Murat Unalacak

Levels of serum IL-1beta, IL-2, IL-8 and tumor necrosis factor-alpha in patients with unstable angina pectoris.

OBJECTIVES Inflammation is the most important mechanism of plaque disruption playing an essential role in acute coronary syndromes. It is controversial whether the inflammatory mediators are the cause or the result in the development of plaque rupture. Stimulation of interleukins increases adhesion molecules, fibrinogen and plasminogen activator inhibitors,which cause the activation of inflammation and thrombosis. However, the importance of interleukins in acute coronary syndromes has not been clearly defined. We did not find any article concerning relations between the levels of serum interleukin(IL)-1beta, IL-2, IL -8 and tumor necrosis factor (TNF)-alpha in patients with unstable angina pectoris (UAP). So the aim of this study was to determine the levels of serum I -1b, IL-2, IL-8 and TNF-alpha during the early stage of UAP. METHODS AND RESULTS Thirty-seven patients with UAP(12 females and 25 males; mean age, 57.5 +/- 9.7 years) within 6 h of admission and 20 healthy volunteers(eight females and 12 males; mean age, 51.3 +/- 6.3 years) were included in the study. IL-1beta, IL-2, IL-8 and TNF-alpha levels were measured using the enzyme-linked immunosorbent assay method. Patients with acute or chronic inflammation, renal failure or chronic heart failure were excluded from the study. The age, gender and risk factors of the study and control groups were similar. The levels of IL-1beta, IL-8 and TNF-alpha were significantly increased (p < /0.0001, p < /0.001 and p < /0.016, respectively) in patients with UAP. There was no difference of IL-2 levels between the UAP group and controls. CONCLUSION We detected high levels of IL-1beta, IL-8 and TNF-alpha in patients with UAP during early phase. We suggest that proinflammatory cytokines (e.g. IL-1beta,IL-8, TNF-alpha) may play an important role in the development of atherosclerosis and its complications.

Smoking Prevalence, Behaviour and Nicotine Addiction among Coal Workers in Zonguldak, Turkey

Smoking Prevalence, Behaviour and Nicotine Addiction among Coal Workers in Zonguldak, Turkey: Murat Unalacak, et al. Department of Family Medicine, Zonguldak Karaelmas University, Faculty of Medicine, Turkey—To assess the smoking status of coal workers, as coal dust exposure and concomitant cigarette smoking contribute to the increased prevalence of pulmonary interstitial fibrosis, chronic obstructive pulmonary disease and other pulmonary diseases. A survey was conducted to determine the smoking prevalence, behaviour and nicotine addiction in coal workers. The target population consisted of 475 underground coal workers who lived in Zonguldak city of Turkey, and we reached 389 of them. Each subject completed a detailed smoking history questionnaire (included 56 question). Chest X‐rays and pulmonary function tests were performed to evaluate patients’ related diseases and complications. Smoking status of the workers was as follows; Sixty‐nine never smokers (17.7%), 62 ex‐smokers (15.9%) and 258 current smokers (66.3%). The mean age of starting smoking was similar among ex and current smokers (15.9 ± 4.2 versus 15.0 ± 4.0). The most common reason for starting smoking was smoking interest (50%) and friends’ influence (15.5%). The most frequent reason stated for successful smoking cessation was experience of smoking—related symptoms or development of a medical condition (51%). The most important reason given by current smokers for smoking cessation attempts was increased chance of developing lung cancer, pneumoconiosis and other diseases (22.9%). Nicotine addiction was assessed by the Fagerstroem test. Mild (0–3 points), moderate (4–6) and severe (7 or more) addiction ratios were found to be 39.1%, 44.2% and 16.7 % respectively. Ex‐smokers had the highest prevalence of large and small airway obstruction on spirometry. Smoking prevalence is high in coal workers living in Zonguldak city of Turkey. Most of the smokers know that smoking is dangerous and want to quit smoking. A detailed smoking history during medical surveillance may help the occupational physician to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.

