The Relationship Between Active and Passive Exposure to Cigarette Smoke and Severe Lumbar Intervertebral Disc Degeneration According to Demographic Data

Objective:To investigate the effect of current, former and passive smoking status on degeneration of lumbar intervertebral discs.Method:Three hundred and sixty patients between the ages of 20 and 70 years, who underwent lumbar spinal magnetic resonance imaging, were included in the study. The patients were grouped according to their smoking status as current, former, passive smokers and non-smokers. The cumulative smoking dose for current and former smokers was calculated in terms of pack-years and categorized further into two subgroups: smoked ≤9 pack-years or >9 pack-years. Patients who had been exposed to cigarette smoke for more than one year and more than one hour a day were included in the passive smoker group. The lumbar intervertebral discs were evaluated by the Pfirrmann disc degeneration grading system using sagittal T2-weighted magnetic resonance images. Grades IV and V were considered as “severe disc degeneration”.Results:There was a statistically significant difference between smoking status and gender, age, body mass index and lumbar lordosis angle (p9 pack-years current smoking was found to be significantly associated with L5-S1 disc degeneration (p<0.05).Conclusion:There is a significant relationship between passive smoking and severe disc degeneration at upper lumbar levels. Also it was thought that quitting smoking could reverse some of the negative effects associated with smoking contributing to disc degeneration

Long term effects of tear gases on respiratory system: Analysis of 93 cases

Aim. This study aimed to assess the long-term respiratory effects of tear gases among the subjects with history of frequent exposure. Materials and Methods. A questionnaire by NIOSH and pulmonary function tests was performed in 93 males exposed to the tear gases frequently and 55 nonexposed subjects. Results. The mean numbers of total exposure and last 2 years exposure were 8.4 ± 6.4 times, 5.6 ± 5.8 times, respectively. Tear gas exposed subjects were presented with a higher rate for cough and phlegm more than 3 months (24.7% versus 11.3%, &gt; 0.05). Mean FEV1/FVC and % predicted MMFR in smoker exposed subjects are significantly lower than those in smoker controls (81.7% versus 84.1%, = 0.046 and 89.9% versus 109.6%, = 0.0004, resp.). % predicted MMFR in nonsmoker exposed subjects is significantly lower than that in nonsmoker controls (99.4% versus 113.1%, = 0.05). Odds ratios for chest tightness, exercise dyspnea, dyspnea on level ground, winter morning cough, phlegm, and daily phlegm were increased almost 2 to 2.5 folds among tear gas exposed subjects. Conclusion. The rates for respiratory complaints were high in the case of the exposure to the tear gases previously. Tears gas exposed subjects were found to be under the risk for chronic bronchitis

Comparison of a 4-Day versus 2-Day Low Fiber Diet Regimen in Barium Tagging CT Colonography in Incomplete Colonoscopy Patients

Our aim was to compare the amount of residual feces, residual fluid, the tagging quality, and patient compliance using 4-day versus 2-day low fiber diet regimen in barium tagging CT colonography in incomplete colonoscopy patients. Methods. A total of 101 patients who underwent CT colonography were assigned to 2-day diet group (n=56) and 4-day diet group (n=45). Fecal tagging was achieved with barium sulphate while bisacodyl and sennoside B were used for bowel preparation. Residual solid stool was divided into two groups measuring <6 mm and ≥6 mm. We graded the residual fluid, tagging quality for solid stool, and fluid per bowel segment. We performed a questionnaire to assess patient compliance. Results. 604 bowel segments were evaluated. There was no significant difference between 2-day and 4-day diet groups with respect to residual solid stool, residual fluid, tagging quality for stool, and fluid observed in fecal tag CT colonography (P>0.05). The prevalence of moderate discomfort was significantly higher in 4-day group (P<0.001). Conclusion. Our study shows that 2-day limited bowel preparation regimen for fecal tag CT colonography is a safe and reasonable technique to evaluate the entire colon, particularly in incomplete conventional colonoscopy patients

Detection of Hepatitis B Virus Polymerase Gene Variants Associated with Lamivudine, Adefovir and Entecavir Resistance and Some Undefined Mutations Isolated from Chronic Hepatitis B Patients in the South of Turkey

