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Öğe Association between varicocele and chronic obstructive pulmonary disease(Wiley, 2006) Erdoğmuş, Beşir; Yazıcı, Burhan; Balbay, Öner; Annakkaya, Ali Nihat; Özdere, Betül Ayça; Bulut, İsmetPurpose. To evaluate the relationship between varicocele and chronic obstructive pulmonary disease (COPD) via color duplex sonography. Materials and Methods. Forty-four male patients with COPD (age range, 50-89 years; mean +/- SD, 66 +/- 9) and 44 male healthy controls (age range, 47-75 years; mean +/- SD, 65 +/- 6) were evaluated with color duplex sonography for unilateral or bilateral varicocele. Results. The incidence of right, left, and bilateral varicocele was 47.7%, 65.9%, and 38.6% respectively, in the COPD group, versus 22.7%, 52.3%, and 13.6% in the control group. The incidence of right and bilateral varicocele in the COPD group was significantly higher than in the control group (p < 0.05). The incidence of varicocele also increased with increase in COPD severity. Conclusions. The incidence of varicocele in COPD patients is high. Varicocele might be one of the most important causes of scrotal pain and infertility in COPED patients.Öğe A Case with Tracheobronchopathia Osteochondroplastica Presenting Upper Airway Obstruction(Duzce Univ, 2009) Akin, Nese; Dumlu, Talha; Balbay, Ege Gulec; Yildirim, Umran; Karatas, Naciye; Kucuk, Ebru; Annakkaya, Ali NihatTracheobronchopathia Osteochondroplastica (TO) is a rare, slowly progressive benign condition characterized by the presence of bony and cartilaginous nodules in the tracheal and bronchial submucosa. 65 years old man attending to chest disease policlinic with chest pain and upper airway obstruction in his spirometry was diagnosed as TO according to thorax CT and fiberoptic bronchoscopy findings. We have presented herein a rare but benign condition sometimes leading to upper airway obstruction and to emphasize the importance of flowvolume loop in follow up of patient.Öğe Clinical Characteristics of the Late Resolving Pneumonia Cases(Aves, 2005) Erbas, Mete; Annakkaya, Ali Nihat; Arbak, Peri; Balbay, Oner; Bilgin, Cahit; Bulut, IsmetIt has been well known that advanced age, cigarette smoking, presence of comorbid illnesses, multilobar radiographic involment, ongoing leukopenia, corticosteroid therapy are associated with late resolving pneumonia. We aimed to evaluate the effects of certain factors that were relatively less investigated such as gender, smoking, localization and pattern of radiographic involvement, the time of initiation of antibiotic therapy and antibiotic type on resolution of pneumonia. We retrospectively assessed the records and radiographs of 98 patients diagnosed as pneumonia. Mean age was 54 +/- 15 years, 52% of patients were female whereas 48% of them male. Delaying in resolution was detected in 17.3% of cases with pneumonia. Delaying in resolution of pneumonia was significantly higher in females (13/51) when compared to males (4/47). Delayed radiographic resolution was significantly more often observed in interstitial radiographic involvement than segmental and lobar involvement respectively. Mean initiation time of antibiotic therapy in patients with late resolving pneumonia was 14 +/- 6 days whereas 10 +/- 6 days with pneumonia that resolved in expected time (p<0.05). Most of the patients with normally resolving pneumonia were using single antibiotic (75/81) where all the patients in late resolving group were recieving single antibiotic. In conclusion, we decided some factors including gender initiation time of antibiotic treatment, radiografic involvement patterns have significant effects on resolutin of pneumonia.