In this research project, we examined the relationship between tracheal size and respiratory function in individuals with Idiopathic Pulmonary Fibrosis (IPF). IPF is a long-term condition that affects the functioning of the lungs. This retrospective study included 86 patients diagnosed with IPF. Tracheal and bronchial diameters were measured using high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs); Force vital capacity (FVC), diffusion capacity for carbon monoxide (DLCO) and the gender, age, physiology (GAP) index was calculated. Patients were grouped according to demographic characteristics such as age, gender and smoking. There was a significant positive correlation between the anteroposterior (AP) and transverse diameters of the trachea in the subcricoid region and the GAP index (r = 0.318, p = 0.003 and r = 0.312, p = 0.004, respectively). Similarly, subcricoid and carina areas were significantly correlated with both GAP index (r = 0.307, p = 0.006 and r = 0.334, p = 0.003, respectively) and FVC/DLCO ratio (r = 0.218, p = 0.049 and r = 0.245, p = 0.027, respectively). The main bronchial areas were also positively correlated with the GAP index, but no significant correlation was found between FVC and DLCO values and airway measurements. Each unit increase in GAP index was associated with a 1.69-fold increase in mortality risk (p = 0.0016, 95

OBJECT:Idiopathic pulmonary fibrosis (IPF) is a chronic lung disease with characterized by progressive fibrosis. Galectin-3(Gal-3) is a B-galactoside binding lectin plays a central role in inflammation and fibrosis. In our study, we aimed to define levels of serum galectin-3 protein in IPF patients by comparing them with healthy subjects. We also aimed to show that galectin-3 concentrations can be used as a diagnostic and prognostic biomarker in the serum of IPF patients and that the use of galectin-3 inhibitors in combination with antifibrotic treatments may be useful in the therapeutic management of fibrosis. METHODS:44 patients with IPF and 35 control patients who were followed up in our outpatient clinic between 2016 and 2022 were evaluated, anamnesis, spirometric measurements and galectin-3 results were recorded. Patients were grouped according to their antifibrotic treatment. RESULTS:The mean galectin-3 level in the patient group was 8.4 ng/ml and in the control group was 8.2 ng/ml. Serum levels were 8.9 ng/ml in pirfenidone users and 8.2 ng/ml in nintedanib users. Gal-3 was found to be higher in patients taking pirfenidone compared to nintedanib, but there was no statistically significant difference (p > 0.05). CONCLUSION:Galectin-3 levels were found to be slightly higher in IPF patients compared to healthy subjects. In addition, gal-3 levels decreased as the follow-up period increased in IPF patients in our study. Considering that the patients were receiving pirfenidone or nintedanib treatment during the follow-up period, it may be possible that galectin-3 levels decreased as exposure to these drugs increased. Further studies are needed to clarify these mechanisms.

BACKGROUND AND AIM: The CRP-albumin-lymphocyte (CALLY) index, which combines C-reactive protein (CRP), albumin, and lymphocyte values, serves as a predictive tool for patients with cancer and inflammatory diseases. However, the CALLY index has not been evaluated for its application in idiopathic pulmonary fibrosis (IPF). This study examined the relationship between CALLY scores and acute exacerbations, mortality, and lung function assessment results in patients with IPF. METHODS: Atotal of 129 IPF patients diagnosed between January 2020 and December 2023 were studied by reviewing demographic information, test results, and pulmonary function assessments. Patients were enrolled from both outpatient and inpatient services at a single tertiary center. The CALLY index was calculated using the formula: albumin (g/dL) / [CRP (mg/dL) x NLR], with NLR representing the neutrophil-to-lymphocyte ratio. Data on acute exacerbations of IPF (AE-IPF) and all-cause mortality were obtained from longitudinal follow-up records. Participants received follow-up care for a median of 36 months (range: 6-48 months). RESULTS: Of the 129 patients analyzed, 30 (23.3%) died and 10 (7.8%) experienced AE-IPF during followup. The CALLY index was significantly lower in patients with AE-IPF compared to those without (1.41 +/- 1.58 vs. 3.48 +/- 3.93, p=0.012), and similarly lower in deceased patients compared to survivors (1.85 +/- 2.11 vs. 3.79 +/- 4.14, p=0.014). Receiver operating characteristic (ROC) curve analysis demonstrated fair discriminatory capacity of the CALLY index for AE-IPF (area under the curve [AUC]: 0.72, cut-off: 0.66, sensitivity: 50.0%, specificity: 85.0%) and mortality (AUC: 0.69, cut-off: 1.19, sensitivity: 58.0%, specificity: 76.0%). The Gender-Age-Physiology (GAP) index showed comparable performance, with AUCs of 0.73 for AE-IPF and 0.75 for mortality, and no significant difference between the two indices (p=0.88 for AE-IPF; p=0.45 for mortality). Among pulmonary function parameters, only diffusing capacity of the lung for carbon monoxide (DLCO%) showed a significant positive correlation with the CALLY index (r=0.265, p=0.0024). CONCLUSIONS: The CALLY index provides an effective method to evaluate functional deterioration and adverse outcomes in IPF patients while serving as a useful predictive instrument. The CALLY index offers a prognostic value similar to the GAP index using standard laboratory tests. Additional prospective validation studies should be conducted.

