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Öğe Apricot sulfurization: An occupation that induces an asthma-like syndrome in agricultural environments(Wiley, 2003) Koksal, N; Hasanoglu, HC; Gokirmak, M; Yildirim, Z; Gultek, ABackground Several cases of bronchial asthma have been presenting with acute attacks during the seasons of apricot sulfurization. The aim of this study was to reveal the effects of sulfur dioxide (SO2) exposure on the airways of the workers involved in this process. Methods SO2 levels in air were measured on 15 apricot farms, while the symptom scores of 69 workers were recorded before, during, and after SO2 exposure. Physical examination and pulmonary function tests (PFT) of the workers were also done prior to and after exposure periods. Results The measured SO2 concentrations ranged between 106.6 and 721.0 ppm. Dyspnea (80%), cough (78%), and eye and nose irritation (83-70%) were the most commonly observed symptoms. The workers had significant decreases in pulmonary functions after SO2 exposure. Decrements in FEV1, FEV1/FVC%, and FEF25-75% showed that the acute effect of SO2 on pulmonary functions of the workers was mostly of obstructive pattern. Conclusions Acute exposure to SO2 induces asthma-like syndrome (ALS) in apricot sulfurization workers. SO2 which has not been previously reported in agricultural environments as a cause of ALS may be considered as a new agent. (C) 2003 Wiley-Liss, Inc.(dagger).Öğe Comparison of the echocardiographic and pulmonary function test findings in orderly treated and untreated essential hypertensive patients(Taylor & Francis Ltd, 2003) Guven, A; Koksal, N; Sokmen, G; Özdemir, RObjective: Although it has been well established that hypertension effects pulmonary functions negatively, the effect of regular antihypertensive therapy on pulmonary functions is not known. In this study, we aimed to compare the pulmonary function tests of the hypertensive patients taking regular antihypertensive therapy with those of the ones not taking any antihypertensive medicine, to document the differences in pulmonary functions of both hypertensive groups. Materials and Methods: Patients who had received antihypertensive treatment (Group I: 29 males, 24 females, mean age 42.3 +/- 8.2 years), and untreated cases (Group II: 28 males, 22 females, mean age 43.4 +/- 6.4 years) were included in the study. Patients with a history of coronary heart disease, respiratory diseases, smokers and those who were obese were excluded from the study. Results: Forced vital capacity (FVC) and forced expiratory volume at the first second (FEV1) levels were found significantly lower in Group II ( p < 0.05). In echocardiographic evaluation, the mitral E/A ratio of Group II was lower than that of Group I ( p < 0.05). Isovolumetric relaxation time and deceleration time was higher in Group II than in Group I ( p < 0.05). There was a significant association between pulmonary function tests and impaired left ventricular diastolic parameters; especially, mitral E/A ratio was significantly associated with decreased FVC and FEV1 in Group II (respectively r = -0.695, p = 0.01 and r = -0.591, p = 0.03). Conclusion: FVC and FEV1 levels in untreated hypertensive cases were lower than in those of treated hypertensive cases, and this may be caused by diastolic function rather than the systolic function. In the evaluation of dyspnea in hypertensive patients, it would be useful to examine respiratory function in addition to echocardiographic investigation.Öğe Effects of Ranitidine on pulmonary function tests of patients with chronic obstructive pulmonary disease(Academic Press Ltd- Elsevier Science Ltd, 2003) Hasanoglu, HC; Yidirim, Z; Hasanoglu, A; Ozcan, C; Gokirmak, M; Koksal, N; Kalkan, SSince the incidence of peptic ulcer and gastroesophageal reflux (GER) is more common in patients with chronic obstructive pulmonary disease (COPD) than normal population, H-2 receptor blockers are given more extensively to COPD patients. This study evaluated the effects of Ranitidine on pulmonary function tests (PFT) of the patients having COPD and peptic ulcer or GER, and of healthy volunteers. Fifty milligrams of Ranitidine was given intravenously to 30 COPD patients and 25 healthy volunteers. PFT were done before and 15, 30, 60, 120 min after Ranitidine injection. Although mean forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and forced midexpiratory flow rate (FEF25-75%) Of COPD patients were found to be decreased 60 and 120 min after Ranitidine injection, the decrements were statistically insignificant. The decrements in PFT of healthy volunteers were also not statistically significant. H-2 receptor blockers can be used safely for treatment of gastrointestinal disorders in COPD patients who have mild or moderate obstruction. Minimal decreases in FEV1 and FVC due to treatment by H-2 receptor blockers may clinically worsen COPD patients who have severe obstruction. (C) 2003 Elsevier Science Ltd. All rights reserved.