A comparison of propofol-midazolam and midazolam alone for sedation in endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective cohort study.

OBJECTIVES: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new, minimally invasive, bronchoscopic technique used in the evaluation of inthrathoracic lymph nodes.Use of sedation drugs before the procedure differs among centres. There is no standardization about sedation before EBUS-TBNA.We used a policy decision to shift from use of propofol with midazolam vs midazolam alone in a large tertiary hospital to evaluate the diagnostic yield and safety of EBUS-TBNA procedure. METHODS: Files of all the patients who were performed EBUS-TBNA between the dates of September 2010 and May 2014 were surveyed. All the EBUS-TBNA cases were performed under sedation of propofol and midazolam with an accompanying anesthesiologist in the beginning, however, sedation is applied with midazolam without an accompanying anesthesiologist after April 2013 due to changes in sedation policy. The diagnostic yield and complication rates were compared by chi-squared analysis between two groups. RESULTS: The files of 340 EBUS-TBNA performed patients were evaluated. Of the patients 274 eligible patients were analysed. 152 patients who fulfilled the inclusion criteria were analysed in propofol-midazolam (P) sedated group and 122 patients were analysed in midazolam (M) group. There is no statistically significant difference between two different sedated groups in terms of age and gender. Diagnostic value was detected as 77.6% in P group and 85.7% in M group and the difference was not statistically significant. No difference between complication rates of both groups was observed. CONCLUSION: Both sedation-types for performing EBUS-TBNA showed similar diagnostic value and complication rates in our study. Propofol with midazolam application requires with an accompanying anaesthesiologist, therefore, it increases cost. EBUS-TBNA procedures had been performed in safe with no decrease in diagnostic yield under moderate sedation.

Biomass smoke exposure as a serious health hazard for women.

INTRODUCTION: Lung diseases caused by biomass exposure cause a significant health hazard particularly amongst women. The present study was designed to investigate biomass exposure in women suffering from lung disease. MATERIALS AND METHODS: A total of 100 women [mean (SD) age: 55.13 (17.65) years] hospitalized for chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, tuberculosis or interstitial lung disease were included in this study conducted between September 2008-March 2009 in three chest disease clinics at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital. Data collection on biomass exposure was based on application of hospital-based survey questionnaire including items on occupation, level of education, place of birth (location, region), exposure to biomass fuel fumes for heating and cooking purposes (animal dung, wood, charcoal, dried plant) and years of exposure with animal dung, wood, charcoal, dried plant. RESULTS: COPD in 22% patients, lung carcinoma in 12%, bronchitis in 8%, tuberculosis in 26%, and interstitial lung disease in 17% were the diagnosis for hospitalization. The most identified occupation was housewifery 86%. Active, former and non-smokers composed 6%, 22% and 72% of the population. Birth place was village in 67% patients while districts in 9%. According to regional distribution, the most common place of birth was Central Anatolia region in (29%). Exposure to biomass fuels was identified in all of patients including wood (92%), animal dung (30%), charcoal (23%), and dry plant (23%). Mean (SD) years of exposure was identified to be 52.6 (17.9) years for wood, 40.8 (17.9) years for animal dung, 48.1 (20.8) years for dry plant and 38.5 (21.4) years for charcoal. The most common type of biomass exposure was wood in village (97%), city (79%) and county (89%). CONCLUSION: Findings indicating impact of biomass exposure in women seem to emphasize the need for analytic epidemiologic studies assessment measuring biomass exposure levels-particularly for women and young children.

Management of and risk factors related to hepatotoxicity during tuberculosis treatment.

INTRODUCTION: Hepatotoxicity is one of the most frequent adverse events occurring during tuberculosis treatment that may negatively affect treatment compliance, clinical outcome. This study was designed to evaluate management, risk factors related to hepatotoxicity during tuberculosis treatment. PATIENTS AND METHODS: Hospitalized patients for tuberculosis treatment at Sureyyapasa Chest Diseases, and Chest Surgery Training and Research Hospital were included, between January 2004 and December 2007. Prevalence of hepatotoxicity, risk factors were evaluated among tuberculosis patients under anti-tuberculosis treatment according to World Health Organization (WHO) guideline. Hepatotoxicity was defined any elevated liver function tests with accompanying symptoms. Age, gender, past history of anti-tuberculosis treatment, extensity of radiological findings, co-morbid disorders and drug resistance were the risk factors evaluated in terms of development and recurrence of hepatotoxicity. RESULTS: Of 1443 patients (38.37 ± 16.74 years; 64.5% were males), 106 (7.3%) was identified to develop hepatotoxicity on an average of 20 days after beginning treatment and lasting an average of 14 days. Hepatotoxicity for once in 78.3% (n= 83) of patients and more than once in 21.7% (n= 23) patients. All anti-tuberculosis drugs was continued at full dosage after the normalization of liver enzyme in 76.4% (n= 81). In recurrence a step-by-step treatment was re-started by exclusion of responsible drug/s. Treatment was administered without modification of WHO regimes in 79.2%. Pyrazinamide was omitted in 15 cases while rifampicin only in one patient. Triple drug regimen with isoniazid, ethambutol and streptomycin was used in six cases. Quinolon was added to treatment only in one patient. Presence of a co-morbidity was determined to be significant predictor of hepatotoxicity development OR= 3.093 (CI= 1.95-4.89; p= 0.000) past history of anti-tuberculosis treatment was significantly associated with recurrence (p= 0.027). There was no hepatotoxicity dependent mortality. CONCLUSION: Hepatotoxicity can be successfully management of hepatotoxicity without second line tuberculosis drugs in ongoing treatment regime.