Öğe Effect of symptom-to-treatment interval on prognosis in lung cancer(Sage Publications Ltd, 2007) Annakkaya, Ali Nihat; Arbak, Peri; Balbay, Öner; Bilgin, Cahit; Erbaş, Mete; Bulut, İsmetAims and background: To evaluate the relationship between delayed diagnosis and the degree of invasion and survival in lung cancer. Methods: One hundred and three patients (96 men) with lung cancer were included. Stages in the diagnosis of lung cancer were classified as follows: symptom-to-doctor interval, i.e., the interval from the first symptoms related to the presence of lung cancer to the first consultation with a medical professional; doctor-to-diagnosis interval, i.e., the interval between the first medical visit and confirmation of the diagnosis; and diagnosis-to-treatment interval, i.e., the interval between diagnosis and complete TNM staging and treatment. The symptom-to-treatment interval (STI) was the sum of the 3 intervals. The degree of invasion was determined by the TNM classification. Results: The patients were followed up for a mean period ( SD) of 7.4 +/- 8.7 months. Seventy-six (74%) patients were diagnosed with non-small cell lung cancer (NSCLC) and 27 patients (26%) with small cell lung cancer (SCLC). The mean length of STI was 120 +/- 101 days (median, 90). The mean length of the symptom-to-doctor interval was 63 +/- 62 days (median, 45), while the doctor-to-diagnosis and diagnosis-totreatment intervals were 41 +/- 82 days (median, 10) and 16 +/- 12 days (median, 12), respectively. When the STIs of the patients were correlated with tumor stage, tumor invasion, lymph node involvement and metastasis, no significant differences were found. Patients with an STI longer than 60 days had a significantly longer survival. Regarding the type of lung cancer and STI, the median survival was shorter in patients with an STI of less than 60 days both in NSCLC and SCLC, although this was not statistically significant in SCLC. Conclusions: The shorter the diagnostic interval, the shorter was the median survival in our study. The reason for the apparent discrepancy between poor prognosis of lung cancer patients in spite of early diagnosis might be much faster progression of the disease itself.Öğe Effects of cruroraphy and laparoscopic Nissen fundoplication procedures on pulmonary function tests in gastroesophageal reflux patients(E-Century Publishing Corp, 2014) Ozaydin, Ismet; Annakkaya, Ali Nihat; Ozaydin, Cigdem; Aydin, MetinGastroesophageal reflux disease plays a role in the etiology of asthma, chronic bronchitis, aspiration pneumonia, bronchiectasis and interstitial lung fibrosis by affecting the upper respiratory system. To investigate the changes in pulmonary function tests in patients who underwent cruroraphy and laparoscopic Nissen fundoplication for gastroesophageal reflux disease. Between January and October of 2012, cruroraphy and laparoscopic Nissen fundoplication have been carried out on 40 patients with gastroesophageal reflux disease in the Department of General Surgery, Faculty of Medicine, Duzce University. Patients had pulmonary function tests were measured preoperatively and on postoperative day 20. Increases in forced vital capacity, forced expiratory volume in 1 second/forced vital capacity and forced expiratory flow between 25-75% of vital capacity were observed postoperatively in all patients and these increases were found to be statistically significant (p=0.001). Change in the forced expiratory volume in 1 second was not statistically significant (p=0.182). We conclude that treatment of reflux in early stages by surgical procedures could prevent development of chronic lung disease by safeguarding the pulmonary system functions.Öğe Effects of iohexol on pulmonary functions in patients undergoing diagnostic coronary angiography(2004) Akdemir, Ramazan; Özhan, Hakan; Balbay, Öner; Erbaş, Mete; Gündüz, Hüseyin; Arbak, Peri; Yazıcı, Mehmet; Erbilen, Enver; Albayrak, Sinan; Annakkaya, Ali Nihat; Uyan, CihangirBackground: Adverse respiratory reactions have been reported with intravascular radiographic contrast media. The aim of the present study was to assess the effects of iohexol on pulmonary functions in patients undergoing diagnostic coronary angiography. Methods: Thirty patients diagnosed as coronary artery disease undergoing diagnostic coronary angiography were enrolled in the study. Subjects with chronic obstructive pulmonary disease, asthma, allergic bronchitis, myocardial infarction and documented