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Purpose: Chest radiography is normal in approximately 20-40% of acute pulmonary embolism (PE) patients without cardiopulmonary disease. The aim of this study was to determine whether there is any difference between the patients with normal chest X-ray and those with pathological findings in terms of clinical severity and prognosis. Methods: 178 of PE patients were included in the study. 110 patients had no parenchymal pathology, whereas group 1 (n = 110); group 2 (n = 68) had various pathological parenchymal findings in 68 patients. Clinical and radiological parameters were compared between these groups. Following the diagnosis of PE, the cases were recorded in the fifth year. Results: In 178 participants; those with normal chest X-ray (group 1), with parenchymal pathological findings on the chest X-ray (group 2); echocardiographic systolic pulmonary artery pressure (sPAP) (p = 0.68), gender (p = 0.9) and thrombus type (p = 0.41) were similar. The patients in group 1 were not different in terms of central thrombus detected in computed tomography pulmonary angiogram compared to the patients in group 2; however, the chest radiograph of the patients in group 1 had no parenchymal pathology. Central thrombus group 1, group 2, respectively; 97 (89.0%), 53 (77.9%), p = 0.07. There was no significant difference between the two groups in terms of mortality which was followed up in fifth year (p > 0.05). Conclusions: Normal chest X-ray in PE can determine mortality and may involve increased risk of massive PE.

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.

Background In this study, we aimed to compare the intensive care unit (ICU) admission rate of hospitalized mild/moderate COVID-19 patients treated with hydroxychloroquine (HCQ), favipiravir, and HCQ plus favipiravir. Methods Single center retrospective designed observational study conducted in Ankara City Hospital. Patients who were hospitalized between March 15, 2020 and June 1, 2020 in COVID-19 inpatient clinics with laboratory confirmed diagnosis of COVID-19 were included in the study. An inverse probability of treatment weighting (IPTW) for multiple treatment groups approach was used to balance the differences in several variables on admission. Results Among 2441 patients hospitalized with diagnosis of COVID-19 during the study period, 824 were eligible for the analysis. Median age of patients was 42 (18−93 years). Among all, 347 (43.2%) of the patients had mild disease, 470 (56.8%) had pneumonia. Propensity scores ranged from 0.1841 to 0.9381 in the HCQ group, from 0.03643 to 0.29885 in the favipiravir group, and from 0.03542 to 0.56184 in the HCQ plus favipiravir group. After IPTW for multiple treatment groups was applied, all the covariates in the planned propensity score had weighted standardized effect sizes below 10% which were ranged from 0.005 to 0.092. Multivariate analysis of treatment effect (adjusted effect of treatment) was indicated that there is no statistically significant difference between HCQ, favipiravir, and HCQ plus favipiravir treatment. After using combination of SMOTE and Bootstrap resampling approach, we found no statistically significant difference between HCQ and HCQ plus favipiravir groups in terms of ICU admission. However, compared with the HCQ group, ICU admission rate was statistically significantly higher in the favipiravir group. We obtained the similar results after the sensitivity analysis. Conclusions HCQ with or without favipiravir treatment is associated with reduced risk of ICU admission compared to favipiravir alone in mild to moderate COVID-19 adult patients.

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

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.

Objectives: To compare dynamic thiol/disulfide homeostasis between patients with community-acquired pneumonia (CAP) and healthy controls. Methods : This prospective, case-control study was conducted in the Department of Pulmonary Diseases, Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey, between August 2016 and August 2017. In total, 50 hospitalized patients with CAP and 35 healthy individuals were enrolled. Patients with comorbidities and smokers were excluded. The thiol/disulfide state was evaluated in each group. Thiol levels (native/total) and % polymorhonuclear leukocytes and C-reactive protein levels association were evaluated in patients with CAP. Results : There was no significant difference between the CAP and control groups in age or gender (both, p greater than 0.05). The disulfide (SS) levels were similar between the 2 groups ( p= 0.148). The total thiol (TT) and native thiol (SH) levels were significantly lower (all, p= 0.001) and the SS/TT levels were significantly higher ( p= 0.019) in the CAP group compared with the controls. Conclusions : This study showed that the oxidant/antioxidant ratio was shifted to the oxidative side in CAP patients. An abnormal thiol/disulfide state may be an important factor in the pathogenesis and monitoring the treatment response. The thiol resources may use for treatment in CAP and may positively affect the prognosis. Saudi Med J 2018; Vol. 39 (5): 495-499 doi: 10.15537/smj.2018.5.22111 How to cite this article: Parlak ES, Alisik M, Hezer H, Karalezli A, Hasanoglu HC, Erel O. Evaluation of dynamic thiol/disulfide redox state in community-acquired pneumonia. Saudi Med J . 2018 May;39(5):495-499. doi: 10.15537/smj.2018.5.22111.

