Browsing by Author "Irmak, H."

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Chronic Hepatitis Delta Virus Infection in Van Region of Eastern Turkey
(2005) Türkdoǧan, M.K.; Bozkurt, H.; Uygan, I.; Tuncer, I.; Irmak, H.; Buzgan, T.; Akdeniz, H.
Background/aims: Hepatitis delta virus infection is an important cause of liver morbidity and mortality worldwide. In Eastern Turkey, hepatitis B virus infection is the major cause of chronic liver diseases. We aimed to research the role of hepatitis delta virus infection in chronic liver diseases related to hepatitis B virus infection in the Van region of Eastern Turkey. Methods: Serological markers of hepatitis B virus and hepatitis delta virus infection [HBsAg, HbeAg, Anti-HBe and Anti- hepatitis delta virus total (IgM+IgG)] were determined by ELISA test in patients with chronic hepatitis and cirrhosis. Serum hepatitis B virus DNA was determined by polymerase chain reaction (PCR) method in chronic hepatitis B patients. Results: Hepatitis delta virus infection was detected in 5% (7/138) of asymptomatic hepatitis B virus carriers, in 16% (24/148) of chronic hepatitis B patients and in 45% (34/75) of cirrhotic hepatitis B virus patients, hepatitis delta virus infection showed a three-fold increase in chronic hepatitis (p<0.01) and nine-fold increase in cirrhosis (p<0.001) compared to hepatitis delta virus carriers. Also, it was three times more frequent in cirrhosis (p< 0.001) compared to chronic hepatitis. Chronic hepatitis delta virus infection was equally distributed between sexes in patients with chronic hepatitis B virus infection, whereas chronic hepatitis B virus infection alone was three times more frequent in males (p<0.001). Mean ages of hepatitis delta virus carriers, chronic hepatitis D and hepatitis delta virus cirrhosis patients were 30.7±8 (14-65), 36±13 (19-70) and 44±16 (25-55), respectively. Conclusions: The higher prevalence of hepatitis delta virus infection in more severe form of hepatitis B virus infection suggests that hepatitis delta virus infection increases the severity of chronic hepatitis B virus infection in the Van region, hepatitis delta virus infection remains a second major cause of chronic liver diseases in Eastern Turkey in spite of its decreasing prevalence in Western countries and in Western Turkey.
Fatal Hemophagocytic Syndrome Associated With Hepatitis B Virus Infection: Case Report and Review of the Literature
(2000) Akdeniz, H.; Irmak, H.; Buzgan, T.; Ugras, S.; Demiroz, A.P.
A 16-year old boy was admitted with a 20 day history of fever, loss of appetite, jaundice and dark urine, and recent epistaxis. Physical examination revealed icteric sclera, generalized lymphadenopathy, diffuse abdominal tenderness and marked hepatosplenomegaly. Laboratory findings showed bicytopenia, coagulopathy, hypofibrinogenemia and hypoproteinemia in addition to elevated ESR, C-reactive protein, serum bilirubin, transaminases, alkaline phosphates, lactic dehydrogenase, gamma-glutamyl transpeptidase, and triglyceride levels. Hepatitis-B surface antigen and hepatitis B core IgM antibody were positive, while lymph node biopsy demonstrated infiltration with histiocytic series displaying marked erythrophagocytosis. The patient was diagnosed with hepatitis B virus infection-associated hemophagocytic syndrome. The condition deteriorated rapidly and he died 12 days after admission. This report suggests that in patients with hepatitis B infection presenting unexplained fever, localized bleeding due to thrombocytopenia and showing a rapid clinical deterioration, early bone marrow or lymph node biopsy for diagnosis and intensive therapy should be performed.
Food-Borne Botulism Cases in Van Region in Eastern Turkey: Importance of Electromyography in the Diagnosis
(2003) Anlar, O.; Irmak, H.; Tombul, T.; Akdeniz, H.; Caksen, H.; Kose, D.; Ceylan, A.
Objectives: Food-borne botulism is an acute form of poisoning that results from ingestion of a toxin produced by Clostridium botulinum. Botulism toxin causes its major effect by blocking neuromuscular transmission in autonomic and motor nerve terminals. Methods: In this study, we present the features of eleven cases of food-borne botulism admitted to our hospital in 2001. All of the cases were caused by home-prepared foods; green beans. In these cases, the main symptoms and signs were generalized muscular weakness, dry mouth, dysphagia, dispnea and diplopia. Electrophysiological studies were performed on four patients. Results: Motor conduction studies showed that compound muscle action potentials were decreased with normal latencies and conduction velocities. The needle electromyography showed signs of denervation potentials like fibrillation and positive waves in four patients. Repetitive nerve stimulation with high frequency (20 Hz) induced an increment close to 100% in the amplitudes in 2 of 4 patients. Conclusion: Although toxin could not be detected in the patients, the electromyographic findings supported our diagnosis. We concluded that electromyography has an important role in diagnosis of botulism, especially in the condition that serologic tests are negative or cannot be performed.
Tibial Osteomyelitis Following Intraosseous Infusion: a Case Report
(2004) Dogan, A.; Irmak, H.; Harman, M.; Ceylan, A.; Akpinar, F.; Tosun, N.
Fluids, medications, and blood products can be rapidly administered via intraosseous infusion under emergency conditions, particularly to pediatric patients aged from 0 to 2 years. A five-month-old infant who had been hospitalized with a diagnosis of sepsis developed swelling and hyperemia at the infusion site 10 days after an intraosseous infusion in the right proximal tibia. Physical examination showed a serous discharge from a fistula on the anteromedial side of the right proximal cruris. Plain radiographs demonstrated periosteal reaction in the right tibia and osteolytic areas in the proximal metaphysis. With a diagnosis of acute osteomyelitis, drainage and medullary irrigation were performed and parenteral antibiotic treatment was initiated. Cultures from the surgical site yielded Candida albicans, upon which fluconazole (8 mg/kg) treatment was administered for four weeks. A complete clinical and radiographic improvement was observed at the end of a 12-month follow-up.