Research Burden of Interstitial Lung Diseases in Turkey - RBILD.

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.

Association between burnout, anxiety and insomnia in healthcare workers: a cross-sectional study.

All healthcare workers (HCWs) encounter stress during in their working lives, and are constantly exposed to adverse conditions. The present study evaluates the relationship between burnout syndrome, anxiety levels and insomnia severity among healthcare workers, who mostly work in shifts. The Maslach Burnout Inventory, the Insomnia Severity Index and the Beck Anxiety Inventory were used to measure burnout, insomnia severity and anxiety status, respectively. This cross sectional study included a total of 1,011 HCWs and 679 (67.2%) of the study respondents were women. The respondents were aged 20-72, with a mean age of 35.67 ± 8.61 years. Fifty-eight percent (n = 589) of the participants were rotating shift workers. Working on-call led to a significant difference in all burnout parameters (for each, <0.001). Age and on-call duty were seen to lead to a significant difference in the severity of insomnia (p = 0.028, p < 0.001, respectively). The total ISI score was found to be statistically significant positively correlated with the MBI subscales and the total BAI score (for each, <0.001). An increased awareness of the impact of sleep deprivation, burnout and anxiety among HCWs and meaningful interventions promoting change within the healthcare system are needed.

Pneumomediastinum as a complication of COVID-19 disease: A case report.

As the COVID-19 pandemic progresses, awareness of uncommon presentations of the disease increases. Such is the case with pneumomediastinum. Recent evidence has suggested that these can occur in the context of COVID19 pneumonia, even in the absence of mechanical ventilation-related barotrauma. We present a patient with COVID-19 pneumonia complicated by pneumomediastinum.

Assessment of the risk of obstructive sleep apnoea syndrome among healthcare workers.

INTRODUCTION: Sleep deprivation is known to increase the risks for workplace accidents, neuro-behavioural symptoms and reduced quality of life. Shift work leads to sleep related problems, such as sleep deprivation, poor sleep quality and daytime sleepiness. The purpose of our study is to assess snoring prevalence and obstructive sleep apnoea risk among healthcare workers (HCWs) by using the Berlin Questionnaire. MATERIALS AND METHODS: HCWs employed at different centres that agreed to take part in this study were enrolled. Employing the Berlin Questionnaire, demographic characteristics, smoking histories, comorbidities, on-call shifts, number of on-call shifts and sleep durations of the participants were surveyed. RESULT: 604 HCWs including specialist, nurse, junior doctor, medical student, clinical academic, health technician and hospital staff were enrolled in this study. In terms of sleep apnoea, 92 (15.1%) participants were identified as high-risk and 512 (84.8%) as low-risk according to the findings of the questionnaire. When the two groups identified as high and low risk for sleep apnoea according to the Berlin Questionnaire were compared, significant differences were found between the two groups in terms of age, sex, height, weight, BMI value and hypertension (p< 0.001 for all variables). Multivariate logistic regression analysis has shown that on-call shifts (OR= 0.199, CI= 0.053-0.747, p= 0.017) are negative associated with sleep apnoea risk. CONCLUSIONS: With extended working hours and on-call shifts increasing the risk of sleep disorders among HCWs, surveys designed for screening can be used to identify the prospective cases in this population for further examination.

Betatrophin association with serum triglyceride levels in obstructive sleep apnea patients.

BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep problem, in which patients are at increased risk for metabolic and cardiovascular problems, including metabolic syndrome, diabetes mellitus (DM), and dyslipidemia. Betatrophin is a novel protein that regulates fatty acid and triglyceride (TG) metabolism and is related to obesity and metabolic abnormalities, including metabolic syndrome, DM, and dyslipidemia. Although OSA and betatrophin share common abnormalities, their relationship has not been investigated. AIM: The aim of this study is to investigate the relationships among betatrophin, OSA, and the serum lipid profile. METHODS: Ninety consecutive patients with suspected OSA underwent polysomnography (PSG) to confirm OSA. Plasma betatrophin, leptin, adiponectin, and the full lipid profile were analyzed. The patients were categorized as OSA or control based on the apnea-hypopnea index (AHI). RESULTS: About 61% of patients had OSA, and 39% had normal PSG. The levels of betatrophin, leptin, and adiponectin were higher in patients with OSA (256.59 ± 29.35, 374.20 ± 37.93, and 17.86 ± 2.63 µg/mL, respectively) compared to the controls (141.86 ± 26.20, 205.53 ± 14.75, and 7.52 ± 1.02 µg/mL, respectively). Betatrophin levels were correlated with the AHI, leptin (r = 0.413, P = 0.002, r = 0.782, P = 0.000). TG levels were significantly higher, and high-density lipoprotein cholesterol (HDL-C) levels were lower, in OSA patients compared to controls (244 ± 20.33 vs. 138 ± 14.89, and 37.21 ± 1.26 vs. 43.78 ± 1.62, respectively). The TG level was correlated with betatrophin (r = 0.353, P = 0.013). Multiple regression analysis showed that the AHI, leptin, and arousals were independent predictors of betatrophin level (B = 1.70 P = 0.046 95%, B = 0.56 P < 0.005, and B = 1, 2, P = 0.003, respectively). CONCLUSIONS: Our results suggest a complex relationship between OSA, betatrophin, TG, and HDL, as well as other adipokines. Our results require further investigation to assess this complex association and re-evaluate previous related studies.

A case of sarcoidosis with pleural involvement.

Sarcoidosis is a chronic, multisystem inflammatory disorder of unknown etiology that is characterized by noncaseating granulomas. Although lung involvement is common in sarcoidosis, pleural involvement is rare. Pleural involvement may manifest as a pleural effusion, pneumothorax, pleural thickening and nodules, hydropneumothorax, hemothorax, or chylothorax. Here, we describe a case of sarcoidosis with pleural nodular thickening.

The relationships among the levels of oxidative and antioxidative parameters, FEV1 and prolidase activity in COPD.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a progressive condition characterized by poorly reversible airflow limitations associated with an abnormal inflammatory response of the lung. METHODS: We investigated whether prolidase levels in serum, total antioxidant status, total oxidative status (TOS), and the oxidative stress index (OSI) were associated with the etiopathogenesis of COPD, and whether there is a relationship between prolidase activity and oxidative parameters and carotid artery intima-media thickness (CIMT) in patients with COPD. This study included 91 patients with COPD and 15 control cases. Routine haematological and biochemical parameters were determined in all patients. All subjects were fully informed about the study and provided consent. RESULTS: The mean age of the patients with COPD was 61.3 ± 10.5 years and that of the control group was 56.2 ± 12.1 years. The control group had a significantly higher plasma prolidase level than that in the COPD group. TOS and OSI levels in the control group were significantly lower than those in the COPD group. However, no significant differences were found in TALs or CIMT levels between the COPD and control groups. A negative correlation was detected between prolidase activity and age; however, no significant difference in age was observed between the two groups. CONCLUSION: These results indicate that prolidase activity decreases in patients with COPD.

Two-year survival of severe chronic obstructive pulmonary disease subjects requiring invasive mechanical ventilation and the factors affecting survival.

OBJECTIVE: To investigate two-year survival rates and the factors affecting survival in patients of severe chronic obstructive pulmonary disease requiring invasive mechanical ventilation. METHODS: The retrospective study was conducted at Yuzuncuy?l University, Van, Turkey, and comprised record of in-patients with moderate to severe chronic obstructive pulmonary disease who required invasive mechanical ventilation in the intensive care unit of the Pulmonary Diseases Department between January 2007 and December 2010. Correlation between survival and parameters such as age, gender, duration of illness, history of smoking, arterial blood gas values, pulmonary artery pressure, left ventricular ejection fraction, body mass index and laboratory findings were investigated. SPSS 19 was used for statistical analysis. RESULTS: Of the 69 severe COPD subjects available, 20 (29%) were excluded as they did not meet the inclusion criteria. Overall in-hospital mortality rate was 42% (n:29). Of the remaining 20 (29%) who comprised the study group, 14(70%) were men and 6(30%) were women. The mortality rates at the end of 3rd, 6th, 12th and 24th months were 61%, 76%, 84% and 85.5% respectively. There was no correlation between gender and survival in time point (p>0.05). The only factor that affected the rate of mortality at the end of the 3rd month was age (p<0.05). Mortality was high in subjects with advanced ages (p<0.05). Duration of illness affected the survival at the end of the six month (p<0.05). Survival rates were high in subjects with longer illness durations (p<0.05). Haematocrit level was the only factor that affected mortality rates at the end of 12th and 24th months (p<0.05). Subjects with higher haematocrit levels had higher survival rates (p<0.05). CONCLUSIONS: Age, duration of illness and haematocrit levels were the most important factors that affected survival in chronic obstructive pulmonary disease patients requiring mechanical ventilation.