IIn order to detect the mutation patterns related to Lamivudine (LAM), Adefovir (ADV) and Entecavir (ETV) resistance, we examined totally 230 stored HBsAg (+) and HBV DNA (+) sera samples of patients suffering chronic hepatitis B and treated with LAM, ADV and ETV in the south of Turkey. 100, 110 and 20 sera wereobtained from patients treated with LAM (for at least 2 years), ADV (for at least 2 years) and ETV (for at least1 year), respectively. A 422 bp segment of HBV polymerase gene which included B, C and D domains of viral polymerase gene was amplified by a nested PCR protocol and sequenced by a silver staining based cyclesequencingreaction. Mutation patterns related to LAM, ADV and ETV resistance were detected in 23 of 100 (23.00%), 3 of110 (2.75 %) and 0 of 20 (0.00%) sera in 3 groups, respectively. rtM204I and rtM204VrtL180M dual mutationswere detected in 13 of 100 (13.00%) and 10 of 100 (10.00%) sera, respectively in LAM treated group. rtN236Tmutation was detected in 3 of 110 (2.75%) sera in ADV treated group. rtM204I and rtM204VrtL180M mutations were also detected in 8 of 110 (7.27%) and 5 of 110 (4.54%) sera in ADV treated group. No mutation pattern was detected related to ETV resistance. However, rtM204I mutation was also detected in 3 of 20 (15.00%)in ETV treated group. Additionally, some undefined mutations such as rtI233V, rtN238R, P237H and rtK241Ewere detected in 3 of 110 (2.75%), 2 of 110 (1.80%), 1 of 110 (0.90%) and 1 of 110 (0.90%) sera, respectively inADV treated group. The study reveals that detection of mutations associated with viral polymerase inhibitors isimportant for better patient treatment. Antiviral therapy of hepatitis with viral polymerase inhibitors is still controversial.IIn order to detect the mutation patterns related to Lamivudine (LAM), Adefovir (ADV) and Entecavir (ETV) resistance, we examined totally 230 stored HBsAg (+) and HBV DNA (+) sera samples of patients suffering chronic hepatitis B and treated with LAM, ADV and ETV in the south of Turkey. 100, 110 and 20 sera wereobtained from patients treated with LAM (for at least 2 years), ADV (for at least 2 years) and ETV (for at least1 year), respectively. A 422 bp segment of HBV polymerase gene which included B, C and D domains of viral polymerase gene was amplified by a nested PCR protocol and sequenced by a silver staining based cyclesequencingreaction. Mutation patterns related to LAM, ADV and ETV resistance were detected in 23 of 100 (23.00%), 3 of110 (2.75 %) and 0 of 20 (0.00%) sera in 3 groups, respectively. rtM204I and rtM204VrtL180M dual mutationswere detected in 13 of 100 (13.00%) and 10 of 100 (10.00%) sera, respectively in LAM treated group. rtN236Tmutation was detected in 3 of 110 (2.75%) sera in ADV treated group. rtM204I and rtM204VrtL180M mutations were also detected in 8 of 110 (7.27%) and 5 of 110 (4.54%) sera in ADV treated group. No mutation pattern was detected related to ETV resistance. However, rtM204I mutation was also detected in 3 of 20 (15.00%)in ETV treated group. Additionally, some undefined mutations such as rtI233V, rtN238R, P237H and rtK241Ewere detected in 3 of 110 (2.75%), 2 of 110 (1.80%), 1 of 110 (0.90%) and 1 of 110 (0.90%) sera, respectively inADV treated group. The study reveals that detection of mutations associated with viral polymerase inhibitors isimportant for better patient treatment. Antiviral therapy of hepatitis with viral polymerase inhibitors is still controversial.</p

Long term effects of tear gases on respiratory system: Analysis of 93 cases

Aim. This study aimed to assess the long-term respiratory effects of tear gases among the subjects with history of frequent exposure. Materials and Methods. A questionnaire by NIOSH and pulmonary function tests was performed in 93 males exposed to the tear gases frequently and 55 nonexposed subjects. Results. The mean numbers of total exposure and last 2 years exposure were 8.4 ± 6.4 times, 5.6 ± 5.8 times, respectively. Tear gas exposed subjects were presented with a higher rate for cough and phlegm more than 3 months (24.7% versus 11.3%, P > 0.05). Mean FEV1/FVC and % predicted MMFR in smoker exposed subjects are significantly lower than those in smoker controls (81.7% versus 84.1%, P = 0.046 and 89.9% versus 109.6%, P = 0.0004, resp.). % predicted MMFR in nonsmoker exposed subjects is significantly lower than that in nonsmoker controls (99.4% versus 113.1%, P = 0.05). Odds ratios for chest tightness, exercise dyspnea, dyspnea on level ground, winter morning cough, phlegm, and daily phlegm were increased almost 2 to 2.5 folds among tear gas exposed subjects. Conclusion. The rates for respiratory complaints were high in the case of the exposure to the tear gases previously. Tears gas exposed subjects were found to be under the risk for chronic bronchitis. © 2014 Peri Arbak et al

