Suicide Probability Among Patients With Schizophrenia and Bipolar Disorder

PURPOSE

To evaluate the possibility of suicide and related factors among individuals with schizophrenia and bipolar disorder (BD).

METHOD

Data were collected for 270 individuals registered in a community mental health center using the Suicide Probability Scale (SPS). Subsequently, t test and multiple linear regression analyses were conducted on independent samples.

RESULTS

There was no statistically significant difference found between mean SPS scores of participants with schizophrenia and BD. However, hostility subscale mean scores of participants with schizophrenia were higher than those of participants with BD, and the difference was statistically significant. Sex, family history of mental illness, need for help with medication, suicidal ideation in the past 10 days, and number of suicide attempts were important predictors of suicide probability.

CONCLUSION

Individuals with schizophrenia and BD and in remission should be evaluated periodically for the possibility of suicide. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Nursing students' metaphorical perceptions of sexuality in older people: An example of metaphor analysis

PURPOSE

This study aims to describe the metaphorical perceptions of nursing students towards sexuality in older people through metaphor.

BACKGROUND

Age-related changes and health problems can adversely affect sexual functions. Sexuality is a basic physiological need that continues throughout life and it is important to eliminate the problems related to sexual life that occur in old age. Determining the knowledge and attitudes of nursing students, who will be health professionals of the future, towards sexuality in older people can make a significant contribution to providing holistic health care to older individuals. Therefore, it is important to determine the knowledge and attitudes of nursing students about the sexuality of older people to improve their professional competence.

DESIGN

This study was conducted with metaphor analysis technique based on phenomenological method.

METHOD

This study was conducted in a total of 222 nursing students. The study data were collected between January and February 2022 with a questionnaire form prepared by the researchers. In the first part of the questionnaire, questions about socio-demographic characteristics were included, and in the second part, the sentence "sexuality in older people is like., because." was included to determine the metaphors developed by the students about sexuality in older people. These handwritten writings of the students were used as the main data source in this study. Content analysis was used to evaluate the metaphors.

RESULTS

In this study, students produced a total of 222 valid metaphors related to the concept of sexuality in older people. The metaphors revealing the students' perceptions of the concept of sexuality in older people were grouped under 5 categories; "Category related to slowing down and regression", "Category related to need or normal", "Category related to not possible", "Category related to the feeling of love, compassion and friendship" and "Unnecessary, unimportant or should not be category". In the study, it was determined that the category in which the most metaphors were generated was "related to slowing down and regression".

CONCLUSION

In the study, nursing students provided metaphors containing both positive and negative concepts related to sexuality in older people. However, most the metaphors generated contain negative concepts. To support nursing students' positive attitudes towards sexuality in older people, to change their negative attitudes, and to increase their knowledge and awareness, it is proposed to incorporate courses on sexuality in older people into the nursing curriculum and to include sexuality in older people in courses on sexuality.

Spiritual Well-Being and Psychological Well-Being Among Hemodialysis Patients in Turkey: A Descriptive and Correlational Study

This study aimed to determine the psychological and spiritual well-being of hemodialysis patients in Turkey. This descriptive and correlational study included 86 hemodialysis patients. Data were collected using the Spiritual Well-Being Scale and Psychological Well-Being Scale. There was a positive correlation between spiritual and psychological well-being (r = 0.315, p = 0.003). Psychological well-being and age explained 39% of total variance (F = 7.593, p = 0.001). In conclusion, there should be provided individualized spiritual care and counseling to improve the psychological well-being of hemodialysis patients.

Can circulating oxidative stress-related biomarkers be used as an early prognostic marker for COVID-19?

Background

Oxidative stress plays an important role in the pathogenesis of many diseases. This study aimed to investigate the relationship between nuclear factor kappa B (NF-κB) and oxidative stress and the severity of the disease in new COVID-19 patients, and, to compare the levels of NF-κB, oxidized LDL (oxLDL), and lectin-like oxidized-LDL receptor-1 (LOX-1) with oxygen saturation, which is an indicator of the severity parameters of the disease in COVID-19 patients.

Methods

In this prospective study, 100 COVID-19 patients and 100 healthy subjects were selected.

