Osman Elbek

Tobacco Control in Turkey

This report was prepared by WHO within the framework of the Bloomberg Global Tobacco Control Initiative in collaboration with the Ministry of Health and the Tobacco and Alcohol Market Regulatory Authority in Turkey. It outlines the current state of tobacco-smoking in Turkey, including the health and social aspects, epidemiological data and economic, legal and political issues. Turkey, until recently one of the major tobacco-producing countries of the world, has made substantial progress in tobacco control in a short time. The initial efforts of the Ministry of Health in the late 1980s received an impetus when Turkey ratified the WHO Framework Convention for Tobacco Control in 2004. Law No. 4207 of 1996 was substantially amended in 2008 and thus became one of the most advanced tobacco control laws in the world. Even so, smoking is still a serious health problem in the country, with one tenth of all the disabilityadjusted life-years lost due to smoking. About one third of the population smokes, despite a slight decrease over the last 15 years.

Reliability of positron emission tomography-computed tomography in identification of mediastinal lymph node status in patients with non-small cell lung cancer

OBJECTIVE The involvement of mediastinal lymph nodes is a very important prognostic factor in patients with potentially resectable non-small cell lung cancer. Our aim in this study was to investigate the value of positron emission tomographic-computed tomographic scanning in staging lung cancer, especially for mediastinal lymph node evaluation, and to determine whether this could decrease the need for mediastinoscopy. METHODS Seventy-eight patients with non-small cell lung cancer who were potential candidates for surgical resection and admitted to the thoracic surgery unit of our hospital from March 2006 to June 2008 joined this prospective study. Positron emission tomographic-computed tomographic scanning was performed as part of the prospective studies used to diagnose or stage the tumors. All 78 patients underwent tissue sampling of mediastinal lymph nodes to compare these with imaging results. The diagnostic efficacy of the computed tomographic and positron emission tomographic-computed tomographic scans compared with histopathologic findings were calculated with sensitivity, specificity, positive and negative predictive values, and accuracy. RESULTS Final histology was available on 397 lymph node stations (N1, N2, and N3) sampled from 78 patients during mediastinoscopy or surgical intervention. Sensitivity, specificity, and positive and negative predictive values of mediastinal lymph node involvement in patients undergoing thoracic computed tomographic scanning were 45.4%, 80.5%, 27.7%, and 90%, respectively. The accuracy of computed tomographic scanning was 75.6%. The sensitivity, specificity, and positive and negative predictive values of mediastinal lymph node involvement in patients undergoing positron emission tomographic-computed tomographic scanning were 81.8%, 89.5%, 56.2%, and 96.7%, respectively. CONCLUSION There is a need for mediastinoscopy in positron emission tomographic-computed tomographic scanning-positive mediastinal lymph nodes, but it might not be necessary for positron emission tomographic-computed tomographic scanning-negative lymph nodes.

The efficacy and applicability of a pulmonary rehabilitation programme for patients with COPD in a secondary-care community hospital

Background and objective:  Pulmonary rehabilitation is known to have beneficial effects in COPD patients. This study aimed to assess the applicability and efficacy of a pulmonary rehabilitation programme in a community hospital lacking specialist pulmonary rehabilitation services.

Gender differences with respect to psychiatric comorbidity in obstructive sleep apnea syndrome.

Objectives: Psychiatric disorders are common in obstructive sleep apnea syndrome (OSAS); however, interrelating factors influencing psychiatric comorbidity (PC) in OSAS are unclear. The aim of this study is to investigate gender related differences with PC in OSAS. Methods: Data of patients diagnosed as OSAS in University of Gaziantep from January 2006 to January 2010 were retrospectively evaluated. Polysomnographic data were recorded with Viasys Sleep Screen (Viasys Healthcare, Germany). Patients younger than 18 years old were excluded. Results: PC was present in 53.1% of OSAS patients. The rate of male subjects with PC was 42.6%; however, 76.26% of females had PC (P = 0.00). Age (P = 0.00) and body mass index (BMI) (P = 0.00) were higher in patients with PC. Ferritin levels were lower in patients with PC (P = 0.00). Male subjects with PC were older and had lower sleep efficiency and longer rapid eye movement latency than males without PC. BMI was the only contributory factor to PC in female subjects. Conclusion: PC in OSAS is common, especially in females. Apnea hypopnea index does not seem to influence probability of PC.

High prevalence of diffuse parenchymal lung diseases among Turkish tinners.

