) ≥ 5 bulunan olgular OSAS çalışma grubu; AHİ < 5 ve STOP-Bang < 2 olan olgular ise kontrol grubu olarak alındı. Olgulara ait demografik özellikler [yaş, cinsiyet, beden kitle indeksi (BKİ)] ve antropometrik ölçümler (boyun, bel ve kalça çevresi, bel/kalça oranları) kaydedildi. Bulgular: Çalışmaya 20 merkezden yaş ortalaması 50.50 ± 0.21 yıl olan 2684 (%81.3’ü OSAS’lı) olgu alındı. Olgular, ülkemizin altı coğrafi bölgesinden (Akdeniz, Doğu Anadolu, Ege, İç Anadolu, Karadeniz ve Marmara Bölgesi) alındı. Olguların demografik özellikleri ve antropometrik ölçümleri; kontrol grubuna göre karşılaştırıldığında yaş, boyun, bel, kalça çevresi ve bel/kalça oranları ve BKİ özellikleri; bölgelere göre karşılaştırıldığında ise yaş, boyun, bel, kalça çevresi ve bel/kalça oranları istatistiksel olarak farklı bulundu (sırasıyla p< 0.001, p< 0.001, p< 0.05). Cinsiyetlere göre karşılaştırıldığında yaş, boyun ve kalça çevresi, bel/kalça oranı, boy, kilo ve BKİ özellikleri istatistiksel olarak farklı idi (sırasıyla, p< 0.001). Boyun çevresi ve bel/kalça oranı sırasıyla erkeklerde 42.58 ± 0.10 cm (cut-off 41; duyarlılık %61.2; özgüllük %68.3), 0.99 ± 0.002 (cut-off 0.97; duyarlılık %56.4; özgüllük %54.3); kadınlarda 39.24 ± 0.16 cm (cut-off 37; duyarlılık %66.5; özgüllük %63.4), 0.93 ± 0.004 (cut-off 0.89; duyarlılık %70.9; özgüllük %49.5) bulundu. OSAS fenotipleri; klasik OSAS, okült OSAS, REM bağımlı OSAS, pozisyon bağımlı OSAS, REM ve pozisyon bağımlı OSAS, overlap sendromu ve kompleks uyku apne sendromu olarak belirtildi. OSAS fenotiplerine göre karşılaştırıldığında yaş, boyun ve kalça çevresi, boy, kilo ve BKİ özellikleri istatistiksel olarak farklı iken (sırasıyla, p< 0.001) bel/kalça oranı farklı bulunmadı. Sonuç: Boyun çevresi erkeklerde standart değerin altında iken, kadınlarda üstünde bulundu. Bel/kalça oranı hem erkeklerde hem de kadınlarda ideal ölçülerin üzerinde idi. Bu bağlamda ülke değerlerinin tespiti OSAS olasılığı olan hastaların belirlenmesini ve polisomnografi için uyku merkezlerine yönlendirilmesini sağlayacaktır. Introduction: In this study, we aimed to determine the values of anthropometric measurements and rates used in the evaluation of obstructive sleep apnea syndrome (OSAS) in our country. Materials and Methods: Twenty accredited sleep centers in thirteen provinces participated in this multicenter prospective study. OSAS symptoms and polysomnographic examination and apnea-hypopnea index (AHI) ≥ 5 cases OSAS study group; patients with AHI < 5 and STOP-Bang < 2 were included as control group. Demographic characteristics (age, sex, body mass index-BMI) and anthropometric measurements (neck, waist and hip circumference, waist/hip ratio) of the subjects were recorded. Results: The study included 2684 patients (81.3% OSAS) with a mean age of 50.50 ± 0.21 years from 20 centers. The cases were taken from six geographical regions of the country (Mediterranean, Eastern Anatolia, Aegean, Central Anatolia, Black Sea and Marmara Region). Demographic characteristics and anthropometric measurements; age, neck, waist, hip circumference and waist/ hip ratios and BMI characteristics when compared with the control group; when compared according to regions, age, neck, waist, hip circumference and waist/hip ratios were found to be statistically different (p< 0.001, p< 0.001, p< 0.05, respectively). When compared by sex, age, neck and hip circumference, waist/hip ratio, height, weight and BMI characteristics were statistically different (p< 0.001, respectively). Neck circumference and waist/hip ratio were respectively 42.58 ± 0.10 cm, 0.99 ± 0.002, 39.24 ± 0.16 cm, 0.93 ± 0.004 were found in women. Conclusion: The neck circumference was lower than the standard value in men, but higher in women. The waist/hip ratio was above the ideal measurements in both men and women. In this context, the determination of the country values will allow the identification of patients with the possibility of OSAS and referral to sleep centers for polysomnography.