Results

LOX-1, NF-κB, and oxLDL were found to be higher in COVID-19 patients compared to the healthy subjects (p < 0.001 for all). According to the results of correlation analysis, it was found that there was no significant relationship between oxygen saturation and LOX-1, NF-κB and oxLDL parameters. There was significant relationship between oxLDL with LOX-1 and NF-κB in patients with COVID-19 disease. ROC analysis results of the highest discrimination power were oxLDL (AUC: 0.955, CI: 0.904-1.000; sensitivity: 77%, and specificity: 100%, for cutoff: 127.944 ng/l) indicating COVID-19.

Conclusion

Oxidative stress plays an essential role in COVID-19. NF-κB, oxLDL, and LOX-1 seem to represent good markers in COVID-19. Our study also showed that oxLDL has the highest power in distinguishing patients with COVID-19 from the healthy subjects.

The effect of medication adherence on psychosocial adjustment to body weight, image, and self-esteem in patients with schizophrenia

PURPOSE

The present study aimed to evaluate the effect of medication adherence on psychosocial adjustment to body weight, image, and self-esteem in patients with schizophrenia.

DESIGN AND METHODS

This cross-sectional and correlational study consisted of 154 patients with schizophrenia registered in a Community Mental Health Center.

FINDINGS

The patients had moderate psychosocial adjustment to body weight, image, and self-esteem, and 56.5% had poor medication adherence. There was a significant positive correlation between participants' medication adherence and psychosocial adjustment to body weight, image, and self-esteem.

PRACTICE IMPLICATIONS

Psychiatric nurses should support patients regarding medication adherence, and psychosocial adjustment to body weight, image, and self-esteem.

The Relationship between Alexithymia, Psychological Well-Being and Religious Coping in Fibromyalgia Patients in Turkey

This study aimed to investigate the relationship between alexithymia, psychological well-being, and religious coping in fibromyalgia patients. This study was planned as a descriptive and cross-sectional research design. The sample consisted of 175 fibromyalgia patients. Data were collected using the Toronto Alexithymia Scale-20, the Psychological Well-being Scale, and the Religious Coping Scale. Data were analyzed by Pearson's correlation test and Multiple Linear Regression analysis. A negative correlation was found between alexithymia and negative religious coping (r = - 0.377, p = 0.000). A positive correlation was found between psychological well-being and negative religious coping (r = 0.364, p = 0.000). The alexithymia was predicted by psychological well-being level (β = - 0.629), positive (β = 0.170) and negative (β = - 0.216) religious coping levels (p < 0.05). Negative and positive religious coping strategies can affect psychological well-being and expressive thinking in patients with FMS.

Determination of Health Anxiety and Resilience Levels in Patients with Fibromyalgia Syndrome and Rheumatoid Arthritis During SARS-CoV-2 Pandemic: A Case–Control Study

Background

Fibromyalgia Syndrome and Rheumatoid Arthritis are chronic diseases associated with pain. These diseases reduce the patient’s quality of life and cause psychological problems. The study aimed to determine health anxiety and resilience levels in patients with fibromyalgia syndrome and rheumatoid arthritis during the severe acute respiratory syndrome coronavirus 2 pandemic.

Methods

This case–control study conducted in Central Anatolia Region, Turkey, included 180 participants (60 patients with fibromyalgia syndrome, 60 patients with rheumatoid arthritis, and 60 healthy subjects). Data were collected using the Brief Resilience Scale and Health Anxiety Scale. Pain intensity was assessed using the Visual Analog Scale.

Results

Resilience was significantly higher in healthy controls than in the fibromyalgia syndrome and rheumatoid arthritis groups (P < .001). Resilience was also higher in the rheumatoid arthritis group than fibromyalgia syndrome (P < .001) group. Hypersensitivity to somatic symptoms and anxiety, negative results of diseases, and total scores of Health Anxiety Scale were significantly higher in the fibromyalgia syndrome and rheumatoid arthritis groups than healthy controls (P < .001). Also, Health Anxiety Scale scores in the fibromyalgia syndrome group were higher than the rheumatoid arthritis group (P < .001). There was a very strong and negative correlation between the participants’ resilience and health anxiety levels (r = -0.818, P < .001). The most important predictors of resilience were hypersensitivity to somatic symptoms and anxiety (r = -0.335, P < .001), the group (r = 0.302, P = .003), the pain intensity (r = -0.169, P = .043), and the negative consequences of the disease (r = -.149, P = .038). The hypersensitivity to somatic symptoms and anxiety, the Visual Analog Scale, and the negative consequences of the disease were negatively correlated with resilience. But there was a positive correlation between fibromyalgia syndrome and rheumatoid arthritis groups and resilience.