Obstructive sleep apnea related to rapid-eye-movement or non-rapid-eye-movement sleep: comparison of demographic, anthropometric, and polysomnographic features.

OBJECTIVE: To determine whether there are significant differences between rapid-eye-movement (REM)-related obstructive sleep apnea (OSA) and non-REM (NREM)-related OSA, in terms of the demographic, anthropometric, and polysomnographic characteristics of the subjects. METHODS: This was a retrospective study of 110 patients (75 males) with either REM-related OSA (n = 58) or NREM-related OSA (n = 52). To define REM-related and NREM-related OSA, we used a previously established criterion, based on the apnea-hypopnea index (AHI): AHI-REM/AHI-NREM ratio > 2 and ≤ 2, respectively. RESULTS: The mean age of the patients with REM-related OSA was 49.5 ± 11.9 years, whereas that of the patients with NREM-related OSA was 49.2 ± 12.6 years. The overall mean AHI (all sleep stages combined) was significantly higher in the NREM-related OSA group than in the REM-related OSA group (38.6 ± 28.2 vs. 14.8 ± 9.2; p < 0.05). The mean AHI in the supine position (s-AHI) was also significantly higher in the NREM-related OSA group than in the REM-related OSA group (49.0 ± 34.3 vs. 18.8 ± 14.9; p < 0.0001). In the NREM-related OSA group, the s-AHI was higher among the men. In both groups, oxygen desaturation was more severe among the women. We found that REM-related OSA was more common among the patients with mild-to-moderate OSA, whereas NREM-related OSA was more common among those with severe OSA. CONCLUSIONS: We found that the severity of NREM-related OSA was associated mainly with s-AHI. Our findings suggest that the s-AHI has a more significant effect on the severity of OSA than does the AHI-REM. When interpreting OSA severity and choosing among treatment modalities, physicians should take into consideration the sleep stage and the sleep posture.

Sleep Apnea and Fatty Liver Are Coupled Via Energy Metabolism.

BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by intermittent hypoxia. Non-alcoholic fatty liver disease is the most common cause of chronic liver disease worldwide. We aimed to evaluate the relationship between OSA and fatty liver. MATERIAL/METHODS: We enrolled 176 subjects to this study who underwent polysomnography (PSG) for suspected OSA. The control group included 42 simple snoring subjects. PSG, biochemical tests, and ultrasonographic examination were performed all subjects. RESULTS: The simple snoring and mild, moderate, and severe OSA groups included 18/42 (42.86%), 33/52 (63.5%), 27/34 (79.4%), and 28/48 (79.2%) subjects with hepatosteatosis, respectively. There were significant differences in hepatosteatosis and hepatosteatosis grade between the simple snoring and the moderate and severe OSA groups. Logistic regression analysis showed that BMI and average desaturation were independently and significantly related to hepatic steatosis. CONCLUSIONS: Our study shows that BMI and the average desaturation contribute to non-alcoholic fatty liver in subjects with OSA. In this regard, sleep apnea may trigger metabolic mitochondrial energy associated processes thereby altering lipid metabolism and obesity as well.

Evaluation of Oxidative Damage and Antioxidant Mechanisms in COPD, Lung Cancer, and Obstructive Sleep Apnea Syndrome.

