Is household contact screening enough in tuberculosis patients? A Village screening results

Objectives: Transmission of tuberculosis (TB) disease occurs with droplet infection and contact time and intensity are important factors in contagion. In this report, the results of a village TB screening were presented, due to a non-compliant patient that abandoned regular TB treatment. Materials and methods: In ‘Diyarbakir No.1 Tuberculosis Dispensary, TB treatment was started in a 18 year-old male patient with the diagnosis of ‘new sputum smear positive lung tuberculosis’. However, this patient lost to follow-up of therapy in the second month. After three months, the patient was found again and then anti-TB drugs were began for the diagnosis of ‘treatment after interruption smear positive lung tuberculosis’. Therefore directly observed TB treatment was given to this patient and therapy resulted in complete cure.Results: Patient was an inhabitant of a village bound to Diyarbakir city and 810 people lived there, thus a microfilm screening was performed in this village. Microfilms of 485 persons were taken and tuberculin skin test (TST) was performed to 225 people in this investigation. Sputum smear was obtained from 15 people. Four additional people diagnosed as pulmonary TB so these people received antituberculosis therapy. Eighteen people took prophylactic isoniazid therapy due to positive TST reactivity. Four patients with TB were close relatives of the index patient. In this village, tuberculosis prevalence was 617 per thousand in 2006. Conclusion: In low-socioeconomic people, TB patient should be looked for not only with passive methods, but also with active methods. Furthermore, TB scanning should be carried not only in index patient’s household contacts, but also in persons having close relationships with him because of social life

The discrepancies between assessments of physicians in microfilm examination for tuberculosis screening

Objectives: Microfilm (MF) are used in community based screening for tuberculosis (TB) in Turkey. This study aimed differences in evaluation between various physicians.Materials and Methods: In the Mardin Prison, 253 microfilms(MFs) were obtained during periodic TB screening in January 2006. A chest disease specialist doctor, a radiologyspecialist doctor and a general practitioner doctor assessed the MFs separately. The results were classified as i) Normal, ii) Active TB disease findings, iii) and Sequel TB disease findings.Results: A total of 13 MFs were not taken into considerationbecause of technically unsatisfactory radiographs. The end results were as follows; three physicians had agreed about diagnosis in 159 MFs (66.2%). In 81 MFs (33.8%) at least one physician had a different opinion about microfilm. The general practitioner reported 19 MFs (8%) as active TB disease findings and the radiology specialistdoctor reported 22 MFs (9%) as active TB disease. However, the chest diseases specialist doctor reported 26 MFs (11%) as having active TB disease findings. No significant difference was found in active TB diagnosis between three physicians (p>0.05). The frequency of sequelTB diagnosis was higher in Chest disease specialist compared with other physicians (p<0.05).Conclusion: Although MF is a fast screening method, considerable disagreement was found in evaluating abnormalfindings among reporting physicians. As TB is a disease with various radiologic appearances, usage of microbiological diagnostic modalities should be added to subjective radiographic methods

Value of a new inflammatory parameter in malignant pleural mesothelioma prognosis

Malignant Pleural Mesothelioma (MPM) generallyassociated with asbestos exposure is a tumor withpoor prognosis. Modified Glasgow Prognostic Score(GPS) which may be a prognostic parameter in patientswith MPM is a designed based score including increasedC-reactive protein (CRP) levels and decreased albumin.In this study we aimed to investigate the effect of GPSscore on the prognosis of MPM and the role of other potentialfactors.Methods: In this retrospective planned study 140 histologicaldiagnosed MPM patients were included.Results: Mean age of 140 MPM patients were 52.92years (83 male and 57 female). A total of 91 patients hadenvironmental asbestos exposure and exposure timewas the 31 years. Symptoms of the patients started approximately4.8 months before the application. The mostfrequently seen symptoms were in 125 patients dyspnea,in 94 patients chest pain and in 22 patients weight loss.GPS score of the patients were as follows; 64 patientstwo, 14 patients one, 22 patients zero. Of the patients,112 died and 28 were alive. Mean survival time was 14months. Patients with GPS score 2 lived for 10 months,GPS score 1 lived for 15 and GPS score 0 lived for 18months. This difference was statistically significant. Furthermore,the male sex and age older than 65 years werefound as poor prognostic parameters on the survival.Conclusion: A simple and inexpensive parameter able tobe used to estimate the prognosis of MPM patients couldnot be developed .GPS score increases in inflammatoryconditions. GPS is a simple and inexpensive parameterthat can be used for detecting the severity of patients withMPM.Key words: Modified Glasgow Prognostic Score, MalignantPleural Mesothelioma, Prognosi

The importance of mean platelet volume in early mortality of pulmonary embolism

Objective: In this study whether mean platelet volume(MPV) is associated with early period hospital mortalityor not in patients with pulmonary embolism (PE) was investigated.Methods: Data of patients that hospitalized in chest diseasesclinic with the diagnosis of PE between the years2009-2012 were screened retrospectively from digital archivesystem. The demographic data, symptoms, treatmentoutcomes and MPV values in complete blood countof patients were recorded.Results: The mean age was 57.93 ± 18.52 years (16-91).The number of patients is 143 and 91 women (63.9%),52 men (36.4%), respectively. MPV values were availablefor 137 of 143 patients. 129 of patients were discharged,and 8 had died in the early period of hospitalization. Themean MPV value was 7.85 ± 1.40 fL in patients who experiencedand 9.08 ± 1.61 fL in died respectively. The differencewas statistically significant (p = 0.01).Conclusion: The results of this study suggests that increasedMPV value may be used as a marker for earlyhospital mortality in patients with PE. J Clin Exp Invest2013; 4 (3): 298-301Key words: Mean platelet volume, mortality, pulmonary embolis

