Work-Related Symptoms of Spice Shop Workers and the Effect of Common Aeroallergen Sensitivity on Work-Related Symptoms.

OBJECTIVE:  Spices, because of their bioactive content, can cause irritation and allergic symptoms in the respiratory system and skin. Spice shop workers are constantly exposed to spices and dried herbs as part of their jobs. This study aimed to investigate the work-related symptoms of spice shop workers. Another aim was to assess the risk status of having an atopic nature for work-related symptoms. MATERIAL AND METHODS:  This was a cross-sectional study. Our research team visited the spice shops and a questionnaire was administered to 112 workers to assess work-related symptoms. In order to determine atopy, 79 of them had skin prick tests with common aeroallergens. RESULTS:  Workers had eye complaints (19.6%), runny noses (22.3%), skin symptoms (9.8%), shortness of breath (9.8%), and coughs (19.6%) at work. The prevalence of atopy was 18%. Atopy was associated with work-related eye complaints (odds ratio (OR): 4.12, 95% CI: 1.17-14.46), work-related runny nose, and work-related cough (OR: 4.85, 95% CI: 1.44-16.32, and OR: 4.41, 95% CI: 1.30-14.97). CONCLUSIONS:  The workers in spice shops are adversely affected by spices and dried herbs in their working environment. Being sensitive to common aeroallergens poses a risk for occupational symptoms.

Elderly and aged asthma have different characteristics: results of a multicenter study.

Background/aim: Characteristics of asthma in the elderly population is not well-known. The aim of the present study was to evaluate asthma in the elderly population, to compare disease characteristics between patients diagnosed <60 (aged asthma) and ≥60 (elderly asthma) years of age. Materials and methods: The study was a prospective, multicenter, cross-sectional type. A questionnaire was filled out to patients 60 years of age and over, that have been followed for asthma for at least 3 months. Asthma Control Test (ACT), eight-item Morisky Medication Adherence Scale (MMAS-8) was filled out, inhaler device technique was assessed. Results: A total of 399 patients were included from 17 tertiary care centers across the country. Mean age was 67.11 years and 331 (83%) were female. The age at asthma diagnosis was ≥60 in 146 (36.6%) patients. Patients diagnosed ≥60 years were older (p < 0.001), had higher education level (p < 0.001), more commonly had first-degree relative with asthma (p = 0.038), asthma related comorbidities (p = 0.009) and accompanying rhinitis/rhinosinusitis (p = 0.005), had better asthma control (p = 0.001), were using less controller medications (p = 0.014). Inhaler technique was correct in 37% of the patients with no difference in between the groups. Treatment compliance was better in elderly asthma patients (p < 0.001). In the multivariate logistic regression analysis, having well-controlled asthma (odds ratio = 1.61, CI = 1.04-2.51), and high medication adherence rate (odds ratio = 2.43, CI = 1.48-4.0) were associated with being in the elderly asthma group. Conclusion: The characteristics of asthma are different among patients aged 60 years and over which seems to be related to onset age of asthma. In our cohort, the elderly asthma patients had higher education level, and treatment adherence and asthma control was better. Patients diagnosed ≥60 years of age did not have more severe disease.

Assessment of Knowledge, Attitude, and Practice Patterns in Pulmonary Arterial Hypertension among Cardiologists and Pulmonologists: Evidence from Turkey.