Objectives: Chronic obstructive pulmonary disease (COPD) is a medical condition defined by persistent airflow limitation and respiratory symptoms caused by airway and/or alveolar abnormalities. Pulmonary hypertension (PH) is one of the cardiovascular comorbidities associated with COPD. We investigated the correlation of NLRC3 levels in patients with COPD with prognostic and surrogate parameters of PH on echocardiography and examined whether it could be used to predict PH in this patient population. Methods: A total of 80 patients diagnosed with COPD and 40 healthy volunteers as the control group were included in the study. The COPD group was further divided into two subgroups according to the systolic pulmonary artery pressure (sPAP) as follows: sPAP<35 mmHg and sPAP≥35 mmHg. The enzyme-linked immunosorbent assay (ELISA) method was used to determine the levels of NLRC3 in peripheral blood. Results: Patients with sPAP≥35 mmHg had a lower mean NLRC3 level than those with sPAP<35 mmHg (P=0.006). The NLRC3 levels showed a significant negative correlation with sPAP, tricuspid regurgitation velocity, right atrium, and pulmonary artery diameter. For NLRC3, the cut-off value was found to be 271,486 ng/L, with a sensitivity of 74%, and specificity of 63% in distinguishing patients with sPAP≥35 mmHg from all patients with sPAP<35 mmHg. Conclusions: Our study results suggest that NLRC3 levels measured from peripheral blood are predictive of PH in patients with COPD. Although the exact function of NLRC3 in the lungs, COPD, and PH have not been completely understood, we believe these findings will serve as a model for future studies.

Background/aim:There is currently no data from Türkiye on whether, following a diagnosis of asthma, patients are given an asthma action plan to implement. There is also no data on whether patients can manage their treatment based on the provided asthma action plans. The present study aimed to determine the use of asthma action plans in Türkiye and the awareness levels of patients about these plans. Materials and methods:A multicenter, cross-sectional descriptive study was conducted in the outpatient immunology, allergy, and pulmonology clinics of secondary and tertiary healthcare centers. Adult asthmatics filled out a case registration form regarding age, sex, educational status, duration of asthma, and smoking history. Subjects answered the Global Initiative for Asthma (GINA) assessment of control questions, indicated whether they had previously been offered an asthma action plan, and if they had received one, whether they benefited from it. Results:Data from 265 asthmatic adults (mean age: 48.4 years, standard deviation: 13.4 years), including 194 (73.2%) females were analyzed. The asthma of 212 (80.0%) patients was controlled, and was uncontrolled in 53 (20.0%) patients. An asthma action plan had been mentioned to 91 (34.3%) of the 265 patients. Among these 91 patients, 85 (93.4%) had been given a written asthma action plan, and 85 (93.4%) stated that they had benefited from the plan. The rate of being given an asthma action plan was significantly lower for illiterate patients than for patients with any education (p < 0.001). Conclusion:The rate of mentioning an asthma action plan to asthmatic patients is low. However, almost all patients who received an asthma action plan benefitted significantly from the plan. Thus, it is important to give asthmatic patients an action plan, ideally in written form.

