Family functioning and its clinical correlates in overweight and obese patients

AIM

Our aim is to evaluate the differences in family functioning and anxiety between normal, overweight, and obese subjects.

METHOD

Overweight and obese patients were selected from the outpatient clinic of internal medicine department of a university hospital. Patients were classified into three groups as normal weight (N=82), overweight (N=33) and obese (N=50) patients. The normal weight group included healthy subjects. The individuals were examined by the same psychiatrist (MA). Beck Anxiety Inventory and Family Assessment Device were applied to all groups.

RESULTS

When compared to normal weight patients, obese and overweight patients had significantly higher anxiety scores and higher scores in general functions, problem solving, communication, roles, affective responsiveness, and behavior control dimensions which reflect increased dysfunctions in their families. The total level of dysfunction that patients experience was predicted by alcohol dependence in the family during childhood period, any medical disorder in the current family, anxiety level and body mass index.

CONCLUSION

When treating them clinicians should keep in mind that families of obese and overweight patients may have higher levels of dysfunctions.

WITHDRAWN The analgesic effect of paracetamol when added to lidocaine for intravenous regional anesthesia

Ahead of Print article withdrawn by publisher AIM: Intravenous regional anesthesia (IVRA) is frequently used in patients who will undergo upper extremity surgical operations for its ease of use, rapid effectiveness and short hospitalization period. Different drug combinations have been used to overcome some systemic adverse effects and to increase the postoperative analgesic effectiveness. In our study, we evaluated the effects of paracetamol (Perfalgan) when added to lidocaine for IVRA, looking specifically at tourniquet pain and postoperative pain. METHODS: Ninety patients undergoing elective hand surgery with IVRA were randomly assigned to three groups to receive either IV saline and C-IVRA with 0.5% lidocaine 3 mg/kg (control group, N=30), IV saline and IVRA with 0.5% lidocaine and 20 mL paracetamol (10 mg/cc) (P-IVRA group, N=30) or IV paracetamol and IVRA with 0.5% lidocaine (L-IV group, N=30). The following were measured: 1) sensory and motor block onset and recovery time, 2) tourniquet pain after tourniquet application and at 10, 20 and 30 min after tourniquet deflation, 3) the visual analog scale (VAS) scores of tourniquet pain at 30 min and 1, 2, 4, 6 and 24 h postoperatively, 4) the time to first analgesic requirement, 5) total analgesic consumption in 24 h and 6) side effects. RESULTS: Sensory and motor block onset and recovery times were similar in both groups. VAS scores of tourniquet pain were lower in group P-IRVA at 1, 2, 4, 6, and 24 h, postoperatively (P<0.01). Anesthesia quality, as determined by the anesthesiologist and surgeon, was similar in both groups. The time to the first postoperative analgesic request was 67.83±57.48 min in group C-IRVA and 93±80.79 min in group P-IRVA (P<0.05). Paracetamol consumption was significantly less in group P-IRVA (1.60± 1 [tablets]) when compared with group C-IRVA (2.45±0.9; P<0.05). CONCLUSIONS: Perfalgan as an adjunct to lidocaine improves postoperative analgesia in IVRA without adverse effects.

Knowledge, attitudes, and behaviors of officials of religion about organ donation in Kahramanmaras, an eastern Mediterranean city of Turkey

OBJECTIVE

To establish the knowledge, attitudes, and behaviors of the officials of religion, a group with potentially powerful influence on the society, in particular regarding organ donation.

METHODS

This study, performed in Kahramanmaras Province, Turkey, included 416 of 641 officials of religion (64.9%): 295 of 492 imams (59.9%) and 121 of 149 Koran course educators (81.2%).

RESULTS

The mean (SD) age of the study group was 37.2 (8.2) years. Only 1.4% had stated that carried organ donation cards. Of participants who had not donated organs asked whether they thought of donation, 14.1% answered yes, 17.1% answered no, and 68.8% were undecided. Of the study group, 88.2% considered organ donation appropriate according to their religion. The imams compared with Koran course educators, and men compared with women demonstrated higher rates of considering organ donation appropriate according to their religion (P < .05). Among participants who stated they had knowledge about organ donation, the 3 leading information sources were television, newspapers or journals, and in-service training by the Directorate of Religious Affairs. The 3 primary organs the study group stated they were aware of being transplanted were kidneys, liver, and heart.

CONCLUSION

Although 88.2% of religious officials in the present study stated that organ donation was appropriate according to their religion, only 1.4% agreed to donate organs. Officials of religion hold an important place in society, and should be well informed and educated about organ donation via in-service training courses, and encourage organ donation by members of society.

