Tuberculosis Treatment Outcomes and Associated Factors in Benadir Somalia. A Multicenter Cohort Study.

Background: In low-resource countries like Somalia, tuberculosis (TB) is still a serious global health concern. Understanding the treatment outcomes of TB patients in specific regions is crucial for developing effective strategies to combat the disease. This study aimed to assess the treatment outcomes of TB patients in Benadir, Somalia. Methods: A retrospective cohort study was conducted using data from TB treatment centers in Benadir, Somalia. The study included all TB patients who initiated treatment between July 1, 2019 and June 30, 2020. Treatment outcomes, including treatment success, treatment failure, lost, death, and transfer out, were analyzed. Factors associated with treatment outcomes were also examined using chi-square test. Results: The study comprised 3165 TB patients in total. The mean age of the observations was 29.9 years, with males making up the majority (64.58%). The overall success rate of TB treatment was 80.6%, with 5.3% lost, 4.6% died, 0.5% failed, 4.6% transferred out, and 4.4% not evaluated. Factors associated with unfavorable treatment outcomes included older age and HIV co-infection. Conclusion: The treatment success rate for TB patients in Benadir, Somalia, is below the global target of 90%. Enhancing access to quality TB diagnostic and treatment services, as well as addressing social and economic barriers to treatment adherence, are essential for improving TB control in Benadir, Somalia.

Evaluation of Oxidative Stress Parameters and Genotoxic Effects in Patients With Work-Related Asthma and Silicosis.

OBJECTIVE: To determine the mechanistic roles of oxidative stress, inflammation, and genotoxicity parameters in patients with work-related asthma (WRA) and silicosis. METHODS: Thirty-eight healthy office workers, 27 employees with a history of exposure and no disease, 24 employees with WRA, and 23 employees with silicosis were included in this study. Superoxide dismutase, catalase, glutathione peroxidase, malondialdehyde, and interleukins (IL) 17, 23, and 27 levels were measured in the serum. Genotoxic damage was evaluated by calculating the frequency of micronuclei in swab samples and 8-hydroxy-2'-deoxyguanosine in serum. RESULTS: Serum superoxide dismutase, catalase, glutathione peroxidase, malondialdehyde, 8-hydroxy-2'-deoxyguanosine, and IL-17, IL-23, and IL-27 levels were found to be statistically significantly higher in the exposure, WRA, and silicosis groups compared with the control group. The frequency of micronuclei in buccal epithelial cells of the patient group was found to be significantly higher than that of the control group. CONCLUSION: These results may provide information for molecular mechanisms and early diagnosis of WRA and silicosis and will be a guide for taking precautions in the early period.

Dynamic thiol disulfide homeostasis in painters as indices of oxidative stress.

This study was designed to determine thiol-disulfide homeostasis as indices of oxidative stress in painters by using a novel and automated colorimetric measurement method. Male painters (n = 117) were separated into three groups according to duration of work; group 1 (<5 years), group 2 (5-14 years) and group 3 (≥15 years). Hippuric acid, trichloroacetic acid (TCA), and phenol in urine was determined. Catalase activity and ischemia-modified albumin (IMA) levels were also assessed. Disulfide/Native Thiol and Disulfide/Total Thiol of group 2 and group 3 were significantly higher than those of group 1 (p < 0.001). A positive correlation was observed between urinary phenol and disulfide/native thiol (r = 0.214, p = 0.035), IMA (r = 0.305, p = 0.002), disulfide (r = 0.209, p = 0.040), and duration of work (r = 0.341, p < 0.001). The newly developed automated colorimetric method used in our study proposes a promising, practical and daily applicable test for evaluating oxidative status of painters.

Alteration of thiol disulfide homeostasis and ischemia-modified albumin levels as indicators of oxidative status in patients with silicosis.