Guttate psoriasis-like lesions following BCG vaccination.

A 7-year-old boy presented to our clinic with a 1-week history of guttate psoriasis-like lesions after BCG vaccination. Although the patient did not have any history of psoriasis, his father and uncle had a history of psoriasis vulgaris. He was treated successfully with topical corticosteroid. Complete healing was seen after 3 weeks and the patient was still in remission 4 months after the cessation of the therapy. We proposed that patients who have psoriasis or predisposition to psoriasis must be carefully followed after BCG vaccination.

Fourteen-Year Trend of Tuberculosis Dynamics in the Northwest of Turkey

Background: The incidence of tuberculosis (TB) in different countries as estimated by the World Health Organization (WHO) vary from 23/100,000 and less in industrialized countries, 191/100,000 in Africa and 237/100,000 in South East Asia. Objectives: The aim of this study was to analyze the dynamics of TB in the northwest of Turkey, between 1988 and 2001. Methods: All pulmonary TB cases reported to the National Tuberculosis Center by local TB dispensaries during 1988–2001 were analyzed. The number of new and relapsed TB cases were documented and classified according to age and type of TB (standard classification of TB patients according to disease type: pulmonary, new, smear positive; pulmonary, smear negative; relapse, and extrapulmonary). We recorded information about the prevalence of TB in different patient groups (patients with a contact history, patients who were detected in active community screening or passive case finding), TB trends in different age groups, type of TB, patients who had relapses, percentage of patients who were lost to follow-up. Results: A total number of 288,996 patients were examined at Zonguldak Tuberculosis Dispensary between 1988 and 2001. Case notification rates of TB decreased over the study period. Respiratory TB was the most commonly encountered form of disease (>90%). The percentage of TB decreased in the 0- to 14-, 15- to 24-year-olds and increased in the 25- to 44- and 45- to 64-year-olds. Conclusion: Properly designed disease surveillance systems are critical for monitoring the TB trends so that each country can identify its own high-risk groups and target interventions to prevent, diagnose, and treat the disease.

Effect of iodine supplementation on goiter prevalence among the pediatric population in a severely iodine deficient area

We evaluated goiter status and urinary iodine excretion (UIC) of 304 school-children (7-12 years old) 3 years after a law was passed for mandatory production of iodinated salt in an area previously characterized by severe iodine deficiency in Zonguldak, a mountainous city in the West Black Sea region in Turkey. We examined all the children for goiter by palpation, measured sonographic thyroid volumes (STV) and UIC. Eighty-two percent of families had been using iodinated salt. UIC was above 100 microg/l in 71.2% of the children and median UIC was sufficient (143.5 microg/l). The prevalence of goiter was lower at ultrasound (14.6%) than by palpation (19.4%). Median STV values were within recommended normal limits at all ages. Although Zonguldak had been a highly endemic region, it became mildly endemic 3 years after mandatory iodination of salt, with decrease of goiter prevalence.

Occupational Allergic Diseases in Kitchen and Health Care Workers: An Underestimated Health Issue

Objective. This study evaluated the frequencies of allergic symptoms and rate of upper respiratory infections during the past year in the general population, kitchen workers (KW) and health care workers (HCW). Methods. The European Community Respiratory Health Survey (ECRHS) was used to inquire retrospectively about asthma and asthma-like symptoms and the number of treatments required for previous upper respiratory tract infections (URTI: acute pharyngitis, acute sinusitis, etc.) during the past year for health care workers, kitchen workers, and members of the general population. Adjusted odds ratios by gender, age, and smoking status were calculated. Results. 579 subjects (186 from the general population, 205 KW, and 188 HCW; 263 females, 316 males) participated in the study. Noninfectious (allergic) rhinitis was significantly higher in the HCW and KW groups than in the general population (P < 0.001). Cumulative asthma was significantly higher only in the HCW group (P < 0.05). In addition, the HCW and KW groups had significantly higher risks of ≥2/year URTI (OR: 1.59, 95% CI: 1.07–2.38 versus OR: 1.57, 95% CI: 1.05–2.38) than the general population. Conclusion. Occupational allergic respiratory diseases are an important and growing health issue. Health care providers should become familiar with workplace environments and environmental causes of occupational rhinitis and asthma.

