Evaluation of effectiveness of pathology reports in active surveillance of tuberculosis.

OBJECTIVE: Despite advancing technology, national TB surveillance systems are still inadequate in terms of patient detection around the world. It was aimed to investigate suspicious cases detected by active surveillance method in pathology laboratories and to evaluate the effectiveness of this method in terms of finding new TB cases. METHODS: This is a descriptive cross-sectional study. It was administrated in Samsun, Turkey, between January 2012-December 2017. Within the scope of active surveillance, pathology laboratories were regularly visited and reported cases with granulomatous inflammation were assessed. The obtained patient list was compared with the records of the Electronic Tuberculosis Management System (ETMS). Patients who were not included in these records were invited to the dispensary and evaluated for TB. They were also referred to the relevant hospitals for diagnosis if necessary. Frequency values and descriptive statistics were calculated using SPSS method. RESULTS: It was found that 35.6% of 703 patients with the diagnosis of granulomatous inflammation were previously diagnosed, treated or currently undergoing treatment in the ETMS registry. As a result of the assessment of remaining 453 cases, 46 patients (10.1%) were newly diagnosed with TB. Newly diagnosed TB patients were reported, and their treatment started. CONCLUSION: As a result, active surveillance method conducted in pathology laboratories are used to detect unknown or late reported TB cases and allows to start treatment without further delay.

[Management and treatment difficulties of multi-drug resistant pulmonary tuberculosis in a pediatric case]. / Çok ilaca direçli akciger tüberkülozu olan çocuk olguda tani ve tedavi yaklasiminda yasanan güçlükler.

Tuberculosis continues to be a major health problem worldwide. Multidrug resistant tuberculosis (MDR-TB) infection that occurs in childhood is caused by adult MDR-TB agents which are in circulation and resistant to primary drugs. In this case report a 17-month-old child with MDR-TB who was cured after a 24-month therapy regimen was presented. Physical examination of a 17-month-old girl admitted to the hospital with the cause of recurrent pneumonia revealed a rubbery lymphadenopathy less than 2 cm in the right upper cervical region. Crepitant rales were detected in the right basal on auscultation of the lung. Interferon gamma release assay (IGRA) and tuberculin skin (TST) tests were negative. Computed tomography (CT) scan of the chest showed mediastinal conglomerate pathologic lymphadenopathy and air bronchograms were detected near the lower lobe of the left lung. Treatment of isoniazid, rifampicin, pyrazinamide with the diagnosis of epituberculosis was started by taking a sample of gastric aspirate culture sample. In the sixth month of the treatment patient was admitted to our clinic with enlarged cervical rubbery lymphadenopathy. It was determined that microbiological test of gastric aspirate culture specimen was positive for M.tuberculosis complex resistant to isoniazid, rifampin, ethambutol, streptomycin, ethionamide and rifabutin. Control CT showed residual peribronchial infiltrations and hilar calcific lymph nodes. Hearing test, vision control and, thyroid function tests were performed and treatment of moxifloxacin, amikacin, para-amino salicylic acid, protionamide and pyrazinamide was started based on minor drug susceptibility results of M.tuberculosis isolate which was still growing in gastric aspirate culture. Gastric aspirate culture for M.tuberculosis was still positive after 3 months of treatment and the current treatment was continued. Amikacin was stopped after 6 months. Therapy regimen was stopped after 24-months. Over the course of a follow-up period of more than 3 years, the clinical and radiological resultsof the patient has improved significantly. The clinical presentation of TB in children is often nonspecific and differs from the patterns seen in adults. MDR-TB cases can be seen in this age group since tuberculosis in children is mainly caused by transmission of drug-resistant strains from adults. This situation is particularly problematic due to the long-term treatment and the lack of specific drug formulations for children.

[A case of coccidioidomycosis in Turkey imported from the United States of America]. / Türkiye'de Amerika Birlesik Devletleri kaynakli bir koksidiyoidomikoz olgusu.

