The Effect of Noise Exposure on Hearing Function and Vestibular Evoked Myogenic Potentials.

Purpose: Exposure to noise can cause damage to both auditory and vestibular systems. The objective of this study is to evaluate how noise exposure affects the hearing and vestibular systems in individuals with noise-induced hearing loss (NIHL). Methods: This study included 80 subjects (40 subjects with NIHL, and 40 controls), between 26 and 59 years old. For hearing assessment, pure-tone audiometry, extended high-frequency audiometry, tympanometry, acoustic reflex threshold, and distortion product otoacoustic emission tests were used; for vestibular assessment, the cervical and ocular vestibular evoked myogenic potentials tests were used. Results: Statistically significant differences were found between the two groups in 3 to 6 kHz frequency thresholds; in extended high-frequency audiometry tests, there were also significant differences between groups at all frequencies from 9.5 to 16 kHz. The cervical and ocular vestibular evoked myogenic potentials thresholds were significantly higher and N1-P1 amplitudes were significantly lower in the NIHL group. Conclusion: Noise can lead to damage to both auditory and vestibular functions. Therefore, audiological assessments and vestibular evoked myogenic potentials could be clinically useful for examining patients with NIHL.

How were Non-COVID pulmonary patients and diseases affected from COVID-19 pandemic period?

OBJECTIVE: This study aimed to focus on non-COVID-19 patients during the process when all physicians focused on COVID-19 patients. Patients with pulmonary diseases in the COVID-19 pandemic period were analyzed. MATERIAL AND METHODS: Non-COVID-19 cases who were hospitalized in the pulmonology clinic, outpatients, and patients who applied to the non-COVID-19 emergency service and requested a pulmonology consultation in the period from March 16, 2020 to May 15, 2020 and in the same period of the previous year (i.e., from March 16, 2019 to May 15, 2019) were included in this study. RESULTS: In the pandemic period, it was found that there was an 84% decrease in outpatient admissions, a 43% decrease in inpatients, and a 75% decrease in emergency services. During the pandemic period, in outpatient setting, male and younger case admissions increased, admissions with chronic obstructive pulmonary disease (COPD), and interstitial lung diseases decreased, whereas the frequency of admission to asthma, pneumonia, and pulmonary thromboembolism increased. In the period of the pandemic, patients with asthma, COPD, and lung cancer were less hospitalized, whereas patients with pulmonary thromboembolism, pneumonia, and pleural effusion were hospitalized more. In non-COVID-19 patient treatments during the pandemic period, usage of a metered dose inhaler increased. CONCLUSION: During the COVID-19 pandemic, non-COVID pulmonary pathologies decreased significantly, and there was a change in the profile of the patients. From now on, to be prepared for pandemic and similar extraordinary situations, to organize hospitals for the epidemic, to determine health institutions to which nonepidemic patients can apply, to make necessary plans in order not to neglect the nonepidemic patients, and to develop digital health service methods, especially telemedicine, would be appropriate.

Demographic, Clinical and Management Characteristics of Newly Diagnosed COPD Patients in Turkey: A Real-Life Study.

Purpose: In order to determine the clinical and sociodemographic characteristics of newly diagnosed treatment-naïve asthma and COPD patients in Turkey, a multicenter study in 2012 was initiated . We aimed to investigate the characteristics and therapies of COPD patients in the original study in more detail. Patients and Methods: This nation-wide, multicentric, non-interventional, prospective, real-life observational cohort study was conducted in 122 centers. The newly diagnosed patients were not receiving any treatment before the recruitment. Their general characteristics, the combined GOLD 2011 COPD categories and exacerbation histories were noted. The patients were followed up with 3 voluntary visits for 1 year. Their adherence to the inhaled treatment according to GOLD 2011 was evaluated during follow-up visits. Results: The study included 776 COPD patients. Their mean age was 59.4±9.1 years, and 11.9% of the patients were female. 35.1% of the patients were in the GOLD 2011 C and D category. 12.6% are frequent exacerbators, and 52.8% had at least one comorbid condition. 71.8% overtreatment rate was detected. Their attendance rates for three follow-up visits became 55.9%, 32.9% and 18.7%, respectively. The adherence rate to the treatment was measured as 81.9%. Conclusion: Although these patients were diagnosed for the first time, the GOLD C and D categories and frequent exacerbator phenotype were found at a high rate. They were usually prescribed an overtreatment regimen. We think that newly diagnosed COPD patients should be evaluated carefully, and best effort should be made to treat these patients in accordance with the recommendations of the major COPD guidelines.

