Background Allergic bronchopulmonary aspergillosis (ABPA), is a hypersensitivity reaction in the lung against the antigens of Aspergillus fumigatus. The aim of this study is to determine the incidence of ABPA, and to determine the risk factors leading to the development of ABPA.Methods The study was designed as a retrospective cohort study. Using the CF Registry System of Turkey data, the incidence of ABPA was determined and the clinical and demographic characteristics of 44 patients newly diagnosed with ABPA in 2022 and 132 patients with similar mutation weight and age range without ABPA diagnosis in that year were examined and compared. Also risk factors affecting the development of ABPA were determined.Results Low pulmonary function test values, having had at least one pulmonary exacerbation in that year, receiving intravenous antibiotic treatment, using inhaled antibiotics, having high number of pulmonary exacerbations, having Pseudomonas aeruginosa colonization, having low body mass index (BMI), having cystic fibrosis related diabetes mellitus were found to be among the risk factors for the development of ABPA.Conclusions Early recognition and treatment of ABPA is essential to prevent further damage to the lungs. Patients with frequent pulmonary exacerbations, low BMI and low pulmonary function test values, chronic colonization should definitely be considered for ABPA.

Background Previous reports from relatively small clinical cohorts have suggested that the clinical presentation of obstructive sleep apnea (OSA) differs between men and women. Objective We aimed to explore sex differences in clinical and polysomnographic features of OSA in a large nationwide registry. Methods Participants from the ongoing Turkish Sleep Apnea Database (TURKAPNE) Study from 34 centers were included in the current analysis. OSA was defined as an apnea-hypopnea index (AHI) >= 5 events/hour and was classified as mild, moderate, and severe according to AHI cut-offs 5, 15, and 30 events/hour, respectively. Results In all, 7130 patients (2259 women) were included. OSA was observed in 6323 (88.7 %), of whom 70.2 % were male and 29.8 % were female. In the OSA group, women were older (56.7 +/- 11.9 vs. 49.5 +/- 11.3 years; p < 0.001) and more obese (body mass index 34.3 +/- 7.2 vs. 31.4 +/- 5.6 kg/m(2); p < 0.001) and had lower AHI (29.8 +/- 24.1 vs. 36.8 +/- 26.2 events/h; p < 0.001) than men. Loud snoring and witnessed apnea were more common in men than in women whereas women were more frequently presented with insomnia, headache, and mood changes. Women had significantly less total sleep time, less sleep efficiency, and longer sleep latency compared with men (p < 0.001 for each). Additionally, comorbid diseases such as diabetes mellitus, hypertension, asthma, psychiatric disorders, hypothyroidism as well as drug use were more common in women than in men independent of age and obesity (p < 0.05 for each). Conclusions Our results suggest significant sex differences in clinical and polysomnographic features in this nationwide Turkish adult population. Women with OSA have more symptom burden and comorbidities despite having a less severe AHI.

Background. Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) variants are essential for determining eligibility for CFTR modulator drugs (CFTRms). In contrast to Europe and the USA, the treatment eligibility profile of cystic fibrosis (CF) patients in Türkiye is not known. In this study we aimed to determine the eligibility of CF patients in Türkiye for the CFTRms. Methods. The Cystic Fibrosis Registry of Türkiye (CFrT) data was used to determine the age of patients in the year 2021 and the genetic variants they were carrying. Age- and CFTR-variant appropriate modulator therapies were determined using the Vertex® algorithm. Results. Among a total of 1930 registered patients, CTFR gene analysis was performed on a total of 1841 (95.4%) patients. Mutations were detected in one allele in 10.7% (198 patients), and in both alleles in 79% (1455 patients) of patients. A total of 855 patients (51.7% for whom at least 1 mutation was detected) were eligible for the drugs. The most appropriate drug among genotyped patients was found to be elexacaftor/tezacaftor/ivacaftor for 486 patients (26.4%), followed by ivacaftor for 327 patients (17.7%) and lumacaftor/ivacaftor for 42 patients (2%). Conclusions. Only half of patients registered in CFrT were eligible for CFTRms, which is a significant difference from the CFTR variant profile seen in USA and Europe. However, access to treatment is hampered for some patients whose genes are not analysed. Further studies in CF populations, where rare mutations are relatively more common, will contribute to the field of CFTR modulator treatments for such rare mutations.