BACKGROUND: Oxidative damage is a major contributing factor to carcinogenesis and obstructive disorders in lungs. Current evidence suggests that the inflammatory processes yield to oxidative mechanisms, which underlie COPD, lung cancer, and obstructive sleep apnea syndrome (OSAS). This study aimed to evaluate the oxidative damage in these diseases by evaluating the oxidative and antioxidant biomarkers. METHODS: Malondialdehyde, 8-oxo-7,8-dihydro-2'-deoxyguanosine, and coenzyme Q10 levels were evaluated in the blood samples of subjects with COPD, lung cancer, and OSAS by high-pressure liquid chromatography. RESULTS: A total of 111 participants (35 females, 76 males) with OSAS (n = 29), COPD (n = 26), and lung cancer (n = 28) and healthy controls (n = 28) were included in the study. The malondialdehyde and coenzyme Q10 levels were significantly higher in all 3 diseases when compared with controls (P < .01), whereas 8-oxo-7,8-dihydro-2'-deoxyguanosine levels were only significantly higher than in healthy controls in subjects with lung cancer (P = .005). The highest levels of malondialdehyde and coenzyme Q10 were determined in subjects with OSAS and lung cancer, respectively. The highest 8-oxo-7,8-dihydro-2'-deoxyguanosine levels were also observed in subjects with lung cancer, but the differences of this biomarker with other diagnoses were not statistically significant (P = .56). CONCLUSION: Oxidative damage was observed in all 3 diagnoses, and, as a response to oxidative stress, antioxidant mechanisms were also active in these diseases. Malondialdehyde and 8-oxo-7,8-dihydro-2'-deoxyguanosine were found to be efficiently usable in the evaluation of oxidative damage in chronic respiratory diseases. (ClinicalTrials.gov registration NCT02406053.).

The Relationship Among Oxidative and Anti-Oxidative Parameters and Myeloperoxidase in Subjects With Obstructive Sleep Apnea Syndrome.

BACKGROUND: Obstructive sleep apnea (OSA) is a highly prevalent breathing disorder in sleep. It is characterized by intermittent hypoxia leading to hypoxemia, hypercapnia, sleep fragmentation, and increased respiratory efforts. We evaluated the relationship between OSA and myeloperoxidase activity, the oxidative stress index (OSI), total anti-oxidative capacity (TAC), and total oxidative capacity (TOC). METHODS: A total of 70 consecutive subjects (mean age ± SD: 51.7 ± 11.7 y) were diagnosed with OSA after a night polysomnography recording between January 2014 and June 2014 consecutively. The subjects in the OSA group were divided according to the severity of the disease into three subgroups, consisting of 11 mild, 17 moderate OSA, and 22 severe OSA subjects. Twenty subjects with simple snoring were considered as the control group. RESULTS: We included a total of 70 subjects: 50 with OSA (11 subjects 6.9% mild, 17 subjects 24.7% moderate, and 22 subjects 68.5% severe) and 20 subjects with simple snoring as control cases. The mean age of the mild OSA subjects was 44.5 ± 11.7 y, moderate OSA subjects' mean age was 52.5 ± 11.9 y, and severe OSA subjects' mean age was 52.1 ± 10.1 y; 54.2% were male. There were statistically significant differences among the 4 groups' OSI, TAC, and TOC levels, but there was no statistically significant difference between the other values. The mean myeloperoxidase, TOC, OSI, and TAC levels were 55 ± 12, 61.2 ± 21.1, 3.04 ± 1.04, and 2.03 ± 0.4 in the mild OSA group; 58.7 ± 17.2, 60 ± 18.9, 3.05 ± 1, and 2 ± 0.33 in the moderate OSA group; 56.6 ± 17.9, 52.1 ± 17.9, 2.7 ± 0.76, and 1.94 ± 0.24 in the severe OSA group; and 49.8 ± 12.5, 54.3 ± 16.4, 3.08 ± 0.88, and 1.78 ± 0.26 in the control group, respectively. CONCLUSIONS: In our study, there were no differences in studied parameters between control and OSA groups. Furthermore, our low number of cases was a restrictive factor. Further studies should be undertaken to clarify this relation.

