RESUMEN
OBJECTIVES: To demonstrate the pure effect of obstructive sleep apnea syndrome (OSAS) on cardiac autonomic function (CAF) using heart rate turbulence (HRT) parameters. PATIENTS AND METHODS: A total of 64 patients with OSAS and 30 age- and gender-matched healthy subjects were enrolled. All subjects had normal coronary arteries and were free from diabetes mellitus (DM) and hypertension (HT). The HRT parameters (TO, turbulence onset; TS, turbulence slope) were obtained from 24-h ambulatory electrocardiogram (ECG) recordings. HRT parameters were compared between groups, and the relationship between HRT and the apnea-hypopnea index (AHI) was examined. RESULTS: No between-group differences were found in age or gender. Mean TO was significantly higher in the OSAS group than in healthy controls (0.89 ± 0.5, -0.08 ± 0.26; p < 0.001; respectively). The mean TS did not differ between the two groups (2.81 ± 3.06 versus 3.14 ± 2.33; p = 0.212). The AHI was positively correlated with TO (r = 0.845, p < 0.001). The multiple logistic regression analysis revealed that after adjustment for other variables, TO was a significant and independent predictor of AHI, OR 2.394 (95% CI: 1.596-3.591). CONCLUSIONS: HRT (TO in particular) is correlated with AHI. Thus, impaired HRT may be an important factor underlying the occurrence of arrhythmia and sudden cardiac death in patients with OSAS.
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Sistema Nervioso Autónomo/fisiopatología , Frecuencia Cardíaca , Corazón/inervación , Apnea Obstructiva del Sueño/fisiopatología , Adulto , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana EdadRESUMEN
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.
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Contaminantes Ocupacionales del Aire/toxicidad , Pulmón/diagnóstico por imagen , Exposición Profesional/efectos adversos , Pleura/diagnóstico por imagen , Cloruro de Polivinilo/toxicidad , Adulto , Contaminantes Ocupacionales del Aire/análisis , Polvo/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Exposición Profesional/análisis , Tomografía Computarizada por Rayos X/métodos , Adulto JovenRESUMEN
BACKGROUND: Several organizations recommend using estimated glomerular filtration rate (eGFR) in kidney function monitoring, preferably calculated with Modification of Diet in Renal Disease (MDRD) formula. The role of this formula is not clear in the risk stratification of contrast induced acute kidney injury (CIAKI) in nonsteady state patients. AIM: Comparative evaluation of the MDRD eGFR in risk stratification of CIAKI. METHOD: GFR was measured twice (pre- and post-examination) by Tc-99m-DTPA, along with serum levels of urea nitrogen and creatinine in 32 patients (mean age+/-SD; 60.1+/-13.2 years) needing hospital care for various reasons and underwent to x-ray examination with contrast media (mean; 90.2+/-16.8 ml). eGFR was calculated by the dedicated formula. Agreement between measured GFR (mGFR) and MDRD eGFR was assessed and patients were scored and stratified for CIAKI by using first mGFR, then eGFR and results were compared. RESULTS: A moderate correlation was obtained between mGFR and eGFR (r=0.47, p < 0.001) and the difference was not significant. However, Bland & Altman analysis revealed large limits of agreement between mGFR and eGFR (-80.3 to 55.2) with a mean difference of -12.5 ml/min/1.73m2. In ROC analysis, when mGFR values were classified as normal (>60ml/min/1.73m2) and decreased (<60ml/min/1.73m2), AUC was 0.80 (95%CI; 0.62-0.92) for eGFR, with a sensitivity of 29% and specificity of 100%. Furthermore, the risk group categorization, using eGFR instead of mGFR was resulted in a group change for four patients (13%); from moderate to low risk group. CONCLUSION: It seems that MDRD eGFR differs from mGFR. In nonsteady state patients CIAKI classification using eGFR should be considered with caution.
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Lesión Renal Aguda/inducido químicamente , Medios de Contraste/efectos adversos , Tasa de Filtración Glomerular , Pacientes Internos , Dieta , Femenino , Humanos , Masculino , Matemática , Persona de Mediana Edad , Estudios Prospectivos , Medición de Riesgo/métodosRESUMEN
In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.
