[Show abstract][Hide abstract] ABSTRACT: One of the most significant diseases related to environmental asbestos exposure is malignant mesothelioma (MM). Sivas province is located in the Central Anatolia where asbestos exposure is common. We aimed to study clinical, demographical and epidemiologic features of the patients with MM in Sivas, along with the history of asbestos exposure. In total, 219 patients with MM who were diagnosed in our hospital between 1993 and 2010 were retrospectively analyzed in terms of demographical and clinical features. Rock, soil and house plaster samples were taken from the habitats of those patients and were evaluated with optical microscopy and X-ray diffraction methods. The age of the patients ranged between 18 and 85 years. The male-to-female ratio was 1.4:1. Most of the patients confirmed an asbestos exposure history. The most frequent symptoms of the patients were chest pain (60 %) and dyspnea (50 %). The gap between the start of first symptoms and the diagnosis date was approximately 4 months in average. The plaster materials used in most of the houses were made up of mainly carbonate and silicate minerals and some chrysotile. Ophiolitic units contained fibrous minerals such as serpentine (clino + orthochrysotile) chiefly and pectolite, brucite, hydrotalcite and tremolite/actinolite in smaller amounts. MM is not primarily related to occupational asbestos exposure in our region, and hence, environmental asbestos exposure may be indicted. Yet, single or combined roles and/or interactions of other fibrous and non-fibrous minerals in the etiology of MM are not yet fully understood and remain to be investigated.
Full-text · Article · Apr 2013 · Environmental Geochemistry and Health
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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%).
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.
No preview · Article · Nov 2012 · Asian Pacific journal of cancer prevention: APJCP
[Show abstract][Hide abstract] ABSTRACT: Aim: To investigate the effect of tobacco smoke (TS) exposure on the quantity of exhaled carbon monoxide (eCO) and hair nicotine (HN) and to evaluate the relationship between these values. Materials and methods: Included in the study were 96 subjects (64 male, 32 female) divided into 3 groups. The subjects in Group 1 (n = 46) were current smokers, and the subjects in Group 2 (n = 20) and Group 3 (n = 30) were nonsmokers with or without environmental TS exposure, respectively. The eCO level of all of the subjects was measured with a breath CO monitor. Gas chromatography/mass spectrometry were used for quantification of the HN (n = 47). Results: The mean age of the subjects was 39.1 years. The mean levels of eCO were 9.3 ppm, 1.3 ppm, and 1.0 ppm and the mean HN concentrations were 20.9 ng/mg, 2.1 ng/mg, and 0.7 ng/mg in the 3 groups, respectively. There was a significant difference between Group 1 and the other groups according to the levels of eCO and HN concentrations, but the levels of eCO and HN concentrations were similar in Group 2 and Group 3. There was a positive correlation between the levels of eCO and the HN concentrations. The cutoff values of eCO and HN for smokers were 6 ppm and 4 ng/mg, respectively. Conclusion: Although nicotine analysis in some biological samples like hair is specific to TS exposure, these methods are expensive and difficult procedures. Our results suggest that instead of HN analysis, a cheap and easy method like eCO measurement may be used, but further studies with more cases are needed.
Preview · Article · Aug 2012 · Turkish Journal of Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: COPD is characterized by chronic air-flow limitation. Smoking is the most important factor in the pathogenesis of COPD. Smoking is associated with increased oxidative stress in the lungs. In this study our aim was to evaluate the differences in the burden of oxidative stress in patients with COPD, smokers, and non-smokers by measuring hydrogen peroxide (H(2)O(2)), malondialdehyde (MDA), and 8-isoprostane levels in the exhaled breath condensate (EBC) samples.
Eighty subjects were included in the study. Group I (no. = 25) had COPD, Group II (no. = 26) was smokers, and Group III (no. = 29) was nonsmokers. The severity of the COPD and dyspnea was assessed according to the results of pulmonary function tests (PFTs) and Medical Research Council (MRC) scale.