A coronary artery anomaly: type IV dual left anterior descending artery

Coronary artery anomalies are seen in about 1.3% of patients undergoing coronary angiography. However, the dual type of left anterior descending (LAD) artery is a rare form of coronary artery anomaly. There are four types of dual LAD; type IV describes the anomaly of a rudimentary LAD artery terminating in the mid-portion of the anterior interventricular sulcus, and the presence of another LAD originating from the right coronary artery and continuing to the anterior interventricular sulcus.

Angiotensin-converting enzyme insertion/deletion gene polymorphism in patients with familial multiple cerebral cavernous malformations

Cavernous malformations can occur in both sporadic and autosomal dominant forms. The aim of this study was to investigate the potential role of insertion/deletion (I/D) polymorphisms of the angiotensin-converting enzyme (ACE) gene in the development of cerebral cavernous malformations (CCM). Forty-one members of two families affected by familial CCM were included in this study. DNA was isolated from peripheral venous blood, and polymerase chain reaction analysis was used to detect I/D polymorphisms of the ACE gene, using HACE3s and HACE3as as primers. Only 10 participants had MRI-confirmed CCM. Of these 10 subjects, seven had the I/D, two had the D/D, and one had the I/I genotype. Of the remaining 31 subjects, 14 had the I/I, 13 had the I/D, and four had the D/D genotype. There was a greater proportion of subjects with the D allele among those with MRI-confirmed CCM than among those without (p<0.05). These results suggest that the D polymorphism of the ACE gene may be involved in the pathogenesis of familial CCM.

P-wave dispersion and its relationship to aortic elasticity in young prehypertensive patients

BACKGROUND

Prolonged P-wave duration (P(dur)) and increased P-wave dispersion (PWD) are independent predictors of atrial fibrillation (AF) in patients with hypertension. This study was designed to evaluate the possible relationship between aortic elasticity and PWD in young prehypertensive patients.

METHODS

Twenty-five newly diagnosed prehypertensive patients (18 men, mean age = 34 +/- 6 years) and 25 healthy control subjects (16 men, mean age = 33 +/- 6 years) were enrolled in the study. The P(dur) measurements were calculated using a 12-lead surface electrocardiogram (ECG). Aortic elasticity parameters were derived from aortic diameters measured by echocardiography, and simultaneous blood pressure (BP) measurements by sphygmomanometry.

RESULTS

The baseline characteristics of patients with prehypertension were homogeneous with those of the controls. PWD and P(maximum) values were found to be higher in patients with prehypertension as compared to those of the controls (PWD; 65 ms vs. 35 ms, P < 0.001; P(maximum); 110 ms vs. 80 ms, P < 0.001). However, P(minimum) values were not significantly different between the two groups (40 ms vs. 45 ms, P = 0.358). Also, a moderate positive correlation was found between stiffness index (SI) and PWD (r = 0.500, P = 0.011), and a moderate negative correlation between aortic elasticity parameters (aortic distensibility and strain indexes) and PWD (for aortic distensibility, r = -0.498, P = 0.011; for strain index, r = -0.578, P = 0.002), in patients with prehypertension.

CONCLUSIONS

Young patients with prehypertension have increased PWD and arterial stiffness. These parameters are correlated and may pose additional risk factors for future cardiovascular events.

Association of low cholesterol with primary intracerebral haemorrhage: a case control study

OBJECTIVES

Epidemiological studies have shown that the incidence of intracerebral haemorrhage (ICH) is high in patients with low cholesterol levels. The aim of this study was to investigate the correlation between ICH and low cholesterol in cases of primary ICH.

MATERIAL AND METHODS

Two hundred and fifty-nine patients with primary intracerebral haemorrhage and 137 healthy individuals were included in this study. Patients with prior cerebrovascular accident, secondary ICH, hereditary lipid metabolism disorders, thyroid diseases and those using lipid-lowering drugs were excluded. In all subjects, cholesterol levels were measured after 12 h of fasting.

RESULTS

Mean cholesterol levels were 205.8 +/- 51.4 mg/dl in the ICH group and 230.2 +/- 38.9 mg/dl in the control group. Mean cholesterol levels of patients were significantly lower than the controls (P < 0.000). In ICH group, the frequency of patients who had very low cholesterol levels was significantly higher than the control group (P < 0.000).

CONCLUSIONS

Individuals with lower cholesterol levels have an increased risk of ICH. Therefore, before treatment with statins, clinicians must be aware of the possible ICH risk.

