Chronic hepatitis C infection: how much are physicians aware of?

AIM: The purpose of our study is to measure the awareness of hepatitis C among physicians employed in Istanbul, and investigate the relationship between awareness and the specialization field, age and presence of chronic hepatitis/positive family history. MATERIAL AND METHODS: Level of awareness of 125 family physicians and 76 internal medicine physicians, employed within Istanbul Province, on hepatitis C infection were evaluated using standard questionnaire. Relationship between their awareness and age, specialization, presence of any chronic hepatitis and chronic hepatitis C in any relatives were investigated. RESULTS: The mean age of the physicians was 30.9 ±7.1 years (range: 23-45 years) and 58% of them were women. Seventy-five (37.3%) physicians were between ages of 23-28, 67 (33.3%) physicians were between ages of 29-32, and 59 (29.4%) physicians ages was greater than 32. Twenty-one (10.4%) physicians had hepatitis or a first-or second-degree relative with hepatitis. Physicians were found to be insufficient in answering the questions on hepatitis C virus transmission routes and who should be screened. When examined based on transmission routes, there were no significant differences between physicians' specializations and positive familial history, but physicians aged 23-28 had significantly poorer awareness at some points. Internal medicine specialists had better awareness on screening tests compared to family physicians but there were no significant differences between positive familial history and physicians' age. CONCLUSIONS: Physicians' awareness should be improved to prevent hepatitis C virus transmission and to identify existing conditions.

Spontaneous pneumomediastinum following pneumonia in a 23-year-old male patient.

Spontaneous pneumomediastinum (SPM) is defined as the presence of interstitial air in the mediastinum without any apparent precipitating factor. We present a case of 23 year old male patient, who has been referred to our outpatient clinic with the complaints of sudden chest pain, dyspnea followed by pneumonia and was diagnosed as SPM. The patient was treated with ampicillin sulbactam (4 gr/day) and methylprednisolon (20 mg/day) for 4 days. and oral intake was stopped during treatment. Post treatment, it was observed that the crepitations were disappeared thoroughly and vesicular sounds were heard by oscultation. The control values of arterial blood gas was as following: pH:7,39 pO2:95 mmHg, pCO2:37 mmHg, SaO2: %97. In the 5th day his oral intake was started and he was discharged.

A rare case of isolated macronodular hepatic tuberculosis (Tuberculous) in an immunocompetent patient.

Tuberculosis is one of the most common and well described infectious diseases, with a world wide distribution and a vast spectrum of clinical manifestations. There are three forms of hepatic tuberculosis. Diffuse hepatic involvement with pulmonary or miliary tuberculosis, diffuse hepatic infiltration without recognizable pulmonary involvement is the second form and the third very rare form presents as a focal/local tuberculoma or abscess. In this case report we describe an unusual appearance of macronodular tuberculomas of the liver.

The importance of upper gastrointestinal endoscopy in morbidly obese patients.

BACKGROUND/AIMS: Obesity is an epidemic and its prevalence and number of patients underwent bariatric surgery continue to increase worldwide. This study aimed to evaluate endoscopic findings and co-morbidities, to investigate the prevalence of Helicobacter pylori (H. pylori) infection and the relationship between body mass index (BMI) and gastroesophageal sphincter incompetency in obese patients. MATERIALS AND METHODS: An upper gastrointestinal system endoscopy and mucosal sampling were performed in all patients hospitalized for bariatric surgery. Age, gender, BMI, co-morbidities and endoscopic findings were recorded. Gastroesophageal sphincter incompetency was classified according to Hill classification. The patients were divided into two groups: group I, endoscopically normal and group II, endoscopically abnormal. RESULTS: Total 127 patients were enrolled into prospective study. Of these, 93 (%73.2) were female and the mean age was 38.9±12.5 years (range: 16-68). Abnormal endoscopic findings and H. pylori were detected in 80.4% and 44.9% of patients, respectively. In group II, patients were older, BMI higher and H. pylori more prevalent (all statistically significant). Diabetes mellitus, hypertension and dyslipidemia were the most frequent common co-morbidities. Rate of multiple co-morbidities were more common in group II. Gastroesophageal sphincter incompetency in total group was observed in a rate of 46.5% and was weakly correlated with BMI. CONCLUSION: Four-fifths of obese patients have at least one endoscopic abnormal finding, three fourth at least one co-morbidity and half H. pylori positivity. Upper gastrointestinal system endoscopy should be performed routinely in all patients to predict and prevent complications following bariatric surgery.

Thrombotic thrombocytopenic purpura and focal segmental glomerulosclerosis associated with the use of ecstasy.

Ecstasy is a drug, which causes serious side effects and sometimes it can be lethal. These effects are due to idiosyncratic reactions as a result of various stimulations in adrenergic receptors. Here we present a case of a 36-year-old male patient who was diagnosed with thrombotic thrombocytopenic purpura associated with the use of ecstasy. Plasmapheresis along with methylprednisolone treatment restores patient condition to normal.