ISSN 1301 - 0883 / E-ISSN 1339 - 3886


Eastern J Med: 19 (1)
Volume: 19  Issue: 1 - 2014
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1.Psoriatic arthritis epidemiology
Göknur Kalkan, Ayşe Serap Karadağ
Pages 1 - 7
Psoriatic arthritis (PsA) is a chronic in?ammatory arthritis that can cause severe joint deformities and disability. The expected prevalence of in?ammatory arthritis among patients with psoriasis has varied from 7% to 40%. Early diagnosis and treatment of PsA is recommended to discourage from disease associated disability and breakdown of work place efficiency. The epidemiological studies are quite limited because of small and selective study populations, limited follow-up, and absence of validated PsA classification criteria. The epidemiology of psoriatic arthritis has been reviewed in this manuscript by summarizing incidence and prevalence estimates up to date and epidemiological studies indicating the degree of genetic load of PsA. Potential risk factors like demographic features, characteristics of psoriasis lesions and the effect of environmental and hormonal factors in epidemiological spectrum of psoriatic arthritis are analyzed.

2.Evaluation of pelvic fractures by radiographical and multi-detector computed tomography following the 2011 Van earthquake in Turkey
Cemile Ayşe Görmeli, Gökay Görmeli, Savaş Güner, Mehmet Fethi Ceylan, Mesut Yıldırım, Recep Dursun, Baran Sarıkaya, Mehmet Fatih Korkmaz, Zeynep Maraş Özdemir
Pages 8 - 12
Pelvic fracture that is frequently encountered in the setting of a multi-trauma patient is major and serious trauma with potentially life-threatening consequences. The aim of this study was to evaluate the radiographical and multidetector computed tomography (MDCT) images of 47 patients injured during the 2011 earthquake in the city of Van, and to define the characteristics of earthquake-related pelvic fractures. Study data were analyzed according to the anatomic localizations of pelvic fractures and classified based on the Tile classification of pelvic ring fractures. The pubic bone was determined as the most frequent localization of pelvic fractures. Type C fractures and Type C2 sub-types were more frequently observed than the other types according to the Tile classification system.

3.Helicobacter pylori seroprevalance in patients with obstructive sleep apnea syndrome
Bilge Gültepe, Hülya Günbatar, Ahmet Cumhur Dülger
Pages 13 - 15
Hypoxemia related conditions are associated with an increased risk of gastric damage. Helicobacter pylori (H.pylori) infection also causes gastric damage and affects approximately 40 million individuals in Turkey. Obstructive sleep apnea syndrome (OSAS) is a sleep disorder and is characterized by episodic upper airway obstruction during sleep. It is associated with oxyhemoglobin desaturations, hypoxemia and discontinuation of sleep. However, there are a few data in the field of H.pylori prevalence among the patients with OSAS which is linked to tissue hypoxemia. The aim of the current study was to investigate the link between H.pylori infection and OSAS. Between February 2011 and February 2012, faeces was collected from OSAS patients ( n=24; 12 female) and healthy individuals (n=100, 50 female) and analysed using the H. pylori Stool Antigen Test. OSAS was detected with polysomnography in connection with disease symptoms and findings. All data was recorded on SPSS and analyzed with chi-square test. Among 24 patients with OSAS, 12 (50%) of them had a positive result for H.pylori fecal test. In control group (100 subjects), H.pylori fecoprevalance was only 15%. H.pylori antibody seropositivity was significantly higher in patients with OSAS compared to control patients (p<0.001). Consistent with recent epidemiologic studies to date, seroprevalence of H.pylori was found higher than normal subjects. Seroprevalance of H.pylori detected with fecal test were significantly higher in patients with OSAS. OSAS is related to presence of H.pylori. A positive correlation between the H.pylori infection and OSAS might be hypothesized. This may be due to gastric damage due to OSAS-related hypoxemia.

