Should isoniazid prophylaxis be prescribed to the patients under tumor necrosis factor-alpha antagonists independent of tuberculin skin test?

INTRODUCTION: The aim of this study was to present the follow-up results of 110 patients who were given anti-tumor necrosis factor alpha (TNF-α) therapy for rheumatic and dermatologic diseases in a country with a high rates of active and latent tuberculosis bacillus infection. MATERIAL AND METHODS: Between February 2008 and January 2015, 110 cases in the age range of 23-77 who are using anti-TNF-α were included in the study retro-prospectively. RESULTS: 52.7% of them (n = 58) were male. The most common diagnoses were rheumatoid arthritis (42.7%) and ankylosing spondylitis (38.2%). Most frequently given treatment were infliximab 37.3% and etanercept 30.9%, respectively. The 65 patients whose first tuberculin skin test (TST) value "5 mm and above" was started daily 300 mg INH prophylaxis for 9 months but 3 patients had not been started because of refusing treatment. In only one case chemoprophylaxis has had to be interrupted because of high liver function test due to the INH prophylaxis. TST conversion was observed in 14 patients. Further follow-up, it was observed that 4 patients had TST's positivity. Isoniazide (INH) prophylaxis was started these 18 patients (42.9%). Although INH prophylaxis has been given in two patients, they developed active tuberculosis in follow-up. CONCLUSION: Considering the INH resistance in our country, all patients especially the ones with residual lesion and history of previous exposure, should be followed up closely during the anti-TNF-α treatment.

Prevalence of the Accessory Cardiac Bronchus on Multidetector Computed Tomography: Evaluation and Proposed Classification.

PURPOSE: Accessory cardiac bronchus (ACB) is a very rare congenital anomaly and may cause some clinical complications, such as recurrent episodes of both infection and hemoptysis. The purpose of this study was to assess the multidetector computed tomography (MDCT) characteristics of ACB and to classify this anomaly according to the MDCT aspects. MATERIALS AND METHODS: The routine thoracic CT scans from 5790 patients were evaluated retrospectively. The prevalence, location, length, diameter, division angle, distance from the carina, and the type of ACB were evaluated. RESULTS: A total of 12 ACBs were identified, with a prevalence of 0.2%. All ACBs originated from the intermediate bronchus. The median largest diameter of the ACBs was 7.75 mm (range: 5.8 to 10.30 mm), the median length was 12.1 mm (range: 8.6 to 35 mm), the median division angle was 61 degrees (range: 42 to 93 degrees), and the median distance from the carina was 16.95 mm (range: 5.7 to 22.20 mm). Six cases (50%) had a blind extremity (type 1: diverticulum or stump type), 3 cases (25%) had a mutiloculated cystic change at the end (type 2: cystic type), and 3 cases (25%) had a ventilated lobulus demarcated by an anomalous fissure (type 3: ventilated type). CONCLUSIONS: ACBs can be classified into 3 types according to their MDCT features. Recognition of ACB is important, as it is associated with clinical complications and is also salient in trauma cases.

[Where the tuberculosis patients are diagnosed and started to treatment?]. / Tüberküloz hastalari nerede tani aliyor ve tedavisi baslaniyor?

INTRODUCTION: Tuberculosis dispensaries have played important roles in management of patients with tuberculosis. Tuberculosis patients diagnosed and treatments are started at dispensaries as well as other health care institutions. Other institutions must be aware of the mission of dispensaries especially at the treatment and follow-up of patients. We aimed to investigate in which health care institutions tuberculosis patients diagnosed and treatment started and whether the awareness about dispanseries is sufficient. PATIENTS AND METHODS: Records of tuberculosis patients in Elazig dispansery examined retrospectively. The data obtained were analyzed by Microsoft Excel. RESULTS: Records of 854 patients with tuberculosis has been reached those followed in Elazig dispensary between the years 2005-2011. Percentages of the patients diagnosed in university hospital, dispensary and state hospitals were 36.3%, 18.5% and 17.3%; respectively. Treatments of patients were started in dispensary (81.9%), university hospital (7.7%), and chest disease hospital (4.3%). CONCLUSION: Treatment starting rate of dispensary was high because patients diagnosed by other health institutions directed to dispensary for taking the first drugs and beginning of the treatment. In tuberculosis control program; dispensaries carry out important operational functions in management of tuberculosis patients and other health institutions are aware of this situation.

