Prognostic value of the lymphocyte-to-monocyte ratio and other inflammatory markers in malignant pleural mesothelioma

OBJECTIVES

Inflammation plays a role in malignant pleural mesothelioma (MPM) prognosis and symptoms. We investigated the roles of the new and old inflammatory indexes and markers in MPM prognosis.

METHODS

Two hundred and ninety-two MPM patients (167 male and 125 female) were included in this retrospective study. Demographic parameters were collected from the patients' files. Kaplan-Meier curves and multivariate Cox regression analyses were used for the analysis of prognosis.

RESULTS

The mean age of the patients was 58.4 years. The mean survival time was 14.6 ± 13.0 months. Twenty-four potential prognostic factors associated with a poor outcome were calculated in the univariate analysis, and 16 potential prognostic factors were associated with a poor prognosis. These 16 potential prognostic factors were also analyzed in multivariate analysis. Multivariate analysis showed that increased age, stage 3-4 disease, the non-epithelial type, a low Karnofsky performance score, a high white blood cell count, and a low lymphocyte-to-monocyte ratio (LMR) were associated with a poor prognosis. The results of the multivariate analysis showed that a decreased LMR was associated with poor survival. Patients with LMR ≤2.6 had poor survival compared with those with LMR >2.6 (mean 9.6 vs. 17.0 months, respectively; p = 0.004).

CONCLUSIONS

LMR is an independent marker of prognosis in patients with MPM and is superior to the other inflammation-based markers. The inexpensive nature and easy reproducibility of the hemogram should encourage the use of the LMR in clinical practice.

Fibulin-3 as a diagnostic biomarker in patients with malignant mesothelioma

BACKGROUND

New tumour biomarkers are being intensely investigated for malignant mesothelioma (MM). Fibulin-3 is produced in MM but its role remains uncertain. The aim of this study was to evaluate the validity of measuring serum fibulin-3 in the diagnosis and prognosis of MM.

MATERIALS AND METHODS

This prospective study was performed on 43 patients and 40 healthy controls who were admitted to our hospital between January 2012 and January 2014. Data from MM patients, including demographic and clinical features, routine laboratory data, levels of serum fibulin-3, and treatment outcomes were defined as potential prognostic factors. The receiver operating characteristic (ROC) curve for fibulin-3 was used to detect the cut-off value with highest sensitivity and specificity. Univariate survival analysis was performed using the Kaplan-Meier method in patients with MM. Afterwards, the possible factors identified with univariate analyses were entered into the cox regression analysis.

RESULTS

Our results revealed that patients with MM had significantly higher serum levels of fibulin-3 than controls. The results showed that the best cut-off point was 36.6 ng/ml with an AUC (area under the curve)=0.976, sensitivity=93.0% and specificity=90.0. In our study, the initial significant poor prognostic factors were advanced stage, high white blood cell count, high platelet count, high C-reactive protein (p<0.05 for each variable). Later, according to multivariate analysis the results showed only advanced stage as significant parameter (p=0.040).

CONCLUSIONS

We determined that real use for serum fibulin-3 was not for prognosis but for diagnosis in MM. Also advanced stage was associated with poor MM prognosis.

Alterations of the neutrophil-lymphocyte ratio during the period of stable and acute exacerbation of chronic obstructive pulmonary disease patients

OBJECTIVES

We aimed to investigate the importance of neutrophil-lymphocyte ratio (NLR) in patients with chronic obstructive pulmonary disease (COPD) for identifying the severity of inflammation and recognition of acute exacerbation.

METHODS

We retrospectively enrolled 100 patients with a diagnosis of COPD exacerbation who were admitted to our clinic. Complete blood count (CBC), measurement of C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were determined within 2 h of hospital admission. Three months after an acute exacerbation, these measurements were obtained from the same patients during the stable period of COPD. The control group included 80 healthy subjects. NLR was calculated from CBC.