Assessment of the sleep parameters in patients with obstructive sleep apnea syndrome with a

Objective: In this study, traffic accident with a history ofobstructive sleep apnea syndrome (OSAS) in patientswith polysomnographic parameters was investigated.Methods: A total of 77 OSAS patients were included inthe study. All-night polysomnographic recordings obtainedfrom patients with enuresis parameters and thepresence of traffic accidents recorded in standard form.Results: The mean age of patients was 45.15 ± 11.53years. 53% of the patients were male and 47% female.The mean apnea hypopnea index (AHI) in patients was13.54 events/h. History of traffic accidents was found in12% patients. Apnea hypopnea index, supine AHI, arousalindex and oxygen desaturation index were found significantlydifferent parameters between history of trafficaccidents group and non-history of traffic accidents group(p <0.05).Conclusion: In this study, patients with OSAS severity ofthe disease with a history of traffic accidents were associatedthe relationship between the parameters. This relationshipwith the severity of the disease might be due tothe negative effects on attention. J Clin Exp Invest 2013;4 (2): 204-207Key words: OSAS, traffic accident, AH

The role of the Syndrome X in the pathophysiology of sleep-apnea syndrome

Objective: Syndrome X or microvascular angina pectoris is defined as angina pectoris due to coronary microvascular dysfunction in patients with non-stenotik epicardial arteries. The aim of his study was to investigate the relationship between obstructive sleep apnea syndrome (OSAS) and syndrome X.Materials and methods: Twenty patients (11 male, 9 female) with the complaint of chest pain who referred to Cardiology Clinics of Dicle University were enrolled in the study as Group 1. All of the patients’ exercise tests were positive, epicardial coronary arteries were normal and coronary flows were slow in Group 1. Thirty healthy person were enrolled in the study as group 2. Polysomnography (PSG) and echocardiography (ECHO) was performed in all patients.Results: In Group 1, 11 (55%) patients had obstructive sleep apnea. In Group 2, three patients (10%) had OSAS. There were significant differences in terms of OSAS frequency among groups. There were no significant differences in terms of left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD), stroke volume, deceleration time (DT) , ejection time (ET) and the left atrium (LA) diameter between Syndrome X and control groups according to echocardiographic examination (p>0.05). However, IVRT, RA diameter, the myocardial performance index (MPI), PAP, and MEV / mav rates were significantly different (p <0.05).Conclusion: OSAS -also known to cause cardiovascular complications- incidence was significantly higher in patients with syndrome X than the healthy subjects. In OSAS patients, apnea hypopnea index, cardiovascular risk factors such as hypertension and dyslipidemia were more common than healthy subjects. Therefore, these patients should be followed up closely and be treated properly

Clinical characteristics and treatment outcomes in 132 patients with malignant mesothelioma

Purpose: Our objective is to scrutinize clinical, laboratory, radiological characteristics, treatment regimens, and treatment outcomes of malignant mesothelioma (MM) cases in our hospital. Materials and Methods: We investigated, retrospectively, the clinical characteristics and treatment outcomes of all 132 MM patients at Dicle University Hospital between January 2006 and April 2010. Results: A total of 82 (62.1%) patients were male, and 50 (37.9%) female. Median age was 56.0 years. Mean survival time was 9.6±6.9 months. Mean survival time of patients who had received best supportive care was 7.5 months, chemotherapy 10.4 months, and multimodality treatment regimen 12.6 months. Patients in the multimodality treatment group survived longer than did those in the other two groups (P=0.042). A total of 76 patients received chemotherapy, of whom 17 (22.3%) were administered Cisplatin/Carboplatin and Gemcitabine, 58 (76.4%) Cisplatin/Carboplatin and Pemetrexed, and one (1.3%) Cisplatin + Docetaxel. Complete and partial response to treatment in patients receiving Cisplatin/Carboplatin and Gemcitabine was found 47.1% and Cisplatin/Carboplatin and Pemetrexed was found 50.0% (P>0.05). Conclusions: MM related to asbestos exposure is seen frequently in Turkey. Patients present with the typical clinical features of dyspnea, weight loss, and chest pain. Survival analysis shows that patients receiving multimodality treatment may be better

Clinical and demographic characteristics of tracheobronchial variations

Background: There are various anatomic variations in tracheobronchial system (tracheal bronchus, ectopic bronchus, and accessory bronchus). We aimed to investigate the bronchoscopic findings of the patients with tracheobronchial variations (TBVs) during bronchoscopy and to describe their clinical characteristics. Materials and Methods: A total of 3322 records of bronchoscopic examinations in university hospital and 1560 in chest disease hospital total 4882 were retrospectively analyzed and 198 (134 male, 64 female) patients were diagnosed as TBV. Results: Mean age of patients was 48.5 ΁ 17.8 (range, 15-78) years. Most of the tracheobronchial variations (n = 68, 33.1%) were localized at the right upper lobe bronchus. The most common type of TBVs at this region was right upper lobe with two segments. Symptoms were found in 21 (10.2%) patients with TBVs (7 accessory cardiac bronchus, 5 tracheal bronchus, 5 accessory segmental bronchus in left main bronchus and 4 accessory segmental bronchus in right main bronchus). Their symptoms cough, hemoptysis and recurrent pneumonia with unknown etiologies were thought as related to TBVs. No other potential causes leading these symptoms were found in these patients. Conclusion: According to our best of knowledge our study population is one of the largest series of bronchoscopy for investigate of TBVs. Although TBVs were usually reported as asymptomatic, nearly 10% of our patients with TBVs had symptoms such as recurrent pneumonia, cough and hemoptysis. TBVs should be taken into consideration in symptomatic patients before fiber-optic bronchoscopic examination