Mustafa Erelel

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

BackgroundTuberculosis (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.ResultsThe 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.ConclusionHCWs 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 additional value of FDG PET imaging for distinguishing N0 or N1 from N2 stage in preoperative staging of non-small cell lung cancer in region where the prevalence of inflammatory lung disease is high.

Purpose: The aim of this study was to evaluate the efficacy of PET imaging and compare it with the performance of CT in mediastinal and hilar lymph node staging in potentially operable non-small cell lung cancer (NSCLC). Methods: Fifty-nine patients with potentially resectable NSCLC who underwent preoperative PET and CT imaging were enrolled into this prospective study. All patients underwent surgical evaluation by means of mediastinoscopy with mediastinal lymph node sampling (14 patients) or thoracotomy (45 patients). Results: The prevalence of lymph node metastases was 53%. Overall, the sensitivity, specificity, accuracy, PPV, and NPV of PET were 79%, 76%, 78%, 86%, and 76% for N0 and N1 lymph nodes and 76%, 79%, 80%, 67%, and 83% for N2 lymph nodes, while those values for CT were 66%, 43%, 58%, 68%, and 43% for N0 and N1 stations and 43%, 66%, 54%, 41%, and 66% for N2 lymph nodes, respectively. PET correctly differentiated cases with mediastinal lymph node involvement (N2) from those without such involvement (N0 or N1) in 76% of cases. Statistical analysis of the diagnostic accuracy of nodal involvement showed that PET improves diagnostic accuracy significantly in the detection of both N0 or N1 and N2 status in the individual patient based on analysis, compared with CT (P < 0.01 and P < 0.01, respectively). When preoperative nodal staging was compared with postoperative histopathological staging, 38 (65%) patients were correctly staged, 9 (15%) were overstaged, and 12 (20%) were understaged by PET, while 29 patients (49%) were correctly staged, 13 (22%) were overstaged, and 17 (29%) were understaged by CT. Conclusion: It has been clearly shown that PET is more accurate than CT for the differentiation of N0 or N1 from N2 disease in patients with NSCLC. However, PET imaging alone does not appear to be sufficient to replace mediastinoscopy for mediastinal staging in patients with lung cancer, especially in geographic regions with high granulomatous or inflammatory mediastinal disease prevalence.

Pulmonary Alveolar Lithiasis in Two Siblings

Pulmonary alveolar microlithiasis (PAM) is a rare disease of unknown etiology and is characterized by the deposition of calcium phosphate microliths within the alveolar airspaces. We report 2 asymptomatic siblings, a 7-year-old girl and her 13-year-old brother, with PAM. In the girl, chest X-ray and computed tomography revealed diffuse interstitial changes but no uptake of technetium 99m (99mTc) on bone scan was noted in the lung. Microliths stained pink with Papanicolaou dye in bronchoalveolar lavage fluid (BALF) but did not stain with von Kossa. In the brother, characteristic radiological findings and 99mTc uptake in the lung were detected. The microliths stained pink with Papanicolaou in BALF and black with von Kossa as well. We hypothesize that the first case is in the early phase of PAM because of lack of 99mTc uptake.

Health Problems of Garbage Collectors in Istanbul

Diseases from poisonous gases and micro-organisms in the air near garbage dumps and poisoning by polluted underground water and soil may result in serious health problems. The object of this study was to determine the negative impact of their occupation on full-time garbage collectors and to determine the microbiologic flora of their immediate environment. This study was performed with 228 selected individuals who worked daily in 5 different garbage collection units in several districts of Istanbul. The level of exposure to microbiologic flora was studied using a Merck Air Sampler MAS 100, and total bacteria, yeast and mildew concentrations per square metre and minute (cfu/m2/min) were calculated. Respiratory functions of all individuals in the study were evaluated with a computerised spirometer (MIR spirobank). Aspergillus and Penicillium spp. were the commonest species detected followed by Candida spp., Mycelia sterilia, Rhizopus spp. and Mucor spp. The study of respiratory functions showed that the FVC%, FEV1%, PEF% and FEF25–75% of the garbage collectors were below 80% compared to non-collectors: OR = 2.89 (95% CI 1.14–7.30) in FVC%, OR = 2.89 (95% CI 1.41–5.92) in PEF%, OR = 2.46 (95% CI 1.33–4.56) in FEF25–75% and OR = 4.48 (95% CI 1.90–10.58) in FEV1%. A long expirium period and ronchus symptoms were detected in 11 collectors (31.4%) and 4 drivers (11.4%) out of 32 collectors and 35 drivers whose respiratory function tests gave low values. Clinical findings between the two groups were statistically significant (p < 0.05), OR = 4.06 (95% CI 1.13–14.46). The exposure to airborne microbes could produce respiratory disorders, gastroenteritis, dermatitis and many other complaints.

Role of Zafirlukast on skin prick test

BACKGROUNDnSome anti-allergic and anti-asthmatic drugs should be discontinued before skin prick test. But there is no knowledge about zafirlukast effects on skin prick test. We investigate the effects of zafirlukast on cutaneous response to histamine and specific allergens.nnnMATERIAL AND METHODSn9 patients suffering from allergic mild asthma or allergic rhinitis and 8 healthy individuals were recruited to the study. All of them took 20 mg zafirlukast twice daily for at least 5 days. Skin prick test was performed before and after treatment by histamine and specific allergens. There was no significant difference between pre- and post-treatment skin prick tests in spite of zafirlukast treatment.nnnCONCLUSIONnZafirlukast does not affect skin reactions against histamine and specific allergens. Diagnostic skin prick test can be performed under zafirlukast treatment.