The aim of this study was to evaluate the oxidative status in patients with silicosis by detecting dynamic thiol disulfide homeostasis (TDH), ischemia-modified albumin level (IMA) catalase (CAT) activity, and the correlation of these markers with pulmonary function tests. Male ceramic workers with silicosis (n = 91) and healthy individuals (n = 47) were recruited for the study. Radiographic abnormalities of pneumoconiosis were classified into three profusion categories (categories 1, 2, and 3), and patients with silicosis, those with category 1, were defined as group 1 and those with category 2 or 3 were defined as group 2. Plasma levels of native thiol (NT), total thiol (TT), disulfide (Ds), IMA, and CAT activities were determined. Pulmonary function tests of groups were compared. NT, TT, and NT/TT ratios were significantly lower in groups 1 and 2 than the control group (p < 0.05). These did not differ between patients with silicosis (groups 1 and 2) and control group (p = 0.421). Ds/NT and Ds/TT ratios were significantly higher in group 2 than the control group (p < 0.05). NT, TT, and Ds did not differ significantly between groups 1 and 2. The oxidant biomarker IMA was higher (p < 0.001), and the antioxidant parameters albumin and CAT were lower in groups 1 and 2 (p < 0.001) compared with the control group. The mean FEV1act, FVCact, forced expiratory volume in 1 second/forced vital capacity (%), and value of 25-75 percent maximum expiratory flow were significantly lower in groups 1 and 2 than control group. We have used a novel colorimetric method to assess TDH in patients with silicosis. Alteration of plasma thiol/disulfide homeostasis and IMA levels might be novel indicators of oxidative stress in silicosis.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Inflammatory Markers in Patients With Welders' Lung Disease.

OBJECTIVE: To investigate neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with welders' lung disease (PWLD) and its relation with pulmonary function parameters. METHODS: One hundred sixteen male PWLD and 118 healthy non-exposed individuals were recruited. Pulmonary function tests (PFTs), complete blood count, erythrocyte sedimentation rate (SED), c-reactive protein (CRP), NLR and PLR of both groups were retrospectively analyzed. RESULTS: NLR, PLR, WBC, ESR, and CRP were significantly higher in PWLD compared to controls (all P < 0.001). All PFTs, except for FEV1/FVC, significantly decreased in PWLD compared to controls as. NLR correlated positively with ESR (r = 0.241 and P < 0.001). CONCLUSION: Our results show that NLR and PLR can be considered as new inflammatory markers in PWLD with their cheap, fast and easily measurable feature with routine blood count analysis.

Dynamic thiol/disulphide homeostasis as indicator of oxidative stress in automotive workers.

Purpose: To examine thiol-disulphide homeostasis auto painters.Materials and methods: A total of 115 male workers, including 60 auto painters workers and 55 reference group, of the painting and assembly line units respectively, were included in the study. Thiol-disulphide parameters and ischaemia-modified albumin (IMA) of groups were determined. Urinary hippuric acid, (HA) phenol, hexanedione, trichloroacetic acid, arsenic and blood lead and manganese were analysed.Results: The median urinary HA level was significantly higher in auto painters when compared to the reference group [(2461 (1212) vs. 520 (513) µgr/L), (p < 0.001)] . The mean disulphide level [19.7 (4.3) vs 0.15.1(4.1) µmol/L, (p < 0.001)], the disulphide/native thiol ratio [4.72 (1.47) vs. 3.13 (1.21, (p < 0.001)] and the disulphide/total thiol ratio [4.31 (1.23) vs. 2.94 (1.06), (p < 0.001)] were higher in auto painters when compared to the reference group. There was a statistically significant positive correlation between urinary HA and disulphide concentrations (r = 0.536 and p < 0.001), disulphide/native thiol ratio (r = 0.564 and p < 0.001) and the disulphide/total thiol ratio (r = 0.564 and p < 0.001) and IMA (r = 0.396 and p < 0.001).Conclusion: The results presented in this study showed that oxidative stress can be associated with occupational exposure to toluene denoted by alteration of thiol disulphide homeostasis and ischaemia-modified albumin levels.

Radiological progression and lung function decrements among silica-exposed ceramic workers: a longitudinal study.

Objectives: This follow-up study set out to evaluate the natural course and radiographic progression of silicosis among ceramic workers and describe the risk factors related with disease progression. Materials and methods: We retrospectively analyzed the data of ceramic workers with silicosis who were referred to our hospital between February 2010 and March 2018. A total of 165 ceramic workers followed at least 24 months and with at least two chest radiographs were included in the study. Results: The duration of silica exposure ranged from 5.5 to 27 (median 13.6) years. The numbers of patients according to follow-up time were as follows: 38 (2-2.9) years, 77 (3-3.9) years, 26 (4-4.9) years, 17 (5-5.9) years, and 7 (≥6) years. Overall 62 of 165 (37.5%) cases showed radiologic evidences of progression ranging from 2 to 8.9 years (mean 3.7 years). Pulmonary function loss rate among silicosis patients was 36.9% (61/165). Multiple logistic regression analysis showed a significant relation between radiographic progression and age (OR, 1.079: 95% CI, 1.011-1.152), follow-up time (OR, 1.557: 95% CI, 1.144-2.118), and the ILO category (category 2 or 3) at first visit (OR, 3.507: 95% CI, 1.505-8.170). Conclusions: Our findings suggest that one-third of Turkish ceramic workers with silicosis who were followed up to 8.9 years showed progression that was related to increasing age greater ILO category at time of initial visit and follow-up duration.