systolic dysfunction by transthoracic echocardiography were excluded. The respiratory functions of the patients before and immediately after the coronary angiography were measured and arterial blood gas analyses were performed. The subjects were divided into two groups according to results of angiography as having coronary artery disease (Group 1) and without significant coronary artery disease (Group 2). The angiography procedures were performed by a single, experienced angiographer. Left Ventriculography was not performed on any patient Results: The results gathered before and after angiography procedure were compared. Forced expiratory volume in the first second (FEV1), maximum mid-expiratory flow rate, (MMFR) 25-75, arterial oxygen pressure (PaO2) and bicarbonate (HCO3) were significantly reduced ( p<0.01), where as forced vital capacity (FVC), pH, oxygen saturation and arterial carbondioxide pressure were not changed. The comparison between two groups resulted that FEV1 and PaO2 were significantly decreased after angiography in Group 1. Conclusions: Diagnostic coronary angiography using iohexol decreases ventilatory functions in a small but significant extent in patients without any overt pulmonary disease. Therefore they should be used cautiously in patients with chronic lung disease.Öğe Evaluation of tumor markers in asthma patients(2006) Coşkun, Abdurrahman; Balbay, Öner; Yavuz, Özlem; Memişoğulları, Ramazan; Annakkaya, Ali Nihat; Bulut, İsmet; Bilgin, CahitBackground: Although tumor markers have been used as biomarkers for monitoring response to therapy and detecting early relapse in malignancies, it is well known that most tumor marker increases are not specific enough to be used for diagnosis of cancer. Aim: The aim of this study was to investigate the serum concentrations of α-fetoprotein (AFP), carcinoembryonic antigen (CEA), cancer antigen (CA) 19-9, CA 125, CA 15-3 and IgE in asthma patients. Materials and Methods: Thirty-five newly diagnosed asthmatic patients and 14 healthy subjects were included into the study. Blood samples were drawn from antecubital vein of asthma patients and control subjects. Serum AFP, CEA, CA 125, CA 15-3 and CA 19-9 levels were determined by chemiluminescent and IgE levels by electrochemiluminescent immunometric method on automatic hormone analyzers. Results: Serum levels of AFP, CEA, CA 19-9, CA 125, and CA 15-3 of asthma patients were not significantly different when compared with the control group. In asthma patients, there was a significant negative correlation between serum IgE and CA 125 (r = -0.401; p = 0.017) and a positive correlation between CA 125 and CA 15-3 (r = 0.368; p = 0.029). Conclusions: We concluded that in asthma patients’ sera, AFP, CEA, CA 125, CA 19-9 and CA 15-3 levels were not different from control subjects. Elevation in any of these tumor markers in asthma patients should be a sign for clinicians to evaluate patients for additional diseases.Öğe Extrapulmonary involvement in patients with sarcoidosis in Turkey(Wiley, 2011) Okumuş, Gülfer; Müsellim, Benan; Çetinkaya, Erdoğan; Türker, Hatice; Uzaslan, Esra; Annakkaya, Ali NihatBackground and objective: Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey. Methods: This study was conducted by Turkish Thoracic Society Clinical Problems Study Group. New cases of sarcoidosis between 1 June 2004 and 31 May 2006 were recorded on electronic case record forms sent to all potential investigators and information about extrapulmonary involvement was collected. Results: One hundred and nineteen of 293 patients (83 female, 36 male, mean age = 45 +/- 12 years) had extrapulmonary involvement in this study (40.6%). The median time to diagnosis was 6 months and this was longer than patients with just thoracic sarcoidosis (P = 0.001). Extrapulmonary symptoms were present in 181 (61.8%) patients, and skin lesions, arthralgia and back pain were the commonest (33.4%, 20.8% and 16.4%, respectively). Incidence of organ involvement was independent of age with the exception of ocular involvement, which was higher in those under the age of 40 years (P = 0.007). Conclusions: Skin and peripheral lymph node involvement were the most common sites of extrapulmonary involvement and ocular involvement was more common in those under the age of 40 years in patients with sarcoidosis in a Turkish population.