The relationship between oxidative stress markers and 1H-Magnetic resonance spectroscopy findings in obsessive compulsive disorder

INTRODUCTION

The purpose of this study was to examine N-acetyl aspartate (NAA)/creatine (Cr) and glutamate, glutamine, and gamma-aminobutyric acid complex (Glx)/Cr levels in patients with obsessive compulsive disorder (OCD) and healthy controls' orbitofrontal cortex (OFC) and caudate nucleus (CN) by proton magnetic resonance spectroscopy (1H-MRS) method and to investigate their relationship with oxidative stress markers glutathione peroxidase (GPx) and superoxide dismutase (SOD).

METHODS

This study included patients with OCD (n = 25) and healthy controls (n = 25) ranging in age from 18 to 65. We used the ELISA method to evaluate serum SOD and GPx levels. Levels of NAA/Cr and Glx/Cr in the orbitofrontal cortex and caudate nucleus were measured using the 1H-MRS method.

RESULTS

Our study did not detect statistically significant differences in the orbitofrontal cortex Glx/Cr and NAA/Cr levels between the OCD patients and the control group. OCD patients exhibited a decrease in NAA/Cr levels, consistent with impaired neuronal integration, and an increase in Glx/Cr levels, consistent with hyperactivation, in the caudate nucleus compared to the control group. We observed a negative correlation between NAA/Cr levels in the caudate nucleus and the levels of SOD and GPx.

CONCLUSIONS

Our study is the first to assess CN and OFC together in OCD patients using 3 T MR, investigating the relationship between neurometabolite concentrations and oxidative stress parameters. The negative correlation we observed between NAA/Cr levels and SOD and GPx in the caudate nucleus suggests that increased oxidative stress in this brain region in OCD patients may contribute to impaired neuronal integration and functionality.

Neoadjuvant calcium electroporation for potentially curable colorectal cancer

BACKGROUND

The development of new perioperative treatment modalities to activate the immune system in colorectal cancer might have a beneficial effect on reducing the risk of recurrence after surgery. Calcium electroporation is a promising treatment modality that potentially modulates the tumor microenvironment. The aim of this study was to evaluate the safety of the procedure in the neoadjuvant setting in localized left-sided colorectal cancer (CRC).

METHODS

The study included patients with potentially curable sigmoid or rectal cancer with no indication for other neoadjuvant treatment. Patients were offered calcium electroporation as a neoadjuvant treatment before elective surgery. Follow-up visits were conducted on the preoperative day before elective surgery, POD2, POD14, and POD30, with an evaluation of adverse events, impact on elective surgery, clinical examination, and quality of recovery.

RESULTS

Endoscopic calcium electroporation was performed as an outpatient procedure in all 21 cases, with no procedure-related complications reported. At follow-up, five adverse events were registered, two of which were classified as serious adverse events. Surgery was performed as planned in 19 patients (median time to surgery, 8 days), and the final two patients underwent surgery with a delay due to adverse events (14 and 33 days). No significant impact on the quality of recovery scores nor inflammatory markers were seen before and after calcium electroporation, nor baseline and POD30.

CONCLUSIONS

Endoscopic calcium electroporation is a safe and feasible procedure in patients with potentially curable CRC. The study showed limited side effects and limited impact on the following elective surgical resection.

Nutrition and oral health in children with recently and previously diagnosed celiac disease

OBJECTIVES

To evaluate the nutritional and oral health status of children with previously diagnosed celiac disease (CD) who follow a gluten-free diet and recently diagnosed CD patients.

MATERIALS AND METHODS

Previously and recently diagnosed groups were formed from children with CD, aged 4 to 15 years. A questionnaire was completed about the children's dental history and nutritional and oral hygiene habits. All the children underwent an oral examination, and dmft-DMFT indices were determined. Dental plaque status, periodontal health, and dental enamel defects were recorded. Oral soft tissues were examined for the presence of lesions. Unstimulated salivary flow rate and pH value were evaluated.

RESULTS

A statistically significant difference was determined between the previously and recently diagnosed patients in terms of toothpaste preference (p=0.003), frequency of going to the dentist (p=0.039), and the types of dental treatment they had received (p=0.001). A statistically significant difference was determined between the previously and recently diagnosed patient groups in terms of dmft values (p=0.005).

CONCLUSIONS

Children with CD should be directed to a pediatric dentist to improve oral and dental health, relieve the symptoms of oral mucosal lesions, be informed about enamel defects, and be encouraged to use gluten-free oral care products.