Introduction: Cystic fibrosis transmembrane conductance regulator (CFTR) modulator drugs target the underlying defect and improve CFTR function. They are a part of standard care in many countries, but not all patients are eligible for these drugs due to age and genotype. Here, we aimed to determine the characteristics of non-eligible patients for CFTR modulators in the CF registry of Turkey (CFRT) to highlight their clinical needs. Methods: This retrospective cohort study included CF patient data from the CFRT in 2021. The decision of eligibility for the CFTR modulator was determined according to the 'Vertex treatment-Finder' on the Vertex (R) website. Demographic and clinical characteristics of patients were compared between eligible (group 1) and ineligible (group 2) groups for CFTR modulators. Results: Among the study population (N = 1527), 873 (57.2%) were in group 1 and 654 (42.8%) were in group 2. There was no statistical difference between groups regarding sex, meconium ileus history, diagnoses via newborn screening, FEV1 z-score, CF-associated complications, organ transplant history, and death. Patients in group 2 had a higher incidence of pancreatic insufficiency (87.7% vs. 83.2%, p = .010), lower median height z-scores (-0.87 vs. -0.55, p < .001), lower median body mass index z-scores (-0.65 vs. -0.50, p < .001), longer days receiving antibiotics due to pulmonary exacerbation (0 [interquartile range, IQR: 0-2] vs. 0 [IQR: 0-7], p = 0.001), and more non-invasive ventilation support (2.6% vs. 0.9%, p = 0.008) than patients in group 1. Conclusion: The ineligible group had worse clinical outcomes than the eligible group. This highlights their need for life-changing drugs to improve clinical outcomes.

Objective To examine the potential relationship between the presence of asbestos-related diseases (ARDs) in the region of Kastamonu, Turkey. Methods The places of birth of patients with ARDs and control subjects diagnosed between 2008 and 2019 and identified in a tertiary hospital in Istanbul. Soil samples were taken from plaster surfaces and quarries. The analysis was done with transmission electron microscopy. Results ARDs was detected in 55(17.9%) of 307 participants. Patients had a mean age of 68 ± 11 years. Residential proximity to ophiolites increased ARD incidence by 6.2% per kilometer (P = 0.003). Birthplaces were identified as being inside an ophiolitic unit, or if they were not, the Google Earth software was used to determine the beeline distance between the settlement's center and the edge of the closest ophiolitic unit. The appropriate threshold for this case is 12.75 km, with 75% sensitivity and 87% specificity. Conclusion ARDs due to naturally occurring asbestos (NOA) are present in hitherto unknown places. Geological maps including ophiolites can help locate these places.

Background: Many pulmonary and extrapulmonary factors may impair balance in patients with chronic obstructive pulmonary disease (COPD), but the determinants of this impairment are still debated. The primary aim was to compare both balance-related and independent variables that may affect balance with healthy subjects. The secondary aim was to investigate the potential determinants of balance in patients with COPD. Methods: This comparative study recruited 23 patients with COPD and 23 age- and comorbidity-matched healthy subjects. Participants were assessed regarding demographic and clinical data, “Postural Stability Test” (PST), “Limits of Stability Test” (LOST), “Clinical Test of Sensory Integration of Balance” (CTSIB), pulmonary function, respiratory and peripheral muscle strength, functional capacity, and cognitive function. Results: There were significant differences in all outcome measures assessing balance, pulmonary function, respiratory muscle strength, peripheral muscle strength, and functional capacity, but not cognitive function, in the COPD group compared to the healthy group (p < 0.05). The PST had a significant and strong correlation with maximal inspiratory pressure (MIP) (r = −0.630, p = 0.001) and a significant and moderate correlation with m. quadriceps strength and 6 min walk test (6MWT) distance (r = −0.472, p = 0.023; r = −0.496, p = 0.016; respectively). MIP, m. quadriceps strength, and 6MWT distance were independent predictors to explain the PST with an R2 = 0.336 (p = 0.004). Conclusions: The present study revealed that balance is impaired in adults with COPD, even if compared with age- and comorbidity-matched healthy subjects. Assessing and improving balance and its determinants, inspiratory and peripheral muscle strength, and functional capacity may be important for fall prevention and disease management in patients with COPD.