Coccidioidomycosis caused by Coccidioides immitis or Coccidioides posadasii is a rare infectious disease except in endemic regions. In this report the third documented imported case of coccidioidomycosis in Turkey was presented. A thirty-year-old male patient was admitted to our hospital with fever and purulent drainage from his chest tube. He had worked in Arizona, USA, until 4 months before this presentation. While in Arizona, he experienced cough and hemoptysis and was diagnosed as pulmonary coccidioidomycosis. He was treated with itraconazole for two months and he had no symptoms for 3 years. He then returned to Turkey and 2 months after his return to Turkey, he was admitted to another hospital in Istanbul with dyspnea and diagnosed as hydro-pneumothorax, and pleural fluid obtained from the inserted chest tube was found to be purulent. One gram of BID amoxicillin-clavulanate was given. Physical examination on admission revealed a purulent drainage on the right side chest tube, a temperature of 38.5°C and decreased breath sounds on the right lung. Piperacillin-tazobactam 3 x 4.5 g intravenous and fluconazole 400 mg intravenous once daily were started. Human immunodeficiency virus test was negative. Gram-negative diplococci and rods, gram-positive cocci and septate hyphae were seen in the Gram stain of his pleural fluid. Pleural fluid culture revealed Moraxella catarrhalis after 24 hours incubation and a mold after 72 hours of incubation. Anti-coccidioidal antibodies were found positive in a titer of 1/2. Hydro-pneumothorax, atelectasis and a 3 mm nodules in the right lung were seen in his thorax CT. The patient's pleural fluid and the culture plates were sent to the Public Health Institute of Turkey, Mycology Reference Laboratory (PHIT-MRL), with a clinical suspicion of coccidioidomycosis. The specimen and plates were submitted to the PHIT-MRL Bio Safety Level-3 laboratory for mycological evaluation. The microscopic examination of 15% KOH preparations of pleural fluid specimens revealed septate hyphae which appear to be in the early stages of forming arthroconidia. The pleural fluid culture grew buff-white coloured colonies with aerial hyphae, which were suspected of being a Coccidioides spp. The strain was identified as C.immitis/posadasii by direct microscopy and culture, and subsequently confirmed by the FDA-approved DNA probe. DNA sequence analysis of the ITS and D1/D2 rDNA regions confirmed the isolate to be C.posadasii species [ITS 100% match to GenBank Accession No. AB232901 (630/630 base pair match), and D1/D2 100% match to GenBank Accession No. AB232884 (617/617 base pair match)]. ITS1 and ITS2 barcode analysis also confirmed the species to be C.posadasii, which is the species endemic in Arizona. Susceptibility testing was performed according to Clinical and Laboratory Standards Institute M38-A2 guidelines in the Fungus Testing Laboratory of the University of Texas Health Science Center at San Antonio and minimal inhibitory concentration values were; 0.125 µg/ml for amphotericin B, posaconazole and voriconazole, 0.5 µg/ml for itraconazole and 8 µg/ml for fluconazole. He had decortication of the pleura and was discharged from hospital after six weeks treatment with intravenous fluconazole which was continued orally for one year. Anti-coccidioidal antibodies were negative after two months of treatment. The patient is currently asymptomatic. The presented case is the third case reported from Turkey and provides additional contribution to the existing literature with regard to the appearance of arthroconidium, which is the unusual hyphal form, instead of the expected spherules in the infected tissue.

[Investigation of parameters related to prognosis in diffuse parenchymal lung diseases prognosis in interstitial lung diseases]. / Difüz parankimal akciger hastaliklarinda prognozla iliskili parametrelerin arastirilmasi.

INTRODUCTION: Parameters related to prognosis in diffuse parenchymal lung disease (DPLD) have a decisive influence on treatment and follow-up processes. We aimed to define baseline characteristics and factors that effect the mortality of the group of patients with DPLD and to determine distinctions between subgroups. MATERIALS AND METHODS: Demographic characteristics, complaints, comorbidity, treatment, pulmonary function tests, echocardiographic findings, six minute walking test (6MWT), arterial blood gases analysis, radiological findings and survival time were collected from outpatient clinics database. Patients' survival time and mortality-related parameters were evaluated. RESULT: This study consisted of 104 patients. Forty-four of them idiopathic pulmonary fibrosis (IPF), 34 scleroderma and 26 rheumatoid arthiritis (RA) with lung involvement. Mortality rates were similar for the groups but median survival was shorter in patients with IPF than scleroderma and RA (IPF: 35.1 ± 22.4 months, scleroderma: 61.1 ± 27.9 months, RA: 60.0 ± 52.1 months; p= 0.001, p= 0.016 respectively). Mortality was higher in patients who are > 60 years old (24/64 vs. 5/40, p= 0.007), had chronic obstructive pulmonary disease (COPD) (5/7 vs. 24/97, p= 0.017), gastroesophageal reflux (7/13 vs. 22/91 p= 0.043) and usual interstitial pattern (11/48 vs. 18/56, p= 0.054), low PaO2 (< 60 mmHg) at admission (6/8 vs. 8/32, p= 0.014), desaturation on 6MWT (13/28 vs. 1/18, p= 0.003), high reduction of DLCO/year (6/10 vs. 4/33, p= 0.023). COPD and 6 minute walking distance (6MWD) were found as independently related factors for mortality (p= 0.013, p= 0.02) for whole group. CONCLUSIONS: As a result, 6MWD and COPD were found as independently related factors for mortality for all patients. In subgroup analysis for IPF, scleroderma, and RA; 6MWD is only independent factor for mortality.