RESULTS

NLR and other inflammatory markers, such as WBC, CRP and ESR were found to be significantly elevated in exacerbated COPD compared to stable COPD and control participants. There was a significant correlation of NLR with CRP (r = 0.415, P < 0.001), WBC (r = 0.304, P = 0.002) and ESR (r = 0.275, P = 0.035). For an NLR cutoff of 3.29, sensitivity for detecting exacerbation of COPD was 80.8% and specificity was 77.7% (AUC 0.894, P = 0.001). Some patients presenting with acute exacerbation of COPD and CRP, WBC or ESR levels lower than the optimal cut-off value had high NLR values.

CONCLUSIONS

Elevated NLR can be used as a marker similar to CRP, WBC and ESR, in the determination of increased inflammation in acutely exacerbated COPD. NLR could be beneficial for the early detection of potential acute exacerbations in patients with COPD who have normal levels of traditional markers.

High social anxiety and poor quality of life in patients with pulmonary tuberculosis

Pulmonary tuberculosis (PT) has been previously related with various psychosocial adverse consequences including stigmatization and social isolation.Social anxiety is a psychiatric condition that may be associated with social isolation and fear of social exclusion.To date no study has investigated social anxiety and its impact on quality of life (QoL) among patients with PT. Therefore, we aimed to determine the severity of social anxiety in a group of patients with PT.Among patients who were recently discharged from hospital with the diagnosis of PT 94 patients and 99 healthy control subjects who had similar demographical features have been included in the study. A psychiatrist interviewed all participants and a semistructured interview form, which was prepared by the authors, Liebowitz Social Anxiety Scale (LSAS), and Short Form-36 were administered to them.Patients with PT showed higher levels of performance avoidance and social avoidance than healthy control subjects. They reported lower QoL scores across all dimensions. Among patients women showed higher levels of LSAS subscale scores and total score. Fear of social exclusion was predicted by perceived illness severity and emotional role difficulty. On the other hand, perceived illness severity was predicted by fear of exclusion and sedimentation level.PT patients seem to experience higher levels of social anxiety and associated fear of social exclusion that add to their worse QoL during the earlier months of their disease. Among them fear of social exclusion is related with perceived illness severity.

Relationship between hepcidin levels and periodic limb movement disorder in patients with obstructive sleep apnea syndrome

PURPOSE

This study was aimed to assess potential correlations between periodic leg movement (PLM) index, hepcidin levels, and iron status in patients with obstructive sleep apnea syndrome (OSAS).

METHODS

Forty-four newly diagnosed OSAS patients and 49 non-apneic controls were enrolled in this study. All patients underwent polysomnographic evaluation. The hepcidin, iron, ferritin, total iron binding capacity, and C-reactive protein levels were measured.

RESULTS

The mean age was 47.4 ± 7.2 years (18-68) in the OSAS group and 44.9 ± 11.1 years (23-65) in the control group. There were no differences in age, gender, and smoking between OSAS patients and controls. Mean apnea-hypopnea index (AHI) was 25.1 events/h. Mean serum hepcidin levels were significantly higher in OSAS subjects (725.9 ng/ml) than in control subjects (646.0 ng/ml) (p < 0.001). Serum iron levels were significantly lower in the OSAS and PLM disorder groups than in control subjects (p < 0.001). Serum hepcidin levels were significantly correlated with AHI (r = 0.453) and PLM index (r = 0.114). Serum iron levels were significantly negatively correlated with AHI (r = -0.169) and PLM index (r = -0.180).

CONCLUSIONS

In our study, the level of hepcidin was increased in patients with OSAS. Our study indicates that levels of hepcidin correlate with the AHI and PLM index severity of OSAS.

The value of inflammatory parameters in the prognosis of malignant mesothelioma

Objective

This study investigated the relationship between potential prognostic parameters that may be associated with increased inflammation and survival in patients with malignant mesothelioma (MM).

Methods

This retrospective study assessed potential prognostic parameters measured at the time of MM diagnosis. Data on asbestos exposure, histopathological subtype of MM and laboratory parameters were collected.