Loeffler's syndrome: an interesting case report.

Loeffler's syndrome is an acute pneumonia with an unclear cause. One fourth of Loeffler's syndrome patients are idiopathic, although the most common etiologic causes include parasites. Asymptomatic form is usually a reversible, self-limited disease, which does not require a specific treatment regimen. We presented a 17-year-old young man with diagnosis of Loeffler syndrome.

Assessments of the associations of thrombus localization with accompanying disorders, risk factors, D-dimer levels, and the red cell distribution width in pulmonary embolism.

OBJECTIVE: Pulmonary embolisms occur as a wide spectrum ranging from clinically asymptomatic thrombi to massive thrombi that lead to cardiogenic shock. The purpose of this study was to determine the associations of thrombus localization with risk factors, accompanying disorders, D-dimer levels and the red blood cell distribution width in patients with pulmonary embolism. MATERIAL AND METHODS: In 148 patients diagnosed with pulmonary embolism, the presence and anatomical localization of the thrombus were assessed via computed tomographic pulmonary angiography. The accompanying disorders, risk factors, serum D-dimer levels, and red blood cell distribution width of the patients were retrospectively evaluated. ClinicalTrials.gov: NCT02388841. RESULTS: The mean age of the patients was 54±16.0 years, and 48 patients were ≥65 years of age. The most frequent accompanying disorders were chronic obstructive pulmonary disease (22%) and malignancy (10.1%), and the most frequent risk factors were recent operation (14.1%) and immobilization (18.2%). Thrombi were most frequently observed in the right pulmonary artery (37.8%). In 31% of the patients, the thrombus was localized to the main pulmonary arteries. Immobile patients exhibited a higher proportion of thrombi in the main pulmonary arteries than mobile patients. The mean D-dimer level and the mean red blood cell distribution width in the patients with thrombi in the main pulmonary arteries were higher than those in the patients with thrombi in more distal pulmonary arterial branches. CONCLUSION: Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed.

Assessments of the associations of thrombus localization with accompanying disorders, risk factors, D-dimer levels, and the red cell distribution width in pulmonary embolism

OBJECTIVE: Pulmonary embolisms occur as a wide spectrum ranging from clinically asymptomatic thrombi to massive thrombi that lead to cardiogenic shock. The purpose of this study was to determine the associations of thrombus localization with risk factors, accompanying disorders, D-dimer levels and the red blood cell distribution width in patients with pulmonary embolism. MATERIAL AND METHODS: In 148 patients diagnosed with pulmonary embolism, the presence and anatomical localization of the thrombus were assessed via computed tomographic pulmonary angiography. The accompanying disorders, risk factors, serum D-dimer levels, and red blood cell distribution width of the patients were retrospectively evaluated. ClinicalTrials.gov: NCT02388841. RESULTS: The mean age of the patients was 54±16.0 years, and 48 patients were ≥65 years of age. The most frequent accompanying disorders were chronic obstructive pulmonary disease (22%) and malignancy (10.1%), and the most frequent risk factors were recent operation (14.1%) and immobilization (18.2%). Thrombi were most frequently observed in the right pulmonary artery (37.8%). In 31% of the patients, the thrombus was localized to the main pulmonary arteries. Immobile patients exhibited a higher proportion of thrombi in the main pulmonary arteries than mobile patients. The mean D-dimer level and the mean red blood cell distribution width in the patients with thrombi in the main pulmonary arteries were higher than those in the patients with thrombi in more distal pulmonary arterial branches. CONCLUSION: Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed. .

Successful management of pulmonary hemorrhage and aspergillosis in a patient with acute myeloid leukemia (AML-M3).

