Inherited vitamin K deficiency: case report and review of literature

Vitamin K is the cofactor for the hepatic carboxylation of glutamic acid residues in a number of proteins including the procoagulants factors II, VII, IX, and X. The role of vitamin K in normal bone function is not fully understood. Inherited deficiency of vitamin K dependent coagulation factors is a rare bleeding disorder reported only in a few patients. Here we present an 18-month old child who presented with osteopeni due to inherited vitamin K deficiency. While the patient had high bone specific alkaline phosphatase and parathyroid hormone levels and low osteocalcin and bone mineral density values, with the regular supplementation of vitamin K all the mentioned parameters returned to normal values.     

Domestic violence: a tragedy behind the doors

OBJECTIVE: To explore the prevalence, type, frequency and causes of domestic marital violence among Turkish women in a socio-economically developed metropolitan setting. METHODS: A cross-sectional study was performed in 2003. All married women, aged 18 years and over, who were visiting any of the 50 primary health care units for different purposes were asked to participate in the study. Of 1427 asked, 1010 gave consent and completed face-to-face interviews. Multiple correspondence analysis, and logistic regression were used for statistical analyses. RESULTS: Domestic violence was statistically significantly associated with educational level. Illiterate women reported marital abuse 2.6 times more than university or more educated women. No statistically significant relationship was observed between domestic marital violence and women's age or occupation, marital duration or family income. The most frequently reported type of violence was physical, followed by psychological. Among women reporting domestic violence, those with the lowest educational level and income were experiencing all types of domestic violence frequently. CONCLUSION: Placing more importance on educating girls could be a key component of preventing domestic violence.     

Current therapeutic approaches in childhood chronic hepatitis B infection: a multicenter study

BACKGROUND AND AIM: The aim of the present study was to compare the therapeutic efficacy of three different regimens in childhood chronic hepatitis B (CHB) infection. METHODS: A total of 182 children with CHB infection were prospectively allocated to three random groups. Sixty-two patients in the first group received high-dose interferon (IFN)-alpha 2b (10 MU/m2) thrice/weekly alone for 6 months. In the second (n = 60) and third groups (n = 60), IFN-alpha was used for 6 months (5 MU/m2) thrice/weekly in combination with lamivudine (LAM) (4 mg/kg, maximum 100 mg/day) for 12 months. Lamivudine was started simultaneously with IFN in the second group, while it was started 2 months prior to IFN injections in the third group. RESULTS: The initial mean alanine aminotransferase (ALT) values for the first, second and third groups were 109 +/- 93 IU/L, 101 +/- 64 IU/L and 92 +/- 42 IU/L, respectively (P > 0.05). At the end of the therapy, ALT values decreased to 82 +/- 111 IU/L, 38 +/- 41 IU/L and 29 +/- 16 IU/L in groups 1, 2 and 3, respectively. The mean ALT value of the first group was significantly different to the second and third groups (P = 0.046 and P = 0.002, respectively) at the end of the therapy and these differences were found to be sustained after 18 months. However, results in the second and third groups were similar (P > 0.05). There were no significant differences in HBeAg clearance and anti-HBe seroconversion at the initial stage, 12 months and 18 months between the three groups (P > 0.05). Hepatitis B virus (HBV) DNA clearance in the first group was different from the second and third groups, while the second and third groups had similar HBV DNA clearance ratios at 12 and 18 months. No significant difference was found in the complete response (normalization of ALT, clearance of HBV DNA and seroconversion of anti HBe) ratios of all groups (at 12 months: 28.8, 45.5, 35.8% and at 18 months 33.3, 49 and 34% in groups 1, 2 and 3, respectively, P > 0.05). CONCLUSIONS: Although the ALT normalization and HBV DNA clearance ratios of IFN plus LAM combination groups were better than the high-dose IFN-alpha monotherapy group, no significant difference was found in the complete response ratios of all three groups.     

Primary nasopharyngeal tuberculosis in a patient with the complaint of snoring

Isolated nasopharyngeal tuberculosis is a rare condition, even in endemic tuberculosis areas. The most common presentation of nasopharyngeal tuberculosis is with a cervical lymphadenopathy followed by nasal discharge or obstruction. Here we present a 58-year-old patient with nasopharyngeal tuberculosis whose only complaint was snoring. Her oropharyngeal and anterior rhinoscopic examination was normal. On endoscopic examination, mucosal oedema and hyperaemia of the nasopharynx was observed. There was no cervical lymphadenopathy. The tuberculin skin test was positive and histopathological examination of the biopsy taken from posterior nasopharyngeal wall supported the diagnosis of tuberculosis. After anti-tuberculosis therapy, the snoring stopped and the nasopharyngeal examination was normal.     

Xanthoma disseminatum with hepatic involvement in a child

Xanthoma disseminatum is a rare, usually self-healing dermatologic disease of unknown etiology. Involvement of other organs and tissues including bone marrow, bone, and brain may be seen rarely in children. However, to date, hepatic involvement has not been reported. We describe a child with xanthoma disseminatum who had hepatic involvement, and discuss his course and treatment with steroid and azathioprine.     

Simultaneous coronary artery bypass grafting and ascending aorta to bifemoral bypass for ischemic heart disease combined with critical leg ischemia: case reports

Coronary artery disease may coexist with aortoiliac occlusive disease, and concomitant revascularization procedures may be required. The ascending aorta may be used as the source of inflow to both the femoral and coronary arteries in patients who present with coronary artery disease and critical leg ischemia. We present here 2 patients in whom coronary artery bypass grafting and ascending aorta-to-bifemoral bypass operations were performed simultaneously.