Tuberculosis screening and efficacy of prophylaxis in contacts of patients with pulmonary tuberculosis.

INTRODUCTION: To evaluate tuberculosis screening and efficacy of prophylaxis in contacts of patients with pulmonary tuberculosis. PATIENTS AND METHODS: A total of 7453 contacts of 1909 patients with pulmonary tuberculosis treated at four tuberculosis dispensaries located in Istanbul, between 2005 and 2009 were included in this retrospective screening-based study. Data on demographics, smear positivity, PPD positivity, rate and onset of secondary tuberculosis and prophylaxis were recorded in contacts. RESULT: Overall 184 (2.5%) secondary cases of tuberculosis were identified within a mean 2.9 (1-5) years of follow-up. The rate for secondary tuberculosis was 3.1% (163/5335) in smear positive and 1.0% (20/2118) in smear negative contacts. With and without prophylaxis rates for secondary tuberculosis after 6 months of index case was identified in 0.7% (6/912) and 2.0% (9/455) of contacts aged 0-15 years, in 0.9% (3/339) and 2.8% (51/1826) of contacts aged 16-35 years and in 0% (0/215) and 0.9% (14/1507) of contacts aged ≥ 36 years, respectively. CONCLUSION: In conclusion, our findings indicate high risk of being infected and diseased in smear positive contacts along with efficacy of prophylactic therapy among contacts not only in the childhood but also in adults, particularly in contacts aged 16-35 years.

Case report of fatal Mycobacterium tilburgii infection.

There are few reports concerning Mycobacterium tilburgii infection in humans because this bacterium is non-cultivatable. Herein, using new molecular techniques, we report the case of an immunocompromised patient with fatal disseminated lymphadenitis that was caused by M. tilburgii.26 years old Caucasian HIV negative female patient presented with abdominal pain. Her clinical assessment revealed disseminated lymphadenitis, that was acid fast bacilli positive. Further molecular evaluation showed the causative agent as M. tilburgii. Despite anti mycobacterial therapy and careful management of intervening complications patient died because of an intraabdominal sepsis. This is the first fatal M. tilburgii infection in the literature. This case points the importance of careful management of patient's immune status and intervening infections besides implementation of effective drug treatment.

Long term effects of tear gases on respiratory system: analysis of 93 cases.

AIM: This study aimed to assess the long-term respiratory effects of tear gases among the subjects with history of frequent exposure. MATERIALS AND METHODS: A questionnaire by NIOSH and pulmonary function tests was performed in 93 males exposed to the tear gases frequently and 55 nonexposed subjects. RESULTS: The mean numbers of total exposure and last 2 years exposure were 8.4 ± 6.4 times, 5.6 ± 5.8 times, respectively. Tear gas exposed subjects were presented with a higher rate for cough and phlegm more than 3 months (24.7% versus 11.3%, P > 0.05). Mean FEV1/FVC and % predicted MMFR in smoker exposed subjects are significantly lower than those in smoker controls (81.7% versus 84.1%, P = 0.046 and 89.9% versus 109.6%, P = 0.0004, resp.). % predicted MMFR in nonsmoker exposed subjects is significantly lower than that in nonsmoker controls (99.4% versus 113.1%, P = 0.05). Odds ratios for chest tightness, exercise dyspnea, dyspnea on level ground, winter morning cough, phlegm, and daily phlegm were increased almost 2 to 2.5 folds among tear gas exposed subjects. CONCLUSION: The rates for respiratory complaints were high in the case of the exposure to the tear gases previously. Tears gas exposed subjects were found to be under the risk for chronic bronchitis.

Effect of smoking and indoor air pollution on the risk of tuberculosis: smoking, indoor air pollution and tuberculosis.

