Ocupational Asthma And Rhinitis Among Health Care Workers In Tertiary Health Care Centers

Amaç: Mesleksel astım ve rinit tanısında ilk basamak semptomların doğası ve işyeri ile ilişkisi ve özel mesleksel maruziyetlerin sorgulandığı ayrıntılı öyküdür. Çalışmanın amacı sağlık çalışanlarında meslek astımı ve/veya meslek rinit ile ilişkili semptomların sıklığının araştırılmasıdır. Materyal ve Metot: Üçüncü basamak sağlık hizmeti veren merkezlerde bakteriyoloji, biyokimya/hematoloji ve patoloji laboratuvarları ile ağız ve diş sağlığı merkezi çalışanlarına açık uçlu anket yöntemi ile mesleki astım ve rinit ile ilişkili şikayetleri ve şikayetlerin işyeri ile ilişkisi sorgulandı. Bulgular: Değerlendirilen toplam 230 olgunun (165 kadın ve 65 erkek) ortalama yaşı 34,39 ± 0,51, ortalama çalışma süresi 10,13 ± 0,49 yıldı. İşyeri ile ilişkili semptom tanımlayan olgu sayısı 172 (%74,78) olarak bulundu; bu kişiler ortalama 4,92 ± 0,42 yıldır işyerinde semptomlarının olduğunu belirtti. Patoloji bölümünde çalışanların tümünde, ağız ve diş sağlığı çalışanlarının büyük çoğunluğunda (%92,19), bakteriyoloji (%72,92), biyokimya/hematoloji laboratuvarı (%50,63) çalışanlarının ise yarıdan çoğunda semptom vardı. Sorgulanan semptomlar içinde en sık nazal ve oküler yakınmalar iken diğer yakınmalar solunumsal, konstitüsyonel ve dermatolojikti. Semptomların belirli maddeyle ilişkisi olduğunu %54,65 olgu tarifleyebiliyordu. Olguların %88,37’si semptomlarının işe geldiği günlerde daha kötü olduğunu; %50,58’i hafta sonuna doğru şiddetlendiğini; %20,93’ü hafta sonu tatilinde ve %8,14’ü uzun süreli tatillerde devam ettiğini belirtti. Semptom varlığına rağmen ileri tetkik yapılmasını olguların sadece %55,81’i kabul edebileceğini bildirdi. Sonuç: Üçüncü basamak sağlık hizmeti veren merkezlerde çalışanların büyük bölümünde işyeri ortamı ile ilişkili birden fazla sistemi ilgilendiren semptomların varlığı görüldü. Buna karşın bireylerin bu konuyu yeterince önemsemedikleri ve ileri araştırma istemedikleri görüldü. Sağlık çalışanlarının da işyeri sağlığı konusunda bilgilendirilmeleri ve uygun işyeri şartlarının sağlanması gereklidir.Objectives: The first diagnostic tool for the diagnosis of occupational asthma and rhinitis is clinical history, which inquires about the nature of symptoms and their relationship to work and specific occupational exposures. The present study aims to search for the presence of symptoms related to occupational asthma and/or rhinitis among health care workers. Materials and Methods: With an open questionnaire health-care workers employed in bacteriology, biochemistry/hematology, pathology and dental laboratories in tertiary health-care centers were questioned about the presence of symptoms regarding occupational asthma and rhinitis as well as the relationship of their symptoms with the workplace. Results: Of 230 subjects (165 females, 65 males) mean age was 34.39 ± 0.51 and they were exposed at work for a mean duration of 10.13±0.49 years. Work-related symptoms were positive in 172 (%74.78) subjects for about 4.92±0.42 years. All subjects employed in the pathology department and most of the ones (92.19%) in dental hospital and more than half of employees of bacteriology (72.92%), biochemistry/hematology laboratories (50.63%) were symptomatic. The most commonly reported symptoms by participants were nasal and ocular whereas other symptoms were found to be respiratory, constitutional and dermatological. 54.65% of the subjects were able to identify a specific agent related to their symptoms. Of the patients 88.37% stated that their symptoms were worse on the days when they came to work; 50.58% that their symptoms were intensified progressively throughout the week; 20.93% and 8.14% stated that they continued to be symptomatic during the weekend and long term holidays, respectively. Although being aware of the symptoms only %55.81 of the subject were willing to be tested in the clinic. Conclusion: The majority of the health-care workers working in tertiary centers have work-related symptoms involving one or more systems. However, most of them ignore their symptoms and are not willing to be evaluated for occupational asthma and/or rhinitis. Health-care workers should be informed about occupational health and their workplace conditions should be improved

The role of component-resolved diagnosis in Hymenoptera venom allergy in clinical practice

Background: Hymenoptera venom allergy is an immunoglobulin (Ig) E mediated hypersensitivity reaction to Hymenoptera venoms. Obvious identification of the culprit insect that causes the clinical symptoms and, hence, the accurate selection of venom for curative treatment, is of great importance for the effectiveness and safety of venom immunotherapy. Objective: In this study, the contribution of component-resolved diagnostics (CRD) is evaluated in the diagnosis of Hymenoptera venom allergy. Method: Ninety-three patients from four different centers in Turkey were included in the study. Conventional tests, including prick and intradermal skin tests, with commercial venom extracts and serum specific IgE (sIgE) levels for whole venoms were performed. An sIgE analysis for venom allergen components, including rApi m 1, rApi m 2, rApi m 10, rVes v 1, rVes v 5, were evaluated by immunoblotting. Results: In conventional test results, 17 of 35 patients with bee venom allergy were positive to honey bee venom, whereas 18 patients were positive to bee and wasp venoms. In 28 of 35 patients with bee venom allergy, the diagnosis was confirmed with CRD. CRD revealed a sensitivity of 80% in patients with bee venom allergy. According to conventional tests, 7 of 24 patients with vespid venom allergy demonstrated sensitivity only to Vespula species, whereas 17 patients revealed double positivity. The total diagnostic sensitivity of Ves v 1 and Ves v 5 was calculated as 87.5%. Ten of 23 patients with a history of hypersensitivity to both venoms showed double sensitivity with CRD; one patient had cross-reactivity, one patient was found to be sensitive only to bee venom, and, eight patients were sensitive only to Vespula species. Eleven patients had an uncertain history in terms of the culprit insect type and six of them had double sensitivity in CRD. Conclusion: CRD seemed to be more helpful in diagnosing vespid venom allergy than bee venom allergy. It can also discriminate clinically significant sensitizations from irrelevant ones.Research Fund of Istanbul University [TSA2017-26335]This work was supported by the Research Fund of Istanbul University (Project TSA2017-26335

The role of component-resolved diagnosis in Hymenoptera venom allergy in clinical practice.

Background: Hymenoptera venom allergy is an immunoglobulin (Ig) E mediated hypersensitivity reaction to Hymenoptera venoms. Obvious identification of the culprit insect that causes the clinical symptoms and, hence, the accurate selection of venom for curative treatment, is of great importance for the effectiveness and safety of venom immunotherapy

Daily Practice of Mechanical Ventilation and Weaning in Turkish PICUs: A Multicenter Prospective Survey

Objectives