Levent Akyildiz

MDCT Findings of Denim-Sandblasting-Induced Silicosis: a cross-sectional study

BackgroundDenim sandblasting is as a novel cause of silicosis in Turkey, with reports of a recent increase in cases and fatal outcomes. We aimed to describe the radiological features of patients exposed to silica during denim sandblasting and define factors related to the development of silicosis.MethodsSixty consecutive men with a history of exposure to silica during denim sandblasting were recruited. All CT examinations were performed using a 64-row multi-detector CT (MDCT). The nodules were qualitatively and semi-quantitatively analyzed by grading nodular profusion (NP) on CT images.ResultsSilicosis was diagnosed radiologically in 73.3% of patients (44 of 60). The latency period (the time between initial exposure and radiological imaging) and duration of silica exposure was longer in patients diagnosed with silicosis than in those without silicosis (p < 0.05). Nodules were present in all cases with centrilobular type as the commonest (63.6%). All cases of silicosis were clinically classified as accelerated and 11.4% had progressive massive fibrosis (PMF). Mild NP lesions were the most prevalent in all six zones of the lung. The NP score was significantly correlated with the duration of silica exposure, the latency period, presence of PMF, and pleural thickening. Enlarged lymphadenopathy was present in 45.5% of patients.ConclusionsThe duration of exposure and the latency period are important for development of silicosis in denim sandblasters. MDCT is a useful tool in detecting findings of silicosis in workers who has silica exposure.

Incidence of tuberculosis disease and latent tuberculosis infection in patients with end stage renal disease in an endemic region.

Aim. Patients in chronic renal failure suffer impaired cellular immunity and have an increased risk of tuberculosis (TB). Our aim in this multicenter study was to determine the incidence of TB and to evaluate latent tuberculosis infection (LTBI) in hemodialysis patients. Methods. We retrospectively evaluated the frequency of TB in 779 dialysis patients at 13 hemodialysis centers in five different cities in Southeast Turkey. The tuberculin skin test (TST) was conducted in 733 patients to detect LTBI. Results. The mean age of the patients was 51.2 ± 15.9 years; 398 (51.1%) of the patients were female, and 53.9% of patients had a BCG scar. The mean dialysis duration time was 35.1 ± 33.4 months. TB was diagnosed in 34 cases. The incidence rate of TB in patients undergoing hemodialysis was 3.1%. Ten patients had a history of TB before beginning hemodialysis, and 24 patients had a history of TB after beginning hemodialysis. A diagnosis of TB was made based on clinical data in eight patients and microbiologically or pathologically in 26 patients. The median time between the initiation of dialysis to the diagnosis of TB was 11 months. Extrapulmonary TB occurred in 45.8% of cases, and the most common site of involvement was the lymph nodes. The TST was positive in 61.8% of TB patients and in 37.5% of those with no history of TB. Conclusions. The incidence of TB is high in hemodialysis patients, and they should be evaluated periodically to exclude insidious infection and reduce morbidity and mortality.

Does Biomass Exposure Affect Serum MDA Levels In Women

Abstract It is believed that the inhalation of biomass fuel, a substance that is used for bread baking and heating in rural areas, is associated with chronic obstructive pulmonary disease (COPD) and pulmonary symptoms. The products of biomass are claimed to affect the oxidant/antioxidant imbalance, which plays a significant role in such a disease COPD. In our study, the serum level of malonyldialdehyde (MDA) was accepted as a marker of oxidant/antioxidant imbalance, and it was measured by the thiobarbituric acid method. A total of 43 women living in the central and rural areas of Diyarbakir was chosen randomly for the study and they were divided into two groups. The first group, also called the study population, consisted of 28 women living in rural areas. The mean age of the sample was 43 yr (range 31–63 yr). All were healthy and nonsmokers. Among these women the mean duration of the exposure to biomass was 12 h/wk for 25 yr. The mean MDA level (±SD) was 3281 ± 0.789 nmol/ml. The second group, the control population, consisted of 15 healthy women of age 42 yr (range 30–65 yr). They were again nonsmokers and healthy. These women were selected from the central Diyarbakir. The mean MDA level (±SD) was 1.474 ± 0.630 nmol/ml. The difference between two populations were statistically significant (p < 0.0001). In conclusion, we believe that the high level of serum MDA in women is a result of biomass exposure.

Adapted T Cell Interferon-Gamma Release Assay for the Diagnosis of Pleural Tuberculosis

Background: Better and more rapid tests are needed for the diagnosis of tuberculous pleural effusion (TPE), given the known limitations of conventional diagnostic tests. Objectives: To estimate diagnostic accuracy of the QuantiFERON-TB Gold In-Tube (QFT-GIT) test (and its components) using data-derived cutoffs in pleural fluid. Methods: The QFT-GIT test was performed on whole blood and pleural fluid from 43 patients with TPE and 29 control subjects (non-TPE). To achieve the objective, QFT-GIT test, estimating likelihood ratios and receiver operating curve analysis were performed. Results: The sensitivity and specificity using the QFT-GIT for the diagnosis of TPE were 48.8% and 79.3%, respectively, in pleural fluid. The best cutoff points for tuberculosis (TB) antigen, nil and TB antigen minus nil results were estimated at 0.70, 0.90 and 0.30 IU/ml, respectively. Area under the curve of TB antigen IFN-γ response was 0.86 (CI: 0.76–0.93), nil tube was 0.80 (CI: 0.69–0.89) and TB antigen minus nil tube was 0.82 (CI: 0.72–0.90). When the best cutoff scores of the nil tubes were set at this value, the results of a likelihood ratio of a positive and a negative test were 9.44 (7.4–12.0) and 0.37 (0.09–1.5), respectively. The percentages of indeterminate results in pleural fluid among the TPE cases were 42% (most of them caused by high nil IFN-γ values) using the QFT-GIT test. Conclusion: QFT-GIT test or its components have poor accuracy in the diagnosis of TPE, largely because of a high number of indeterminate results due to high background IFN-γ production in the TPE.

Environmental Asbestos-Related Pleural Plaque in Southeast of Turkey

ABSTRACT It is known that many malignant and benign pleural diseases occur due to environmental exposure to mineral fibers. Calcified pleural plaque (CPP) is an important sign of asbestos exposure on chest radiographic examination. To study the possible change in the prevalence of CPP and diffuse pleural thickening 3 decades after cessation of asbestos exposure. CPP were detected in 29.9% of the villagers; 4.7% had diffuse pleural thickening and 0.7% had asbestosis. The significant variable for CPP and diffuse pleural thickening was age. The youngest villager with CPP was 33 years of age and the prevalence of CPP increased with an increase in age. The reason for our cases with CPP being of advanced age is the discontinuation of asbestos exposure. This finding enables us to suggest that environmental asbestos-related disease will gradually decrease in future decades.

Multiple Metastatic Tuberculosis Abscesses and Pott's Disease in an Immunocompetent Patient: Case Report

pecially in Asia and Africa. Globally, 9.2 million new cases and 1.7 million deaths from TB occurred in 2006.1 Tuberculosis gumma or metastatic tuberculosis abscess is a rare form of cutaneous tuberculosis that develops because of hematogenous metastasis. Lesions are generally multiple in children with malnutrition and immunosuppressed adults.2,3 The most common locations are the lower extremities and chest. Cutaneous tuberculosis abscess is now rare in developed countries and tuberculosis is not often suspected as the possible cause of cutaneous abscesses.4 We present a