Long Term Effects of Tear Gases on Respiratory System: Analysis of 93 Cases

Aim. This study aimed to assess the long-term respiratory effects of tear gases among the subjects with history of frequent exposure. Materials and Methods. A questionnaire by NIOSH and pulmonary function tests was performed in 93 males exposed to the tear gases frequently and 55 nonexposed subjects. Results. The mean numbers of total exposure and last 2 years exposure were 8.4±6.4 times, 5.6±5.8 times, respectively. Tear gas exposed subjects were presented with a higher rate for cough and phlegm more than 3 months (24.7% versus 11.3%, P>0.05). Mean FEV1/FVC and % predicted MMFR in smoker exposed subjects are significantly lower than those in smoker controls (81.7% versus 84.1%, P=0.046 and 89.9% versus 109.6%, P=0.0004, resp.). % predicted MMFR in nonsmoker exposed subjects is significantly lower than that in nonsmoker controls (99.4% versus 113.1%, P=0.05). Odds ratios for chest tightness, exercise dyspnea, dyspnea on level ground, winter morning cough, phlegm, and daily phlegm were increased almost 2 to 2.5 folds among tear gas exposed subjects. Conclusion. The rates for respiratory complaints were high in the case of the exposure to the tear gases previously. Tears gas exposed subjects were found to be under the risk for chronic bronchitis

Impact of Education and Process Surveillance on Device-Associated Health Care-Associated Infection Rates in a Turkish ICU: Findings of the International Nosocomial Infection Control Consortium (INICC)

Objective: The aim of this study was to analyze the impact of process and outcome surveillance on rates of device-associated health care-associated infections (DA-HAI) in an intensive care unit (ICU) in Turkey over a four-year period.Material and Methods: An open label, prospective cohort, active DA-HAI surveillance study was conducted on 685 patients admitted to the ICU of a university hospital in Turkey from January 2004 to December 2007, implementing the methodology developed by the International Nosocomial Infection Control Consortium. DA-HAI rates were recorded according to Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN) definitions. We analyzed the rates of DA-HAI, mechanical ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CAUTI), as well as microorganism profile, extra length of stay, and hand hygiene compliance. Pooled DA-HAI rates were calculated and compared by year.Results: The DA-HAI rate per 100 patients declined as follows: for 2004, the DA-HAI rate was 58.4%; for 2005, it was 38.9%; for 2006, it was 34.8%; and for 2007, it was 10.9%. The DA-HAI rate per 1,000 bed-days also declined: for 2004, it was 42.8, and for 2007 it was 10.7. The rates decreased from 25.8 to 13.4 for VAP; from 29.9 to 25.0 for CLA-BSI; and from 9.2 to 6.2 for CAUTI cases per 1,000 device-days during the study period. Conclusion: Process and outcome surveillance of DA-HAI significantly reduced DA-HAI

Evaluation of Pandemic Influenza A (H1N1) Cases

Introduction: The pandemic H1N1 virus has also affected our country between June 2009 and March 2010. This study aimed to evaluate the cases affected by the pandemic and hospitalized in one’s clinic. Materials and Methods: Demographic characteristics, risk factors, laboratory and radiological findings of the patients hospitalized with a provisional diagnosis of H1N1 influenza between October 2009 and March 2010 were retrospectively evaluated. Results: Seventy-five patients admitted to the study, 49 (65.3%) of them were female, and the mean age was 35.9 (18-80). Of the female patients, 13 (26%) were pregnant. The most obvious symptoms of referred patients were fever (98.6%), chills (89.3%), weakness (88%) and cough (85%). Bilateral involvement existed on direct chest X-ray examination during the first application of all patients who needed mechanical ventilation or died later. Forty three percent of the patients had at least one chronic disease. Five of the patients died. The presence of H1N1 was confirmed in 44 (58%) cases by polymerase change reaction (PCR). Exposure to a patient with influenza was positive in 45.5% of the cases (p= 0.019). Lymphopenia was the most common laboratory finding in all patients (64%). Monocyte values were significantly low in certain cases (p= 0.0016). Oseltamivir treatment was used in 72 (96%) patients. Antibiotics were added to treatment in 63 (84%) patients. The most common complication was pneumonia (82%). Conclusion: H1N1 pandemic showed a similar pattern of seasonal influenza but transmission from person to person had been more frequent. Mortality was more common in middle-aged population without underlying comorbid condition

A Case of Acute Fatty Liver of Pregnancy

We described a case of acute fatty liver developed early postpartum period. Acute fatty liver of pregnancy (AFLP) is a rare medical condition and is important due to its implications on maternal and fetal morbidity and mortality. AFLP is managed with supportive care and close surveillance is needed in these patients. We report the case of a previously healthy 29 year old woman within the postpartum first day who presented to the emergency department with postpartum severe vaginal bleeding. An evaluation revealed hepatic and renal failure. The patient required aggressive supportive care, transfusion of multiple blood products in intensive care unit. This case was unusual because AFLP was reported in postpartum period and the patient presented due to postpartum severe vaginal bleeding after vaginal delivery and was subsequently diagnosed as AFL