The aim of this study was to assess clinical findings, radiological data, pulmonary functions and physical capacity change over time and to investigate factors associated with radiological abnormalities after coronavirus disease 2019 (COVID-19) in non-comorbid patients. This prospective cohort study was conducted between April 2020 and June 2020. A total of 62 symptomatic in non-comorbid patients with COVID-19 pneumonia were included in the study. At baseline and the 2nd, 5th and 12th months, patients were scheduled for follow-up. Males represented 51.6% of the participants and overall mean age was 51.60 ± 12.45 years. The percentage of patients with radiological abnormalities at 2 months was significantly higher than at 5 months (P < .001). At 12 months, dyspnea frequency (P = .008), 6-minute walk test (6MWT) distance (P = .045), BORG-dyspnea (P < .001) and BORG-fatigue (P < .001) scores was significantly lower, while median SpO2 after 6MWT (P < .001) was significantly higher compared to results at 2 months. The presence of radiological abnormalities at 2 months was associated with the following values measured at 5 months: advanced age (P = .006), lung involvement at baseline (P = .046), low forced expiratory volume in 1 second (P = .018) and low forced vital capacity (P = .006). Even in COVID-19 patients without comorbidities, control computed tomography at 2 months and pulmonary rehabilitation may be beneficial, especially in COVID-19 patients with advanced age and greater baseline lung involvement.

OBJECTIVE: This study aimed to evaluate the SARS-CoV-2 immunoglobulin G (IgG) levels after 6 months of polymerase chain reaction (PCR) negative but assumed to be COVID-19 positive cases to investigate the relationship between IgG levels and thoracic computed tomography (CT) findings.METHODS: This was a single-center study that included patients whose PCR test results were negative at least three times using nasopharyngeal swabs but had clinical findings of COVID-19 and thoracic CT findings compatible with viral pneumonia. Six months after discharge, the IgG antibodies were analyzed. The cutoff value for negative and positive serology was defined as <1.4 (index S/C) and >= 1.4 (index S/C), respectively. In addition, the patients were categorized according to their thoracic CT findings as high (typical) and low (atypical). Also, the patients were grouped into classes as <5% lung involvement versus >= 5% lung involvement.RESULTS: The patients' mean age was 49.78 +/- 12.96 years. PCR was negative, but patients with COVID-19 symptoms who had SARS-CoV-2 IgG positive were 81.9% (n=95). The antibody titer and lung involvement >= 5% were statistically significantly higher in SARS-CoV-2 IgG positive cases (p<0.001 and p=0.021). Age and chest CT findings were the risk factors for lung involvement (OR=1.08, p<0.001 and OR=2.19, p=0.010, respectively).CONCLUSION: This study is valuable because increasing severity (>= 5%) of lung involvement appears to be associated with high and persistent IgG antibody titers. In probable cases of COVID-19, even if the PCR test is negative, high IgG titers 6 months after discharge can predict the rate of lung parenchymal involvement.

Introduction:The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients.Material-Method:The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally.Results:In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira.Conclusion:We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution.

Objective: We aimed to evaluate the effects of nutritional factors, dependence in daily life activities, and polypharmacy on the length of hospitalization, clinical prognosis and mortality among hospitalized older COVID-19 patients.Materials and Methods: The charts of hospitalized COVID-19 patients older than 60 years old were reviewed retrospectively. We obtained findings on admission, comorbidities and the number of drugs used. The Mini Nutritional Assessment (MNA), the Barthel Index for Activities of Daily Living (BADL) and the Lawton Instrumental Activities of Daily Living (IADL) Scale were used to analyze the findings.Results: Out of the 73 patients, 39 were female and the mean age was 69.65 +/- 7.39 years. Fourteen (19.2%) patients were transferred to the intensive care unit, and nine (12.3%) of them died. After adjustment for age, the number of respiration at the first admission was significantly higher (p=0.001), and BADL, IADL scores and oxygen saturations were significantly lower (p=0.00, p=0.001) in the patients transferred to the intensive care unit compared to the patients discharged. There was no association between the length of hospitalization and age, the number of drugs, BADL and IADL scores, but there was a significant negative correlation between the length of hospitalization (r:-0.310), MNA score (r:-0.275) and daily protein intake (p=0.008). No association between polypharmacy and clinical progression of COVID-19 was detected (p=0.109).Conclusion: Decrease in MNA scores and daily protein intake in older COVID-19 patients were associated with prolonged hospitalization. Functional dependence was associated with the need for intensive care and mortality.