QT dispersion ratio in patients with unstable angina pectoris (a new risk factor?)

BACKGROUND

QT dispersion has been shown to be associated with fatal arrhythmias and sudden death in coronary artery disease. A recent study indicated that marked QT dispersion in electrocardiograms (ECGs) obtained during acute ischemia demonstrated a significant correlation with ventricular fibrillation.

HYPOTHESIS

This study investigated the ECG parameters for repolarization (QT dispersion, corrected QT, corrected QT dispersion, and QT dispersion ratio) and their interrelation with acute ischemia.

METHODS

QT parameters as well as a newly developed repolarization index, QT dispersion ratio [(QT dispersion/RR interval) x 100] were calculated digitally during rest and ischemia in 32 patients with coronary artery disease (rest angina, Braunwald class III). Results were correlated with clinical consequences, mainly arrhythmias, within a follow-up period of 5 +/- 2 days.

RESULTS

While most patients had an increase in all four parameters, only the QT dispersion ratio showed a significant difference when correlated with ventricular arrhythmias (p < 0.001, F ratio = 38).

CONCLUSION

QT dispersion ratio appears to be a new and promising parameter in predicting ventricular arrhythmias in patients with acute ischemia.

The protective role of topical propolis on experimental keratitis via nitric oxide levels in rabbits

The aim of this study was to investigate antioxidant, anti-inflammatory, and antibacterial properties of propolis in the treatment of experimental Staphylococcus aureus keratitis. Twenty young New Zealand white rabbits were used in this experiment. Staphylococcus aureus were given by intrastromal injection to 16 rabbits and 4 rabbits were used as control group (Group 1). Group 2 was treated with phosphate-buffered solution drops; Group 3 was administered ethanolic extract of propolis drops; Group 4 received topical ciprofloxacin drops; Group 5 was treated with topical ciprofloxacin drops along with ethanolic extract of propolis drops. The eyes were examined by slit lamp to assess corneal opacity. And then, corneas were removed to determine nitric oxide (NO) levels and count bacteria. Corneas were also evaluated histologically. Corneal NO concentration in group 5, treated with a combination of propolis and ciprofloxacin was determined significantly lower (10.0+/- 1.8 micromol/g wet tissue) than in Group 4, treated with ciprofloxacin (24.0+/- 3.1 micromol/g wet tissue), from Group 3, treated with propolis (15.6+/- 1.8 micromol/g wet tissue), and treated with PBS (44.7+/- 7.8 micromol/g wet tissue). There were significantly fewer bacteria in eyes that received propolis plus ciprofloxacin than in eyes treated with ciprofloxacin (p = 0.0001) or propolis (p = 0.0001) or eyes treated with PBS (p = 0.0001). The light microscopic examination revealed that the control group showed normal corneal morphology. In the nontreated group, sections of the stromal infiltration revealed the presence of inflammatory cells, which were diffusely distributed (p < 0.05). Administrations of ciprofloxacin plus propolis resulted in a significantly reduced histological damage with fewer bacterial inoculation of the corneal stroma in comparison with the other groups (p < 0.05). Based on these findings, we suggest that ethanolic extract of propolis has antioxidant, anti-inflammatory, and antibacterial properties for S. aureus keratitis in rabbits.

Chiari malformation type III and results of surgery: a clinical study: report of eight surgically treated cases and review of the literature

BACKGROUND

The characteristics of Chiari malformation type III and its treatment are evaluated in this study. Radiological and surgical findings were correlated and the benefits of the therapy are discussed.

METHODS

Eight patients (6 males, 2 females) with Chiari malformation type III were studied. All patients underwent surgery to remove encephalocele along with neural tissue and to repair the dura and the skin. Associated pathologies such as hydrocephalus, tethered cord syndrome and syringomyelia were also surgically treated. Follow-up was based on the evaluation of postoperative motor and mental development, as well as on magnetic resonance imaging findings.

RESULTS

Ventriculoperitoneal shunt malfunction in 2 patients was the only surgical complication. One patient died 10 days after the operation, 7 patients survived, and the outcome of 2 patients was quite poor because of severe mental retardation and neurological deficits at the beginning. In the remaining patients, motor and mental development was normal, and the neurological outcome was satisfactory.

CONCLUSION

Surgery in the newborn period, initial severity of neurological deficits, the presence of intermittent apnoea, delayed treatment of hydrocephalus and the amount of neuronal tissue within the excised encephalocele were determined as unfavourable prognostic factors for the outcome. If the appropriate surgical procedure is done at the right time, the outcome of the Chiari malformation type III patient can be satisfactory with a low mortality rate.