Recombinant tissue plasminogen activator (rt-PA) is the most commonly used thrombolytic agent in patients with high risk and intermediate to high mortality risk acute pulmonary embolism (PE). Clinical trials have shown early efficacy and safety of low-dose rt-PA. This study investigated the effects of low-dose rt-PA treatment on acute PE in long-term prognosis, recurrence of pulmonary thromboembolism, or the development of late complications. In this study, 48 patients undergoing low-dose rt-PA for the relative contraindications of thrombolytic therapy and 48 patients undergoing standard-dose therapy were evaluated retrospectively. Long-term follow-up investigated the chronic PE, recurrence, and causes of morbidity and mortality. In both treatment groups, embolism-induced mortality and overall mortality rates were similar in the first 30 days (p=1.000, p=0.714, respectively). Overall mortality rates in long-term follow-up were 41.7% in the low-dose treatment group and 16.7% in the standard-dose treatment group (p=0.013). The mortality rate at the first year was higher in the low-dose-treated group (p=0.011) and most of the deaths were due to accompanying comorbidities. There was no difference in PE recurrence and duration of recurrence between the groups (p=0.598, p=0.073, respectively). Intracranial hemorrhage due to therapy developed in one patient in both groups. Low-dose thrombolytic therapy in acute PE reduces PE-related mortality in the early period. Long-term follow-up showed that thrombolytic therapy did not affect mortality rates independently of the dose and PE recurrence.

Amac: Yogun bakim unitelerinde (YBU) calisan saglik personelinde tukenmislik sendromu yaygin olup bu durum saglik calisanlarinin mesleki bakim kalitesini ve performansini etkileyebilmektedir. Bu calisma yogun bakim ortaminda gun isigi faktorunun tukenmislik sendromuna etkisini incelemek amaciyla planlanmistir. Materyal ve Metot: Yogun bakim unitesinde calisan doktor ve hemsirelere iki bolumden olusan anket formu uygulanmistir. Anketin ilk bolumunde sosyo-demografik veriler, calistiklari yogun bakimin kosullari ve yogun bakim ortami ile ilgili sorular, ikinci bolumde ise “Maslach Tukenmislik Olcegi” bulunmaktadir. Calismada pencereli ve penceresiz YBU’de calisanlar iki gruba ayrilarak karsilastirildi. Bulgular: Arastirmaya gun isigi alan olan ust YBU’nde calisan 46 ve penceresiz olan alt YBU’lerde calisan 59; toplam 105 kisi katildi. Yas ortalamasi sirasiyla 31,17±6.00 ve 28,53±5,23 (p=0,02) bulundu. Katilanlarin 75'i (%71,4) hemsire ve 30'u (%28,6) doktordu. Katilimcilarin %98'i "calisma ortaminizda pencere bulunsun mu?" sorusuna evet cevabini verdi, %89' u ise ortam gun isiginin performansini olumlu etkileyecegini belirtti. Alt katlarda bulunan penceresiz YBU’de calisanlarda duygusal tukenmislik ve duyarsizlasma gun isigi alan ust kat YBU calisanlarina gore anlamli oranda yuksek bulundu (sirasiyla p=0,02, p=0,002). Sonuc: Yogun bakim unitelerinin gun isigi alacak sekilde duzenlenmesi, tukenmislik sendromu gelisme oranini azaltarak YBU’nde calisan saglik personelinin is performans ve verimligini arttiracagi gibi, tibbi hata yapma olasiliklarini da azaltacaktir.

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.

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

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.

Background: Thrombolytic therapy is considered to be the most effective treatment for high risk/life-threatening PE, and could also be effective for some intermediate risk PE with right ventricular dysfunction and/or myocardial. In this study, we aimed to evaluate the long-term efficacy and safety of half-dose recombinant tissue plasminogen activator (rt-PA) in PE treatment. Materials and Methods: 96 patients with the diagnosis of massive or submassive PE, who had thrombolytic therapy were evaluated retrospectively. 46 patients who were treated with 50 mg/1 hour (h) rt-PA were included in the study group. In the control group, 46 patients who treated with 100mg/2 h intravenous infusion of rt-PA were included. All patients were evaluated for radiological findings, echocardiographic changes, PE recurrence, chronic PE, and all-cause mortality. Result: There were no significant differences between the groups in terms of demographic data, the type of embolism, average symptom durations, initial systolic pulmonary artery pressures (sPAP) and oxygen saturation values, D-Dimer and troponin (p> 0.05). There was no difference between groups in terms of mortality rates in the first month and after the first year of treatment (p = 0.384, p = 1.000, respectively). Fifth year survival rates were similar between the groups (p> 0.05). Conclusion: It is considered that with half-dose treatment and reduced bleeding complications and also with sharing data that is indicating the same efficacy, the optimal therapeutic dose may change in the future.