CLINICAL RELEVANCE

The collaboration of pediatric gastroenterologists and pediatric dentists can prevent the progression of oral symptoms in children with CD and eliminate long-term complications in terms of both oral health and multisystemic problems.

Two doses of the Pfizer-BioNTech vaccine, two different side effects: Skin and eye

A 47-year-old male patient presented to our clinic with the complaints of eye pain, reduced vision and redness in the right eye three days after administration of the second dose of the Pfizer-BioNTech vaccine. The patient was diagnosed with uveitis associated with the Pfizer-BioNTech vaccine and inflammatory glaucoma due to the uveitis. In addition, an erythematous, morbilliform rash had developed three days after the first dose of the vaccine. This is the first case report in the literature to show both skin and eye side effects after the Pfizer-BioNTech vaccine.

Comparison of long-term results of obliterative colpocleisis and reconstructive vaginal surgery including sacrospinous ligament fixation in patients with total genital prolapse

Background

Treatment of total genital prolapse in elderly patients is still controversial in terms of postoperative objective and subjective results.

Aim

The present study aimed to compare the long-term objective and subjective cure rates of sacrospinous ligament fixation and Le Fort operation for treatment of total genital prolapse.

Patients and Methods

Patients over the age of 60 with stage 3 or 4 pelvic organ prolapse that presented to the Obstetrics and Gynaecology Clinic of the Faculty of Medicine of *** University. The study sample consisted of 17 patients that underwent Le Fort operation and 29 patients that underwent sacrospinous ligament fixation. Data on duration of operation, intraoperative complications, duration of hospital stay, and differences between preoperative and postoperative estimated blood loss, postoperative complications, and relapse in the long term were obtained. Questionnaires exploring quality of life, incontinence, and pelvic floor disorders were applied to the patients.

Results

As subjective cure rates, postoperative patient satisfaction (P = 0.001), regret rate (P = 0.038) and recommendation rate (P = 0.044), as well as postoperative questionnaire results, Pelvic Floor Impact Questionnaire and SF36 were found to be significantly better in the Le Fort group (respectively P = 0.039 and 0.042). As objective cure rates, there was no difference between the two groups in terms of postoperative cystocele, rectocele, and cystorectocele (P = 0.955) and postoperative recurrence of prolapse beyond the hymen (P: 0.893). Duration of operation and duration of hospital stay were found to be significantly shorter in the Le Fort group (respectively P = 0.032 and 0.012).

Conclusion

Le Fort operation could be the intervention of choice in sexually inactive elderly patients with stage 3 or 4 pelvic organ prolapse.

Lymphocyte/mean platelet volume ratio, a new marker; is it effective in predicting the prognosis of COVID-19 cases?

OBJECTIVES

This study aims to determine the prognostic significance of the lymphocyte/mean platelet volume ratio (LMR) in terms of the clinical course of the disease in patients with COVID-19.

METHODS

Patients over 18 who were evaluated for COVID-19 during the period from April 1, to April 30, 2020 were retrospectively scanned. Patients with at least 1 positive PCR test result were as assigned to Group 1 while patients with negative test results were assigned to Group 2. The LMR ratio was calculated by dividing the lymphocyte value by that of MPV. The relationship between LMR, severity of patients' CT findings and 28-day mortality was evaluated.

RESULTS

A total of 938 patients were included in the study. It was observed that the lymphocyte and LMR levels were significantly different in those who died within 28 days (p < 0.001, p ≤ 0.001). In the ROC analysis for the LMR level, the area under the curve (AUC) was found to be 0.737 (95% CI 0.639‒0.834). When the cut‑off value of LMR was 0.045, the sensitivity was found to be 99.0 % and specificity was 15.2 %.

CONCLUSION

LMR can be a guide in multiple cases of care provided to critical patients, as is the case in the COVID-19 pandemic and can be used in recognizing critical patients (Tab. 5, Fig. 1, Ref. 21).

