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    Adapted T Cell Interferon-Gamma Release Assay for the Diagnosis of Pleural Tuberculosis
    (Karger, 2011) Ates, Gungor; Yildiz, Tekin; Ortakoylu, Mediha Gonenc; Ozekinci, Tuncer; Erturk, Baykal; Akyildiz, Levent; Caglar, Emel
    Background: Better and more rapid tests are needed for the diagnosis of tuberculous pleural effusion (TPE), given the known limitations of conventional diagnostic tests. Objectives: To estimate diagnostic accuracy of the QuantiFERON-TB Gold In-Tube (QFT-GIT) test (and its components) using data-derived cutoffs in pleural fluid. Methods: The QFT-GIT test was performed on whole blood and pleural fluid from 43 patients with TPE and 29 control subjects (non-TPE). To achieve the objective, QFT-GIT test, estimating likelihood ratios and receiver operating curve analysis were performed. Results: The sensitivity and specificity using the QFT-GIT for the diagnosis of TPE were 48.8% and 79.3%, respectively, in pleural fluid. The best cutoff points for tuberculosis (TB) antigen, nil and TB antigen minus nil results were estimated at 0.70, 0.90 and 0.30 IU/ml, respectively. Area under the curve of TB antigen IFN-gamma response was 0.86 (CI: 0.76-0.93), nil tube was 0.80 (CI: 0.69-0.89) and TB antigen minus nil tube was 0.82 (CI: 0.72-0.90). When the best cutoff scores of the nil tubes were set at this value, the results of a likelihood ratio of a positive and a negative test were 9.44 (7.4-12.0) and 0.37 (0.09-1.5), respectively. The percentages of indeterminate results in pleural fluid among the TPE cases were 42% (most of them caused by high nil IFN-gamma values) using the QFT-GIT test. Conclusion: QFT-GIT test or its components have poor accuracy in the diagnosis of TPE, largely because of a high number of indeterminate results due to high background IFN-gamma production in the TPE. Copyright (C) 2011 S. Karger AG, Basel
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    A Case of Lymphocytic Interstitial Pneumonitis Associated With Sjgren's Syndrome With Atypical Radiological Findings
    (Bilimsel Tip Publishing House, 2008) Yildiz, Tekin; Akyildiz, Levent; Topcu, Fusun; Yilmaz, Fahri
    The 42 year old female patient admitted to our hospital with the compliants of cough, sputum, loss of weight, hoarseness and dryness of the eyes and skin. On the chest x-ray, opacification was found in the right lower zone. The chest CT scan demonstrated nodular lesions, including air bronchograms showing a partial alveolar pattern in the middle and lower right lobes and bilateral pleural plaques. The diagnosis of Sjogren's Syndrome was made on the basis of bilateral Schirmer test positivity in the ophthalmologic examination and anti-SSA: (+++) positivity, with a titration of 1/100. The cytologic examination of bronchoalveolar lavage fluid and histopathological evaluation of transbronchial biopsy were not diagnostic. Lymphocytic interstitial pneumonia was diagnosed by evaluation of a transthoracic fine needle biopsy (tru cut). In this case report, we present a case of lymphocytic interstitial pneumonia associated with Sjogren's syndrome with atypical radiological findings, who responded favourably to steroid and cyclophosphamide treatment.
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    Effect of passive smoking on the development of chronic obstructive pulmonary disease in southeastern Turkey
    (Tubitak Scientific & Technological Research Council Turkey, 2010) Yildiz, Tekin; Topcu, Fusun; Celik, Lisa; Akyildiz, Levent; Ates, Gungor; Durak, Dilek
    Aim: To determine the effect of passive smoking on the development of chronic obstructive pulmonary disease (COPD) among persons who spend a long time in cafes Materials and methods: The study sample included 348 male smokers who were older than 40 years and spend a long time in cafes The questions were derived from the European Coal and Steel Community (ECSC) questionnaire We also inquired about the nature of cafe visits (hours/day, visits/week, visits/month) Results: COPD was found in 18 1% (63/348 subjects) of the smokers aged >= 40 years In these 63 subjects, based on spirometry results, the rate of mild and moderate airflow limitation was 23 8% (15/63) and 76 2% (48/63), respectively Of the 63, 60 (95%) had no previous diagnosis of COPD After we had accounted for known risk factors for the development COPD, we identified new risk factors, time spent in cafes (hours/day), the number of cafe visits per week (visits/week), and the number of cafe visits per month (visits/month), which had higher odds ratios for smokers without COPD (5 376, 2 721, and 2 337, respectively) Conclusion: Spending time in cafes regularly may contribute as an additional risk factor for the development of the COPD
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    The Effectiveness of Scoring Systems and Various Biochemical Parameters in Predicting Survival in a Respiratory Intensive Care Unit
