Exposure to SO2 does not have a chronic effect on pulmonary functions of apricot workers.

The authors have previously demonstrated that apricot sulfurization workers develop asthma-like syndrome during apricot sulfurization due to exposure to sulfur dioxide (SO(2)) gas. The aim of the current study was to demonstrate if exposure to SO(2) gas had any chronic effects on pulmonary functions and bronchial reactivity of the workers. Twenty-five apricot sulfurization workers and a control group were included in the study. Physical examination, skin prick tests, pulmonary function tests (PFTs), and bronchoprovocation tests (BPTs) were performed before and after the season of sulfurization in the worker group. Skin prick tests, PFTs, and BPTs were performed also in the control group without a history of exposure to SO(2) gas. There was no statistically significant difference between PFT and BPT results of the workers and the control group. Comparison of the PFT results of the workers before and after the season of apricot sulfurization neither reveal a significant difference. Four (16%) out of 25 workers were positive for BPTs before the period. Only one worker who had a negative BPT result before the sulfurization season was positive afterwards. The lack of a chronic effect on pulmonary functions is consistent with the diagnosis of asthma-like syndrome in apricot sulfurization workers.

C-reactive protein levels in patients with chronic obstructive pulmonary disease: role of infection.

OBJECTIVE: To investigate the value of C-reactive protein (CRP) as a marker of chronic obstructive pulmonary disease (COPD) exacerbations or specifically bacterial exacerbations and to evaluate a correlation between raised CRP levels and other markers of inflammation in patients with an acute exacerbation (AECOPD). SUBJECTS AND METHODS: The medical records of patients with AECOPD were retrospectively analyzed. They were categorized according to the nature of sputum as mucoid or purulent and to the findings on chest radiographs as with pneumonia (PCOPD) or without pneumonia. Stable COPD (SCOPD) patients and a group of asymptomatic nonsmokers were also included in the study. RESULTS: All COPD patients (SCOPD: 30; AECOPD: 51; PCOPD: 32) and control subjects (30) were male. The mean CRP levels and WBC counts of the groups were PCOPD: 108.1 +/- 61.8 mg/l and 13.7 +/- 6.8 x 10(9)/l; AECOPD: 36.8 +/- 43.9 mg/l and 11.4 +/- 4.8 x 10(9)/l; SCOPD: 3.9 +/- 1.4 mg/l and 7.9 +/- 1.9 x 10(9)/l; control: 2.1 +/- 0.9 mg/l and 7.7 +/- 1.1 x 10(9)/l. The mean CRP level of AECOPD was statistically different from those of PCOPD and SCOPD (p = 0.0001, p = 0.002, respectively). The sensitivity and specificity of CRP to determine an acute exacerbation were 72.5 and 100%, respectively. Among the patients with AECOPD, 25 had purulent sputum and a mean CRP level of 46.4 +/- 48.6 mg/l, which is significantly higher than the CRP level (28.0 +/- 44.5 mg/l) of the 18 patients with mucoid expectoration (p = 0.015). Among the mucoid-expectorating subgroup, the patients with leukocytosis had significantly higher CRP levels than the patients without leukocytosis (p = 0.034). CONCLUSION: A high serum CRP value may indicate an infectious exacerbation in COPD patients and it correlates with sputum purulence and increased serum WBC counts.

[C-reactive protein, leukocyte count and ESR in the assessment of severity of community-acquired pneumonia]. / Toplum kökenli pnömonilerin agirliginin degerlendirilmesinde C-reaktif protein, lökosit sayisi ve eritrosit sedimentasyon hizinin yeri.

This study aimed to evaluate the relations between the levels of CRP, leukocyte count and ESR on admission and the severity of pneumonia according to the criteria of Turkish Thoracic Society (TTS) and British Thoracic Society (BTS) CAP guidelines. This study included the adult patients with CAP admitted to our clinic between the years 2003-2005. The history, physical findings, hemogram, ESR, the levels of CRP and the results of other laboratory investigations were obtained from the medical records. The patients were grouped according to BTS and TTS guidelines. The mean age was 47.2 years; 70 patients (75.3%) were male and 23 patients (24.7%) were female. The severity of pneumonia according to BTS criteria was correlated with the levels of CRP and leukocyte count (p= 0.037, p= 0.01, respectively). The severity of pneumonia according to TTS criteria was correlated with the levels of CRP, leukocyte count and ESR (p= 0.000, p= 0.014, p= 0.015, respectively). Among TTS pneumonia groups, there were statistically significant differences between groups 1 and 3; groups 1 and 4; groups 2 and 3 (p= 0.006, p= 0.041, p= 0.05, respectively) for mean CRP levels. The mean levels of CRP (103.2 +/- 76.4 mg/L), leukocyte count (19.8 +/- 9.5 x 10(3)/microL) and ESR (57.2 +/- 26.8 mm/hour) were statistically significantly higher in inpatients than the mean levels of CRP (53.2 +/- 52.8 mg/dL), leukocyte count (14.6 +/- 5.4 x 10(3)/microL) and ESR (43.1 +/- 25.9 mm/hour) in outpatients (p= 0.000, p= 0.001, p= 0.012, respectively) according to TTS. It is considered that CRP, a powerful marker of inflammation, is related with severity of pneumonia and a high level of CRP may be useful to make a decision about hospitalisation.

