Frequency of latent tuberculosis in patients receiving Anti-TNF-Alpha therapy

Setting-Objective: In this study, it was aimed to reveal the incidence of tuberculosis development in patients receiving tumor necrosis factor-alpha (TNF-α) blocker therapy, despite tuberculosis chemoprophylaxis. Design: 520 patients who were receiving anti TNF-α treatment in the last 3 years were evaluated retrospectively. Radiological imaging tuberculin skin test (TST), history of tuberculosis, BCG vaccine, chemoprophylaxis administration, used anti TNF-α drugs were recorded. Results: There were 265(51.0%) of the patients with ankylosing spondylitis (AS), 175(33.7%) with rheumatoid arthritis, 35(6.7%) with Crohn's, 10(1.9%) with ulcerative colitis (UC), 21(4.0%) with psoriatic arthritis, 14(2.7%) with psoriasis vulgaris. In total, 455 (79.6%) patients were given INH prophylaxis. Active tuberculosis development was observed in five patients (4: pulmonary,1: extrapulmonary; 3: UC, 2:AS) who all received anti TNF-α treatment (0.96%), infliximab. Three patients had tuberculosis disease in the 6th month, and the other 2 patients in the 5th and 24th month of their anti TNF-α treatments, and two had 9-month, and 1 had 6-month chemoprophylaxis history. Conclusion: The incidence of tuberculosis development in patients treated with anti TNF-α was found to be higher than the general population. In our country, where tuberculosis is still prevalent, patients receiving Anti TNF-α treatment (especially in-fliximab) should be carefully questioned and examined about tuberculosis

Two-Years Follow-up Results of a Smoking Cessation Clinic in a State Hospital

Objective: the primary aim of the present study was to evaluate the data and success of a smoking cessation clinic in a secondary state hospital. Secondarily, the study aimed to compare the cessation rates of patients using varenicline and bupropion. Methods: A total of 251 patients, admitted to our smoking cessation clinic were retrospectively evaluated. the smoking cessation clinic was run one day every week and included a 35-min presentation on smoking cessation and face-to-face interviews with every patient who attended the clinic. Monthly control visits were conducted, and after 2 years all the patients were asked about their smoking status via a phone call.Results: A total of 152 out of the 251 patients, namely those who were successfully contacted, were included in the study. the average age of the study population was 46.2±11.2 (18-69), and 81 (53.3%) were female. the average nicotine dependence level was 5.8±2.3. the nicotine dependence levels and the amount of current cigarette consumption in one day were higher in the varenicline group (p=0.003 and p=0.002, respectively), whereas the duration of treatment was lower (p=0.009). Among all the patients, the average smoking cessation rate was 61.2% in 6 months, 34.2% in 12 months, 18.4% in 18 months, and 5.3% in 24 months. There were no differences in smoking cessation rates between the varenicline and bupropion groups (p>0.05). Conclusion: An effective success in smoking cessation was observed with the combined use of behavioral and pharmacological modalities. Intensive behavioral interventions and treatment and follow up for longer durations, particularly for patients with risk factors for relapse, can increase the success of smoking cessation clinic