The successful management of an elderly Covid-19 infected patient by plasmapheresis Dear Editor, Coronavirus disease 2019 (COVID-19) is a pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China since December 2019.The epidemic spread rapidly worldwide, became a global threat and was characterized as a pandemic on March 11, 2020 by World Health Organization (WHO) [1].It is not just a viral pneumonia, it can also cause a multisystemic disorder called COVID-19 immune syndrome [2]. In severe COVID-19 patients it was reported that the pro-inflammatory cytokins, mainly IL-6, IL-10, TNF-α were significantly increased around 7-14 days after onset, named as cytokine storm, which is also associated with the aggravation of disease and higher mortality [3,4].Furthermore, most of these patients have already been in an induced-hypercoagulable state and predisposed to thrombosis.Currently, there isn't any specific effective and approved antiviral treatment for COVID-19 [5].There aren't sufficient randomized controlled trials and so strong recommendations for the management of COVID-19 even from the international societies [2].For better results and lower mortality rates, clinicians must both control the viral replication and also optimize the immun response.Plasmapheresis can take place successfully in the management of these patients with the use of anticoagulants and removal of both the inflammatory molecules and high molecular weight viscous components [6].We want to emphasize the role of plasmapheresis by a critically ill Covid-19 patient whose clinical status worsen despite antiviral and tocilizumab treatments and who was successfully managed via performing plasmapheresis.A 65 year old female patient complaining of cough, myalgia and fatigue was admitted to our clinic who had a history of contact with a confirmed Covid-19 case.She had 3 comorbities: asthma, hypertension and type 2 Diabetes Mellitus.Her SARS-CoV-2 PCR test resulted negative, but her chest computed thomography(CT) revealed two small ground glass opacities in both lungs, which indicated COVID-19 pneumonia.According to our national Covid-19 treatment guidelines provided by the Ministry of Health, she was given hydroxychloroquine, azitromycine and oseltamivir.During hospital follow up, her maximum body temperature was 37.8 • C; all other vital signs were normal.Laboratory findings are summarized in Table 1.She completed the treatment schedule and was discharged from hospital after 5 days.On 10th day of the symptom onset she was readmitted to hospital with fever, cough, sputum and shortness of breath.Her fever was 38.5 • C, hearth rate was 118beats/min, respiratory rate was 26/min, blood pressure was 156/84 mmHg and oxygen saturation was 88 % at room air with intermittent prone positioning.Her thorax CT revealed bilateral multiple ground glass infiltrations (Fig. 1).Favipravir, enoxaparine prophylaxis, ceftriaxone and oxygen supplementation of 3 L/min were initiated.Laboratory tests showed elevated inflammation indicating cytokine storm with C-reactive protein 70 mg/L(reference 0-5) and IL-6 45.4 pg/mL(reference <7).Tocilizumab(8 mg/kg total dose) and

OBJECTIVES:The primary aim of The Turkish Sleep Apnea Database (TURKAPNE) study is to generate a cross-sectional nationwide database for defining the clinical and polysomnographic characteristics of the patients with obstructive sleep apnea (OSA) in Turkey.MATERIALS AND METHODS:In this ongoing project, all consecutive adults with suspected OSA are recruited from the sleep centers of the university and research hospitals in Turkey. Information on anthropometric data, educational status, driving license, smoking habits, alcohol use, comorbidities, drug use, questionnaires, polysomnographic, and/or cardiorespiratory polygraphic findings are recorded in a systematized Web-based report form. Blood glucose, lipids and other biochemical markers, lung function, and echocardiography measurements are optionally included. Follow-up data regarding treatment modality and compliance is assessed. Cross-sectional and longitudinal associations between OSA phenotypes and metabolic, pulmonary, and cardiovascular comorbidities as well as traffic accidents, and the impact of treatment will be further explored. We target a total sample of 10,000 participants.RESULTS:The study was registered with ClinicalTrials.gov (NCT02784977) in May 2016 and the first patient was recruited in October 2017. A total of 1911 participants from 19 centers have been enrolled in the study by May 31, 2018.CONCLUSION:The TURKAPNE study will contribute to a better understanding of the health-related burden of OSA phenotypes and its association with the comorbidities and adverse outcomes, including traffic accidents in Turkey. The results may also contribute to a more personalized approach and better management of varying OSA phenotypes with concomitant disorders.