Conclusions

Patients with fibromyalgia syndrome and rheumatoid arthritis have low resilience and high health anxiety. The interventions should be planned to increase resilience and decrease the health anxiety of patients with fibromyalgia syndrome and rheumatoid arthritis.

State anxiety levels of nurses providing care to patients with COVID-19 in Turkey

PURPOSE

This study investigates the state anxiety levels of nurses providing care to patients with coronavirus disease-2019 (COVID-19) in Turkey.

DESIGN AND METHODS

This cross-sectional study is based on the COVID-19 pandemic situation. The State-Trait Anxiety Inventory was used to collect the study data.

FINDINGS

Nurses' state anxiety levels were high (51.51 ± 9.94). Participants evaluated for state anxiety were female; who were married; worked in intensive care units; were service nurses, having more professional experiences; and experienced hand irritation (p < 0.05).

PRACTICE IMPLICATIONS

The mental health of nurses providing primary care to patients with COVID-19 should be evaluated in the long term.

The effect of mindfulness-based therapy on psychiatric symptoms, psychological well-being, and pain beliefs in patients with lumbar disk herniation

PURPOSE

This study was conducted to determine the impact of mindfulness-based therapy on psychiatric symptoms, psychological well-being, and pain beliefs in patients with lumbar disk hernia.

DESIGN AND METHODS

The study was a nonrandomized pretest-posttest controlled quasi-experimental research and carried out in a total of 64 patients. A personal information form, the Depression Anxiety Stress Scale, the Psychological Well-Being Scale, and the Pain Beliefs Scale were used for data collection.

FINDINGS

We observed a statistically significant difference between the intervention and control groups in terms of the posttest mean scores of the psychiatric symptoms, psychological well-being, and pain beliefs.

PRACTICE IMPLICATIONS

The results revealed that mindfulness-based therapy has a positive impact on pain beliefs and psychological well-being.

The effect of sociodemographic factors on anxiety, depression, and perceived social support in patients with internal medicine and surgical problems

PURPOSE

This study aimed to determine the effect of sociodemographic factors on anxiety, depression, and perceived social support in patients with internal medicine and surgical problems.

DESIGN AND METHODS

The study comprised 522 patients who were hospitalized at the internal medicine and surgical clinics of the training and research hospital of a university.

FINDINGS

Of all the patients, 27% were at the risk of anxiety and 51.7% at the risk of depression. Sociodemographic characteristics, health-related issues, and disease characteristics, besides hospitalization-related matters, affected anxiety, depression, and social support levels of patients.

PRACTICE IMPLICATIONS

It was determined that more than half of the patients were at the risk of depression. Perceived social support is essential to reduce the risk of anxiety and depression.

The effects of group mindfulness-based cognitive therapy in nursing students: A quasi-experimental study

BACKGROUND

Academic and clinical stressors are experienced by most nursing students enrolled in a nursing education program. The students who cannot effectively deal with these stressors experience stress, anxiety and depression.

OBJECTIVE

The aim of this study was to determine the effects of group mindfulness-based cognitive therapy on mindfulness, depression, anxiety, and stress levels in nursing students.

DESIGN

This quasi-experimental study was carried out using a nonrandomized control group pre-test, post-test, and follow up design.

SETTING

Department of Nursing, Faculty of Health Sciences, University of Aksaray, Turkey.

PARTICIPANTS

Eighty-two second-year undergraduate university nursing students.

METHODS

The group mindfulness-based cognitive therapy program was conducted with the experimental group. The Mindful Attention Awareness Scale (MAAS) and The Depression, Anxiety and Stress Scale (DASS) were measured at pre- and post- intervention, and at a 4-months follow-up.

RESULTS

The post-test mean scores of MAAS of the experimental group were statistically higher than the control group (p = .006). When the mean scores obtained in the pre-test, post-test and follow-up measurements were compared, the mean scores of MAAS increased (p = .000) and stress scores decreased significantly in the experimental group (p = .004).

CONCLUSION

A group mindfulness-based cognitive therapy program conducted with nursing students had an effect on students' mindful attention awareness and stress levels. These study results indicate that this program can be used to reduce the levels of stress in nursing students.

Relationship between depression, anxiety, cognitive distortions, and psychological well-being among nursing students

PURPOSE

The aim of this study was to determine the relationship between depression, anxiety, cognitive distortions, and psychological well-being among nursing students.

