Serum Asymmetric Dimethylarginine, Nitrate, Vitamin B12, and Homocysteine Levels in Individuals with Pulmonary Embolism

We aimed to analyze the pre- and posttreatment serum asymmetric dimethylarginine (ADMA), nitrate (NO3), vitamin B12 and homocysteine levels in pulmonary embolism (PTE) patients and to determine the prognostic value of these variables in predicting chronic thromboembolic pulmonary hypertension (CTEPH). This study was conducted in 64 patients. The patients were classified into the two groups: patients with normal pulmonary artery pressure (PAP) (group I) and patients with high PAP with persistent lung perfusion defects or who died at the end of 3 months of therapy (group II). We found statistically significant differences between two groups with respect to the partial oxygen pressure, the oxygen saturation, and the PAP, but there was no difference between the two groups with respect to the pretreatment ADMA, NO3, or homocysteine levels. The vitamin B12 levels were higher in group II. The NO3 levels increased and the ADMA and vitamin B12 levels decreased with treatment in both groups. These results suggest that these parameters are not predictive of the development of CTEPH

Clinical Factors Affecting the Direct Cost of Patients Hospitalized with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is a disease of increasing significance in terms of economic and social burden due to its increasing prevalence and high costs. Direct costs of COPD are mostly associated with hospitalization expenditures. In this study, our objective was to investigate the costs of hospitalization and factors affecting these costs in patients hospitalized due to acute exacerbation of COPD (AECOPD)

Antituberculosis drug resistance patterns in two regions of Turkey: a retrospective analysis

BACKROUND: The emergence of Mycobacterium tuberculosis strains resistant to antituberculosis agents has recently received increased attention owing largely to the dramatic outbreaks of multi drug resistance tuberculosis (MDR-TB). METHODS: Patients residing in Zonguldak and Kayseri provinces of Turkey with, pulmonary tuberculosis diagnosed between 1972 and 1999 were retrospectively identified. Drug susceptibility tests had been performed for isoniazid (INH), rifampin (RIF), streptomycin (SM), ethambutol (EMB) and thiacetasone (TH) after isolation by using the resistance proportion method. RESULTS: Total 3718 patients were retrospectively studied. In 1972–1981, resistance rates for to SM and INH were found to be 14.8% and 9.8% respectively (n: 2172). In 1982–1991 period, resistance rates for INH, SM, RIF, EMB and TH were 14.2%, 14.4%, 10.5%, 2.7% and 2.9% (n: 683), while in 1992–1999 period 14.4%, 21.1%, 10.6%, 2.4% and 3.7% respectively (n: 863). Resistance rates were highest for SM and INH in three periods. MDR-TB patients constituted 7.3% and 6.6% of 1982–1991 and 1992–1999 periods (p > 0.05). CONCLUSION: This study demonstrates the importance of resistance rates for TB. Continued surveillance and immediate therapeutic decisions should be undertaken in order to prevent the dissemination of such resistant strains

The Trend of Tuberculosis in Tekirdağ

AimThe incidence rate of tuberculosis (TB) is estimated by the World Health Organization as 128/100.000 worldwide. The main principles of TB control are early case detection and diagnosis, followed by directly observed treatment of patients. The aim of this study was to analyse the dynamics of TB between 2007 and 2011 in Tekirdağ.Material and MethodsData were obtained from TB dispensaries and separated into oneyear categories. Case notification rates were analysed by different age groups (0–14, 15–24, 25–44, 45–64, 65 and above). The patients were divided into two groups according to involved organs: pulmonary (smear/culture positive=PSP and smear/culture negative/unknown=PSN/U) and extrapulmonary. Antibiotic susceptibility tests to major antituberculosis drugs were performed on M. tuberculosis strains that were grown in culture and suspected of being resistant. Resistance to both INH and rifampicin were accepted as multiple drug resistance tuberculosis (MDR-TB).ResultsA total of 162.291 patients were examined, and out of this population, 1311 (0.8%) tuberculosis patients were evaluated. The distribution of case notification rates by year were 44.6%, 34.6%, 33.4%, 28.6%, and 27.6%from 2007 to 2011, respectively. Pulmonary and extrapulmonary TB rates were 74.5%(46.0%PSP and 28.5%PSN/U) and 25.5%, respectively. Extrapulmonary TB rates were 42.3% and 17.6% in men and women, respectively. Resistance rates against INH, rifampicin, ethambutol, and streptomycin were 21.6%, 8.8%, 1.6%, and 6.4%, respectively. The MDR-TB rate was 6.4%.ConclusionSystematic implementation of directly observed treatment programs plays an important role in decreasing TB incidence. Because the TB rates in our region are above the average for Turkey, screening and follow-up procedures must be conducted more stringently and regularly

