Objective Pulmonology consultations play a vital role in in-hospital diagnostic and therapeutic processes. These consultations are requested for various clinical reasons, including respiratory symptoms, radiological findings, and preoperative evaluations, which directly impact the quality of patient care. Material and Method This retrospective analysis evaluated 23,000 consultation records (11,500 unique patients). Diagnostic concordance was defined as the agreement between the preliminary diagnosis (requesting physician) and the final diagnosis (pulmonologist), calculated using Cohen’s kappa (κ). Consultation response times were extracted from the hospital's electronic health record (Enlil HBYS) timestamps. Results The emergency department was the predominant consultation source (32.4%). Preliminary diagnoses focused on dyspnea (12.5%), cough (10.0%), and chest pain (8.0%), while final diagnoses revealed COPD (Chronic Obstructive Pulmonary Disease) (13.8%), pulmonary embolism (11.0%), and pneumonia (9.4%) as the leading conditions. Diagnostic concordance was low (12.3%; Cohen’s κ = 0.15), with mean response times of 160 minutes (median: 145; IQR: 90–210). Among the 11,500 unique patients, 9,614 (83.6%) were preoperative consultations. The majority involved males (57.9%) aged 18–70 years (with 49.2% in the 51–70 group), demonstrating significantly reduced postoperative pulmonary complications versus non-consulted cases (8.7% vs. 14.2%, p =0.011). Conclusion While emergency departments drive most pulmonary consultations with frequent serious diagnoses (COPD/pulmonary embolism), low diagnostic concordance underscores the need for improved evaluation protocols. The demonstrated 38.7% relative risk reduction in postoperative complications (NNT = 18) strongly supports mandatory preoperative pulmonary assessments for high-risk surgical populations.

Objectives: In daily practice, we encounter with obstructive sleep apnoea syndrome (OSAS) patients who require different levels of positive airway pressure (PAP) despite having a similar apnoea-hypopnea index (AHI). We aimed to determine the parameters contributing to the determination of the therapeutic level of PAP. Methods: Data on 548 patients who underwent polysomnography and PAP titration were analysed retrospectively. Patients were divided into groups according to OSAS severity (mild, moderate, and severe) and the mean pressure in each group was determined, after which patients were further divided into those who required a PAP below the mean and those who required a PAP above the mean. Results: The mean optimal PAP level in the mild, moderate, and severe OSAS groups was 7.4 ± 2.3, 8.6 ± 2.4, and 9.8 ± 2.9 cm H2O, respectively. In the moderate and severe OSAS group, the subgroup that needed high pressure had a higher supine AHI, a longer apnoea time, and a longer SaO2 <90% time as compared with the subgroup that needed low pressure. Conclusion: A longer apnoea duration and a higher supine AHI are associated with a higher PAP level in patients with moderate and severe OSAS.

Pancreatic neuroendocrine tumors (PNETs) are rare malignancies characterized by insidious onset and mostly present with metastasis at the diagnosis. Lung metastasis manifesting diffuse ground-glass opacity is a very rare pattern that is difficult to distinguish from nonmalignant pulmonary diseases. Recognition of this atypical metastases pattern and avoidance of this potential pitfall are crucial. We report a unique case of the Metastatic Pancreatic Neuroendocrine Tumor Mimicking Interstitial Lung Disease diagnosed by transbronchial lung biopsie. Keywords: Neuroendocrine Tumor, Metastasis, Groundglass opacity, interstitial lung disease.