Background and Objectives: Pulmonary arterial hypertension (PAH) is a rare chronic disease of the small pulmonary arteries that causes right heart failure and death. Accurate management of PAH is necessary to decrease morbidity and mortality. Understanding current practices and perspectives on PAH is important. For this purpose, we intended to determine physicians' knowledge, attitudes, and practice patterns in adult pulmonary arterial hypertension (PAH) in Turkey. Materials and Methods: Between January and February 2022, an online questionnaire was sent via e-mail to all cardiologists and pulmonologists who were members of the Turkish Society of Cardiology (TSC) and the Turkish Thoracic Society (TTS). Results: A total of 200 physicians (122 pulmonologists and 78 cardiologists) responded to the questionnaire. Cardiologists were more frequently involved in the primary diagnosis and treatment of PAH than pulmonologists (37.2% vs. 23.8%, p = 0.042). More than half of the physicians had access to right heart catheterization. In mild/moderate PAH patients with a negative vasoreactivity test, the monotherapy option was most preferred (82.8%) and endothelin receptor antagonists (ERAs) were the most preferred group in these patients (73%). ERAs plus phosphodiesterase-5 inhibitors (PDE-5 INH) were the most preferred (69%) combination therapy, and prostacyclin analogues plus PDE-5 INH was preferred by only pulmonologists. Conclusions: Overall, clinical management of patients with PAH complied with guideline recommendations. Effective clinical management of PAH in specialized centers that having right heart catheterization achieve better outcomes.

Prevalence and Risk Factors of Work-Related Asthma in Hospital Cleaning Workers.

OBJECTIVE: This study aimed to determine the prevalence and evaluate the risk factors of work-related asthma among professional hospital cleaning workers. MATERIAL AND METHODS: In total, 278 cleaning workers were interviewed (response rate: 75.7%), and pulmonary function tests were performed. The presence of asthma and its work-relatedness was evaluated. Serial peak expiratory flow measurements were planned according to symptoms increased at work or spirometric findings. RESULTS: Totally 40 cleaning workers had asthma (14.3%); of these, 17 (6.1%) had work-related asthma, and 23 (8.2%) had non-work- related asthma. Non-work-related asthma and work-related asthma were significantly associated with the females(odds ratio 95% CI: 3.0, 1.1-8.4, and 3.2, 1.0-10.3, respectively). Non-work-related asthma was significantly associated with a family history of asthma (odds ratio 95%CI: 5.1, 2.0-13.2 and 2.8, 0.99-7.9, respectively) and limescale remover use at work (odds ratio, 95% CI: 0.21, 0.04-0.97, and 1.7, 0.5-5.2, respectively). Only 7 (28.0%) of 25 cleaning workers who were suggested serial peak expiratory flow measurements could complete the measurements. Of those, measurements of 2 cleaning workers were consistent with occupational asthma. CONCLUSION: The negative association between limescale remover use at work and non-work-related asthma suggested health selec- tion bias (avoidance behavior) due to the asthmatic effects of these chemicals.

A basic tool to determine exercise capacity in COPD: 4-meter gait speed.

Introduction: Determination of exercise capacity is crucial for chronic obstructive pulmonary disease (COPD) management since it is an indicator of life quality and mortality. Various previously defined tests, including the cardiopulmonary exercise test (CPET), the 6-minute walking test (6MWT), and the incremental shuttle walk test, are used to determine COPD patients' exercise capacity. However, they all have some disadvantages, such as time, personnel, and equipment requirements, limiting their daily practice use. Here, it was aimed to investigate the role of 4-meter gait speed (4mGS) in evaluating exercise capacity in COPD. Materials and Methods: We included 40-to-70-year-old COPD patients with no contraindications for exercise testing. We performed the tests at standard intervals without affecting each other's results. We also performed spirometry. We used the modified Medical Research Council Scale, COPD Assessment Test, and BODE index to determine the current status of individuals. Result: Twenty-three (female/male= 2/21) subjects aged 58.1 ± 7.3 were included in the study. A statistically significant correlation was observed between 4mGS and peak VO2 values. There was also a statistically significant relationship between 4mGS and 6MWT distance. 4mGS correlated with CAT and BODE scores to represent the general medical status of patients. Conclusions: Considering its easy applicability and reproducibility, 4mGS seems to be a strong candidate for daily clinical use in monitoring the exercise capacity of COPD patients. Further studies in larger patient groups are needed to support these results.

Impact of socioeconomic factors and house cleaning on asthma control in women.

