Background:Obstructive sleep apnea (OSA) is a major disease that can cause significant mortality and morbidity. Chronic intermittent hypoxia is a potential causal factor in the progression from fatty liver to nonalcoholic steatohepatitis.Objectives:This study evaluated the association between the degree of liver steatosis and severity of nocturnal hypoxia.Patients and Methods:In this study, between December 2011 and December 2013, patients with ultrasound-diagnosed NAFLD evaluated by standart polysomnography were subsequentally recorded. Patients with alcohol use, viral hepatitis and other chronic liver diseases were excluded. We analyzed polysomnographic parameters, steatosis level and severity of obstructive sleep apnea (OSA) in consideration of body mass index (BMI), biochemical tests and ultrasonographic liver data of 137 subjects. Patients with sleep apnea and AHI scores of < 5, 5 - 14, 15 - 29 and ≥30 are categorized as control, mild, moderate and severe, respectively.Results:One hundred and thirty-seven patients (76 women, 61 men) with a mean age of 55.75 ± 10.13 years who underwent polysomnography were included in the study. Of 118 patients diagnosed with OSA, 19 (16.1%) had mild OSA, 39 (33.1%) moderate OSA and 60 (50.8%) severe OSA. Nineteen cases formed the control group. Apnea/hypopnea index and oxygen desaturation index (ODI) values were significantly higher in moderate and severe non-alcoholic fatty liver disease (NAFLD) compared to the non-NAFLD group. Mean nocturnal SpO2 values were significantly lower in mild NAFLD and severe NAFLD compared to the non-NAFLD group. Lowest O2 saturation (LaSO2) was found low in mild, moderate and severe NAFLD compared to the non-NAFLD group in a statistically significant manner.Conclusions:We assessed polysomnographic parameters of AHI, ODI, LaSO2 and mean nocturnal SpO2 levels, which are especially important in the association between NAFLD and OSAS. We think that it is necessary to be attentive regarding NAFLD development and progression in patients with OSA whose nocturnal hypoxia is severe.

We think that OSA is very rarely the reason for secondary polycythaemia.

Background & Objective: Obstructive sleep apnea syndrome (OSAS) has a close relationship with many diseases. Hematological parameters are simple diagnostic methods and can give an idea about severity of some diseases. The aim of this study was to examine the relationship of OSAS with comorbid diseases and relationship between OSAS severity, oxygen desaturation index (ODI) and hematological parameters. Methods: This retrospective and cross-sectional study was conducted by evaluating the medical files of patients who underwent polysomnography between 2012 and 2018. 1,119 patients (198 controls; 921 OSA) were participated to the research. Results: Congestive heart failure, hypertension (HT), asthma and chronic obstructive pulmonary diseases (COPD) were seen in 143, 424, 254 and 177 patients respectively. Severe OSAS was found more common in male. Except the patients with HT; neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) levels were higher and lymphocyte levels were lower in patients with comorbid diseases. WBC and erythrocyte distribution width (RDW) levels were higher in patients with COPD than without COPD; PLT levels were higher in patients with asthma than without asthma. WBC level of the moderate-severe OSAS was significantly higher than the control and mild OSAS (p=0.001). Platelet distribution width (PDW) value of the OSAS was higher than the control group (p=0.005). The apnea-hypopnea index and ODI levels were higher in patients with comorbidity than without comorbidity (p=0.001). Conclusions: It can be said that lymphopenia, high NLR, PLR, WBC, RDW and PDW may be useful markers for predicting severity of OSAS in comorbid diseases. The presence of OSAS should be detected in order to treat comorbidity appropriately.