INTRODUCTION: Although epidemiological studies have reported an association between smoking and increases in tuberculosis, the relationship between indoor air pollution and risk of tuberculosis is not fully understood. A limited number of studies have suggested that smoking and indoor air pollution may play a role in the pathogenesis of tuberculosis. In this study, we investigated the effect of smoking and indoor air pollution on the risk of active tuberculosis. MATERIALS AND METHODS: It is prospectively recorded age matched case-control study. Three hundred sixty two active tuberculosis cases and 409 healthy controls were included to the study. All participants were interviewed face to face by using a questionnaire including smoking habit, quantity and duration of smoking, number of room/person in the house, monthly income of the family, indoor heating system, and environmental tobacco smoke. RESULTS: Patients who smoke had a five fold (95% CI: 3.2-7.5, p< 0.0001) higher odds of having active tuberculosis compared with patients who do not smoke. Similarly, patients using coal or wood for indoor heating had a 1.6 fold (95% CI: 1.179-2.305, p< 0.003) higher odds having tuberculosis. People who have less income (< 200 Euro/month) had 3.2 fold (95% CI: 2.113-5.106, p< 0.0001) higher odds of having tuberculosis compared with people having high income. There was a significant correlation between heavy smoking (≥ 20 packet/year, p< 0.0001) and age onset of smoking (< 16 years of age, p< 0.041). There was no significant association between environmental tobacco smoke and tuberculosis. CONCLUSION: Smoking and indoor air pollution may increase the risk of tuberculosis. There is a complex interaction between smoking, socioeconomic conditions, indoor air quality and tuberculosis. Our results suggest that effective indoor air quality control could help to prevent tuberculosis risk.

Pulmonary tuberculosis incidence in Turkish prisons: importance of screening and case finding strategies.

INTRODUCTION: The purpose of this study was to evaluate the burden of pulmonary tuberculosis in 10 prisons mostly located in the Marmara Region of Turkey, and to compare them with the country incidence. PATIENTS AND METHODS: All the inmates in ten prisons mostly located in the four cities in the Marmara Region of Turkey were enrolled in this study. Tuberculosis screening was done between January 2006-January 2007. Radiological screening for tuberculosis was performed by the mobile X-ray system and it was followed by bacteriological analysis of sputum for tuberculosis suspects. Four physicians evaluated the X-rays independently. RESULTS: Four thousand six hundred and fifteen prisoners were detected by radiological screening. Three hundred and one (7%) of them were female and 4314 (93%) were male, age range was between 14-72 years. Age ranges of female and male prisoners were 16-59 and 14-72 respectively. 398/4615 (8.6%) were young adults inmates with an age range of 14-18. Radiological abnormalities consistent with tuberculosis were found in 130 chest X-rays and followed by sputum bacteriology. Smear and culture positive pulmonary tuberculosis diagnosed in five out of 130, were all male with mean age 33 ± 10 years. Tuberculosis prevalence in the prisons was found to be 108/100.000 which was four times higher than the overall incidence of tuberculosis in Turkey in the year which the present study was conducted. CONCLUSION: Prisoners are one of the most important risk groups with high burden of tuberculosis in Turkey. This result highlights the need for adequate case- finding strategies in prisons.

Nontuberculous mycobacteria isolation from sputum specimens: A retrospective analysis of 1061 cases.

