Manganism due to occupational welding fume exposure: a case report.

Occupational exposure to manganese (Mn) primarily occurs through the inhalation of manganese-containing fumes and dust, with welding environments being significant sources of such exposure. Elevated levels of Mn in welding fumes can lead to a neurological syndrome known as manganism. A 28-yr-old male welder with 14 yr of experience, is presenting with complaints of forgetfulness, reasoning disorder, and decreased mental functions persisting for 10 yr. Three months ago, when he started working at the new workplace, he underwent employment screening conducted by the workplace physician. During this screening process, the physician identified a high whole blood Mn level of 25.9 µg/l. The diagnosis of manganism in this patient was established based on exposure to Mn and its compounds, high levels of Mn detected in the whole blood, hyperactive patellar reflexes observed during the physical examination, cranial Magnetic Resonance Imaging (MRI) findings consistent with manganism and complaints reported by the patient that are characteristic of manganism. In this report, the aim is to emphasize the significance of taking a comprehensive occupational history and to draw attention the potential health hazards associated with Mn and its compounds.

Factors Affecting Development of Chronic Obstructive Pulmonary Disease in Pneumoconiosis Cases: A Cross-sectional Study Between 2017 and 2022 in Turkey.

OBJECTIVES: It was aimed to determine the factors affecting the development of chronic obstructive pulmonary disease (COPD) in pneumoconiosis cases. METHODS: Pneumoconiosis cases were divided into two groups as those with only pneumoconiosis and those with coexistence of pneumoconiosis and COPD. Demographic data, smoking habits, pulmonary function test, radiological findings, and occupational risk factors of the cases were compared. RESULTS: Chronic obstructive pulmonary disease was detected in 134 of 465 pneumoconiosis cases (28.8%) included in the study. It was determined that patients who developed COPD were statistically significantly older, had longer exposure duration, had lower forced expiratory volume in 1 second, forced vital capacity, and forced expiratory volume in 1 second/forced vital capacity values, and had more pulmonary symptoms. Chronic obstructive pulmonary disease development was more common in sandblasting workers, dental technicians, and miners than in other occupations. CONCLUSION: It has been shown that the risk of developing COPD is high in cases of pneumoconiosis, independent of smoking, especially in certain occupational groups.

Evaluation of cases with hypersensitivity pneumonia: 10 year analysis.

INTRODUCTION: The aim of this study was to examine the clinical features of hypersensitivity pneumonia (HP) cases, diagnostic methods, and related conditions in our hospital, which is a reference clinic in Turkey for chest disease. METHODS: The population of this retrospective cross-sectional study consists of all hypersensitivity pneumonia patients followed in a tertiary hospital between 2010 and 2019. The data of 78 patients were included in the analysis. Data were grouped by source of exposure (occupational, environmental, and cryptogenic) by examining the files of the patients. RESULTS: Occupational risk factors were detected in 29 (37.2%) of the cases, environmental risk factors were found in 24 (30.8%) cases, neither occupational nor environmental risk factors were detected in 25 (32%) cases, and they were evaluated as cryptogenic. The time from the onset of symptoms to diagnosis was 15.8 ± 26.6 months. The time from the onset of symptoms to diagnosis was found to be longer in the group with occupational risk factors compared with the other groups and was statistically significant (0.044). CONCLUSION: HP is a immune-mediated interstitial lung disease induced by repeated exposure to environmental and occupational antigens. Etiological agent can be detected in HP patients by detailed questioning of occupational and environmental exposure that may be associated with the onset of symptoms in cases with suspected HP.

Progressive Massive Fibrosis Risk Factors: A Retrospective Cross-Sectional Study.