    (Turkish Biochem Soc, 2010) Yildiz, Tekin; Gundogus, Baran; Ates, Guengoer; Akyildiz, Levent; Celik, Yusuf; Topcu, Fuesun; Canoruc, Naime
    Aim: The aim of the present study was to compare various clinical and biochemical parameters, Acute Physiological and Chronic Health Evaluation II (APACHE II), and Sequential Organ Failure Assessment (SOFA) for their effectiveness in distinguishing surviving and non-surviving patients who had acute respiratory failure (ARF) while in the Respiratory Intensive Care Unit (RICU). Materials and Methods: A prospective observational clinical study was carried out in the RICU of the Chest Disease Clinic. One hundred and sixteen patients were observed. Laboratory parameters and scoring points for the first 24 hours were recorded. Patients' demographic characteristics, biochemical parameters, length of stay at the RICU, and GCS, APACHE II and SOFA scores were also recorded. The primary outcome of the current study was the mortality rate in the RICU. Results: Mortality rate was determined to be 39.6% (46 patients) of 116 patients, although the predicted mortality rate was 49.7 %. There was a statistically significant difference between surviving and non-surviving patients in terms of SOFA (p=0.004, OR=1.33, CI=1.10-1.61), INR (p = 0.02, OR = 3.95, CI = 1.30-12.07), albumin (p=0.02, OR=2.58, CI=1.17-5.64), and PCO2 levels (p=0.005, OR=1.04, CI=1.01-1.06), respectively. Conclusion: Our results suggest that the mortality rate may be higher when SOFA, INR, albumin and PCO2 abnormalities are seen. Co-morbidities such as non-pulmonary organ dysfunction and metabolic disorders other than respiratory failure may have contributed additionally to increased mortality risk for patients who were admitted to the RICU. These parameters should be taken into account when ARF patients are admitted to the RICU.
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    Environmental Asbestos-Related Pleural Plaque in Southeast of Turkey
    (Heldref Publications, 2010) Ates, Gungor; Yildiz, Tekin; Akyildiz, Levent; Topcu, Fusun; Erturk, Baykal
    It is known that many malignant and benign pleural diseases occur due to environmental exposure to mineral fibers. Calcified pleural plaque (CPP) is an important sign of asbestos exposure on chest radiographic examination. To study the possible change in the prevalence of CPP and diffuse pleural thickening 3 decades after cessation of asbestos exposure. CPP were detected in 29.9% of the villagers; 4.7% had diffuse pleural thickening and 0.7% had asbestosis. The significant variable for CPP and diffuse pleural thickening was age. The youngest villager with CPP was 33 years of age and the prevalence of CPP increased with an increase in age. The reason for our cases with CPP being of advanced age is the discontinuation of asbestos exposure. This finding enables us to suggest that environmental asbestos-related disease will gradually decrease in future decades.
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    Incidence of Tuberculosis Disease and Latent Tuberculosis Infection in Patients with End Stage Renal Disease in an Endemic Region
    (Taylor & Francis Ltd, 2010) Ates, Gungor; Yildiz, Tekin; Danis, Ramazan; Akyildiz, Levent; Erturk, Baykal; Beyazit, Huseyin; Topcu, Fusun
    Aim. Patients in chronic renal failure suffer impaired cellular immunity and have an increased risk of tuberculosis (TB). Our aim in this multicenter study was to determine the incidence of TB and to evaluate latent tuberculosis infection (LTBI) in hemodialysis patients. Methods. We retrospectively evaluated the frequency of TB in 779 dialysis patients at 13 hemodialysis centers in five different cities in Southeast Turkey. The tuberculin skin test (TST) was conducted in 733 patients to detect LTBI. Results. The mean age of the patients was 51.2 +/- 15.9 years; 398 (51.1%) of the patients were female, and 53.9% of patients had a BCG scar. The mean dialysis duration time was 35.1 +/- 33.4 months. TB was diagnosed in 34 cases. The incidence rate of TB in patients undergoing hemodialysis was 3.1%. Ten patients had a history of TB before beginning hemodialysis, and 24 patients had a history of TB after beginning hemodialysis. A diagnosis of TB was made based on clinical data in eight patients and microbiologically or pathologically in 26 patients. The median time between the initiation of dialysis to the diagnosis of TB was 11 months. Extrapulmonary TB occurred in 45.8% of cases, and the most common site of involvement was the lymph nodes. The TST was positive in 61.8% of TB patients and in 37.5% of those with no history of TB. Conclusions. The incidence of TB is high in hemodialysis patients, and they should be evaluated periodically to exclude insidious infection and reduce morbidity and mortality.