Age at menarche in Turkish adolescents in Kahramanmaras, Eastern Mediterranean region of Turkey

OBJECTIVES

To determine the age at menarche in adolescents in the Eastern Mediterranean city of Kahramanmaras, Turkey.

METHODS

The study was conducted in primary and high schools of Kahramanmaras, during the academic year 2003-2004. Data of 8212 female students were collected by using a standard questionnaire. Mean and median ages at menarche (with 95% confidence intervals) were calculated by Kaplan-Meier survival analysis. Also, probit analysis was performed to determine the age at menarche for all girls by estimating the age at which 10, 25, 50, 75 and 90% of the girls reached menarche.

RESULTS

According to the answers obtained through the questionnaire, 5506 (67.5%) of 8161 respondents had had their menarche. Mean age at menarche was 13.04 years (95% CI: 13.01-13.06), and median age 13.00 years (95% CI: 12.97-13.03). According to probit analyses, the probability of menstruating before the age of 11.48 years was 10% and before 15.08 years 90%.

CONCLUSION

We provide data about age at menarche in Kahramanmaras, an Eastern Mediterranean city of Turkey.

Genotoxic action of fungicide Conan 5FL (hexaconazole) on mammalian cells in vivo and in vitro

The genotoxic effects of fungicide Conan 5FL (containing 50 g/L hexaconazole) in mouse bone-marrow cells and human lymphocytes have been evaluated. Three different concentrations of Conan 5FL (17.50, 35.00 and 70.00 microg/mL for human lymphocytes and 17.50, 35.00 and 70.00 mg/kg for mouse bone marrow cells) were studied. Conan 5FL induced significant increases (except 17.50 mg/kg for mouse bone marrow) in the frequency of chromosomal aberrations (CAs) in both test systems. This fungicide caused structural and numerical abnormalities in both mammalian cells. These are sister chromatid union, chromatid and chromosome breaks, fragments, dicentric and ring chromosomes, and polyploidy. Significant increase was found in induction and in minimum-maximum numbers of sister chromatid exchanges (SCEs) at all treatments compared with the negative control. Conan 5FL did not affect the replication index (RI) in human lymphocyte cultures, however, it significantly decreased the mitotic index (MI) in all treatment concentrations in both test systems. Using of Conan 5FL should be reconsidered due to its possible cytotoxic, clastogenic and mutagenic effects.

Genotoxic damage in Maras powder consumers from Kahramanmaras province of Turkey

In the present study, chromosomal aberrations (CAs) and micronucleus (MN) levels in the lymphocytes from 60 male individuals consisting of 40 habitues of Maras powder (a kind of smokeless tobacco) and 20 unexposed subjects were determined to investigate the possible inducing effect of Maras powder. The consumers of Maras powder had no exposure to any other known mutagens or toxicants. The mean exposure period to Maras powder was 12.25 + 0.93 years (range 3-22). Data obtained from microscopic examination of the slides was analyzed by SPSS (10.0) package programme. Mean frequency of CA and MN was found to be significantly higher in Maras powder consumers as compared to controls. Similarly, there was a significant elevation in the level of aberrant cells (Ab.Cells) with CAs and binucleated cells with MN (BNMN) in habitues. Spearman's rho correlation analysis indicated a significant increase in the frequency of CA and MN with increase in both age and years of exposure in consumers. Our finding of a significant elevation of CA and MN frequencies in peripheral lymphocytes from smokeless tobacco consumers demonstrated a potential cytogenetic hazard associated with Maras powder exposure.

Intra-familial spread of hepatitis B virus infection in eastern Turkey

Hepatitis B virus (HBV) infection is a worldwide health problem. The aim of the present study was not only to determine the prevalence of HBsAg in children of HBV-infected parents but also to identify all HBSAg-positive family members to protect as many children, in the present and future, as possible. The study was carried out with the participation of 2113 family members (1205 children, 453 mothers, and 455 fathers) at Sivas SSK Hospital, Turkey. They were screened for HBV markers using standard enzyme immunoassay between September 2001 and March 2005. The prevalence of any HBV markers and HBsAg among family members of index cases was 50.5% and 30.5% respectively. HBsAg carrier rate was higher among fathers (61%) than mothers (47%), (P<0.05). The children of mother index cases had higher rates of HBsAg compared with the children of father index cases (P<0.01). Our results suggest that intra-familial childhood horizontal transmission (especially mother-to-child) is important for HBV transmission in the Turkish community, and highlights the need for screening of adult siblings and mothers of adult HBsAg carriers in addition to their spouses and children.