Background: In recent years, with the development of laboratory methods, the frequency of nontuberculosis mycobacteria (NTM) infections has increased. The primary aim of this study was to evaluate the clinical significance of therapeutic drug monitoring (TDM) growths in respiratory samples, and the secondary aim was to evaluate the treatment regimens and treatment outcomes of treatment for TDM disease. Methods: This study was a retrospective cohort study. Persons with NTM growth in respiratory samples admitted to the reference hospital between 2009 and 2020 were included in this study. Samples detected as NTM by the immunochromatographic rapid diagnostic test, those requested by the clinicians, species were determined by the hsp65PCRREA method. The subjects were classified into 3 groups: patients with NTM infection who received treatment (135, 12.7%), those followed up without treatment (690, 65.1%), and a last group of patients with Mycobacterium tuberculosis (TB) complex strains were isolated and received TB treatment (236, 22.2%). Initiating NTM treatment was decided in accordance with the American Thoracic Society recommendations. Results: The mean ± standard deviation age of patients was 53.8 ± 16.5 years, and 749 (70.6%) were male. In total, 278 (26.2%) out of 1061 cases had identified, and the most frequent species were MAC (81; Mycobacterium avium: 39, Mycobacterium intracellulare: 39, and MAC: 3), Mycobacterium abscessus (67), Mycobacterium kansasii (48), Mycobacterium fortuitum (23), Mycobacterium chelonae (12), Mycobacterium gordonae (11), and Mycobacterium szulgai (11). In the NTM treatment group, 116 (85.9%) of 135 patients had multiple culture positivity. Previous TB treatment history had 51 (37.8%) of 135 patients, respiratory comorbidities were evident in 37 (27.4%) of 135 patients. Thorax computed tomography imaging in 84 patients revealed nodule 38 (45.2%), consolidation 46 (54.8%), cavity 52 (61.9%), and bronchiectasis 27 (32.1%). Treatment results in the NTM treatment group were as follows: ongoing treatment 14 (10.4%), cure 64 (47.4%), default 33 (24.4%), exitus 19 (14.1%), recurrence 3 (2.2%), and refractory disease 2 (1.5%). Conclusion: This is a large case series evaluating the clinical significance of NTM growths and NTM treatment in Turkey. The clinical significance of NTM growth in respiratory samples is low. Treatment success rates of NTM patients who are treated are low. Treatment defaults and mortality rates are high. New drugs and new regimens are needed.

Investigation of Granulomatous Inflammations in Terms of Tuberculosis Diagnosis: A 5-Year Multi-center Laboratory Study.

OBJECTIVE: Granulomatous inflammation showing "caseification necrosis" is considered pathognomonic for tuberculosis. This study aimed to evaluate patients with granulomatous inflammation and some characteristics to diagnose tuberculosis. MATERIAL AND METHODS: This is a cross-sectional descriptive study. The study includes all pathology laboratories in Samsun between the years 2012 and 2017. Pathology reports that contained the term granulomatous were selected between all patient reports of these laboratories. The patient reports were examined by comparing the dispensary records and the presence of a diagnosis of tuberculosis. RESULTS: In the 703 pathology reports, it was found that 38% were only granulomatous and 33% were caseous granulomatosis lesions. When the prevalence of tuberculosis according to the presence of microscopic necrosis was observed in granulomatous tissue samples, 85% tuberculosis was found in patients with necrotic granulomatous tissue and 14% tuberculosis was found with non-necrotic lesions. The presence of tuberculosis in necrotic granulomatous tissues was statistically significantly higher (P < .00001). CONCLUSION: As a result, when examining a pathology report for the presence of tuberculosis, the existence of a granulomatous reaction should be considered first. Getting stuck on the definition of caseification necrosis will cause the case to be skipped. An indication of necrosis in the pathologic evaluation will guide the diagnosis of tuberculosis.

Outcomes of latent tuberculosis infection treatment in Istanbul.

Aim: Increasing the extensity of latent tuberculosis infection (LTBI) treatment which is one of the important parameters of tuberculosis (TB) control and completing the treatment in success are important. The purpose of this study is to evaluate LTBI treatment indications and treatment outcomes of patients who received LTBI treatment in Istanbul between 2016 and 2018. Methods: The treatment outcomes of people who started LTBI treatment registered in TB dispensaries in Istanbul between 2016 and 2018 were analyzed retrospectively according to the variables of the age groups, gender, dispensary subgroups, and prevention treatment indications. Data collected from the health institutions were evaluated. Results: 26.920 patients received LTBI treatment in all Istanbul TB dispensaries between 2016 and 2018. The evaluation of LTBI treatment indications; contact 15.696, Tuberculin skin test (TST) positivity 2224, immunosuppression 8746, TST conversion 58, sequelae lesion 15, and other indications are identified as 181. The groups which diagnosed with TB disease, mortality, transfer, other, and still in treatment are excluded from the analysis of LTBI treatment outcomes. A total of 25.253 patients were analyzed. 65 percent of the patients had completed LTBI treatment. Variables effective for treatment outcomes are analyzed with logistic regression. Treatment discontinuation was statistically significantly lower in 2017 (odds ratio [OR]: 0.906 confidence interval [CI] [95%] [0.849-0.968]) and 2018 (OR: 0.635 CI [95%] [0.594-0.679]) compared to 2016. Treatment lost to follow-up was statistically significantly lower in those receiving LTBI treatment with the indication of tuberculin skin test positivity (OR: 0.541 CI [95%] [0.487-0.600]) and the indication of immunosuppression (OR: 0.284 CI [95%] [0.142-0.569]) compared to those who received LTBI treatment due to contact. When the treatment results are evaluated according to the TB incidence of the region where the dispensaries are located, treatment lost to follow-up was higher in 101-200 per 100,000 incidence group (OR: 1.201 CI [95%] [1.123-1.285]) and incidence of 201-370 per 100,000 (OR: 1.461 CI [95%] [1.358-1.572]). Treatment lost to follow-up was higher in dispensaries on the European side (OR: 1.293 CI [95%] [1.203-1389]) and the 0-35 age group (OR: 1.248 CI [95%] [1.168-1.333]). Conclusion: In conclusion, the treatment completion rate should be improved for an effective LTBI treatment which is one of the important parameters of targeted TB elimination. Particularly people under the age of 35 years and regions with high-TB incidence should receive special care and close follow-up.

