The Effect of Continuous Positive Airway Pressure (CPAP) Therapy on Serum Caspase-3 Level in Patients with Obstructive Sleep Apnea (OSA).

INTRODUCTION: Intermittent hypoxemia has an important role in the physiopathogenesis of obstructive sleep apnea (OSA) complications. Increased apoptosis due to intermittent hypoxemia may be an important clinical entity in OSA. In this study, we aimed to evaluate caspase-3 enzyme level, which is an indirect marker of increased apoptosis in patients with OSA and to evaluate the effect of OSA treatment with continuous positive airway pressure on caspase-3 enzyme level. MATERIALS AND METHODS: This study included 141 consecutive patients admitted to the sleep-disordered breathing laboratory within 6 months. Caspase-3 was measured in routine blood samples obtained on the morning of polysomnography (PSG) performed at night. The compliance of the patients to CPAP treatment was evaluated and caspase-3 levels were checked again after treatment. RESULTS: A total of 141 patients, 39 females (27,7%) and 102 males (72,3%) were included in the study. The mean age of the patients was 49 ± 12 years (min-17, max-77). According to PSG results, OSA was detected in 95.7% (135/141) of the cases. Mild OSA was 35 (24.8%), moderate OSA 39 (27.7%) and severe OSA 61 (43.3%) cases. Median caspase-3 enzyme levels were similar in men and women in the study group. There was no statistically significant difference in hemogram parameters and caspase-3 enzyme levels between the groups divided according to the presence and severity of OSA. It was determined that caspase-3 enzyme level did not change significantly after 3 months of CPAP treatment in OSA compared to pretreatment. Caspase-3 was found to have a negative correlation with both the percentage of daily use of CPAP therapy and the percentage of CPAP device use for more than 1 h per night. It was found that the control caspase-3 level decreased statistically significantly as the percentage of daily use of CPAP therapy increased (r = -0.397, p = 0.030). It was found that the control caspase-3 level decreased statistically significantly as the percentage of CPAP therapy use for more than 1 h per night increased (r = -0.411, p = 0.024). CONCLUSION: The results of this study did not reveal a relationship between the severity of OSA and caspase-3 levels. However, blood caspase-3 levels decreased as treatment compliance increased, suggesting that CPAP treatment may correct increased apoptosis in OSA. There is a need for more comprehensive studies on this issue.

The Relationship Between Respiratory Complaints and Urine Aluminum Levels in Aluminum Factory Workers.

OBJECTIVE: This prospective case-control study aimed to investigate the forms and conditions of respiratory effects in workers working in an Aluminum Profile Factory. METHODS: All male (42 person, mean age: 32.2 ± 6.9) workers working in an Aluminum Profile Factory were compared with 33 controls. RESULTS: The urinary aluminum levels of the workers were significantly higher than the control group. Complaints of cough, sputum, shortness of breath and wheezing were statistically significantly higher than the control group. In aluminum workers, those with dyspnea had a significantly higher urinary Al level than those without dyspnea. CONCLUSIONS: It is thought that primary and secondary prevention are both important in the workplaces with aluminum exposure. Urinary aluminum level monitoring could be key to protecting the respiratory health of the workers.

Treatment cost of chest diseases during the COVID-19 pandemic: Case analysis at the Düzce University Hospital.