Results

In 155 patients with MM (90 male), mean survival time was 13.9 months. In univariate analysis, age ≥60 years and neutrophil-to-lymphocyte ratio (NLR) ≥3 were associated with significantly shortened median survival times. In multivariate analysis, nonepithelial subtype, red cell distribution width (RDW) ≥20% and NLR ≥3 were associated with significantly shortened median survival times. Mortality rate was increased 2.77-, 1.67- and 1.52-fold in patients with RDW ≥20%, NLR ≥3 and nonepithelial subtype, respectively. Nonepithelial subtype, white blood cell count ≥11 200 µl and platelet-to-lymphocyte ratio ≥300 at baseline were associated with a heightened NLR value.

Conclusions

The NLR and RDW were significant predictive factors for MM prognosis.

Clinical characteristics, treatment and survival outcomes in malignant pleural mesothelioma: an institutional experience in Turkey

PURPOSE

To compare treatment modalities and investigate potential prognostic factors for survival in patients with malignant pleural mesothelioma (MPM).

METHODS

The present study has investigated the data of 150 patients with MPM who were examined and treated in our center from 2005 to 2012.

RESULTS

The study included 87 male (58% and 63 female (42) patients. Surgical resection (pleurectomy/decortications (P/D), and extrapleural pneumonectomy (EPP)) was performed in 32 (36.7%) patients; 87 patients (58%) received chemotherapy alone and 16 (10.7%) had surgery, chemotherapy and radiotherapy (trimodal treatment). The median progression free and overall survival (PFS and OS) for all patients were 10.6 and 14.8 months, respectively. No statistically significant difference was observed between the patients who received pemetrexed/cisplatin (N=54) and gemcitabine/cisplatin (N=28) in terms of PFS and OS (p=0.145, p=0.244, respectively). Also, no statistically significant difference was registered between operated and non operated patients (PFS and OS, p=0.416, p=0.095, respectively). There was no difference in both PFS and OS rates between patients who had P/D or EPP (p=0.87, p=0.652, respectively). Log rank analysis: Eastern Cooperative Oncology Group performance status (ECOG PS) (p=0.018), histology (p<0.001), stage (p<0.001) and leukocytosis (p=0.005) were found to be significant prognostic factors of OS. At multivariate analysis, ECOG PS (p=0.016) and stage (p<0.001) were independent prognostic factors for OS.

CONCLUSION

Median OS was approximately 1 year. ECOG PS, histological type, stage and presence of leukocytosis were prognostic factors that affected both PFS and OS. EPP or P/D surgical options did not provide difference in terms of survival. Survival rates in patients who received a combination of platinum analogues with pemetrexed or gemcitabine as front-line chemotherapy were similar.

Relationship between 18 FDG PET-CT findings and the survival of 177 patients with malignant pleural mesothelioma

BACKGROUND AND OBJECTIVES

Malignant pleural mesothelioma (MPM) is a fatal malignancy. Radiological imaging is necessary for the diagnosis, staging, and clinical management of patients with MPM. The 18 fluorodeoxyglucose positron emission tomography (18 FDG-PET) scan has proven useful in preoperative staging and as a prognostic tool in MPM. We aimed to investigate the relationship between the pre-treatment 18 FDG PET/CT results, together with other known clinical parameters, and the survival of patients with MPM in our region.

PATIENTS AND METHODS

A retrospective analysis was performed on the data of 177 patients with MPM between April 2007 and April 2011. Pre-treatment 18 FDG PET/CT scans were done on all patients. Survival time was calculated by the Kaplan-Meier method.

RESULTS

The mean age was 55.40 years. There were 56% male patients and 44% female patients. The mean survival time was 11 months from time of diagnosis. According to multivariate analysis results, being of male gender increased the poor prognosis 5.30 times, a Karnofsky performance score (KPS) < 60 increased a poor prognosis 2.18 times, being on "best supportive care" increased a poor prognosis 25.40 times, the stage III-IV increased a poor prognosis 11.13 times, and a level of maximum standardized uptake value (SUVmax) > 5 increased a poor prognosis 4.34 times.

CONCLUSIONS

MPM remains a fatal prognosis. Significant predictors of survival include KPS, stage of disease, gender, treatment regimen and level of SUVmax. An understanding of the importance of these markers for MPM prognosis should allow targeted treatments to be developed.

