Sefa Levent Ozsahin

Pulmonary toxicity of chronic exposure to tobacco and biomass smoke in rats

OBJECTIVE: The objective of this study was to examine the separate and combined effects of tobacco and biomass smoke exposure on pulmonary histopathology in rats. INTRODUCTION: In addition to smoking, indoor pollution in developing countries contributes to the development of respiratory diseases. METHODS: Twenty-eight adult rats were divided into four groups as follows: control group (Group I, no exposure to tobacco or biomass smoke), exposed to tobacco smoke (Group II), exposed to biomass smoke (Group III), and combined exposure to tobacco and biomass smoke (Group IV). After six months the rats in all four groups were sacrificed. Lung tissue samples were examined under light microscopy. The severity of pathological changes was scored. RESULTS: Group II differed from Group I in all histopathological alterations except intraparenchymal vascular thrombosis. There was no statistically significant difference in histopathological changes between the subjects exposed exclusively to tobacco smoke (Group II) and those with combined exposure to tobacco and biomass smoke (Group IV). The histopathological changes observed in Group IV were found to be more severe than those in subjects exposed exclusively to biomass smoke (Group III). DISCUSSION: Chronic exposure to tobacco and biomass smoke caused an increase in severity and types of lung injury. CONCLUSION: Exposure to cigarette smoke caused serious damage to the respiratory system, particularly with concomitant exposure to biomass smoke.

Radiografia torácica e bacteriologia na fase inicial de tratamento de 800 pacientes masculinos com tuberculose pulmonar

OBJECTIVE To evaluate chest X-rays of patients with pulmonary tuberculosis and to determine whether the extent of radiographic lesions correlates with bacteriological parameters. METHODS In this retrospective, descriptive study, we evaluated chest X-rays, as well as AFB detection by smear microscopy and culture for Mycobacterium tuberculosis, initially and during the first two months of treatment, in 800 male patients hospitalized between 1995 and the present at a 250-bed hospital in northwestern Turkey. RESULTS The initial mean ESR was 58 ± 37 mm/h. Initial sputum smears and cultures were positive in 83.8% and 89.5% of the patients, respectively. After the first month of treatment, the proportion of patients with positive sputum culture was higher among those with cavitary tuberculosis than among those with non-cavitary tuberculosis (53.7% vs. 37.7%, p < 0.001). The number of affected zones was not correlated with age, symptom duration, contact with an active tuberculosis patient, or concomitant diabetes (p > 0.05 for all) but was positively correlated with the ESR (r = 0.23, p < 0.001). During the first and second months of treatment, conversion to smear-negative status was less common in patients with bilateral involvement than in those with unilateral involvement (p < 0.001 and p = 0.002 for months 1 and 2, respectively). Disease extent did not correlate with age, symptom duration, contact with an active tuberculosis patient, or concomitant diabetes but did correlate with delayed bacteriological recovery. CONCLUSIONS Chest X-ray and bacteriology are valuable tools for the evaluation of pulmonary tuberculosis.

Prevalence of asthma and related symptoms in Sivas, Central Anatolia

Background. In our clinical experience, asthma is an important health problem in our region, but we did not know its prevalence. Objective. The main objective of our study was to assess the prevalence of asthma in Sivas, a city in Central Anatolia. Methods. A cross-sectional study was performed using a screening questionnaire adopted from European Community Respiratory Health Survey (ECRHS). A total of 5448 adults of both genders between 20 and 107 yr of age living in Sivas, a city in the central region of Anatolia in Turkey, participated in the survey. Of the cohort, 2691 were men (49.4%) and 2757 (50.6%) were women. Results. The mean age was 38.2 yr (SD = 12.7 yr), almost half of the study population was at or younger than 40 yr of age. The prevalence of wheezing in the last 12 months, diagnosis of asthma, asthma attack in the last 12 months, and use of asthma medicine were 20.9%, 4.5%, 4.9%, and 3.4%, respectively. Awakening with chest tightness, with shortness of breath, or with cough were reported as 14.2%, 14.8%, and 22.7%, respectively. The prevalence of respiratory symptoms related to asthma was statistically higher in women than that of men (p = 0.000, OR 1.346, 95% CI: 1.228–1.475). Those who had asthma/allergic symptoms in their family members were significantly younger than others (p : 0.001). Conclusions. The results of this study demonstrate that symptoms suggestive of asthma are quite common and constitute a major health problem in Sivas, Turkey. This study also showed that, despite a high rate of reported symptoms exists, the rate of diagnosis and treatment of asthma is low among the adult population in Sivas.

Thoracic computed tomography findings in malignant mesothelioma.

Background Malignant pleural mesothelioma (MPM) is an uncommon neoplasm. MPM occurs more frequently in patients born or living in certain villages of Turkey. Objectives We aimed to review radiological findings of MPM. Patients and Methods We reviewed the CT findings in 219 biopsy-proven MPM patients admitted to our clinic between 1993 and 2008. Results The most common CT findings included pleural thickening (n=197, 90%) classified as diffuse (n=138, 63%), nodular (n=49, 22%) and mass-type (n=16, 7%). Pleural effusion was found in 173 patients (79%), involvement of the interlobar fissures in 159 (73%), mediastinal pleural involvement in 170 (78%), volume contraction in 142 (65%), mediastinal shift in 102 (47%) and mediastinal lymphadenopathy in 54 (25%). Conclusion MPM may present with diverse radiological features. Pleural thickening and pleural effusion were the most frequent radiological findings. Thoracic CT scans might be assessed more cautiously in patients with environmental exposure to asbestos.