The mean age of the subjects was 58 ± 8.9 years. While 8-isoprostane and H(2)O(2) levels were significantly higher in subjects with COPD (44.8 ± 40.2 pg/mL and 1.9 ± 0.8 μmol/L) and smokers (41.3 ± 26 pg/mL and 1.7 ± 0.7 μmol/L) than non-smokers (15.8 ± 6.9 pg/mL and 0.8 ± 0.4 μmol/L), levels were similar between smokers and COPD subjects. MDA levels were similar between the 3 groups (P = .31). There was no correlation between 8-isoprostane and H(2)O(2) levels and PFT parameters. There was a significant positive correlation between dyspnea grade on the MRC scale and 8-isoprostane levels (r = 0.805, P < .001).
Even if respiratory function tests are within normal limits, oxidant burden in lungs of smokers is equivalent to that in COPD patients. 8-isoprostane could be useful in assessing symptom severity and health status of COPD patients.
[Show abstract][Hide abstract] ABSTRACT: Oxidative stress has a critical role in inflammatory responce against tobacco smoke (TS). Testing exhaled breath condensate (EBC) samples is one of the methods used for assessment of airway inflammation caused by TS. We aimed to investigate oxidative stress in the lungs associated with TS and to evaluate the effect of this stress with pulmonary function tests (PFTs).
We included 69 subjects as three groups into the study (Group I; 26 smokers, Group II; 21 passive smokers, Group III; 22 non-smokers without TS exposure). Levels of malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), nitrite/nitrate [index of nitric oxide (NO) production], vitamin C, superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) were measured in EBC samples collected using a condenser and PFTs were performed.
The levels of MDA, 8-OHdG, SOD and GSH-Px were higher in smokers. NO levels gradually increased from Group I to Group III. MDA levels were lower in Group III than Group II. The levels of vitamin C were similar in all groups. We determined negative correlation between 8-OHdG levels and forced expiratory volume in one second (FEV₁), and maximum mean expiratory flow (MMEF), and a positive correlation between SOD levels and FEV₁.
TS exposure affected the balance between oxidative stress and antioxidant capacity of lungs. Preventing environmental TS exposure might decrease oxidative damage. Increased levels of 8-OHdG and SOD levels could be assessed as an early sign of airway damage.
No preview · Article · Sep 2011 · Clinical Chemistry and Laboratory Medicine
[Show abstract][Hide abstract] ABSTRACT: To evaluate the knowledge and manner of cafe, pub and restaurant (with/without alcohol) workers in our city center about the ban on restriction of indoor smoking. To determine the preparation about the ban, smoking characteristics of workers, the knowledge on passive smoking. A questionnaire was performed to workers. The type of workplace, the number of workers, existence of a restriction of indoor smoking, any preparation about the ban were asked. The job of worker, whether the worker has a knowledge on the ban or not, the idea of the workers on the necessity and practicability of the ban were asked. Smoking history and the knowledge about passive smoking of workers were recorded. Fagerstrom nicotine dependent test (FNDT) was performed to smokers. Eighty four work places with 568 workers included in the study. The questionnaire was performed to 337 workers whose mean age was 29.1/years. 292 of workers were male. 190 of cases were current smokers. 166 of cases (49.3%) know the meaning of passive smoking. Alcohol offering was made at 8 of workplaces. Smoking was forbidden in 20 of workplaces. A preparation was performed about the ban in 30 of (46.9%) other workplaces. 88.4% of workers have knowledge on the ban, 64.7% of them know the punishment of the noncompliance of the ban. 81.3% of the workers believe the necessity and 45.7% of them believe the practicability of the ban. Smokers and especially who's FNBT > 5 have a stronger belief on the necessity and practicability of the ban. We determined that the preparation about the ban was inadequate although there was an little time for the put into practice the law. So we think that the controls of workplaces should be happened frequent.