DESIGN AND METHODS

This descriptive, correlational, cross-sectional study was conducted with 330 nursing students. Data were collected using the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Cognitive Distortion Scale (CDS), and the Psychological Well-being Scale (PWBS).

FINDINGS

The PWBS negatively correlated with the BDI, BAI, and CDS (P < .05). Preoccupation with danger was the strongest predictor, followed by hopelessness, self-blame, total CDS and BDI (P < .05).

PRACTICE IMPLICATIONS

Nursing students should be evaluated for psychological well-being to prevent psychiatric symptoms such as anxiety and depression.

The effect of mentoring program on adjustment to university and ways of coping with stress in nursing students: A quasi-experimental study

BACKGROUND

Mentoring programs are effective in improving some characteristics related to university adaptation, such as increasing student satisfaction, gaining social skills and effective communication, reducing stress and anxiety, and improving cognitive and psychomotor skills as well as academic performance.

OBJECTIVE

The aim of this study was to determine the effect of mentoring program on adjustment to university and ways of coping with stress in nursing students.

DESIGN

This quasi-experimental study was carried out using a nonrandomized control group pretest and posttest design.

SETTING

The study was conducted at a university school of nursing in Turkey.

PARTICIPANTS

Ninety-one first-year undergraduate nursing students were included in the study.

METHODS

The 8-week peer mentoring program was conducted with the experimental group. The Adjustment to University Scale (AUS) and The Ways of Coping Inventory (WCI) were measured at preintervention and postintervention.

RESULTS

The posttest mean scores of AUS of the experimental group were statistically higher than the control group (p < .05). The posttest mean scores of optimistic and seeking social support approaches of the experimental group were also statistically higher than the control group (p < .05). Mentoring program had an effect on self-confident, optimistic, seeking social support, submissive, and helpless approaches in the experimental group (p < .05).

CONCLUSION

Mentoring program had a positive effect on adjustment to university and ways of coping with stress in nursing students. These study results indicate that this program can be used to increase the adjustment to university and ways of coping with stress in nursing students.

High levels of impulsivity in rats are not accompanied by sensorimotor gating deficits and locomotor hyperactivity

High levels of impulsivity have been linked to a number of psychiatric disorders, including attention-deficit/hyperactivity disorder, drug abuse and schizophrenia. Additionally, schizophrenia patients commonly show deficits in another rather preattentive form of response inhibition, called sensorimotor gating. Given that higher-order functions, such as impulse control, are protected by early and preattentive processes, disturbed gating mechanisms may hamper more complex cognitive-executive functions. In the present study, we therefore tested whether high levels of impulsivity are accompanied by impaired sensorimotor gating in rats. High (HI) and low impulsive (LI) rats were identified based on the number of premature responses in the 5-choice serial reaction time task. Here, LI rats showed higher numbers of omission errors which may suggest attentional deficits while HI rats completed significantly less trials which could indicate a decrease in motivation. However, HI and LI rats did not differ in terms of impulsive decision-making in a delay-based decision-making T-maze task, prepulse inhibition of the acoustic startle response (a measure of sensorimotor gating mechanisms) or locomotor activity levels. Overall, our data indicate that high motor impulsivity is not a suitable predictor of deficient sensorimotor gating and is further not necessarily associated with attentional deficits and/or locomotor hyperactivity in rats.

Fukushima radionuclides at air filter and rain water samples collected from Istanbul and their atmospheric removal time

Accident at Fukushima Daiichi Nuclear Power Plant (FDNPP) is one of the most serious accident in the world after Chernobyl accident. Following the continuing release of radionuclides in air after FDNPP, traces of fission products ((131)I, (134)Cs and (137)Cs) were recorded in the air filter and rain water samples collected from the ÇNAEM area at İstanbul on 4 April 2011. Airborne particle samples were collected daily in air filters and radio assayed with a high purity germanium detector. The fission products (131)I, (134)Cs and (137)Cs were measured with the maximum activity concentrations of 1.03±0.08, 0.25±0.03 and 0.23±0.03 mBq m(-3), respectively. For determination of the origin of the releases the (134)Cs/(137)Cs ratio was calculated between 1.09 and 0.85. The authors find removal times for (137)Cs of 8.13 d, (134)Cs of 7.25 d and (131)I of 6.82 d.