Predictive risk factors for development of silicosis in Turkish ceramic workers.

INTRODUCTION: Silicosis is still one of the the most common occupational disease in the world. The ceramic industry is one of the main sectors where silicosis patients are increasingly reported. The aim of this study was to evaluate the differences in demographic characteristics, radiological findings and pulmonary function test results of the ceramic workers with silicosis and those did not develop the disease. MATERIALS AND METHODS: A total of 626 workers, 459 with silicosis and 167 without silicosis, working in the ceramics industry those admitted to Ankara Occupational and Environmental Diseases Hospital between 2009 and 2018 were included in the study. The cases were evaluated retrospectively. RESULT: The median age and duration of work of the workers with silicosis were significantly higher (p< 0.001) compared to workers without silicosis. The risk of silicosis was found to be 22.5 times higher in 50 years or older age. Working 11-20 years and more than 20 years increased the risk of silicosis by 3.1 fold and 3.9 fold respectively. Smoking more than 10 package-years was found to increase the risk of silicosis 2 fold. The workers who had worked in clay processing, sanding, glazing or smelting were found to have 5.2-fold, 3.8-fold 2.5 and 2.4 fold higher silicosis risk, respectively. CONCLUSIONS: In this study, it has been shown that older age, longer duration of work, smoking, working in clay processing, sanding, glazing or smelting sections increase the risk of silicosis in ceramic workers.

Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as haematological indices of inflammatory response in ceramic workers' silicosis.

INTRODUCTION: Occupational exposure to crystalline silica over time may result in silicosis: a fatal, irreversible occupational disease leading to lung function impairment. A complex inflammatory process, excessive accumulation of mesenchymal cells and collagen production are the primary mechanisms underlying silicosis. Neutrophil to lymphocyte ratio (NLR) and the platelet to lymphocyte ratio (PLR) have emerged as representative indices of systemic inflammation. OBJECTIVES: The purpose of the present study was to investigate the relationship between NLR, PLR and silicosis. METHODS: We retrospectively analysed the demographic and laboratory data of ceramic workers who were referred to our Hospital between 2010 and 2018. Five hundred and seventy-three patients with silicosis and 222 ceramic workers without silicosis (controls) were included in the study. RESULTS: The radiographic ILO classification of silicosis patients was as follows: category 1 (71.5%), category 2 (19.2%), category 3 (7.5%). NLR and PLR in categories 2 and 3 were significantly higher when compared with the control group (P < .005). FEV1 , FEV1 %, FVC, FVC % and PEF were significantly lower in all silicosis patients and also in patients with subcategories (all P < .005). NLR showed a poor positive correlation with CRP (r = 0.095, P < .05) and ESR (r = 0.207, P = .000) while PLR only with ESR (r = 0.317, P = .000) in patients with silicosis. NLR and PLR showed negative correlations with FEV1 , FVC and PEF (all P < .005). CONCLUSION: We conclude that NLR and PLR have significant but poor correlations with pulmonary functions and severity of silicosis, especially in late radiographic profusion categories.

The utility of RDW in discrimination of sarcoidosis and tuberculous lymphadenitis diagnosed by ebus.

