Avian influenza A (H5N1) infection in eastern Turkey in 2006.

BACKGROUND: An outbreak of highly pathogenic avian influenza A (H5N1) that had previously been detected throughout Asia, with major economic and health repercussions, extended to eastern Turkey in late December 2005 and early January 2006. METHODS: We documented the epidemiologic, clinical, and radiologic features of all cases of confirmed H5N1 virus infection in patients who were admitted to Yuzuncu Yil University Hospital in Van, Turkey, between December 31, 2005, and January 10, 2006. RESULTS: H5N1 virus infection was diagnosed in eight patients. The patients were 5 to 15 years of age, and all eight had a history of close contact with diseased or dead chickens. The mean (+/-SD) time between exposure and the onset of illness was 5.0+/-1.3 days. All the patients had fever, and seven had clinical and radiologic evidence of pneumonia at presentation; four patients died. Results of enzyme-linked immunosorbent assay and rapid influenza tests were negative in all patients, and the diagnosis was made by means of a polymerase-chain-reaction assay. CONCLUSIONS: H5N1, which causes a spectrum of illnesses in humans, including severe and fatal respiratory disease, can be difficult to diagnose.

Hospital experience of an avian influenza A (H5N1) outbreak in Turkey.

This study reports the hospital experience of an avian influenza (H5N1) outbreak in Turkey. Out of a total of 602 cases, H5N1 infection was not suspected in 290, prophylactic therapy was given to 165 due to contact with poultry, and 147 were hospitalized, 10 of whom were confirmed as having H5N1 infection. Three peaks in the number of hospital applications were observed during the epidemic; all were related to particular items in the media. The proportion of confirmed H5N1 cases was 1.66% of all applications. The mean age was 10.4 years for confirmed cases and 16.3 years for both unconfirmed and confirmed H5N1 cases in contact with poultry. The mean hospitalization period was 5.0 and 12.2 days in suspected and confirmed cases, respectively. A total of 8 days of mechanical ventilator usage was required for the 10 confirmed cases. Four confirmed cases died during the outbreak. Efforts should be directed towards training health professionals, improving crisis management during an outbreak and, as children are prone to H5N1 infections, implementing school training programmes.

Induction of labor in great grandmultipara with misoprostol.

OBJECTIVE: To compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in great grandmultiparous pregnancies with a Bishop score of <6. STUDY DESIGN: Sixty-four great grandmultiparous (delivering the tenth, or greater, infant) pregnant patients with a Bishop score of <6 were randomized in two groups with 32 patients receiving 50 microg intravaginal misoprostol four times with 4h intervals, and 32 patients receiving oxytocin infusion for induction of labor starting from 2 mIU/min, increasing it every 30 min with 2 mIU/min increments up to maximum of 40 mIU/min. The time from induction to delivery, the route of delivery, fetal outcome and maternal complications were recorded. Statistical analyses were performed using Mann-Whitney U-test, Chi-Square test and hypothesis test about differences for two proportions (t-test) to determine differences between the two groups. P < or = 0.05 was considered significant. RESULT: The mean time from induction to delivery was 9.91+/-4.30 and 10.88+/-4.72 h in the misoprostol and oxytocin administered group, respectively, with no significant difference between the groups. The rate of vaginal delivery was 84.4 and 87.5% in the misoprostol and oxytocin administered group, respectively, with no significant difference between the groups (P = 0.72). The rates of placental abruption and postpartum hemorrhage were similar in both groups and no case of uterine rupture occurred. The 1 and 5 min mean Apgar scores were 6.91+/-1.57-8.88+/-1.39 and 7.22+/-1.24-9.06+/-0.84 in the misoprostol and oxytocin administered group with no significant differences between the groups (P = 0.38 and 0.51). No case of asphyxia was present. The rate of admission to neonatal intensive care unit was higher in the misoprostol administered group, but the difference was not significant. CONCLUSION: Intravaginal misoprostol is an alternative method to oxytocin in induction of labor in great grandmultiparous pregnant women with low Bishop scores, as it is effective, cheap and easy to use. Safety about rare complications and neonatal morbidity needs clarifications with further studies.

Recurrent impetigo herpetiformis in a pregnant adolescent: case report.

