BACKGROUND: Infrequent serious complications of convex-probe endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA) have been reported. The aim of this study was to assess serious complications related to convex-probe EBUS-TBNA and to determine the complication rate in a large group of subjects. METHODS: In this retrospective study, a 15-item questionnaire on features of cases with EBUS-TBNA complications was sent to experienced bronchoscopists performing convex-probe EBUS-TBNA at 3 pulmonary centers. The medical records were then reviewed by these bronchoscopists to complete the questionnaire. Hemorrhage responsive to topical treatment, temporary laryngospasm/bronchospasm, transient oxygen desaturation, and fever lasting <24 h were excluded. Only complications requiring further treatment/intervention were considered serious. The rate of serious complications was calculated from the obtained data. RESULTS: In a total of 3,123 cases within a 5-y period, EBUS-TBNA was performed for staging lung cancer in 15.8%, diagnosis in 67.5%, and diagnosis and staging in 16.3%. Of the 3,123, 11.6% had parenchymal lesions adjacent to major airways. EBUS-TBNA was performed 11,753 times (3.76/case) at 6,115 lymph node stations and lesions (1.92/station or lesion). Five serious complications were recorded (0.16%): fever lasting >24 h, infection of bronchogenic cyst, mediastinal abscess, pericarditis, and pneumomediastinitis with empyema, each in one case. Four complications occurred in cases diagnosed with benign disease by EBUS-TBNA. All complications were treated with broad-spectrum antibiotics. Four subjects were hospitalized for 21.7 ؎ 20.7 d. CONCLUSIONS: Convex-probe EBUS-TBNA is a safe method in general. However, serious complications, including infections, can be encountered rarely. All precautions should be taken for complications before and during the procedure.

Iodopovidone is an effective, inexpensive, safe, and easily available alternative in chemical pleurodesis in MPE. The success rates of pleurodesis were found to be similar regardless of the type of the tube inserted.

A retrospective analysis of 108 patients admitted to the hospital for hemoptysis in the year 2000 was performed. The aim of the study was to clarify the etiologic distribution of hemoptysis and the relation of etiology to the severity and recurrence of it. Of the cases, 79 were men and 29 were women, and the mean age was 51.74 +/- 17.51. In 77 of the cases it was the first attack, while in 31 it was recurrent. According to the severity of hemoptysis, it was classified as "mild" (<30 cm3), "moderate" (30-100 cm3), "severe" (100-600 cm3) and "massive" (>600 cm3). Lung cancer was the leading cause of hemoptysis (34.3%) followed by bronchiectasis (25.0%), tuberculosis (17.6%), pneumonia (10.2%) and pulmonary embolism (4.6%). Statistical analysis by chi-square test revealed that most of the lung cancer patients had mild hemoptysis (odds ratio 3.5; P<0.05), and the most frequent etiology in recurrent hemoptysis was bronchiectasis (odds ratio 3.25; P=0.01). Most of the lung cancer patients were male (P=0.002). The two leading causes of hemoptysis in our study are similar to many previous reports. The high rate of tuberculosis in our study is probably due to the high prevalence of tuberculosis in our country.

BACKGROUND: Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP) are the gold standard treatments for obstructive sleep apnea syndrome (OSAS), but CPAP/BPAP is not well tolerated and requires long-term follow-up. OBJECTIVE: We prospectively assessed subjective and objective adherence and factors that affect adherence in OSAS patients. METHODS: Subjects using CPAP/BPAP were questioned about adverse effects of CPAP/ BPAP and were assessed with the Epworth Sleepiness Scale (ESS) at the first, third, sixth, and twelfth month, and once every 6 months after the first year. CPAP/BPAP use and objective and subjective adherence were assessed. Subjects who used CPAP/BPAP for at least 4 hours per night for at least 70% of the days monitored were regarded as adherent, and those who did not were considered non-adherent. The relationships between adherence and demographic data, polysomnography findings, ESS scores, and adverse effects were statistically analyzed. RESULTS: Sixhundred forty-eight subjects who were diagnosed with OSAS by polysomnography and accepted to use CPAP/BPAP in our sleep center between January 2005 and June 2011 were included. Fourhundred fifty-one subjects (69.6%) were men, and 197 (30.4%) were women. Two-hundred fortyeight (38.3%) subjects attended follow-ups, 246 (37.9%) were called by telephone, and 154 (23.8%) could not be reached. Of the whole population, 63.9% had obtained their CPAP/BPAP machine. In the 248 subjects who attended follow-ups, subjective adherence was 85.1% and objective adherence was 64.5%. Improvement in ESS score (P < .001) and satisfactory sleep (P < .001) were found to be significantly higher in the adherent group. Chest discomfort, difficulty falling asleep, and sleep disturbances were significantly higher in the non-adherent group (all P < .01). CONCLUSIONS: Of the whole population, just 38.3% attended follow-ups. The objective adherence was lower than the subjective adherence in subjects who attended follow-ups. Younger subjects were more adherent, and the most important factors that correlated with adherence were substantial improvement of daytime sleepiness and effect of CPAP/BPAP on satisfactory sleep. CONCLUSIONS: CPAP/ BPAP adherence should be followed with objective monitoring.