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Política de Salud , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/prevención & control , Organización Mundial de la Salud , Enfermedad Crónica , Humanos , Prevalencia , Enfermedades Respiratorias/patología , Índice de Severidad de la Enfermedad , Turquía/epidemiologíaRESUMEN
Sandblasting denim using silica has emerged as a new cause of silicosis in Turkey. Following the discovery of several cases of silicosis in (young) workers who used this process, the frequency and main occupational risk factors of silicosis among former denim sandblasters in the region of Erzurum (Turkey) were evaluated. Demographic characteristics and information on working conditions were obtained by questionnaire and interview. In addition, spirometry testing was performed and chest radiographs were evaluated according to International Labour Office (ILO) classification of pneumoconioses in 157 former denim sandblasters. All subjects were male, with a mean (range) age of 23 (15-44) yrs. They had worked for a mean (range) of 36 (1-120) months, starting employment at a 17 (10-38) yrs of age. Most subjects (83%) had respiratory symptoms, especially dyspnoea (52%) but also chest pain (46%). Radiological evidence of silicosis (ILO score 1/0 or higher) was present in 77 (53%) out of 145 subjects with interpretable chest radiographs. These subjects had lower forced expiratory volume in one second and forced vital capacity. The risk of silicosis correlated with seniority (i.e. working as a foreman), exposure duration and number of places of work. Considering the high prevalence rate of silicosis in such workplaces, further problems are inevitable in the future unless effective measures are taken.
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Silicosis/epidemiología , Silicosis/etiología , Adolescente , Adulto , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Exposición Profesional/efectos adversos , Radiografía , Pruebas de Función Respiratoria , Factores de Riesgo , Silicosis/fisiopatología , Fumar , Industria Textil , Turquía/epidemiologíaRESUMEN
Results of measurements of radon around of the Black Sea are shown. Radon stations in zones of active faults were placed. Simultaneous hourly measurements of soil radon in 2005 were carried out in the Sivrice Fault Zone that is a segment of East Anatolian Fault System, in the town of Tbilisi (Georgia) and in the South Russia. In 2008 simultaneously hourly measurements of soil radon were carried out in the Western Caucasus (Russia) and in the Mytilene Island (Greece). In 2013 radon in underground waters simultaneously in midday was measuring in Crete (Greece), in the Pamukkale geothermal region (Southwest Turkey) and in the Western Caucasus. Measurements of radon concentration in the points located around of the Black Sea have shown identical regularities in changes of the data. Influence of meteorological, tidal and solar factors on changes of water radon concentrations and soil radon concentrations was observed in all researches points. But this influence was insignificant. Seismological application of observed results also was considered. Various mathematical methods of definition of anomaly in the radon data during earthquakes were considered. During researches in the Black Sea region basically earthquakes with M from 2.0 up to 5.0 and in a depth about 10â¯km were occurred. For these earthquakes method of daily subtraction of the data of the next and previous day was used. This method has allowed solving a problem with a choice of average value. Probability up to 0.69 (number of earthquakes with radon anomalies/total number of earthquakes) of detection of radon anomalies before earthquakes was achieved applying this method. Changes of radon maps before regional earthquakes were also observed. The frequency analysis of variations of the radon data on the basis of the Wavelet analysis was carried out. Occurrence of the short periods (about 2 days) was observed during regional earthquakes.
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Monitoreo de Radiación , Radón/análisis , Contaminantes Radiactivos del Suelo/análisis , Mar Negro , Terremotos , Grecia , Agua Subterránea , Federación de Rusia , Suelo , TurquíaRESUMEN
AIM: We investigated specific aetiology and different therapeutic approaches in patients with empyema in a General Thoracic Surgery Clinic. MATERIAL AND METHODS: Charts of 139 patients admitted with empyema, between January 1998 and March 2005 were retrospectively reviewed. Although not completely comparable, patients were divided into two groups; Paediatric (n = 71) and adult (n = 68) cases. In addition to demographic characteristics, treatment options, complications and clinical outcomes were investigated according to the specific group. RESULTS: The mean age was 5.6 years (4 mo - 17 y) for paediatric patients and 49.6 years (20-81 y) for adult patients. Overall, 65% of the patients (n = 91) were male. All paediatric cases had parapneumonic empyema, while 63% of the adult cases had parapneumonic and 23.5% had postoperative empyema. Of the paediatric cases, 50% received fibrinolytic treatment in addition to tube thoracostomy and 35% had decortication. In adults, 42% had tube thoracostomy and fibrinolytic treatment, and decortication was required in 9% only. Thoracomyoplasty was performed in 12% of the patients (n = 8). We had no mortality in paediatric patients, however mortality rate was 8% in the adult group. Morbidity, consisted mostly of prolonged air leakage and impaired lung expansion. CONCLUSION: Early decortication and fibrinolytic treatment are sufficient for paediatric patients, while a variety of techniques including open drainage, rib resection and thoracomyoplasty are required in adult patients with empyema.
