Mehmet Meral

Silicosis Caused by Sandblasting of Jeans in Turkey: A Report of Two Concomitant Cases

Silicosis is a fibrotic disease of the lungs caused by inhalation, retention, and pulmonary reaction to crystalline silica. Crystalline silica exposure is widespread, and silica sand is an inexpensive and versatile component of many manufacturing processes. Its use and the incidence of silicosis are increased in industrial operations by the mechanization and the use of sandblasting, drilling, pulverizing, cutting, grinding tools and other pneumatic equipment. Sandblasting involves forcefully projecting a stream of abrasive particles onto a surface, usually with compressed air or steam. Mostly, silica sand is forced by compressed air onto the target surface. It has been commonly used in abrading metal or glass. Recently, it has been widely and increasingly used in sandblasting of jeans in Turkey. In this report, we present two concomitant cases of silicosis occurring in the same workplace, located in Istanbul, and caused by sandblasting of jeans. To our knowledge, there is no previous description of silicosis in such an occupation.

Comparison of Clinical Characteristics and Outcomes of Patients with COPD Exacerbation with or without Venous Thromboembolism

Background: Although some studies evaluated venous thromboembolism (VTE) prevalence in patients with chronic obstructive pulmonary disease (COPD), they contain no detailed description of the patients’ characteristics. Objectives: It was the aim of this study to investigate the frequency and clinical characteristics and outcomes of VTE in patients with COPD exacerbation. Methods: Between October 2004 and February 2005, 120 consecutive patients were included in the study. On admission, Doppler examination of lower extremities in all cases and spiral computed tomography of the thorax in cases with a suspicion of pulmonary thromboembolism were performed. A questionnaire was used to take a detailed history. In addition to routine laboratory tests, chest X-ray, postbronchodilator spirometry, arterial blood gas analysis and serum levels of D-dimer and C-reactive protein were evaluated, as well as dyspnea score and performance status before exacerbation. The hospitalization durations and mechanical ventilation requirements were also recorded. Results: VTE was determined in 16 cases (13.3%). In patients with VTE, the travel history was higher (p < 0.001), the dyspnea score worse (p = 0.005), the duration of hospitalization longer (p < 0.001) and the mechanical ventilation requirement increased (p < 0.001); a change in mental status was highly associated with the presence of VTE (p < 0.001). Conclusions: It seems that VTE occurrence was higher in the presence of a risk factor causing immobility such as travel history and increased dyspnea. The cases with severe disease are more likely to have VTE. Preventive measures may be considered in such patients because their hospitalization stay and mechanical ventilation requirement are increased.

Comparison of the efficacy of nebulised budesonide with parenteral corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease.

ObjectiveTo compare the efficacy and safety of nebulised budesonide and systemic corticosteroid in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD).DesignRandomised, double-blind, placebo-controlled, parallel-group trial.Patients and interventionsA total of 40 patients who had moderate to severe acute exacerbations of COPD and required hospitalisation were enrolled in the study. The patients were randomised to receive either nebulised budesonide 8mg daily (n = 21) or systemic (intravenous) prednisolone 40mg daily (n = 19). Airway obstruction (peak expiratory flow rate [PEFR]) and gas exchange (arterial partial pressure of oxygen [PaO2] and carbon dioxide [PaCO2], pH and oxygen saturation [SaO2]) were evaluated at 30 min, at 6, 24 and 48 hours, and at day 10.ResultsThere were no significant differences between groups at baseline. In both groups, differences were significant for PEFR, SaO2 and PaO2 (p < 0.001), but not for PaCO2 and pH, in comparison with their baseline values. There were no significant differences between groups for all parameters (PEFR, PaO2, PaCO2, pH and SaO2) at all time periods. No adverse events were recorded in either group.ConclusionsOur study suggests that nebulised budesonide may be an alternative to parenteral corticosteroids in the treatment of acute exacerbations of COPD.

Serum IL-18 levels in tuberculosis: Comparison with pneumonia, lung cancer and healthy controls

Objective:  The aim of the present study was to document the serum IL‐18 levels in patients with pulmonary tuberculosis (P‐TB), extrapulmonary tuberculosis (EP‐TB), pneumonia, lung cancer and in healthy controls, and to investigate whether it may assist in the differential diagnosis of P‐TB.

Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic

BackgroundPharmacologic therapies have an important role in the success of interventions for smoking cessation. This study aims to determine the efficacy of several pharmacologic treatments in patients who applied to a smoking cessation clinic.MethodsThis retrospective study includes 422 patients who presented to our smoking cessation clinic between January 2010 and June 2013, used the pharmacologic treatment as prescribed and completed the one-year follow-up period. All patients were assessed using the Fagerström Test for Nicotine Dependence (FTND) and received both behavioral therapy and pharmacotherapy. Patients’ smoking status at one year was assessed by telephone interview.ResultsThe patients were 24.3% female (103/422) and 75.7% male (319/422) with a mean age of 38 ± 10 years. Patients were divided into three groups: varenicline (166 patients), bupropion (148 patients) and nicotine replacement therapy (108 patients).The smoking cessation rates of these groups were 32.5%, 23% and 52.8%, respectively, and were statistically significant (p > 0.001). The overall success rate was 35%. Further analysis revealed that pharmacologic therapy (p > 0.001) and gender (p = 0.01) were factors that showed statistically significant effects on smoking cessation rates. Males had higher success rates than females. The overall relapse rate was 21.6% and the bupropion group showed the highest relapse rate among treatment groups. Lack of determination emerged as the most important factor leading to relapse.ConclusionNicotine replacement therapy was found to be more effective at promoting abstinence from smoking than other pharmacologic therapies.