IntroductionChronic obstructive pulmonary disease (COPD) is a major global health problem due to its high prevalence, increasing incidence, and very serious personal, social and economic cost(1).It is associated with acut exacerbations which are required additional treatment, may occur during the clinical course of disease and increase the mortality (2).Mortality ranges from 11% to 48% in following acute exacerbation of the disease (3-8).COPD has a high level of morbidity and progresses with acute attacks that require frequent admission to the intensive care unit(ICU)(5).Patients with COPD hospitalized in the ICU usually have more than one comorbidity, presenting with acute respiratory failure (ARF) as a result of an infection-related acute attacks(4,6).Previous studies have focused on clinical parameters aiming to predict 30-day mortality following acute exacerbations of COPD (AECOPD) (8,9).These studies used parsiyel karbondioksit basıncı (PaCO2), oxygen saturation, Body Mass Index, age, and comorbidities as predictors of in-hospital mortality during AECOPD.However, very little evidence is available on the determinants of ICU mortality in AECOPD patients.In the present study, we aimed to identify risk factors for ICU mortality in AECOPD patients who required invasive mechanical ventilation (IMV).Predicting the risk factors for mortality is ABSTRACT Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) frequently necessitate intensive care unit (ICU) admissions.The purpose of this study is to determine risk factors for ICU mortality in AECOPD who required invasive mechanical ventilation (IMV).Patients requiring IMV for AECOPD between January 2013 and March 2019 were retros pectively reviewed.Patients' characteristics, comorbidities, and laboratory results were reviewed from the medical charts.Subjects' acute physiology and chronic health evaluation (APACHE) II score, Glasgow Coma Scale (GCS), IMV (days), and mortality were recorded.As an output or dependent variable, ICU mortality was considered.Other variables were considered to independent factors or risk factors.Then, Logistic regression analysis was performed to determine risk factors for ICU mortality in AECOPD.The study, 134 patients were included.The mean duration of IMV were 11.6 ± 12.2 days.The ICU mortality were 51.4 %.On admission to ICU, patients had APACHE-II scores of 23.0 ± 6.2.Nonsurvivors had lower blood Mg levels (1.8 ± 0.2 mmol/L, p = 0.002), lower blood Ca levels (8.0 ± 0.7 mg/dL, p = 0.005), higher Uric Acid, (8.5±3.8 mg/dl, p = 004), higher CRP levels (87.2 ± 71.8 mg/dl, p = 0.048), higher leukocyte count (14.7 ± 10.2 103L, p= 0.040), higher serum lactate (2.3 ± 1.7 mmol, p = 0.003) compared to survivors.APACHI score and uric acid level were found statististically significant risk factors for ICU mortality.

In this study, our aim was to examine the effect of obesity and depression on asthma control in a way that questions the usability of ABSI, which is new in abdominal obesity measurement.

To investigate the cases of pulmonary thromboembolism (PTE) and to analyze the risk factors in patients undergoing gynecologic oncology operations.Material and methods: The medical records of all patients who underwent gynecologic oncology surgery from January 2015 to September 2022 were collected from the hospital's database.Cases with the diagnosis of PTE were retrieved and analyzed retrospectively.Nine cases of clinically apparent PTE were identified in the medical records.The mean age of the patients was 56.1 3.4.The mean BMI was 27.21.4.The majority of the cases were advanced stage ovarian malignancy who underwent a major surgery including pelvic-paraaortic lymphadenectomy (5/9).Dyspnea and shortness of breath was the main complaint.Tachypnea was the main finding in all cases.The leukocytosis and the thrombocytosis were notable in PTE cases.PTE remains as one of the fatal complications after gynecologic surgeries.In our case-cohort, increasing age, obesity and the complexity of surgery are significant predictors of pulmonary embolism in gynecologic oncology operations.Further multicenter studies stratifying risk factors are warranted to reach a proper prophylactic strategy and prevent PTE.

BACKGROUND:COVID-19 has continued to aggressively spread and kill. The incidence of complications and associated mortality rates are high. Cardiac damage, which is related to survival, is one of these. The purpose of this study is to assess the role of BNP, a cardiac biomarker, in predicting mortality in COVID-19.MATERIALS AND METHODS:This single-center, prospective observational study was performed from July to September 2020 in a tertiary university hospital designated for the treatment of COVID-19 patients. Patients whose diagnoses were confirmed with real-time polymerase chain reaction (RT-PCR) tested nasopharyngeal swabs and with thoracic computed tomography (CT) findings compatible with COVID-19 pneumonia were included in the study. All clinical and laboratory data were obtained within the first 24 hours of hospital admission. To determine the risk of in-hospital death, patients were followed from admission until their discharge (1 to 15 days). The primary outcome was in-hospital death, defined as the case-fatality ratio.RESULTS:Among all biomarkers that were included in the multivariate analysis only high BNP levels was independently associated with mortality [Mean 1.012, 95% CI (1.005 - 1.02 pg/mL) (p = 0.002)]. Mortality was found to be significantly associated with older age and higher BNP, LDH, AST, HGB, PLT, ferritin, D-dimer, and CRP levels. In addition, mortality was found to be higher with longer duration of hospitalization (p = 0.041).CONCLUSIONS:Our fundamental goal for COVID-19 is to determine whether the hospitalized patients are in the mortality risk group at an early stage of disease. Adding measurement of BNP levels to routine laboratory tests for COVID-19 may be a practical approach to determine the patients with a high risk of mortality.

A 28-year-old female patient was admitted with ongoing chest pain for one day, having started treatment for ovulatory dysfunction with clomiphene citrate 20 days prior.The patient's pulse rate was 120 bpm and blood pressure was 100/60 mmHg.Sinus tachycardia was detected on electrocardiography.Both hypoxia and hypocapnia were detected on an arterial blood gas test.The patient's d-dimer level was measured as 5.2 µg/ml.A computed tomography angiography revealed filling defects in the right lower lobe pulmonary artery and lower lobe segment branches, consistent with pulmonary embolism.The ejection fraction was 65% on the transthoracic echocardiography and no thrombus was observed.The patient was diagnosed with pulmonary embolism due to clomiphene citrate use, and started on anticoagulation therapy with bemiparin sodium, and was subsequently discharged.Acute pulmonary embolism due to the use of clomiphene citrate is an uncommon but life-threatening complication when encountered.Physicians should be aware of the potential risk of pulmonary embolism.

Background/Aim: Lung cancer, where early diagnosis is particularly important, is one of the leading causes of death worldwide. Unfortunately, patients with lung cancer present at advanced stages. Biomarkers are needed to detect cancer at an earlier stage. In the present study, we aimed to emphasize that Plexin C1 level can be used in the early diagnosis of patients with lung cancer. Methods: This prospective case-control study included 50 patients with lung cancer who presented between May 2020-September 2020 (25 males and 25 females) in the patient group and 40 healthy individuals (23 males and 17 females) in the control group. All patients with lung cancer underwent routine preoperative tests. Additionally, the preoperative Plexin C1 levels of all patients were measured with the ELISA method and compared between the patient and control groups, and with respect to cancer staging. Results: The median Plexin C1 levels in the patient and control groups were 9.5 ng/mL and 4.0 ng/mL, respectively (P<0.001). The patients with Stage 4 tumors had significantly higher serum Plexin C1 levels than those with Stage 1, Stage 2, and Stage 3 tumors (P<0.001). Also, Plexin C1 levels were higher in patients with greater depth of invasion (P<0.001), more lymph node involvement (P<0.001), and distant metastasis (P<0.001). Conclusion: Plexin C1 can be used as a predictive biomarker at the time of diagnosis for lung cancer, and for cancer stage discrimination to show early, advanced, or metastatic disease.

The coronavirus disease 2019 (COVID-19) continues to spread all around the world. Mortality and morbidity rates are increasing-up to now. Although convalescent plasma therapy can be thought to be useful in the treatment of COVID-19, it carries potential risks, such as transfusion-related acute lung injury (TRALI). In COVID-19 infection, tachypnea, tachycardia, increased need for oxygenation, and the presence of bilateral widespread infiltrates on radiological imagings are evaluated as acute respiratory distress syndrome (ARDS). This clinical situation may develop independently from disease progression in patients receiving convalescent plasma therapy and it is called TRALI. We aimed to present our case to discuss the difficulty of this situation to differentiate from COVID-19 related ARDS.