4.Evaluation of the treatment after default rates in a Tuberculosis Dispensary in 10 years period and the effect of directly observed treatment
Nagihan Durmuş Koçak, Mine Solakoğlu Uçar, Filiz Öztürk, Dilek Polat, Elif Torun
Pages 16 - 21
We aimed to evaluate that defaulting from tuberculosis (TB) treatment rates and patient characteristics in our dispensary in 10 years period. The files of patients with treatment after default between 1997 and 2006 were retrospectively analysed. Statistical analyses were made using SPSS package programme. Between 1997 and 2006 a total of 3142 patients undergoing treatment, 67 (2.13%) had defaulting from treatment. Treatment after default rates with respect to years were 3.2% in 1997, 2.8% in 1998, 3.0% in 1999, 3.0% in 2000, 2.9% in 2001, 3.4% in 2002, 1.4% in 2003, 1.0% in 2004, 0.5% in 2005 and 1.3% in 2006. The mean period for treatment after default was 2.4±1.6 months. When patients were grouped into two with respect to treatment periods (1997-2001 and 2002-2006); age, gender, marital status, education status, the number of household contacts, the mean treatment after default months, the type of the disease, demonstrated no statistically significant difference. The first group had greater mean of the treatment after default rate than the second group (p<0.001) It was found out that treatment after default rates in our dispensary in 10 years period is less than 5% which is targeted by World Health Organization (WHO). No differences about social and clinical characteristics of cases were detected. However, decline in treatment after default rates was found to be statistically significant with application of directly observed treatment (DOT). Close monitoring of patients and to be sensitive for their needs, may contribute to decrease the default rates from TB treatment.

5.The impact of HMG on follicular fluid hormone levels, embryo quality and IVF outcome
Gokce Anik Ilhan, Gozde Erkanli Senturk, Ozgur Oktem, Fatih Durmusoglu
Pages 22 - 27
The objective of this study is to evaluate the effect of HMG on the follicular fluid hormone levels, embryo quality and IVF outcomes when added at different times of stimulation to rFSH in a long protocol. Seventy infertile women were randomized into three groups; group 1(n=23) was stimulated only with rFSH; whereas, HMG was added from the beginning (group 2, n=23) or when a 10 mm follicle developed (group 3, n=24). Follicular fluid hormone levels, day 3 embryo quality, implantation and clinical pregnancy rates were assessed. The number of grade 1 embryos, and estradiol/ progesterone ratio were significantly higher in group 2 compared to group 1. The numbers of grade 2 and 3 embryos, and day 3 embryos with less than 5 cells were significantly higher in group 1. Clinical pregnancy rate was significantly higher in group 2 than group 1. In conclusion, HMG supplementation to rFSH does not increase the number of oocytes retrieved, the number of day 3 embryos and day 3 embryos at 8-cell or more stages of development, fertilization and implantation rates. HMG supplementation from the beginning of rFSH stimulation result in improvement of clinical pregnancy rates and other indices of embryo quality such as embryo grading.

6.The relationship of mean platelet volume with endogenous sex hormones and cardiovascular risk parameters in postmenopausal women
Nilgün Güdücüoğlu, Salih Serdar Kutay, Güliz Sidar, Uzay Görmüş, Zehra Neşe Kavak, İlkkan Dünder
Pages 28 - 32
Evaluation of the relationship among mean platelet volume (MPV) and endogenous sex hormones and cardiovascular (CV) risk parameters. We designed a retrospective study in postmenopausal women. Patient charts were reviewed for the results of mean platelet volume, hormonal and biochemical parameters. MPV correlated only with white blood cell and platelet counts (r=-0.270, p=0.023 and r=-0.558, p=0.001 respectively). There was no statistically significant difference in MPV of patients with and without metabolic syndrome. We could not detect any relationship between MPV and endogenous sex hormones and parameters indicating higher CV risk.

7.Sheehan’s syndrome with recurrent hyponatremia and anemia: A case report
Dilek Benk Şilfeler, Murat Çelik, Cumali Gökçe, Ali Balcı, Kenan Serdar Dolapçıoğlu, Ayşe Güler Okyay
Pages 33 - 37
Sheehan’s syndrome (SS) occurs due to ischemic pituitary necrosis after severe postpartum hemorrhage. The clinical spectrum of SS is wide and changes from non-specific complaints such as weakness, fatigue, and anemia to severe pituitary insufficiency including secondary adrenal failure and hypothyroidism resulting in coma and death. We present a case of Sheehan’s syndrome who had recurrent hyponatremia episodes due to the late diagnosis of the disorder.