Impetigo Herpetiformis is a rare pustular dermatosis that typically occurs in pregnant women with unknown etiology. A 17 year old patient who developed Impetigo Herpetiformis for the second time in the 27th week of her 2nd pregnancy is presented. The patient improved with corticosteroids treatment but the lesions did not clear completely and had flare ups during stressful periods which brings us to conclusion that Impetigo Herpetiformis at least has a common pathway with Generalized Pustular Psoriasis in the pathogenesis as stress provoked exacerbations.

Sociodemographic factors in organophosphate poisonings: a prospective study.

The sociodemographic features of organophosphate poisonings (OPPs) in the east Anatolian region of Turkey were investigated in this study. All OPPs admitted to the Emergency Department of Yüzüncü Yil University Medical Faculty Hospital in Turkey from 1 April 1999 to 31 August 2001 were prospectively studied. Data collected included age, gender, education, employment and marital status, socioeconomic levels, time and route of exposure of the toxic agents, treatment before admission, duration of hospitalization and complications. The proportion of OPPs was 15.1% among 564 poisonings. Fifty-seven (67.1%) patients were female, 28 (32.9%) were male. Fifty-six (65.9%) cases were attempted suicides and 29 cases (34.1%) were due to accidental events. Mean age was 22.1 +/- 9.2 years in the suicidal cases and 43 (76.8%) of them were less than 24 years (P = 0.001). Among the suicide attempts, 29 (51.8%) patients were unmarried and 43 (76.8%) patients were female. The attempted suicide proportion was 46.4% in men and 75.4% in women (P = 0.008). Eighty per cent of cases had a primary education level or were illiterate and 78.8% of the patients were in the lower socioeconomic status. The patients' mean arrival time to the hospital after poisoning was 4.4 +/- 3.7 (1-15) hours and mean hospitalization duration was 4.9 +/- 4.1 (1-32) days. Exposure routes were gastrointestinal in 75 (88.2%), respiratory in five (5.9%), dermal in four (4.7%) and both dermal and respiratory in one case (1.2%). Seventeen patients (23.5%) were admitted to the ICU and four (4.7%) of them died. In conclusion, OPPs especially affected young unmarried females, and most of them were due to attempted suicide. As OPP is the important cause of morbidity and mortality in the region, therapy should be started as early as possible so undesirable consequences can be avoided.

Induction of labor in toxemia with misoprostol.

BACKGROUND: To compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in toxemia of pregnancy with a modified Bishop score of < or =4. METHODS: A hundred preeclamptic women with a modified Bishop score of < or =4 were randomized into two groups of 50 patients one group receiving 50 microg intravaginal misoprostol 4 times at 4 hour intervals, the second group receiving oxytocin infusion for induction of labor starting from 1 mIU/per minute, increasing it every 30 minutes with 2 mIU/per minute increments up to maximum of 30 mIU/per minute. Modified Bishop scores 12 hours after induction, the time from induction to delivery, the route of delivery, fetal outcome and maternal complications were recorded. Statistical analyses were performed using Mann Whitney-U, Chi-Square and hypothesis tests about differences for two proportions (t test) to determine differences between the two groups. p< or =0.05 was considered significant. RESULTS: Misoprostol was significantly superior for induction of labor in toxemia of pregnancy with modified Bishop score of < or =4. After 12 hours median modified Bishop scores of misoprostol administered group and oxytocin administered group were 7 and 4 respectively. Misoprostol administered group 1 was significantly better than oxytocin administered group 2 (p=0.027). The rate of patients who were in labor after 12 hours were 94% and 80% in group 1 and 2 respectively and the difference showed significant difference (p<0.05). The median time from induction to delivery was 14 hours and 16 hours in the misoprostol and oxytocin administered group respectively with significant difference between the groups (p=0.003). The rate of vaginal delivery was significantly higher in the misoprostol administered group 1 (82%) when compared with the oxytocin administered group 2 (66%) (p<0.05). The 1 and 5 minutes median Apgar scores were 5-7 and 6-7.5 in group 1 and 2, respectively with no significant differences between the groups (p=0.96, p=0.64). The rate of admission to neonatal intensive care unit was similar in both groups. The complication rates were similar in all groups and no significant detrimental effects were noted. CONCLUSIONS: Intravaginal misoprostol is an efficacious, cheap and safe method of induction of labor in toxemia of pregnancy with modified Bishop score of < or =4.