Introduction: The aim of the study was to determine the cost of Coronavirus disease-19 (COVID-19) patients who were treated as outpatients and inpatients at Düzce University Health Application and Research Center (DUHARH) Chest Diseases Clinic before and after the pandemic from the perspective of the Social Security Institution (SSI). Materials and Methods: The study included 26.438 patients who applied to the Chest Diseases clinic in DUHARH before the COVID-19 pandemic (March 10 2019-March 10 2020) and after (March 11 2020-March 11 2021) and 2.971 patients who were hospitalized in the service. A sample was not selected in the research, and the entire universe was included in the study. The data obtained retrospectively were analyzed from bottom to top and through document analysis management. Frequency and percentage calculations, Spearman Correlation analysis, and Mann-Whitney U tests were used to evaluate the data. Result: Before the COVID-19 pandemic, the average unit cost in the policlinic was 46.14 TL/patient ($8.14/patient), and the average unit cost was 64.69 TL/ patient ($9.23/patient) after the COVID-19 pandemic. The average cost of the pre-COVID-19 pandemic service was calculated as 1.139,64 TL/patient ($200/patient). After the COVID-19 pandemic, the average unit cost in the service was 2.136,27 TL/patient ($304.75/patient). A statistically significant difference in terms of costs was found between the two periods. It was determined that the costs of COVID-19 patients changed in terms of length of stay, age, and sex (p<0.05). Conclusions: Even though the number of patients in the Chest Diseases clinic has decreased during the pandemic process, the costs have increased due to the high cost of COVID-19 patients and the patients needing advanced examination and treatment in this period. For this reason, patients need to apply to the relevant unit early.

Clinical and polysomnographic evaluation of sleep-related breathing disorders in patients with sarcoidosis.

OBJECTIVE: This study aimed to evaluate the frequency of obstructive sleep apnea (OSA) in patients with sarcoidosis and related clinical factors. MATERIALS AND METHOD: Consecutive patients diagnosed with sarcoidosis in our clinic were evaluated for OSA risk during sleep using the Epworth Sleepiness Scale, Stanford Sleepiness Scale, Pittsburgh Sleep Quality Index, Berlin questionnaire, STOP and STOP-BANG questionnaires, and polysomnography (PSG). RESULTS: A total of 60 sarcoidosis patients (mean age: 50 ± 11 years, 45 (75%) women) were included in the study. Polysomnography was performed in 54 cases and revealed the diagnosis of OSA in 70% (38/54) of the patients. The mean age was higher in patients with sarcoidosis and OSA (54 ± 11 vs. 47 ± 13, p = 0.041) and body mass index values were significantly higher as well (31.9 ± 4.4 vs, 29.0 ± 4.6 kg/m2, p = 0.034). Polysomnography revealed a higher rate of OSA in patients with sarcoidosis who had high-risk scores in Pittsburgh Sleep Quality Index, STOP questionnaire, and STOP-BANG questionnaire (p = 0.024, p < 0.001, and p < 0.001, respectively). Based on polysomnography, OSA was detected in 39% (5/13) with stage 1 sarcoidosis, 78% (28/36) with stage 2, and in all cases (5/5) with stage 3. OSA frequency and apnea-hypopnea index (AHI) were determined to increase with advanced sarcoidosis stage (p = 0.003, p = 0.043, respectively). AHI was positively correlated with sarcoidosis stage (p = 0.003, r = 0.391). The prevalence of OSA was significantly higher in patients receiving treatment compared to treatment-naïve patients (88% vs. 57%, p = 0.018). Multivariate logistic regression analysis revealed the stage of the disease (p = 0.026) to be the single independent risk factor associated with increased risk of OSA in patients with sarcoidosis. CONCLUSION: High rates of OSA were detected in sarcoidosis, increasing with the advanced disease stage. The findings suggest that patients with sarcoidosis and advanced age, obesity, steroid treatment, and involvement of lung parenchyma (stages 2 and 3) should be evaluated for OSA risk. Further investigations are needed to establish the potential causes of the high prevalence of OSA in sarcoidosis.

Assessment of the frequency of deep venous thromboembolism in obstructive sleep apnea syndrome.