Frequency of respiratory function disorders among dental laboratory technicians working under conditions of high dust concentration

BACKGROUND AND OBJECTIVES

Dental laboratory technicians (DLTs) have much exposure to mineralogical dust that may have adverse effects on their lung health. The aim of our study was to investigate occupational dust exposure, and to determine the frequency of respiratory function disorders and radiologic abnormalities among DLTs.

MATERIALS AND METHODS

The study enrolled 94 DLTs who were exposed to dust in dental laboratories and 94 control subjects. Dust concentrations in the workplaces were measured.

RESULTS

The mean age of DLTs was 30.70 ± 9.84 years. No significant difference was found between the DLTs and the control groups for age or smoking status (p > 0.05). Spirometric values for the DLTs were found to be lower than the control group (p < 0.05). The mean working period for DLTs was 9.19±5.9 years. The pulmonary function test results for the DLTs showed that 65.9% had a normal pattern, 22.4% were restrictive, and 11.7% showed obstructive type pulmonary function disorder. Negative correlations were found between the working period time and Forced Expiratory Volume in 1 second in the DLTs (R = -0.675 p = 0.000). Negative correlations were also found between working period time and Forced Vital Capacity in the DLTs (R = -0.720 p = 0.000). All DLTs had chest X-rays and 16 (17%) of them showed radiological pneumoconiosis.

CONCLUSIONS

This study showed a negative association between level of respiratory function and working period in DLTs.

Effects of treatment regimens on survival in patients with malignant pleural mesothelioma

BACKGROUND AND OBJECTIVE

In this study, we aimed to investigate the factors affecting the survival of patients with malignant pleural mesothelioma (MPM) according to their treatment regimens, including best supportive care (BSC), chemotherapy, surgical group and multimodality (MM) therapy.

PATIENTS

A retrospective analysis was performed on clinical data and treatment outcomes of 400 patients registered in our hospital with MPM between January 1989 and April 2010.

RESULTS

Mean age (p < 0.001), presence of asbestos exposure (p = 0.0014), presence of smoking history (p < 0.001), Karnofsky performance status (p < 0.001), histological subtype (p = 0.034) and stage (p < 0.001) variables were found to be significantly different among the four treatment regimens. Mean survival time of all patients was 12.32 months. Mean survival time 10.5 months for the BSC group, 15.7 for the surgical group, 16.02 for the chemotherapy group, and 26.55 for the MM group. There were significant differences in mean survival time among the four treatment regimens. In addition, a significant difference was found in survival time between the two chemotherapy groups (p = 0.032). Mean survival time for cisplatin + gemcitabine was found to be 14.49 months and for cisplatin + pemetrexed, 18.34 months.

CONCLUSIONS

The MM group had better survival rates than the other groups. The new chemotherapy combination, cisplatin + pemetrexed, can be helpful in improving survival time.      

Coenzyme Q10, copper, zinc, and lipid peroxidation levels in serum of patients with chronic obstructive pulmonary disease

Severity of chronic obstructive pulmonary disease (COPD) exacerbation is associated with increased level of copper (Cu), zinc (Zn), and lipid peroxidation (malodialdehyde, MDA). The aim of this study was to investigate the levels of lipid peroxidation, Coenzyme Q10 (CoQ10), Zn, and Cu in the COPD exacerbations. Forty-five patients with COPD acute exacerbation and 45 healthy smokers as control group were used in the study. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were lower in exacerbation group than in control. C- reactive protein levels, white blood cell count, and sedimentation rate were significantly (p<0.001) higher in patients than in control. CoQ10 level and Cu/Zn ratio was significantly (p<0.05) lower in patients than in control, although MDA, Cu, and Zn levels were significantly (p<0.05) higher in patients than in control. Negative correlations were found among MDA, Cu, Zn, FEV1, and FVC values in exacerbation and control subjects (p<0.05). In conclusion, we observed that oxidative stress in the exacerbation period of COPD patients was increased. The decrease in CoQ10 level and Cu/Zn ratio and elevation in Cu and Zn levels observed in the patients probably result from the defense response of organism and are mediated by inflammatory-like substances.

