Hayriye Gönüllü

High prevalence of chronic hepatitis D virus infection in Eastern Turkey: urbanization of the disease

Introduction Both hepatitis B virus (HBV) and hepatitis D virus (HDV) infection play an increasingly important role in liver diseases. The main objective of this study was to investigate the socio-epidemiological, laboratory and radiological aspects of both HBV and HDV infection near the Iranian border of Turkey. Material and methods The study included 3352 patients with HBV and HDV infection. Socioepidemiological, laboratory and radiological aspects of the study subjects were retrospectively examined. Comorbid metabolic diseases were not assessed due to the retrospective design of the study. Results Most of the study subjects were HBe antigen negative. No significant difference in terms of HBV-DNA levels or HBe antigen seropositivity was detected between the city centre and rural areas (p > 0.005). The mean HBV-DNA level in the anti-HDV-positive group was significantly lower than in the anti-HDV-negative group (p < 0.001). The rate of HDV-RNA positivity in women was higher than in their male counterparts (p = 0.017). Anti-HDV-IgG was detected in 18.4% of tested subjects who came from an urban area. In contrast, 12.5% of subjects of the rural group had a positive result for anti-HDV-IgG. Among 134 ultrasonographically evaluated delta hepatitis patients, 37.3% had liver cirrhosis. On the other hand, in 1244 patients with hepatitis B monoinfection, there were 90 patients with liver cirrhosis. Radiologically, the rate of hepatic steatosis in delta hepatitis patients was lower than in those with HBV monoinfection. Conclusions Hepatitis D virus infection was particularly prevalent among the urban population as well as in female subjects. More broadly, the current observations are the first to suggest an inverse correlation between delta hepatitis and ultrasonography-proven hepatic steatosis.

Serum prolidase enzyme activity and oxidative stress levels in patients with acute hemorrhagic stroke

Abstract Background. It has been indicated that oxidative damage contributes to secondary brain injury in both ischemic and hemorrhagic stroke patients. Collagen is a major component of the extracellular matrix, and prolidase plays a role in collagen synthesis. The aim of this study was to evaluate the serum prolidase activity, nitric oxide (NO) levels, total antioxidant capacity (TAC) and total oxidant status (TOS) in patients with acute hemorrhagic stroke. Methods. Twenty-five patients with acute hemorrhagic stroke and 25 controls were enrolled. Serum prolidase activity, catalase activity, NO levels, TAC and TOS were measured spectrophotometrically. Oxidative stress index (OSI) was calculated. Results. Serum TAC levels and catalase activity were significantly lower in acute hemorrhagic stroke patients than controls (both, p < 0.001), while NO levels, TOS levels, OSI values and prolidase activity were significantly higher (all, p < 0.01). When patients with acute hemorrhagic stroke were divided according to gender, no differences were observed between females and males in respect to serum prolidase enzyme activity, NO levels, TAC levels, TOS levels and OSI values (all, p > 0.05). Conclusions. Findings from the study suggest an association between increased oxidative stress levels, decreased antioxidant levels and increased prolidase enzyme activity in patients with acute hemorrhagic stroke compared with controls. More studies are needed to elucidate mechanistic pathways on oxidative stress in patients with acute hemorrhagic stroke.

Acute toxic fulminant myocarditis after a black widow spider envenomation: case report and literature review.

A 15-year-old boy with no medical history was bitten by a black spider on his right shoulder while sleeping indoors. The spider was killed and brought to the emergency department (ED) and later identifi ed as Latrodectus tredecimguttatus . Twenty min later, he felt chills, headache, and severe pain in the extremities: generalized itching, nausea, vomiting, and dizziness. On admission to the ED, approximately an hour after the spider bite, he was diaphoretic and he had a painless priapism. There was a red spot on his right shoulder (Fig. 1A). Arterial blood pressure and heart rate were 125/85 mmHg and 106 beats per min, respectively. Electrocardiography (ECG) was normal except mild sinus tachycardia. The chest radiography was unremarkable. Laboratory fi ndings (complete blood count and electrolytes) were within the normal range. During the ED course, the patient received intravenous 5 mg midazolam, 100 μ g fentany l, 45.5 mg feniramin male at, 100 mg ranitidine, and 125 mg methylprednisolone. Approximately fi ve h after the spider bite, the patient developed chest pain and shortness of breath with a respiratory rate of 32 breaths per min and oxygen (O 2 ) saturation of 80% on room air. Arterial blood pressure and heart rate were 160/100 mmHg and 104 beats per min, respectively. Physical examination revealed prevalent fi ne crackling rales in both the lungs. ECG revealed ST-segment elevation in leads DI, aVL, and ST-segment depression in leads DII, III, aVF, and V4 – V6 (Fig. 1B). Chest X-ray showed the classic appearance of interstitial pulmonary edema. Transthoracic echocardiography (TTE) revealed global hypokinesis of left ventricle with an ejection fraction of 30%. Serum biomarkers of myocardial injury were also elevated, and measuring troponin I was 1.4 ng/dL (0 – 0.04 ng/dL). The patient was transferred to the intensive coronary care unit, and he was initiated on standard acute decompensated heart failure medication (2.5 mg ramipril and 50 mg metoprolol succinate once a day; intravenous furosemide infusion (0.6 mg/kg/h) over three h with a noninvasive ventilation). Antivenom was not administered, because it is not available in Turkey. Following the supportive therapy, his symptoms resolved completely within 48 h, and he was discharged from the hospital after ten days without any complaints. ECG obtained two weeks later showed normal sinus rhythm with no ST – T wave changes. TTE obtained four weeks later revealed normal LV size with the recovery of systolic function (EF, 60%). Latrodectus tredecimguttatus or BWS is a member of the arthropod family which is widely distributed on earth and usually emerges between April and November. The major component of the venom is α -latrotoxin which can cause a wide variety of symptoms including dyspnea, severe muscle cramps, myalgia, weakness, sweating, headache, dizziness, vomiting, diarrhea, diaphoresis, priapism and hypoor hypertension. 1 Cardiovascular manifestations are relatively rare except hypertension and tachycardia, but in our case, the main clinical presentations of the BWS bite were associated with cardiovascular complaints. Myocardial involvement after a scorpion sting has been well described, but so far, only a few cases of myocarditis associated with BWS envenomation have been reported, and clinical experience with such cases is indeed limited. 2 – 8 Clinical Toxicology (2013), 51, 191–192 Copyright