The present study aimed to investigate the frequency of deep venous thrombosis (DVT) among patients with obstructive sleep apnea syndrome (OSAS). Patients who referred the preliminary diagnosis of OSAS were included in this study. D-dimer levels of all patients were measured, and D-dimer (+) patients were evaluated by Doppler USG of the lower-extremity. Mean age of the patient group was 52 ± 12 years and 31.8% (76/239) were women. The rate of D-dimer positivity among severe-OSAS cases (15/85) was significantly higher compared to the rest (13/154) (17.6% and 8.4%, respectively; p = 0.034). The risk of D-dimer positivity was elevated by 2.3 folds in severe-OSAS cases (OR: 2,324, 95% confidence interval: 1.048-5.152). Among 28 D-dimer (+) cases, 4 (14.2%) had DVT as demonstrated by USI of the lower-extremity. All four cases with DVT had severe OSAS. D-dimer was positive in 17.6% (15/85) of all severe OSAS cases. DVT was diagnosed in 4.7% (4/85) of severe-OSAS cases. DVT frequency was 26.6% (4/15) in D-dimer (+) severe-OSAS. Findings of this study indicate that severe-OSAS can be a significant risk factor for DVT. Additionally, data obtained in this study underline the benefits of questioning severe-OSAS patients with respect to DVT symptoms, investigating D-dimer levels and evaluating D-dimer (+) severe-OSAS cases for DVT prophylaxis.

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

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

Are serum eosinophilic cationic protein levels of toll collectors affected by diesel exhaust exposure?

OBJECTIVE: There are few studies on the diesel exhaust particulates (DEP) / eosinophilic cationic protein (ECP) level relationship. This study aimed to detect ECP levels in a highly DE exposed group, named as toll collectors. METHODS: In a cross-sectional study, levels of serum ECP, rates of respiratory symptoms, mean levels of respiratory functions, smoking status, and variations in peak expiratory flow (PEF) during weekends and working days were compared for 68 toll collectors (TC) (range of age, 24-48 years) and 28 controls (range of age, 25-61 years). All subjects in the study group were men. RESULTS: No significant difference was observed in terms of symptoms and smoking rates between the toll collectors and control group. The number of toll collectors [12/68 (17.7%) vs 1/28 (3.5%)] with diurnal PEF variability in the working period was higher than that of controls (p=0.058). Mean ECP level of toll collectors was higher than that of controls (32.8 vs 21.4 ng/L), but the difference was not significant. Mean ECP levels were higher in subjects experiencing diurnal PEF variability during work and off-work periods (34.9 vs 28.3 ng/L, p=0.410). CONCLUSIONS: Serial PEF measurements combined with serum ECP measurements did not add a new tool to detect the sensitivity of workers dealing with DE. Much more diesel exhaust exposed workers should be included to search for cheap and available methods when evaluating airway.

Use of a portable monitoring device (Somnocheck Micro) for the investigation and diagnosis of obstructive sleep apnoea in comparison with polysomnography.

OBJECTIVE: Polysomnography (PSG) remains the gold standard for the diagnosis of obstructive sleep apnoea syndrome (OSAS). While PSG is essential for OSAS, this technique is not suitable for epidemiological investigation due to its high cost. This study aimed to compare a portable monitoring device with PSG for the measurement of parameters related to the diagnosis of OSAS in rural areas. METHODS: We conducted a descriptive study of 155 patients (30 women and 125 men; mean age, 52±12years) who visited to the Hendek Government Hospital Sleep Laboratory between February 2011 and January 2013 Apnoea hypopnea index (AHI), mean levels of O2 (meanO2), desaturation index (DI), and minimum oxygen saturation (minO2) variations as measured using both PSG and a portable Somnocheck Micro (SM) device were compared. RESULTS: Differences were found between the meanO2 and DI, but not between AHI and minO2. Differences between the methods were not desired, but the relationship between the methods was distinct and supported our hypothesis. CONCLUSIONS: The results of our study have shown that the SM portable device can be used as an alternative diagnostic tool in this population either at home or in sleep clinic.

An unusual cause of recurrent spontaneous pneumothorax: the Mounier-Kuhn syndrome.

We present a case of 63-year-old man who was referred to the emergency department with a right-sided pneumothorax. He had a history of spontaneous pneumothorax for 2 times. The chest computed tomographic scan showed tracheobronchomegaly with an increase in the diameter of the trachea and right and left main bronchus. Fiberoptic bronchoscopy revealed enlarged trachea and both main bronchus with diverticulas. These findings are consistent with a diagnosis of Mounier-Kuhn syndrome. Mounier-Kuhn syndrome is a rare clinical and radiologic condition. It is characterized by a tracheal and bronchial dilation. Diagnosis is made by computed tomography and bronchoscopy. Mounier-Kuhn syndrome should be kept in mind in the differential diagnosis of recurrent spontaneous pneumothorax.