Öğe Hypobaric-hypoxia-induced pulmonary damage in rats ameliorated by antioxidant erdosteine(Elsevier Gmbh, Urban & Fischer Verlag, 2006) Uzun, Özge; Balbay, Öner; Çomunoğlu, Nil Üstündağ; Yavuz, Özlem; Annakkaya, Ali Nihat; Güler, Selver; Sılan, CoşkunFree radical-mediated injury to lung and pulmonary vasculature is an important mechanism in hypoxia-induced lung damage. In this study, we aimed to investigate the potential protective effects of erdosteine as an antioxidant agent on hypobaric hypoxia-induced pulmonary hypertension. Adult mate rats were assigned randomly to three groups. The first group of rats was exposed to hypobaric-hypoxia and the second group was treated with erdosteine (20 mg/kg, daily) for 2 weeks, during which time they were in a hypoxic chamber. These groups were compared with normoxic controls. All. rats were sacrificed after 2 weeks. The hypoxia-induced increase in right ventricle to left ventricle plus septum weight ratio (from 0.20+/-0.01 to 0.26+/-0.01) was reduced significantly in the erdosteine-treated group (0.23+/-0.01). Malondialdehyde levels were elevated (from 0.33+/-0.11 to 0.59+/-0.02) and total antioxidant status was not changed significantly (from 1.77+/-0.42 to 2.61+/-0.23) by hypoxia. In contrast to the hypoxia-exposed group, malondialdehyde levels were significantly decreased in the erdosteine-treated group (0.37+/-0.02). Total antioxidant status (4.03+/-0.22) was significantly higher in erdosteine-treated rats when compared to non-treated rats. Histopathotogical examination demonstrated that erdosteine prevented inflammation and protected lung parenchyma and pulmonary endothelium of hypoxia-exposed rats.Öğe Intima-media thickness of the common carotid artery in highway toll collectors(John Wiley & Sons Inc, 2006) Erdoğmuş, Beşir; Yazıcı, Burhan; Annakkaya, Ali Nihat; Bilgin, Cahit; Şafak, Alp Alper; Arbak, Peri; Tugay, AliPurpose. To assess the effects of exposure to exhaust particles on intima-media thickness of the common carotid artery in highway toll collectors, Methods. Sixty-one highway toll collectors (HTCs) between 24 and 56 years of age (mean, 36.2 +/- 7.3) and 48 controls between 24 and 64 years of age (mean, 42.6 +/- 10.6) were evaluated with gray-scale sonography to measure intima-media thickness (IMT) of the common carotid artery (CCA). Subgroups were categorized according to duration of exhaust exposure and further divided according to tobacco use. Results. CCA IMT was higher (0.8 +/- 0.2 mm) in HTCs than in the control group (0.6 +/- 0.1 mm; p < 0.001) and remained higher when subgroups with similar smoking habits were compared. In HTCs, IMT was greater when the number of years working in tollbooths was greater (p = 0.023). IMT was lower in HTCs with an exposure duration of < 10 years compared with a duration of 10-20years (p = 0.017) or > 20years (p value not significant). Conclusion. Air pollution has a widely acknowledged negative effect on humans. This study confirms that exposure to exhaust particles might cause wall thickening of carotid arteries.Öğe Persistent serpentine supravenous hyperpigmented eruption associated with docetaxel(Wiley, 2005) Aydoğan, İlker; Kavak, Ayşe; Parlak, Ali Haydar; Alper, Murat; Annakkaya, Ali Nihat; Erbaş, MeteVarious mucocutaneous reactions have been reported with the use of systemic docetaxel. We describe a 47-year-old man who developed a persistent serpentine supravenous hyperpigmented eruption (PSSHE), beginning at the site of docetaxel injection and spreading along the superficial venous network in the anterior aspect of the right forearm and distal arm. The eruption occurred after the first infusion of docetaxel following insufficient venous washing. A second infusion was administered through a vein in the other forearm, but this time, abundant venous washing was performed and a similar eruption did not occur. To our knowledge, this is the second report of docetaxel-induced supravenous discoloration and we discussed the terminology and mechanism of this unique reaction.