Call centers and noise-induced hearing loss.

Noise is defined as unwelcome sound. It has been estimated that 16% of adult hearing loss in the world is due to noise exposure at the workplace. This report offers a case that diagnosed with hearing loss of whom working as a call center operator at home. Home agent operators should be explored.

The role of molds in the relation between indoor environment and atopy in asthma patients.

BACKGROUND: The effect of mold fungi to allergic sensitization is not well-known. We aimed to evaluate the role of molds in the relation between indoor environment and atopy in asthmatics. MATERIALS AND METHODS: The air samples obtained from 66 stable asthmatics and 35 control subject's houses were sprayed into Sabouraud dextrose agar. Allergy skin testing were performed in both groups. The temperature and humidity of each house were measured. RESULTS: The incidence of atopy was similar in cases (59.1%) and controls (51.4%). The average amount of mold was 35.9 CFU/m(3) and 34.3 CFU/m(3), respectively. The number of household residents was positively correlated with the amount of molds. There was no difference in the amount of mold with respect to dosage of inhaler corticosteroids as well as symptom levels in asthmatics. The most frequently encountered allergens were Dermatophagoides farinae/Dermatophagoides pteronyssinus, grass/weeds and molds. Spending childhood in a village was more common among atopics. CONCLUSION: Living environment during the childhood might affect atopy and asthma. Based on the identification of molds as the second most frequent allergen after mites in our study population, assessment of mold sensitization as well as in forming patients about ways to avoid them seem likely to contribute to the effective management of uncontrolled asthma.

[Prevalence of silicosis among employees in feldspat and quartz mills and associated factors with silicosis]. / Kuartz ve feldspat degirmenlerinde çalisanlarda silikoz sikligi ve silikoz ile iliskili faktörler.

INTRODUCTION: Problems in legal definition and diagnosis of occupational diseases in Turkey makes the diagnosis of these diseases and informing the parties important. For this purpose, this study was planned to elicit the frequency of silicosis in quartz mill workers in Cine which is one of the largest quartz and feldspat areas, and to detect the working conditions, to inform the workers to improve the working conditions. The aim was to evaluate 592 workers in 10 quartz mill and mines around Cine in 2004. MATERIALS AND METHODS: A structured questionnaire including personal information and work-related questions was applied. Standards chest X-rays taken in the last six months were evaluated according to International Labour Organization (ILO) 1980 standards. Dust concentration and respirable dust concentration in the work place were measured in enterprises. RESULTS: The mean age of the workers was 31.8 ± 8.26 years and 71.7% was smoker. Duration of working was ≤ 5 years in 80.5% and ≥ 10 years in only 4.2%. According to the results of dust measurements, threshold value was found to be exceeded in chopping, packaging and bagging parts of three workplaces. Frequency of silicosis was calculated to be 23.7%. CONCLUSION: Frequency of pneumoconiosis was found to be high like previous studies carried out in similar workplaces in this study. Although it was impossible to put forward the cumulative effect of dust exposure because of frequent altering in workplace, the high frequency of working in similar workplaces among the cases supported the significant risk of silicosis in these enterprises. The workplaces were observed after the workers and persons responsible from occupational health and safety.