Background: Asthma controller medications can be delivered via pressurized metered dose inhaler (pMDI) or dry powder inhaler (DPI) devices. Objective: This study aimed to evaluate the frequency of exacerbations and satisfaction rate with device use in asthmatics using pMDIs or DPIs. Methods: A multicenter, cross-sectional study was conducted in adults who used pMDIs or DPIs with correct inhaler technique and good adherence for asthma treatment. Demographic and asthma-related characteristics of the subjects and data regarding device satisfaction were collected through a face-to-face interview in the outpatient clinic. Rates of pMDI and DPI users and the data were compared between the two groups. Results: The study included 338 patients (mean age: 48.6 ± 14.5 years, 253 [74.9%] women). Among participants, 96 (28.4%) were using pMDI and 242 (71.6%) were using DPI. The age of patients using pMDI were significantly lower compared with DPI users. No significant difference was observed in terms of device satisfaction and clinical outcomes of asthma between pMDI and DPI users with good inhaler technique and good adherence. Conclusion: More asthmatics use DPIs, however, pMDIs are used in younger asthmatic patients. No significant difference in terms of device satisfaction and clinical outcomes of asthma was observed between pMDI and DPI users.

Mean platelet volume (MPV) can provide important information about the course and prognosis of many diseases. MPV is an early indicator of platelet activation, which has an important role in the pathogenesis of thrombosis. In this study, we aimed to investigate whether MPV was a predictive marker for the development of thrombosis in hospitalized patients with COVID-19 infection. Fifty-seven patients whose courses were followed after the diagnosis of COVID-19 infection using a polymerase chain reaction test during the pandemic were included in the study. Our results demonstrated that there was a negative correlation between platelet count and MPV (r=0.470, p≤ 0.01), and there was a positive correlation between Platelet Distribution Width (PDW) and MPV (r=0,933, p≤ 0.01), but no significant correlation was found between the other variables and MPV.

Aim: Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder characterized by repeated episodes of apnea and hypopnea during sleep.The repetitive hypoxemic and hypercapnic events can lead to increased proinflammatory cytokine production, endothelial dysfunction, oxidative stress, metabolic dysregulation, and insulin resistance in OSAS patients.In previous studies, some of the hemogram values increased in patients with OSAS and a decrease in these increased values was observed with continuous positive airway pressure (CPAP) treatment.CPAP is the most effective method for treating OSAS and alleviating the patients' symptoms.The aim of this study was to assess the effect of three-month CPAP therapy on hemocyte profile in people with OSAS.Materials and Methods: Forty patients were included in the study.Data including clinical assessment, full previous polysomnography reports, and baseline and after CPAP therapy, complete blood profile (leukocytes, neutrophils, lymphocytes, hemoglobin, hematocrit, platelets, MPV, PDW, MCV, N/L, and P/L, CRP and fibrinogen) of the participants were collected from the electronic medical record. Results:All patients who completed the study were CPAP compliant (5.53±0.39h/night).After three months of CPAP treatment, the mean levels of leukocytes, lymphocytes, hemoglobin, hematocrit, MPV, MCV, N/L, and P/L, CRP and fibrinogen were significantly decreased compared to baseline values. Conclusion:Our study showed significant decrease in hemoglobin, hematocrit, leukocyte, lymphocyte, MPV, MCV, N/L, and P/L, CRP and fibrinogen after three-month CPAP therapy.

INTRODUCTION:The kidneys are some of the most frequently affected organs during coronavirus disease 2019 (COVID-19). This multicenter study evaluated the incidence of and risk factors for acute kidney injury (AKI) in COVID-19 patients followed up in intensive care unit (ICU) and its association with mortality.METHODS:Three hundred twenty-eight patients diagnosed with COVID-19 and hospitalized in ICU were included. Risk factors associated with AKI and mortality were evaluated.RESULTS:Eighty-eight patients (27.9%) were diagnosed with AKI. AKI was significantly associated with older age, higher baseline creatinine level, lower albumin level, and coexistence of cardiovascular disease and chronic obstructive pulmonary disease. Mortality in the entire study group was significantly associated with AKI, older age, requirement of invasive mechanical ventilation, higher neutrophil level, lower lymphocyte, and albumin levels.CONCLUSION:AKI is frequently seen during the course of COVID-19 and is associated with high mortality. Identifying AKI-related risk factors appears essential in the management of COVID-19 patients.

