Kerim Güler

Brucellosis in a mother and her young infant: probable transmission by breast milk.

Brucellosis, although primarily a zoonotic infection, is also a threat for human health. Infection can be transmitted to humans through direct contact with infected animals, products of conception, or animal discharges, and through consumption of potentially infected milk, milk products, or meat. Human-to-human transmission is rare. There have been case reports of transmission via blood transfusion and bone marrow transplantation from infected donors. Sexual intercourse is a possible means of transmission. Neonatal infection can be acquired transplacentally or during delivery. This report describes a mother with brucellosis who probably transmitted the infection to her 3-month-old baby by breast milk.

Acute Wood or Coal Exposure with Carbon Monoxide Intoxication Induces Sister Chromatid Exchange

Objective: The object of this study was to investigate the genotoxic effect of acute overexposure to combustion products originating from coal or wood stoves in patients presenting with acute carbon monoxide intoxication. Study Design: In a prospective study, we analyzed the frequency of sister chromatid exchange and the carboxyhemoglobin concentration in 20 consecutive patients without a history of smoking or drug use who had been treated in the Emergency Care Unit of Istanbul Medical Faculty due to acute carbon monoxide intoxication. All of these cases were domestic accidents due to dysfunctioning coal or wood stoves. The results were compared with a control group of 20 nonsmoking, nondrug-using healthy individuals matched for age, sex, and absence of other chemical exposure. Results: The mean sister chromatid exchange frequency per metaphase was significantly higher in the study group compared to the control group: 8.11±2.39 vs. 6.33±1.60 (p=0.008). We found that there was no positive correlation between the blood carboxyhemoglobin concentration and sister chromatid exchange frequency. Conclusions: These results suggest that acute exposure to combustion products of wood or coal is genotoxic to DNA. Potential causes of genotoxicity include known mutagenic compounds present in coal or wood smoke and ash, oxygen radicals formed during combustion, as well as hypoxic and reperfusion injury mechanisms initiated by carbon monoxide intoxication. Additional studies on separate carbon monoxide exposure from smoke and ash are needed to understand individual genotoxic contributions and mechanisms.

Lens Opacities in Bloom Syndrome: Case Report and Review of the Literature

Bloom syndrome is an autosomal recessive disorder characterized by proportionate short stature, photosensitivity, immunodeficiency, hypogonadism and a tendency to develop various malignancies. The greatly increased frequency of sister chromatid exchanges (reciprocal exchange of homologous segments between the two sister chromatids of a chromosome) is regarded as pathognomonic for BS. We describe an 18-year old girl who presented with short stature. She was diagnosed with BS based on an extremely increased frequency of sister chromatid exchanges. Ophthalmological examination revealed mild lens opacities bilaterally, which, to our knowledge, has not been previously reported to be associated with BS.

Suicide attempt with clopidogrel

We report the case of a 49-year-old male who took an overdose of 1650 mg of clopidogrel with suicidal intend. The patient developed abnormalities of platelet aggregation, but never developed symptoms. Clopidogrel is a commonly prescribed drug. Reports of overdose of clopidogrel were very rarely reported in the literature.

A Case Study: Rare Lepiota brunneoincarnata Poisoning

Amatoxin poisoning from the genus Lepiota may have a deadly outcome, although this is not seen as often as it is from the genus Amanita. In this report, we present a patient who was poisoned by a sublethal dose of Lepiota brunneoincarnata mushrooms. The patient was hospitalized 12 hours after eating the mushrooms. The patients transaminase levels increased dramatically starting on day 4. Aspartate transaminase peaked at 78 hours. Starting at 1265 IU/L, alanine transaminase peaked at 90 hours at 5124 IU/L. The patient was discharged on day 8 to outpatient care, and his transaminase levels returned to normal ranges in the subsequent days. A toxin analysis was carried out on the mushrooms that the patient claimed to have eaten. Using reversed-phase high-performance liquid chromatography analysis, an uptake of approximately 19.9 mg of amatoxin from nearly 30 g of mushrooms was calculated. This consisted of 10.59 mg of α-amanitin, 9.18 mg of β-amanitin, and 0.16 mg of γ-amanitin. In conclusion, we present a patient from Turkey who was poisoned by L. brunneoincarnata mushrooms.