The role of oxidative stress in bronchoconstriction due to occupational sulfur dioxide exposure.

BACKGROUND: We previously showed that apricot sulfurization workers (ASW) are exposed to high concentrations of SO(2), resulting in an asthma-like syndrome. The aim of this study was to evaluate whether oxidative stress plays a role in the pathogenesis of asthma-like syndrome due to the high concentrations of SO(2) exposure in agricultural environment. METHODS: Serum antioxidant enzyme activities and malondialdehyde (MDA) concentrations, which are markers of lipid peroxidation, and pulmonary function tests (PFT) were measured in 40 volunteer ASW and compared to 20 healthy control subjects. RESULTS: The superoxide dismutase (SOD, 2.2+/-0.6 vs. 3.2+/-0.7 U/ml), glutathione peroxidase (GSH-Px, 0.6+/-0.3 vs. 1.1+/-0.3 U/ml) and catalase (107.6+/-27.4 vs. 152.6+/-14.3 k/l) activities in ASW were significantly (p<0.0001) lower than controls, whereas the malondialdehyde concentration (4.1+/-0.9 vs. 1.9+/-5.3 nmol/l) was higher in ASW (p<0.0001). ASW had significant decreases in pulmonary function parameters after exposure. CONCLUSION: These results show that occupational exposure to high concentrations of SO(2) enhances oxidative stress and lipid peroxidation may be considered as a new mechanism of SO(2)-induced bronchoconstriction.

The role of nitric oxide and cytokines in asthma-like syndrome induced by sulfur dioxide exposure in agricultural environment.

BACKGROUND: We previously demonstrated that apricot sulfurization workers are exposed to high concentrations of SO(2), subsequently causing asthma-like syndrome. This study investigated the effects of SO(2) exposure on serum TNF-alpha, IL-1beta, IL-6, IL-8, nitrite and nitrate levels to understand the mechanism of SO(2)-induced bronchoconstriction in asthma-like syndrome. METHODS: We measured the serum levels of the cytokines, direct nitrite, total nitrite and nitrate obtained from 40 volunteer workers after an hour of exposure to SO(2) and 23 healthy controls. RESULTS: The concentrations of the cytokines, direct nitrite, total nitrite and nitrate were significantly (p<0.0001) higher in the workers than in the controls. The mean serum concentrations of TNF-alpha, IL-1beta, IL-6, IL-8, direct nitrite, total nitrite and nitrate were 430.60+/-397.03 pg/ml, 436.67+/-316.31 pg/ml, 752.11+/-394.95 pg/ml, 262.12+/-287.99 pg/ml, 7.75+/-3.34 micromol/l, 115.72+/-48.78 micromol/l and 107.97+/-46.19 micromol/l in the workers, while they were 9.83+/-3.12 pg/ml, <5 pg/ml, 7.49+/-1.27 pg/ml, 9.38+/-1.99 pg/ml, 2.17+/-0.77 micromol/l, 59.91+/-7.56 micromol/l and 57.74+/-7.20 micromol/l in the controls, respectively. CONCLUSION: These results show that TNF-alpha, IL-1beta, IL-6, IL-8 and nitric oxide may play a role in the pathogenesis of bronchoconstriction in asthma-like syndrome due to the SO(2) exposure.

Environmental exposure to asbestos in eastern Turkey.

In this study, the authors investigated the prevalence of asbestos-related disorders among the inhabitants of Güzelyurt, a town in Malatya, located in eastern Turkey. The authors examined river bed, white soil, and stucco samples taken from various locales in Güzelyurt, and they confirmed the presence of tremolite and chrysotile asbestos fibers. Subjects (N = 920; 449 males and 471 females) were examined by photofluoroscopy. Eighty-five patients (9.2%) had asbestos-related radiological findings; risk increased with age. Calcified pleural plaques were seen more frequently in individuals > or = 50 yr of age, compared with younger subjects (p < 0.01). Asbestos-related disorders were prevalent in the inhabitants of Güzelyurt, the population of which is exposed environmentally to asbestos--primarily the result of the stuccoing and whitewashing of houses with soil that contains asbestos.

