Zehra Seyfikli

Strong association between the GSTM1-null genotype and lung cancer in a Turkish population

Glutathione S-transferases are possibly related to the detoxification of many xenobiotics involved in the etiology of cancer. To investigate the role of the glutathione S-transferase M1 deletion (GSTM1-null) in lung cancer, the polymerase chain reaction was used to determine the GSTM1 genotypes of lung cancer patients (n=101) and hospital (n=206) in a Turkish population. The prevalence of the GSTM1-null genotype in the case group was 48%, compared to 18% in the control group, giving an odds ratio (OR) of 4.14 (95% confidence interval [CI]=2.36-7.27). The analysis of patients by histologic type of lung cancer (10% adenocarcinoma, 43% squamous cell carcinoma, 26% small cell carcinoma, and 11% large cell carcinoma) showed no association between histopathologic type of lung cancer and GSTM1-null genotype. When the interaction between the GSTM1-null genotype and smoking status was analyzed, among the 67 smokers, the GSTM1-null genotype was found in 37 (55%) with an OR of 2.58 (95% CI=1.00-6.73) indicating a significant association. However, no association was found between smoking exposure (<30 and > or =30 packs/year) and GSTM1-null genotype. We conclude that, in this study the null GSTM1 genotype is an independent risk factor for the development of lung cancer for Turkish population.

Evaluation of pulmonary changes due to biomass fuels using high-resolution computed tomography

Abstract.Biomass fuels are frequently used in rural areas of the world for cooking and heating frequently. It has been reported that the use of these fuels causes hazardous effects on the lungs. In this study, we evaluated the pulmonary changes due to the use of biomass fuels in a female population that lives in our territory by high-resolution computed tomography (HRCT). The study analyzed three groups of women. The first group comprised those subjects who were exposed to biomass without respiratory symptoms (group 1; n=32). The second group comprised those individuals that were exposed to biomass and showed respiratory symptoms, such as cough, sputum production, and dyspnea (group 2; n=30). The third group was composed of women who were not exposed to biomass and also had no respiratory symptoms (group 3; n=30). Women with a history of concomitant pulmonary diseases were excluded from the study. All groups were examined with HRCT. Groups 1 and 2 (individuals exposed to biomass fuels) had more pathologic findings than group 3 (not exposed to biomass fuels). Ground-glass appearance was seen in 71.9% in group 1, 23.3% in group 2, and 3.3% in group 3. The difference between the groups was statistically significant (p<0.05). Fibrotic bands were seen 50% in group 1, 63.3% in group 2, and only 6.7% in group 3 (p<0.001). Exposure to biomass fuels was the cause or predisposing factor for many pulmonary diseases, ranging from chronic bronchitis to diffuse lung diseases. We believe that these pathological changes due to biomass fuels can be detected earlier by HRCT and the diseases might be prevented or treated earlier.

Clinical Characteristics, Treatment and Survival Outcomes in Malignant Mesothelioma: Eighteen Years' Experience in Turkey

BACKGROUND Malignant mesothelioma (MM) is an insidious tumor with poor prognosis, arising from mesothelial surfaces such as pleura, peritoneum and pericardium. We here aimed to evaluate the demographic, clinical, and radiological features of patients with MM followed in our center as well as their survival. METHODS The study included 228 patients (131 male, 97 female) who were followed up in our institution between 1993 and 2010 with the diagnosis of MM. RESULTS The mean age was 59.1 years in men and 58.7 years in women and the sex ratio was 1.4:1 in favor of males. Environmental asbestos exposure was present in 86% of the patients for a mean duration of 40±20 years (range: 3-70). Pleural effusion and thoracic/abdominal pain were the most common presenting signs and symptoms (70.2% and 57.8%, respectively). One hundred-thirteen (66%) patients were treated with platinum-based combination chemotherapy (PBCT) plus supportive care (SC) and 67 (34%) patients received SC alone. The median follow-up time was 10.0 months. The median overall survival was significantly improved with PBCT plus SC compared to SC alone (11.4 vs. 5.1 months; p=0.005). The 6, 12, 18, and 24-month survival rates were significantly improved with PBCT plus SC compared to SC alone (72%, 43%, 19%, and 2% vs. 49%, 31%, 11%, and 1%). CONCLUSION The survival of patients with MM improved in patients treated with PBCT. The survival advantage continued 12- and 24-month after the initial time of combination chemotherapy.

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.

'Biomass Lung': Primitive Biomass Combustion and Lung Disease

Domestic burning of biomass fuel is one of the most important risk factors for the development of respiratory diseases and infant mortality. The fuel which causes the highest level of disease is dung. In the rural areas of developing countries some 80% of households rely on biomass fuels for cooking and often heating as well and so suffer high indoor air pollution. Even when the fire or stove is outside the home those near it are still exposed to the smoke. In areas where the winters are long and cold the problem is aggravated since the fire or stove is indoors for many months of the year. The consequence of biomass burning is a level of morbidity in those exposed to the smoke as well as mortality. The rural areas of Turkey are among many in the world where biomass is the major fuel source. In this case report 8 patients from rural areas, particularly Anatolia, who used biomass are presented. Many of these are non-smoking, female patients who have respiratory complaints and a clinical picture of the chronic lung diseases which would have been expected if they had been heavy smokers. Typically patients cook on the traditional ‘tandir’ stove using dung and crop residues as the fuel. Ventilation systems are poor and they are exposed to a high level of smoke pollution leading to cough and dyspnoea. Anthracosis is a common outcome of this level of exposure and several of the patients developed lung tumours. The findings from clinical examination of 8 of these patients (2 M, 6 F) are presented together with their outcome where known.