OBJECTIVE: This study aimed to determine the occupational and clinical characteristics of patients with progressive massive fibrosis (PMF) and factors related to the development and severity of PMF. METHODS: Personal, occupational, radiological, and functional findings of 129 patients diagnosed with PMF were evaluated. RESULTS: Sandblasting workers were found to be diagnosed with pneumoconiosis at an earlier age than those in other professions. The dust exposure durations of sandblasting and ceramic workers were significantly less than those of workers in other occupations. Statistically, a significant negative correlation was found between lung functions and small opacity size, small opacity profusion score, and large opacity size. No relationship was found between large opacity size and smoking status, concomitant tuberculosis, and duration of dust exposure. CONCLUSIONS: An effective surveillance system that considers factors that accelerate pneumoconiosis progression should be established.

Prevalence and Risk Factors of Work-Related Asthma in Hospital Cleaning Workers.

OBJECTIVE: This study aimed to determine the prevalence and evaluate the risk factors of work-related asthma among professional hospital cleaning workers. MATERIAL AND METHODS: In total, 278 cleaning workers were interviewed (response rate: 75.7%), and pulmonary function tests were performed. The presence of asthma and its work-relatedness was evaluated. Serial peak expiratory flow measurements were planned according to symptoms increased at work or spirometric findings. RESULTS: Totally 40 cleaning workers had asthma (14.3%); of these, 17 (6.1%) had work-related asthma, and 23 (8.2%) had non-work- related asthma. Non-work-related asthma and work-related asthma were significantly associated with the females(odds ratio 95% CI: 3.0, 1.1-8.4, and 3.2, 1.0-10.3, respectively). Non-work-related asthma was significantly associated with a family history of asthma (odds ratio 95%CI: 5.1, 2.0-13.2 and 2.8, 0.99-7.9, respectively) and limescale remover use at work (odds ratio, 95% CI: 0.21, 0.04-0.97, and 1.7, 0.5-5.2, respectively). Only 7 (28.0%) of 25 cleaning workers who were suggested serial peak expiratory flow measurements could complete the measurements. Of those, measurements of 2 cleaning workers were consistent with occupational asthma. CONCLUSION: The negative association between limescale remover use at work and non-work-related asthma suggested health selec- tion bias (avoidance behavior) due to the asthmatic effects of these chemicals.

Computed Tomography Findings in Progressive Massive Fibrosis: Analyses of 90 Cases.

PURPOSE: Radiological identification of lung masses in patients with pneumoconiosis is difficult. The aim of the study is to characterize Computed Tomography (CT) findings of Progressive Massive Fibrosis (PMF). METHODS: The data of pneumoconiosis patients, who were diagnosed with PMF between 2014-2019 in a tertiary hospital, were collected. Demographic data, work-related data, Pulmonary Function Test results and radiological imaging results were gathered. Separate evaluations were made for the right and left lungs, and the CT findings and measurement results were recorded. RESULTS: In 90% of our cases, PMF lesions were bilaterally located. Eighty-eight point five percent of the unilateral lesions were located in the upper lobe of the right lung. Enlarged lymph nodes were found in 83.3% and calcification was found in the lymph nodes in 63% of the cases. Band structures extending between the PMF lesion and the adjacent pleura were observed in 86% of the cases, and invagination in the lung parenchyma adjacent to the PMF was observed in 80% of the cases. CONCLUSION: In general, our findings were consistent with the radiologically defined PMF. In addition, pleural findings, which are not frequently studied in the literature except for asbestosis, were also described in the study. METHODS: The data of pneumoconiosis patients, who were diagnosed with PMF between 2014-2019 in a tertiary hospital, were collected. Demographic data, work-related data, PFT results and radiological imaging results were noted. Separate evaluations were made for the right and left lungs, and the CT findings and measurement results were recorded. RESULTS: In 90% of our cases, PMF lesions were bilaterally located. 88.8% of the unilateral lesions were located in the upper lobe of the right lung. Enlarged lymph nodes were found in 83.3% and calcification was found in the lymph nodes in 63% of the cases. Band structures extending between the PMF lesion and the adjacent pleura were observed in 86% of the cases, and invagination in the lung parenchyma adjacent to the PMF was observed in 80% of the cases. CONCLUSION: In general, our findings were consistent with the radiologically defined PMF. In addition, pleural findings, which are not frequently studied in the literature except asbestosis, were also described in the study.