Keutel syndrome in a patient presenting with hearing loss

Keutel syndrome (KS) is a rare autosomal recessive disease which is mainly characterised by abnormal cartilage calcification, peripheral pulmonary artery stenosis, sensorineural and conductive hearing loss, brachytelephalangism, and midface hypoplasia. Here, we present and discuss a Keutel syndrome patient with hearing loss born to consanguineous parents (first cousins), along with all the characteristic features of KS.

Expanding CEP290 mutational spectrum in ciliopathies

Ciliopathies are an expanding group of rare conditions characterized by multiorgan involvement, that are caused by mutations in genes encoding for proteins of the primary cilium or its apparatus. Among these genes, CEP290 bears an intriguing allelic spectrum, being commonly mutated in Joubert syndrome and related disorders (JSRD), Meckel syndrome (MKS), Senior-Loken syndrome and isolated Leber congenital amaurosis (LCA). Although these conditions are recessively inherited, in a subset of patients only one CEP290 mutation could be detected. To assess whether genomic rearrangements involving the CEP290 gene could represent a possible mutational mechanism in these cases, exon dosage analysis on genomic DNA was performed in two groups of CEP290 heterozygous patients, including five JSRD/MKS cases and four LCA, respectively. In one JSRD patient, we identified a large heterozygous deletion encompassing CEP290 C-terminus that resulted in marked reduction of mRNA expression. No copy number alterations were identified in the remaining probands. The present work expands the CEP290 genotypic spectrum to include multiexon deletions. Although this mechanism does not appear to be frequent, screening for genomic rearrangements should be considered in patients in whom a single CEP290 mutated allele was identified.

Prenatal diagnosis of isolated macrodactyly

Congenital enlargement of one or several digits of the hands or feet, known as macrodactyly, is a rare malformation. True macrodactyly, characterized by overgrowth of all mesenchymal elements, must be differentiated from that due to tumorous enlargement of a single element, as in hemangioma, lymphangioma or enchondroma. Furthermore, macrodactyly may be isolated, but it can also be associated with several syndromes. Here we present a case of prenatally diagnosed isolated true macrodactyly of the second toe of the left foot at 24 weeks of gestation, and discuss the key points in its differential diagnosis and management.

Supernumerary chromosome der(22)t(11;22): Emanuel syndrome associates with novel features

Emanuel syndrome results from +der(22)t(11q23;22q11). Cleft palate, ear anomalies, heart defects, genital anomalies, hypotonia, and mental retardation are the main features of the syndrome. We report a nine-year-old boy with the t(11;22)(q23;q11) chromosome, transmitted in an unbalanced fashion from his mother, and originated in the maternal grandmother's meiosis. In addition to mental retardation, hypotonia, craniofacial anomalies, and cryptorchidism, he has novel findings such as, joint hyperextensibility, left liver lobe agenesis, left sided malposition of the gallbladder and pancreas hypoplasia. This is the first report associating these features with Emanuel syndrome.

Acute severe reversible oligohydramnios induced by indomethacin in a patient with rheumatoid arthritis: a case report and review of the literature

Although the association between oligohydramnios and indomethacin use for premature labor has been well known for many years, there have been few cases published about it. We present a case of indomethacin-induced oligohydramnios due to use in a patient for rheumatoid arthritis. A 27-year-old G2P1 woman was referred to our prenatal unit with oligohydramnios at 33 weeks of pregnancy. Ultrasonography revealed severe oligohydramnios with an amniotic fluid index of 0.9 cm. She gave a history of daily 150 mg indomethacin use for newly diagnosed rheumatoid arthritis. All possible reasons for oligohydramnios were excluded and indomethacin was discontinued. In four days the amniotic fluid was observed as normal. We concluded that the oligohydramnios caused by indomethacin occurs quickly, is dose-related and reversible. Amniotic fluid volume should be monitored while using indomethacin.

Joubert syndrome co-existing with partial Xp trisomy: review of the literature

We report a five-year-old girl who has been clinically diagnosed as Joubert syndrome. Her cytogenetic analysis showed 46,XX,der(2)add(2q37) karyotype. Cytogenetic analysis of her mother and maternal grandmother revealed a karyogram designated as 46,X,t (X;2)(p11.2;q37). The proband's derivative chromosome was further confirmed to be a translocation chromosome 2 carrying segments from chromosome X, which originated from a segregation event of the maternal grandmother's balanced translocation passed on as a balanced translocation to the proband's mother either. So far, a number of candidate genes including EN1 on 2q were analyzed for Joubert syndrome. Based on our proband's abnormal karyotype, we suggest that further mapping studies for the syndrome should also be directed towards the chromosome X segments present on the derivative chromosome 2 of our proband.