TNF-alpha antagonist therapy modify the tuberculin skin test response.

Tumour necrosis factor-alpha (TNF-α) antagonist drugs have been associated with increased risk of tuberculosis (TB). Tuberculin skin test (TST) is the most frequently used tool for identification of latent TB infection. We herein aimed to analyse the effect of TNF-α antagonists on the TST responses in a prospective study. The study group consisted of 182 patients (99 female, 83 male) who received TNF-α antagonists for various rheumatic disorders. All patients were evaluated with TST along with other parameters on the day of referral and on the 12th month visit. For those patients with a response of <5 mm induration at the initial evaluation, the TST was repeated to observe the booster effect. Out of 182 patients, 87 patients (48%) had a negative (0-4 mm) and 95 (52%) had a positive (≥ 5 mm) TST response at initial evaluation. The TST responses were converted from negative at initial visit to positive at 1-year repeat in 26 (30%) patients. A significant increase was observed in the diameters of TST that were repeated on the first year of TNF-α antagonist treatment (9.15 ± 0.55) compared to their initial diameters (6.60 ± 0.51) (P < 0.001). Increased TST responses in patients receiving TNF-α antagonists may be associated with the restoration of suppressed immune reactivity against TB antigens with the decreased disease activity. The meaning of TST conversion in the definition of latent TB infection and the need for chemoprophylaxis in these patients remains to be answered by further studies.

A Current Example of Historical Cases: Occupational Pulmonary Aluminosis.

Pulmonary aluminosis (PA) is a rare form of pneumoconiosis caused by aluminum powders and vapors. Although the pathogenesis is not fully elucidated, it is thought to make a number of changes in the lungs, resulting in fibrosis. Our patient, who had cough, sputum, and dyspnea and had thorax computed tomography results showing reticular density changes and symmetrical ground-glass opacity in the bilateral upper and middle zones, informed us that he had worked in aluminum casting for 20 years and was exposed to iron, aluminum, and zinc vapors, and dust in the workplace. The patient was scheduled for bronchoscopy; aluminum analysis in bronchoalveolar lavage revealed 0.256 mg/kg of aluminum. The patient, with a history of occupational exposure, was diagnosed with aluminum metal fume-induced PA. This case shows that, even if it is preventable, PA can still occur if the occupational health and safety regulations are not met and also emphasizes the importance of the detailed occupational history in interstitial lung diseases.

Premature Deaths Due to Silicosis in Turkey, 2006-2017: A Twelve-Year Longitudinal Study.