Giriş: Bu çalışmada, obstrüktif uyku apne sendromu (OSAS)'nun değerlendirilmesinde kullanılan antropometrik ölçüm ve oranlarınülkemize ait değerlerini belirlemek istedik.Materyal ve Metod: Çok merkezli prospektif olarak planlanan çalışmamıza 13 ilimizde yer alan, akredite olmuş 20 uyku merkezikatıldı. OSAS semptomları olan ve polisomnografik inceleme ile apne-hipopne indeksi (AHİ) ≥ 5 bulunan olgular OSAS çalışmagrubu; AHİ < 5 ve STOP-Bang < 2 olan olgular ise kontrol grubu olarak alındı. Olgulara ait demografik özellikler [yaş, cinsiyet, bedenkitle indeksi (BKİ)] ve antropometrik ölçümler (boyun, bel ve kalça çevresi, bel/kalça oranları) kaydedildi.Bulgular: Çalışmaya 20 merkezden yaş ortalaması 50.50 ± 0.21 yıl olan 2684 (%81.3’ü OSAS’lı) olgu alındı. Olgular, ülkemizin altıcoğrafi bölgesinden (Akdeniz, Doğu Anadolu, Ege, İç Anadolu, Karadeniz ve Marmara Bölgesi) alındı. Olguların demografik özellikleri ve antropometrik ölçümleri; kontrol grubuna göre karşılaştırıldığında yaş, boyun, bel, kalça çevresi ve bel/kalça oranları ve BKİözellikleri; bölgelere göre karşılaştırıldığında ise yaş, boyun, bel, kalça çevresi ve bel/kalça oranları istatistiksel olarak farklı bulundu(sırasıyla p< 0.001, p< 0.001, p< 0.05). Cinsiyetlere göre karşılaştırıldığında yaş, boyun ve kalça çevresi, bel/kalça oranı, boy, kilo veBKİ özellikleri istatistiksel olarak farklı idi (sırasıyla, p< 0.001). Boyun çevresi ve bel/kalça oranı sırasıyla erkeklerde 42.58 ± 0.10 cm(cut-off 41; duyarlılık %61.2; özgüllük %68.3), 0.99 ± 0.002 (cut-off 0.97; duyarlılık %56.4; özgüllük %54.3); kadınlarda 39.24 ±0.16 cm (cut-off 37; duyarlılık %66.5; özgüllük %63.4), 0.93 ± 0.004 (cut-off 0.89; duyarlılık %70.9; özgüllük %49.5) bulundu.OSAS fenotipleri; klasik OSAS, okült OSAS, REM bağımlı OSAS, pozisyon bağımlı OSAS, REM ve pozisyon bağımlı OSAS, overlapsendromu ve kompleks uyku apne sendromu olarak belirtildi. OSAS fenotiplerine göre karşılaştırıldığında yaş, boyun ve kalça çevresi,boy, kilo ve BKİ özellikleri istatistiksel olarak farklı iken (sırasıyla, p< 0.001) bel/kalça oranı farklı bulunmadı.Sonuç: Boyun çevresi erkeklerde standart değerin altında iken, kadınlarda üstünde bulundu. Bel/kalça oranı hem erkeklerde hem dekadınlarda ideal ölçülerin üzerinde idi. Bu bağlamda ülke değerlerinin tespiti OSAS olasılığı olan hastaların belirlenmesini ve polisomnografi için uyku merkezlerine yönlendirilmesini sağlayacaktır.