Background: It is known that socioeconomic factors affect various chronic diseases and also might affect asthma control. Exposure to house-cleaning products has been shown to impact both the onset and control of asthma. Objective: This study aimed to determine the effect of socioeconomic factors and house cleaning on asthma control of women with asthma. Methods: Adult women with asthma (N = 204) with informed consent were included in this single-center, cross-sectional observational study. A questionnaire, including items related to demographic, clinical, and socioeconomic features of the patients, was administered with a face-to-face interview by an investigator. A test to assess the level of asthma control was used to classify the patients as uncontrolled, partially controlled, and fully controlled. Wealth perception was measured with a visual analog scale. Investigated socioeconomic features were household size, monthly household income, education status, working status, occupation, and education status of the mothers of the patients. Results: Of the 204 adult female patients, 68.6% had uncontrolled, 14.7% had partially controlled, and 16.7% had fully controlled asthma. Partially or fully controlled asthma was higher (odds ratio [OR] 2.6 [95% confidence interval [CI], 1.09-6.22]) in the highest income quantile compared with the lowest income quantile. Asthma was better controlled in women with a visual analog scale score of wealth perception ≥ 7 (OR 1.93 [95% CI, 1.04-3.59]) and, in those who cleaned their houses, one to two times per week compared with zero times per week (OR 2.94 [95% CI, 1.19-7.26]). Conclusion: Having a higher household income was the only socioeconomic factor associated with better asthma control. After adjusting for age, duration of asthma, and comorbidities, better asthma control was significantly associated with cleaning the house one to two times a week.

Environmental asbestos exposure and nonmalignant pleural findings: a retrospective evaluation of a five-year chest CT repository.

This registry-based case-control study aimed to assess the association between asbestos deposits in the birthplace and/or residence and nonmalignant pleural findings, namely pleural plaques (PPs) and pleural thickening (PT), on chest CT scans. In total, 39,472 CT scans obtained over five years in a tertiary referral hospital in Ankara, Turkey, were evaluated. Cases involving patients with PP (n = 537), PT (n = 263), PP&PT (n = 69), and controls (n = 543) from the same study base without those conditions were included. Each case group was compared to controls using unconditional logistic regression. The presence of asbestos deposits in the district of birthplace (adjusted OR = 2.13, 95% CI: 1.35-3.37) and both birthplace and residence (aOR = 4.32, 95% CI: 2.26-8.27) was significantly related to the PPs. As the importance of environmental asbestos exposure in Turkey continues, future prospective studies could contribute to developing screening strategies.

Performance of pulmonary embolism severity index in predicting long-term mortality after acute pulmonary embolism.

OBJECTIVE: In this study, we aimed to evaluate the accuracy of the original and simplified pulmonary embolism (PE) severity index (PESI) to predict all-cause mortality after 30 days of acute PE diagnosis up to five years within consecutive sub-periods. METHODS: Adult patients diagnosed with acute PE between January 1, 2003, and June 30, 2013, were retrospectively included. Data on baseline characteristics and mortality during a five-year follow-up were collected. RESULTS: The study included 414 patients (Male/Female=192/222). The median age at diagnosis was 61.5 (minimum-maximum, 18-93) years. Mortality rates were 13.3% at 30 days, 21.8% at 90 days, 32.6% at one year, and 51.0% at five years. Both stratification into risk classes according to the original PESI and low vs. high-risk classification of original and simplified PESI were significantly correlated with the 30-day, 31-90-day, 91-day-one-year, and one-five-year mortality. Significant PESI predictors for mortality were history of cancer [hazard ratio (HR): 3.31, 95% confidence interval (CI): 1.64-6.68; p=0.001] and heart failure (HR: 2.35, 95% CI: 1.04-5.32, p=0.041) at 31-90-day, history of cancer (HR: 5.45, 95% CI: 2.86-10.40, p<0.001) at 91-day-one-year, advancing age (HR: 1.04, 95% CI: 1.02-1.06, p<0.001) and history of cancer (HR: 5.53, 95% CI: 3.41-8.98, p<0.001) at one-five-year after acute PE diagnosis. CONCLUSION: All-cause long-term mortality in high-risk patients with acute PE according to original or simplified PESI significantly increased up to five years of follow-up. This survival disadvantage was mainly related to cancer and comorbidities rather than acute clinical manifestations. Future prospective studies are needed to demonstrate the effect of various comorbidities on long-term mortality in these patients.