BACKGROUND: Deaths due to epidemics of silicosis still continue to be reported both in developing and developed countries, and silica exposure from different sectors remains an important occupational health concern. AIMS: To identify characteristics of silicosis cases by focusing on a developing country and evaluate the frequency of and factors related to premature deaths and also reveal preventable causes of premature deaths in silicosis. STUDY DESIGN: Retrospective cohort. METHODS: We reviewed the records of 9769 patients who were diagnosed with occupational diseases in Istanbul Occupational Diseases Hospital between 2006 and 2017. According to International Classification of Diseases (ICD)-10 codes, 1473 silicosis cases were detected. The sociodemographic characteristics, job characteristics, comorbidities, serological, functional, and radiological data, and follow-up time were obtained from the medical records. Mortality data were gathered from The National Death Notification System of Ministry of Health. RESULTS: The study examined 9769 cases diagnosed with an occupational disease, and 15.0% (n = 1473) of them were diagnosed with silicosis. The median age of silicosis patients was 40.0 years, and 26.9% of them were child labor when they started to work in dusty industries. Child labor was mostly seen among dental technicians (57.7%), denim sandblasters (46.4%), and miners (37.0%). In the follow-up period, 26.3% of Teflon sandblasters, 11.1% of coal miners, 8.6% of denim sandblasters had died before their average life expectancy, and the years of loss of life was 26.0 ± 11.6 years all over the group. Premature death was associated with occupation [hazard ratio (Teflon sandblasting): 3.93, CI: 1.43-10.78; hazard ratio (marble production): 4.4, CI: 1.02-19.21]; large opacities in posterior anterior chest X-ray [hazard ratio: 2.14, CI: 1.18-3.86]; tuberculosis [hazard ratio: 2.60, CI: 1.42- 4.76]; and reduction in forced vital capacity (forced vital capacity% ≤80) during diagnosis [hazard ratio: 4.43, CI: 2.22-8.83]. CONCLUSION: More than a quarter of silicosis cases are those who start working in dusty industries at an early age. Factors associated with premature death in patients with silicosis are patient occupation, large opacities on chest X-ray, tuberculosis, and pulmonary function loss at diagnosis.

Follow-up results of 702 patients receiving tumor necrosis factor-α antagonists and evaluation of risk of tuberculosis.

The objective of this study is to estimate the incidence of active tuberculosis in patients with inflammatory diseases receiving tumor necrosis factor-alpha (TNF-alpha) antagonists and to figure out the characteristics of patients who develop tuberculosis. 702 patients with different inflammatory diseases receiving TNF-alpha antagonists were followed up from August 2005 to July 2008 at our department of chest disease. All patients had tuberculin skin test (TST) and postero-anterior chest radiograph (CXR) prior to anti TNF-alpha antagonist treatment. All patients with a TST result > or =5 mm or fibrotic lesions on CXR were administered chemoprophylaxis with isoniazid (INH) for 9 months. 6 (0.85%) patients developed active tuberculosis (4 pulmonary and 2 extrapulmonary) during the follow-up period. TST was found to be positive in 434 (61.8%) of the patients. Patients, who were already on immunosuppressive therapy and who were not, were compared for the difference in their TST results and no statistically significant difference was found. Chemoprophylaxis was administered overall to 583 (83.0%) patients among which 31 (5.3%) developed hepatotoxicity. Of the patients who developed active tuberculosis, all were decided to receive INH chemoprophylaxis, however, only three of them adhered proper treatment. Diagnostic accuracy of TST for detecting latent tuberculosis is high among patients with inflammatory diseases even in the setting of immunosuppression. The risk of development of active TB is increased in this group of patients despite chemoprophylaxis, but this risk remains within the acceptable limits even in a moderate-tuberculosis incidence country, if proper chemoprophylaxis regimen is adhered.

Rheumatological Diseases in Denim Sandblasters with Silicosis: What Should Pulmonologists Look for?

OBJECTIVE: Silica exposure is not only the cause of silicosis, also associated rheumatological diseases like rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc). This report will reveal the rheumatological diseases of silicosis patients who were exposed to silica while working as denim sandblasters. Additionally, we will describe some clinical and laboratory findings that will help pulmonologist suspect, recognize and manage rheumatological diseases related to silica exposure in patients with silicosis. MATERIAL AND METHODS: We reviewed the records of 142 sandblasters diagnosed with silicosis and found ten silicosis cases who also had rheumatological diseases between the years 2009 and 2017. The occupational characteristics, serological, functional and radiological data, were collected for patients of silicosis with rheumatological diseases. RESULTS: Ten silicosis patients with concomitant rheumatological diseases were found. Six patients among our cases had diagnosed SSc (4.2%), three of them had RA (2.1%), and one of them was being monitored for SLE (0.7%). The mean silica exposure time of the cases was 4.3±1.9 years (min: 1 max: 8). We also found elevated LD, sedimentation and CRP levels in our cases. CONCLUSION: It should be kept in mind that, in silicosis cases with arthralgia, joint tenderness or sclerosis at the fingertips may be indicative of rheumatological diseases related to silica exposure, and in these cases, the unexplained elevations of sedimentation and CRP levels may also be a result of silica-induced rheumatological diseases.

