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

Expert Opinion on Practice Patterns in Mild Asthma After the GINA 2019 Updates: A Major Shift in Treatment Paradigms from a Long-Standing SABA-Only Approach to a Risk Reduction-Based Strategy with the Use of Symptom-Driven (As-Needed) Low-Dose ICS/LABA

Purpose of Review This expert opinion, prepared by a panel of chest disease specialists, aims to review the current knowledge on practice patterns in real-life management of mild asthma and to address the relevant updates in asthma treatment by The Global Initiative for Asthma (GINA) to guide clinicians for the best clinical practice in applying these new treatment paradigms. Recent Findings On the basis of the emerging body of evidence suggesting the non-safety of short-acting beta 2-agonists (SABA)-only therapy and comparable efficacy of the as-needed inhaled corticosteroids (ICS)-formoterol combinations with maintenance ICS regimens, GINA recently released their updated Global Strategy for Asthma Management and Prevention Guide (2019). The new GINA 2019 recommendations no longer support the SABA-only therapy in mild asthma but instead includes new off-label recommendations such as symptom-driven (as-needed) low-dose ICS-formoterol and low dose ICS taken whenever SABA is taken. The GINA 2019 asthma treatment recommendations include a major shift from long-standing approach of clinical practice regarding the use of symptom-driven SABA treatment alone in the management of mild asthma. This expert opinion supports the transition from a long-standing SABA-only approach to a risk reduction-based strategy, with the use of symptom-driven (as-needed) low-dose ICS/LABA in mild asthma patients, particularly in those with poor adherence to controller medications. The thoughtful and comprehensive approach of clinicians to these strategies is important, given that the exact far-reaching impact of this major change in management of mild asthma in the real-world settings will only be clarified over time.AstraZeneca TurkeyThis expert panel study was supported by AstraZeneca Turkey which played a role in organization of expert panel meeting in collaboration with The Turkish Respiratory Society and compensation for editorial support. Astra-Zeneca Turkey had no role in the study design, selection of experts, data collection and analysis, decision to publish, or preparation of the manuscript. The authors would like to thank Cagla Ayhan, MD, and Prof. Sule Oktay, MD, PhD. from the KAPPA Consultancy Training Research Ltd, Istanbul, who provided editorial support funded by Astra-Zeneca Turkey

ATOPIK DERMATIT TANI VE TEDAVISINEYAKLAŞIM: ULUSAL REHBER 2018veÜRTIKER TANI VE TEDAVISIGÜNCEL DURUM RAPORU

To maintain smooth and efficient gait the motor system must adjust for changes in the ground on a step-to-step basis. In the present study we investigated the role of sensory feedback as 19 able-bodied human subjects walked over a platform that mimicked an uneven supporting surface. Triceps surae muscle activation was assessed during stance as the platform was set to different inclinations (±3 deg, ±2 deg and 0 deg rotation in a parasagittal plane about the ankle). Normalized triceps surae muscle activity was significantly increased when the platform was inclined (2 deg: 0.153 ± 0.051; 3 deg: 0.156 ± 0.053) and significantly decreased when the platform was declined (−3 deg: 0.133 ± 0.048; −2 deg: 0.132 ± 0.049) compared with level walking (0.141 ± 0.048) for the able-bodied subjects. A similar experiment was performed with a subject who lacked proprioception and touch sensation from the neck down. In contrast with healthy subjects, no muscle activation changes were observed in the deafferented subject. Our results demonstrate that the ability to compensate for small irregularities in the ground surface relies on automatic within-step sensory feedback regulation rather than conscious predictive control