ÖzetRomatoid artrit (RA) nüfusun yaklaşık %0,3-1,5'inde görülen etiyolojisi bilinmeyen, eklemlerden iç organlara kadar vücudun farklı bölgelerinde tutulumla karakterli kronik otoimmün bir hastalıktır. Plöropulmoner tutulum ikinci sıklıkla görülen tutulum olup en başta gelen mortalite nedenidir. Plöropulmoner tutulum RA tanısı almadan önce ortaya çıkarsa, ayırıcı tanıda düşünülmeyip gözden kaçabilir. Başlangıç semptomu olarak plevral efüzyon, solunum sıkıntısı ve son altı aydır devam eden göğüs ağrısı şikâyetleri ile gelen ve takibinde RA tanısı alan olguyu literatür bilgileri ışığında sunmayı amaçladık. Anahtar sözcükler: Romatoid artrit, plevral efüzyon, plörit AbstractRheumatoid arthritis (RA) is a chronic autoimmune disease with unknown aetiology which effects a variety from joints to internal organs and other sites of organism. It's seen in 0.3-1.5% of population. Pleuropulmonary involvement which is the second frequent involvement is the major cause of mortality. If the pleuropulmonary involvement exists before the diagnosis of rheumatoid arthritis, it may be overlooked. We aimed to present a case with pleural effusion, respiratory distress and chest pain lasting for 6 months as initial symptoms and diagnosed as rheumatoid arthritis in follow up on the light of literature data.

Objectives: Patients who develop cytokine storm while they have coronavirus disease 2019 (COVID-19) experience more severe symptoms. This article aims to evaluate the effect of biochemical parameters on the clinical course of the disease in patients treated with tocilizumab (TCZ) due to cytokine storm.Methods: Medical documents of patients with COVID-19 were searched retrospectively. Patients who entered cytokine storm were classified as group 1 and divided into two subgroups as patients who were followed up in the ward and in the intensive care unit (ICU). Less severe COVID-19 patients who did not enter cytokine storm were included in the control group as group 2.Results: A total of 522 patients with COVID-19 infection were included in the study. The mean age was 62.0 ± 15.6 years, and the majority were male (64.4%). Hypertension and diabetes mellitus were the two most common diseases, seen in 50.8% and 29.9%, respectively. There were 392 patients with TCZ application (group 1) and 130 patients without TCZ (group 2). Significantly higher serum glucose, magnesium, and sodium and lower calcium levels were present in group 1 than in group 2 (<0.001). Hypocalcemia, hypernatremia, hypermagnesemia, and hyperkalemia were more frequently detected in the ICU compared with the patients treated in the wards (P = 0.001, P < 0.001, P = 0.039, and P < 0.001, respectively).Conclusions: Following up closely electrolyte disturbances may support patient survival and decrease the probability of ICU necessity. This approach should be taken before the development of important disorders to be effective in the treatment process of the main disease.

AbsractAim. Tuberculous pleurisy is one of the most common form of pulmonary tuberculosis, and may be confused with many other diseases. This study was designed to assess the diagnostic value of pleural fluid neopterin levels in patients with tuberculous pleurisy. Methods. A total of 57 patients [tuberculosis pleurisy (n=30), malignant pleural effusion (n=17), pleural effusion due to congestive heart failure (n=10)] were included in the study. The measurement of neopterin levels was conducted by the enzymeimmunassay method and Trinity-Biotech XL fully automatic ELISA kit device and neopterin IBL kit. Results. The neopterin levels in patients with tuberculous pleurisy were significantly higher than that of both malignancy and congestive heart failure (p<0.001). The neopterin levels of patients with congestive heart failure and malignancy were found as similar (p=0.920). There was no significant difference in the neopterin levels with regard to age and sex (p>0.05). Conclusions. Tuberculous pleurisy increases neopterin levels of pleural fluid when compared with malignancy and congestive heart failure. In this respect, neopterin level in the pleural fluid may be a useful diagnostic marker of tuberculous pleurisy.Keywords: Neopterin; pleural effusion; tuberculous pleurisy Özet Amaç. Tüberküloz plörezi akciğer tüberkülozunun en sık formlarından biri olup birçok hastalıkla karışabilir. Bu çalışma tüberküloz plörezili hastaların plevral sıvılarındaki neopterin seviyelerinin tanısal değerini belirlemek için yapılmıştır. Yöntem. Toplam 57 hasta [tüberküloz plörezi (n=30), malign plevral efüzyon (n=17) ve konjestif kalp yetmezliği