INTRODUCTION: Erythrocyte distribution width (RDW) is an important indicator of anisocytosis, which is used in the differential diagnosis of anemia and is easily accessible in the complete blood count results. Increased RDW values in coronary artery diseases, pulmonary hypertension and malignancies were detected in the studies. We aimed to demonstrate the usefulness of blood RDW level for the differential diagnosis of granulomatous lymphadenitis associated with tuberculosis and sarcoidosis in our study. MATERIALS AND METHODS: A total of 331 patients, 229 with sarcoidosis (stage I and stage II) and 102 with TB-LA and 50 healthy control group were included in the study. The biopsies were obtained via EBUS-TBNA from 705 lymph nodes of 331 patients. Of tissue diagnosis was non-erosive granulomatous inflammation patients with tuberculosis negative proved by microbiological tests were accepted as sarcoidosis after other causes of granulomatous disease were excluded. RESULT: Of the sarcoidosis patients, 169 (73.7%) were in stage I, and 60 (26.3%) were in stage II. The mean RDW was 14.31 (± 1.6) in the stage I group, 14.99 (± 2.3) in the stage II group, 14.11 (± 2.0) in the TB-LA group, and 13.89 (± 1.3) in the control group. There was a significant difference between the stage II group and the stage I, TB-LA, and control groups (p< 0.05 for all). There was a significant difference in the C-reactive protein levels between the TB-LA and stage I groups (p< 0.01). The eritrocyte sedimentation rate values were higher in the TB-LA group than in both the stage I and stage II groups (p< 0.05). CONCLUSIONS: This is the first study to demonstrate the diagnostic value of RDW in patients with TB-LA and sarcoidosis (Stage I-II) patients diagnosed by EBUS-TBNA. Higher RDW in stage II sarcoidosis than in stage I, TB-LA and control group is related with parenchymal involvement and indicates active inflammation.

Can we prevent recurrences in the endoscopic treatment of endobronchial hamartomas?

INTRODUCTION: Recently, treatment of endobronchial hamartomas with interventional bronchoscopic methods has become possible. Although there are several reports of therapeutic benefits, the protocol of administration varies between centers and high recurrence rates continue to be a problem. In this study, we aimed to show that cryotherapy applied to the root of the bronchial wall after removal of the intraluminal portion of endobronchial hamartoma with interventional bronchoscopic methods can prevent recurrences. MATERIALS AND METHODS: Between 2012-2016, the treatment outcomes and long-term follow-up data of patients with symptomatic endobronchial hamartomas treated by interventional bronchoscopic methods were prospectively recorded. After debulking, cryotherapy was applied to the root of the bronchial wall of all lesions. The data were analyzed retrospectively. RESULT: A total of 21 consecutive patients were studied. Twenty (95.2%) of the patients underwent complete resection and only 1 (4.8%) had incomplete resection with various interventional bronchoscopy techniques. One (4.8%) patient who underwent incomplete resection and ineffective cryotherapy relapsed. The other 20 (95.2%) patients were followed up periodically for an average of 36.0 ± 15.0 months. No recurrence was detected. No complications or deaths related to the procedure were observed. CONCLUSIONS: Debulking of endobronchial hamartomas with interventional bronchoscopic methods is effective and safe. Cryotherapy to the root of the lesion may prevent high recurrence rates.

Cost analysis and evaluation of nosocomial infections in intensive care units.

BACKGROUND/AIM: The purpose of this study was to evaluate nosocomial infections occurring in our hospital intensive care units (ICUs) and the risk factors for these, and to determine the effect of these infections on mortality and cost. MATERIALS AND METHODS: This retrospective study was performed via infection control committee surveillance data, ICU records, and information processing data between 1 January and 31 December 2013 at the Kanuni Education and Research Hospital. RESULTS: A total of 309 nosocomial infections were observed in 205 out of 566 patients. The density of nosocomial infections was 25.4 in 1000 patient days. Hospitalization was prolonged, and APACHE II and Charlson comorbidity scores were high in patients developing nosocomial infections (P < 0.001). Of the patients diagnosed with a nosocomial infection, 170 died. Infections were determined as the cause of death in 62 (36.5%) of the nonsurviving patients with a nosocomial infection. Acinetobacter baumannii was identified in 46 (74.2%) of the patients that died from nosocomial infections. The mean cost in patients developing a nosocomial infection was 15,229.30 Turkish lira (TL), compared to 9648.00 TL in patients without a nosocomial infection (P = 0.002). CONCLUSION: Regular infection control education sessions need to be held and the number of nurses needs to be increased in order to be able to reduce this high mortality, morbidity, and cost.

An assessment of ventilator-associated pneumonias and risk factors identified in the Intensive Care Unit.