Two of the drugs are frequently used in COVID-19 treatment algorithm because of their low cost, easy availabil ity and application;Hydroxychloroquine (HCQ) and Favipiravir. Our aim in this study is to compare the laboratory parameters of patients diagnosed with COVID-19 Pneumonia in whom HCQ and Favipiravir treatment was initiated, and to reveal the difference in the effectiveness of the treatments. 64 COVID-19 patients whose diagnoses were confirmed by real-time polymerase chain reaction test (RT-PCR) of nasopharyngeal swab samples and pneumonia image compatible with COVID-19 on Thorax CT were included in the study. Patients were divided into three groups: treated with HCQ, treated with favipiravir, and who were switched to favipiravir treatment when they did not benefit from HCQ. We compared the laboratory values on Day 1, Day 5 and at discharge. When compared in terms of laboratory values, there was no significant difference between the groups in which HCQ and Favipiravir was initiated. In the patient group who did not improve with HCQ and switched to favipiravi r treatment, lymphocyte levels increased and ferritin, CRP and d-dimer values decreased. The decrease in D-dimer and CRP values was statistically significant (p= 0.029, p= 0.048). PLT, Hemoglobin, RDW, MPV, NLR, PLR, INR values did not change significantly in any patient group. Our study with the most commonly used drugs in our country reveals that HCQ and Favipiravir are not superior to each other. When we changed the treatment with favipiravir in the group of patients receiving HCQ whose clinical an d / or laboratory values deteriorated, D-dimer and CRP values decreased during discharge. This finding shows how effective the timely treatment change is in the recovery of the patient by closely following the patient clinically and interpreting the laboratory values correctly. In COVID-19, we should direct the treatment of our patients by following the symptoms, risk factors and especially laboratory values.

ÖZ GİRİŞ ve AMAÇ: Cerrahi girişimler ve uygulanan anestezi sonrasında meydana gelen patofizyolojik değişiklikler akciğer komplikasyonlarının gelişimini kolaylaştırmaktadır

Introduction: The SARS-CoV-2 virus affects many organs, especially the lungs, with widespread inflammation. We aimed to compare the endogenous oxidative damage markers of coenzyme Q10, nicotinamide dinucleotide oxidase 4, malondialdehyde, and ischemia-modified albumin levels in patients with pneumonia caused by SARS-CoV-2 and in an healthy control group. We also aimed to compare these parameters between patients with severe and non-severe pulmonary involvement. Methods: The study included 58 adult patients with SARS-CoV-2 pneumonia and 30 healthy volunteers. CoQ10 and MDA levels were determined by high-pressure liquid chromatography. NOX4 and IMA levels were determined by ELISA assay and colorimetric method. Results: Higher levels of CoQ10, MDA, NOX4, and IMA and lower levels of COQ10H were observed inpatients with SARS-CoV-2 pneumonia than in the control group. MDA, IMA, NOX4, and CoQ10 levels were significantly higher in patients with severe pulmonary involvement than in patients with non-severe pulmonary involvement, but no significant difference was observed in CoQ10H levels. CoQ10 levels were significantly and positively correlated with both ferritin and CRP levels. Conclusion: SARS-CoV-2 pneumonia is significantly associated with increased endogenous oxidative damage. Oxidative damage seems to be associated with pulmonary involvement severity.