Case Report: Unremitting COVID-19 Pneumonia, Viral Shedding, and Failure to Develop Anti-SARS-CoV-2 Antibodies for More Than 6 Months in Patient with Mantle Cell Lymphoma Treated with Rituximab.

Severe cases of COVID-19 are being reported in patients with comorbidities and drug-induced immunosuppression. The risk seems to depend on the type of immunosuppressive agents used, and it is particularly high with rituximab because of its long-lasting effects. We report a 71-year-old man with COVID-19, mantle cell lymphoma, and rituximab-associated immunodeficiency. His COVID-19 clinical course was severe, unremitting, prolonged, and with frequent acute exacerbations requiring hospitalization. Viral shedding and failure to develop anti-severe acute respiratory syndrome coronavirus 2 antibodies continued for at least 6 months.

Environmental asbestos exposure and nonmalignant pleural findings: a retrospective evaluation of a five-year chest CT repository.

This registry-based case-control study aimed to assess the association between asbestos deposits in the birthplace and/or residence and nonmalignant pleural findings, namely pleural plaques (PPs) and pleural thickening (PT), on chest CT scans. In total, 39,472 CT scans obtained over five years in a tertiary referral hospital in Ankara, Turkey, were evaluated. Cases involving patients with PP (n = 537), PT (n = 263), PP&PT (n = 69), and controls (n = 543) from the same study base without those conditions were included. Each case group was compared to controls using unconditional logistic regression. The presence of asbestos deposits in the district of birthplace (adjusted OR = 2.13, 95% CI: 1.35-3.37) and both birthplace and residence (aOR = 4.32, 95% CI: 2.26-8.27) was significantly related to the PPs. As the importance of environmental asbestos exposure in Turkey continues, future prospective studies could contribute to developing screening strategies.

The potential value of volume-based quantitative PET parameters and increased bone marrow uptake for the prediction of survival in patients with malignant pleural mesothelioma.

PURPOSE: The aim of this study was to investigate the relationship between volume-based quantitative PET parameters and survival in patients with malignant pleural mesothelioma (MPM) and to evaluate the potential value of bone marrow (BM) uptake in predicting prognosis. MATERIALS AND METHODS: We retrospectively reviewed the data of 51 patients with MPM who underwent initial staging by fluorine-18-fluorodeoxyglucose (F-FDG) PET/computerized tomography (PET/CT). F-FDG-PET images were visually and quantitatively re-evaluated and maximum standardized uptake values (SUVmax), mean standardized uptake values (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis of primary tumors, and pleural thickening were calculated. In addition, BM and liver uptakes were measured; also, the degree of BM uptake was scored visually. BM/liver ratio and visual BM uptake score were noted. The correlations between quantitative PET parameters, BM uptake, and overall survival were analyzed. RESULTS: F-FDG-PET scans upstaged 6 (11.8%) of 51 patients because of detection of previously unknown distant metastasis. On univariate analysis, advanced disease stage, high leukocyte count (≥10×10/ml), pleural thickening greater than 13 mm, SUVmax, SUVmean, MTV, total lesion glycolysis, BM/liver greater than 1.01, and visual score 1 and 2 were negative prognostic factors (P<0.05). In multivariate analysis, SUVmax greater than 8.6 [P=0.027, hazard ratio (HR): 2.961], MTV greater than 112 (P=0.001, HR: 4.861), and visual score 2 (P=0.035, HR: 3.827) were associated independently with a poor prognosis. CONCLUSION: The presence of distant metastasis is more predictive of survival than PET nodal status in MPM patients. PET/CT has the potential to provide prognostic information in MPM patients and there was a good correlation between overall survival and volume-based PET parameters. Determination of BM uptake may contribute toward the prediction of patient outcome with other quantitative PET parameters.

Prognostic factors in malignant pleural mesothelioma: a retrospective study of 60 Turkish patients.