Seasonality of Tuberculosis in Tekirdağ City, 2007-2011

AimIt is well known that the incidence of many respiratory infections shows seasonal variability. Unlike other respiratory infections, in many studies tuberculosis (TB) diagnoses increase in summer and the mechanism underlying this fluctuation remains unknown. We aimed to examine whether TB has an annual seasonal pattern in Tekirdağ.Materials and MethodsData were obtained from TB dispensaries in Tekirdağ retrospectively. There were 1311 cases of TB notified between January 2007 and December 2011. TB notifications show a seasonal pattern, with a peak in spring and summer, which is present in both pulmonary and extra pulmonary tuberculosis.ResultsTB notification was found highest in summer with the value of 28,4 %.ConclusionTB incidence in Tekirdağ showed seasonality like previous studies held in different countries. There is a need for large longitudinal studies to clarify the underlying mechanisms that may provide a better disease control

Pamuk ipliği fabrikası çalışanlarında pamuk tozuna bağlı solunumsal etkiler ve bissinozis prevalansı

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.SUMMARY RESPIRATORY EFFECTS OF COTTON DUSTS ON THE WORKERS OF COTTON - MILL AND PREVALENCE OF B YSSINOSIS This study was performed to determine acute pulmonary effects of cotton dusts and byssinosis prevalence on the workers of cotton - mill between June - August 1998 in Denizli. There were 227 workers in the factory and 223 workers were attended to the study. 182 workers were working in the dusty sections, another 41 workers were working non - dusty area as a control group. Pulmonary symptoms of the workers was recorded by a modified guestionaire which is the report of WHO ( no: 684 ). Lung function tests were measured by a portable spirometer. Measured envioremental dust concentration was between 0.0958 - 0.4138 mg/m3. FEVi ( forced expiratory volume in one second ) parameter was used in pulmonary function tests which are measured 4 times / week; before and after work shift on Monday, after work shift on Wednesday, after work shift on Friday. The pulmonary functions of workers on the dusty area were lower after work shift on Monday, but on the subsequent days pulmonary functions were found healing. Acute changes due to cotton dust was found 34.0 % and mild, moderate and severe changes were sequencely 18.1 %, 11.5 %, 4.4 5. Chronic changes were detected in 15.3 % of workers and mild - moderate and severe changes were measured sequencely 12.6 %, 2.7 %. To the functional investigation, grade 0 byssinosis 46.4 %, grade 1 byssinosis 25.0 %, grade 2 byssinosis 25.0 %, grade 3 byssinosis 3.6 % were found. Symptoms prevalence 27.5 %, byssinosis prevalence 15.4 % were found in the workers and prevalence of chronic bronchitis and asthma were also 6.0 % and 1 1.5 %. Opposite to the historical knowledge, no byssinosis were found in carding section. Considering highenic conditions and envioremental dust concentrations byssinosis prevalence seems higher than expected. Possibly, the problem in understanding of meaning of chest tightness and additional effects of asthma and chronic bronchitis are important and also we don't know endotoxin concentration of the cotton dust used here. 766. PAMUK İPLİK FABRİKASI ÇALIŞANLARINDA PAMUK TOZUNA BAĞLI SOLUNUMSAL ETKİLER VE BİSSİNOZİS PREVALANSI Çalışma Denizli ilindeki bir iplik fabrikası işçilerinde pamuk tozuna bağlı solunumsal etkiler ve bissinozis prevalansını belirlemek amacıyla Haziran - Ağustos 1998 tarihleri arasında gerçekleştirilmiştir. 227 kişi çalışmaya alınmış, ancak bunların 223 ( % 98.2 ) 'üne ulaşılabilmiştir. Olguların 182'si tozlu ortamda çalışırken 41 kişi ise toz maruziyeti olmayan kontrol olgularıdır. İşçilerin solunum sistemi yakınmaları WHO'nun 684 nolu teknik raporundan modifiye edilerek hazırlanan anket formu ile, solunum fonksiyonları taşınabilir bir spirometre ile yapılmış ve ayrıca iş yeri solunabilir toz konsantrasyonları ölçülmüştür. Toz konsantrasyonları ( mg / m3 olarak ) 0.0958 - 0. 4138 arasında bulunmuştur Çalışanların solunum fonksiyon testleri FEVı ( 1. saniyedeki zorlu ekspiratuvar volüm ) ile haftada 4 kez; hafta başı iş öncesi, iş sonrası, hafta ortası ve hafta sonu iş sonrası olarak ölçülmüştür. Tozlu ortamda çalışan işçilerin solunum fonksiyonları haftanın ilk günü belirgin düşmesine karşın ilerleyen günlerde düzelmektedir. Toza bağlı solunumsal akut etkilenme işçilerin % 34'ünde saptanırken hafif, orta ve ciddi düzeylerde etkilenme sırasıyla % 18.1, % 1 1.5, % 4.4'tür. Kronik etki ise işçilerin % 15.3'de görülürken hafif- orta düzeyde etkilenme % 12.6, ciddi düzeyde etkilenme ise % 2.7 oranında saptanmıştır. Fonksiyonel incelemede bissinozisli olguların % 46.4'ü grade 0, % 25'i grade 1, % 25'i grade 2, % 3.6'sı ise grade 3'tür. Çalışanlarda semptom prevalansı % 27.5 bulunurken bissinozis prevalansı % 15.4 olarak saptanmıştır. Kronik bronşit % 6.0 ve astma % 11.5 oranında bulunmuştur. Tarihsel bilginin tersine tarak bölümünde bissinozis saptanmamıştır. Fabrikanın hijyenik koşulları düşünüldüğünde bu oran yüksek görünmektedir. Burada göğüste şişkinlik hissi ( chest tightness ) yakınmasının anlaşılmasındaki zorluk ve kronik bronşit ve astmanın eşlik etmesi, sonucu etkilemektedir. Ayrıca burada toz içerisindeki endotoksin düzeyleri de etkili olabilir, ancak ölçülemediğinden yorum yapmak güçtür. 7