Introduction: Tuberculosis drug resistance can be assessed by physicians with different approaches on issues such as the choice of treatment protocol and duration of treatment. Materials and Methods: In this study, we aimed to evaluate the treatment regimens and treatment results of patients with non multi-drug resistant tuberculosis (MDR-TB) drug resistance implemented in different chest disease clinics in our hospital. The 167 culture-positive patients with nonMDR-TB drug resistance diagnosed between 2008-2010 were analyzed retrospectively. Patients' age, gender, previous TB treatments, bacteriological cruise, drug resistance patterns and treatment outcomes were analyzed. Results: One hundred sixty-seven patients with eligible data were evaluated; there were 117 (70.1%) men and 50 (29.9%) women, mean age was 42.35 (18-90) years, respectively. Among mono drug resistance; H resistance in 75 (44.9%) patients and R resistance in 11 patients was detected. In 19 (11.4%) patients HS resistance was detected as multiple drug resistance. One hudred and twenty-five (74.9%) were new cases. When treatment the results of in all patients evaluated, 136 (81.4%) of the patients achieved treatment success. Sixty-four (51.2%) of the new TB cases treated with "standard treatment protocols for new cases" (2HRZE/4H) and 51 (40.8%) of them treated with "other treatment protocols". Ten (23.8%)of the recurrent TB cases" standard treatment for recurrent cases (2HRZES/HRZE/5HRE) and 9 (21.4%) 33 (19.8%) of them treated with other protocols. The combination of the rthe treatment protocol and descriptive information about the duration of the treatment could not be created as 33 (19.8%) of the cases left without completing their treatment. Conclusion: As a result of the analysis, patients have completed their treatment, there was no significant difference in treatment outcomes. Patients with Non MDR-TB drug resistance should be monitored well and should be careful in terms of MDR-TB.

Introduction Welding produces miscellaneous gases and particles that has various impact on respiratory system and long term exposure may result "welders'lung". The aim of this study is to describe the radiological findings of welders' and make an awereness for welders radilogical findings. Materials and Methods The clinical and radiological findings of welders' who had hospital applications with respiratory symptoms between January 2010-January 2017 were evaluated retrospectively. Result A total of 16 male welders with mean age 37 ± 8 years had the mean duration of welding occupation 12 ± 7 years. The most common symptoms were coughing (87%), sputum production (63%) and dyspnoea (63%).Thirteen welders were working in shipyards and 3 in construction business and other workplaces. Three (19%) patients had rhonchi on physical examination and these patients had decreased FEV1/FVC values below 70% on spirometry. Poorly-defined centrilobular micronodules that were not clearly visible on chest radiographs observed on thorax high resolution computed tomography. Bronchoscopy was performed to 7 patients. Iron-positive pigment granules and ferruginous bodies were revealed in 3 patients' bronchoalveolar lavage. Conclusions Welders' chest X-ray deserve a closer look. In pulmonary radiology, there may be radiographical findings ranging from small ill defined nodules to groundglass opacites. Physcians should look more careful to welders' chest X-ray and incase of suspicious findings best can be detected on high HRCT. An awareness for the radiological findings will also reduce interventional procedures in these patients hereby, occupational history must be included in daily practice of physicians.

Introduction: Pneumonia is a major mortality and morbidity reason among elderly. Age limit is commonly accepted as 65 years, but actually age definition varies by country.Objective: In the present study we aimed to evaluate the course of pneumonia in patients age 75 and older as "75-84 years" and "85 and older" patients.Materials and Method: This is a retrospective cohort study in a chest disease clinic between January 2009 and May 2013. Pneumonia patients aged 75 and older followed in chest disease ward were included in the study. The patients were evaluated in two groups: "75-84 years" and "85 and older". Demographics, CURB65 score, hospital and short term mortality (mortality within 30 days after discharge) were recorded.Results: A total number of 116 pneumonia patients, 54% male were enrolled. The mean age was 83 +/- 5 years. There were 76 patients in "75-84 years" group and 40 in "85 and older" group. The incidence of congestive heart failure/coronary artery disease was significantly higher in "85 and older" patients (P = 0.002). Penicillins and cephalosporins were the most commonly used antibiotics. In both age groups in-hospital and short-term mortalities were similar. The length of hospital stay was similar in both age groups, but "75-84 years" patients were more likely to transfer to intensive care unit than "85 and older" patients (11% vs. 3%, p = 0.13)Conclusion: The course of pneumonia, LOS, and in-hospital and short-term mortality are analogous among "75-84 years" and "85 and older" patients. Close clinical follow-up, good compliance to guidelines and a good management to comorbidities is required. As multidisciplinary approach and close follow-up is vital for elderly patients, a focus on hospital workforce conditions while planning and organizing is essential.