Fetal cerebellar hemorrhage in a severely growth-restricted fetus: natural history and differential diagnosis from Dandy-Walker malformation

This is a report of an intracerebellar hemorrhage in a severely growth-restricted fetus with pathological Doppler findings of the fetal and uteroplacental circulations. The diagnosis was made sonographically at 22 weeks of gestation and the natural course of the hemorrhage was followed. Interestingly, the final sonographic appearance of the posterior fossa was quite similar to that of the classic form of Dandy-Walker malformation: absence of the vermis and an enlarged fourth ventricle. However, careful sonographic examination showed that the enlargement of the fourth ventricle was actually caused by a porencephalic cystic lesion of the left cerebellar lobe. Pathological examination revealed complete absence of the vermis and cerebellar hypoplasia.

Dysmorphic face in two siblings with infantile neuroaxonal dystrophy

Infantile neuroaxonal dystrophy (INAD) is an autosomal recessive, neurodegenerative disease with onset in the first or second year of life. It has been reported that INAD shows numerous phenotype characteristics including problems associated with vision, hearing and physical coordination. It has however been very rare to see facial dysmorphism in these children. The study analyzes a girl and boy of a first cousin marriage with infantile neuroaxonal dystrophy affected at birth. At infancy, the children were examined in the Cerrahpaşa Medical Faculty Genetic Research Center, Istanbul. They had typical INAD features such as the lack of head control, vision, speech, sitting, and walking which are also seen in children with other congenital abnormalities. These children showed remarkable dysmorphism in the face which included prominent forehead, strabismus, small nose, fish mouth (boy), micrognathia, and large and low-settled ears. The presence of these facial features makes the patients appear unique and diagnosis more accurate. While these features are commonly seen diagnosis may be difficult at its onset. Until now this appearence has not been reported in INAD patients. In conclusion, in the first few months of life without any clinical or neurological signs, the physician should also consider diagnosing the disease of the infant as INAD.

Trisomy 9p syndrome in two brothers: with new clinical findings and review of the literature

We report an eleven years old boy and his fourteen years old brother who both have trisomy 9p syndrome. Their cytogenetic analysis using GTL-banding showed 46,XY,der(22)add(22)(p11) karyotype. Cytogenetic analysis of their mother and sister revealed a karyogram designated as 46,XX,t(9;22) (9pter-->9p12::22p11-->22qter). With the help of FISH technique, the derivative chromosome in the proband was further confirmed to be a translocation chromosome 22 carrying the aforementioned segments from chromosome 9 which originated from a segregation event of a mother's balanced translocation. Regarding clinical aspects of our cases, both showed similar findings of 9p trisomy syndrome but low frontal hairline, circular placement of the hair around the face and scarce, inverted eyebrows, findings not previously mentioned in the literature. We conclude that these new clinical findings could be used in the clinical diagnosis of the 9p trisomy syndrome along with the other well-documented symptoms.

Changes in the antioxidant system in epileptic children receiving antiepileptic drugs: two-year prospective studies

The aim of this study was to measure changes in the antioxidant systems of epileptic children who had been receiving either valproate or carbamazepine monotherapy for 2 years. For this purpose, levels of erythrocyte glutathione, glutathione peroxidase, superoxide dismutase, and serum lipid peroxidation in 25 healthy children and 27 children who had previously been diagnosed as having epilepsy but who had not, prior to the study, received antiepileptic drugs were tested. Of the 27 epileptic children, 14 were given valproate, and the remaining 13 were given carbamazepine; these tests were repeated in the 13th and 24th months of treatment. The results showed that, during valproate therapy, the lipid peroxidation levels of the epileptic children increased and the glutathione peroxidase levels decreased in comparison with those levels recorded in the control and pretreatment groups. In addition, the superoxide dismutase levels were found to be increased during the first year of valproate therapy when compared with those of the pretreatment group. However, during carbamazepine therapy, lipid peroxidation levels increased when compared with the control group only, not the pretreatment group. Furthermore, the results showed that during the second year of treatment, the superoxide dismutase levels of the children receiving carbamazapine monotherapy were found to be higher than those of both the control and pretreatment groups. From these results, it can be concluded that the antioxidant systems of the children who had been receiving valproate therapy during the 2 years were more significantly affected than those of the children who had been receiving carbamazepine.