Amaç: Yoğun bakım ünitelerinde (YBÜ)çalışan sağlık personelinde tükenmişlik sendromu yaygın olup bu durum sağlıkçalışanlarının mesleki bakım kalitesini ve performansını etkileyebilmektedir.Bu çalışma yoğun bakım ortamında gün ışığı faktörünün tükenmişlik sendromunaetkisini incelemek amacıyla planlanmıştır.Materyal ve Metot: Yoğun bakım ünitesinde çalışandoktor ve hemşirelere iki bölümden oluşan anket formu uygulanmıştır. Anketinilk bölümünde sosyo-demografik veriler, çalıştıkları yoğun bakımın koşulları veyoğun bakım ortamı ile ilgili sorular, ikinci bölümde ise “Maslach TükenmişlikÖlçeği” bulunmaktadır. Çalışmada pencereli ve penceresiz YBÜ’de çalışanlar ikigruba ayrılarak karşılaştırıldı.Bulgular: Araştırmaya gün ışığı alanolan üst YBÜ’nde çalışan 46 ve penceresiz olan alt YBÜ’lerde çalışan 59; toplam105 kişi katıldı. Yaş ortalaması sırasıyla 31,17±6.00 ve 28,53±5,23 (p=0,02)bulundu. Katılanların 75'i (%71,4) hemşire ve 30'u (%28,6) doktordu.Katılımcıların %98'i "çalışma ortamınızda pencere bulunsun mu?"sorusuna evet cevabını verdi, %89' u ise ortam gün ışığının performansınıolumlu etkileyeceğini belirtti. Alt katlarda bulunan penceresiz YBÜ’deçalışanlarda duygusal tükenmişlik ve duyarsızlaşma gün ışığı alan üst kat YBÜçalışanlarına göre anlamlı oranda yüksek bulundu (sırasıyla p=0,02, p=0,002). Sonuç: Yoğun bakım ünitelerinin gün ışığıalacak şekilde düzenlenmesi, tükenmişlik sendromu gelişme oranını azaltarakYBÜ’nde çalışan sağlık personelinin iş performans ve verimliğini arttıracağıgibi, tıbbi hata yapma olasılıklarını da azaltacaktır.&nbsp, Objectives: Burnoutsyndrome is widespread among health care workers working in intensive care units(ICU), which can affect the quality of patient care and performance. This studywas planned to investigate the effect of windows and daylight on burnoutsyndrome in an intensive care setting. Materials andMethods: A questionnaire consisting of two parts was appliedto doctors and nurses working in intensive care units. In the first part of thequestionnaire, questions about socio-demographic data, intensive careconditions and intensive care environment were studied, and the second part wasthe "Maslach Burnout Scale". Two groups, workers in the ICU with andwithout windows were compared in the study. Results: There are 46workers in the upper ICU who are taking daylight and 59 workers in the lowerICU without windows; a total of 105 people attended to the research. The meanage was 31.17±6.00 and 28.53±5.23, respectively and 75 (71.4%) of theparticipants were nurses, 30 (28.6%) were doctors. To the question "Do youwant a window in your working environment?" 98.1% of respondents gave theanswer yes and 89.5% stated that the ambient daylight would have a positiveeffect on their performance. Exhaustion and cynicism were significantly higherat the lower floor ICU workers than the upper floor ICU workers (p=0.02,p=0.002).Conclusion: ArrangingICUs with windows to receive daylight is a useful way to increase the workperformance and productivity and to decrease medical mistakes of health staffwho works in ICUs by reducing the incidence of burnout syndrome.&nbsp