Pregnancy and trauma: analysis of 139 cases.

OBJECTIVE The aim of this study was to examine the diagnoses and treatment methods and demographical and clinical characteristics of pregnant women who were exposed to trauma and in additon, review of the literature was carried out in this regard. MATERIAL AND METHODS One hundred thirty-nine pregnant women who presented at the Yüzüncü Yıl University between January 2006 and September 2009 with local or general body trauma complaints were analysed retrospectively. RESULTS The average age of the cases was 26.72±6.29 years and the age group ranging from 21-34 composed the majority. When they were studied according to their etiologies, falls during daily activities formed 43.9%. When they were analyzed in terms of their gestational weeks, 64.46% were in the 3(rd) trimester. Pregnant cases with trauma resulted in maternal (3 cases) and fetal (9 cases) loss. It was found that 19 cases who had imaging techniques involving radiation and whose gestation was continuing had a problem-free gestation period and healthy children. CONCLUSION It is mandatory to evaluate both mother and fetus together when trauma exposure is in question, the general well-being of the fetus should be provided and the mother should be informed about the presence of advanced trauma life support.

The effects on complications and myopathy of different voltages in electrical injuries

BACKGROUND The purpose of this study was to investigate the demographic and clinical characteristics of electrical injuries, laboratory findings, complications, and mortality and morbidity rates of these injuries. METHODS Patients with electrical injuries admitted to the emergency department between January 2006-2010 were retrospectively analyzed. The cases were evaluated by age, gender, source of electrical power (low-high voltage), seasonal distribution, ECG changes, laboratory findings, clinical care units, complications, and mortality rate. RESULTS Eighty-four (57.1%) of the cases were exposed to low-voltage electricity (Group I), while 63 (42.9%) of the cases were exposed to high-voltage electricity (Group II). The majority of cases with electrical injuries were aged 26-45 years. Thirty of the women (85.7%) were wounded by low-voltage while 58 of the men (51.8%) were wounded by high-voltage electricity. Alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatine kinase, and CK-MB levels were higher and the level of calcium was lower in Group II. Complications (pathologies due to fall from high levels, cardiac dysrhythmias, compartment syndrome) and the mortality rate were higher in Group II. CONCLUSION In cases with high-voltage electrical injuries, cardiac complications, complications due to fall from high levels and the mortality rate increase in conjunction with the degree of the muscle damage.

Brucellosis-related acute pancreatitis: A rare complication of a universal disease.

Objectives To determine the prevalence and determinants of acute pancreatitis in patients with acute brucellosis. Methods Adult patients with brucellosis were retrospectively recruited. Brucellosis and acute pancreatitis were diagnosed according to standard criteria. Laboratory analyses included Wright agglutination titre, serum biochemical parameters and blood count. Results Patients with acute pancreatitis (n = 21) had significantly higher Wright agglutination titres, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyl transpeptidase, amylase, lipase and serum glucose concentrations, and significantly lower haemoglobin concentrations and haematocrit than patients with brucellosis alone (n = 326). Conclusions Hyperglycaemia, anaemia, and liver transaminase and cholestatic enzyme concentrations may represent new approaches for assessing disease severity in patients with brucellosis and acute pancreatitis.