Tansiyon pnömotoraksı taklit eden dev bül

Göğüs grafisinde, tansiyon pnömotoraksı, bir hemitoraksta geniş radyolüsenite ve mediastinal yapıları karşı tarafa itmiş olarak izleriz. Dev bül de geniş radyolüsen görünümü ve mediastinal şift oluşturarak tansiyon pnömotoraksı taklit edebilir. Sunduğumuz olgu dev akciğer bülü olan 35 yaşında bir kadındır. Dev bül acil serviste tansiyon pnömotoraks olarak teşhis edilerek göğüs tüpü takılmıştır. Tansiyon pnömotoraks ile dev bülü ayırt etmek çok zordur. Bu iki çok benzer antitenin tedavileri tamamen farklıdır. Bundan dolayı anamnez, fizik muayene ve radyolojik incelemede, doğru tanı için çok dikkatli olmalıyız.In the chest X-ray, we observe tension pneumothorax (TPX) as wide radiolucent view in a hemithorax and pushing the mediastinal structures contralateral. Giant bulla may mimic TPX with wide radiolucent view and mediastinal shift. The present report includes giant pulmonary bulla in 35-year-old woman. The giant bulla was diagnosed as a TPX in emergency, and chest tube was performed. The differentiation between TPX and a giant bulla may be very difficult. The therapies of these two similar entities are completely different. So that, we must be careful about anamnesis, physical examination and radiology for true diagnosis