[Provincial assessment in the scope of the tuberculosis control program]. / Tüberküloz kontrol programi kapsaminda il degerlendirmesi.

INTRODUCTION: We aimed to expose the status of tuberculosis in Corum, to analyze the conducted studies about the tuberculosis control on provincial basis and contribute to future studies. MATERIALS AND METHODS: The records of the patients who were followed and treated between 2005 and 2010 at tuberculosis dispensary in Corum were respectively investigated. The statistical analyses of the data were completed as using SPSS 16.0. RESULTS: A total of 628 patients were enrolled in this study; 59.8% (n= 376) were male, 40.2% (n= 252) were female. The ratio of the pulmonary and the extrapulmonary involvement were detected as 63.7% (n= 400) and 36.3% (n= 228) respectively. The incidence of new cases was 93.5% (n= 587) whereas the percentage of previously treated cases was 6.5% (n= 41). The 0.7% (n= 4) percentage of the patients were multi-drug resistant therefore they had been treated with secondary group of drugs. 400 patients with pulmonary tuberculosis were investigated about the ratios of the following parameters; performed microscopic examination, the positivity of the microscopic examination, the performed culture examination, the positivity of the culture examination and the performed drug susceptibility test. According to this; the results were determined as 85.5% (n= 334), 44.5% (n= 178), 66% (n= 264), 35% (n= 140) and 15% (n= 60) respectively. Directly observed treatment was performed 49.7% (n= 312) of the patients by health care workers. The success of treatment for all patients with tuberculosis was determined as 93.8% (n= 576). CONCLUSION: According to the data of our study, we can conclude that, although there were some deficiencies about control of tuberculosis, the conducted control program was successful in Corum. However; having a large number of young patients with tuberculosis proved that the transmission was still going on. Besides; the examined tests like microscopy, culture and drug susceptibility were found low in rates. The practices of directly observed treatment should provide to be improved.

[Evaluation of carotis intima media thickness in chronic obstructive pulmonary disease patients]. / Kronik obstrüktif akciger hastaliginda karotis intima mediya kalinliginin degerlendirilmesi.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) and atherosclerosis may occur due to similar risk factors and have a significant cause of morbidity and mortality. In this study to assess the relationship between COPD and atherosclerosis; carotid intima media thickness (CIMT) of COPD patients and adult healthy individuals with normal body mass index and metabolic parameters compared. MATERIALS AND METHODS: 2298 participants aged between 18-92; 46 patients diagnosed with COPD according to clinical features and pulmonary function tests the study, 47 healthy controls who do not have exclusion criteria were evaluated. Doppler ultrasound was performed for the assessment of CIMT to all participants. p values < 0.05 were considered to be significant. RESULTS: Mean CIMT in COPD group and control group were 0.79 ± 0.16 mm and 0.616 ± 0.1 mm, respectively (p< 0.001). In multiple linear regression analysis that made to determine the atherosclerotic risk parameters affecting CIMT; it was found that CIMT was related to age with direct proportion (p= 0.002) and to FEV(1)% with inversely proportion (p= 0.04). In multivariate logistic regression analysis that made to determine the parameters affecting atherosclerosis; we found that any parameters were related with atherosclerosis. CONCLUSION: Persistent low-grade systemic inflammation in COPD and atherosclerotic disease may possibly have been reported a factor in both pathologies. Early atherosclerosis and cardiovascular risks in adults with COPD increase independent of risk factors. CIMT which shows direct proportion with age and inverse proportion with FEV(1)% is a non-invasive, easily applicable and cheap method that can be used in determining the risk of atherosclerosis.