Diagnostic usefulness of pregnancy-associated plasma protein-A in suspected pulmonary embolism

BackgroundThe role of biomarkers for prognostication and diagnosis of pulmonary embolism (PE) is increasing. It has been reported that pregnancy-associated plasma protein-A (PAPP-A) can be used as a proatherosclerotic marker. The present study was aimed to evaluate whether PAPP-A levels are helpful in the differential diagnosis of patients presenting with suspected PE.Methods53 consecutive patients evaluated for suspected PE were prospectively enrolled in the study. Serum PAPP-A levels were measured in the blood samples which were taken at admission. Multi-slice computed tomographic angiography was used to verify the diagnosis of PE.ResultsPE was detected in 24 out of the 53 patients, while it was excluded in 29 patients by thorax multi-detector computerized tomography scan. No significant difference was detected in mean serum PAPP-A level between groups (5.72 ± 0.31 mg/L vs. 5.67 ± 0.06 mg/L, respectively).ConclusionsSerum PAPP-A level has no role in the evaluation for PE.

Significance of serum cardiac troponin I levels in pulmonary embolism

BACKGROUND Some biomarkers can be helpful in the diagnosis of pulmonary embolism (PE) and determining of severity and prognosis of the disease. In this study, we aimed to analyze the elevated cardiac troponin I (cTnI) levels and its association with electrocardiography (ECG) and transthoracic echocardiography (TTE) findings in patients with PE. METHODS Totally 106 patients with suspected PE were included in the study. PE was confirmed in 63 of them, whereas it was excluded in the remaining 43 patients. Levels of cTnI were measured in all patients before the prescription of the anticoagulation therapy. RESULTS High cTnI levels were found in 50.8% of patients with PE, and in 11.6% of patients without PE (P<0.001). Sensitivity and specificity of the test for the diagnosis of PE were 50.7%, 88.3% respectively. ECG findings were similar in PE patients having either elevated or normal cTnI levels. Approximately 75% of the PE patients with high cTnI had normal ECG findings; the most common pathological changes seen in ECG were S1Q3T3 pattern (~31%). TTE findings were not found to be distinguishing in the patients with suspected PE and high cTnI levels. Pulmonary hypertension (PHT) was the most common echocardiographic finding (~74%) in patients with PE and elevated cTnI levels. However, there was not a statistically significant difference between TTE findings in PE patients with increased and normal cTnI levels. CONCLUSIONS In patients presenting with clinical, electrocardiographic and echocardiographic features suggesting pulmonary embolism, increased serum cTnI levels endorse the diagnosis of severe PE.

Obstrüktif uyku apne sendromu ve fibromiyalji sendromu birlikteliği

Ozet Amac: B u calismada her iki hastalikta da dinlendirmeyen uyku, gunduz asiri uyuma ihtiyaci, sabahlari olan bas agrisi gibi ortak semptomlarin varligindan yola cikarak OUAS hastalarinda FMS birlikteligini incelemeyi amacladik. Yontem: OUAS suphesi olan 100 ardisik hasta alindi. Bu hastalara polisomnografi (PSG) uygulandi ve FMS acisindan fizik tedavi uzmani tarafindan degerlendirildi. OUAS tanisi icin Uluslararasi Uyku Bozukluklari Siniflamasi (ICSD-2) kriterleri, FMS tanisi icin Amerika Romatoloji Dernegi (ACR)’nin 1990 yilinda yayimladigi ve gunumuzde kullanilan kriterler temel alindi. Bulgular: Yuz hastanin 74’unde OUAS saptandi. OUAS saptanan 74 hastanin 20‘sinde (%27) FMS saptanirken OUAS olmayan 26 hastanin 4’unde (%15,4) FMS saptandi ve her iki grup arasinda FMS sikligi acisindan istatiksel anlamli fark yoktu. OUAS olan gruptaki hastalari FMS varligi ve yokluguna gore gruplara ayirdigimizda ve bu gruplar arasinda horlama, tanikli apne, gunduz asiri uyku hali (GAUH) ve uc major semptom birlikteligini kiyasladigimizda tanikli apne ve GAUH sadece OUAS olan FMS olmayan grupta istatiksel olarak anlamli oranda daha yuksekti (p 0,05). Sonuc: Sonuc olarak calismamizda OUAS’li hastalarda FMS birlikteligi acisindan anlamli iliski saptamasak da GAUH, dinlendirmeyen uyku, sabahlari olan bas agri gibi ortak semptomlarin varligi daha genis orneklemli ve daha cok sayida calismalara ihtiyac oldugunu gostermektedir. Anahtar sozcukler : Uyku apne, fibromyalji Abstract Aim. W e aimed to study coexistence of FMS in OSAS patients since there are common symptoms such as non-relaxing sleep, over need for sleep during the day, morning headaches in both diseases. Methods. 100 consecutive OSAS patients contributed to the study. These patients are evaluated by physical rehabilitation specialist with application of polysomnography (PSG). International Classification of Sleep Disorders (ICSD-2) criteria used for OSAS diagnosis and American College of Rheumatology (ACR) criteria published in 1990 and some criteria which are used today used for diagnosis for FMS. Results. OSAS determined in 74 patients of 100. While in 20 of 74 patients (27%) with OSAS FMS determined, in 4 of 26 patients with no OSAS (15.4%) FMS determined and there was no statistical difference in regards to FMS incidence between groups. In OSAS group, when groups separated according to FMS existence and absence and when coexistence of symptoms such as witnessed apnea, excessive day time sleepiness (GAUH), and 3 major symptoms only witnessed apnea and GAUH was statistically high, in only OSAS non-FMS group (p 0.05). Conclusion. In conclusion, although we did not determined significant coexistence of FMS in OSAS patients, common symptoms such as GAUH, non-relaxing sleep, morning headaches shows that further study need to be done in large scales. Key words : Sleep apnea, fibromyalgia