The attitude toward tobacco dependence and barriers to discussing smoking cessation: a survey among Turkish general practitioners.

OBJECTIVES: To evaluate the general attitude of a sample of Turkish general practitioners (GPs) toward tobacco dependence and to assess their knowledge and behavior regarding smoking cessation (SC). METHODS: A self-administered questionnaire modified from WHO, Global Health Professional Survey was distributed to GPs, working in our district, Isparta. RESULTS: As much as 41% of GPs were current smokers. Ever smokers were generally less likely to agree with statements that would change their freedom to smoke in certain places. While 46% of GPs frequently inquired about tobacco use in their patients, 13.5% did not advise any of their patients to quit smoking during the month preceding the questionnaire. The most common barriers reported by GPs to discussing SC with their patients were as follows: considering the discussion not to be effective (57.8%), having low confidence in knowledge (48.1%), having unpleasant personal experience or considering it a thankless task (46.1%). CONCLUSIONS: It appears essential to reduce the number of GPs who smoke and to improve GP training on SC procedures for integrating SC treatment into primary care in Turkey.

Allergic granulomatosis and angiitis in the absence of asthma and blood eosinophilia: a rare presentation of limited Churg-Strauss syndrome.

Allergic granulomatosis and angiitis, also known as Churg-Strauss syndrome (CSS), is an uncommon vasculitis of unknown etiology. We report a 21-year-old male patient with fatigue, dry cough, and progressive dyspnea. He had no history of asthma or eosinophilia. Thorax computed tomography showed bullous/cystic areas with thin walls in varying sizes (5-15 mm). Histopathological examination of the open lung biopsy revealed granulomatous infiltration with histiocytes and eosinophilic leukocytes. This extremely rare variant of CSS is discussed.

Apricot sulfurization: an occupation that induces an asthma-like syndrome in agricultural environments.

BACKGROUND: Several cases of bronchial asthma have been presenting with acute attacks during the seasons of apricot sulfurization. The aim of this study was to reveal the effects of sulfur dioxide (SO(2)) exposure on the airways of the workers involved in this process. METHODS: SO(2) levels in air were measured on 15 apricot farms, while the symptom scores of 69 workers were recorded before, during, and after SO(2) exposure. Physical examination and pulmonary function tests (PFT) of the workers were also done prior to and after exposure periods. RESULTS: The measured SO(2) concentrations ranged between 106.6 and 721.0 ppm. Dyspnea (80%), cough (78%), and eye and nose irritation (83-70%) were the most commonly observed symptoms. The workers had significant decreases in pulmonary functions after SO(2) exposure. Decrements in FEV(1), FEV(1)/FVC%, and FEF(25-75%) showed that the acute effect of SO(2) on pulmonary functions of the workers was mostly of obstructive pattern. CONCLUSIONS: Acute exposure to SO(2) induces "asthma-like syndrome" (ALS) in apricot sulfurization workers. SO(2) which has not been previously reported in agricultural environments as a cause of ALS may be considered as a new agent.

Effects of ranitidine on pulmonary function tests of patients with chronic obstructive pulmonary disease.

Since the incidence of peptic ulcer and gastroesophageal reflux (GER) is more common in patients with chronic obstructive pulmonary disease (COPD) than normal population, H(2) receptor blockers are given more extensively to COPD patients. This study evaluated the effects of Ranitidine on pulmonary function tests (PFT) of the patients having COPD and peptic ulcer or GER, and of healthy volunteers. Fifty milligrams of Ranitidine was given intravenously to 30 COPD patients and 25 healthy volunteers. PFT were done before and 15, 30, 60, 120min after Ranitidine injection. Although mean forced vital capacity (FVC), forced expiratory volume in 1s (FEV(1)) and forced midexpiratory flow rate (FEF(25-75%)) of COPD patients were found to be decreased 60 and 120min after Ranitidine injection, the decrements were statistically insignificant. The decrements in PFT of healthy volunteers were also not statistically significant.H(2) receptor blockers can be used safely for treatment of gastrointestinal disorders in COPD patients who have mild or moderate obstruction. Minimal decreases in FEV(1) and FVC due to treatment by H(2) receptor blockers may clinically worsen COPD patients who have severe obstruction.