High Prevalence of Diffuse Parenchymal Lung Diseases among Turkish Tinners: Oner Dikensoy, et al. Department of Pulmonary Diseases, Gaziantep University, Turkey—The objective is to investigate the prevalence of parenchymal lung diseases among tinners. Twenty‐four tinners who signed an informed consent form in the Gaziantep area were the subjects of this study. Demographics, spirometric test results, and high resolution computed tomography (HRCT) scans were obtained for all the tinners. Out of 24 tinners, eleven tinners (46%) had HRCTs consistent with DPLD. Of these 11 subjects, HRCT findings were consistent with respiratory bronchiolitis interstitial lung disease in nine, usual interstitial pneumonia pattern in one, and non‐specific interstitial pneumonia in one. HRCT patterns consistent with DPLDs are significantly prevalent among Turkish tinners. This is the first field study reporting this occupational lung hazard in tinners. Future research is needed to uncover the underlying mechanisms.

CT findings related to exposure to polyvinyl chloride

BACKGROUND Although some adverse health effects of exposure to polyvinyl chloride (PVC) are well known, there is limited evidence of its effects on the respiratory system. AIMS To assess the pulmonary effects of exposure to PVC with high-resolution computed tomography (HRCT). METHODS Workers and administrative staff of two PVC production plants completed questionnaires and went through pulmonary function testing and HRCT. Analysis of PVC dust in the work environment was performed by the Directorate of Occupational Health and Safety. RESULTS In total, 104 PVC-exposed workers and 43 administrative controls participated. HRCT revealed pleural and/or parenchymal changes in 55% of the exposed subjects. Pleural thickening was detected in 14 subjects, 13 of whom were in the exposed group (P < 0.05). Isolated pleural thickening without parenchymal involvement was present in seven workers, who were all in the exposed group (P < 0.05). Pleural thickening was frequently bilateral and localized to the parietal and visceral pleura. Round opacities, heterogeneous attenuation and ground-glass opacities were only detected in the exposed group (P < 0.05). Exposure to dust increased the risk of findings on HRCT (odds ratio (OR) 4.2, P < 0.05). There were no correlations between pulmonary function tests or respiratory symptoms and HRCT findings. HRCT changes were more common in subjects with forced mid-expiratory flow (FEF(25-75)) < 50% (P < 0.001). CONCLUSIONS This study found that exposure to PVC dust, at levels below the legal limit for respirable particulate matter, was associated with parenchymal changes and pleural thickening on HRCT.

Allergy skin test results of an outpatient pulmonary clinic in Gaziantep

Environmental factors play an important role in allergic sensitization. The aim of this study was to determine the spectrum of aeroallergen sensitivity of patients. The skin prick test results of patients with symptoms compatible with allergic diseases between March 2002 and December 2004 were retrospectively evaluated in Gaziantep University Pulmonary outpatient clinic. Of 1627 patients in whom skin prick tests (Stallergenes, France) were performed, 528 (32.5%) patients had at least one positive result among 8 allergens. The mean age of patients who had positive allergic skin test was 33.03 ± 11.80 (16-69), and 335 (63.4%) of those were female. Two hundred twenty five (52%) patients had positive skin prick test for one allergen tested, while 253 (48%) patients had positive skin prick test for multiple allergens. Phleum pratensis was the most common allergen found to be positive in 221 (41.8%) patients. The prevalence of positive tests were as follows; cockroach (32.9%), Dermatophagoides pteronyssinus (32.7%), Olea europea (27%), cat dander (14.9%), Parieteria officinalis (11.7%), Cladosporium (9.8%) and Alternaria (8.9%).Phleum pratensis and cockroach were the most common allergens causing a sensitivity reaction detected in our clinic.

Diffuse alveolar haemorrhage due to 5‐nitroimidazole treatment

Diffuse alveolar haemorrhage (DAH) is indicated by the presence of red blood cells, fibrin and haemosiderin deposits in the lung parenchyma. We present a case of DAH in a 25‐year‐old male following 5‐nitroimidazole treatment. The first episode of haemoptysis occurred following metronidazole treatment 10 months previously. The second episode of haemoptysis occurred following ornidazole treatment 10 days before admission. During his first admission, the patients haemoglobin concentration decreased to 40 g/L. The CXR was normal, whereas high resolution CT of the lungs revealed a diffuse acinonodular pattern. Serological tests for connective tissue diseases were negative. The haemorrhagic appearance of the BAL fluid obtained during fibreoptic bronchoscopy was consistent with DAH. Microbiological analysis of the BAL fluid showed no evidence for bacterial or mycobacterial infection. Haemosiderin laden macrophages were detected in BAL fluid and lung biopsy specimens. DAH due to use of 5‐nitroimidazole was diagnosed on the basis of the patients previous history and complete recovery following treatment with corticosteroid. This is the first reported case of DAH due to use of 5‐nitroimidazole. Physicians should be aware of this side‐effect when prescribing this group of drugs to patients.