Öğe Postoperative pulmonary complications(Bilimsel Tıp Publishing House, 2005) Annakkaya, Ali Nihat; Tozkoparan, Ergün; Deniz, Ömer; Bedirhan, İbrahim; Bilgiç, Hayati; Ekiz, Kudret; Demirci, NecmettinThe aim of this study was to evaluate postoperative pulmonary complications of patients undergoing operations in 10 different surgery clinics between November 2002 and June 2003. A total of 158 patients, 66 (41.8%) females and 92 males (58.2%), whose mean age was 53 +/- 18 (20-102) were included in the study. The study was mainly based on the postoperative consultations requested by these clinics. The most common causes of consultation requests were dyspnea (31% [49/158]) and abnormal radiological findings (17.7% [28/158]). Hypoxemia was detected in 36.1% (57) of the patients. Chest X rays of 38% (60) of patients were found as normal. Pleural effusion was the most common radiological abnormality (17.1% [27/158]). Thoracic computed tomography was performed in 28 (17.7%) patients, ventilation perfusion lung scan was performed in 16 (10.1%) patients. Respiratory system examination was normal in 13.3% (21) of patients while postoperative pulmonary complications were detected in 64.6% (102) of patients. The most common respiratory complications observed postoperatively were diaphragmatic dysfunction 20.6% (21/102), worsening of obstructive lung disease (bronchospasm) 18.6% (19), atelectasis 17.6% (18) and pneumonia 14.7% (15) respectively. Upper abdominal and thoracic surgeries had significantly higher rates of prolonged mechanical ventilation and pleural effusion complications than other surgeries (p<0.05).Öğe The prevalence of venous insufficiency in patients with chronic obstructive pulmonary disease evaluated by color duplex ultrasonography(Springer Wien, 2006) Erdoğmuş, Beşir; Annakkaya, Ali Nihat; Yazıcı, Burhan; Bulut, İsmet; Özdere, Betül Ayça; Büyükkaya, RamazanObjectives: We hypothesized that in patients with chronic obstructive pulmonary disease (COPD) some extrapulmonary effects such as increase in intra-abdominal and intra-thoracic pressures, presence of cor pulmonale and pulmonary artery hypertension could cause venous insufficiency (VI) in the lower limbs. Our aim in this study was to assess the prevalence of VI in patients with COPD in comparison with healthy controls. Methods: Thirty-nine male patients with COPD and 36 healthy male controls were evaluated for VI. All the participants were in the same age group and their smoking intensities were similar. Patients with COPD were classified as having mild, moderate, severe or very severe disease according to criteria of the Global Initiative for Chronic Obstructive Lung Disease. All the patients and control group were examined for unilateral or bilateral VI of the common femoral vein, superficial femoral vein, deep femoral vein and popliteal vein using color duplex ultrasonography. Results: The prevalence of VI of the lower extremity in patients with COPD (69.2%) was significantly higher than in the healthy control group (41.7%). The prevalence increased as the COPD severity increased and VI was detected in all the patients with very severe COPD [mild COPD, 50.0% (2/4); moderate, 58.8% (10/17); severe, 75.0% (9/12); very severe, 100% (6/6)]. Conclusion: VI of the lower extremity appears more frequent in patients with COPD. We suggest ruling out COPD in patients with otherwise unexplained "primary" VI.