8.Von Willebrand Disease type 2B: A diagnostic dilemma
W. Hamizan Aneeza, Rajalingham Sakthiswary, Suria Hayati Md Pauzi, B.S. Gendeh
Pages 38 - 40
A young female was presented with isolated chronic unilateral intractable epistaxis with non healing granular mass in the left nasal cavity. Histopathological examination was reported as acute and chronic non specific inflammation which did not respond to antibiotics or steroid. After ten years follow up she was finally diagnosed to have Von Willebrand disease type 2B. This is the first case report of von Willebrand disease presenting with intermittent epistaxis as its sole disease manifestation. Although epistaxis is a common complaint in Otorhinolaryngology clinics, this case posed a diagnostic dilemma.

9.Central sleep apnea in a patient with clinically isolated syndrome
Nergiz Hüseyinoglu, Serkan Ozben
Pages 41 - 43
Central sleep apnea (CSA) is characterized by the cessation of air flow without respiratory effort during sleep. Various neurological diseases have been shown to be associated with CSA. In this case, we report a 37-year-old male with who admitted to us for sleep respiratory disturbance. CSA was diagnosed after a full-night polysomnography. Although the neurological examination of the patient was normal, we detected hyperintense brain lesions in magnetic resonance imaging (MRI), past history for optic neuritis and delayed visual evoked potential responses on the left eye and diagnosed as clinically isolated syndrome (CIS) accompanying to CSA. These findings show and emphasize the importance of MRI in patients with CSA even their neurological examination is normal. Up to our knowledge, this is the first case of CSA reported in a patient with CIS.

10.The co-occurrence of Guillain-Barré syndrome and inappropriate ADH syndrome in a Rheumatoid arthritis patient
Refah Sayın, Ahmet Cumhur Dülger, Mehmet Atilla Erkuzu, Temel Tombul, Bünyamin Sertoğullarından
Pages 44 - 46
Rheumatoid Arthritis (RA) is the most frequently seen connective tissue disorder. In RA, the peripheral nervous system involvements including distal sensory or sensorimotor polyneuropathy and entrapment neuropathies are more common than the central nervous system involvements. Guillain-Barré syndrome (GBS), an autoimmune disorder, can be encountered in any age groups. The syndrome of inappropriate secretion of ADH (SIADH) is characterized by the non-physiologic release of ADH, resulting in impaired water excretion with normal sodium excretion that causes hyponatremia. Herein, we present the co-occurrence GBS and SIADH in a RA patient treated with Methotrexate (Mtx). A 57 year-old female developed ascending weakness, starting from the legs and spreading to the arms while having pneumonia. Electromyography findings were consistent with sensorimotor demyelinating polyneuropathy. The laboratory investigations were compatible with SIADH. In conclusion, the SIADH in GBS should be taken into account for RA patients on Mtx.

11.Sick sinus syndrome masquerading as idiopathic primary generalized epilepsy
Nitin K. Sethi, Frances Cukierwar, Prahlad K. Sethi, Josh Torgovnick, Ali May, Linn E. Katus
Pages 47 - 50
Idiopathic primary generalized epilepsy (IPGE) is characterized by generalized convulsions with loss of consciousness (LOC) at times associated with lateral tongue bite and loss of bladder control. Interictal EEG record shows an organized background with a 9-12 Hz posterior dominant rhythm (PDR) and generalized spike wave and polyspike wave discharges. We present here a patient whose typical spells were characterized by abrupt LOC accompanied with tonic posturing and convulsive movements and occasional bladder incontinence. Interictal EEG was reported as intermittent generalized spike wave discharges leading to initiation of levetiracetam therapy. Marked sinus bradycardia was noted during examination during inpatient video-EEG admission. A typical event captured on video-EEG with simultaneous telemetry revealed sinus arrest leading to cerebral hypoperfusion and seizure as the underlying cause of his “epilepsy”.

12.Sclerosing stromal tumor of the ovary with torsion in a postmenopausal woman with elevated serum CA-125 levels
Gülşah Balık, Şenol Şentürk, Işık Üstüner, Mehmet Kağıtcı, Cüneyt Yurdakul, Emine Seda Güvendağ Güven
Pages 51 - 53
Sclerosing stromal tumor of the ovary is a subtype of sex cord stromal tumors which is hormonally inactive, benign and extremely rare. Most of the patients are below 30 years of age. These tumors do not cause an increase in tumor markers levels such as CA-125. In here, we present a 66-year-old postmenopausal woman with acute abdomen, elevated CA-125 level and torsion of sclerosing stromal tumor of the ovary.