Interstitial lung disease in coppersmiths in high serum copper levels

Coppersmith is a worker who uses copper most commonly for the production of kitchen appliances in Turkey. This is an ancient occupation practiced for centuries in Turkey. Our objective was to investigate the prevalence of parenchymal lung diseases among coppersmiths in Kahramanmaras city in Turkey. Thirty coppersmiths were included to the study, and they all signed an informed consent. Demographics, spirometric test results and high-resolution computed tomography (HRCT) scans, and blood samples were obtained. Laboratory analysis of the serum samples showed that serum copper levels of the subjects were 0.93 +/- 0.14 mg/L. Serum copper level in control group was found as 0.70 +/- 0.14 mg/L, and it was significantly different between the two groups (p < 0.05). Of 30 coppersmiths, 17 HRCT findings are abnormal and seen with diffuse parenchymal interstitial lung disease pattern-ten (58.8%) respiratory bronchiolitis interstitial lung disease, five (29.4%) nonspecific interstitial pneumonia, and two (11.8%) usual interstitial pneumonia. The most prevalent HRCT pattern was micronodular pattern in workers. This is the first field study reporting the radiologic findings of coppersmiths and effect of the occupation on lung diseases.

A clinical, radiographic and laboratory evaluation of prognostic factors in 363 patients with malignant pleural mesothelioma

BACKGROUND

Malignant pleural mesothelioma (MPM) has a poor prognosis.

OBJECTIVES

Only few studies in literature investigated the presence of pleural fluid and radiographic findings for the prognosis of MPM.

METHODS

We retrospectively investigated the hospital charts of 363 MPM patients who were diagnosed from January 1989 to March 2010. Survival time was calculated by the Kaplan-Meier method. Pretreatment clinical, laboratory and radiographic features of each patient at the time of diagnosis were obtained from patients' charts.

RESULTS

The mean age of 363 patients (217 men, 146 women) was 50.6 ± 11.2 years (range 19-85) and the mean survival time was 11.7 ± 8.6 months (range 1-53). Histological types of MPM were epithelial (71.2%), mixed (15.9%) and sarcomatous type (4.9%). The frequency of disease stages were 31.4% for stage 1, 24.2% for stage 2, 28.6% for stage 3 and 15.8% for stage 4. The most frequent symptoms were dyspnea (82.1%), chest pain (68.3%) and weight loss (58.9%). Results of univariate and multivariate analyses revealed that a Karnofsky performance score ≤60, a pleural fluid glucose level ≤40 mg/dl, a C-reactive protein level >50 mg/l, a serum lactate dehydrogenase level >500 U/l, the presence of pleural fluid, pleural thickening >1 cm and a platelet count of >420 × 10(3)/μl were found to be associated with poor prognosis in MPM.

CONCLUSIONS

Our data suggest that low pleural fluid glucose and high C-reactive protein, the presence of pleural fluid and pleural thickening were associated with poor MPM prognosis. Further prospective studies are needed to highlight prognostic factors more clearly.

Risk factors for multidrug-resistant tuberculosis in Diyarbakir, Turkey

BACKGROUND

Multidrug-resistant (MDR) tuberculosis (TB) is a serious public health problem. This study aimed to investigate probable risk factors for developing MDR in the patients treated for TB at Tuberculosis Control Dispensaries (TCD).

MATERIAL/METHOD

The records of 34 patients with MDR-TB and 70 patients with TB sensitive to all first-line drugs (DS), who were treated at TCD between January 2002 and December 2008, were reviewed retrospectively in Diyarbakir, Turkey.

RESULTS

The mean age was 34.47+/-16.99 (32.35+/-14.21 in MDR group and 35.50+/-18.19 in control group) with the range from 2 to 76 years. Of the patients, 63 were male and 41 were female. When risk factors for MDR were evaluated with univariate analysis methods, low socio-economic status, the presence of accompanying disease, previous TB history, previously administered TB treatment, inappropriate TB treatment, and noncompliance with TB treatment were all found to be significant risk factors. When these risk factors were analyzed with logistic regression analysis, regardless of other risk factors, MDR risk was significantly increased with previous TB history by 22.31, with previously taking TB medication by 13.19, and with low socio-economic status by 6.03.

