Increased risk of tuberculosis in health care workers: a retrospective survey at a teaching hospital in Istanbul, Turkey

BACKGROUND: Tuberculosis (TB) is an established occupational disease affecting health care workers (HCWs). Determining the risk of TB among HCWs is important to enable authorites to take preventative measures in health care facilities and protect HCWs. This study was designed to assess the incidence of TB in a teaching hospital in Istanbul, Turkey. This study is retrospective study of health records of HCWs in our hospital from 1991 to 2000. RESULTS: The mean workforce of the hospital was 3359 + 33.2 between 1991 and 2000. There were 31 cases (15 male) meeting the diagnostic criteria for TB, comprising eight doctors, one nurse and 22 other health professionals. Mean incidence of TB was 96 per 100,000 for all HCWs (relative risk: 2.71), 79 per 100,000 for doctors (relative risk: 2.2), 14 per 100,000 for nurses and 121 per 100,000 (relative risk: 3.4) for other professionals. The mean incidence of TB in Turkey between 1991 and 2000 was 35.4 per 100,000. Incidence of TB was similar in the Departments of Chest Diseases and Clinical Medicine but there were no TB cases in the Basic Science and Managerial Departments. CONCLUSION: HCWs in Turkey who work in clinics have an increased risk for TB. Post-graduate education and prevention programs reduce the risk of TB. Control programs to prevent nosocomial transmission of TB should be established in hospitals to reduce risk for HCWs

The skin prick test - European standards

Peer reviewe

Impact of Promising Biomarkers on Severity and Outcome of Acute Pulmonary Embolism

Gulseren Sagcan,1 Zeki Dogan,2 Hafize Uzun,3 Caglar Cuhadaroglu,1 Gulfer Okumus,4 Orhan Arseven4 1Department of Chest Diseases, Faculty of Medicine, Acıbadem University, İstanbul, Turkey; 2Department of Cardiology, Faculty of Medicine, Istanbul Atlas University, Istanbul, Turkey; 3Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, Istanbul, Turkey; 4Department of Chest Diseases, Faculty of Medicine, Istanbul University, İstanbul, TurkeyCorrespondence: Gulseren Sagcan, Department of Chest Diseases, Faculty of Medicine, Acıbadem University, İstanbul, Turkey, Tel +902166495751 ; +905323637953, Fax +902166495373, Email [email protected]: Acute pulmonary embolism (APE) is a common clinical condition. Its severity ranges from asymptomatic radiological findings to fatal obstructive shock. The potential circulating biomarkers have been studied to predict APE outcomes. This study aimed to explore their predictive power on prognosis in APE.Material and Method: It was a prospective observational study between March 2008 and April 2010. All consecutive patients diagnosed with APE were categorized as massive/high-risk, submassive/moderate-risk, and non-massive/low-risk. Cardiac troponin T (cTnT), myoglobin, N-terminal pro-brain natriuretic peptide (NT-proBNP), heart-type fatty acid-binding protein (H-FABP), growth differentiation factor-15 (GDF-15), and D-dimer levels were measured.Results: Of these patients, 14 (29.8%), 16 (34.0%), and 17 (36.2%) patients were categorized as low-risk, moderate-risk, and high risk-patients, respectively. There was no significant difference between the patient groups categorized based on the risk stratification in terms of demographic and clinical characteristics. The cTnT, myoglobin, HFABP, and D-dimer levels have also not differed significantly between the groups. There was a significant difference between the groups in respect of NT-proBNP and GDF-15 levels (p=0.009 and p=0.037, respectively). Nine (19.1%) patients had died by the 3rd-month follow-up. Adverse events were seen in 26 (55.3%) patients. GDF-15 had the highest area under the curve (AUC) value for predicting any adverse event (cut-off value=9.3 ng/mL, AUC=0.796, CI (confidence interval) 95%: 0.653– 0.899). NT-ProBNP was determined as the best predictor for mortality (cut-off value=229.2 pg/mL, AUC=0.889, CI 95%: 0.756– 0.964).Conclusion: Higher levels of NT-proBNP and GDF-15 were found to be associated with more severe APE, worse outcomes, and mortality.Keywords: pulmonary embolism, biomarkers, adverse clinical outcome, natriuretic peptides, growth differentiation factor-1

Is sexual dysfunction in women with obstructive sleep apnea-hypopnea syndrome associated with the severity of the disease? A pilot study