We present 2 cases of pulmonary thromboembolism (PTE). The first case, a 50-year-old man, was admitted to the emergency department because of sudden onset dyspnea and left side chest pain. He was diagnosed with intermediate-risk (submassive) PTE, and thrombolytic treatment was commenced. The patient fully recovered, but 5 days later, he was diagnosed with a new, high-risk PTE. The second patient, a 23-year-old woman, presented with syncope, dyspnea, and chest pain for 2 days. She was diagnosed with high-risk (massive) PTE. Thrombolytic treatment was commenced, and the patient fully recovered, too. But the later patient was also diagnosed with a new PTE 4 days later. We applied repeated thrombolytic treatment in the patients due to repeated PTE. The first patient fully recovered and was discharged from the hospital, but the second patient died because of gastrointestinal bleeding and renal insufficiency. A repeated thrombolytic treatment could be an alternative treatment for these patients, considering treatment's risks.

Radiation-induced lung diseases are common after radiotherapy of the chest wall or intrathoracic organs. The damage of radiations is ground-glass opacity, consolidation, fibrosis, traction bron chiectasis, and volume loss. Development of pleural fluid or a new mass is rarely seen. A solid lesion was detected in the computed thoracic tomography of 53 year-old male patient. The lesion was at the apex of the right lung, 66x61 mm in size and invading the trachea, esophagus and right subclavian artery. Weekly chemotherapy and radiotherapy were applied concurrently, and the tumor was quickly disappeared, leaving its place to an unexpected cavitary lesion. The case has been reported because of its rarity in the literature.

Radiotherapy (RT), used for the treatment of cancers, such as lung cancer, lymphoma, breast cancer, bone marrow transplantation, and esophageal cancer, causes the exposure of lungs to radiation. Since the lungs are very sensitive to ionizing radiation, radiation-induced lung diseases due to radiation therapy are usually common. In this article, lung diseases secondary to RT and the diagnosis and treatment of these diseases were evaluated in light of the literature.

Cardiac sarcoidosis is an infiltrative, granulomatous inflammatory disease of the myocardium. Generally, it can be difficult to diagnose cardiac sarcoidosis clinically because of the non-specific nature of its clinical manifestations. This property can be based on the presence of any clinical evidence of sarcoidosis in the other organs. We present two cases of cardiac sarcoidosis so as to demonstrate its different clinical manifestations. The first patient displayed no cardiac symptoms; the electrocardiogram showed an incidental right bundle branch block. Her cardiac magnetic resonance imaging (CMRI) revealed late-phase opaque material enhancement involving the inferior and inferoseptal segment of the left ventricle. The second patient was severely symptomatic in terms of cardiac involvement, and a transthoracic echocardiogram revealed global hypokinesia and septal brightness; his ejection fraction decreased to 45 %. These cases highlighted the challenges encountered in the diagnosis and treatment of cardiac sarcoidosis. CMRI should be considered in all patients who have suspected findings for cardiac involvement.

Background Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic method for tuberculosis (TB). This study was conducted to determine the efficiency of polymerase chain reaction (PCR) testing for detecting TB lymphadenitis in samples obtained by EBUS-TBNA. Materials and Methods A total of 93 consecutive patients with hilar/mediastinal lymphadenopathies and diagnosed with granulomatous diseases through histopathological evaluation were included in the study. The specimens provided by EBUS-TBNA were evaluated through pathological, microbiological, and molecular tests. Results Eighty-nine (95.7%) of the 93 patients had histopathologically granulomatous diseases by EBUS-TBNA. Tuberculosis was diagnosed in 27 (30.3%) patients and sarcoidosis was diagnosed in 62 (69.7%) patients. Four (4.3%) patients were diagnosed through mediastinoscopy. Endobronchial ultrasound–guided transbronchial needle aspiration had an overall diagnostic efficiency in TB of 96.9%, a sensitivity of 90.9%, and a specificity of 100%. Mycobacterium tuberculosis PCR was positive in 17 of the 30 patients. The sensitivity of PCR was 56.7%, the specificity was 100%, and the general efficiency of the test was 96.4%. Conclusions As a result, the use of M. tuberculosis PCR in the EBUS-TBNA specimens provides a rapid and an accurate diagnosis of TB. Therefore, we recommend the use of M. tuberculosis PCR in the EBUS-TBNA specimens as a rapid diagnostic method for mediastinal lymphadenopathies in patients with suspected TB.