OBJECTIVES: Ventilator-associated pneumonia (VAP) is a significant cause of hospital-related infections, one that must be prevented due to its high morbidity and mortality. The purpose of this study was to evaluate the incidence and risk factors in patients developing VAP in our intensive care units (ICUs). METHODS: This retrospective cohort study involved in mechanically ventilated patients hospitalized for more than 48 hours. VAP diagnosed patients were divided into two groups, those developing pneumonia (VAP(+)) and those not (VAP(-)).\. RESULTS: We researched 1560 patients in adult ICUs, 1152 (73.8%) of whom were mechanically ventilated. The MV use rate was 52%. VAP developed in 15.4% of patients. The VAP rate was calculated as 15.7/1000 ventilator days. Mean length of stay in the ICU for VAP(+) and VAP(-) patients were (26.7±16.3 and 18.1±12.7 days (p<0.001)) and mean length of MV use was (23.5±10.3 and 12.6±7.4 days (p<0.001)). High APACHE II and Charlson co-morbidity index scores, extended length of hospitalization and MV time, previous history of hospitalization and antibiotherapy, reintubation, enteral nutrition, chronic obstructive pulmonary disease, cerebrovascular disease, diabetes mellitus and organ failure were determined as significant risk factors for VAP. The mortality rate in the VAP(+) was 65.2%, with 23.6% being attributed to VAP. CONCLUSION: VAPs are prominent nosocomial infections that can cause considerable morbidity and mortality in ICUs. Patient care procedures for the early diagnosis of patients with a high risk of VAP and for the reduction of risk factors must be implemented by providing training concerning risk factors related to VAP for ICU personnel, and preventable risk factors must be reduced to a minimum.

Copeptin: a new predictor for severe obstructive sleep apnea.

INTRODUCTION: Copeptin which is the C-terminal fragment of antidiuretic hormone (ADH), is a biomarker that has been reported to be increased in various cardiovascular disorders, cerebrovascular diseases and associated with prognosis. Patients with obstructive sleep apnea syndrome (OSAS) have a tendency to develop coronary and cerebral atherosclerotic diseases. OBJECTIVES: The aim of the present study was to study copeptin levels in patients with obstructive sleep apnea and in a control group in order to determine whether copeptin could be used as a biomarker predicting the severity of OSAS and possible complications in this group. METHODS: A total of 116 patients with OSAS, diagnosed by polysomnography, and 27 controls were included in the study. Blood samples were collected after overnight fasting, and copeptin levels were measured with enzyme-linked immunosorbent assay. RESULTS: Copeptin levels were significantly higher in the OSAS group compared to control group (2,156±502; 1,845±500 pg/mL, respectively, P=0.004). Mean copeptin level of the patients having apnea-hypopnea index (AHI) ≥30 was significantly higher than that of the patients having AHI <30 (2,392±415; 2,017±500 pg/mL, respectively, P<0.001). A multivariate regression analysis showed that copeptin level, (hazard ratio: 1.58; 95% confidence interval: 1.09-2.30) was a predictor of severe OSAS (P=0.016). Copeptin levels showed significant positive correlation with AHI (r=0.32; P<0.001), desaturation index (r=0.23; P=0.012), arousal index (r=0.24; P=0.010) and CRP (r=0.26; P=0.011) respectively. CONCLUSION: Copeptin levels are high in OSAS patients and copeptin is a potential marker for identifying patients with a high risk of early cardiovascular complications of OSAS. Copeptin has modest sensitivity (84%) for discriminating severe OSAS patients who are candidates for severe cardiovascular complications.

Soluble urokinase-type plasminogen activator receptor is a novel biomarker predicting acute exacerbation in COPD.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory condition, and progresses with acute exacerbations. (AE). During AE, levels of acute phase reactants such as C-reactive protein (CRP) and inflammatory cells in the circulation increase. Soluble urokinase-type plasminogen activator receptor (suPAR) levels increase in acute viral and bacterial infections and in diseases involving chronic inflammation. The purpose of this study was to investigate the effectiveness of suPAR in predicting diagnosis of AE of COPD (AE-COPD) and response to treatment. METHODS: The study population consisted of 43 patients diagnosed with AE-COPD and 30 healthy controls. suPAR, CRP, and fibrinogen levels were measured on the first day of hospitalization and on the seventh day of treatment. RESULTS: We found that fibrinogen (P<0.001), CRP (P<0.001), and suPAR (P<0.001) were significantly higher in patients with AE-COPD than in healthy controls. Fibrinogen (P<0.001), CRP (P=0.001), and suPAR (P<0.001) were significantly decreased by the seventh day of treatment. However, the area under receiver operator characteristic curve showed that suPAR is superior to CRP and fibrinogen in distinguishing AE-COPD. There was a correlation between fibrinogen, CRP, and suPAR. However, only fibrinogen was a powerful predictor of suPAR in multiple linear regression. In multiple logistic regression, only suPAR and fibrinogen were strong predictors of AE-COPD (P=0.002 and P=0.014, respectively). Serum suPAR was negatively correlated with forced expiratory volume in 1 second (r=-478, P=0.001). CONCLUSION: suPAR is a marker of acute inflammation. It is well correlated with such inflammation markers as CRP and fibrinogen. suPAR can be used as a predictor of AE-COPD and in monitoring response to treatment.