OBJECTIVES:Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new, minimally invasive, bronchoscopic technique used in the evaluation of inthrathoracic lymph nodes.Use of sedation drugs before the procedure differs among centres. There is no standardization about sedation before EBUS-TBNA.We used a policy decision to shift from use of propofol with midazolam vs midazolam alone in a large tertiary hospital to evaluate the diagnostic yield and safety of EBUS-TBNA procedure.METHODS:Files of all the patients who were performed EBUS-TBNA between the dates of September 2010 and May 2014 were surveyed. All the EBUS-TBNA cases were performed under sedation of propofol and midazolam with an accompanying anesthesiologist in the beginning, however, sedation is applied with midazolam without an accompanying anesthesiologist after April 2013 due to changes in sedation policy. The diagnostic yield and complication rates were compared by chi-squared analysis between two groups.RESULTS:The files of 340 EBUS-TBNA performed patients were evaluated. Of the patients 274 eligible patients were analysed. 152 patients who fulfilled the inclusion criteria were analysed in propofol-midazolam (P) sedated group and 122 patients were analysed in midazolam (M) group. There is no statistically significant difference between two different sedated groups in terms of age and gender. Diagnostic value was detected as 77.6% in P group and 85.7% in M group and the difference was not statistically significant. No difference between complication rates of both groups was observed.CONCLUSION:Both sedation-types for performing EBUS-TBNA showed similar diagnostic value and complication rates in our study. Propofol with midazolam application requires with an accompanying anaesthesiologist, therefore, it increases cost. EBUS-TBNA procedures had been performed in safe with no decrease in diagnostic yield under moderate sedation.

Pulmonary alveolar microlithiasis (PAM) is a rare lung disease characterized by the deposition of calcium in the alveolar spaces and bilateral diffuse micronodular ''sandstorm'' radiographic pattern.The current report presents the case of a 48-year-old woman with pulmonary alveolar microlithiasis.The patient presented with exertional dyspnea for the past five years.The physical examination was within normal limits and respiratory sounds were normal.The chest x-ray revealed a bilateral diffuse micronodular pattern in the middle and the lower areas of both lungs.On the parenchymal window of thorax computed tomography (CT), bilateral diffuse widespread millimetric calcified nodules that were more prominent in the lower lobes were observed.Whole body bone scintigraphy with technetium-99m revealed bilateral, diffuse, heterogeneous, increased uptake in the pulmonary parenchyma.Regarding the current special radiological findings, further invasive diagnostic examination was not performed, the patient was diagnosed with PAM and continues to be followed-up on without treatment.

Introduction, objective: Endobronchial ultrasound -guided transbronchial needle aspiration ( EBUS TBNA ) is a method used in the diagnosis and/or staging of pulmonary diseases. Premedication drugs for sedation are different among centers. Besides the midazolam sedation, use of propofol to suppress the cough reflex and loss of consciousness, provide an acceptable safety profile. In this study we aimed to compare the diagnostic yield and complication of EBUS-TBNA using two method of sedation during the procedure. Materials and Methods: 224 patients who underwent EBUS-TBNA between January 2010 and December 2013 were included into the study. Propofol combined with midazolam administered to 144 patients. Only midazolam ( 0.05 to 0.1mg / kg) was given to 88 patients for sedation. Complications and pathological results were recorded.Results:The mean age of 224 cases were 55.8 ±11.6 years. Diagnostic yield was 77.1% in the group receiving propofol plus midazolam, while 83.8 % were found in the midazolam group. Table 1:Diagnostic yield of EBUS TBNA procedure in propofol added and not added groups EBUS Negative EBUS Positive N (%) N (%) Without Propofol 13a (16.25) 67a (83.75) With Propofol 33a (22.91) 111a (77.10) Total 46 (21.50) 178 (79.50) Significant values are shown in different alphabetic symbol No significant difference was seen between two groups (p =0.156).There were not seen any complication in midazolam group, howewer hypoxia and hypotension were seen in propofol added group. Conclusion:Propofol did not appear to contribute additional diagnostic yield in EBUS-TBNA procedure . Propofol is helpful to process to be comfortable, but side effects such as hypoxia and hypotension may be seen rarely.