[Mortality and factors affecting mortality in chronic obstructive pulmonary disease]. / Kronik obstrüktif akciger hastaliginda mortalite ve mortaliteyi etkileyen faktörler.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality and morbidity in the world. Mortality rates vary between 15-54% in investigations. There is a limited number of studies evaluating factors associated with mortality and morbidity in our country. The aim of this study is to detect the mortality rate and to investigate the factors affecting mortality. PATIENTS AND METHODS: 427 patients with COPD between July 2004-November 2005 were evaluated. RESULTS: Mortality rate was found to be 17.3% at the end of four years. Deaths were most frequently due to pulmonary causes and secondly cardiac factors. Deaths due to lung cancer were 31%. Age, amount of smoking, COPD stage, FEV1 (L), FEV1% predicted, FVC (L), FVC% predicted, FEV1/FVC, PEF (L/sn), PEF% predicted, FEF25-75 (L) and FEF25-75% predicted values, presence of comorbid diseases, Modified Borg Scale and dyspnea severity according to MMRC, six minutes walking test and oxygen saturation following the test, BODE index, SF-36 quality of life questionnaire, physical function, physical role, emotional role and energy scores parameters and all parameters of SGRQ questionnaire were found to be significantly associated with mortality. CONCLUSION: COPD is a disease with high mortality and is one of the problems related with the public health. In the follow up of COPD, the usage of other measures like exercise capacity and quality of life besides spirometric measures should be encouraged. To make the patients and cases in the risky group conscious of their disease is important since the risk factors are preventable. This method may also contribute to the prevention of comorbid diseases.

Quality of life, depression and anxiety in young male patients with silicosis due to denim sandblasting.

The aim of this study was to estimate the quality of life, depression and anxiety in patients with silicosis due to denim sandblasting. This study was conducted on 50 young male patients with silicosis and 30 controls. A socio-demographic data form, Short Form-36 (SF-36), the Beck depression inventory (BDI) and the Beck anxiety inventory (BAI) were used to determine quality of life, depression and anxiety. The mean scores of SF-36, BDI and BAI were higher in the patients than in the controls. Correlation analysis revealed a strong negative correlation between all scales of SF-36 and BDI scores. Additionally, there was strong negative correlation between five scales of SF-36 and BAI scores. We suggest that silicosis might be detrimental to the quality of life and increase depression and anxiety in patients with silicosis due to denim sandblasting.

[Does exposure to biomass and occupational dust can be causative for asthma among women?]. / Kadinlarda biomass ve mesleksel toza maruziyet astima yol açabilir mi?

In the developing countries, most of the house energy necessity is supplied from the biomass. Because of this reason, chronicle airway diseases and the respiratory symptoms that have been triggered by the house inside air pollution is very common. As an example from the real life of this entity, an asthmatic woman who has an history of using biomass in her house for heating, cleaning and cooking in all her life (because of the economical difficulties) and also an history of occupational organic dust exposure as a seasonal worker during the last 20 years was reported. After the medical investigation, the case was diagnosed as severe persistent asthma. The case was externated after ordering the appropriate inhaler treatment and she was taken to the follow up programme.

General aspects of hypersensitivity pneumonitis in Turkey.

Hypersensitivity pneumonitis prevalence rates are between 5 and 15% of the overall population exposed to known inciting antigens but a small number of cases have been reported from Turkey until now. We aimed to present a broad picture of hypersensitivity pneumonitis in Turkey, thus promoting interest in this relatively common disease in developing countries. Search engines were utilized to retrieve the cases reported from Turkey. Other published journals and meeting abstracts which have not been registered into electronic databases were manually reviewed. Twenty-two cases from 13 reports were characterized by demographics, clinical features, occupational and environmental exposures, diagnostic tools and prognostic data. The majority of the group consisted of women (68.2%) and had a positive history for contact with an avian (59%). Mean exposure period was 69 ± 77.6 months. The most common reported clinical form was chronic hypersensitivity pneumonitis (58.8%). Reticulonodular pattern was the basic pathological finding (45%). Restrictive impairments of the forced vital capacity (FVC) and carbon monoxide diffusing capacity (DLCO) of the lungs were the basic pathologies observed in pulmonary function tests. Interstitial fibrosis was the most common pathological finding (61.5%). Few cases reported with preponderance of chronic hypersensitivity pneumonitis with avian exposure from 70 million populations suggest that many hypersensitivity pneumonitis cases, especially acute forms, have been ignored. Also, hypersensitivity pneumonitis somehow appears to be a neglected occupational disease. The present situation should be considered as a common problem currently faced by developing countries and occupational groups under risk must be investigated promptly.