Öğe Effects of the sibutramine therapy on pulmonary artery pressure in obese patients(Blackwell Publishing Ltd, 2004) Guven, A; Koksal, N; Cetinkaya, A; Sokmen, G; Ozdemir, RAim: Obesity is a major global public health problem. Previous drugs (dexfenfluramine and fenfluramine) used for the treatment of obesity have been withdrawn due to various cardiac side effects. Sibutramine is an anti-obesity agent. The purpose of this study was to assess cardiac valve disease and pulmonary artery pressure (PAP) of the patients who used once daily doses of sibutramine. Methods: One hundred and six obese patients (51 men and 55 women) determined to have minimal tricuspid regurgitation (TR) on echocardiographic examination were included in the study. All patients had a complete physical examination, complete blood count and measurement of lipid parameters, and echocardiography was performed by which cardiac valves and PAP were evaluated. After the mean duration of 24-week of follow up, all examinations were repeated for each patient. Results: The drug was well tolerated by all patients for the follow-up period. A significant weight loss was recorded in all patients compared to the baseline values (93.1 +/- 9.6 kg vs. 85.8 +/- 7.7 kg, p < 0.001). Blood pressures and heart rate of the patients increased compared to the baseline measurements (systolic 122.3 +/- 8.5 vs. 124 +/- 10.2 mmHg, p = 0.128, diastolic 79.3 +/- 4.7 vs. 80 +/- 5.7 mmHg, p = 0.42 and heart rate 79.5 +/- 6.5 vs. 85 +/- 5.7 beats/min, p < 0.001). Echocardiographically determined aortic or mitral valve dysfunction appeared in none of the patients. PAP lightly increased after the treatment but the difference between pre and post-treatment values was not found statistically significant (14.7 +/- 1.8 vs. 16.3 +/- 1.6 mmHg, p = 0.06). Conclusions: A 24-week treatment with sibutramine does not affect heart valves and pulmonary artery pressure.Öğe Environmental exposure to asbestos in eastern Turkey(Heldref Publications, 2003) Hasanoglu, HC; Gokirmak, M; Baysal, T; Yildirim, Z; Koksal, N; Onal, YIn this study, the authors investigated the prevalence of asbestos-related disorders among the inhabitants of Guzelyurt, a town in Malatya, located in eastern Turkey. The authors examined river bed, white soil, and stucco samples taken from various locales in Guzelyurt, and they confirmed the presence of tremolite and chrysotile asbestos fibers. Subjects (N = 920; 449 males and 471 females) were examined by photofluoroscopy. Eighty-five patients (9.2%) had asbestos-related radiological findings; risk increased with age. Calcified pleural plaques were seen more frequently in individuals greater than or equal to 50 yr of age, compared with younger subjects (p < 0.01). Asbestos-related disorders were prevalent in the inhabitants of Guzelyurt, the population of which is exposed environmentally to asbestos-primarily the result of the stuccoing and whitewashing of houses with soil that contains asbestos.Öğe Lung cancer and mesothelioma in towns with environmental exposure to asbestos in Eastern Anatolia(Springer, 2006) Hasanoglu, HC; Yildirim, Z; Ermis, H; Kilic, T; Koksal, NObjective: Our previous study demonstrated the presence of environmental tremolite and chrysotile asbestos fiber exposure in Hekimhan town in Malatya located in eastern Turkey. The aim of this study was to investigate whether environmental asbestos exposure increases the incidence of lung cancer and mesothelioma. Method: One hundred and forty-nine patients with mesothelioma and lung cancer living in the center or in the towns of Malatya were retrospectively analyzed. The Incidences of lung cancer and mesothelioma were calculated. Results: The incidences of lung cancer and mesothelioma were 3.39/100,000 and 0.21/100,000, respectively, for the whole population of Malatya; while they were 8.23/100,000 and 1.45/100,000 in Hekimhan. The incidences were strikingly high (22.39/100,000 for lung cancer and 7.46/100,000 for mesothelioma) in Arguvan, another town in Malatya where an analysis for asbestos could not be performed. The overall incidence in Turkey was reported as 5.9/100,000 by the Health Ministry in 1994. The incidences of lung cancer were nearly 1.3-fold higher in Hekimhan and fourfold higher in Arguvan then in the general population of Turkey. Conclusion: The incidences of mesothelioma and lung carcinoma in Hekimhan were higher than those of the general population in Turkey, suggesting a role of environmental asbestos exposure in lung cancer and mesothelioma.Öğe Organophosphate intoxication as a consequence of mouth-to-mouth breathing from an affected case(Elsevier, 2002) Koksal, N; Buyukbese, MA; Guven, A; Cetinkaya, A; Hasanoglu, HCWe report three cases of organophosphate (OP) poisoning. One patient was a 19-year-old woman who drank OP compounds in an attempt at suicide. The other two patients became intoxicated on the way to the hospital during mouth-to-mouth breathing. The first patient died in the emergency department, and the other two were taken to the ICU. There, they were treated with atropine and pralidoxime. Three days later, all symptoms and signs had disappeared, and they, were discharged from the hospital satisfactorily.