This expert opinion, prepared by a panel of chest disease specialists, aims to review the current knowledge on practice patterns in real-life management of mild asthma and to address the relevant updates in asthma treatment by The Global Initiative for Asthma (GINA) to guide clinicians for the best clinical practice in applying these new treatment paradigms. On the basis of the emerging body of evidence suggesting the non-safety of short-acting β2-agonists (SABA)-only therapy and comparable efficacy of the as-needed inhaled corticosteroids (ICS)-formoterol combinations with maintenance ICS regimens, GINA recently released their updated Global Strategy for Asthma Management and Prevention Guide (2019). The new GINA 2019 recommendations no longer support the SABA-only therapy in mild asthma but instead includes new off-label recommendations such as symptom-driven (as-needed) low-dose ICS-formoterol and “low dose ICS taken whenever SABA is taken.” The GINA 2019 asthma treatment recommendations include a major shift from long-standing approach of clinical practice regarding the use of symptom-driven SABA treatment alone in the management of mild asthma. This expert opinion supports the transition from a long-standing SABA-only approach to a risk reduction–based strategy, with the use of symptom-driven (as-needed) low-dose ICS/LABA in mild asthma patients, particularly in those with poor adherence to controller medications. The thoughtful and comprehensive approach of clinicians to these strategies is important, given that the exact far-reaching impact of this major change in management of mild asthma in the real-world settings will only be clarified over time.

Aim:Pulmonary functional and volumetric evaluation is routinely performed with pulmonary function test (PFT). However, volumetric evaluation is also possible in computed tomography (CT) imaging. The aim of this study is to examine the relationship between PFT and CT volumetric findings.Materials and Methods:Between April 2017 and May 2020, a total of 69 patients (34 males, 35 females) having thorax CT (without any parenchymal disease) and PFT were studied retrospectively. The images and PFT examinations with an optimum quality were enrolled. In CT, the volume and density of both lungs as well as total lung volume (TLV) and total lung density (TLD) were calculated. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio were recorded for the assessment with CT.Results:In a total of 69 patients (34 male, 49.3%; 35 female, 50.7%), the mean age was 55±14.56 years, FEV1=2.12±0.87, FVC=2.92±1.05, FEV1/FVC ratio=72.19±13.07, right lung volume=2118.06±662.36, right lung density=-806.8±68.16, left lung volume=1755.35±605.02, left lung density=-774.80±248.98, TLV=3820±1272.35 and TLD=-1597.17±295.70. FEV1, FVC and FEV1/FVC ratio showed a positive correlation with bilateral (right and left) lung volume and density (p<0.05).Conclusion:PFT provides important quantitative pulmonary functional data that can evaluate the severity and course of diseases causing respiratory symptoms. However, in cases where PFT cannot be performed (such as Coronavirus Disease-2019), CT quantitative pulmonary volumetric evaluation can be an alternative in the evaluation of main pulmonary functions.

Nitrofurantoin, a 5-nitrofuran derivative, is the first choice in the treatment of uncomplicated urinary tract infections in female patients. Significant side effects have been reported in its use, including lung involvement independent of dose. Acute pulmonary reactions usually develop within 3-8 days after start using nitrofurantoin. However, it can also occur a few hours to 4 weeks after the first dose. In this case report, a patient with acute lung toxicity due to nitrofurantoin use will be presented.

Coronavirus-related disease-2019 (COVID-19)-associated coagulopathy presents predominantly with thrombosis and leads to complications in close association with inflammatory process. Soluble endothelial protein C receptor (sEPCR), which is the soluble form of EPCR, reduces the anticoagulant and anti-inflammatory activity of activated protein C. The purpose of this study is to investigate the relationship between sEPCR and the laboratory parameters and thorax computed tomography (CT) findings in the course of COVID-19. Twenty-five laboratory-confirmed [reverse transcription-quantitative polimerase chain reaction (RT-qPCR) positive] and 24 clinically diagnosed (RT-qPCR negative) COVID-19 patients were enrolled in the study. Blood specimens were collected for sEPCR and haematological and biochemical parameter measurement. Thorax CT was performed to detect COVID-19 findings. These parameters from RT-qPCR positive and negative patients were then compared. Although there was no difference between the groups in terms of symptoms, the time between the onset of symptoms and the admission time was shorter in RT-qPCR positive group (P = 0.000). sEPCR levels were significantly higher in the RT-qPCR positive group (P = 0.011). Patients with ground-glass opacity and bilateral involvement on thorax CT have higher serum sEPCR levels (P = 0.012 and 0.043, respectively). This study has shown for the first time that serum sEPCR levels, which is a member of coagulation cascade and has also been reported to be associated with inflammation, is higher in patients with positive RT-qPCR test and patients with GGO or bilateral involvement on thorax CT regardless of the PCR result.