Two different dosages of nebulized steroid versus parenteral steroid in the management of COPD exacerbations: a randomized control trial.

Background The study aimed to compare the efficacy and safety of nebulized steroid (NS) with systemic corticosteroids (SC) and to determine optimal NS dose in the treatment of patients with COPD exacerbations requiring hospitalization. Material/Methods The study was a randomized, parallel design trial. Eligible patients (n=86) were randomly allocated to 1 of the 3 treatment groups: parenteral corticosteroid (PS) (n=33), 4 mg (NB) (n=27), or 8 mg NB (n=26). Partial pressure of arterial oxygen (PaO2), carbon dioxide (PaCO2), pH, and oxygen saturation (SaO2) were evaluated at baseline, 24 h, 48 h, and discharge. Airway obstruction (forced vital capacity [FVC] and forced expiratory volume 1 s [FEV1]) was evaluated at admission and discharge. Results There were no significant differences between the groups for all parameters at all time periods, except for higher FEV1 value in the 8-mg NB group at baseline. In groups, significant differences were determined for FVC, FEV1, PaO2, and SaO2 (p<0.001), but not for PaCO2 and pH, in comparison to their baseline values. As adverse events, hyperglycemia and oral moniliasis were observed in the PS group (n=4) and in the NB groups (n=5), respectively, and treatment change was required in 9 patients (2 patients in the PS group and 7 patients in the NB groups) (p=0.57). Conclusions Nebulized budesonide may be used as an alternative to SC because of its equal effectiveness and lesser systemic adverse effects. The choice of optimal dosage needs to be evaluated carefully because adverse effect and dropout rates varied according to dosage. However, there is a need for further studies including more severe cases and evaluating long-term outcomes or relapses comparing the 3 arms.

Liver dysfunction in patients with acute pulmonary embolism

Aim:  Although liver injury due to cardiac, chronic respiratory and circulatory failure has been reported, this has yet to be studied in patients with pulmonary embolism (PE). We investigated liver injury in patients with acute PE.

Low-Molecular-Weight Heparin Use with Thrombolysis: Is it Effective and Safe? Ten Years' Clinical Experience

Background: There is no data on the use of subcutaneous low-molecular-weight heparin (SC LMWH) in cases that require thrombolysis. Objective: Having used SC LMWH with thrombolytics for more than 10 years, we aimed to review our data, share our experiences and find out whether the use of SC LMWH with thrombolytics had been effective and safe. Method: This is a retrospective cohort study. Patients who were diagnosed as acute pulmonary embolism (PE) and received either SC LMWH treatment or SC LMWH with thrombolytics in our hospital (a tertiary hospital) between 2000 and 2010 were included in the study. For both treatments, the rates of mortality and complications were calculated. Results: A total of 392 patients, 210 female (53.5%) and 182 male (46.5%) with an average age of 60 years, ±16 SD, with acute PE, were included in the study. Of these patients, 107 (27.2%) were massive and 285 (72.8%) were nonmassive and were administered SC LMWH plus thrombolytics and only SC LMWH, respectively. The mortality rate was 16.8% (18 of 107) in patients who were massive and 3.5% (10 of 285) for those who were nonmassive (p < 0.001). Major hemorrhage occurred in 3.7% (n = 4) and 0.7% (n = 2) and minor hemorrhage in 12.1% (n = 13) and in 3.8% (n = 11) of the cases who received SC LMWH plus thrombolytics and SC LMWH, respectively. Conclusion: SC LMWH use with thrombolytics seems to be feasible and safe. Prospective, large, randomized control trials are still required in order to confirm these results.

Analysis of HLA class I and II alleles regarding to lymph node and distant metastasis in patients with non-small cell lung cancer

The aim of this study was to investigate the relation of HLA alleles in patients with non-small cell lung cancer (NSCLC). The incidence of class I and II HLA alleles of 63 patients with NSCLC were prospectively compared with the incidence of class I and II HLA alleles with 88 healthy controls. The number of cases with stage I and II (early stage) was 12 and there were 51 cases with stage III and IV (advanced stage). Metastasis rates of the regional lymph node in patients were as follow; N(0): n=10; N(1): n=13; N(2): n=26 and N(3): n=14. Lymph node metastasis was detected by pathological staging in 15 cases and by clinical staging in 48 cases. Lymph node metastasis was searched in all patients by a helical thorax CT. All distant metastasis were investigated by thorax CT, abdominal CT, brain CT or MRI and bone scintigraphy, and distant organ metastasis was detected in 25 cases. The patients and healthy controls were typed for HLA class I and II alleles. HLA-A2 was an independent risk factor for both critical lymph node (N(2 and 3)) involvement and distant metastasis. HLA-B44, -CW6 and -CW7 frequencies appear to be significant in controls compared to patients. HLA-A2 frequency was higher in patients with advanced stage than early stage, while HLA-A26, -B35 and -CW4 frequencies were more expressed in patients with early stage than in patients with advanced stage. Compared with controls, frequency of HLA-DRB1*07, -DQ02 and -DQ07 were lower expressed in patients. Compared patients with advanced stage, HLA-DRB1*07 was higher in patients with early stage. HLA-A2 was an independent risk factor for lymph node and distant metastasis, and the allele was significantly higher in patients with critical lymph node for surgery and distant metastasis. HLA-A26 appeared to be a significance protective allele against to metastases.

Frequency of Class I and II HLA alleles in patients with lung cancer according to chemotherapy response and 5-year survival

Lung cancer is the most common cause of cancer death in the world, and the most common type is non‐small‐cell lung cancer (NSCLC). At present, surgical resection, chemotherapy, and radiation therapy are the main treatments for patients with NSCLC, but unfortunately outcome remains unsatisfactory.