A Comparative Fatigue Analysis of GFRP, CFRP and Structural Steel for Connecting Rod Using ANSYS

The connecting rod, as an important part in internal combustion engines, has been most widely used in automotive industry, and its main function is to transfer the reciprocating motion of the piston into the rotatory motion of the crankshaft. In this study, fatigue analysis of the connecting rod is performed numerically for different engine speeds. With this aim, it is attempted to reduce the weight of the connecting rod by choosing the low density and high strength of GFRP and CFRP composite materials instead of structural steel. In this way, it is possible to improve the engine efficiency with saving unnecessary balancing weights as well as reducing the cost of the connecting rod. In the current study, the connecting rod was modeled using Solidworks software, and its CAD model was transferred to the ANSYS/Workbench software for Finite Element Analyses (FEA). In FEA, fatigue analyses were performed to determine fatigue parameters such as alternating stress, deformation, fatigue life and safety factor according to Soderberg’s fatigue model. Results from this study showed that alternating stress and safety factor reached a critical value between piston pin end and crank end near to the piston pin end. Alternating stress values of the GFRP and CFRP connecting rods were much lower than those of structural steel rod. In contrast to reduction of the weight by 1/5, fatigue life of the connecting rod with structural steel material was much greater than those of GFRP and CFRP providing a higher safety factor compared with composite materials.

The variability of electric pulp response thresholds in primary molars: a clinical study

PURPOSE

The variability of the EPT response threshold is the most important part of accurate diagnosis of pulp status of caries-affected resorbing primary teeth. This study evaluated the mean EPT threshold values and appropriate electrode placement sites for primary molar teeth based on their physiological root resorption levels.

METHODS

This study was conducted with 100 primary second molars in 100 children ages 3-12 (mean age: 7.88 years). Teeth were divided into 2 groups according to physiological root resorption levels. EPT response thresholds were recorded at the mesiobuccal cusp, occlusal third, middle third and cervical third of the crown. Data were analyzed according to resorption level using one-way analysis of variance and Duncan tests, with the level of significance set at 0.05.

RESULTS

Mean threshold values at all placement sites were higher in the group with the higher level of physiological root resorption. In terms of placement, the lowest mean EPT threshold values were obtained at the mesiobuccal cusp regardless of resorption level.

CONCLUSIONS

According to the study results, higher resorption levels were associated with higher physiologocial threshold values for EPT of primary second molars, with the mesiobuccal site identified as the most appropriate electrode placement site, regardless of resorption level.

Does Obesity Have an Effect on the Outcomes of Unicondylar Knee Arthroplasty in Patients with Isolated Medial Gonarthrosis?

PURPOSE OF THE STUDY The aim of this study was to evaluate and compare the functional outcomes and complication rates of patients in the midterm follow-up period when patients applied with medial unicondylar knee arthroplasty (UKA) were grouped according to Body Mass Index (BMI) values MATERIAL AND METHODS The study included 125 patients applied with medial UKA between December 2013 and December 2017 because of isolated medial compartment gonarthrosis and completed at least 2 years of follow-up. The patients were separated into three groups: non-obese with a BMI < 30 kg/m2, obese with BMI of 30-39 kg/m2, and morbidly obese (BMI ≥ 40 kg/m2). The implants used in all surgeries were cemented fixed-bearing implants. All patients were evaluated preoperatively with bilateral orthoroentgenograms, and weight-bearing anteroposterior and flexed lateral knee X-rays. Postoperatively, bilateral orthoroentgenograms and weight-bearing anteroposterior and flexed lateral knee X-rays were taken. Pre- and post-operative clinical outcomes were evaluated using the Knee Society Score (KSS), functional Knee Society Score (fKSS) Oxford Knee Score (OKS) and Visual Analogue Scale (VAS). RESULTS The 125 study patients comprised 83 females and 42 males with a mean age of 54 years (range, 42-71 years). No significant difference was determined between the three groups in respect of age, gender and side distribution (p > 0.05). In all three groups, the fKSS, KSS, OKS and VAS values at the final follow-up examination were statistically significantly improved compared to the preoperative values. No periprosthetic infection was determined in any patient throughout the follow-up period. Revision surgery was applied for various reasons to 5 patients; 2 in the non-obese group, 2 in the obese group, and 1 in the morbidly obese group. DISCUSSION In the last 20 years, a general increase has been seen in the number of obese patients with knee osteoarthritis requiring surgery. The increase in obesity represents an important worldwide public health problem. CONCLUSIONS The results of this study suggest that obesity does not influence the middle term outcomes of UKA. The functional outcome scores after surgery and improvement in these scores were comparable to patients with normal BMI. Key words: medial gonarthrosis, obesity, unicondylar knee arthroplasty.