Is obstructive sleep apnea syndrome a risk factor for pulmonary thromboembolism? / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In many studies, obstructive sleep apnea (OSA) has been shown to be an independent risk factor for cardiovascular disease. Conversely, there are few reports establishing possible relation between OSA and venous thromboembolism (VTE). In this study, the aim is to evaluate OSA via polysomnography in patients with pulmonary embolism and drawing the attention of clinicians to the presence of obstructive sleep apnea syndrome (OSAS) may be a risk factor for pulmonary embolism.</p><p><b>METHODS</b>Fifty consecutive patients who were diagnosed with pulmonary embolism (PE) were evaluated prospectively for OSAS. Polysomnographic examination was conducted on 30 volunteer patients. The frequency of OSAS in PE was determined and PE cases were compared to each other after being divided into two groups based on the presence of a major risk factor.</p><p><b>RESULTS</b>The study consisted of a total of 30 patients (14 females and 16 males). In 56.7% of the patients (17/30), OSAS was determined. The percent of cases with moderate and severe OSAS (apnea hipoapnea index > 15) was 26.7% (8/30). Patients who had pulmonary thromboembolism (PTE) without any known major VTE risk (n = 20), were compared to patients with VTE risk factors (n = 10), and significantly higher rates of OSAS were seen (70% and 30% respectively; P = 0.045). The mean age of the group with major PE risk factors was lower than the group without major PE risk factors (52 years old and 66 years old, respectively; P = 0.015), however, weight was greater in the group with major PE risk factors (88 kg and 81 kg, respectively; P = 0.025). By multivariate Logistic regression analysis, in the group without any visible major risk factors, the only independent risk factor for PE was OSAS (P = 0.049).</p><p><b>CONCLUSIONS</b>In patients with PTE, OSA rates were much higher than in the general population. Moreover, the rate for patients with clinically significant moderate and severe OSA was quite high. PTE patients with OSA symptoms (not syndromes) and without known major risk factor should be examined for OSA. There seems to be a relationship between OSA and PTE. However, whether this relationship is a causal relationship or a relationship due to common risk factors or long-term complications of OSA is not clear. Further comprehensive studies on those special topics are needed to clarify these points.</p>

[Very rare presentation of extrapulmonary tuberculosis: primary gastric tuberculosis]. / Akciger disi tüberkülozun nadir görülen bir sekli: Primer gastrik tüberküloz.

The most common site for gastrointestinal involvement in tuberculosis is the ileocecal region. Tuberculosis of stomach is quite uncommon. It is usually associated with pulmonary tuberculosis or with immunodeficiency. In this case non specific gastrointestinal complaints yielded a diagnosis of primary gastric tuberculosis, which is very rare. Absence of pulmonary focus and endoscopic findings of pangastritis are different features of this case which makes it presentable.

Factors that effect sputum culture conversion rate in hospitalized patients with pulmonary tuberculosis who were applied directly observation therapy and non-directly observation therapy.

Directly observation therapy (DOT) has been accepted as the basic method for controlling tuberculosis. The present study aimed to determine the risk factors that affect sputum culture conversion rate in the DOT managed and non-DOT managed hospitalized patients. The study was included 50 cases with positive sputum cultures between the dates April 2001-April 2002 when DOT was not applied and 60 cases between the dates May 2002-May 2003 when DOT was applied. The relation between sputum culture conversion rate and the risk factors of age, gender, cough, hemoptysis, primary drug sensitivity, high initial bacillary load, smoking and alcohol consumption, presence of diabetes mellitus (DM), and radiological dissemination were determined. In the present study, sputum culture conversion rate was found 68.3% in DOT managed patients, 62% in non-DOT managed patients. In DOT managed and non-DOT managed patients; there was no statistically significant difference between complaints of cough, sputum, night sweating, hemoptysis, DM, bacillary load, primary drug resistance and culture conversion rate. In DOT managed patients; a significant difference was determined between smoking and alcohol consumption and culture conversion rate. The factors determined above as being related with the sputum culture conversion rate were similar with the results of the other studies investigating the same topic. Despite no statistical significance, an increase in the sputum culture conversion rate in DOT managed patients, when compared with non-DOT managed patients was determined.