[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.

Pneumoconiosis and work-related health complaints in Turkish dental laboratory workers.

Dental technicians make the missing tooth and complementary prosthesis and bridges according to the dentist's measurements. They use various materials including silica. Exposure to these materials increases the multi-systemic health problems in addition to respiratory health problems related with work. We planned to evaluate the work history, working conditions and frequency of health problems including pneumoconiosis. Two hundred and fourteen cases in total from 9 workplaces were evaluated. A face to face questionnaire was used to determine the demographic features of workers and standard chest X-rays were evaluated by an expert reader according to ILO 1980 standards. Mean age of the workers was 28.1 + or - 8.3. Seventy four cases were non-smoker. Mean daily working time was 11.0 + or - 1.6 hours. Mean total working period in this sector was 12.1 + or - 9.0 years. One hundred cases had at least 1 respiratory complaint. Radiological findings were correlated with pneumoconiosis in 33 (23.6%) workers. Pneumoconiosis frequency was 50.0% in cases with sandblasting history. There was not any significant correlation between pneumoconiosis and cough, sputum, dyspnea, wheezing, physical examination findings and tenure. Dental technicians have serious respiratory risks including dermal and muscle-skeleton system arising from occupational setting in Turkey. Working conditions in dental laboratories must be improved by informing the workers and workplaces must be regularly controlled for worker health and hygiene.

Community acquired pneumonia and direct hospital cost.

In Turkey, there is inadequate data about the direct or indirect cost of community acquired pneumonia (CAP). This study aims to identify the clinical, laboratory, and radiological properties, direct hospital costs of CAP, and the factors that affect these costs. Grouping of the subjects and cost analysis were evaluated in accordance with Pneumonia Severity Index (PSI) and 'Turkish Thoracic Society (TTS) CAP Guideline'. 114 cases with an average age of 70.9 were analyzed retrospectively. Average hospital stay was 11.0 +/- 6.6 days. Three of the cases that appeared to be in group IIIb in accordance with TTS CAP Guideline, and that had a PSI score of 102.7 died. Average costs of medicine was 484.59 Euro, radiology costs were 65.38 Euro, laboratory costs were 329.38 Euro and the total cost was 1630.77 Euro. In group IIIb cases, costs of medicine and the total costs were higher than other groups. Radiological, laboratory and the total costs were not determined to be different among cases that did or did not conform to initial treatment guidelines (p> 0.05). There were no effect of gender and advanced age (>/= 65 years) on total cost (p> 0.05). Existence of a comorbid disease was detected to have increased the total cost (p= 0.003). Total costs according to PSI scoring were 1274.60 Euro in low-risk group, and 1929.49 Euro in high-risk group (p= 0.04). Hospital mortality due to CAP was 2.6%.

[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.

[The importance of the at risk COPD patients (Stage 0) and clinical differences]. / KOAH riski altinda olan (Evre 0) olgularin önemi ve klinik farkliliklari.

Chronic obstructive pulmonary disease (COPD) is an important world health problem and estimated that the prevalance will increase. In early period this disease in symptomatic with cough, sputum and dyspnea. FEV(1)/FVC was greater than 70% in early period and it was accepted as stage 0 (at risk) COPD before the last The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline. In last GOLD guideline this stage is excluded. In this study we aimed to find out the clinical differences between this cases and healty population. Prospectively spirometric measures, exercise capacity, dyspnea index, saturation of O2 (SpO2) and life quality are compared between two groups. We evaluated 58 at risk cases and 63 healty adults. There was no difference between two groups about age, sex and smoke cessations. In at risk group 77.6% cough, 53.4% sputum and 62.1% dyspnea were the symptoms. In currently smokers cough and sputum were dominant symptoms however dyspnea was dominant symptom in exsmokers. Absolute FEV1, FEF25-75 values, predicted FEV1/FVC, FEV1, FVC, PEF, FEF25-75% values are lower in at risk group (p<0.05). Mean six minutes walking distance were lower in at risk group but not statistically significant (p>0.05). Dyspnea index before walking were not different between two groups (p>0.05) however dyspnea index after walking and change were higher in at risk group (p>0.05). Resting SpO2, SpO2 after exercise and desaturation with exercise (DeltaSpO2) were lower in at risk group but not statistically significant. Physical and mental components of Short Form 36 (SF36) scores were similar in two groups (p>0.05). COPD at risk group is separated from healty population with chronic respiratory symptoms and inhalation of smoke or other irritans. In these cases spirometric measures are significantly worse although functional parametres are similar with healty population, so it is thought about being a subclinical disease. These cases must be educated about COPD, encouraged about giving up smoking and prevented occurring COPD.

[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.