Occupation and tuberculosis: a descriptive study in Turkish patients with tuberculosis.

INTRODUCTION: The present study was designed to determine the distribution of tuberculosis patients according to their occupations in Turkey. PATIENTS AND METHODS: A total of 757 patients with bacteriologically and histopathologically confirmed diagnosis of tuberculosis and under the tuberculosis treatment were included in this retrospective descriptive study. Medical records of patients admitted to the Ministry of Health Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital between the years of 2004 and 2007 were evaluated in terms of patient demographics and the occupations. Occupations were classified into 10 groups according to the International Standardization Classification Occupation (ISCO-88). RESULTS: Males composed 67% of the overall population [mean age (SD) was 41.3 (16.4) years]. Recurrent and newly diagnosed tuberculosis patients composed 81 and 19% of the patients, respectively. The most frequently identified major occupational groups were; craft and related workers (32%), plant and machine operators and assembler (10%), followed by the subgroups of textile, garment and related trades workers (12.9%), motor vehicle drivers (5.8%). The youngest subgroup among the most popular subgroups with a mean age (SD) of 29.5 (11.1) years, was textile, garment and related trades workers while the subgroup of mining and construction laborers was the oldest with a mean age (SD) of 63.9 (7.9) years. In all occupational subgroups, the frequency of males was higher than females. In female patients, the most frequently identified subgroup was, textile, garment and related trades workers while, mining and construction laborers, motor vehicle drives, building frame and related trades workers were composed solely of males. The frequency of newly diagnosed patients was significantly higher than former tuberculosis patients in the occupational subgroups. CONCLUSION: It seems crucial to improve conditions of workplaces with arrangements enabling healthier environment such as adequate ventilation, appropriate living space as well as routine health controls of employees especially for the textile industry.

Tracheobronchopathia osteochondroplastica: an unusual presentation.

A 24-year-old woman presented with chronic cough and noisy breathing. Chest x-ray revealed diffuse irregularity and narrowing of the tracheal lumen. Thorax computed tomography showed irregularity, stenosis, and areas of ossification throughout the trachea and both main bronchia. Flexible bronchoscopy revealed multiple nodules protruding into the tracheal lumen. Histopathology of the nodules confirmed the diagnosis of "tracheobronchopathia osteochondroplastica." Tracheobronchopathia osteochondroplastica is a rare, benign disease that is characterized by multiple cartilaginous and osseous submucosal nodules protruding through tracheal lumen and large bronchia. The etiology is still unexplained.

[Evaluation of Nazilli Tuberculosis Dispensary activities executed between June 1996-May 2000: Pre-DOT situation]. / Nazilli Verem Savas Dispanseri'nde Haziran 1996-Mayis 2000 tarihleri arasinda yürütülen çalismalarin degerlendirmesi: DGT öncesi durum.

OBJECTIVE: To evaluate Nazilli Tuberculosis Dispensary activities executed between 1st June, 1996- 31st May, 2000 and to compare differences among 12-month-periods. DESIGN: Retrospective analyses of data. SETTINGS: People living in the villages under responsibility of Nazilli Tuberculosis Dispensary. POPULATION: People examined in out-patient clinic as symptomatic cases, for health report or during contact examination, number of mycobacteriological and radiological examinations, and tuberculosis cases detected in each year. MAIN RESULTS: Average number of newly diagnosed tuberculosis patient in every 12-month-period was 105. The average rate for new tuberculosis cases finding was 52.5%. Pulmonary tuberculosis was in 74.8% of all tuberculosis cases. The range of smear positive pulmonary tuberculosis cases in all tuberculosis cases differed from 49% to 71% and a decrease in the rate of cases with no sputum smear from 18% to 3% were observed. The average of bacteriological conversion rate at the end of second therapy month was 70.5%. The average of cure rate in new smear positive patients was 82%. According to drug susceptibility test results, 13 of new smear positive cases and 5 of old cases were multi-drug resistant tuberculosis. CONCLUSION: Although the treatment success of either new smear positive or old smear positive tuberculosis cases were high, it is necessary to plan strategies for increasing the new case finding rate to 70%, the rate suggested by World Health Organization. The data obtained by this study showed that hopeful results may be achieved by stable staff and team-work in tuberculosis dispensary.