Hemitoraksta dev liposarkom

Obezitesi olan 57 yaşındaki kadın hasta, şiddetli dispne ve göğüs ağrısı yakınması ile acil servise başvurdu. Hastanın akciğer grafisinde sol hemitoraksı tamamen kapatan opasite ve sağ mediastinal şift saptandı. Bilgisayarlı toraks tomografisinde sol hemitoraksı tamamen dolduran ve mediastinal kaymaya neden olan heterojenik yoğunlukta dev kitle izlendi. Liposarkomun komplet cerrahi rezeksiyonu yapıldı. Cerrahi sonrası yapılan patolojik inceleme sonucu plevral liposarkom olarak bildirildi. Bu yazıda plevral liposarkom tedavisi literatür eşliğinde tartışıldı.A 57-year-old female with obesity was admitted to the emergency service with the complaint of severe dyspnea and chest pain. Chest X-ray showed opacity occupying left hemithorax completely and the right mediastinal shift. Thoracic computed tomography indicated a heterogeneous density of a giant mass in the left hemithorax and right mediastinal shift. Complete surgical resection of the liposarcoma was performed. The pathological examination following surgery suggested pleural liposarcoma. In this article, treatment of pleural liposarcoma was discussed in the light of literature review

Zonguldak kömür havzasında çalışan kömür işçilerinde çalışma koşulları ve pnömokonyoz durumu: 1985-2004

Ülkemizde yer altında emek yoğun çalışmayı gerektiren taşkömürü üretimi sadece Zonguldak ili ve çevresinde, Türkiye Taşkömürü Kurumu (TTK) işletmelerinde sürdürülmektedir. Bu işletmede 1960 yılında toz kontrol programı, 1969 yılında da periyodik pnömokonyoz araştırması başlamış olmasına rağmen bölgeye ait basılmış veriler oldukça sınırlıdır. Bu çalışmada, 1985-2004 yıllarına ait işletmelerin tümüne ait toz değerleri ve kömür üretiminde çalışanların tamamına ait sağlık kontrol verileri TTK'dan elde edilerek çalışma alanlarındaki toz konsantrasyonu ile pnömokonyoz prevalansı arasındaki ilişki araştırılmıştır. Çalışma alanlarında 1978 yılından itibaren yer altında ortalama solunabilir toz konsantrasyonu 1.66 mg/m3, yer üstünde ise 0.73 mg/m3 olarak saptanmıştır. İşletmelerdeki toplam işçi sayısı 1985 yılında 38.231 iken, 2004 yılında 8932 işçi yer altında olmak üzere toplam 12.261 işçiye inmiştir. Bu dönemde yer üstünde çalışan işçilerde pnömokonyoz saptanmamıştır. Pnömokonyoz insidansı bu yıllar arasında %0.17-2.8 arasında, prevalans ise %1.23-6.23 aralığında değişmektedir. Pnömokonyoz saptanan olgulardaki radyolojik opasiteler genellikle küçük opasiteler olarak rapor edilmiştir. Sonuç olarak, bu çalışma Zonguldak kömür havzasına ait 20 yıllık pnömokonyoz verilerini sunan ilk çalışmadır. Toz kontrol önlemlerinin uygulamada olmasına ve solunabilir toz konsantrasyonunun yasal sınırın altında bulunmasına rağmen kömür çıkarma noktasında çalışanlarda pnömokonyoz ortaya çıkma riski hala söz konusudur. Çalışma ortamındaki solunabilir toz konsantrasyonunun uluslararası sınır değer olan 1 mg/m3 düzeyine düşürülmesi hedeflenmelidir. Alınacak önlemlerle birlikte bölge verileri daha kapsamlı epidemiyolojik çalışmalarla da irdelenmelidir.In Turkey, bituminous coal mining is performed only in Zonguldak coal basin since 1940. Pneumoconiosis surveillance programs and dust control measures are in effect, but published pneumoconiosis data from this area is lacking. In this study, we aimed to evaluate the change in prevalence and case detection between 1985 and 2004 and assess the correlation between the dust concentration in workplaces and the prevalence of pneumoconiosis. Data on respirable dust concentrations and number of workers diagnosed as pneumoconiosis between 1985 and 2004 were obtained from Turkish Coal Enterprises authorities. Mean respirable dust concentrations in workplaces underground and on the ground were 1.66 mg/m3 and 0.73 mg/m3 respectively. Total number of workers decreased from 38.231 in 1985 to 12.261 in 2004 including 8932 underground workers. In this period, pneumoconiosis has not been reported in the ground workers. Incidence of pneumoconiosis ranged between 0.17-2.8 percent and prevalence ranged between 1.23-6.23 percent between 1985 and 2004. Radiologic opacities compatible with pneumoconiosis were predominantly small opacities. This is the first report about the incidence and prevalence rate of coal worker's pneumoconiosis in the main coal mining area of Turkey. Dust measurement and screening standards should be improved and adapted to international standards and we conclude that surveillance data should be closely monitored in this region and further epidemiologic studies in this area are warranted