The Effects of Nanosilica and Nanoclay Particles Inclusions on Mode II Delamination, Thermal and Water Absorption of Intraply Woven Carbon/Aramid Hybrid Composites

The effects of nanosilica (NS) and nanoclay (NC) particle inclusions on mode II delamination and thermal properties as well as water absorption capability of carbon/aramid fiber reinforced hybrid composites (CAFRE) were experimentally investigated at different nanoparticle contents. NS and NC particles modified CAFRE samples were reinforced with intraply woven and twill weave of carbon and aramid fibers, and were manufactured by using hot mold press assisted with hand-layup method. Various thermal properties such as thermal conductivity, thermal diffusivity, and specific heat capacity were experimentally measured with respect to NS and NC particle weight contents according to ISO-22007 standard. In addition, the water absorption test was performed according to ASTM D570-98 standard. Results from this study showed that addition of NS and NC particles improved mode II delamination toughness of CAFRE composites at 1.5 wt% and 2 wt% of NS and NC particle contents, respectively. Water absorption capacity of the CAFRE samples was increased as increasing NS and NC weigh contents while thermal tests showed that thermal diffusivity values increased, and specific heat decreased with increasing both NC and NS particle weight contents.

Evaluation of Risk Factors for ADHD and Co-Morbid Psychiatric Disorders Among the Parents of Children With ADHD

OBJECTIVE

The aim of this study is to investigate the presence of ADHD and other psychiatric disorders among parents with at least one child with ADHD relative to parents with children who do not have ADHD.

METHOD

Eighty five parents of children with ADHD with 68 control parents who had healthy children without ADHD were interviewed for participation in present study. Each parent was evaluated for co-existing psychiatric disorders using the Structured Clinical Interview for the DSM IV Axis I Disorders (SCID I).

RESULTS

We found that ADHD and co-morbid psychiatric symptoms were increased in the parents of children with ADHD in comparison with the healthy control group.

CONCLUSION

Psychiatric co-morbidity was more common among the parents of patients with inattentive and combined presentations. Adult ADHD is associated with psychiatric co-morbidities including anxiety disorders, mood disorders, and somatoform disorders as well as substantial role impairment.

Evaluation of serum inflammatory markers in treatment-resistant manic patients and adequate responder manic patients

Mania is accompanied with immune activation as indicated by increased pro-inflammatory cytokines, acute phase proteins; and carcinoembryonic antigen (CEA) is known to accompany signs of immune-inflammatory responses in bipolar disorder (BD) and medical disorders. In this study, it was aimed to compare high sensitivity C-reactive protein (hsCRP), CEA levels and white blood cells (WBCs) counts in the treatment-resistant BD (Group 3), the treatment-responsive BD patients (Group 2), and the healthy control group (Group 1). The sociodemographic data form, the Young Mania Rating Scale (YMRS), the Hamilton Depression Rating Scale (HDRS), and the Clinical Global Impression Severity of Illness (CGI-S) Scale were applied to the patients. In Group 3, the WBCs counts, and CEA levels were significantly higher than the other two groups. There was a positive correlation between WBCs counts and YMRS and CGI-S scores in all manic patients. There was a positive correlation between CEA levels and YMRS, HDRS and CGI-S in manic patients. This study shows that there is an activation of the immune-inflammatory response system in treatment resistant manic patients; and, WBCs counts and CEA levels are associated with severity of disease in manic patients.

Customary practices, domestic violence, and psychosomatic pain among adolescent mothers in Turkey

Background

Adolescent motherhood is present in many societies worldwide, including Turkey.

Aims

We aimed to determine the demographical and cultural characteristics of adolescent mothers, lifetime domestic violence and history of miscarriage, and whether they suffer from any kind of medically unexplained (psychosomatic) pain in a study in south-eastern Turkey.

Methods

We included 501 mothers in this case-control study. The study group comprised 228 mothers who gave their first deliveries at or before 19 years of age, and the control group consisted of 273 mothers who first delivered after 19 years of age. The case-control study was conducted between February and April 2013 in Diyarbakir, Turkey.

Results

Adolescent mothers marry more frequently with their relatives. They have a higher prevalence of culture-bound customary applications such as bride price. They are less likely to be asked for their consent to marry and tend to have more children. They are more frequently victims of domestic violence and more often report medically unexplained psychosomatic pain.

Conclusions

Adolescent motherhood is still a public health problem that seems to be related to certain culture-bound customary practices, continuing domestic violence across generations, increased number of children, and more prevalent psychosomatic pain.