Association of baseline diaphragm, rectus femoris and vastus intermedius muscle thickness with weaning from mechanical ventilation.

BACKGROUND: To determine whether baseline diaphragm (Tdi), rectus femoris (RF) and vastus intermedius (VI) muscle thickness (TRF and TRF + VI) are associated with weaning success. MATERIAL AND METHODS: Right Tdi, TRF and TRF + VI were measured by ultrasonography within 36 h of intubation and diaphragmatic excursion (DE) was evaluated at the first spontaneous breathing trial in adult critically-ill patients. Reintubation or death within 7 days after extubation was defined as weaning failure. Weaning failure and success groups were compared in terms of ultrasonographic measurements and clinical features. RESULTS: Thirty-eight patients were assessed for weaning, 15 (39.4%) being in the weaning failure group. The median body mass index (BMI) was lower while the median clinical frailty scale (CFS), vasopressor use, duration of mechanical ventilation, intensive care and hospital mortality rate were higher in the weaning failure group, and the median TRF + VI (14.0 [12.3-26.2] vs 23.6 [21.3-27.1] mm, p = 0.03) and median DE (19.4 [14.6-24.0] vs 25.9 [19.3-38.5] mm, p = 0.045) were lower. The median Tdi was similar in two groups (1.9 [1.5-2.3] vs 2.0 [1.7-2.4] mm, p = 0.26). In ROC analysis, area under the curve for TRF + VI was 0.71 (95% CI: 0.51-0.90; p = 0.035), with 21 mm cut-off having sensitivity of 82% and specificity of 57%. Binary logistic regression analysis revealed TRF + VI < 21 mm as the only predictor of weaning failure with an odds ratio of 10.5 (95% CI: 1.1-97.8, p = 0.038) after adjusting for age, sex, BMI and CFS. CONCLUSIONS: TRF + VI lower than 21 mm, measured by ultrasonography within 36 h of intubation, was associated with weaning failure among critically-ill patients.

COVID-19 Pandemic and the Global Perspective of Turkish Thoracic Society.

It has been more than 3 months now since the first case of COVID-19 was reported in Turkey. Globally, the number of confirmed cases and deaths reached 9,653,048 and 491,128 respectively, as reported by 216 countries by June 27, 2020. Turkey had 1,396 new cases, 194,511 total cases, and 5,065 deaths by the same date. From the first case until today, the Turkish Thoracic Society (TTS) has been very proactive in educating doctors, increasing public awareness, undertaking academic studies, and assisting with public health policies. In the present report, social, academic, and management perspectives of the pandemic are presented under appropriate subtitles. During this critical public health crisis, TTS has once again demonstrated its readiness and constructive stance by supporting public health, healthcare workers, and the environment. This review summarizes the perspective of TTS on each aspect of the COVID-19 pandemic and casts light on its contributions.

Physicians' opinions about the causes of underreporting of occupational diseases.

Occupational diseases cause an important burden on health and economy; however, they are substantially underestimated. We aimed to investigate the opinions of physicians about causes of underreporting of occupational diseases. We collected data with a questionnaire, listing 30 possible causes for underreporting of occupational diseases. 478 physicians participated in the study. The first 3 most frequent causes perceived as "very important" are; employers' perception of occupational safety and health services as a loss of revenue (64.9%), prevalent employment without a legal contract (64.6%), and prevalent employment as subcontracted (59.4%). 52.1% of the physicians worked or currently working as an occupational physician. With the increase of working year as an occupational physician, there was a statistically significant decrease in the strength of importance for 17 of the 30 statements. This finding may be one of the important causes of underreporting of occupational diseases.

Screening instrument to identify skin prick test-negative patients with asthma and/or rhinitis.