Background: Oxidative stress and environmental oxidants resulting from oxidant/antioxidant imbalance play an important role in respiratory tract diseases and inflammation. Objectives: The aim of this prospective case–control study is to evaluate dynamic thiol/disulfide homeostasis relationship between patients with community-acquired pneumonia (CAP) and healthy control. Methods: This study enrolled 38 patients with CAP and 35 healthy individuals. The patients with comorbidies and smokers were excluded. In both groups, the thiol/disulfide status levels were evaluated. Results: There was no significant difference between the pneumonia and control groups in age or gender (both p>0.05). The disulfide (SS) levels were similar between in the two groups (p=0,066). The total thiol, native thiol (SH), SS/SH levels were significantly lower in the CAP group compared with the controls (respectively; p=0,001; p=0,001; p=0,028). We also evaluated the pneumonia severity index (PSI) and thiol/disulfide status parameters in the CAP group. Correlation analysis showed a significant negative correlation between PSI and the native and total thiol measurements (respectively; r=-0,341, p=0,036; r=-335, p=0,40). Conclusion: This study showed that the oxidative/antioxidative balance shifted to the oxidative side in the CAP. Abnormal thiol/disulfide status may be an important factor in the pathogenesis of the CAP.

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.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is highly accurate in diagnosing mediastinal lymphadenopathies of lung cancer and benign disorders. However, the utility of EBUS-TBNA in the diagnosis of mediastinal lymphomas is unclear. The aim of this study was to determine the diagnostic value of EBUS-TBNA in patients with suspected lymphoma. Materials and Methods: Sixty-eight patients with isolated mediastinal lymphadenopathy and suspected of lymphoma were included in the study. EBUS-TBNA was performed on outpatients under moderate sedation. The sensitivity, specificity, negative predictive value and diagnostic accuracy of EBUS-TBNA were calculated. Results: Sixty-four patients were diagnosed by EBUS-TBNA, but four patients with non-diagnostic EBUS-TBNA required surgical procedures. Thirty-five (51.5%) patients had sarcoidosis, six (8.8%) had reactive lymphadenopathy, nine (13.3%) had tuberculosis, one (1.5%) had squamous cell carcinoma, two (2.9%) had sarcoma and fifteen (22%) had lymphoma (follicular center cell, large B-cell primary, and Hodgkin lymphomas in three, two, and ten, respectively). Of the 15 lymphoma patients, thirteen were diagnosed by EBUS and two by thoracotomy and mediastinoscopy. The sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA for the diagnosis of lymphoma were calculated as 86.7%, 100%, 96.4%, and 97%, respectively. Conclusions: EBUS-TBNA can be employed in the diagnosis of mediastinal lymphoma, instead of more invasive surgical procedures.

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.

Sarkoidozda gastrointestinal sistem (GIS) tutulumu nadirdir. GIS’de en sik tutulum yeri mide olup antrum tutulumu daha siktir. GIS sarkoidozu pulmoner sarkoidozun bir parcasi olabilecegi gibi tek basina da olabilir. En sik semptomlar epigastrik agri ve bulantidir. Tani mide endoskopisi sirasinda alinan mukozal biyopsilerde nonkazeifiye granulomlarin gorulmesiyle konur. Klinigimizde daha once sarkoidoz tanisi konulan, ilacsiz takip edilen ve dispeptik yakinmalari nedeniyle yapilan GIS endoskopisi sonucu tani alan, steroid tedavisine iyi yanit veren mide sarkoidozu hastasi sunuldu.

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.

Mediastinal lymphadenopathy is common in extrathoracic malignancies and should not always be considered a metastatic lesion. The purpose of this study is to determine the diagnostic value of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) in patients with extrathoracic malignancies. Materials and methods: This study included 54 consecutive patients with extrathoracic malignancies who had suspected mediastinal metastases and had undergone EBUS-TBNA for diagnosis. Results: Using EBUS-TBNA, 27 of 54 patients (50%) were diagnosed with mediastinal metastases. Among patients with mediastinal metastases, 2 (3.7%) had a sarcoid-like reaction, 5 (9.3%) had tuberculosis, and 17 (31.5%) had reactive lymph nodes. In 3 cases (5.5%), a specific diagnosis could not be determined following EBUS-TBNA. Two patients underwent surgical staging of their mediastinal lymphadenopathy, which allowed the detection of mediastinal metastases in 1 patient and that of reactive lymph nodes in the other. The sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA for the diagnosis of extrathoracic malignancies were calculated as 93%, 100%, 92.6%, and 96.3%, respectively. Conclusion: EBUS-TBNA is a safe and effective procedure. We should consider whether EBUS-TBNA should be the primary diagnostic tool for the diagnosis of mediastinal lymphadenopathy in patients with extrathoracic malignancies.

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.