Kronik obstrüktif akciğer hastalığı ataklarında mortalite

We conducted a retrospective study to determine the mortality rate and death causes of chronic obstructive pulmonary disease (COPD) exacerbations at the hospital. In our cilinic 68 patients died due to COPD exacerbations between 1997-1999. The mean age was 70.1 (43-93) years, and 82.4% of the patients were male and 17.6% were female. The mortality rate due to COPD exacerbations was 6.2% and this ratio was 18.6% of the all deaths occurred in our clinic. The mean duration of hospitalization was 16.9 days (1-92). The most common comorbid disease was ischaemic heart disease. Nosocomial pneumonias caused by gram (-) bacteria and S. aereus occurred in 44.1% of the patients and it was statistically related to the duration of hospitalization (p;lt;0.05). Respiratory failure, nosocomial pneumonia and complications of heart disease were found to be the most important factors effecting mortality.Kronik obstrüktif akciğer hastalığı (KOAH) ataklarına bağlı hastanede görülen mortaliteyi ve bunu etkileyen faktörleri araştırmak amacıyla geriye dönük bir çalışma yapıldı. 1997 ile 1999 tarihlerinde 3 yıllık süre içinde toplam 68 hastanın KOAH ataklarına bağlı olarak hastanede yaşamını yitirdiği belirlendi. Yaş ortalaması 70.1 (43-93) olan olguların %82.4'ünün erkek, %17.6'sının kadın olduğu saptandı. Kliniğimizde meydana gelen ölümlerin %18.6'sından KOAH ataklarının sorumlu olduğu ve KOAH atakları sırasında hastanede gözlenen mortalitenin %6.2 olduğu gözlendi. Hastanede yatış süresi ortalama 16.9 (1-92) gün olan olgularda en sık gözlenen ek patoloji koroner arter hastalığıydı. Olguların %44.1'inde Gram (-) bakterilerden ve S. aereus'tan kaynaklanan nozokomiyal pnömoni geliştiği saptandı. Hastaların yatış süresi ile nozokomiyal infeksiyon gelişimi arasındaki ilişki istatistiksel olarak anlamlı bulundu (p0.05). Mortalite nedeni olarak solunum yetersizliğinin, başta nozokomiyal pnömoniler olmak üzere solunum sistemi infeksiyonlarının ve kardiyovasküler sistem hastalıklarına bağlı komplikasyonların en önemli faktörler olduğu anlaşıldı

Erişkin bir hastada demonstractif radyografik bulgularıyla primer tüberküloz

A 21-year-old woman with a two-month history of left pleuritic chest pain, fatigue, cough and night sweating was referred to our department. The postero-anterior chest radiogram showed left-sided pleural effusion, extending to the edge of the fourth anterior rib; left hilary enlargement and a 2x3 cm semi-homogenous density with its irregular shape on the left upper zone. There were many linear densities between this lesion and left hilus. A thoracentesis was performed from the left hemithorax. Pleural fluid biochemistry showed an exudative pleurisy with high Adenosine Deaminase (ADA) level of 59 U/L. In the cytological examination of the pleural fluid, there were many lymphocytes, and no mesothelial cell. The sputum smears for acid-fast bacilli were negative three times. The culture was positive for AFB on the first month. The patient was established as primary tuberculosis because of Ghon complex on the Chest X-Ray, laboratory findings and her history. On the tirth week of antituberculosis therapy with Isoniasid, Rifampicine, Morphozinamide and Streptomycine, the pleural fluid improved and Ghon complex regressed after the treatment. This case was presented for its demonstrative radiological findings for primary tuberculosis.Yirmi bir yaşında kadın hasta 2 aydan beri devam eden sol yan ağrısı, halsizlik, öksürük ve gece terlemesi yakınmalarıyla başvurmuştur. Posteroanterior akciğer radyogramında sol altta 4. kosta ön kenarına kadar ulaşan ve plevral effüzyonla uyumlu olduğu düşünülen homojen dansite artışı, ayrıca sol hiler genişleme ve sol üstte 2x3 cm boyutlarında düzensiz kenarlı yarı homojen dansite artışıyla birlikte bu lezyonla sol hilus arasında uzanan lineer dansiteler saptanmıştır. Sol hemitorakstan yapılan torasentez sonucunda eksuda niteliğinde sıvı alınmış ve adenozin deaminaz (ADA) düzeyinin ise 59 U/L gibi yüksek düzeyde olduğu görülmüştür. Sıvının sitolojik incelemesinde lenfositten zengin olduğu, mezotel hücrelerinin görülmediği belirtilmiştir. Olguda balgam direkt bakısında ARB üç kez negatif bulunmuştur. Bir aylık tüberküloz kültüründe üreme olmuştur. Akciğer radyogramındaki demonstratif ghon kompleksi görünümü, tüberküloz plöritini düşündüren laboratuvar bulguları ve anamneziyle birlikte primer tüberküloz düşünülmüştür. İzoniazid, rifampisin, morfozinamid ve streptomisinden oluşan antitüberküloz tedavisinin üçüncü haftasında plevral sıvının gerilediği ve ghon kompleksinin küçüldüğü görülmüştür. Bu vaka primer tüberküloz için demonstratif radyografik bulgular nedeniyle sunulmuştur