Endobronchial ultrasound (EBUS) is a new technique that can be used for the diagnostic imaging of central pulmonary thromboembolism (PE). In eight cases at our clinic, EBUS was used because of mediastinal lymphadenopathies or paramediastinal nodular lesions and at the same time images were obtained of a PE by means of EBUS. The PE was diagnosed before the EBUS with computed tomography (CT) of the lungs in all cases (5 women and 3 men). The repletion defects of all the cases compatible with a PE were clarified with CT-angiography. EBUS may be an alternative method for the diagnosis of PE, as it can indicate the presence of a thrombus in the central pulmonary arteries in hemodynamically-stable cases.

Resumen La ecografia endobronquial (EBUS) es una nueva tecnica que puede utilizarse para el diagnostico por la imagen del tromboembolismo pulmonar (TEP) central. En 8 casos de nuestra clinica se utilizo la EBUS a causa de adenopatias mediastinicas o lesiones nodulares paramediastinicas, y al mismo tiempo se obtuvieron imagenes de un TEP mediante la EBUS. El TEP se diagnostico antes de la EBUS mediante tomografia computarizada (TC) pulmonar en todos los casos (5 mujeres y 3 varones). Los defectos de replecion de todos los casos compatibles con un TEP se esclarecieron mediante angio-TC. La EBUS puede ser un metodo alternativo para el diagnostico del TEP, ya que puede indicar la presencia de un trombo en arterias pulmonares centrales en casos en los que la hemodinamica es estable.

INTRODUCTION Transbronchial needle aspiration (TBNA) by the guide of endobronchial ultrasonography (EBUS) is a diagnostic method which may be used in diagnosing benign granulomatous diseases in contemporary practice. In this study, we planned to evaluate the diagnostic value of TBNA by the guide of EBUS for benign granulamatous diseases and to investigate the impact of cytological, microbiologic and tuberculosis (TB)-polimerase chain reaction (PCR) results in specimens. MATERIALS AND METHODS Thirty-four patients (20 female, 14 male) who had EBUS-TBNA and histopathological diagnosis of granulamatous inflammatory reaction were included in the study. The mean age of patients was 49.62 ± 12.72 years (26-72). The specimens provided by EBUS-TBNA were evaluated for pathologic, microbiologic, and molecular (TB-PCR) examinations. RESULTS As a result of clinical, radiological and laboratory studies of the patients with granulomatous inflammation, 13 (38.2%) patients had TB, 21 (61.7%) patients had sarcoidosis. Diagnoses of histopathological granuloma were established by EBUS-TBNA in 30 (88.2%) patients among patients with isolated mediastinal lymphadenopathies. Seven of mediastinal TB lymphadenopathies patients were TB-PCR positive. The sensitivity of PCR was 54% and the specificity was 100%, general efficiency of the test was found to be 82%. CONCLUSION In cases with granulomatosis lymphadenopathies, TB-PCR specimens which achieved by EBUS-TBNA results provided important contribution for the TB diagnosis. Therefore, we thought that TB-PCR is a diagnostic method to be studied in the cases who investigating for mediastinal lymphadenopathies.