Öğe Protective effect of ipratropium bromide on bronchoconstriction induced by sulfur dioxide exposure during apricot sufurization processes that causes asthma-like syndrome in agricultural environment(Academic Press Ltd- Elsevier Science Ltd, 2005) Yildirim, Z; Kilic, T; Koksal, N; Kotuk, MWe previously showed that apricot sulfurization workers are exposed to high concentrations of sulfur dioxide (SO2) resulting in an asthmalike syndrome. The aim of this study was to investigate whether pre-treatment of ipratropium bromide protects bronchoconstriction induced by SO2 exposure during apricot sulfurization processes that causes asthma-like syndrome. Firstly, pulmonary function tests were measured before and immediately after SO2 exposure due to processes of apricot sulfurization in 21 healthy volunteer apricot sulfurization workers who did not use any medication in apricot farms. One week later, same measurements were repeated in the same workers when they were working in same farm but they were administered two puffs of ipratropium bromide (20 mu g per dose) before 30 min second SO2 exposure for protection Of SO2-induced bronchoconstriction. Occupational SO2 exposure caused significant decrement in forced vital capacity (FVC), forced expiratory volume (FEVI) and forced mid-expiratory flow rate (FEF25-75%) in the worker and these decrements were prevented by ipratropium bromide given 30 min before SO2 exposure. This result suggests that pre-treatment of ipratropium bromide protects SO2-induced bronchoconstriction in healthy worker during apricot sulfurization processes that causes asthma-like syndrome in agricultural environment. (c) 2005 Elsevier Ltd. All rights reserved.Öğe The role of nitric oxide and cytokines in asthma-like syndrome induced by sulfur dioxide exposure in agricultural environment(Elsevier, 2003) Koksal, N; Yildirim, Z; Gokirmak, M; Hasanoglu, HC; Mehmet, N; Avci, HBackground: We previously demonstrated that apricot sulfurization workers are exposed to high concentrations of SO2, subsequently causing asthma-like syndrome. This study investigated the effects of SO, exposure on serum TNF-alpha, IL-1beta, IL-6, IL-8, nitrite and nitrate levels to understand the mechanism of SO-induced bronchoconstriction in asthma-like syndrome. Methods: We measured the serum levels of the cytokines, direct nitrite, total nitrite and nitrate obtained from 40 volunteer workers after an hour of exposure to SO2 and 23 healthy controls. Results: The concentrations of the cytokines, direct nitrite, total nitrite and nitrate were significantly (p < 0.0001) higher in the workers than in the controls. The mean serum concentrations of TNF-alpha, IL-1beta, IL-6, IL-8, direct nitrite, total nitrite and nitrate were 430.60 +/- 397.03 pg/ml, 436.67 +/- 316.31 pg/ml, 752.11 +/- 394,95 pg/ml, 262.12 +/- 287.99 pg/ml, 7.75 +/- 3.34 mumol/l, 115.72 +/- 48.78 mumol/l and 107.97 +/- 46.19 mumol/l in the workers, while they were 9.83 +/- 3.12 pg/ml, < 5 pg/ml, 7.49 +/- 1.27 pg/ml, 9.38 +/- 1.99 pg/ml, 2.17 +/- 0.77 mumol/l, 59.91 +/- 7.56 mumol/l and 57.74 +/- 7.20 mumol/l in the controls, respectively. Conclusion: These results show that TNF-alpha, IL-1beta, IL-6, IL-8 and nitric oxide may play a role in the pathogenesis of bronchoconstriction in asthma-like syndrome due to the SO2 exposure. (C) 2003 Elsevier B.V. All rights reserved.Öğe The role of oxidative stress in bronchoconstriction due to occupational sulfur dioxide exposure(Elsevier, 2003) Gokirmak, M; Yildirim, Z; Hasanoglu, HC; Koksal, N; Mehmet, NBackground: We previously showed that apricot sulfurization workers (ASW) are exposed to high concentrations of SO2, resulting in an asthma-like syndrome. The aim of this study was to evaluate whether oxidative stress plays a role in the pathogenesis of asthma-like syndrome due to the high concentrations of SO2 exposure in agricultural environment. Methods: Serum antioxidant enzyme activities and malondialdehyde (MDA) concentrations, which are markers of lipid peroxidation, and pulmonary function tests (PFT) were measured in 40 volunteer ASW and compared to 20 healthy control subjects. Results: The superoxide dismutase (SOD, 2.2 +/- 0.6 vs. 3.2 +/- 0.7 U/m), glutathione peroxidase (GSH-Px, 0.6 +/- 0.3 vs. 1.1 +/- 0.3 U/m) and catalase (107.6 +/- 27.4 vs. 152.6 +/- 14.3 k/l) activities in ASW were significantly (p < 0.0001) lower than controls, whereas the malondialdehyde concentration (4.1 +/- 0.9 vs. 1.9 +/- 5.3 nmol/l) was higher in ASW (p < 0.0001). ASW had significant decreases in pulmonary function parameters after exposure. Conclusion: These results show that occupational exposure to high concentrations of SO2 enhances oxidative stress and lipid peroxidation may be considered as a new mechanism of SO2-induced bronchoconstriction. (C) 2003 Elsevier Science B.V. All rights reserved.