Çocuklara kötü muamele: İstismar ve ihmal

Hemangiomas are the most common tumors of infancy. Most of them require no treatment, but treatment is needed if dramatic aesthetic, and/or functional impairment as visual or airway obstruction or ulceration arises. We reported a 6-month-old infant presented with a 6-week history of a rapidly growing cutaneus hemangioma on the right eyelid and caused visual impairment. The patient was successfully treated with the use of oral propranolol therapy. We suggest that propranolol can be considered as a first line treatment in a patient with infantil hemangioma.Objectives: The aim of this study was to examine levator palpebralis superior muscle histologically in patients with congenital blepharoptosis and to investigate the relationship between these findings and age, sex and degree of blefaroptosis in this patient group. Materials and methods: Levator muscle of 13 patients with congenital ptosis, who had applied to Dicle University Medical Faculty Ophthalmology Clinic and had undergone levator palpebralis superior muscle resection between january 2009-january 2010, has been examined histopathologically in Histology and Embriology Deparment. During preoperative period, ptosis amount, levator function (LF), tear functions, Bell\s phenomenon and jaw-winking phenomenon were evaluated. All patients underwent resection of levator palpebralis superior muscle. Received postoperative levator muscle was examined by light microscopy. Results: The average age of 9 (69.2%) male and 4 (30.8%) female cases were 10.61 p 4.77 (4- 19) years. In histological examination, the quality and quantity of the levator muscle fibrils have been assessed. There was no relationship detected between histological features of levator palpebralis superior muscle and patient\s age and gender (p>0.05). Patients with weak levator palpebralis superior muscle were detected to have fatty degeneration histologically. The higher the levator palpebralis superior muscle function revealed decreased fatty degeneration and increased skeletal muscle fibrils. Conclusion: More ultrastructural studies in larger populations are needed to support the relationship between structure and function of levator palpebralis superior muscle in patients with congenital blepharoptosis.Amac: Lateral epikondilit (tenisci dirsegi) en fazla tani konulan dirsek yan agri nedenidir. Bu calismanin amaci tenisci dirsegi tedavisinde tek doz kortikosteroid enjeksiyonu ile otolog trombositten zengin plazma (TZP) enjeksiyonunun etkilerini karsilastirmaktir. Gerec ve yontem: Dirsek yan kisminda agri sikâyeti sonucu klinigimize muracaat edip, lateral epikondilit tanisi konan 15 hastanin (6 erkek ve 9 kadin) 15 dirsegi calisma kapsamina alindi. Olgularin 1. grubuna tek doz 0,5 ml Bethametasone ve 0.5 ml Prilokain karisimi, 2. grup olgulara 1ml otolog TZP lokal olarak uygulandi. Bulgular: Verhaar skorlama sistemine gore alinan sonuclara gore ilk takiplerde lokal steroid enjeksiyonu yapilan hasta grubunda sonuclarin daha iyi oldugu fakat sonraki takiplerde iyi sonuclarin goruldugu vaka sayisinda azalma oldugu goruldu. TZP grubunda ise ilk takiplerde sonuclarin kotu oldugu fakat sonraki takiplerde daha iyi sonuclarin alindigi goruldu. Sonuc: Otolog TZP enjeksiyonun lateral epikondilitte iyi yonde etkinliginin zamanla artigi soylenebilir, fakat bunun daha iyi anlasilmasi icin olgu sayisi ve takip suresi artirilmis yeni calismalarin yapilmasi gereklidir.