CONCLUSIONS

Socio-economic factors also play an important role in this issue. To minimize the effect of patients' risk factors, health workers should be able to reach all patients, and therapies must be given under direct observation.

Cigarette use frequency and the affecting factors in primary and high school students in Diyarbakir

Cigarette, alcohol and substance use is a worldwide threat which especially affects young people and a preventable public health problem. Aim of the study is to investigate the prevalence of substance use and the factors affecting this prevalence among the students of primary and high school students in Diyarbakir. 62% of the students were males, and 38% were females. The age range was from 11 to 20 and the mean age was 15.2 + 2.0. The smoking prevalence was a total of 14.8% (6.0% in females and 20.2% in males), 5.8% in primary school students, 23.7% in high school students. The mean first-smoking age was found as 12.6 + 2.3 years. Smoking were more common among male students than girls. Close friends and teachers were source of imitation to smoke cigarettes. Other associated factors were age, buying cigarettes from the corner shops for parents, usage of other addictive substances. Cigarette use among students attending to schools in Diyarbakir is significant health problem and preventive interventions should be employed without delay. Interventions which will be implemented in this context not only should comprise the young, but also the all society. Families, teachers and primary school students are the groups which are of priority for intervention. The law about cigarette smoking should be fully enforced.

[The opinions of Turkish physicians about the tasks of tuberculosis central dispensary]

Department of tuberculosis control is the main tuberculosis branch of Minister of Health, with coordinators in cities as intermediate departments and Tuberculosis Central Dispensaries (TCD) as peripheral branches. This study was performed through January-May 2007 in seven different geographical regions to figure out opinions of physicians on tuberculosis dispensaries. A specific questionnaire was distributed to doctors in two cities in each geographical region. A number of 1250 doctor participated in the study as at least fifty doctors in each city. Mean age of the subjects was 32.58 +/- 6.63 (22-65), 52.1% (651) of whom had diagnosed tuberculosis before. It was found in the study that two important functions of tuberculosis central dispensaries for the doctors were the treatment of patients regularly and freely, and scanning the persons who have very close contact with active tuberculosis patient. A number of 157 doctors accepted all seven functions of dispensary as important. Female doctors, pediatricians and chest physicians had better knowledge on the tasks of tuberculosis central dispensaries (p< 0.005). This study showed that Turkish physicians did not have enough knowledge about tuberculosis and its tasks. We believe that practical training procedures for the physicians on the goals and functions of TCD will help to treat tuberculosis.

Tuberculosis in Turkey: high altitude and other socio-economic risk factors

BACKGROUND

In Turkey, there are insufficient data regarding the relation between altitude and the incidence of tuberculosis (TB).

OBJECTIVES

This study aimed to investigate the effect of high altitude and socio-economic conditions on the incidence of TB in Turkey.

METHODS

The mean incidence of TB in 56 Turkish cities was measured as n/100,000 population between 1999 and 2005. The mean altitude of each city was recorded in metres.

RESULTS

The incidence of TB was lower in cities located at high altitude (P=0.000) and higher in cities with a high population density (P=0.000). Multivariate analysis showed that the incidence of TB in low altitude cities was 3.28-fold higher than in high altitude cities (P=0.000). In cities with a population density >80 people/km(2), the incidence of TB was 4.18-fold higher than in cities with a lower population density (P=0.000) Other factors found to affect the incidence of TB were having a social insurance card and a low annual income.

CONCLUSIONS

There was a strong negative correlation between altitude and the incidence of TB, and population density was significantly associated with the incidence of TB. Possession of a social insurance card and fertility rate were also risk factors for TB. The authors believe that altitude has a stronger influence on the incidence of TB than the other factors. The effect of altitude on TB may reveal new data, but further studies need to be undertaken to assess the effects of potential factors on the incidence of TB.