Working conditions and pneumoconiosis in Turkish coal miners between 1985 and 2004: a report from Zonguldak coal basin, Turkey.

In Turkey, bituminous coal mining is performed only in Zonguldak coal basin since 1940. Pneumoconiosis surveillance programs and dust control measures are in effect, but published pneumoconiosis data from this area is lacking. In this study, we aimed to evaluate the change in prevalence and case detection between 1985 and 2004 and assess the correlation between the dust concentration in workplaces and the prevalence of pneumoconiosis. Data on respirable dust concentrations and number of workers diagnosed as pneumoconiosis between 1985 and 2004 were obtained from Turkish Coal Enterprises authorities. Mean respirable dust concentrations in workplaces underground and on the ground were 1.66 mg/m(3) and 0.73 mg/m(3) respectively. Total number of workers decreased from 38.231 in 1985 to 12.261 in 2004 including 8932 underground workers. In this period, pneumoconiosis has not been reported in the ground workers. Incidence of pneumoconiosis ranged between 0.17-2.8 percent and prevalence ranged between 1.23-6.23 percent between 1985 and 2004. Radiologic opacities compatible with pneumoconiosis were predominantly small opacities. This is the first report about the incidence and prevalence rate of coal worker's pneumoconiosis in the main coal mining area of Turkey. Dust measurement and screening standards should be improved and adapted to international standards and we conclude that surveillance data should be closely monitored in this region and further epidemiologic studies in this area are warranted.

[Occupational and environmental exposures and relations with pulmonary health]. / Mesleksel, çevresel maruziyetler ve akciger sagligi iliskisi.

The effects of living conditions and occupational and environmental exposures on pulmonary health are well known. Turkey, as a developing country, has a high risk of occupational and environmental exposure, and knowledge on the issue is limited. To prove the general living conditions of the inpatients in our clinic, and to study relation of pulmonary diseases with respiratory exposures. Detailed history of occupational and environmental exposure of the subjects who were followed as inpatients has been examined, and the relation with their diseases has been evaluated. Lung cancer, chronic obstructive pulmonary disease, and pneumonia were the most common reasons for hospitalization. Respiratory disease was observed 1.93 times more in males. The risk of lung cancer was 6.36 times higher in smokers, 4.28 times more in ex-smokers, and 2.19 times more in subjects living in downtown. And the risk of respiratory disease was 2.12 times in the dwellers of concrete buildings, and 1.70 times in subjects utilizing one of the risky heating equipment. When the disease distribution was examined in accordance with the occupational groups, civil servants, farmers, teachers, and petty officers were more prone to lung cancer, whereas, workers, housewives, and merchants were inclined to other diseases. Environmental and occupational exposure becomes frequent and complicated because of the current socioeconomic conditions. While exposure to tobacco smoke becomes the most important threat, exposures resulting from the common environment or job ambients should also be taken into consideration.

Comparison of six-minute walking tests conducted with and without supplemental oxygen in patients with chronic obstructive pulmonary disease and exercise-induced oxygen desaturation.