Desquamative interstitial pneumonia is a type of smoking-associated major idiopathic interstitial pneumonia, which is characterized by accumulation of alveolar macrophages in alveolar lumens and septa and develops secondary to mainly active or passive exposure to cigarette smoke. Desquamative interstitial pneumonia mostly occurs in male smokers in association with non-specific symptoms responsive to steroid therapy and has a better prognosis than usual interstitial pneumonia. To date, no large-scale clinical studies have been performed on desquamative interstitial pneumonia patients. Factors responsible for the scarcity of data on the clinical course of this condition include the retrospective nature of the available information as well as its rare occurrence. Despite this, a general consensus exists as to the nature of its symptoms, association with smoking, age and gender distribution, findings of respiratory function tests, steroid responsivity and mortality. The objective of the present review article was to report on desquamative interstitial pneumonia and to describe its etiology, risk factors and clinical features, as well as the laboratory, bronchoalveolar lavage, radiological and histopathological findings, and the treatment and prognosis of affected patients.

Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima‐media thickness (CIMT) is a noninvasive method assessing atherosclerosis.

INTRODUCTION:Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was to analyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey.MATERIALS AND METHODS:Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale.RESULT:Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss > 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia.CONCLUSIONS:In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Objective: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. Subjects and Methods: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. Results: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. Conclusion: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

OBJECTIVE:Obstructive sleep apnea syndrome (OSAS) has been associated with elevated biochemical markers of inflammation. Although the exact mechanism is unknown, both sleep deprivation and hypoxemia are believed to be important causative factors. YKL-40, also known as chitinase-like protein, has been shown to be related to various inflammatory conditions including atherosclerosis, diabetes, cancer, and asthma. The present study aimed to evaluate the relationship between YKL-40 levels and the Apnea Hypopnea Index (AHI) in patients with obstructive sleep apnea syndrome.PATIENTS AND METHODS:The study was conducted at the Sleep Unit of the Namik Kemal University Research Center. From January 2013 to December 2013, 120 patients diagnosed with OSAS by polysomnography and 40 subjects without OSAS were recruited. Patients in both groups were matched by age, sex, and body mass index (BMI). They were further divided into groups of mild, moderate and severe OSAS based on their AHI value. Serum YKL-40 concentrations were measured by the enzyme-linked immunosorbent assay (ELISA).RESULTS:OSAS patients showed significantly elevated YKL-40 levels compared to the control group; 102,05 (23.14) pg/ml in the control group vs. 144.81 (65.53) pg/ml in the OSAS group. A Spearman correlation analysis showed that serum YKL-40 levels were significantly and positively correlated with AHI (r = 0.434, p < 0.001) and oxygen desaturation index (r = 0.374, p < 0.001).CONCLUSIONS:The study demonstrated that high serum YKL-40 levels correlated with the severity of OSAS and might serve as a nonspecific biomarker for prediction and progression of the disease.

The aim of the present study was to increase awareness regarding the rational use of medicines. The data were obtained via the Material Resources Management System Module of the Ministry of Health. For the appropriateness of treatments, the Global Initiative for Asthma, the Global Initiative for Chronic Obstructive Lung Disease, and the guidelines for the rational use of medicines were used. We also investigated whether any de-escalation method or physical exercise was performed. Statistical analyses were performed using descriptive statistics to determine the mean, standard deviation, and frequency. The results showed that healthcare providers ignored potential drug reactions or adverse interactions, and reflecting the lack of adherence to the current treatment guides, 35.8% irrational use of medicines was recorded. Thus, de-escalation methods should be used to decrease costs or narrow the antibiotic spectrum, antibiotic selection should consider the resistance patterns, culturing methods should be analyzed, and monotherapy should be preferred over combination treatments.