No preview · Article · Jul 2010 · Tuberkuloz ve toraks
[Show abstract][Hide abstract] ABSTRACT: Objective: In this study, our aim was to evaluate the general characteristics of the malignant pleural mesethelioma (MPM) cases, value of interventions used for diagnosis and to define the mortality of cases. Material and Method: Records of patients were evaluated retrospectively. Records of the Population Registry Office of Tokat were used to determine the median survival rate and mortaliy at 6, 12, 24 and 48 months. Results: Thirty five MPM patients were included in the study. The mean age was 61.5 years, and 17 of them were males. The most common complaint was dyspnea (86%), 24 of them had a history of environmental asbestos exposure. The value of diagnostic interventions was analyzed by the data of 27 patients who were diagnosed in our hospital. The cytology of pleural effusion was diagnostic in 7 of 24 samples (29%), and closed pleural biopsy in 10 of 22 samples (46%). Thoracoscopic biopsy was performed in 13 patients and and excisional biopsy from the chest wall in one patient, and all were diagnostic. Eight of 27 patients were diagnosed as epithelial type MPM, 17 patients (63%) could not be classified. All of the 13 patients whose samples were stained immunohistochemically showed strong / intermediate positivity for calretinin. Immunohistochemical staining was not useful in differentiating subtypes in 5 patients. Median survival was 14.9 months for all patients. Three patients (8.6%) died in the first six months. The mortalities for 12, 24 and 48 months were 42%, 65%and 100%, respectively. Conclusion: MPM should be considered in cases who had a history of asbestos exposure. Immunohistochemical staining should be perfomed for differentiating subtypes.
No preview · Article · Mar 2010 · Turk Toraks Dergisi
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the primary drug resistance rates and genotypes of resistant Mycobacterium tuberculosis strains isolated in the Kelkit Valley. Materials and Methods: Primary resistance to isoniazid (INH), rifampicin (RIF), ethambutol (ETB), and streptomycin (SM) was determined with the BACTEC 460 radiometric system. Forty-eight resistant M. tuberculosis strains isolated from tuberculosis patients living in the Kelkit Valley were genotyped using the spoligotyping method. Results: Approximately 11.6% of the strains were resistant against at least one major drug, and 8.3% were resistant against more than one drug. Single-drug resistance for INH, ETB, SM, and RIF was found as 5.8%, 2.1%, 3.7%, and 0.0%, respectively. Two or more drug resistance rates for SM + ETB, SM + INH, INH + RIF, RIF + ETB, INH + ETB + RIF, SM + ETB + INH and INH + ETB + RIF + SM were determined as 0.8%, 1.7%, 0.4%, 0.8%, 2.9%, 0,4%, and 1.2%, respectively. Fifteen spoligotype groups were created when the results were compared with the world databank (SpolDB4). Families of four strains could not be determined. The spoligotype groups most frequently encountered in our study were ST4 (n = 10, 20.8%), ST53 (n = 6, 12.5%), ST7 (n = 4, 8.3%), ST41 (n = 4, 8,3%) and ST31 (n = 4, 8.3%), and the most frequently encountered families were TI (n = 18, 37.5%), S (n = 12, 25%) and LAM-7 TUR (n = 4, 8.3%). Conclusions: High rates of primary resistance against major anti-tuberculosis drugs, the LAM-7 TUR clone, and high grouping rates were detected in this study, the first such study carried out in the Kelkit Valley.
No preview · Article · Feb 2009 · Turkish Journal of Medical Sciences
[Show abstract][Hide abstract] ABSTRACT: Wegener's granulomatosis is a type of vasculitis characterized by necrotizing granulomatosis respiratory tract lesions and necrotising glomerulonephritis. Nasal, lung and renal biopsies and positive antineutrophil cytoplasmic antibody (c-ANCA) analysis is helpful in diagnosis. Early diagnosis and treatment is critical in prognosis. A 42 years-old male had dyspnea, coughing, hemoptysis, fatigue, loss of appetite, night sweating and arthralgia. Violaceous palpable, purpuric lesions were detected on the sublingual region of the mouth. On chest X-ray, there was nonhomogeneous infiltration in the parenchyma of both lungs. There was alveolar density involving upper lobes of both lungs detected in thoracal computerized tomography as well as patchy densities on the right lung upper-middle lobes. A nasal mucosa biopsy showed strongly destructive vasculitis. c-ANCA test was positive. We report an unusual case with Wegener's granulomatosis, characterized by a rare presentation of tongue involvement and atypical lung radiology with alveolar opacity.