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Empiema Pleural/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Drenaje/estadística & datos numéricos , Empiema Pleural/epidemiología , Empiema Pleural/etiología , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Lactante , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/complicaciones , Complicaciones Posoperatorias , Estudios Retrospectivos , Toracoplastia/estadística & datos numéricos , Toracostomía/estadística & datos numéricos , Turquía/epidemiologíaRESUMEN
Photoneutron production on the nuclei of high-Z components of medical accelerator heads can lead to a significant secondary dose during a course of bremsstrahlung radiotherapy. However, a quantitative evaluation of secondary neutron dose requires improved data on the photoreaction yields. These have been measured as a function of photon energy, neutron energy and neutron angle for natW, using tagged photons at the MAX-Lab photonuclear facility in Sweden. This work presents neutron yields for natW(gamma, n) and compares these with the predictions of the Monte Carlo code MCNP-GN, developed specifically to simulate photoneutron production at medical accelerators.
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Neutrones , Fotones , Radioterapia de Alta Energía , Tungsteno/efectos de la radiación , Método de Montecarlo , Dosificación Radioterapéutica , Radioterapia de Alta Energía/métodos , Programas InformáticosRESUMEN
Algae and cyanobacteria are capable living under harsh conditions in the natural environments and can develop peculiar survival processes. In order to evaluate radiation shielding properties of green algae; Chlorella vulgaris, Scenedesmus obliquus, and cyanobacteria; Synechococcus sp., Planktothrix limnetica, Microcystis aeruginosa, Arthrospira maxima, Anabaena affinis, Phormidium articulatum, and Pseudoanabaena sp. were cultured in batch systems. Air dried biomass was tested for its high tolerance to gamma-radiations in terms of linear attenuation coefficients. In the present work, the linear and mass attenuation coefficients were measured at photon energies of 1173 and 1332 keV. Protection capacity of some biomass was observed to be higher than a 1-cm thick lead standard for comparison. Gamma ray related protection depends not only to thickness but also to density (g/cm3). Hence the effect of biomass density also was tested and significantly found the tested biomass absorbed more of the incoming energy on a density basis than lead. This paper discusses the a new approach to environmental protection from gamma ray. The findings suggest that the test samples, especially cyanobacteria, have a potential for reducing gamma ray more significantly than lead and can be used as shielding materials.
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Chlorophyta/fisiología , Cianobacterias/fisiología , Rayos gamma , Fotones , Biodegradación Ambiental , Biomasa , Chlorella vulgaris/crecimiento & desarrollo , Chlorella vulgaris/fisiología , Chlorella vulgaris/efectos de la radiación , Clorofila/metabolismo , Clorofila A , Chlorophyta/crecimiento & desarrollo , Chlorophyta/efectos de la radiación , Cianobacterias/crecimiento & desarrollo , Cianobacterias/efectos de la radiación , Scenedesmus/crecimiento & desarrollo , Scenedesmus/fisiología , Scenedesmus/efectos de la radiación , Espectrometría gammaRESUMEN
PURPOSE: The main goal of this retrospective study was to re-evaluate all available records of clinical and laboratory data of patients with tuberculosis (TB) in Sivas province, Middle Anatolia, Turkey. METHODS: TB registration data held at health institutions in Sivas province were compared and matched with data obtained from the local official TB registries from January 2000 to December 2001. RESULTS: Of the 536 TB cases found in 2000 and 2001, 255 (47.6%) were officially registered. Of the 127 cases with smear-positive pulmonary TB (PTB), only nine cases labelled as smear-positive were registered in local dispensaries. The incidence of unregistered cases with smear-positive PTB found by this study was approximately 40-fold and eightfold greater than the incidence of registered cases for 2000 and 2001, respectively. CONCLUSION: There were many more unofficially recorded TB patients compared with officially recorded cases in Sivas province between 2000 and 2001. The results of this study are disappointing and alarming for Turkey's national TB control programme, at least for its regional applications.