Introduction Cigarette smoking is just important problem of public health. In the present study, our aim; was to determine to factors that increasing tendency to smoking cessation, the cases who are involved to policlinic of smoking cessation. Materials and methods Two hundred-forty five cigarette smokers were included in this study. It was recorded demographic signs, the novel of cigarette smoking, the degree of knowledge about the harmful of smoking in their opinion, the reason of starting to cigarette. It was evaluated that the principle reason to come to policlinic of smoking cessation and the other reasons. Results There were 53.9% male, 46.1% female in our study. Median (min-max) age was 45 (21-73) in females, 42 (20-75) in males. When evaluating the state of education; there was 35.9% primary school, 31.4% high school, 7.3% academy, 25.3% university graduates. 97.1% in all participants have used only cigarette smoking from tobacco products. Primarily reasons were 44% the fear of deterioration of health, 16.3% to be better model for their children, 9.8% to have disease at the time and 6.9% breathlessness for smoking cessation. Secondary reasons were of smoking harm to the environment, economic reasons, bad smell, being a good example of the environment and recommended by a physician. Conclusion The most of cases are want to quit smoking because of smoking harm to their health. Specially, parents wish to quit smoking because of they don't want to be bad model for their children. As a result; it is given to necessary support to participants who are this awareness in policlinics of smoking cessation. However, we think that it was necessity that should be continue increase of the therapy to growing to these awareness for the smokers who couldn't be enough awareness and who didn't think of quit smoking.

Data on the use and efficacy of complementary and alternative medicine (CAM) in patients with asthma are limited, and there is a lack of studies documenting the use of CAM in patients with chronic obstructive pulmonary disease (COPD) in Turkey.To determine the prevalence of CAM usage in patients with asthma and COPD and to assess the clinical and demographic factors associated with the use of CAM.A total of 521 patients (313 with asthma and 208 with COPD) were randomly enrolled into this cross-sectional survey. A face-to-face interview was conducted using a structured questionnaire.One hundred sixty-three patients (52%) with asthma and 70 patients (33%) with COPD were reported to be using some form of CAM (p0.001). The most popular modalities were herbal remedies (46% and 28% in the two groups, respectively) and animal products (28% and 5% in the two groups, respectively). CAM-practicing asthma patients were typically younger with longer duration of disease and higher income than the CAM-practicing COPD patients. For the patients, the main source of information on CAM practices was their relatives and friends. Only a small number of the patients consulted with their physicians about CAM. The main reasons to use CAM for patients with asthma and COPD were harmlessness and symptomatic relief, respectively. CAM-related adverse effects and difficulties to obtain CAM were significantly higher in patients with asthma than in patients with COPD.There is a high prevalence of CAM usage in patients with asthma and COPD in Turkey. Hence, becoming familiar with CAM therapy and inquiring about patient practice of CAM as part of the routine medical history will allow the physicians to provide reliable information to their patients on these medical practices.

Bronchoesophageal fistula (BEF) is an undesirable consequence of esophageal cancer. A BEF is encountered in 5% to 15% of patients with esophageal cancer. It is generally a life-threatening complication because of the development of recurrent pulmonary infection and sepsis. We present a case with esophageal cancer and acquired BEF. The fistula allowed herniation of the esophageal wall into the endobronchial lumen, causing significant obstruction of the airway lumen, findings not reported previously.

Introduction Pulmonary embolism (VTE) comes in different degrees of severity from massive pulmonary embolism to nonmassive pulmonary embolism with no symptoms or hypoxia. Thrombolytic therapy is a lifesaver especially for patients who are in the high-risk group. In this study, we aimed at evaluating symptoms and clinical and laboratory findings in patients who had a diagnosis of massive or submassive VTE and treated with 50-mg recombinant tissue plasminogen activator (rt-PA) per hour for various problems as opposed to the standard dose, which is 100 mg every 2 hours. Materials and Methods Forty-six patients with a diagnosis of massive or submassive VTE who received thrombolytic therapy were evaluated retrospectively. Twenty-three patients who were treated with 50-mg rt-PA per hour were included in the study group. On the other hand, 23 patients who were treated with 100 mg of intravenous infusion of rt-PA every 2 hours were included in the control group. Echocardiographic assessment of the right ventricular size, systolic pulmonary artery pressure (sPAP), oxygen saturation, systemic arterial pressure, and heart rate before the thrombolytic therapy and in the first 24 hours after the administration of therapy were checked and noted in both of the groups. Results No significant difference was found between the 2 groups with regard to demographic data, Wells scores, type of embolism, average symptom duration, sPAP, and oxygen saturation. Differences in recovery, as inferred from vital symptoms and sPAP measurements, were not significant between the 2 groups. Conclusions Lower-dose thrombolytic therapy showed similar efficacy versus the standard dose in VTE. Thrombolytic therapy is a life-saving treatment in massive VTE. Furthermore, a harm/benefit analysis may lead to the administration of half-dose therapy in selected cases when it is contraindicated for various reasons.