A 35-year-old man presented with a one month history of gingival bleeding. He was diagnosed with Acute Myeloid Leukemia (AML-M3). During treatment he developed alveolar hemorrhage for which he was treated with a steroid. After the steroid treatment he developed a nodule, a cavitary lesion and atelectasia in the left lung. He was treated with voriconazole. After therapy with voriconazole his lesion significantly decreased. This case illustrates the efficacy and safety of antifungal therapy with voriconazole for aspergillosis complicated by AML.

The correlation between red blood cell distribution width levels with the severity of obstructive sleep apnea and carotid intima media thickness.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive collapse of the upper airway during sleep. Red blood cell distribution width (RDW) increases platelet activation and has been reported as an independent predictor of adverse outcomes in the general population and is believed to be associated with cardiovascular morbidity and mortality. We evaluated RDW, mean platelet volume (MPV), and platelet distribution width (PDW) as a severity index in OSAS and the relationship between carotid intima media thickness and pulmonary hypertension. MATERIAL/METHODS: The study population consisted of 99 patients who were admitted to the sleep laboratory. Based on the apnea-hypopnea index, patients were grouped into 3 OSAS severity categories. Morning blood samples were withdrawn from patients after a 12-hour fasting period. MPV, PDW, and RDW were measured in a blood sample. Bilateral common carotid arteries of the patients were scanned. RESULTS: Ninety-nine patients--73 with OSAS and 26 simple snoring control cases--were included. Mean values of MPV, PDW, and RDW were similar in patients compared to simple snoring subjects in the control group (p=0.162, p=0.656, p=0.091). RDW showed an inverse correlation with mean desaturation and lowest desaturation (p<0.01). Body mass index, apnea-hypopnea index, pulmonary artery pressure, and desaturation time under 90% were positively correlated with RDW (p<0.05). MPV, PDW, and carotid intima media thickness had no correlation with any other parameters. CONCLUSIONS: The study showed a positive relationship between RDW and the apnea-hypopnea index and systolic pulmonary hypertension in patients with OSAS.

Utility of computed tomography in assessment of pulmonary hypertension secondary to biomass smoke exposure.

BACKGROUND: The aim of this study was to investigate the feasibility of main pulmonary artery diameter quantification by thoracic computerized tomography (CT) in the diagnosis of pulmonary hypertension seconder to biomass smoke exposure. MATERIAL AND METHODS: One hundred and four women subjects with biomass smoke exposure and 20 healthy women subjects were enrolled in the prospective study. The correlation between echocardiographic estimation of systolic pulmonary artery pressure and the main pulmonary artery diameter of the cases were studied. RESULTS: The main pulmonary artery diameter was 26.9 ± 5.1 in the control subjects and 37.1 ± 6.4 in subjects with biomass smoke exposure. This difference was statistically significant (p<0.001). The systolic pulmonary artery pressure was 22.7 ± 12.4 in the control subjects and 57.3 ± 22 in subjects with biomass smoke exposure. This difference was statistically significant (p<0.001). Systolic pulmonary artery pressure was significantly correlated with the main pulmonary artery diameter (r=0.614, p<0.01). A receiver operating characteristic (ROC) curve analysis showed that a value of 29 mm of the main pulmonary artery diameter differentiated between pulmonary hypertension and non-pulmonary hypertension patients. The sensitivity of the measurement to diagnose pulmonary hypertension was 91% and specificity was 80%. CONCLUSIONS: Our results indicate that main pulmonary artery diameter measurements by SCT may suggest presence of pulmonary hypertension in biomass smoke exposed women.

Yellow nail syndrome presenting with postpartum massive pleural effusion.

Yellow nail syndrome (YNS) is an uncommon clinical syndrome characterized by yellow-green discoloration of nails and recurrent respiratory tract lesions, pleural effusions and lymphedema. A 38-year-old woman was referred to the emergency complaining of chronic cough and increasing dyspnea within last 2 weeks. She had given birth 1 month ago. On examination, the patient exhibited dystrophic yellowish nails and mild peripheral lymphedema. A chest roentgenogram revealed a large right pleural effusion and a small left pleural effusion. YNS is a rare clinical entity but should be taken into consideration in patients with massive pleural effusions and persistent lymphedemas on the postpartum period.