Follow-up of 1887 patients receiving tumor necrosis-alpha antagonists: Tuberculin skin test conversion and tuberculosis risk.

OBJECTIVES: To evaluate the characteristics of patients who developed tuberculosis while receiving tumor necrosis factor-alpha (TNF-α) antagonists and the related factors with tuberculosis. METHODS: Patient's demographics, tuberculin skin test (TST), isoniazid prophylaxis and type of TNF-α antagonist were recorded. TST conversion (≥5 mm increase) was evaluated for patients who had baseline and 1-year TST. RESULTS: Files of 1887 patients who were receiving TNF-α antagonists between August 2005 and June 2015 were evaluated. TST significantly increased at the end of 1 year (n = 748 baseline:7.36 ± 7.2 mm vs. 1 year:9.52 ± 7.5 mm, P < 0.001). One-third of patients (31.2%) who had negative TST at baseline had positive TST at 1 year. Tuberculosis developed in 22 patients (1.16%). The annual incidence of tuberculosis was 423/100 000 patient-year. TNF-α antagonist indications were ankylosing spondylitis (n = 8), inflammatory bovel diseases (n = 7) and rheumatoid arthritis (n = 4). Ten (45.5%) patients received infliximab, six (27.3%) patients received etanercept and six (27.3%) patients received adalimumab. Nineteen (86.4%) patients were under isoniazid prophylaxis. Twelve patients had extrapulmonary tuberculosis (54.5%; four lymph node, three pleura, two periton, one pericarditis, one intestinal, one joint). Atypical mycobacterium was detected in one patient. Adalimumab treatment (9.5× increase), male sex (15.6× increase) and previous tuberculosis disease history (11.5× increase) were risk factors for active tuberculosis. Conversion of TST was not found related with tuberculosis. CONCLUSIONS: Despite the high proportion of isoniazid prophylaxis, the incidence of tuberculosis in our patients receiving TNF-α antagonist was higher than the literature. Adalimumab treatment, male sex and previous tuberculosis disease history were found as risk factors for tuberculosis.

[The importance of contact tracer in detection of childhood and female TB cases; a retrospective case-control study in Istanbul]. / Cocuk ve kadin tüberkülozlu olgularin saptanmasinda temasli taramasinin önemi; Istanbul'da retrospektif bir olgu-kontrol çalismasi.

We compared age, sex and the forms of disease between the group consisted of patients admitted to dispensaries by symptoms and the other group consisted of patients found by screening of the contacts. Study covers randomly selected 640 patients from the group diagnosed by passive methods (P-Tbc) and 419 patients from the group diagnosed by active methods (A-Tbc) in Istanbul dispensaries between 1999-2000. Data, since 1997 in Istanbul Union against Tbc, were taken from the central archives. Of P-Tbc cases, 27% (174/640) was female, 73%(466/640) was male. Of A-Tbc cases, 46% (193/419) was female and 54% (226/419) was male (p= 0.0001). While 3.4% of P-Tbc cases (22/640) was between 0-14 years old, it was 7.8% (33/419) in the A-Tbc group (p= 0.002). Study shows that screening the tuberculosis patients' close contact give us an important numbers of contagious cases. It also seems how to increase the female and child tuberculosis patients diagnosing.

Clinical significance of P16INK4A and retinoblastoma proteins in non-small-cell lung carcinoma.

This study was performed to determine the frequency of expression loss of p16 and pRb; their relations with each other, tumour histology, tumour stage, nodal status, and survival in formalin fixed, paraffin embedded tumour tissues of patients with non-small-cell lung carcinoma (NSCLC). P16 and/or pRb expression loss is observed in 72 (75.8%) out of 95 patients, and 70 (73.7%) of them showed inverse correlation (P<0.05). Thirty-six (37.9%) of the p16 positive cases usually showed weak or moderate immunohistochemical staining. Loss of p16 expression was found to be significantly greater in squamous cell carcinoma than in adenocarcinoma cases, whilst no relation was observed with other clinical parameters. Immunohistochemical reactivity for pRb was generally moderate or strong. PRb expression loss was observed in 15.8% of the cases, and no relation was found between pRb loss and age, sex, tumour histology, tumour stage, or nodal status. PRb negative squamous cell carcinoma cases had significantly shorter survival independent of nodal status. These results suggest that disruption of p16/pRb pathway is frequently involved in NSCLC, and pRb expression loss in cases with squamous cell carcinoma may predict clinical outcome.