Diagnostic value of oropharyngeal examination findings in differentiating pediatric obstructive sleep apnea syndrome from habitual snoring

Amaç: Çocukluk çağı tıkayıcı uyku apnesi sendmmu (TUAS) çocukların yaklaşık % 2'sinde görülen ciddi bir hastalık olup uyku sırasında tekrarlayan kısmi veya tam üst hava yolu tıkanıklığı epizodlan ile karakterizedir. Habituel horlama (HH) çocukların % 7-9'unda görülen sık bir semptomdur. HH'h çocuklarda hipoksemi ve hiperkapni bulunmamasına rağmen, TUAS varlığına işaret eden muayene bulgularının bulunması bu iki durumun klinik ayrımını güçleştirmektedir. Bu çalışmada, habituel horlama ve TUAS'u olan çocukları inceleyerek, bu iki bozukluğun klinik ayrımında orofarengeal muayene bulgularının tanısal değerini araştırdık. Gereç ve Yöntem: Bu çalışmaya her gece horlama şikayeti olan 74 çocuk dahil edildi. Her çocuğun TUAS ile ilişkili semptomlar açısından ayrıntılı anamnezi alındı ve fizik muayenesi yapıldı. Polisomnogra.fi sonuçlarına göre çocuklar TUAS ve habituel horlama gruplarından birine dahil edildi. Uykuda saat başı iki veya daha fazla apne veya hipopne atağı olan çocuklar TUAS olarak sınıflandırıldı. Palatin tonsil, adenoid büyüklüğü ve mallampati skorları her bir evre için iki grup arasında ki-kare testi ile karşılaştırıldı. Bulgular: Olguların 17'si HH ve 57'si TUAS'lı idi. Adenotonsil hipertrofili veya mallampati evresi yüksek olan hastaların TUAS ve HH grupları arasındaki dağılımı açısından istatistiksel olarak anlamlı farklılık saptanmadı (p>0.05). Evre 1 palatin tonsil'büyüklüğü HH grupta TUAS'lı gruba göre sınırda anlamlı olarak daha yüksek oranda bulundu (p = 0.07) Sonuç: Bu çalışmada elde edilen bulgulara göre,sadece evre 1 palatin tonsil büyüklüğü HH grupta TUAS'lı gruba göre sınırda anlamlı olarak daha . yüksele oranda görülmekte olup, orofarengeal muayene bulguları İVAS ve HH'nm kesin ayrımında yeterli olmamakta, her iki grupta da benzer muayene bulguları gözlenmektedir.Objective: Obstructive sleep apnea syndrome (OSAS) in children is a serious disease, estimated to occur in approximately 2% pf children and is characterized by repeated episodes of complete or partial upper airway obstruction during sleep. Habitual snoring (HS) is a common symptom seen in %7-Q of children. Although there is no hypercapnia and hypoxemia in HS, presence of examination findings suggestive of OSAS in HS makes the clinical differentiation of these two conditions a challenging one. In this study we evaluated children with HS and OSAS and assessed the diagnostic value of the findings of oropharyngeal examination in the clinical differentiation of these two disorders. Material and Method: 74 children with every night snoring symptom were included in the study. Detailed history with regard to OSAS symptoms was obtained and physical examinations was performed for each child. Children were classified in either OSAS orHS group according to polysomnography results. Children with more than two spells of apnea or hypopnea per hour of sleep were classified as OSAS. Palatine tonsil and adenoid vegetation sizes and mallampati scores were compared between the two groups for each stage by using chi-square test. Results: There were 17 and 57 children in the HS and OSAS groups, respectively. There wasn't any statistically significant difference between the two groups in terms of adenotonsillary hypertrophy and higher mallampati scores (p>0.05). Stage 1 palatine tonsil size was more frequent in HS group than OSAS group and the difference was close to statistical significance (p-0.07). Conclusion: According to the findings of this study only stage 1 palatine tonsil size was more frequent in HS group than OSAS group with a difference close to statistical significance.- Oropharyngeal . examination findings are not sufficient to distinguish children with HS from those with OSAS and the findings are similar in two groups