Giriş: Obstüktif Uyku Apne Sendromu’nda kardiyovasküler hastalıklar platelet aktivasyonu ve inflamasyonun rol aldığı bir süreç ile gelişir. Platelet aktivasyonu ve inflamasyonu ise Eritrosit Dağılım Genişliği(EDG), Trombosit Dağılım Aralığı(TDA) ve Ortalama Trombosit Hacmi(OTH) parametreleri gösterebilir. Bu çalışmada OUAS hastalarında, kolay ulaşılabilen, maliyeti düşük bir değerlendirme olan tam kan sayımı kullanılarak EDG, TDA, OTH değerleri ile eşlik eden kardiyovasküler hastalıklar arasındaki ilişkinin değerlendirilmesi amaçlandı. Materyal ve Metod: Polisomnografi ile OUAS tanısı alan hastalar AHİ(Apne Hipopne İndeksi) skorlarına göre sınıflandırıldı. Grup A: basit horlama(AHI30) OUAS olarak tanımlandı. Tam kan sayımı sonuçlarından EDG, TDA ve OTH değerlerine bakıldı. Bulgular: 140 hastanın dahil edildiği çalışmada hastalar 18-78 yaş arasındaydı. TDA, EDG, OTH, hemoglobin(Hb) ve Hematokrit(Htc) değerlerinde hastalık ağırlığı ile ilişkili bir değişiklik saptanmadı (p>,05). Sigara içiciliği, Diyabet(DM), Hipertansiyon(HT), Kardiyovasküler Hastalık(KVH) varlığı ile TDA, EDG ve OTH arasında istatistiksel olarak anlamlı bir ilişki yoktu. Ortalama ve en düşük Oksijen saturasyonu değerleri ağır OUAS grubunda en düşük düzeydeydi (p

Introduction: We aimed to investigate the efficacy of Hounsfield unit (HU) attenuation measured on computed tomography (CT) as a non-invasive method for pleural effusion characterization. Methods: Patients with pleural effusion who underwent thoracic CT imaging and thoracentesis within a maximum of three days were included in this retrospective study (15 transudate and 36 exudate). By drawing a circular region of interest (ROI) on the section with the thickest pleural effusion in terms of anteroposterior diameter in the upper-medial-lower zone on axial images, a total of three HU values, one from each level, were averaged. An independent t-test was applied to the CT attenuation (HU) values for the transudate-exudate differentiation. A receiver operating characteristic (ROC) analysis was then made. Results: The mean attenuation±standard deviation (minimum-maximum) value for the patients with transudate was 2.17±3.76 ((-7.5)-7.5) HU, whereas the mean HU value for the patients with exudate was 8.38±6.2 ((-6)-22). The independent t test made for the transudate-exudate differentiation revealed a statistically significant difference (P=0.001). In the ROC analysis carried out to determine the cut-off value of the attenuation value of pleural effusion in the transudate-exudate differentiation, the area under the curve was found to be 82.8%. When the cut-off value was taken as 2.75HU for the area under the curve, sensitivity was found to be 84%, and specificity was 60%. Conclusion: Although CT-HU values are statistically significant in the differential diagnosis of transudate-exudate, there is still a need to establish a correlation with other tomographic findings and clinical laboratory findings.

INTRODUCTION:As asthma has a wide range of inflammatory pathways, the researchers were focused on the markers that may be associated with exacerbation and stability in asthma.OBJECTIVE:Our aim is to investigate the serum levels of some inflammatory markers and cytokines in stable and exacerbated asthmatic patients.METHODS:The study included in 59 non-smoker asthma patient (Exacerbated=25, Stable=34) and 30 healthy volunteers. The serum level of periostin, YKL-40, IL-4, IL-5, IL-37, and TNF-α were detected by enzyme-linked immunosorbent assay.RESULTS:Except for IL-37, the periostin, YKL-40, IL-4, IL-5, and TNF-α level in asthmatic patients were significantly higher than those of healthy control. In the exacerbated group, the periostin, YKL-40, IL-5, and TNF-α level were significantly higher than stable asthma and healthy control groups. The serum levels of IL-4 in exacerbated and stable asthma groups were significantly higher than healthy control group. There was a significant difference between IL4 levels, in stable asthma and healthy control groups. In exacerbated asthma group, IL-37 level was significantly lower than stable and healthy control groups. The highest area under the ROC curve (AUC) was found for IL-4. While there was a significant negative correlation between these parameters and FEV1, there was a positive correlation between IL-37 and FEV1, but not significant.CONCLUSIONS:This study showed that increased serum periostin, YKL-40, IL-5, IL-4, and TNF-α and decreased serum IL-37 were associated with exacerbation showing uncontrolled asthma.