Tuberculosis cases presenting with spontaneous hemopneumothorax and hypotension

Sir, Tuberculosis (TB) is the second most common fatal infectious disease, following human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS), in the adult population. Socio-economic deprivation, immigration, wars, omission of tuberculosis control programs, and HIV/AIDS epidemics have led to an increase in the incidence of tuberculosis. The World Health Organization (WHO) publishes a global tuberculosis report annually. The 2013 report stated that, in 2012, 8.6 million people developed TB, and 1.3 million people died from the disease, including 320,000 deaths among HIV-positive individuals

Kombine preparat ya da tek başına uzun etkili beta agonist kullanan kronik obstrüktif akciğer hastalığı olgularında pnömoni gelişme oranının retrospektif olarak karşılaştırılması

Aim: Data from recent studies revealed that the use of combinations of inhaled corticosteroids and long acting beta 2 agonists (LABA) may increase pneumonia risk in chronic obstructive pulmonary disease (COPD) patients. The aim of this retrospective study is to compare the occurence of pneumonia in COPD patients who received regularly inhaled corticosteroid and LABA combinations with the patients who received inhaled LABA only. Materials and Methods: Sixty-two COPD patients were included in the study. Patients were divided into 2 groups according to the inhaled agents they used; “combination group” (31 patients; 26 male , 5 female ; median age;plusmn;SD : 68;plusmn;9) and “LABA group” (31 patients; 27 male , 4 female ; median age;plusmn;SD: 66;plusmn;8). Medical recotds of patients were retrospectively evaluated and all patients were contacted via telephone.Results: Ten patients in combination group had severe or very severe COPD (FEV 1 ;lt;50% ) versus 8 patients in LABA group. Seventeen episodes (54% ) of pneumonia was detected in the combination group, whereas 10 (32% ) in LABA group (p=0.06). Diabetes mellitus was present as a comorbidity in two patients in the combination group and in three in the LABA group. Conclusion: Since study population was limited, statistical difference between the two groups was found to be insignificant. But, there was a trend of higher incidence of pneumonia in the combination group, similar to previous studies.Amaç: Son çalışmalarda, kronik obstrüktif akciğer hastalığı (KOAH) olgularında k ombine preparat (uzun etkili beta agonist+inhale steroid) kullanımının pnömoni riskini arttıracağına dair bazı veriler el de edilmiştir. Bu retrospektif çalışmanın amacı, düzenli olarak inhale kombine preparat ya da sadece uzun etkili beta 2 agonist (long acting beta 2 agonist, LABA) kullanan KOAH olgularında pnömoni gelişim oranlarını karşılaştırmaktır. Gereç ve Yöntem : Altm ış iki 62 KOAH olgusu çalışmaya alın dı. Hastalar kullandıkları inhale ajana göre “kombine grubu” (31 olgu ; 26 erkek, 5 kadın ; ortalama yaş±SS: 68±9) ve “LABA” grubu (31 olgu ; 27 erkek, 4 kadın , ortalama yaş±SS: 66±8) olarak iki gruba ayrıl dı. Hasta dosyaları retrospektif olarak incelen di ve her hastayla telefonla görüşül dü . Bulgular: Hastalık ağırlık derecesi kombine grubunda 10 hasta ve LABA grubunda 8 hasta ağır ya da çok ağır (FEV1 %50) KOAH olarak değerlendiril di . Klinik bulgular ile pnömoni rastlanma oranı kombine grubunda 17 epizod (%54) ve LABA grubunda ise 10 epizod (%32) olarak saptan dı (p=0. 06). Ek hastalık olarak kombine grubunda 2 hastada ve LABA grubunda 3 hastada diabetes mellitus mevcuttu. Sonuç: Hasta sayılarının sınırlı olması nedeni ile iki grup arasındaki fark istatistiksel olarak anlam lı bulunmadı. Ancak, daha önce yapılan çalışmalara benzer şekilde, çalışmamızda da kombine preparat kullananlarda pnömoni gelişme riski artmış olarak saptan dı