13.A case of primary Sjögren’s syndrome with polyserositis
Masashi Ohe, Satoshi Hashino, Kenzo Ohara
Pages 54 - 57
Sjögren’s syndrome (SS) is an autoimmune disease with glandular and extraglandular manifestations. In terms of pulmonary and cardiac involvement, pleural and pericardial effusion are rare. Moreover, pleural effusion accompanied by pericardial effusion is very rare. We report a case of primary SS (pSS) presenting as pleural effusion, pericardial effusion and ascites. A 58-year-old woman was admitted to our hospital with a 2-week history of dyspnea. Bilateral pleural effusion, pericardial effusion and ascites were detected. Primary SS was diagnosed, based on xerophthalmia, xerostomia, positive results for the Shirmer test and anti-SS-A antibody, and abnormal salivary gland sialography. Pleural and pericardial effusions were attributed to autoimmunological inflammation and ascites was thought to be due to hyperinflammation-induced severe hypoalbuminemia. Treatment with high-dose corticosteroid was proved successful.

14.The efficacy of prophylaxis for anaphylaxis in cyst hydatid surgery
Uğur Goktas, Nureddin Yuzkat, Yasemin Isik, M. Bilal Cegin, Ayşe Avsar
Pages 58 - 60
Hydatic cyst is caused by a parasite called Echinococcus granulosus which found in agriculture and animal husbandry and environmental health and preventive medicine measures are inadequate in all societies. People mainly get the disease by dogs which have illness and with the consumption of contaminated vegetables and water. 14 year old female patient, preoperative physical examination and laboratory findings were normal. Abdominal ultrasonography was compatible with the view of hydatic cysts. For prophylaxy of anaphylaxis, intravenous methylprednisolone and pheniramine maleate were performed. While placing 6F catheter into the cyst cavity by using modified Seldinger method, sudden hypotension and arrhythmia were observed. Intravenously adrenaline and atropine were administered. Colloid and crystalloid infusion was started quickly. Decrease in systolic blood pressure up to 35mmHg anaphylactic reaction was thought. Soon bronchospasm developed and SpO2 dropped to 72%. Spontaneous respiration started 30 minutes after the induction and blood pressure was measured 70/50 mmHg, SpO2:92%. After the completion of the radiological intervention patient was taken to intensive care unit with intubated. After 8 hours, the onset of anaphylaxis symptoms, the patient was extubated.. 24 hours after the surgery patient was sent to ward of pediatric surgery. As a result, for the hydatid cysts invasive procedures although prophylaxis for the anaphylaxis has been given, anaphylaxis still occurred. But the prophylaxis may reduce the mortality and make the anaphylaxis milder.

15.Early onset hepatotoxicity associated with low dose fluconazole therapy in a critically ill patient: A case report
Jaime Yoke May Chan, Chai Fung Kiew, Chee Ping Chong
Pages 61 - 65
Hepatoxicity associated with fluconazole is less implicated than other antifungals although cases of fatalities were reported. We describe a 34-year-old kidney impaired male with Marfan syndrome manifested with elevated liver enzymes due to fluconazole therapy intravenous (IV) 200 mg stat followed by IV 100 mg daily. His baseline alanine aminotransferase (ALT) was 38 U/L, total bilirubin was 36 µmol/L and prothrombin time was 19.7 seconds. Marked elevation of ALT level (214 U/L), total bilirubin (54 µmol/L) and prothrombin time (37 seconds) were noticed starting from day 4 of fluconazole therapy. The patient subsequently developed nausea and vomiting; ALT and total bilirubin level further rose to 2394 U/L and 94 µmol/L on day 6. Discontinuation of fluconazole without rechallenged on day 8 resulted in sharp decreased in prothrombin time from 65.3 seconds to 31.9 seconds and normalization of liver enzymes in 2 weeks time. In conclusion, low dose fluconazole may induce early onset of hepatotoxicity in critically ill patient with kidney damage. Prompt discontinuation of fluconazole therapy is needed to prevent further deterioration in liver function.

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