Introduction. Obstructive sleep apnea-hypopnea syndrome (OSAHS) may have a significant negative effect on sexual function. Aim. To evaluate female sexual function in women with OSAHS. Methods. Twenty-six patients with OSAHS were evaluated in two groups according to apnea-hypopnea index as mild (5-15, Group I, N=16) or moderate-severe (?15, Group II, N=10). A third group (N=10) of patients suspected of sleeping disorders other than OSAHS who also underwent polysomnographic studies served as the control group. All women were evaluated with a detailed sexual history including Female Sexual Function Index (FSFI) questionnaire and Beck Depression Inventory (BDI). Meanwhile, serum levels of estradiol, prolactin, total and free testosterone and dihydroepiandrostenedione-S were determined. Main Outcome Measures. FSFI, BDI, and serum hormonal levels. Results. The mean ages and total FSFI scores of Group I, Group II and the control group were 46 ± 7.1, 45 ± 3.8, and 41 ± 5.4 (P >0.05); 24.7 ± 5.3, 24. 5± 6.3, and 30.0 ± 2.5 (P 0.05) (desire, 3.18 ± 1.2 vs. 2.92 ± 1.6; arousal, 3.96 ± 1.1 vs. 3.67 ± 1.2; lubrication, 4.83 ± 1.0 vs. 4.12 ± 1.1; orgasm 4.0 ± 1.1 vs. 5.15 ± 2.9; satisfaction 3.96±1.1 vs. 4.05 ± 1.4 pain; 4.84±1.2 vs. 4.65 ± 1.3). However, the mean scores of desire (3.18 ± 1.2 vs. 3.96 ± 0.7), orgasm (4.0 ± 1.1 vs. 5.0 ± 1.1), and satisfaction (3.96 ± 1.1 vs. 4.76 ± 1.0) domains of Group I were significantly lower than the control group. Meanwhile, the mean scores of desire (2.92 ± 1.6 vs. 3.96 ± 0.7) and lubrication (4.12 ± 1.1 vs. 5.22 ± 0.9) domains were statistically different between Group II and the control group. The mean BDI scores of patients in Group I, Group II and the control group were 19.3 ± 6.3, 20.2 ± 6.6, and 11.0 ± 7.1, respectively (P0.05). Conclusions. OSAHS is associated with a significant decrease in female sexual function. However, severity of OSAHS is not related with the degree of female sexual dysfunction (FSD). This situation reveals that both organic and psychogenic issues are being involved in FSD related with OSAHS. Onem K, Erol B, Sanli O, Kadioglu P, Yalin AS, Canik U, Cuhadaroglu C, and Kadioglu A. Is sexual dysfunction in women with obstructive sleep apnea-hypopnea syndrome associated with the severity of the disease? A pilot study. © 2008 International Society for Sexual Medicine

Thoracic surgical operations performed under local anesthesia and sedation for diagnosis and treatment

Generally, the operative procedures for the diagnosis or treatment of mediastinal, intrathoracic and/or chest wall lesions requiring rib resection are performed under general anesthesia. Although evidence suggests that thoracoscopy can be performed under local anesthesia, no report has indicated that some major thoracic procedures can be accomplished without general anesthesia. In our study, we advocate that certain surgical procedures could be performed under local anesthesia with a performance similar to that of general anesthesia. Thirty patients underwent thoracic procedures with local anesthesia and sedation for diagnosis and treatment. Seventeen of the patients were men, and the mean age of the patients was 49.6 years (range 16 to 71 years). There were 13 diagnostic procedures, and 17 procedures were for treatment purposes. The operative procedures performed using only local anesthesia were mini-thoracotomy (n=9), mediastinotomy (n=4), revision of a full-thickness posterolateral thoracic incision (n=7), resection of the chondroma (n=4), Eloesser flap (n=1), metastasectomy of the chest wall (n=3), empyectomy (n=1), and video-assisted thoracoscopy (n=2). Severity of pain was evaluated by VAS. There were no oral or intravenous analgesic requirements in the early postoperative period. No complications attributable to the procedure were observed. Thoracic surgical procedures for diagnosis and treatment performed under local anesthesia are simple, effective, economical and comfortable for the patient

COVID-19: booster(s) vs. hospitalization and Intensive Care Unit admission

OBJECTIVE: As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients’ vaccination status and document the efficacy of boosters. PATIENTS AND METHODS: The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols. RESULTS: 2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses. CONCLUSIONS: The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups