Diaphragmatic ultrasonography in patients with IPF: Is diaphragmatic structure and mobility related to fibrosis severity and pulmonary functional changes?Introduction: There is evidence to suggest that dyspnea and impaired exercise capacity are associated with respiratory muscle dysfunction in idiopathic pulmonary fibrosis (IPF) patients. We aimed to evaluate the functions of the diaphragm with ultrasonography (US) and to determine the correlation of the data obtained with the pulmonary function parameters of the patients, exercise capacity, and the extent of fibrosis radiologically.Materials and Methods: Diaphragmatic mobility, thickness, and thickening fraction (TF) were measured by ultrasonography in IPF patients and the control group. The correlation between these measurements, pulmonary function tests (PFT), six-minute walking test (6MWT), mMRC score, and total fibrosis score (TFS) was evaluated.Results: Forty-one IPF patients and twenty-one healthy volunteers were included in the study. No difference was found between the patient and control groups in diaphragmatic mobility during quiet breathing (QB) on ultrasound (2.35 cm and 2.56 cm; p= 0.29). Diaphragmatic mobility during deep breat-hing (DB) was found to be lower in the patient group when compared to the control group (5.02 cm and 7.66 cm; p< 0.0001). Diaphragmatic thickness was found to be higher during QB and DB in IPF patients (0.33 cm and 0.31 cm, p= 0.043; 0.24 cm and 0.22 cm, p= 0.045). No difference was found between the two groups in terms of thickening fraction (39.37%, 44.16%; p= 0.49). No significant correlation was found between US measurements and PFT, 6MWT, mMRC score, and TFS in IPF patients (p> 0.05).Conclusion: The functions of the diaphragm do not appear to be affected in patients with mild-to-moderate restrictive IPF. This study showed that there was no relationship between diaphragmatic functions and respiratory function parameters and the extent of fibro-sis. Further studies, including advanced stages of the disease, are needed to understand the changes in diaphragmatic functions in IPF and to determine whether this change is associated with respiratory function parameters and the extent of fibrosis.

Comparison of clinical outcomes in idiopathic pulmonary fibrosis patients with and without hiatal hernia Introduction: Idiopathic pulmonary fibrosis (IPF) is a progressive disease of unknown etiology with an unpredictable course. We aimed to investigate the effects of the presence of hiatal hernia (HH) and its consequences on the clinical manifestation of IPF. Materials and Methods: Patients diagnosed with IPF with or without hiatal hernia were retrospectively compared in terms of clinical findings, total fibrosis scores (TFS), and lung function in the interstitial lung diseases (ILD) outpatient clinic. Results: A total of 142 IPF patients were included in the study. HH was detected in 62.7% (n= 89) of the patients. There was no statistically significant difference between IPF patients with or without HH in terms of age, gender, smoking history, and anti-reflux drug use (p> 0.05). There was no statistically significant difference between IPF patients with or without HH in terms of symptoms such as dyspnea, cough, regurgitation, heartburn, nausea, dysphagia, chest pain, and hoarseness (p> 0.05). In addition, no statistically significant difference was found between IPF patients with or without HH in terms of mortality rate, survival time after diagnosis, and exacerbations (p> 0.05). Six-minute walking distance and SpO(2) change, percentage of predicted forced vital capacity (FVC) value, and percentage of predicted diffusing capacity for carbon monoxide (DLCO) value did not differ significantly between the groups (p> 0.05). There was no statistically significant difference between the groups in terms of total fibrosis score (p= 0.668). Conclusion: According to the results of this study, 62.7% (n= 89) of IPF patients had HH, and there was no difference in clinical outcomes, TFS, and pulmonary functions between IPF patients with or without HH.

Introduction:There is increasing evidence that dyspnea and impaired exercise capacity are partially associated with respiratory muscle dysfunction,particularly diaphragmatic dysfunction,in patients with IPF.We aimed to assess the functions of the diaphragm, which is the main respiratory muscle,using both US and sEMG in patients with IPF,and to establish the correlation of these data with pulmonary function parameters,exercise capacity and radiological extent of fibrosis. Methods:We measured diaphragmatic mobility,diaphragmatic thickness and TF by US and the strength of diaphragmatic contraction on sEMG in IPF patients and compared with healthy individuals.We further assessed the correlation of these measurements with each other and with FVC,DLCO,6MWT,spO2 changes,mMRC score and TFS in patients with IPF. Results:41 IPF patients and 21 healthy individuals were included in the study.There was no difference in diaphragmatic mobility on US during quiet breathing between the patient and control groups(2.35 cm vs. 2.56 cm;p=0.29).Diaphragmatic mobility during deep breathing was lower in the patient group compared to the control group(5.02 cm vs. 7.66 cm;p0.05).When the relationship between US and sEMG findings in IPF patients was evaluated,a positive correlation was found between the diaphragmatic thickness during quiet breathing and the strength of contraction(r=0.32;p=0.04). Conclusion:The functions of the diaphragm do not appear to be affected in IPF patients with mild-to-moderate restriction.However,the functions of the diaphragm may deteriorate as a result of inadequate compensatory response to the load on respiratory muscles in the later stages of the disease.

Background/Objectives: Sarcoidosis is a multisystem inflammatory disease characterized by heterogeneous clinical manifestations and variable disease severity. Hematological inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), red cell distribution width (RDW), and systemic immune-inflammation index (SII), have recently attracted attention as accessible indicators of systemic inflammation in sarcoidosis. This study aimed to evaluate radiological stage, symptom burden, pulmonary function parameters, and hematological markers in patients with sarcoidosis. Methods: This retrospective multicenter cohort study included histopathologically confirmed sarcoidosis patients from 10 centers. Demographic characteristics, clinical manifestations, pulmonary function test parameters, serum angiotensin-converting enzyme (ACE) levels, and hematological inflammatory markers (MPV, RDW, NLR, PLR, SII) were evaluated. Patients were categorized according to radiological stage (stage 0–I vs. stage II–IV), symptomatic status, and symptom burden (<3 vs. ≥3 symptoms). Results: Among 458 patients included in the study, stage I (47.8%) and stage II (46.9%) disease were the predominant radiological presentations. Patients with stage II–IV disease were older and demonstrated significantly lower forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, and diffusing capacity for carbon monoxide (DLCO) values together with higher serum ACE levels compared with stage 0–I disease. Dyspnea, weight loss, and extrapulmonary involvement were more frequent in stage 2–4 disease. No significant associations were observed between radiological stage and NLR, PLR, or SII values. MPV and RDW values differed significantly between symptomatic and asymptomatic patients. Patients with ≥3 symptoms demonstrated significantly lower pulmonary function parameters together with statistically significant higher NLR, PLR, and SII values. In multivariate analyses, only the SII demonstrated an independent association with a high symptom burden. Conclusions: Serum ACE levels were associated with advanced radiological stage, whereas hemogram-derived inflammatory indices, particularly the NLR, PLR, and SII, were associated with symptom burden rather than radiological stage in sarcoidosis and may reflect symptomatic inflammatory activity.