BACKGROUND: There are contradictory reports in the literature on the effects of supplemental oxygen administered before or after exercise tests. In light of this, we compared the results of 6-minute walking tests performed in room-air conditions (A6MWT) and with supplemental oxygen (O6MWT) in patients with chronic obstructive pulmonary disease (COPD) and exercise-induced oxygen desaturation. PATIENTS AND METHODS: Thirty-one patients with COPD were included in the study. The A6MWT and O6MWT were performed in randomized order on each patient. During the tests, severity of dyspnea and tiring of the leg were evaluated by the Modified Borg Scale. Heart rate and pulsed oxygen saturation and blood pressure were measured by pulse oximeter. RESULTS: Walking distance was longer with the O6MWT than with the A6MWT (P=0.001). The O6MWT resulted in a smaller increase in dyspnea, leg fatigue, and heart rate and a smaller drop in pulsed saturation than the A6MWT (P<0.05). The walking distance with the O6MWT correlated with respiratory function and hemodynamic parameters (P<0.05). CONCLUSION: The O6MWT, which produced less hemodynamic stress and was safer than the A6MWT, might provide more accurate information on exercise limitation for patients with COPD. These results suggest that the O6MWT can be used as a standard walking exercise test for patients with COPD and exercise-induced oxygen desaturation.

[Microbiological results of bronchoalveolar lavage that was performed for opportunistic pulmonary infections]. / Firsatçi pulmoner infeksiyon ön tanisiyla yapilan bronkoalveoler lavajin mikrobiyolojik sonuçlari.

Between 2001-2002; in 62 cases, 33 (53%) male, 29 (47%) female, mean age 51.4 +/- 18.1 years) bronchoalveolar lavage (BAL) was performed for diagnosis of opportunistic pulmonary infection and specimens were evaluated for results of microbiological examinations. There was hematological malignancy in 18 (29%) and solid organ malignancy in 13 (21%) cases. Thirty-one (50%) cases were immunocompromised for reasons other than malignancy. By endoscopic evaluation endobronchial lesion was seen in 2 (3%) cases, indirect tumor signs were seen in 2 (3%) cases and signs of infection were seen in 11 (18%) cases. Forty-even (76%) cases were endoscopically normal. Acid-fast bacilli (AFB) direct examination was positive in 3 (5%) cases. In 4 (6%) cases mycobacterial culture was positive, Mycobacterium tuberculosis-polymerase chain reaction (PCR) was also positive in these four cases. Examination of gram-stained smears for bacteria was associated with infection in 14 (23%) cases. Bacteriologic cultures were positive for single potential pathogen in 10 (16%) cases, and for mixed pathogens in 7 (11%) cases for a total number of 17 (27%). Fungal cultures were positive in 3 (5%) cases all of which had hematological malignancy. As a result in 24 (39%) cases microbiological agent of infection is determined: in four mycobacteria, in 17 bacteria other than mycobacteria and in three fungi.

[Evaluation of silicosis in ceramic workers]. / Seramik fabrikasi isçilerinde silikozis.

This study is aimed to evaluate the incidence of silicosis and the relation of it with personal and work-related factors among workers exposed to silica in ceramic factory. Workers were evaluated by respiratory symptoms, physical examination, pulmonary function and radiological findings. Occupational and Enviromental Pulmonary Disease Evaluation Questionnaire of the Turkish Thoracic Society Enviromental and Occupational Pulmonary Diseases Working Group was used. 365 of 626 workers had exposure to silica and the rest 261 were concerned as control group. There was no difference between mean age, duration of work and smoking pack year among the groups (p> 0.05). Cough and sputum rates were higher in silicosis group FEV1 and FVC values were lower in silica group but this was not statistically significant. When the two subgroups of silica group (the workers in high dust concentration and the ones in low concentration) were compared, the high concentrated group had significantly more sputum but the other symptoms and pulmonary functional parameters were not different significantly. 24 workers had parenchymal densities adjusted with pneumoconiosis. The workers with the pneumoconistic finding, had a higher mean age and longer duration of work. As a conclusion, ceramic industry has risk for silicosis. And the risk increase by time and age.