[Factors affecting incidence of tuberculosis in Diyarbakir]

Last decade, there have been important improvements about tuberculosis (Tbc) in the world. Today, 32% of world populations are infected by Tbc basil's, every year about 9 million people have been catching Tbc. We have purposed to determine the incidence of Tbc and the factors affect it, using rate of bacteriology in diagnosis, rate of treatment completion and to constitute an idea for innovation. Diyarbakir, standard monthly data forms used for informing of Tbc in tuberculosis control dispensary are investigated retrospectively among 1996-2004. The mean incidence of yearly Tbc is 37.77/100.000 and pulmonary Tbc is 30.11/100.000. In this period have been determined 3724 new Tbc patient; 2969 (79.7%) are pulmonary Tbc and 755 (20.3%) extrapulmonary Tbc. 842 patient (22.6%) of pulmonary Tbc are smear positive. Tbc pleurisy is the most common type of extrapulmonary Tbc in our series. 3354 (90.1%) of whole patients and 2624 (88.4%) with pulmonary Tbc had completed treatment. There is no data about the rate of cure. This is the most common problem Tbc control system. In 2005, cure rates will have been determined by the way of new form. 162 (4.4%) patient had abandoned treatment. Incidence of Tbc is higher than the incidence of Turkey. It was considered that at the first place highly growing population, the crowded family pattern sharing the same house and bad socioeconomic factors have been playing a major role. Furthermore, it was found that the rate of bacteriological diagnosis was low. In order to increasing of this rates should be carried out necessary studies, should be tried to diagnose all patients with bacteriological methods. End of the treatment cure should be tried to demonstrate by way of examination of sputum. The treatment process should be pursued by directly observed treatment strategy.

Determination of environmental exposure to asbestos (tremolite) and mesothelioma risks in the southeastern region of Turkey

In this study, the authors examined the concentrations and mineralogical analyses of asbestos, and investigated mesothelioma risk in southeastern Anatolia, Turkey. They used a gravimetric dust sampler to collect samples from 2 villages and 2 asbestos mines (1 active). Samples were then evaluated by an X-ray diffractometer and an electron microscope. The authors found high concentrations of asbestos in an active mine (4.9 fibers[f]/cm3) and at a house that was plastered with asbestos (1.24 f/cm3) and had a very active population. They found a low concentration (0.0042 f/cm3) in indoor measurements taken in Armutova village, and an even lower concentration (0.000081 f/cm3) in the inactive mine environment. Outdoor measurements included a low concentration of 0.007 f/cm3 in the village environment, and a high concentration of 1.17 f/cm3 on the mine road during the passing of a sheep herd. The people in the region are continuously exposed to asbestos during normal activities. This cumulative exposure to asbestos carries sufficient risks for mesothelioma development.

Tuberculosis among health care workers in a short working period

BACKGROUND

Tuberculosis (TB) is an important problem among health care workers (HCWs), both in Turkey and in other countries. The purpose of this study was to determine the risk ratio and features of tuberculosis (TB) among health care workers (HCWs) at a teaching hospital in southeast Turkey.

METHODS

In a hospital-wide study at Dicle University Hospital, a referral center in southeast Turkey, data from HCWs with TB were collected from clinic and hospital records. The incidence and relative risk (RR) of TB among HCWs between 1986 and 2000 were analyzed and evaluated retrospectively according to TB incidence in the general population of Turkey.

RESULTS

In this 15-year period, there were 22 HCWs with pulmonary tuberculosis (9 men, 13 women; 4 doctors, 13 nurses, 5 paramedics) out of an average of 734 workers per year over the study period. The mean age of the doctors was 27.1 years; nurses, 20.6 years; and paramedics, 30.5 years. The mean working experience of HCWs was 3.5 years (2.8 years for doctors, 2.8 years for nurses, 6.4 years for paramedics). The mean incidence of TB among the general population of Turkey between 1986 and 2000 was 40.8 of 100,000 persons. The mean incidence of tuberculosis in all HCWs of the hospital was 199.9 of 100,000 persons (RR = 4.9), 127.1 of 100,000 persons in doctors (RR = 3.1), 274.4 of 100,000 persons in nurses (RR = 6.7), and 160.2 of 100,000 persons (RR = 3.9) in paramedics.

CONCLUSION

Hospital acquired tuberculosis is prominent among young nurses who work in high-risk departments.