The relationship between obstructive sleep apnea syndrome and apolipoprotein E genetic variants.

BACKGROUND: Clinical and epidemiological studies indicate that obstructive sleep apnea syndrome (OSAS) has a strong genetic basis. OBJECTIVES: To investigate the apolipoprotein E (APOE) alleles as a genetic risk factor in OSAS. METHODS: A total of 73 patients (37 male) were included. All underwent full-night polysomnography and were evaluated for APOE alleles. RESULTS: The mean age was 51 ± 12 years. Forty-two of the patients had OSAS. The APOE3 allele was found in 97.3% (71/73) of the study population. The most common APOE genotype was E3/E3 (55/73, 75.3%). Compared to the individuals with no APOE2 alleles (E3/E3, E3/E4), the individuals with at least one APOE2 allele (E2/E3, E2/E4) had a 9.37-fold greater OSAS risk (OR = 9.37, 95% CI 1.13-77.7, p = 0.019). The individuals with APOE2 alleles (E2/E3, E2/E4) compared to the individuals with only an E3/E3 allele genotype had a 10-fold greater OSAS risk (OR = 10.3, 95% CI 1.24-86.61, p = 0.0308). Compared to the individuals with no APOE4 alleles (E2/E3, E3/E3), the individuals with APOE4 alleles (E2/E4, E3/E4) had a high but insignificant risk for OSAS (OR = 2.9, 95% CI 0.55-15.05, p = 0.286). The individuals with APOE4 alleles (E2/E4, E3/E4) compared to APOE3 alleles (E3/E3) had an increased but insignificant risk for OSAS (OR = 3.62, 95% CI 0.96-19.05, p = 0.127). CONCLUSION: Specific APOE genotypes are associated with OSAS in a high-risk population.

Respiratory symptoms and pulmonary function tests in security and safety products plant workers.

OBJECTIVE: Lock and key factory workers are under the risk of metal pneumoconiosis and occupational asthma. In this cross-sectional study, it's aimed to evaluate the relationship between metal dust exposure and respiratory symptoms, pulmonary function tests of workers in different section of lock and key factory. METHODS: 54 male workers (mean age, 32.8 ± 5.4) in a security and safety products plant were evaluated for respiratory symptoms, pulmonary function tests and smoking habits. Results have been interpreted by comparison of the painting (28/54) and grinding group workers (26/54). RESULTS: There was no significant difference between painting (32.1 ± 4.8) and grinding (33.6 ± 6.1) groups regarding mean age (P > 0.05). Smokers were in significantly higher in grinding group (18/26). Cough and sputum were reported 14.3% (4/28) in painting and 3.8% (1/26) in grinding workers (P > 0.05). Chest tightness was seen in 7.1% and 7.7% of painting and grinding workers, respectively (P > 0.05). But no chest tightness was reported in both groups when they were away work. Breathlessness was seen in 10.7% and 7.7% of painting and grinding workers, respectively (P > 0.05). Breathlessness was similar in both groups (7.1% vs. 3.8%) when they were away work. When comparing painting and grinding workers respiratory functions no significant difference observed. Chest radiography in painting and grinding workers showed hyperlucency (3.6% vs.11.4%), respectively. CONCLUSION: Painting groups in lock and key factory workers had more but statistically insignificantrespiratory complaints. Interestingly, chest tightness was only observed when both groups were at work. It was thought that ventilation and using personal protective equipment in factory could provide significant benefits.

Effects of cruroraphy and laparoscopic Nissen fundoplication procedures on pulmonary function tests in gastroesophageal reflux patients.

Gastroesophageal 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.

Serum IgE antibodies against hazelnut in hazelnut processing workers.