Non-Hodgkin lymphoma generally affects the thorax in nearly half of the cases, but endobronchial non-Hodgkin lymphoma is rare. A 65-year-old man presented with refractory cough and progressive dyspnea on exertion of 2 months' duration. The patient denied fever, weight loss, or night sweats. A chest x-ray revealed bilateral lower lobe infiltrates. A computed tomography scan of the chest revealed large matted mediastinal lymph nodes without clear margination. Bronchoscopic examination revealed bilateral endobronchial diffuse nodular lesions. Bronchial mucosal biopsy demonstrated B-cell lymphoma. The patient was treated with R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone) regimen with near-total resolution of endobronchial and parenchymal lesions.

Considering the popularity of Complementary and Alternative Medicine (CAM) in allergic patients, physicians involved in allergic patients' care need to be aware of CAM. To assess self-reported knowledge, attitude and approach to CAM of physicians who deal with allergic patients, a total of 500 structured questionnaires were distributed to physicians who participated in "Turkish National Society of Allergy and Clinical Immunology Congress-2009". For the questionnaires handed out, 242 (48.4%) physicians (median age 36.0 years, range 25–64 years) responded; 22.4% were fellows in training and 48.5% were residents. The main specialties were pediatrics (49.3%), and pulmonology (36.8%); half were either specialists or training in allergy and one-quarter (25.6%) referred patients to CAM. Asthma (42.1%) and chronic urticaria (28.9%) were the most common CAM referral diseases. Referred therapies were herbal (10.3%) and diet-based medicine (7.4%). The differences between physicians in terms of age, gender, experience in medicine, and specialty/allergy subspecialty were not statistically significant (p = 0.01). Affiliation to a university hospital was significantly associated with no CAM referral vs. affiliation in a state/private hospital or private practice. Academic degree and reported level of knowledge negatively/positively affected attitudes toward CAM, respectively. More than half of the respondents (68.8%) reported lack of or insufficient information about CAM, while 58.7% of physicians desired CAM education. This first report on physicians involved in allergic patients' care shows that they are reluctant to refer for CAM therapies. A minority believes that they have enough knowledge, and most are interested in continuing medical education on CAM. Considering physicians' interest and tendency to communicate significantly with their patients about CAM when they feel that they have sufficient knowledge and popularity of CAM among patients, training possibilities should be created to improve physicians' education in this field.

This article describes the case of a 40 year-old man presenting with pleuritic pain on the right side, cough, sputum and sweating symptoms. He had smoked 40 pack-years of cigarettes and consumed 140 ml alcohol/day for 20 years. Breath sounds were diminished at the right lung base. Chest X-ray showed right hemi-diaphragm elevation and heterogeneous opacity on the right inferior zone. Antibiotherapy was commenced for possible diagnosis of pleuropnemonia. The patient developed dyspnea after a few days. Right hemithorax filled with a parabolic shadow was observed on the chest X-ray. Serosanguineous exudate was sampled. Very high levels of amylase and lipase levels were detected in the pleural fluid. Furthermore, magnetic resonance imaging revealed pancreatic pseudocyst near the left diaphragmatic crus. Four thousand milliliters of pleural fluid was drained using an intercostal drain within a 4-day period, and chest symptoms were relieved. Upon follow-up, suitable therapy for chronic pancreatitis was administered, and the patient was stable without any recurrence.