Infantile-onset megalencephalic leucoencephalopathy in two siblings

Infantile-onset megalencephalic leucoencephalopathy (IML) is a recently recognized autosomal recessive white matter disorder. Unlike other megalencephalic leucoencephalopathies, in patients with IML a mild clinical course, a slowly progressive delay in motor development and mild mental deterioration are typical. We report on two affected siblings who have typical clinical and radiological findings of IML. Cranial magnetic resonance imaging showed involvement of the capsula externa, extrema and interna, nucleus dentatus, crus cerebri, periventricular and subcortical white matter. In addition, bilateral cystic changes were determined predominantly in the temporal lobes. There were no clear biochemical or metabolic disturbances. In the present paper, we discuss the clinical and neuroimaging findings of IML.

Erythrocyte glutathione, glutathione peroxidase, superoxide dismutase and serum lipid peroxidation in epileptic children with valproate and carbamazepine monotherapy

This prospective study was carried out to determine changes in the antioxidant system in epileptic children receiving long term antiepileptic drugs (AEDs). Levels of erythrocyte glutathione (GSH), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and serum lipid peroxidation were determined in 25 healthy children and 30 epileptic children who had not yet received AEDs. Sixteen patients were treated with valproic acid (VPA) and 14 with carbamazepine (CBZ); 13 months later these parameters were retested. The results showed that SOD and lipid peroxidation levels were increased but the GSH-Px levels were decreased in epileptic children on VPA therapy compared with the control group and the results before treatment. No significant differences of these parameters were found in epileptic children on CBZ therapy compared with the control group and the results before treatment, except that lipid peroxidation level was slightly higher in epileptic patients before treatment. We conclude that antioxidant systems in epileptic children on CBZ therapy are better regulated in comparison with epileptic children on VPA therapy.

Siblings with cystic leukoencephalopathy and megalencephaly

Cystic leukoencephalopathy with megalencephaly is a newly described entity with mild clinical involvement. Patients suffer from developmental problems and seizures in childhood. Progression is gradual into adulthood. Typical magnetic resonance imaging findings include subcortical cysts and diffuse leukoencephalopathy. The etiology is unknown with possibly autosomal-recessive inheritance. We present two pairs of siblings with this disease and emphasize the characteristic and variable patterns even within the same family.

A variant of Cenani-Lenz type syndactyly

Cenani-Lenz syndrome is a form of complete syndactyly resembling the spoon hand in Apert syndrome. It is often associated with disorganization of phalanges, the fusion of metacarpals and mesomelic shortness of the arm. We describe an additional case of Cenani-Lenz type of syndactylism in a 16 month-old girl who also has rib and vertebral abnormalities and mixed type hearing loss, that have not been seen before in a single patient.

The effects of carbamazepine and valproic acid on the erythrocyte glutathione, glutathione peroxidase, superoxide dismutase and serum lipid peroxidation in epileptic children

Some epileptic drugs may change antioxidant enzyme activities in humans and experimental animals. Recent studies suggest that membrane lipid peroxidation may be causally involved in some forms of epilepsy, and the differences are reported in free radical scavenging enzyme levels. GSHpX, SOD, GSH are important parameters of antioxidant defence mechanisms. This study was undertaken to evaluate the effects of valproic acid and carbamazepine (CBZ) therapy on erythrocyte glutathione (GSH), glutathione peroxidase (GSHpX), superoxide dismutase (SOD) and lipid peroxidation. During the treatment with VPA or CBZ, the erythrocyte GSHpX and GSH levels of epileptic children were significantly changed as compared to those of health control subjects. The mean levels of serum lipid peroxidation and erythrocyte superoxide dismutase were not statistically different from controls. The methods used for investigation of glutathione peroxidase, superoxide dismutase, glutathione and serum lipid peroxidation were all based on spectrophotometric measurement.

Two female siblings with a previously unreported MCA/MR syndrome: pre- and postnatal growth retardation, iris colobomata, spasticity, facial dysmorphism and dilated ventricles

We report two siblings from non consanguineous parents with a similar MCA/MR syndrome: Pre- and postnatal growth retardation, microcephaly, mental retardation, iris colobomata, facial dysmorphism, spasticity, dilated ventricles and abnormal immunoglobulin levels. Review of published reports and the use of the London Dysmorphology Database suggests that these siblings may present a new syndrome.