Aim. Previous studies have shown a higher sensitization rate to hazelnut in processing workers but no relation was found between the respiratory symptoms in workplace and hazelnut sensitization. Material and Method. To evaluate the association between the hazelnut sensitization and workplace-related respiratory complaints, hazelnut processing workers had undergone a questionnaire included work-related respiratory symptoms, smoking history, pulmonary function testing, and measurement of serum IgE antibodies against hazelnut. Results. This study consisted of 88 hazelnut processing workers (79 females and 9 males), aged 14-59 years (Mean ± SD: 33.8 ± 10.5 years). The mean working duration was 38.8 ± 36.6 months (min: 1-max: 180). Specific IgE against hazelnut allergens was positive in 14 of cases (17.1%). There was no significant difference between the cases with and without specific IgE against hazelnut allergens regarding respiratory symptoms, history of allergy, smoking status and spirometric values. Conclusion. 17.1% of the hazelnut processing workers were seropositive against hazelnut. Being sensitized to hazelnut was not found to be associated with work-related respiratory symptoms in this study. Further studies are needed in hazelnut workers respiratory health to search topics other than asthma.

Extrapulmonary involvement in patients with sarcoidosis in Turkey.

BACKGROUND 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.

[Evaluation of Quantiferon-TB Gold and tuberculin skin test in patients with tuberculosis, close contact of patients, health care workers and tuberculosis laboratory personnel]. / Tüberkülozlu hastalar, yakin temaslilari, saglik çalisanlari ve tüberküloz laboratuvari personelinde Quantiferon-TB Gold ve tüberkülin cilt testinin degerlendirilmesi.

Tuberculin skin test (TST) has been used effectively for a long time, despite inherent sensitivity and specificity limitations. Patients with a positive TST without active tuberculosis are identified as having latent tuberculosis infection. Identifying patients with latent tuberculosis infection with this test is an important part of control of the disease. A whole-blood inferferon gamma (IFN-γ) assay, the Quantiferon TB Gold test (QTG; Cellestis, Australia) which is a promising in vitro diagnostic test for the identification of latent tuberculosis infection (LTBI), has potential advantages over the TST. This test includes Myobacterium tuberculosis specific ESAT- 6 and CFP-10 antigens. The aim of this study was to compare the results obtained by QTG and TST in active tuberculosis (TB) patients, close contacts of patients, health care workers and tuberculosis laboratory personel. Twenty-six patients with active pulmonary TB, 6 close contacts of those patients, 11 health care workers with contact to TB patients and 8 TB reference laboratory personnel were included in the study. Prior to administration of the TST, blood samples were drawn from each participant for QTG test. All subjects were asked for BCG vaccination history and examined for a BCG scar. All individuals had a BCG scar. The QTG assay was performed in whole blood samples according to manufacturer's instructions. The agreement between TST and QTG was measured with kappa statistical analysis. In active TB patients (true-infected cases) TST (PPD) positivity was found 34.6% (9/26) while QTG positivity was 65.3% (17/26). Although the positivity rate was higher in QTG test, this difference was not found statistically significant (p > 0.001). TST and QTG positivity rates for health care workers, close house contact of TB patients and TB laboratory staff were as follows, respectively; 36% (4/11) and 27% (3/11); 16.6% (1/6) and 83% (5/6); 37.5% (3/8) and 75% (6/8). The mean PPD diameter was 11 mm in QTG negative group and 14 mm in QTG positive group with a statistically significant difference (p < 0.001). However, there was no statistical significance between QTG positive and negative groups by means of age (p ≥ 0.05) and gender (p < 0.001). In conclusion, QTG assay was superior to TST in its ability to detect LTBI and active TB infection, not to be affected with BCG vaccination, to discriminate responses due to non-tuberculous mycobacteria, and to avoid variability and subjectivity associated with application and reading the TST. Besides, QTG assay needs only one visit to the test unit. However, its being expensive than TST and requirement for special equipments and skilled laboratory personnel, are among the disadvantages of QTG assay.

Bronchial wall thickness in toll collectors.