Extensive research has been conducted to identify the predictive criteria for COVID-19 disease. White blood cell, C-reactive protein, CRP/albumin ratio, neutrophil-to-lymphocyte ratio and ferritin are among the indicators of increased inflammatory response; hence, they could be used to determine the prognosis of COVID-19 cases. Within the scope of this study, we aimed to elucidate the predictivity of NLR, CAR and other laboratory parameters on the duration of hospital stay and mortality in patients with COVID-19. Materials and Method:The data of 1516 COVID-19 patients who were hospitalized in our institution have been analyzed retrospectively. Patients were divided into two groups those who deceased within the first 10 days of hospitalization (Group I, ≤10 days) and those who deceased in the later period (Group II, >10 days). Age, gender, time to mortality after hospitalization, neutrophil count, CRP, neutrophil-to-lymphocyte ratio (NLR), CRP/albumin ratio (CAR), and D-dimer values were obtained from blood samples taken during hospitalization. Results: NLR and CAR values were significantly higher in those who died in the first 10 days compared to the other group (p<0.02 and p<0.001, respectively). In addition, WBC, neutrophil, CRP and D-dimer levels were statistically significantly higher than the other group (p<0.05). Logistic regression analysis results for NLR and CAR were significant. The cut-off values were calculated (5.74 and 4.27, respectively) for both parameters. Among the most common comorbid diseases were hypertension (HT) in 41%, coronary artery disease (CAD) in 41.7%, asthma-chronic obstructive pulmonary disease (COPD) in 36.7%, diabetes mellitus (DM) in 36.1%. Conclusion: NLR and CAR may have a decisive influence in determining the length of stay in hospital for patients who die in hospital due to COVID-19. In addition, it is recommended that COVID-19 cases with diabetes be followed closely.

Objective: It is known that anxiety and depression are associated with sleep disorders and many systemic diseases. This study aims to analyse the relationship between anxiety, depression symptoms and sleep parameters among the patients subjected to polysomnographic recording. Material and Methods: A total of 808 patients who were subjected to a polysomnographic recording were included in the retrospective cross-sectional and hospital-based study. Body mass index (BMI) was calculated. Anxiety and depression symptoms were evaluated using the Beck anxiety and Beck depression inventory. Patients were divided into groups according to anxiety and depression scores. The apnoea hypopnea index (AHI), oxygen desaturation index (ODI), and peripheral oxygen saturation (SaO2) were obtained from the polysomnographic recordings. Results: In the study, there were 528 (65.3%) male and 280 (34.7%) female patients with the mean age 47.64 ± 12.25 (18-82). Depression was detected in 307 (38.0%) patients according to Beck depression score. Mild anxiety symptoms were detected in 516 (63.9%), moderate anxiety symptoms in 215 (26.6%) patients and severe anxiety symptoms in 77 (9.5%) patients according to Beck anxiety score. There was a statistical difference for all polysomnographic parameters in depression and anxiety severity groups (p=0.001). In patients with depression had lower free-T3 and higher C-reactive protein (CRP) levels (p=0.001, p=0.014). The difference between thyroid stimulating hormone (TSH) and FT4 levels was determined according to the severity of the depression (p=0.037, p=0.047). CRP was higher in patients with severe anxiety (p=0.008); and free-T3 was lower in patients with moderate and severe anxiety (p=0.003, p=0.001). In the logistic regression analysis, free-T3, minimum SaO2 and BMI had an impact on anxiety (p=0.002, p=0.033, p=0.031) and depression (p=0.001, p=0.017, p=0.035). Conclusion: Anxiety and depression symptoms are affected by numerous factors, especially sleep characteristics. Minimum SaO2, CRP and free-T3 are main predisposing factors on anxiety and depression