Pitfalls of using the ILO classification for silicosis compensation claims.

BACKGROUND: The International Labour Organization (ILO) Classification of Radiographs of Pneumoconioses is used as the primary tool to determine compensation for pneumoconiosis in Turkey. AIMS: We aimed to evaluate how the ILO classification applied, but obtaining chest radiographs in the workplace for screening until the completion of compensation claim files by the referral centres, based on the ILO reading. METHODS: The study included 320 digital chest radiographs previously taken for screening from eight different ceramic factories and having finalised claim files by referral centres. We used an expert reference panel consisting of five ILO readers to re-evaluate all the radiographs independently using ILO standard films and reached a conclusion based on the agreement among at least three readers. The evaluation primarily included technical quality and silicosis diagnosis with an ILO 1/0 or above small profusion. The results were compared with previous findings. RESULTS: Sixty-three (20%) chest radiographs were unacceptable for classification purposes according to the ILO technical quality grades. Among the remaining 257 chest radiographs, we diagnosed 103 with silicosis (40%), while the referral centres diagnosed 182 (71%). A discrepancy was found between our results and previous evaluations. We diagnosed silicosis in 50% and 17% of the previous silicosis and normal evaluations, respectively. CONCLUSIONS: Our findings suggest that the use of the ILO classification for compensation claims may be problematic due to the way of its implementation in Turkey in addition to its subjectivity.

[Is short-course therapy enough at drug-resistant tuberculosis?] / Kisa süreli tedaviler çok ilaca dirençli haricindeki dirençlerde yeterli mi?

INTRODUCTION: Tuberculosis drug resistance can be assessed by physicians with different approaches on issues such as the choice of treatment protocol and duration of treatment. MATERIALS AND METHODS: In this study, we aimed to evaluate the treatment regimens and treatment results of patients with non multi-drug resistant tuberculosis (MDR-TB) drug resistance implemented in different chest disease clinics in our hospital. The 167 culture-positive patients with nonMDR-TB drug resistance diagnosed between 2008-2010 were analyzed retrospectively. Patients' age, gender, previous TB treatments, bacteriological cruise, drug resistance patterns and treatment outcomes were analyzed. RESULT: One hundred sixty-seven patients with eligible data were evaluated; there were 117 (70.1%) men and 50 (29.9%) women, mean age was 42.35 (18-90) years, respectively. Among mono drug resistance; H resistance in 75 (44.9%) patients and R resistance in 11 patients was detected. In 19 (11.4%) patients HS resistance was detected as multiple drug resistance. One hudred and twenty-five (74.9%) were new cases. When treatment the results of in all patients evaluated, 136 (81.4%) of the patients achieved treatment success. Sixty-four (51.2%) of the new TB cases treated with "standard treatment protocols for new cases" (2HRZE/4H) and 51 (40.8%) of them treated with "other treatment protocols". Ten (23.8%)of the recurrent TB cases" standard treatment for recurrent cases (2HRZES/HRZE/5HRE) and 9 (21.4%) 33 (19.8%) of them treated with other protocols. The combination of the rthe treatment protocol and descriptive information about the duration of the treatment could not be created as 33 (19.8%) of the cases left without completing their treatment. CONCLUSIONS: As a result of the analysis, patients have completed their treatment, there was no significant difference in treatment outcomes. Patients with Non MDR-TB drug resistance should be monitored well and should be careful in terms of MDR-TB.