Although the epidemiological and clinical characteristics of COVID-19 patients have been described; the pathogenesis of the disease and its long-term consequences are still unclear. Pulmonary fibrosis is one of these late outcomes. In this study we evaluated Interleukin-17 (IL-17), vascular endothelial growth factor (VEGF), and immunoglobulin G4 (IgG4) levels of COVID-19 infected patients with different clinical course and their effect on pulmonary fibrosis in post-COVID period. In total, 90 patients were evaluated. Among the patients who presented for a control visit between 3-12 weeks after acute infection; patients with signs of pulmonary sequelae radiologically (traction bronchiectasis, interseptal thickening, disorders in parenchyma architecture) were classified as Group I (n= 32), patients who recovered without sequelae radiologically as Group II (n= 32). The Control group included healthy individuals who did not have COVID-19, and was classified as Group III (n= 26). The mean age in Group I was significantly higher than Group II and III (p<0.001). There was a statistically significant difference between the VEGF and IL-17 values based on the patient group they are in (p<0.05). Vascular endothelial growth factor values of Group I and III were significantly lower than the patients in Group II (p<0.001). IL-17 values of Group I and II were found to be significantly lower than Group III (p= 0.005). There was no statistically significant relationship between groups in terms of IgG4 values. In our study, it was observed that the profibrotic effects of VEGF, IL-17, and IgG4 were not dominant in patients who recovered with pulmonary sequelae after COVID; therefore, it is thought that different mechanisms mentioned or not yet revealed may cause this outcome.

Background: Allergic rhinitis and allergic asthma are respiratory tract diseases predominantly triggered by allergens such as pollens, house dust mite, mold etc. The prevalence of respiratory allergens varies according to geographic location. Ragweed (Ambrosia artemisiifolia), a prevalent weed particularly in South America and Europe, is being investigated for its sensitization frequency in the Black Sea region of our country. This study aims to evaluate ragweed and other allergens associated with respiratory allergic diseases in this region and determine their disease frequency. Materials and methods: A retrospective analysis was performed on patients diagnosed with allergic rhinitis, conjunctivitis, and asthma who attended the Immunology and Allergy outpatient clinic at Samsun Training and Research Hospital between 2017 and 2024. Data from 3,000 diagnosed patients were examined. Results: Of the 3,000 patients, 2,124 (70%) were female and 876 (30%) were male. All patients were diagnosed with allergic rhinitis, while conjunctivitis was observed in 2,300 patients (76%), and asthma was diagnosed in 1,382 patients (46.6%). The most frequently detected allergen was house dust mite (75%). Ragweed pollen was identified as the most common cause of seasonal allergic rhinitis (15%). Moreover, ragweed pollen was found to be the allergen associated with the highest risk of asthma development (p-value: 6.69 × 10−52). Conclusion: Ragweed pollen allergy is common in our region, and the allergenicity load is high. The sensitization rate may increase over time. If the prevalence is determined accurately, appropriate preventive measures and treatments can be developed.

Heavy metals even at low concentrations can damage all systems in the human body from the cellular level by causing disruptions in DNA repair mechanisms, cell division and apoptosis. A 49-year-old man who had been working in the sanding and deburring department of a factory producing underground water pipes for 15 years, presented with complaints of effort dyspnea, cough and loss of strength in his left hand. Computed tomography of the lung revealed diffuse micronodular appearance in all zones in both lungs, subpleural nodule and bronchial dilatation. All serological tests for autoimmune disease were negative. Neurological examination of the patient revealed signs of 2nd motor neuron involvement only in one upper extremity. All of the tests that were studied for the differential diagnosis of multifocal motor neuropathy were found negative. Open lung biopsy with videothoracoscopy was practiced and interstitial changes were observed in the lung parenchyma with intense iron accumulation with Prussian blue stain. The patient was diagnosed with hard metal lung disease (HMLD) and toxic neuropathy (TN) with peripheral nerve involvement due to exposure to metal dust in the working environment. Although the patient had no loss of lung function, he was removed from the working environment, because of function loss in the left hand and is still being followed up.

