Arif ÇIMRIN, Nur Şafak ALICI, Ayşe COŞKUN BEYAN

Türkiye'de sektörlere göre pnömokonyoz ve farklı özellikleri

Giriş: Pnömokonyoz, tamamen önlenebilir bir hastalık olmasına rağmen, günümüzde halen en sık görülen meslek hastalığıdır.Türkiye'de pnömokonyozun günümüzdeki durumuna ışık tutması amacı ile son 2 yıl içerisinde kliniğimize müracaat ederek pnömokonyoztanısı koyduğumuz olgular, kişisel, sektörel, tıbbi ve sosyoekonomik yönleri ile sunuldu.Hastalar ve Metod: Merkezimize 2013-2015 yılları arasında başvuran ve pnömokonyoz tanısı alan 61 olgunun bilgileri retrospektifolarak değerlendirildi. Kişisel, mesleksel özellikleri radyolojik ve fonksiyonel durumları ile birlikte değerlendirildi.Bulgular: Olguların 60'ı erkekti ve bunlardan; 24 (%39.3) olgu seramik, 24 (%39.3) olgu diş protez yapımı, 5 (%8.2) olgu kumlamacı,2 (%3.3) olgu kaynakçı, 3 (%4.9) olgu maden işçisi, 3 (%4.9) olgu mermer kesimcisi idi. Maruziyetin en erken başladığı iş kolları dişprotez işçiliği ve kumlamacılık iken, en kısa çalışma süresine sahip iş kumlamacılık idi. Tanı sırasında diş teknisyenleri seramik işçilerinegöre daha genç idi (Kruskall-Wallis p= 0.003). Kumlamacıların maruziyet süresi özellikle seramik işçilerine göre anlamlı olarak dahakısaydı (Kruskall-Wallis p= 0.002). Diğer çalışmalardan farklı olarak çalışmamızda, yüksek çözünürlüklü bilgisayarlı tomografi bulgularıbulunup PA akciğer grafisinde patolojik görünüm saptanmayan olgular pnömokonyoz tanısı aldı. Yüksek çözünürlüklü bilgisiyarlı tomografidemikronodül saptanan 44 olgunun 15'i PA akciğer grafisinde küçük opasite profüzyonu 0/1 olarak değerlendirilmişti.Sonuç: Türkiye'de pnömokonyoz varlığını sürdürmektedir. İki yıl gibi kısa süreli bir maruziyet pnömokonyoza yol açabilmektedir. Farklısektörlerdeki çalışanlarda farklı fonksiyonel, radyolojik özellikler ve sigara içme durumu hastalığın seyrine etkilidir. Bu durum işyeriortamı ve çalışan sağlığı izlemi ile ilişkili ciddi kısıtlılıkların olduğunu göstermektedir.

Pneumoconiosis in different sectors and their differences in Turkey

Introduction: Pneumoconiosis which is one of the ancient diseases, still affects many workers throughout the world despite "existing" control programs. We add data from a single center reviewing risk factors for pneumoconiosis; evaluate functional and radiological findings in different sectors. Patients and Methods: We reviewed medical records of patients diagnosed with pneumoconiosis who were admitted to our center between the years 2013 and 2015. Several personal and occupational features, together with functional and radiologic data, were collected.Results: 60 were young males. Twenty-four of the cases (39.3%) worked at dental technician, 24 cases (39.3%) were ceramic workers, 5 cases (8.2%) were sandblasters, 2 cases (3.3%) were welders, 3 cases (4.9%) were miners, and 3 cases (4.9%) were marble cutters. The sectors in which the exposure started at the earliest ages were dental technicians and sandblasters, while the shortest working time was in sandblasting. The dental technicians were younger than the ceramic workers at the age of diagnosis (Kruskall-Wallis p= 0.003). The exposure time of the sandblasters was significantly shorter, especially than the ceramic workers (Kruskall-Wallis p= 0.002). The cases have been referred to us with pneumoconiosis suspicion based on the radiographic findings in the PA chest roentgenogram performed during the periodic examinations at their work place; but unlike other studies, in our study, following the HRCT assessment, cases which did not present any visible pathology in the re-evaluation of their PA chest roentgenogram, but had HRCT findings have been diagnosed as pneumoconiosis. Among the 44 cases in which micro-nodules had been detected at their HRCT, 15 of them had been previously classified as profusion of small opacities 0/1 according to their PA chest roentgenogram findings. It has been seen that the HRCT findings differ among sectors. Ceramics workers and sandblasters had significantly more micro-nodules, while dental technicians had significantly more mediastinal lymphadenopathies (Chi square, p= 0.004 and p= 0.007 respectively). When the relationship between the existence of big opacities and complaints was studied, statistically significant weight loss was detected in cases which had C opacities (chi square p= 0.01). Statistically significant FEV decrease was observed in cases which had weight loss (independent samples t-test p= 0.046). It has been observed that when the profusion of small opacities increased, while there was no statistically significant functional status change in non-smokers, a significant functional impairment was observed in smokers.Conclusion: Pneumoconiosis still exists in Turkey. Even a short exposure time as 2 years can cause pneumoconiosis. Workers in different sectors had different functional, radiological properties and smoking can affect the diseases' course. There are serious limitations related to the surveillance of both the workplace environment and the employees' health in Turkey. Without institutional preventive measures, personal protection and surveillance examinations, occupational hazards will continue to cause premature deaths. Pneumoconiosis in different sectors is a prototype of uncontrolled industry in the developing world.

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