Background We investigated the association between cognitive dysfunction (CD) and chronic obstructive pulmonary disease (COPD) during exacerbation and compare with stable COPD patients and control subjects. Also, we compared the cognitive function of long-term oxygen therapy (LTOT) dependent patients and not receiving LTOT. Methods The 121 people included in the study. They were divided into three groups: exacerbation of COPD (COPD-E), stable COPD (COPD-S) and control groups. Also, COPD patients were divided into two groups, non-user LTOTD-COPD and regular-user LTOTD-COPD. The patients were asked in their native language by exact conversion of the questions of MMSE (Mini Mental State Examination). Results The mean age of patients was 67 and ratio of patients with MMSE results below 24 was 41.6%. MMSE score was 18.9 in patient with exacerbation and 25.7 in stable COPD. Age average was higher and MMSE was lower in COPD-E group. Low educational degree was predicting factor for CD in COPD-E group. Low MMSE was related with decreased FEV1%, pO(2)and sO(2)values, increased pCO(2)values, low educational level and increased comorbidity. MMSE score was 18.8 in reguler-user LTOTD COPD and 24.9 in nonuser LTOTD-COPD. Regular-user LTOTD-COPD groups exacerbation rate was higher than nonuser LTOTD-COPD group. Conclusion MMSE scores was low in COPD-E group and regular-user LTOTD-COPD group. This is important because MMSE identifies clinically significant CD. This suggests that the CD may be linked to the causes of severe exacerbations. Clinicians need to look for CD, because cognitive function needs to be taken into account in their management of the patient.

Multiple benign conditions may be the cause of miliary nodules, but the most common cause is metastatic disease.Even so miliary metastasis of lung cancer is rarely seen.The most common lung cancer with a miliary distribution is adenocarcinoma.It is often difficult to diagnose adenocarcinomas with a progressive course.Anamnesis, physical examination, imaging methods can give an idea but diagnosis should be confirmed histopathologically.As in our case, tissue biopsy should be performed for diagnosis.We aimed to present this case because we performed a tru cut biopsy which is rarely used for histopathologic diagnosis and the miliary nodules in the lung of adenocarcinoma is a rare condition.

Chronic obstructive pulmonary disease (COPD) is a common chronic inflammatory disease with a high mortality and morbidity rate.The aim of our study was to investigate the relationship of hematological parameters including the MPV, PDW and RDW with the severity of COPD.We retrospectively enrolled patients with the diagnosis of COPD who were admitted to our Pulmonary Diseases Department.A total of 201 patients with COPD, diagnosed according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, were included in the study.Patients were divided into 4 groups according to the severity of COPD: group A (mild), group B (mild to moderate), group C (moderate to severe), and group D (severe).159 healthy subjects without any risk factors or chronic diseases who were admitted to our outpatient clinics were included as control.There was statistically significant difference in PDW values between patients with COPD and controls (p =0.001).There was no statistically significant difference in MPV values and RDW rates between patients with COPD and controls (p = 0.591, p = 0.677 respectively).Patients in the severe COPD group were older, more often were male, had higher hematocrit values.There were no statistically significant differences in MPV, PDW, and RDW values in the severity of COPD (p=0.639,p=0.082, p=0.662 respectively).PDW could be used an indicator of hypoxemia, underlying inflammation, and oxidative stress.It could be considered as a new marker in the determination of inflammation in COPD patients wi th rapid, inexpensive, easily measurable properties with routine CBC analysis.Morover, measurement of changes in PDW value during follow -up can be used to assess the inflammatory response.