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Sistema de Registros/estadística & datos numéricos , Tuberculosis Pulmonar/epidemiología , Recolección de Datos/métodos , Humanos , Incidencia , Estudios Retrospectivos , Tuberculosis/epidemiología , TurquíaRESUMEN
The total linear attenuation coefficients micro (cm(-1)) have been obtained using the XCOM program at photon energies of 1 keV to 1 GeV for six different natural marbles produced in different places in Turkey. The individual contribution of photon interaction processes to the total linear attenuation coefficients for marble has been investigated. The calculated results were also compared with the measurements. The results obtained for marble were also compared with concrete.
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Carbonato de Calcio , Materiales de Construcción , Fotones , Protección Radiológica/instrumentación , TurquíaRESUMEN
The case of a female newborn who was first found to have severe recurrent hypoglycemia and then developed cholestasis with conjugated hyperbilirubinemia is presented. No infectious diseases, metabolic defects, or disease of the hepatobiliary system were found. Endocrinological investigations revealed panhypopituitarism. Hypoplasia or aplasia of the pituitary was suspected. Cholestasis and hyperbilirubinemia must be seen in association with growth hormone and cortisol deficiency in the context of pathogenesis.
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Hipoglucemia/congénito , Hipopituitarismo/congénito , Ictericia Neonatal/etiología , Hipófisis/anomalías , Diagnóstico Diferencial , Femenino , Humanos , Recién Nacido , Pruebas de Función HipofisariaRESUMEN
Cholelithiasis is being documented with increasing frequency in the paediatric age group. Causes of gallstone formation in infants and neonates seem to differ from those in older children and adolescents. Two infants with pseudohypo-aldosteronism and cholelithiasis are reported. Salt-wasting and dehydration in pseudohypo-aldosteronism are suggested to be the pathogenetic mechanisms leading to gallstone formation possibly beginning in fetal life. The diagnosis of pseudohypo-aldosteronism may be missed, when salt-wasting is transitional. Cholelithiasis may go undetected when asymptomatic. CONCLUSION Pseudohypo-aldosteronism should be considered in infants with cholelithiasis even without obvious salt-wasting signs. Routine ultrasonographic screening for gallstones should be performed in patients with pseudohypo-aldosteronism.
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Colelitiasis/etiología , Seudohipoaldosteronismo/complicaciones , Colelitiasis/sangre , Colelitiasis/diagnóstico , Deshidratación/etiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Seudohipoaldosteronismo/sangre , Seudohipoaldosteronismo/diagnóstico , Sodio/sangreRESUMEN
Congenital adrenocortical hypoplasia is a malformation of unknown etiology leading to Addison's disease. The prognosis depends on early diagnosis which is difficult during the neonatal period. Decreased maternal secretion of estriol in late pregnancy is an important diagnostic clue.
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Enfermedad de Addison/congénito , Corteza Suprarrenal/anomalías , Insuficiencia Suprarrenal/congénito , Estriol/orina , Diagnóstico Prenatal , Enfermedad de Addison/diagnóstico , Corticoesteroides/sangre , Insuficiencia Suprarrenal/diagnóstico , Adulto , Femenino , Estudios de Seguimiento , Humanos , Hidrocortisona/sangre , Lactante , Recién Nacido , Masculino , EmbarazoRESUMEN
Assumed mutual antagonism of T-helper cell (Th)1 and Th2 diseases suggests that the prevalence of atopy should be decreased in rheumatoid arthritis (RA). We tried to determine that prevalence. Sixty-two patients with RA and 61 with osteoarthritis (control group) were included in the study. A questionnaire was used concerning mainly the symptoms of atopy. Skin prick tests, pulmonary function tests, chest X-rays, immunoglobulin E levels, and eosinophil counts were obtained. The prevalences of asthma, hay fever, and eczema in the RA group were 3.2%, 14.5%, and 1.6%, respectively. In the control group, they were 6.5%, 22%, and 6.5%, respectively. There was no significant difference between groups. There was also no significant difference between immunoglobulin E levels. Eosinophil counts were higher in the control group, however these values were within the normal range. Skin prick tests were obtained in seven RA patients, and eight controls revealed increased positivity. The prevalence of atopy in rheumatoid arthritis was not different from that in the general population. Our study results cannot support the concept of Th1/Th2 mutual antagonism.