Öğe Respiratory symptoms and peak expiratory flow rates among furniture-decoration students(Inst Agricultural Medicine, 2004) Arbak, Peri; Bilgin, Cahit; Balbay, Öner; Yeşildal, Nuray; Annakkaya, Ali Nihat; Ülger, FüsunThis study was designed to evaluate the effects of furniture production, mainly including fir tree (aberia mulleriana), on respiratory health of young workers and to compare the results with those obtained from previous Studies. Sixty-four furniture-decoration students (57 males and 7 females) and 62 controls (54 male, 8 female) from different departments in the same school were included into the Study. All participants were assessed with a questionnaire (concerning history of occupational exposure, work-related respiratory and other symptoms, smoking history, previous asthma history), full physical examination, spirometric evaluation and chest radiograph. Participants then performed serial monitoring of peak expiratory flow rates (PEER) at work and away from work within a month. Mean age of students was 20.9 +/- 3.7 years, 20.5 +/- 2.6 years in controls. There was no difference between study and control groups with regard to age, gender, smoking status and previous asthma history. Reported cough (23.4% vs. 8.1%) and shortness of breath (18.8% vs. 6.5%) were significantly higher in furniture-decoration students than in controls (p = 0.016 and p = 0.034, respectively). Furniture-decoration students had higher conjunctivitis (34.4% vs. 9.7%, p = 0.001) and rhinitis (34.4% vs. 19.4%, p = 0.044) history when compared with controls. Both students and controls were normal in terms of respiratory examination. PEF recordings were performed for approximately one month. Diurnal variability greater than 20% was seen in 12/64 (18.7%) of students at work, whereas it was detected in 4/62 (6.4%) of controls (p = 0,034). When comparing for the presence of diurnal variability greater than 20% in weekends, no difference was found between groups (p = 0.457). In conclusion, early detection of work-related respiratory changes by serial monitoring of peak expiratory flows should save the workers from hazardous respiratory effects of the furniture production, especially in young population.Öğe The results of bedside pulmonary consultations(Gulhane Medical School, University of Health Sciences, 2005) Annakkaya, Ali Nihat; Tozkoparan, Ergün; Deniz, Ömer; Özkan, Metin; Bílgiç, HayatiBedside pulmonary consultations (BPC) in Gülhane Military Medical Academy during 7 month-period were recorded prospectively in order to evaluate clinical characteristics of the cases, the investigations performed during BPC and the conclusions. Five hundred and ten patients 220 (43.1%) of whom were female, 290 of whom (56.9%) were male and mean age of whom was 57±18 (16-102) were consulted at bedside. BPC requests were made from 15 (56.7%) internal and 10 (43.2%) surgery departments. Ninety-four (18.4%) were consulted as emergency. The most frequent reasons for BPC were respiratory symptoms and radiological abnormalities in 218 (42.7%) and 99 (19,4%) of the cases respectively and the most frequent radiological finding was pleural effusion (14.5%). Hypoxemia was detected in 39.4% (201) of the patients. Computed tomography, sputum examination for acid-fast bacillus and tuberculosis culture and pulmonary function testing were ordered in 136 (26.7%), 76 (14,9%) and 64 (12.5%) of the cases respectively. Pulmonary infection, an obstructive lung disease and a cardiac disease were diagnosed and normal respiratory system finding were detected in 70 (13.7%), 70 (13.7%), 52 (10.2%) and 97 (19%) of the cases respectively. As medication, bronchodilator, heparin and steroids (inhaled or systemic) were ordered in 191 (37.5%), 137 (26.9%) and 93 (18.2%) of the cases. Of the BPCs requested from surgery departments 64 (28.8%) were in preoperative and 158 (71.2%) were in postoperative period. As a result, postoperative pulmonary complications in surgery departments and pulmonary infections and obstructive pulmonary diseases in internal departments were determined more frequently with BPC.Öğe Serum neopterin concentrations in healthy healthcare workers compared with healthy controls and patients with pulmonary tuberculosis(Int Scientific Information, Inc, 2006) Özdemir, Davut; Cesur, Salih; Annakkaya, Ali Nihat; Tarhan, Gülnür; Güçlü, Ertuğrul; Şencan, İrfan; Balbay, ÖnerBackground: The aim of this study was to compare Serum neopterin levels in patients with active pulmonary tuberculosis, healthy healthcare workers who had close contact with patients, and healthy volunteers. PVII of the healthy volunteers stated that they had not encountered possible risk factors for exposure to Mycobacterium tuberculosis infection. 