Introduction Endobronchial ultrasound-guided fine-needle aspiration biopsy (EBUS-FNAB) is a minimally invasive method used to obtain cytological or histological specimens of masses and lymphadenopathies (LAP) adjacent to the trachea and bronchi. Granulomas, which represent a chronic inflammatory response and occur for a variety of reasons, like a 'sarcoid-like reaction', cause LAPs. In this study, it was aimed to evaluate the long-term follow-up results of granulomatous lymphadenitis diagnosed with EBUS-FNAB and to investigate whether granulomatous lymphadenopathies were precursors of malignancies that occurred during the follow-up period. Material and methods The medical records of 123 patients who underwent EBUS-FNAB and were diagnosed with granulomatous lymphadenitis were retrospectively reviewed. Age, gender, acid-fast bacilli (ARB) staining, tuberculosis culture and tuberculosis polymerase chain reaction (PCR) culture results were examined by FNAB, and the procedure indications of all patients diagnosed with granulomatous lymphadenitis were recorded. The long-term health records of 52 patients could not be accessed. Data were collected from 71 patients. The progression, regression or stable conditions of LAPs in the long-term radiological follow-up of at least two years and the treatment conditions of diagnosis after biopsy were examined. Results One hundred twenty-three patients were included in the study. Rapid onset evaluation (ROSE) was performed in 93 (75.6%) patients. In 62 (66.6%) of the 93 patients, the smear results were consistent with granulomatous reaction at baseline. Malignancy was present in seven patients (5.6%) at the time of the procedure. In two patients (1.62%), tuberculous lymphadenitis was diagnosed by a positive tuberculosis culture. The long-term follow-up results were not obtained in 52 (42.7%) patients included in the study. At the long-term follow-up of six patients' LAPs with known malignancies, three of them regressed, one of them progressed, and two of them remained stable after chemoradiotherapy. Methylprednisolone treatment was started in eight patients with the diagnosis of sarcoidosis. While LAP remained stable in five patients, regression was observed in three patients. Idiopathic LAPs remained stable in 24 of 55 patients who received no treatment and regressed spontaneously in 31 of them. One of the patients was diagnosed with lymphoma, and the other patient was diagnosed with primary lung cancer in the long-term follow-up. Conclusion In cases where tuberculosis is suspected, not only cytomorphology but also microbiological confirmation is important. Granulomatous lymphadenitis can be detected both in the disease course of patients with a history of malignancy and as a precursor to undiagnosed malignancy. So the diagnosis of granulomatous lymphadenitis is a clinicopathological diagnosis that must be followed up in patients without symptoms or other findings.

Sedation is often required during flexible fiberoptic bronchoscopy (FFB) to ensure patient comfort and the success of the procedure. The choice of sedative agents may differ between anesthesiologists and pulmonologists. This pilot study aimed to investigate the current pre-procedure preparation, monitoring, premedication and sedation practices for FFB in Türkiye, focusing on the preferences and practices of pulmonologists. A structured survey consisting of 30 questions was distributed to pulmonologists at various hospitals in Türkiye via Google Forms. A total of 97 responses were received, of which 80 were analyzed. Participants were divided into two groups based on their FFB experience: Group 1 with ≥10 years of experience and Group 2 with <10 years of experience. The majority of pulmonologists ordered complete blood count, biochemistry, and coagulation tests before the procedure. The most preferred oral ingestion duration was 6-8 hours. Additionally, 98% of the physicians reported using at least one agent for premedication purposes. Routine topical local anesthetic use was high in both groups (88.3% and 85%, respectively). In addition, 40% of the physicians stated that they always applied sedation during FOB, and 48% stated that they applied sedation in certain situations, and that patient request was the most effective factor. Without the assistance of an anesthesiologist, pulmonologists preferred mono midazolam or a combination of midazolam and fentanyl for sedation. In Group I, two physicians reported using dexmedetomidine for combination sedation. It was also determined that propofol was not used in cases where an anesthesiologist was not available. Additionally, 47% of the physicians reported that they found current sedation practices completely adequate. Findings highlight the variability in sedation practices for FFB in Türkiye and underscore the need for standardized guidelines to optimize patient care and procedural outcomes. This study can be considered as a fundamental step towards more comprehensive studies by pulmonologists.