Respiratory Problems in Tannery Workers in Istanbul

Tannery workers are exposed to many chemical and physical hazards. The current study involved 730 workers from 23 leather factories located in the Tuzla Organized Industry Region, Istanbul. Participants were interviewed and underwent clinical examination. After the basic physical examination, respiratory functions were measured by spirometer and the workers questioned about asthma. Health problems included gastrointestinal complaints (7.30%), bronchitis (3.11%) and asthma (3.0%). Signs of bronchial obstruction — wheeze and rhonchus — were detected in 71 (9.72%) workers. A deficit in the values of FVC%, FEV 1%, FEV1/FVC%, PEF%, FEF25— 75% was set nominally at 80% of the respiratory function test parameters. Decreased pulmonary function results were found for FVC% in 36 (4.93%) workers, FEV1 in 71 (9.72%), FEV1/FVC in 18 (2.59%), PEF in 183 (25.1%) and FEF25—75% in 204 (27.94%). The number of those with respiratory obstruction detected by spirometry was 294 cases (40.27%), more than the number of cases, 263 (36.02%), who claimed res- piratory problems in the questionnaire. This study was a contribution towards efforts to improve the factory envi- ronment and control workplace risks. Together with med- ical examinations before and during employment and provision of continuous health services and training will reduce the risk of occupational disease to a minimum. Introduction Leather production is one of the worlds oldest trades, consisting of a chemical process that turns animal hides into the much less perishable material, leather. As part of this process, after the removal of the epidermis and subcu- taneous tissue, the dermal collagen fibres are stabilized by means of chemical treatment known generically as tanning [1]. Employees who work in tanneries are liable to be affected by their exposure to lots of hazardous materials and processes during tanning. These hazards can be grouped into four categories: biological, physical and chemical hazards and work accidents.

Are pulmonary bleb and bullae a contraindication for hyperbaric oxygen treatment

BACKGROUNDnAir cysts or blebs in the lungs may predispose pulmonary barotrauma (PBT) by causing air trapping when there is a change in environmental pressure. The changes in the environmental pressure are also seen during hyperbaric oxygen treatments (HBOT).nnnAIMnThe aim of this study was to determine how patients were evaluated for pulmonary blebs or bullae, and PBT prevalence in different HBOT centers.nnnMETHODSnHBOT centers were asked to participate in this study and a questionnaire was send via e-mail. A total of 98 centers responded to our questionnaire.nnnRESULTSnSixty-five HBOT centers (66.3%) reported that they applied HBOT to the patients with air cysts in their lungs. X-ray was the most widely used screening method for patients with a history of a lung disease. The prevalence of PBT in theses centers was calculated as 0.00045%.nnnCONCLUSIONSnOur survey demonstrated that (1) a significant portion of the HBO centers accept patients with pulmonary bleb or bullae, (2) although insufficient, X-ray is the mostly used screening tool for patients with a history of pulmonary disease and (3) the prevalence of pulmonary barotrauma is very low in HBOT.

Metabolic syndrome in collection and disposal of solid waste sector

ObjectivesThis study aims to assess the frequency and factors relevant to metabolic syndrome in workers employed in the collection and disposal of solid waste sector.Materials and MethodsThis cross-sectional study was conducted in the major solid waste collecting and disposal company named İSTAÇ AŞ (İstanbul Environmental Protection and Waste Processing Corporation) in Istanbul, Turkey. All 715 male employees of the company were included in the study without sampling. The study was completed with 619 subjects. Since it was a small group, female workers were not taken into account in the study. Metabolic syndrome frequency was investigated according to the NCEP-ATP III criteria including the levels of systolic and diastolic blood pressure, waist perimeter, HDL, triglyceride, fasting blood glucose values.ResultsMetabolic syndrome was present in 40.9% of participating employees. Metabolic syndrome was more common in those working in the excavation field (54.0%), such as caterpillar operators (56.5%), and less common in employees working in administrative offices, such as office staff or managers, who were under 35 years old and who had been working for less than 10 years (p < 0.05). Employees working in work stations other than administrative offices had a 2.60 times higher risk compared to those working in administrative offices.ConclusionsMetabolic syndrome may be related to work station, job, age and period worked by the subjects.

Biological Hazards in Tannery Workers

A total of 431 workers from 14 leather factories located in the Tuzla Organized Industry Region, Istanbul were involved in the study. Subjects were interviewed and examined individually with regard to asthma symptoms. Physical examinations were undertaken and respiratory function measured by spirometer. Moreover, the atmosphere of the working areas in the factories was assessed microbiologically. The fungal genera most often detected were Penicillium spp., followed by Aspergillus spp., Alternaria spp., Scopulariopsis spp., and Cladosporium spp. multiplying at differing rates. The number of those physically examined with indications of peripheral respiratory obstruction was 176 (40.8%) while those with suspected asthma following questioning was 153 (35.5%). The obstruction demonstrated by the use of respiratory function tests was associated with the mold isolated from the environment and was included in the logistic model that was developed as a risk factor for increasing obstruction. Workers employed in tanneries encounter many health problems. These may be reduced by: improving the factory environment, environmental control of allergens, elimination of allergen reservoirs, control of humidity and reducing exposure to excessive heat or cold. In addition there should be air filtration and vacuum cleaning to control dust mites and control of other workplace risks not necessarily associated with tanning. Importantly, workers should have medical examinations before employment and periodic examinations during training and employment to reduce the risk of occupational diseases to a minimum.

Follow-up of 1887 patients receiving tumor necrosis-alpha antagonists: Tuberculin skin test conversion and tuberculosis risk

To evaluate the characteristics of patients who developed tuberculosis while receiving tumor necrosis factor‐alpha (TNF‐α) antagonists and the related factors with tuberculosis.