INTRODUCTION: To the best of our knowledge, there is no prediction tool for determining respiratory allergy in patients with asthma and/or rhinitis. OBJECTIVES: As such, this study aimed to develop an instrument for identifying skin prick test (SPT)-negative patients with asthma and/or rhinitis. METHODS: This cross-sectional study screened 510 consecutive patients diagnosed with asthma and/or rhinitis between November 2009 and May 2011 in Ankara, Turkey. A structured questionnaire was the screening tool that was administered during the initial visit by the treating specialist and compared with a SPT result. All 15 variables were analysed using the logistic regression model to obtain ß values (a score) for each variable. Each variable had a score, and scores were summed up to obtain final score for each patient. RESULTS: The study included 363 patients, of which 165 (45.5%) were SPT positive. The final model included 13 variables. The lowest and highest scores were -21 and 26. A total score of 5.5 had sensitivity of 63% and specificity of 80%. The area under the receiver operating characteristic curve was 0.78. The histogram of the total scores for the study population was bimodal. CONCLUSIONS: We designed a highly specific 13-item instrument for identifying SPT-negative patients. It may be used in middle income countries where allergy testing is expensive, not reimbursed or few allergy clinics are available. We think that our idea is interesting, that needs further research.

Absenteeism and Delay to Work Due to Sleep Disorders in the Turkish Adult Population: A Questionnaire-Based National Survey.

Sleep problems may have negative effects on work-life balance, overall health, and safety. We aimed to investigate the association between sleep disorders and absenteeism and delay to work (being late or tardy) among the working adult population. The study was conducted by using data from a large survey of working adults who participated in the Turkish Adult Population Epidemiology of Sleep Study (TAPES) managed by Turkish Sleep Medicine Society (TSMS). Secondary analyses was employed to examine absenteeism and delay to work and their associations with sleep problems, including sleepiness by Epworth Sleepiness Scale (ESS), parasomnias, sleep apnea (by Berlin Questionnaire), sleep quality (by Pittsburgh Sleep Quality Index), and restless leg. History of any absenteeism and delay to work was observed in 276 (18%) and 443 (29%) out of 1,533 working adults, respectively. In the multivariate analyses, absenteeism was associated with younger age, female gender and poor sleep quality, while delay to work was associated with younger age, poor sleep quality, parasomnia, and sleepiness. In the presence of absenteeism and delay to work, sleep disorders including sleepiness, poor sleep quality, and parasomnia should be considered. Such evaluation may improve worker well-being and provide some additional benefits in terms of increasing productivity and lowering work-related costs.

Polycystic ovary syndrome and the risk of obstructive sleep apnea: a meta-analysis and review of the literature.

BACKGROUND AND OBJECTIVE: Polycystic ovary syndrome (PCOS) has been reported to be associated with the development of obstructive sleep apnea (OSA). The objective of this meta-analysis is to assess the relationship between PCOS and OSA. METHODS: A literature search was conducted to identify studies linking PCOS with the risk of OSA. Studies in which the presence of OSA was confirmed with overnight polysomnography were included. Random effects models were used to calculate pooled relative risks. RESULTS: Eight studies conducted in adults and five studies conducted in adolescents were identified. The pooled OSA prevalence was 0.22 (95% confidence interval (CI): 0.08-0.40) in PCOS patients. The pooled prevalence of OSA was higher in adults (0.32, 95% CI: 0.13-0.55) than adolescents (0.08, 95% CI: 0.00-0.30). Risk of OSA was significantly increased in adult patients with PCOS (odds ratio (OR) 9.74, 95% CI: 2.76-34.41). Risk of OSA was not significantly increased in adolescents (OR: 4.54, 95% CI:0.56-36.43). CONCLUSIONS: These findings demonstrate a significant association between PCOS and OSA in adult patients. Considering the increased risk for long-term cardiometabolic disorders associated with both PCOS and OSA, it is important to diagnose and treat OSA in patients with PCOS.

Paper #3: Can TGR change the natural history of pulmonary functions in EOS? Is Radiological Straightness Correlated with Normal Lung Development?

Even though traditional growing rod (TGR) patients score lower in exercise tolerance and spirometry compared to age-matched controls, their pulmonary functions are similar to those of instrumented adolescent idiopathic scoliosis (AIS) patients.