AIM: Malignant pleural mesothelioma (MPM) is an aggressive tumor with poor prognosis. The study aims to examine the effect of certain clinical, laboratory, radiologic, and pathologic characteristics on survival. PATIENTS AND METHODS: Sixty patients who had undergone PET/CT evaluation at initial diagnosis were included. We investigated the effect of certain clinical, laboratory, radiologic characteristics, SUVmax of the tumor, and pathological characteristics such as histological subtype, mitotic activity index (MAI), tumor necrosis, and inflammation on survival. The pathological slides of each patient were re-evaluated for MAI, presence of necrosis, and inflammation. The patients were grouped based on number of mitosis as MAI 1:≤ 9, MAI 2:10-19, MAI 3: >19 mitosis. RESULTS: There were 34 male and 26 female patients with a mean age of 53.6 ± 10.6 years. Mean and median survival time was 14.83 ± 10.75 and 11.95 (min 0.43-max 48.10) months, respectively. Using univariate analysis leukocytosis (P = 0.009), rind-like pleural thickening (P = 0.037), advanced disease stage (P = 0.004), best supportive therapy alone (P = 0.004), SUVmax higher than 8 (P = 0.023), MAI higher than 1 (P = 0.033), and presence of tumor necrosis (P = 0.037) were found as poor prognostic factors. At multivariate analysis, leukocytosis (P = 0.026, HR: 2.27), advanced disease stage (P = 0.021, HR: 2.46), best supportive therapy alone (P = 0.029, HR: 5.12), and MAI higher than 1 (P = 0.01, HR: 3.01) were independently associated with survival, whereas SUVmax of the tumor failed to enter the model (P = 0.07, HR: 1.89). CONCLUSION: Presence of leukocytosis, advanced disease stages, supportive therapy alone, and higher MAI were found to be negative prognostic factors in patients with MPM.

The cell block method increases the diagnostic yield in exudative pleural effusions accompanying lung cancer.

OBJECTIVE: Thoracentesis is the first investigation to be performed in a patient with lung cancer and pleural effusion. The diagnostic yield of conventional smear studies varies in the first thoracentesis. In this study, we aimed to investigate if the cell block method increases the diagnostic yield in exudative pleural effusions accompanying lung cancer. MATERIAL AND METHOD: Forty patients with lung cancer and exudative pleural effusions were included. Ten mililiters of fresh pleural fluid was obtained by thoracentesis from all patients in the initial evaluation. The pleural fluid sample was divided into two equal parts. One part was subjected to conventional smear and the other to the cell block method. Conventional smears were stained with May-Grünwald-Giemsa and Hematoxylin-Eosin. Cell block sections were stained with Hematoxylin-Eosin and mucicarmine. Conventional smear findings were grouped as "benign cytology" or "malignant cytology". Th e cell block sections were evaluated for the presence of single tumor cells, acinary or papillary pattern, solid islands and staining with mucicarmine. RESULTS: There were 20 patients each in the benign and malignant conventional smear group. In the benign group, adding the cell block method to conventional smear provided a diagnosis of malignancy in 4 more patients and the diagnosis of malignant effusion was increased by a ratio of 10% (4/40). In the malignant group, adding the cell block technique provided the subtyping of lung cancer as adenocarcinoma in 7 patients (7/20, 35%). CONCLUSION: Our study confirms that the cell block method combined with conventional smear increases the diagnostic yield in exudative pleural effusions accompanying lung cancer.

Fibrosing mediastinitis mimicking bronchogenic carcinoma.