[Pseudomonas aeruginosa colonisation in bronchiectatic patients and clinical reflections]. / Bronsektazi olgularinda Pseudomonas aeruginosa kolonizasyonu ve klinik yansimalari

Bronchiectasis is characterized with irreversible dilatation according to destruction of epithelium, elastic and muscular layer. Most important cause of bronchiectasis is chronic bacterial infections. Pseudomonas aeruginosa colonisation is frequently seen in bronchiectatic patients. We aimed to find out P. aeruginosa colonisation frequency and clinical, radiological and spirometric reflections due to colonisation. We analysed 83 cases retrospectively. Mean age was 58.2 and 54.2% of them were female. Bronchiectasis were localised 19.3% in left lung, 19.3% right and 61.4% bilaterally. 29 (35.8%) normal, 28 (34.6%) obstructive, 7 (8.6%) restrictive, 17 (21%) mixed type disorders are detected in spirometric measures. Sputum culture performed in 50 cases. No microorganism colonisation determined in 30 (60%) cases, P. aeruginosa colonisation 16 (32%), Haemophilus influenzae 2 (4%), 1 (2%) Streptococcus pneumoniae and Proteus mirabilis 1 (2%) cases. P. aeruginosa colonisation determined more frequent in males (p<0.05). No significant correlation detected between colonisation and age or smoking habits (p>0.05). In cases with colonisation; clubbing and hemoptysis were significantly frequent (p<0.05). Only peribronchial thickening was significantly correlated with colonisation in radiological findings (p<0.05). In blood gase analysis PaO2, oxygen saturation were lower and PaCO2 higher in cases colonised with P. aeruginosa but it was not statisticaly significant (p>0.05). Hospitalization rate was higher in P. aeruginosa colonised cases (p>0.05). It is an important problem about mortality because of higher hemoptysis and hospitalisation requirement rate in P. aeruginosa colonised cases.

[Dust exposure levels and pneumoconiosis prevalence in a lignite coal miners]. / Linyit madeni isçilerinde toz maruziyet düzeyleri ve pnömokonyoz sikligi.

The effects of working conditions on health in lignite mines in Turkey have not been studied comprehensively. The aim of this study was to determine the prevalence of coal miner pneumoconiosis among lignite miners and to evaluate the effects of working conditions. The study was carried out between 2001 and 2003. All workers in the lignite mine and maintenance workers were consisted in the study. A face to face questionnaire was used to obtain demographics and work life variables. Posterior-anterior chest radiograms were evaluated by an A reader chest physician, according to ILO 1980 standard guidelines. Profusion of densities related with pneumoconiosis as 1/0 and above regarded as the "suspected pneumoconiosis". Parenchyma degeneration and/or massive opacities have been accepted as complicated silicosis. Dust concentrations in the work environment obtained from the periodical examinations. Two thousand four hundred and sixty-four X-ray were evaluated and 333 (13.5%) pneumoconiosis compatible changes were found. Among the pneumoconiosis cases, 25 (7.5%) were assigned as complicated silicosis. There was significant and positive association between worked years and pneumoconiosis prevalence (p= 0.019). Our findings indicated that pneumoconiosis prevalence among lignite miners in Turkey comparable to the USA prevalence prior to implementation of effective dust control programmes. It has been suggested that dust exposure in the work environment were high enough to developed pneumoconiosis in lignite mines. Dust control systems and measures should be re-evaluated.

[Pleural empyema due to Salmonella typhi]. / Salmonella typhi'ye bagli ampiyem.

65 years old female was admitted to hospital with fever, purulent sputum and dyspnea. The patient has hepatic cirrhosis secondary to autoimmune hepatitis and hepatocellular carcinoma. Immunosuppressive treatment is used for autoimmune hepatitis. In physical examination matute and diminished respiratory sounds were determined at right hemithorax. Ascitis was determined in abdominal examination. Chest X-ray showed pleural effusion in right hemithorax. Serohemorrhagic fluid was aspirated by thoraco-synthesis. Pleural fluid pH was 6.9 and had an exudative nature. The patient was the diagnosed as empyema. Right tube thoracostomy was performed and sulbactam-ampicillin 6 g/day therapy was started. In patient's ascite fluid no bacteria and leucocytes was seen. Salmonella typhi was isolated from pleural fluid. No microorganisms were isolated from ascite fluid, urine and stool culture. Klebsiella pneumoniae is isolated in patient's hemoculture. Clinical improving was detected. Chest X-ray showed total regression of pleural fluid and the tube thoracostomy removed. We presented this case because of rarely seen microorganism (S. typhi) in immunocompromised patients a cause of pleural empyema which is frequently seen gastrointestinal infections.