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Öğe Altitude: Is determinant for tuberculosis incidence?(2006) Tanrikulu A.Ç.; Abakay A.; Abakay Ö.; Alp A.In the last year, there have been very important improvements about tuberculosis (TB) all over the world. In this study, it was researched TB control studies at two cities in Turkey between 1999 and 2003 in order to determined the factors affecting to TB prevalence. The forms using those dispensaries in two cities to informing about diagnosis and treatment of TB have been investigated retrospectively. In This period, 2387 new TB patients were determined in Diyarbakir, 1844 (77.2 %) of them were pulmonary TB and 543 (22.8 %) extrapulmonary TB. 691 (37.5 %) with pulmonary TB were smear positive. In same period, 375 new TB patients were determined in Kars, 276 (73.6 %) of them were pulmonary TB and 99 (26.4 %) extrapulmonary TB. 50 (18.1 %) patients with pulmonary TB were smear positive. The average incidence of TB was 37.55/100000 in Diyarbakir and 19.59/100000 in Kars (p<0.05). The average incidence of pulmonary TB was 29.04/100000 in Diyarbakir and 14.53/100000 in Kars (p<0.05). The altitude at Diyarbakir is 660 meters and 1768 meters in Kars. According to research from the State Planning Organization of Turkey, there has been an important difference regarding the rates of urbanization and rates of literacy between two city (p<0.05). It was thought that the significant difference regarding incidence of TB between two cities was due to the difference of altitude of those city (2.3 times). Moreover, it was thought that some socioeconomic parameters could be affective on TB prevalence. However, some extensive study should be carrying out to clearly understand the factors affecting TB prevalence.Öğe Approach of doctors about diagnosis and treatment of COPD(2005) Abakay A.; Tanrikulu A.Ç.; Kirbaş G.; Eren-Da?li C.; Aritürk Ö.; Palanci Y.It is known that primary care level doctors make mistakes and use spirometry less for the diagnosis of COPD. In this study, it was aimed to learn the approach of doctors about COPD and precautions that must be taken were discussed. A questionnaire including 13 questions were applied to 230 doctors from 1.2. and 3. care levels in Diyarbakir and Mardin in November 2003. 119 (%51.7) practitioners, 68 (% 29.6) interns and 43 (%18.7) specialists (9 chest diseases, 23 internal diseases and 11 other) were included. Of the doctors; 157 (%68.3) expressed dyspnea, 54 (%23.5) cough, 15 (% 6.5) sputum as a symptom of priority. Comparing the period of being a doctor with knowledge of symptom, the level of knowledge was found to decrease as the period increased and this difference was significantly important (p=0.007). The level of awareness that spirometry (SFT) is the definite diagnosis method decreased as the period of being a doctor increased (p=0.0001). This subject was best known by chest diseases specialists then intern doctors. Significant difference was found between branches (p=0.0001). Finding SFT necessary for diagnosis was detected as %78 in doctors having SFT in their institutions and as %56 in doctors not having PFT (p=0.0001). The doctors having SFT found spirometric investigation necessary 2.73 (1.51-4.95) fold higher than the doctors not having SFT. Statistically no significant difference was detected among the doctors about period and branch relating the risk factors of COPD, precautions that must be taken the choice of treatment and usage of antibiotics. The level of information decreases among doctors as the period of being a doctor increases and in the places not having PFT the level of knowledge of doctors is worse. Periodic education and providing PFT in the primary care level will be usefull in the struggle against this disease.Öğe Close contacts examination and chemoprophylaxis care level of Diyarbakir no 1 tuberculosis control dispensary(2006) Abakay A.; Abakay Ö.; Tanrikulu A.Ç.; Coşkunsel M.The preventive chemothreapy is important for preventing of tuberculosis in the close contacts. This regard the close contacts of tuberculosis patients are evaluated carefuly. In this study we investigated retrospectively 1986 close contacts of 360 tuberculosis patients who registered Diyarbakir No. 1 Tuberculosis Control Dispensary. In the tuberculosis patients, the mean age 31.5±16.1 years, 218 (% 60.6) cases were male and 142 (% 39.4) cases were female. Examinations reasons of tuberculosis patients were as 280 (% 77.8) and 74 (% 20.6) individual examination and close contact examination, respectively. It was found that index cases were as % 75 of pulmonary tuberculosis and % 25 extra pulmonary tuberculosis. Pulmonary tuberculosis cases were as % 63.7 of smear positive % 36.3 of smear negative. In the close