No preview · Article · Jan 2009 · Tuberkuloz ve toraks
[Show abstract][Hide abstract] ABSTRACT: In our country quartz is widely used for denim sandblasting and new cases with silicosis are defined. Silicosis is a preventable occupational lung disease caused by inhaled dust containing crystalline silica and no effective treatment for silicosis is available (1). CASE 1: A 23-years old man was admitted to the hospital with dyspnea on effort and cough. He had worked in a denim manufacturing factory for three years at sandblasting and dyeing. Physical examination revealed decreased breath sounds. Chest X-ray showed bilateral reticulonodular densities predominantly at middle and lower zones and minimal pneumothorax. Hypoxemia was determined in arterial blood gas analysis (BGA). Pulmonary function tests (PFTs) showed restrictive disorder. Lymphocytic alveolitis was demonstrated in the bronchoalveolar lavage fluid. Open lung biopsy revealed interstitial fibrosis and foreign particles which were seen more clearly under polarized light in interstitial areas. The patient was diagnosed as accelerated silicosis. CASE 2: A 25-years old man was admitted to the hospital with shortness of breath and haemopthysis. Two years ago, he had worked at the same place for 1.5 years. Bilateral reticulonodular densities at middle and lower zones and minimal unilateral pneumothorax were seen in chest X-ray. Restrictive disorder at PFT and hypoxemia in BGA were observed. Because of the similarity of complaints, radiological findings and occupational history with the former patient, no other further and invasive procedure was planned and the patient was diagnosed as accelerated silicosis. CONCLUSION: The usage of sandblasted denims increase recently and denim sandblasting is being frequently made especially in small work places. Since there is no definite treatment for silicosis, it is important to take necessary precautions to improve the conditions of the factories.
Full-text · Article · Jan 2007 · Tuberkuloz ve toraks
[Show abstract][Hide abstract] ABSTRACT: Studies consistently show that patients with sleep related diseases (SRD) have higher accident rates. Polysomnography (PSG) is the gold standard for the diagnosis of SRD. Sleep habits questionnaires are also useful tool for research of the prevalence of SRD on large populations. The aim of this study is to investigate the prevalence of SRD and SRD related traffic accidents on the whole population of professional drivers in Sivas city. A questionnaire that includes questions about drivers' background such as how long they have been driving, if they had any accidents, and if they drive just in Sivas city or inter state. This questionnaire composed of 50 questions about SRD and was asked to drivers answer them face to face. Three hundred forty male drivers participated for this study. Their mean age was 39.5+/-9.3 (21-68) years. The mean driving duration was 13.3+/-7.9 years. The percentage of drivers who drove in Sivas was 52.1% and 47.9% of the drivers drove inter state. The percentage of drivers who had at least one accident was 36.3%. The prevalence of habitual snoring, insomnia, sleep apnea, nocturnal myoklonus were 41.2%, 39.1%, 32.9%, and 33.6% respectively. The traffic accident Odds ratio was 1.619 for drivers with habitual snoring (95% CI, 1.034 to 2.536, p=0.02). In conclusion, this study found out that drivers with habituel snoring seems to have tendency (approximately 2-folds) of involving in traffic accidents than drivers who do not have habituel snoring. Polysomnography of candidate drivers with sleep disordered symptoms has to be logical before giving to driving license.
No preview · Article · Feb 2006 · Tuberkuloz ve toraks
[Show abstract][Hide abstract] ABSTRACT: 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.
No preview · Article · Oct 2003 · Cancer Genetics and Cytogenetics
[Show abstract][Hide abstract] 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.
No preview · Article · Oct 2003 · European Radiology
[Show abstract][Hide abstract] ABSTRACT: In our clinical experience, asthma is an important health problem in our region, but we did not know its prevalence.
The main objective of our study was to assess the prevalence of asthma in Sivas, a city in Central Anatolia.
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.
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).
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.
No preview · Article · Feb 2003 · Journal of Asthma