[Elevated pleural copeptin levels can distinguish to exudate from transudates]. / Yüksek plevral copeptin düzeyleri eksüdayi transüdadan ayirabilir.

INTRODUCTION: Copeptin is released simultaneously along with arginine-vasopressine as a result of different stimuli from the neurohypophysis. Physiological function of copeptin is still unclear. Increased blood copeptin levels is associated with poor prognosis in many diseases. Pleural effusion is a common clinical condition. The most common causes of pleural effusions are heart failure, parapneumonic effusion, pulmonary embolism and malignacy.Tuberculosis is one of the other major causes of pleural effusion in developing countries. In this study, we aimed to assess whether pleural copeptin level may be a new discriminative biomarker for exudates and transudates pleural effusions. MATERIALS AND METHODS: Research was done at Recep Tayyip Erdogan University School of Medicine in the Department of Chest Diseases. The concentrations of pleural copeptin and typical pleural and serum marker levels were measured in 76 subjects with pleural effusions including 22 transudates caused by congestive heart failure (CHF), and 54 exudates including 18 parapneumonic (PPE), 18 tuberculous pleural effusions (TBPEs), 18 malignant effusions (MPEs). RESULTS: Median pleural fluid copeptin levels were higher in exudates than in transudates (1936 ng/mL and 1313 pg/mL, p value < 0.001). There was no statistical significancy for pleural fluid copeptin levels with in-group exudates (n= 54). Pleural copeptin levels of exudates, with a cut off value of 1469 ng/mL, yielded a 79.6% sensitivity, 81.8% specificity, with an are a under the curve of 0.851. CONCLUSION: Pleural copeptin level is a new biomarker to separate exudates from transudates. Pleural effusion discriminative effect of copeptin is lower than plasma protein level and plasma lactat dehydrogenase (LDH). Pleural copeptin measurement is not recommended for routine clinical use. Pleural copeptin level is not contribute to different iate exudative pleural fluids from each other like PPE, TBPE and MPE.

Frequency of pleural effusions in patients with pulmonary arterial hypertension associated with connective tissue diseases.

BACKGROUND: Pleural effusions frequently accumulate in patients with left-sided heart failure. However, our recent study in patients with idiopathic and heritable pulmonary arterial hypertension (PAH) demonstrated that pleural effusions frequently occur in patients with isolated right-sided heart failure (RHF). The objective of this study was to determine the frequency of pleural effusions in patients with PAH associated with connective tissue disease (CTD). METHODS: We retrospectively studied consecutive patients with PAH associated with CTD who were treated in the Vanderbilt Pulmonary Vascular Center. Pleural effusions were identified by chest radiograph, chest CT scan, thoracic ultrasonography, or autopsy. RESULTS: Thirty-five of 89 patients (39.3%) with PAH associated with CTD had pleural effusions: 23 of 51 (45.1%) with scleroderma, six of 16 (37.5%) with systemic lupus erythematosus, five of 18 (27.8%) with mixed connective tissue disease, and one of two (50.0%) with Sjögren syndrome. There were alternative explanations for the pleural effusions in six of these patients. Of the 29 patients without alternative explanation for their pleural effusions, 28 had RHF. When compared with the patients without pleural effusions, the 29 patients with pleural effusions had significantly higher mean right atrial pressures (11.3 ± 5.1 mm Hg vs 8.3 ± 4.0 mm Hg, P = .004) and lower cardiac indices (2.1 ± 0.6 L/min/m(2) vs 2.5 ± 0.7 L/min/m(2), P = .011). The pleural effusions were predominantly trace to small (58.6%) in size and bilateral (51.7%) in distribution. CONCLUSIONS: Pleural effusions frequently accumulate in patients with PAH associated with CTD and are associated with RHF.