Neuroimaging findings of four patients with Sandhoff disease

Sandhoff disease is a severe form of GM2 gangliosidosis that is caused by the deficiency of both hexosaminidase A and B. Startle reaction, hypotonia, psychomotor retardation, and blindness are the main clinical features. Presented are computed tomography and magnetic resonance imaging findings of four patients with Sandhoff disease diagnosed by enzymatic analyses. Bilateral homogeneous thalamic hyperdensity was evident on computed tomography. Magnetic resonance imaging scans revealed mild cortical atrophy, a thin corpus callosum, and abnormal signal intensities in the caudate nucleus, globus pallidum, putamen, cerebellum, and brainstem. No correlation was evident between the severity of the central nervous system imaging findings and the clinical pictures. In this article the neuroimaging findings of four patients with Sandhoff disease are discussed.

Preparation of spray-dried microspheres of indomethacin and examination of the effects of coating on dissolution rates

In this study, microspheres were prepared by the spray drying technique using suspensions of indomethacin (IM) as active substance and coated by three different polymers in order to increase the dissolution rate of IM. Water solutions (0.1, 0.2 and 0.5%) of hydroxypropylmethyl cellulose (HPMC), polyvinyl alcohol (PVA) and hydroxypropyl cellulose (HPC) were used as coating materials. Polyethylene glycol 400 (PEG 400) was added to all formulations as plasticizer. Changes of particles size and surface characteristics of the coated products were examined using optical microscopy and scanning electron microscopy (SEM), respectively. The effects of coatings on the dissolution rates of IM were examined using USP XXIII Method II in water and phosphate buffer pH 7.4. It was observed that coating the IM particles with HPMC, PVA and HPC polymers using the Spray-Drying Technique increased the dissolution rate of IM significantly.

N-acetyl-beta-glucosaminidase and beta-galactosidase activity in children receiving antiepileptic drugs

To evaluate renal tubular function in children receiving antiepileptic drugs the urinary activity of two lysosomal enzymes, N-acetyl-beta-glucosaminidase and beta-galactosidase, were measured. The enzyme levels were determined before the administration of antiepileptic drugs and 8 months after. Fourteen epileptic children received valproate, and 17 received carbamazepine. The urinary activity of these enzymes in 25 healthy control patients also was examined. Increased N-acetyl-beta-glucosaminidase activity was found in 50% of patients taking valproate and in 17.6% of patients taking carbamazepine. Increased beta-galactosidase activity was found in 28.5% of patients taking valproate and 11.7% of patients taking carbamazepine compared with the results before treatment. On the basis of these results, it is suggested that patients taking antiepileptic drugs, especially valproate, may demonstrate minor signs of tubular dysfunction. In those patients who use these drugs at increased dosage levels or for long periods, the possibility of tubular dysfunction may be increased, and these dysfunctions may manifest in clinical symptoms.

A family presenting Goltz syndrome (focal dermal hypoplasia) in three generations

In this report we present three affected females of the same family in three generations. The cases have features of focal dermal hypoplasia (Goltz syndrome). One of the three affected females is the index case and the others are her mother and her grandmother. We performed skin biopsies on them. According to histopathological examinations skin lesions were compatible with Goltz syndrome. These cases exhibited focal dermal hypoplasia (FDH) manifestations including skin, dental and skeletal abnormalities. The affected females were seen in three generations of the same family which pointed to its X-linked dominance.

The extent of leprosy-related disabilities in Istanbul Leprosy Hospital, Turkey

This study was carried out between January and December 1992 at the Istanbul Leprosy Hospital. Seven hundred and eleven leprosy patients were evaluated according to their age, gender and type of disease and disability according to the WHO disability grading system (1980). There were 527 males (74.2%) and 184 females (25.8%) in the group. The average age was 50.0 +/- 13.5 years and the average duration of disease was 25.9 +/- 13.2 years. Six hundred and seventy-eight patients (95.4%) were in borderline (BL) and lepromatous (LL) leprosy. The extent of disabilities was very high in 711 leprosy patients. It was found that 539 of the patients (75.8%) had eye disabilities, 511 of them (71.8%) had hand disabilities, 521 of them (73.3%) had foot disabilities. The most frequent eye, hand and foot disabilities were a decrease of vision (52.7), acute or chronic iridocyclitis (48.8%), slightly-marked corneal sensory loss (43.2%), mobile claw hand (33.3%), palmar insensitivity (16.3%), plantar ulcer (37.2%) and plantar insensitivity (19.8%). Eye deformities were the most common of the three affected areas in this study.