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    MDCT Findings of Denim-Sandblasting-Induced Silicosis: a cross-sectional study
    (Bmc, 2010) Ozmen, Cihan Akgul; Nazaroglu, Hasan; Yildiz, Tekin; Bayrak, Aylin Hasanefendioglu; Senturk, Senem; Ates, Gungor; Akyildiz, Levent
    Background: Denim sandblasting is as a novel cause of silicosis in Turkey, with reports of a recent increase in cases and fatal outcomes. We aimed to describe the radiological features of patients exposed to silica during denim sandblasting and define factors related to the development of silicosis. Methods: Sixty consecutive men with a history of exposure to silica during denim sandblasting were recruited. All CT examinations were performed using a 64-row multi-detector CT (MDCT). The nodules were qualitatively and semi-quantitatively analyzed by grading nodular profusion (NP) on CT images. Results: Silicosis was diagnosed radiologically in 73.3% of patients (44 of 60). The latency period (the time between initial exposure and radiological imaging) and duration of silica exposure was longer in patients diagnosed with silicosis than in those without silicosis (p < 0.05). Nodules were present in all cases with centrilobular type as the commonest (63.6%). All cases of silicosis were clinically classified as accelerated and 11.4% had progressive massive fibrosis (PMF). Mild NP lesions were the most prevalent in all six zones of the lung. The NP score was significantly correlated with the duration of silica exposure, the latency period, presence of PMF, and pleural thickening. Enlarged lymphadenopathy was present in 45.5% of patients. Conclusions: The duration of exposure and the latency period are important for development of silicosis in denim sandblasters. MDCT is a useful tool in detecting findings of silicosis in workers who has silica exposure.
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    Multiple Metastatic Tuberculosis Abscesses and Pott's Disease in an Immunocompetent Patient: Case Report
    (Ortadogu Ad Pres & Publ Co, 2011) Ates, Gungor; Ozmen, Cihan Akgul; Yildiz, Tekin; Kisin, Bulent; Akyildiz, Levent
    Metastatic tuberculous abscess (tuberculous gumma) is a rare form of cutaneous tuberculosis. A 16 years old female presented with painless cutaneous swelling at her neck and right thigh. She also suffered from back pain. She was diagnosed as soft tissue abscess according to ultrasound findings. These abscesses were painless and fluctuant. Chest computed tomography revealed an abscess involving the chest wall and the paravertebral area. Smear and sputum culture were negative for M. tuberculosis. In addition, smears and cultures of the abscess were negative for bacteria and fungi. There was no history of tuberculosis and no contact with patients with contagious tuberculosis. M. tuberculosis grew in the abscess culture. She was diagnosed as tuberculous gumma and Pott's disease. The patient recovered after antituberculous treatment. Subcutaneous abscess should be considered as tuberculosis abscess based on the negative smear and nonspecific culture results of pus.
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    A New Approach in Distinguishing Exudative and Transudative Pleural Effusions
    (Aves, 2010) Yildiz, Tekin; Senyigit, Abdurrahman; Celik, Yusuf; Akyildiz, Levent; Ates, Gungor; Colakoglu, Sedat; Bayram, Hasan
    Objective: Light's criteria, which were accepted in 1972 for the differential diagnosis of pleural effusions as transudates or exudates, are widely used worldwide. It has been reported in various studies that Light's criteria have lower specificity, and new recommendations have emerged. The discriminative ability of Light's criteria and adapted formulas, which are our new proposal, were studied by Receiver Operating Characteristics (ROCs) analysis and Area Under the Curves (AUCs). Material and Method: These criteria were evaluated in 451 patients in our study. Of these cases, 151 had transudates, while 300 patients presented with exudates. Results: AUCs of Light's criteria (P/Sprot, P/SLDH, PLDH) were measured as 0.931 (95% CI: 0.899-0.963), 0.936(95% CI: 0.9040967) and 0.957(95% CI: 0.934-0.981), respectively, and the differences between the measured values were found to be statistically significant (p<.001). AUCs of our new adapted formulas (F-1, F-2, F-3) were found to be slightly higher than those of Light's criteria, with the values of 0.987(95% CI: 0.9760.998), 0.935(95% CI 0:. 908-0.963) and 0.980(95% CI: 0.9660.993), respectively, and the differences were also significant (p<. 001). Conclusion: In our opinion, further studies are needed with a wider study population to determine the value of the new formulas in differentiating exudative and transudative pleural effusions. Proving our proposal would be useful in clinical practices.
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    Quality of life, depression and anxiety in young male patients with silicosis due to denim sandblasting
    (Turkish Assoc Tuberculosis & Thorax, 2011) Yildiz, Tekin; Essizoglu, Altan; Onal, Suna; Ates, Gungor; Akyildiz, Levent; Yasan, Aziz; Ozmen, Cihan Akgul
    The aim of this study was to estimate the quality of life, depression and anxiety in patients with silicosis due to denim sandblasting. This study was conducted on 50 young male patients with silicosis and 30 controls. A socio-demographic data form, Short Form-36 (SF-36), the Beck depression inventory (BDI) and the Beck anxiety inventory (BAI) were used to determine quality of life, depression and anxiety. The mean scores of SF-36, BDI and BAI were higher in the patients than in the controls. Correlation analysis revealed a strong negative correlation between all scales of SF-36 and BDI scores. Additionally, there was strong negative correlation between five scales of SF-36 and BAI scores. We suggest that silicosis might be detrimental to the quality of life and increase depression and anxiety in patients with silicosis due to denim sandblasting.