Neurosurgical Injuries Caused by the 2011 Van Earthquake: The Experience at the Van Regional Training and Research Hospital

BACKGROUND On October 23, 2011, a devastating earthquake, magnitude 7.2 on the Richter Scale, jolted the province of Van in the east of Turkey and led to hundreds of casualties. OBJECTIVES In this study, we aimed to present our clinical experience in the management of patients with cranial and spinal injuries who were admitted to the Van Regional Training and Research Hospital. METHODS The retrospective study included 44 (77.2%) patients who were referred to the neurosurgery department after being diagnosed with spinal and cranial injuries due to earthquake at the emergency department between October 23 and 27, 2011. RESULTS The patients comprised 32 male (72.7%) and 12 (27.3%) female patients with a mean age of 23.5 years. The injuries included scalp injury (n = 16), burst fracture (n=7), compression fracture (n=3), epidural hematoma (n=9), subdural hematoma (n=3), contusion (n=1), traumatic subarachnoid hemorrhage (n=2), depressed skull fracture (n=3), linear fracture (n=9), cervical fracture (n=2), and pneumocephalus (n=1). Most of the patients (90.9%) had isolated injuries and the others (9.1%) presented with combined cranial and spinal injuries. At discharge, the 3 patients with spinal fractures were paraplegic, and of the 2 patients who were operatively treated due to subdural hematoma, 1 was hemiparesic and the other was hemiplegic. No mortality occurred in our patients. CONCLUSIONS The results of this study demonstrated that, in the aftermath of a natural disaster, conducting correct triage procedures and performing a prompt intervention with appropriate and qualified equipment play key roles in reducing morbidity and mortality.

Acetaminophen intoxication is associated with decreased serum paraoxonase and arylesterase activities and increased lipid hydroperoxide levels

Background: Acetaminophen is at present one of the most commonly used analgesics and antipyretics. Recent evidence has suggested that oxidative stress is involved in the mechanism of acetaminophen intoxication. Paraoxonase-1 (PON1) plays an important role as an endogenous free-radical scavenging molecule. The aim of this study was to evaluate the influence of serum PON1 activity and oxidative stress in patients with acetaminophen intoxication. Methods: A total of 20 patients with acetaminophen intoxication and 25 healthy controls were enrolled. Serum total antioxidant capacity (TAC), lipid hydroperoxide (LOOH) levels, and paraoxonase and arylesterase activities were measured spectrophotometrically. Results: The serum TAC levels and the paraoxonase and arylesterase activities were significantly lower in patients with acetaminophen intoxication compared with controls (all, p < 0.001), while the serum LOOH levels were significantly higher (p < 0.001). Conclusions: Our results suggest that decreased PON1 activity seems to be associated with increased oxidative stress in patients with acetaminophen intoxication. Measuring serum PON1 activity may be useful in assessing the development of toxicity risk in acetaminophen toxicity. It would be useful to recommend vitamins with antioxidant effects such as vitamins C and E along with medical treatments.

Pulmonary Edema and Myocarditis Developing Due to Scorpion Stings

DOI: 10.4328/JCAM.1412 Received: 20.11.2012 Accepted: 11.12.2012 Publihed Online: 11.12.2012 Corresponding Author: Hayriye Gönüllü, Yüzüncü Yıl Üniversitesi, Tıp Fakültesi, Acil Tıp AD, Van, Türkiye. T.: +905057672477 E-Mail: drhayriyegonullu@windowslive.com Özet Akrep sokmalarının birçoğu zararsız olmakla beraber, öldürücü akrep türleri multiorgan yetmezliği, nörotoksisite, kardiyotoksisite ve pulmoner ödeme neden olabilir. Sistemik etkilerin gelişme ihtimaline karşı bu hastalar acil serviste gözlenmelidir. Özellikle pulmoner ödem ve miyokardit gibi ölümcül komplikasyonlar akılda tutulmalıdır. Bu çalışmada acil servise akrep sokması nedeniyle başvuran ve miyokardit ve pulmoner ödem saptanan olgu sunuldu.

Delta hepatitis-related thyroid disease: a unique phenomenon.

Introduction Hepatitis delta virus (HDV) infection is a serious health problem worldwide. Thyroid disturbances represent a major limitation to the efficacy of interferon treatment targeting chronic HDV (C-HDV) infection. Moreover, pre-treatment thyroid diseases may be influenced by interferon therapy. Despite this, the characteristic features of the thyroid diseases in C-HDV patients remain poorly characterised. Aim To determine the prevalence of thyroid diseases and evaluate the impact of delta hepatitis on thyroid function tests. Material and methods We retrospectively reviewed the charts of 127 hepatitis C virus (HCV)-negative adults, treatment-naive outpatients with C-HDV, between July 2013 and July 2014. Thyroid-stimulating hormone (TSH) and thyroid antibodies (TAbs) including anti-thyroid peroxidase antibodies (anti-TPO), liver transaminases, and other routine laboratory tests were conducted during the study period. Results A total of 127 C-HDV patients (female 52.9%, mean age 54.5 ±8.01 years) were enrolled. The rate of hypothyroidism, defined as a TSH level above 10 IU/l, was 4.7%. No patient had hyperthyroidism. Both elevated levels of liver transaminases and HDV ribonucleic acid (HDV-RNA) were positively correlated with high levels of thyroid autoantibodies. Conclusions The rate of hypothyroidism is higher than the rate of hyperthyroidism at baseline. Most remarkably, for the first time we discovered a correlation between disturbed thyroid autoantibodies and elevated liver transaminases as well as high HDV-RNA levels even in euthyroid delta hepatitis patients. But in order to have an adequate understanding of such correlations, further studies are needed.