The ill child in the emergency department and the accompanying people: a cross-sectional analysis.

OBJECTIVE: The objective of this study is to investigate relationship between the number of the family members visiting the emergency department with pediatric patients and patient characteristics such as age, insurance status, traumatic complaint, whether event was acute or not, and to estimate number of family members who had any time off from their work among this group. METHOD: A prospective cross-sectional study was performed using a questionnaire which included demographic characteristics, number of family members, number of family members who were taking hours off from work. In the 15-day period (1-15 August 2003), all persons who accompanied the children to the university-based PED (annual volume: 18,000) were asked to participate in the study. RESULTS: A total of 575 persons accompanied the 300 children seen in PED (1.92 persons per child). Number of persons accompanying the children was found to be inversely related to age (Pearson correlation, P = 0.000). Seventy-nine children (32.1%) of those with acute complaints had family members who took time off from their work, whereas 29 (53.70%) of those with chronic illnesses had such family members (P = 0.003). The mean number of family members of children who had been referred from another healthcare institution was 2.06 +/- 0.77, whereas the mean number of family members of patients who presented directly to the PED was 1.85 +/- 0.63 (P = 0.013). The mean number of family members of patients who had insurance for their child and those who do not have were 1.84 +/- 0.66 and 2.06 +/- 0.71, respectively, (P = 0.001). CONCLUSIONS: Numbers of family members were positively associated with a history of referral to another institution for the same reason, and inversely related to the parents' age and insurance status.

Do the residents in the emergency department appropriately manage patients with acute asthma attack? A study of self-criticism.

The objective of this study was to investigate the management of patients with asthma attack admitted to the emergency department (ED) in terms of compliance with international guidelines. The records of patients with asthma who were admitted to a university-based ED between December 2001 and December 2002 were evaluated. A total of 72 cases with available data were evaluated retrospectively. Twenty-six patients (36.1%) were admitted more than once during the study period. The number of multiple admissions ranged from 2 (15 patients, 20.0%) to 11 (2 patients, 2.8%). Peak expiratory flow (PEF) measurements were recorded in 17 patients (23.6%) on presentation. Pulse and respiratory rates were recorded in 70 (97.0%) and 67 patients (93.0%), respectively. Thirty-four patients (47.2%) underwent chest x-ray; results were normal in most patients. Salbutamol was the most commonly used drug as first-line therapy. Ipratropium bromide (inhaled) and systemic corticosteroids were added to the salbutamol in 47 (65.2%), 42 (58.4%), and 32 patients (44%), respectively. Pulmonologists were consulted in only 7 cases (9.7%). Thirty patients (43.4%) were prescribed corticosteroids on discharge. The role of functional parameters in determining asthma severity and monitoring treatment effects should be emphasized in clinical practice. Finally, more prevalent use of management guidelines will help determine their usefulness.

Prevalence and risk factors of occupational asthma among hairdressers in Turkey.

This study was designed to evaluate the questionnaire-based prevalence and possible risk factors of occupational asthma among hairdressers in Turkey. We investigated occupational history and respiratory, ocular, dermal, and nasal symptoms using a standardized questionnaire, evaluated worksite pulmonary function tests, and performed allergen skin testing. We then determined asthma risk factors using age- and gender-adjusted logistic regression models. The prevalence of occupational asthma in hairdressers was 14.6%. The odds ratio for hairdressers in a high work intensity group was 3.6 (95% confidence interval, 1.2 to 10.9) with a significant dose-response trend (chi 2 trend = 4.875; P = 0.027). The odds ratio for occupational asthma among workers with atopy was 4.5 (95% confidence interval, 1.2 to 17.2). We also observed an excess risk of occupational asthma with allergic rhinitis and conjunctivitis. Occupational asthma did not differ among subgroups of hairdressers. We observed an important risk of occupational asthma among hairdressers. The most prominent risk factors were work intensity and atopy.