0 Material/Methods: Thirty-nine patients, 39 healthy healthcare workers, and a control group of 39 healthy volunteers who had no infection or other diseases were included in this study Neopterin assay was performed in accordance with the manufacturer's instructions. Results: Serum neopterin levels were 18.6 +/- 14.2 nmol/l in patients, 9.8 +/- 2.9 nmol/l in healthy healthcare workers, and 3.4 +/- 5.2 nmol/l in healthy volunteers. Serum neopterin levels in each group were significantly different from each other (p<0.01). Conclusions: Levels of neopterin in patients and healthy healthcare workers significantly differ from the levels in healthy controls. The higher serum neopterin levels in healthy healthcare workers may be attributed to latent Mycobacterium. tuberculosis infection, but it does not seem to be Used in the diagnosis of latent mycobacterium tuberculosis infection alone. However, more experiences are needed.Öğe Serum oxidant and antioxidant levels in diesel exposed toll collectors(Wiley, 2004) Arbak, Peri; Yavuz, Özlem; Bukan, Neslihan; Balbay, Öner; Ülger, Füsün; Annakkaya, Ali NihatSerum Oxidant and Antioxidant Levels in Diesel Exposed Toll Collectors: Peri ARBAK, et al. Department of Chest Diseases, Abant Izzet Baysal University, Duzce School of Medicine, Turkey-it has been suggested that exposure to diesel exhaust may lead to adverse effects due to the generation of oxidants. To evaluate the end products of oxidative stress in DE exposure, toll collectors who are considered a high risk group in regard to occupational toxins were compared to controls who had office-based occupations in the same company in this cross sectional study. A total of 38 toll collectors constituted the study group. All subjects were male. The toll collectors and 29 controls were similar regarding age, smoking status and duration of work. All subjects underwent a clinical examination and an interviewer-administrated questionnaire regarding respiratory symptoms, past medical and occupational history, and pulmonary function tests were performed in all subjects. Serum malondialdehyde (MDA), nitrite+nitrate and vitamin E levels were measured. Toll collectors showed higher serum MDA (5.76 +/- 2.15 mumol/L vs. 3.07 +/- 0.76 mumol/L, p=0.0001) and nitrite+nitrate levels (96.50 +/- 45.54 mumol/L vs. 19.32 +/- 11.77 mumol/L, p=0.0001) than controls. Vitamin E levels were similar in toll collectors and controls (10.57 +/- 3.44 mg/L and 9.72 +/- 2.44 mg/L, respectively, p=0.267). There was no difference between groups in terms of the findings of clinical examinations and respiratory symptoms. In pulmonary function parameters, only peak expiratory flow (PEF) in toll collectors was significantly lower than that of controls (88.9% predicted and 104.2% predicted, respectively, p=0.012). In conclusion, we suggest that serum MDA and nitrite+nitrate levels may be used as biological markers of oxidative stress related to DE exposure, but prospective controlled clinical studies are necessary to clarify the possible association between concentrations of MDA and nitrite+nitrate and pulmonary diseases related to DE exposure.Öğe Tüberkülozlu hastalar, yakın temaslıları, sağlık çalışanları ve tüberküloz laboratuvarı personelinde Quantıferon-TB gold ve tüberkülin cilt testinin değerlendirilmesi(2010) Cesur, Salih; Hoca, Nevin Taci; Tarhan, Gülnur; Çimen, Filiz; Ceyhan, Ismail; Annakkaya, Ali Nihat; Aslan, TuranTüberkülin cilt testi (TCT), uzun bir süredir duyarlılık ve özgüllük değerlerindeki sınırlamalara rağmen etkin bir şekilde kullanılmaktadır. Aktif tüberkülozu olmaksızın TCT pozitif olan hastalar, latent tüberküloz enfeksiyonu (LTBE) olarak tanımlanır. LTBE olan hastaların TCT ile tanımlanması, hastalığın kontrolünde önemli bir aşamadır. Plazma interferon gamma (IFN-?) düzeyini belirleyen Quantiferon-TB Gold Testi (QTG, Cellestis, Austuralya) latent tüberküloz (TB) enfeksiyonu tanısında TCT’ye göre avantajları olan in vitro tanısal bir testtir. Bu test Mycobacterium tuberculosis’e özgül ESAT-6 ve CFP-10 antijenlerini içerir. Bu çalışmanın amacı, TB’li hastalar, yakın temaslıları, sağlık çalışanları ve TB laboratuvarı personelinde QTG ve TCT testi sonuçlarının karşılaştırılmasıdır. Çalışmaya, 26 aktif akciğer TB’li hasta, 6 hasta yakını, 11 hasta teması olan sağlık çalışanı ve 8 TB laboratuvarı personeli dahil edilmiştir. TCT uygulanmadan önce QTG testi için kan örnekleri alınmıştır. Tüm bireyler BCG aşılaması yönünden sorgulanmış ve BCG skarı yönünden incelenmiştir. Çalışmaya katılanların tümünde BCG aşılaması öyküsü ve muayenede BCG skarı tespit edilmiştir. QTG testi plazma örneklerinde üretici firmanın önerileri doğrultusunda çalışılmıştır.TCT ile QTG testi arasındaki uyum kappa istatistiği ile ölçülmüştür. Aktif TB’li hastalarda (gerçek enfekte bireyler) TCT (PPD) pozitifliği %34.6 (9/26), QTG pozitifliği %65.3 (17/26) olarak belirlenmiş; pozitiflik oranı QTG testinde daha yüksek tespit edilmiş olmasına rağmen aradaki fark istatistiksel olarak anlamlı bulunmamıştır (p> 0.001). Diğer çalışma gruplarına bakıldığında; sağlık çalışanları, TB’li hastanın yakın temaslıları ve TB laboratuvarı çalışanlarında TCT ve QTG pozitiflik oranları sırasıyla; %36 (4/11) ve %27 (3/11); %16.6 (1/6) ve %83 (5/6); %37.5 (3/8) ve %75 (6/8) olarak tespit edilmiştir. PPD testi sonucu, QTG negatif grupta ortalama 11 mm iken, QTG pozitif grupta ortalama 14 mm olarak saptanmış ve aradaki fark istatistiksel olarak anlamlı bulunmuştur (p< 0.001). QTG pozitif ve negatif gruplar arasında yaş (p? 0.05) ve cinsiyet (p< 0.001) yönünden istatistiksel olarak anlamlı farklılık saptanmamıştır. QTG testi, latent ve aktif TB enfeksiyonunu saptamada BCG aşısından etkilenmemesi, TB dışı (atipik) mikobakterilere bağlı yanıtları ayırt etmesi ve TCT’nin uygulanması ve değerlendirilmesiyle ilişkili değişkenlik ve birey- sel farklılıklardan etkilenmemesi nedeniyle TCT’den üstündür. Ayrıca, QTG testinin değerlendirilmesi için hastanın sağlık merkezine tekrar gelme zorunluluğu olmaması ve sonuçların daha erken alınabilmesi de avantajları arasındadır. Buna karşın TCT’den daha pahalı olması, test için özel ekipmanlara ve iyi yetişmiş laboratuvar personeline gereksinim duyulması, QTG testinin dezavantajları arasında sayılabilir.Öğe Which patients are able to adhere to tuberculosis treatment? a study in a rural area in the northwest part of Turkey(Natl Inst Infectious Diseases, 2005) Balbay, Öner; Annakkaya, Ali Nihat; Arbak, Peri; Bilgin, Cahit; Erbaş, MeteThe purpose of this study was to investigate various factors, including demographical, socioeconomical, clinical and radiological features, of adherent and nonadherent patients with tuberculosis (TB) who were admitted to a university hospital between 1998 and 2003. One hundred and one patients (65.5%) and 53 patients (34.5%) met the criteria of adherence and nonadherence, respectively. A higher rate of adherence was observed among females than males (79.2 versus 58.4%, respectively, P = 0.012). Older patients were more nonadherent (P = 0.008). The adherence rate in non-smokers was significantly higher than that of smokers (81.4 and 52.4%, respectively, P = 0.000). Patients who underwent "family screening" were more adherent (75.7%) than those (39.5%) who did not (P = 0.000). Patients with pleurisy had higher adherence rates (81.3%), followed by patients with pulmonary TB (65.0%), while patients with extrarespiratory TB had the lowest adherence rates (45.5%) (P = 0.024). The presence of cough was significantly associated with adherence (P = 0.049). A significantly higher adherence rate was observed in patients without hemoptysis (P = 0.001). A univariate logistic regression confirmed that age, smoking, family screening, type of TB, cough and hemoptysis had significant independent effects on the adherence to treatment of TB. High-risk patients may be identified and interventions tailored to promote adherence before concluding that the patient is willfully refusing treatment.