Objectives The purpose of this study was to investigate the sensitivity and diagnostic value of convex probe endobronchial sonographically guided transbronchial needle aspiration (EBUS‐TBNA) in the diagnosis of granulomatous mediastinal lymphadenitis. Methods Patients clinically and radiologically suspected to have granulomatous mediastinal disease and followed in our clinic between October 2008 and July 2010 were included. Convex probe EBUS with local anesthesia and under conscious sedation and EBUS‐TBNA from hilar and mediastinal lymph nodes were performed after physical examination, chest radiography, computed tomography of the thorax, and routine biochemical analysis. Detection of noncaseating/caseating granulomas was accepted as sufficient for diagnosis of sarcoidosis/tuberculosis in the presence of clinical and radiologic findings. For patients whose EBUS‐TBNA results were nondiagnostic, a definitive diagnosis was reached by invasive procedures. The sensitivity of EBUS‐TBNA in the diagnosis of granulomatous lymphadenitis and diagnostic accuracy in granulomatous hilar/mediastinal lymphadenopathies was calculated. Results Seventy‐two patients were included in study (20 male and 52 female; mean age ± SD, 46.22 ± 13.94 years). In 72 cases, 121 lymph node aspirations were performed. The average lymph node short axis was 1.96 cm. With EBUS‐TBNA among the 72 cases, 35 were diagnosed as sarcoidosis and 16 as tuberculous lymphadenitis. A definitive diagnosis could not be reached with EBUS‐TBNA in 21 cases. As a result, 9 of these EBUS‐TBNA–negative cases were diagnosed as reactive lymphadenitis, 9 as sarcoidosis, and 3 as tuberculosis by invasive procedures. The sensitivity values of EBUS‐TBNA for diagnosis of sarcoidosis, tuberculosis, and granulomatous diseases were 79.5%, 84.2%, and 80.9%, respectively. The diagnostic accuracy of EBUS‐TBNA for granulomatous diseases was 83.3%. No major complications occurred. Conclusions In the diagnosis of granulomatous lymphadenitis, EBUS‐TBNA, with high sensitivity and a minimum complication rate, is an alternative to mediastinoscopy.

Highlights Earlier use of tocilizumab in COVID-19 infection is beneficial for survival, length of hospitalization and duration of oxygen support Administration of tocilizumab is based on an increase in requirements of oxygen support, progression of thoracic CT, elevation of inflammation IL-6, CRP, ferritin, d -dimer, and decrease in % lymphocytes Among the inflammation parameters, the earliest changes were detected at the levels of CRP, IL-6 and % lymphocytes

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Study Objectives: A recent study reported an association between obstructive sleep apnea (OSA) and low vitamin D levels. In this study, we measured vitamin D levels in patients referred for evaluation of suspected OSA and sought to identify associated risk factors for vitamin D deficiency. Our objective was to determine whether evaluations of patients with suspected OSA should include routine screening for vitamin D deficiency. Methods: Using a cross-sectional study design, we measured vitamin D levels in consecutively enrolled patients referred for an OSA evaluation to Dr. Lutfi Kirdar Kartal Training and Research Hospital in Istanbul, Turkey. We conducted full-night polysomnography and compared vitamin D levels both between patients with OSA and patients without OSA and across the various severity levels of OSA. We evaluated the association between vitamin D levels and various clinical and demographic characteristics, including the apnea-hypopnea index and body mass index. Results: From April 2014 to June 2015, 195 patients were referred for OSA evaluation. Of these, 181 patients (93%) consented to participate and underwent full polysomnography and measurement of vitamin D levels. The mean ± standard deviation age was 49 ± 12 years and body mass index of 31 ± 6 kg/m 2 . Polysomnography led to the diagnosis of OSA in 162 of the patients (89.5%): 52 (32%) were categorized as having mild OSA, 38 (23.5%) as having moderate OSA, and 72 (44.5%) as having severe OSA. Vitamin D level was 15.5 ± 11.6 ng/mL (95% confidence interval; 13-17 ng/mL) and 134 patients (74%) met the criterion for vitamin D deficiency (< 20 ng/mL). Sex, vitamin D levels, and percentage of patients with vitamin D deficiency were similar in patients with and without OSA (P > .05). Vitamin D levels were similar across OSA severity categories (P = .68). We found no association between vitamin D levels and the apnea-hypopnea index or body mass index. I NTRO DUCTI O NObstructive sleep apnea (OSA) is characterized by recurrent, partial, or complete upper airway obstruction resulting in intermittent hypoxia during sleep. OSA is associated with obesity and diabetes, and is also a risk factor for hypertension and coronary artery disease. 1 Recent reports have suggested that patients with OSA have a higher prevalence of vitamin D deficiency than healthy patients.2,3 Vitamin D plays a key role in calcium absorption and homeostasis, and is obtained both from dietary sources and through the skin via exposure to sunlight. The accepted definition of vitamin D deficiency is vitamin D levels less than 20 ng/ mL in serum [4][5][6] ; such deficiency can lead to additional comorbidities, including multiple bone disorders. 6 Obesity is a risk factor for vitamin D deficiency. Vitamin D is fat soluble and stored in adipose tissue. Obese individuals have more subcutaneous fat, which reduces the release of vitamin D from the skin into circulation. BRIEF SUMMARYCurrent Knowledge/Study Rationale: There are contradictory results about association between obstructive slee...