Turkish doctors’ cohort: healthy despite low screening

ABSTRACT Objectives: We aimed to determine the prevalence of chronic diseases and unhealthy lifestyle behaviors of Turkish doctors as compared with the general population and the frequency of compliance with preventive clinical practices among doctors. Methods: This was an observational, prospective cohort study that enrolled graduates between 1975 and 2004 from six medical schools in Turkey. Data on demographics, disease conditions, and unhealthy lifestyle behaviors were gathered. Preventive care practices were analyzed with regards to age and gender. Results: A total of 7228 doctors participated in the study. Comparison with the national data revealed higher hyperlipidemia and coronary artery disease rates. While 54.5% of the doctors had a doctor visit in the last 12 months, only 31.5% of those over 40 years of age reported a recent blood pressure measurement. Colon cancer screening rate over 50 years of age with any of the acceptable methods was only 3%. One-fourth of the female doctors over 40 years of age underwent mammography within the last two years. Only 7.1% of the doctors over 65 years of age and 10% of the doctors having an indication for a chronic disease had a pneumococcal vaccine, while nearly one-fifth had no hepatitis B vaccine. Conclusion: In this cohort of mainly middle-aged Turkish doctors, the age-standardized rates of chronic diseases were lower than the rates in the general population except for the rates of hyperlipidemia and coronary artery disease. However, doctors did show quite low rates of receipt of screening practices. These results might provoke questions about how to use Turkish doctors’ health behaviors to further improve doctors’ and, relatedly, patients’ health.

Acquired FVIII and FIX Inhibitors after Pregnancy: A Case Report

Acquired hemophilia is a relatively rare clinical presentation, and most cases present with acquired FVIII inhibitor. The co-occurrence of inhibitors to multiple coagulation factors is uncommon. These autoantibodies may induce spontaneous life-threatening bleeding in patients who have had no previous bleeding disorder. Herein, we present a patient with postpartum acquired FVIII and FIX inhibitors who developed intramuscular hematoma and hemothorax during follow-up. She was then treated with activated prothrombin complex concentrate and methylprednisolone.

Autoimmune hepatitis complicated by pyomyositis

at his initial presentation, he may have been cured with a long course of antibiotics. The disease nevertheless progressed to cause small bowel obstruction and external compression of the right ureter. At this stage, the concern was that he might have either had an extensive malignant intra-abdominal tumour or inflammatory bowel disease. With the small bowel obstruction not resolving and concern about potential diagnoses, there was no other option but a laparotomy. With hindsight, a CT scan with needle guided aspiration may have suggested or confirmed the diagnosis of actinomycosis. Even at an advanced stage could he have been treated with antibiotics alone? Although the evidence to support the sole use of antibiotic therapy in advanced abdominopelvic actinomycosis is scanty, Klaaborg et al. (3) reported successful treatment in a case of widespread abdominal fistulisation to the descending colon with a 5-week course of parenteral erythromycin. Other cases of uncomplicated abdominal actinomycosis detected on endoscopy have also been successfully treated with antibiotics (9). Most authors, however, advocated a combination of surgery and long-term antibiotic treatment for complicated abdominal actinomycosis because of failure to obtain an effective bactericidal concentration of antibiotics in areas of active infection (1,6,10,11). In these reports, the preoperative diagnosis of abdominal actinomycosis had not been established, and surgery was performed for suspected abdominal malignancy or diverticulitis. To conclude that a combination of surgery and antibiotics is required without having had the opportunity to treat the condition with the sole use of antibiotics may be unjustified. Although we acknowledge that the data available are not strong enough to support the notion that antibiotic therapy will obviate the need for surgery in advanced abdominal actinomycosis, the fact that there is marked enhancement of actinomycotic inflammatory masses after administration of intravenous contrast medium suggests that there is potential for achieving adequate antibiotic concentrations in these masses (7). We suggest that initial intravenous therapy is required for larger lesions with abdominal abscesses or draining sinus tracts. The recommended dose is penicillin G 10–20 million units daily for 4–6 weeks, followed by oral penicillin (2–4 g ⁄ d) or amoxicillin for 6–12 months. For penicillin-allergic patients, tetracycline, erythromycin or clindamycin are acceptable alternatives (1,8,12).

The diagnostic value of troponin T and myoglobin levels in acute myocardial infarction: a study in Turkish patients.

This study compares the diagnostic value of troponin T (TnT) and myoglobin with creatinine kinase (CK) for myocardial infarction (MI) in a tertiary care centre in a developing nation. The study group comprised 33 acute myocardial infarction patients and 27 healthy controls. Receiver operating characteristic curves for TnT, myoglobin and CK were drawn and areas under the curve calculated. At admission, myoglobin levels had greater diagnostic sensitivity than TnT or CK levels. After 2 h, myoglobin and TnT had equal sensitivity and specificity, whereas CK still had lower sensitivity than myoglobin and TnT. After 4 h there was no difference between the tests. It was concluded that myoglobin levels on admission and TnT at 2 h had the greatest diagnostic rate, whereas all the tests were similar after 4 h for MI.