There is an increasing concern about the possible adverse effects of diesel exhaust particulates on human health. In a diesel exposed occupational group composed of 120 toll collectors, a cross-sectional study was performed to evaluate the chest radiographs and 40 toll collectors were selected for computed tomography examination according to hyperinflation and linear markings. The wall thicknesses and luminal diameters of trachea, main bronchi, and segmental bronchi of right apical and posterior basal segments were measured with manual tracing method. The walls of right upper bronchus in exsmoker toll collectors were significantly thicker than those of nonsmokers (p=0.011). A positive correlation was observed between age and the right upper bronchus wall thickness (r=0.577, p=0.000). An inverse correlation was found between the working duration and the diameter of right main bronchus (r=-0.366, p=0.020). A positive correlation was seen between smoking and the right upper bronchus wall thickness (r=0.457, p=0.005). Diesel exposure might have a role in increase of thickness of large airways wall and a decrease in the diameters of large airways. Studies in this area are needed to protect the population under the diesel exposure risk.

Annual changes in forced expiratory flows in toll collectors: results from a four years observation.

Diesel exhaust (DE) has been accused for various health outcomes including exacerbation of asthma, chronic bronchitis. Exposure to DE has long-term effects on lung development in children and reductions in lung function have been reported. The aim of the study was to evaluate the annual changes in forced expiratory flows among toll collectors in Duzce city from 2002 to 2005. Annual FVC, FEV(1) and MMF changes in smoker and nonsmoker 58 toll collectors and 37 controls selected among men who worked in the same company as officer have been followed up. No significant changes were seen in expiratory flows among smoker-nonsmoker toll collectors and controls (p>0.05). Annual FVC, FEV(1) and MMF changes were not significantly different between smoker and nonsmoker toll collectors. Twelve toll collectors (20.7%) in the study group and 4 (10.8%) controls were found to have FEV(1) and FVC below longitudinal lower limit of normal. The difference between groups did not reach statistically significance (p>0.05). Toll collectors (18/58) and controls (15/37) with spirometric measurements for three times showed no difference according to the rate of annual difference in either FEV(1) (-21.3+/-133.1 ml/yr vs -44.3+/-166.6 (ml/yr) or FVC (13.2+/-202.9 ml/yr vs. -16.1+/-204.2 ml/yr). Further investigations including large groups with long term follow up are needed to observe annual FVC, FEV(1) and MMF changes among toll collectors.

Pregnancy-associated plasma protein-A and asthma.

Pregnancy-associated plasma protein-A (PAPP-A) is potentially a proatherosclerotic metalloproteinase and a new inflammatory marker. Investigators sought to evaluate the significance of PAPP-A in patients with asthma. Blood samples were collected from 35 patients and 20 control subjects. Serum PAPP-A was determined by enzyme-linked immunosorbent assay. PAPP-A levels of patients with asthma (8.1+/-5.0 mU/L) were higher than those of the control group (4.9+/-2.1 mU/L) (P<.01). A significant correlation was noted between serum PAPP-A concentration and asthma severity (r=.581; P<.01). Investigators concluded that PAPP-A may contribute to airway smooth muscle hyperplasia as an insulin-like growth factor-dependent insulin-like growth factor-binding protein-4 protease in patients with asthma.

Comparison of the 2000 and 2005 outbreaks of tularemia in the Duzce region of Turkey.

Tularemia caused by Francisella tularensis, which is considered a biological warfare agent, is a widely distributed zoonosis. In this study, we aimed to compare a 2005 outbreak of tularemia that was confirmed as waterborne by PCR to outbreak of tularemia that was reported as waterborne in 2000 and to investigate the changes of epidemiological characteristics between these two outbreaks occurring in the same region. In the present study, a total of 11 patients were diagnosed with tularemia. In the 2000 outbreak, oropharyngeal type was observed 19 patients, and ulceroglandular type in 3 patients. In the 2005 outbreak, oropharyngeal type was observed in 8 patients, and oculoglandular type in 3 patients. However, our cases are not sufficient to make a conclusion that the characteristics of tularemia seem to be changing.

Serum neopterin concentrations in healthy healthcare workers compared with healthy controls and patients with pulmonary tuberculosis.

BACKGROUND: 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. All of the healthy volunteers stated that they had not encountered possible risk factors for exposure to Mycobacterium tuberculosis infection. 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.