contacts, the mean age 20.2±16.9 years, 948 (% 47.8) cases were male and 1038 (% 52.2) cases were female. It was found that mean 5.51±2.96 close contacts per a tuberculosis patient were recorded. It was found that examination was not made in the 596 (% 30) cases of close contacts. The number of examinated cases of close contacts was 1390. Examination results in the examinated cases were as follows respectively: preventive chemothreapy was applied in 264 (% 18.9) of the cases; active tuberculosis disease were determinated in 32 (% 2.3) of the cases; BCG was applied in 92 (% 6.7) of the cases; second control examination was suggested in 14 (% 1.1) of the cases. Preventive chemothreapy should be applied in 631 (% 45.4) of the examinated close contacts according to National Tuberculosis Guideline. However, it was found that preventive chemothreapy was not applied. It was determinated that the examinated rate was decreased because of the index cases were uneducated and unemployed and the examinated rate was not decreased because of the index cases were uninsured. Conclusion: Some defects were established in the care of tuberculosis control dispensary. It is thought the defects can be corrected by means of the application National Tuberculosis Guideline and the increasing education activities.Öğe Comparison of approaches in tuberculosis diagnosis between dispensary and chest diseases clinics and defects into practice(2006) Abakay A.; Abakay Ö.; Tanrikulu A.Ç.; Coşkunsel M.Tuberculosis (TB) is an important health problem for our country. Tuberculosis conrol dispensaries (TCD) undertake important functions in application of national TB control programme. In this study, comparison of diagnosis methods in TB is aimed between Diyarbakir No.1 TCD and chest diseases clinics. The data of 360 cases were investigated retrospectively in Diyarbakir No.1 TCD. Systematic sample method was used in the selection of this cases within registered 916 cases between January 200? and December 2004. It was found that cases were as 270 (% 75) pulmonary TB and 90 (% 25) extra pulmonary TB. Pulmonary tuberculosis cases were as 172 (% 63.7) of smear positive 98 (% 36.3) of smear negative. Bacteriological and nonbacteriological methods were used in the 117 (% 72.2) cases and 45 (% 27.8) cases of 162 cases as diagnosed at pulmonary TB chest diseases clinics, respectively. Bacteriological and nonbacteriological methods were used in the 58 (% 64.4) cases and 32 (% 35.6) cases of 90 cases as diagnosed at pulmonary TB Diyarbakir No. 1 TCD, respectively. It was found that the diagnosis of 15 (% 46.8) cases that diagnosed by nonbacteriological methods at TCD was determinated to be as false by chest diseases clinics that have different diagnosis possibility. It was determinated that the mean treatment time was 7.51 ± 2.90 month. It was found that the 56 (% 15.6) cases were made some errors according to treatmet regime or treatment time. The false rate was found to be high when used nonbacteriological methods at TCD. National TB programme is suggested that smear negative cases are sent to health centers having different diagnosis possibility. As a result of, our study is in agreement this suggestion.Öğe Mortality in chest diseases department in the last 3 years(2005) Eren-Da?li C.; Tanrikulu A.Ç.; Kirbaş G.We retrospectively evaluated the death cases of our clinics between January 2001 and January 2004 to determine the rate and causes of mortality. Demographic characteristics and causes of death were obtained from the patients's files and death report paper retrospectively. The documentation of the accuracy of death cause and the order of basic, intermediate and final causes of death as proposed by WHO were also checked. In the last 3 years, 150 (% 5.7) of total 2629 patients died in our clinics. Of cases, 104 (% 69) were men and 46 (% 31) were women, the mean age was 60.4±15.3 (15-86 years). The mortality rate was highest in 2002 (% 7.6), (% 3.9 in 2001, % 7.6 in 2002 and % 5.7 in 2003). The cause of death was accurately documented in 99 (% 66) cases but classification of basic,intermediate and final causes of death were not documented. As classified according to basic and final causes of death, the basic causes of death were chronic cor pulmonale (% 31), lung cancer (% 19) and COPD (% 14); the final causes of death were chronic cor pulmonale (% 23), lung cancer (% 16) and respiratory failure (% 11). All the patients who had final death cause report as cardiopulmonary arrest had different basic death cause. As a conclusion, we think that the knowledge of rates and causes of mortality and the documentation of basic,intermediate and final causes of death proposed by WHO are necessary and useful for the epidemiological studies and mortality data.