Fibrosing mediastinitis is a rare but benign disorder characterized by an excessive fibrotic reaction in the mediastinum which can result in compromise of airways, great vessels, and other mediastinal structures. In this paper we presented a patient with fibrosing mediastinitis mimicking bronchogenic carcinoma. The patient was a 32-year-old diabetic male admitting with cough and hemoptysis. There was a right hilar mass and multiple mediastinal conglomerated lymph nodes on chest computed tomography. Positron emission tomography with computed tomography (PET/CT) scan demonstrated increased fluorodeoxyglucose (FDG) uptake at the right hilar mass lesion and mediastinal lymph nodes. Fiberoptic bronchoscopy showed mucosal distortion of right upper lobe. Pathologic examination of the mucosal biopsy revealed inflammation. Endobronchial ultrasound guided transbronchial needle and cervical mediastinoscopic lymph node biopsies were undiagnostic. Diagnostic thoracotomy confirmed the diagnosis fibrosing mediastinitis. Administration of six months of systemic corticosteroid and antituberculous therapy was not beneficial. In conclusion, despite being a rare clinical entity, fibrosing mediastinitis should be kept in mind in the differential diagnosis of mediastinal mass lesions of unknown etiology. The diagnosis is exceptionally difficult in the presence of atypical radiological findings. The treatment is particularly challenging without any proven effective therapy.

[Prevention and law. The legal regulation of prevention in health care]. / Prävention und Recht : Zur rechtlichen Regulierung der Prävention im Gesundheitswesen.

BACKGROUND AND PURPOSE: Law has to make order. The more complex a subject matter is, the more intensive it is usually legally regulated. As such, in Germany health care is an intensively regulated area with an own social code. For prevention, no such code exists, even though it is often praised as the fourth pillar of health care. Two attempts to enact a Prevention Act have failed. Therefore, this study analyzes how prevention is currently regulated in Germany. METHODS: The study evaluates the existing laws that govern prevention and health promotion. For this purpose, the respective legal provisions are analyzed and, then, an overall view of the legal rules and their interplay is performed. RESULTS: The legal regulation of prevention is based on a number of different laws. Mainly, two groups of legal provisions can be differentiated. The first group ist attributable to the field of danger defense. The second group regulates the specific prevention in heath care and health promotion and is part of social law. Most social codes encompass detailed provisions on prevention governing and regulate nearly all stages of prevention. Prominent roles are played by the health and accident insurance laws and rehabilitation laws. CONCLUSION: Even in the absence of a specific Prevention Act, prevention is not practiced without a legal fundament. However, this legal regulation of prevention is structured heterogeneously and built by several laws that either stand parallel side by side or are interwoven. Further, this legal frame involves all social insurance carriers and several authorities. Prevention is a joint effort. Nevertheless, a stronger concentration of the regulation of prevention would be beneficial to strengthen prevention. This is even more so as from a health economic perspective the current coexistence and interaction of numerous laws and authorities is often inadequately expensive. Therefore, the cost-benefit ratio of the legal regulation of prevention seems improvable.

Right amygdalar and temporofrontal activation during autobiographic, but not during fictitious memory retrieval.

What distinguishes the recall of real-life experiences from that of self-created, fictitious emotionally laden information? Both kinds of information belong to the episodic memory system. Autobiographic memories constitute that part of the episodic memory system that is composed of significant life episodes, primarily of the distant past. Functional imaging was used to study the neural networks engaged in retrieving autobiographic and fictitious information of closely similar content. The principally activated brain regions overlapped considerably and constituted temporal and inferior prefrontal regions plus the cerebellum. Selective activations of the right amygdala and the right ventral prefrontal cortex (at the level of the uncinate fascicle interconnnecting prefrontal and temporopolar areas) were found when subtracting fictitious from autobiographic retrieval. Furthermore, distinct foci in the left temporal lobe were engaged. These data demonstrate that autobiographic memory retrieval uses (at least in non-brain damaged individuals) a network of right hemispheric ventral prefrontal and temporopolar regions and left hemispheric lateral temporal regions. It is concluded that it is the experiential character, its special emotional infiltration and its arousal which distinguishes memory of real-life from that of fictitious episodes. Consequently, our results point to the engagement of a bi-hemispheric network in which the right temporo-prefrontal hemisphere is likely to be responsible for the affective/arousal side of information retrieval and the left-hemispheric temporal gyrus for its engram-like representation. Portions of the neural activation found during retrieval might, however, reflect re-encoding processes as well.