High-sensitivity C-reactive protein and high mobility group box-1 levels in Parkinson's disease

Various immunologic and inflammatory factors are contributed to pathogenesis of Parkinson's disease (PD). High mobility group box-1 (HMGB1) is a protein that plays certain roles in inflammation, DNA repair, transcription, somatic recombination, cell differentiation, cell migration, neuronal development, and neurodegeneration. The aim of the present study was to evaluate the serum levels of HMGB1 and high-sensitivity C-reactive protein (hs-CRP) among patients with Parkinson's disease and healthy controls. This study includes 30 patients with PD and 30 healthy controls, matched sex, age, body mass index, and smoking status. HMGB1 and hs-CRP serum levels were compared between the groups. The diagnostic performance of HMGB1 and hs-CRP was evaluated with receiver operating characteristic (ROC) curve analysis. HMGB1 levels were significantly higher in PD patients than in controls. Hs-CRP levels were significantly higher in PD patients than in controls There was a moderate correlation between hs-CRP and HMGB1 levels in the patient group. The cut-off value of HMGB1 level for the prediction of PD was determined as 32.8 ng/mL with 80% sensitivity and 60% specificity (p = 0.006). The cut-off value of hs-CRP level for the prediction of PD was determined as 0.63 mg/L with 66.7% sensitivity and 77.7% specificity (p = 0.007). This study demonstrates for the first time the association between HMGB1, hs-CRP, and PD. We found that HMGB1 and hs-CRP levels to be significantly higher in the PD patients than in the normal controls. As a result of the ROC curve analysis, HMGB1 and hs-CRP levels may be fair markers in the diagnosis of PD.

A Case of Skin Picking Disorder of a Patient with a History of Childhood Abuse

Skin picking (excoriation) disorder is the recurrent excoriation of one's own skin, resulting in noticeable skin damage. People pick their skin for different reasons. For the majority of patients, first skin picking is associated with a history of childhood abuse and personal problems. Subjects who moderately to severely cause injurious self-harm are more likely to have a history of exposure to domestic violence and childhood abuse than those who do not self-harm. At the same time, these conditions could be related to the etiology for majority of other psychiatric disorders. We report herein, a case of a patient with skin picking disorder who had a history of childhood physical and emotional abuse with borderline personality disorder.

Evaluation of Paraoxonase, Arylesterase and Malondialdehyde Levels in Schizophrenia Patients Taking Typical, Atypical and Combined Antipsychotic Treatment

Objective

Human serum paraoxonase (PON1) prevents lipids from peroxidation and functions as an antioxidant mechanism. Malonyldialdehyde (MDA) is the final product of lipid peroxidation and can be used as an indicator of oxidative stress. The aim of this study was to investigate PON1, MDA, and arylesterase (ARY) levels in schizophrenic patients who are taking typical, atypical, or combined (typical and atypical) antipsychotic drug treatment, with respect to those of healthy controls.

Methods

We evaluated 41 patients (11 taking typical antipsychotics, 19 taking atypical antipsychotics, 11 taking combined anti-psychotics) and 43 healthy controls.

Results

MDA levels were higher in schizophrenic patients taking typical antipsychotics compared with healthy controls (p=0.001). ARY levels were higher in patients taking atypical antipsychotics compared with healthy controls (p=0.005). PON1 activity was similar in all groups.

Conclusion

Our results indicate that treatment with typical antipsychotic drugs could be related to increased MDA levels; and antipsychotic medication may increase PON1 levels in schizophrenic patients.

Decreased Prolidase Activity in Patients with Posttraumatic Stress Disorder

OBJECTIVE

Many neurochemical systems have been implicated in the development of Posttraumatic Stress Disorder (PTSD). The prolidase enzyme is a cytosolic exopeptidase that detaches proline or hydroxyproline from the carboxyl terminal position of dipeptides. Prolidase has important biological effects, and to date, its role in the etiology of PTSD has not been studied. In the present study, we aimed to evaluate prolidase activity in patients with PTSD.

METHODS

The study group consisted of patients who were diagnosed with PTSD after the earthquake that occurred in the province of Van in Turkey in 2011 (n=25); the first control group consisted of patients who experienced the earthquake but did not show PTSD symptoms (n=26) and the second control group consisted of patients who have never been exposed to a traumatic event (n=25). Prolidase activities in the patients and the control groups were determined by the ELISA method using commercial kits.

RESULTS

Prolidase activity in the patient group was significantly lower when compared to the control groups. Prolidase activity was also significantly lower in the traumatized healthy subjects compared to the other healthy group (p<0.01).

CONCLUSION

The findings of the present study suggest that the decrease in prolidase activity may have neuroprotective effects in patients with PTSD.

Altered lipid peroxidation markers are related to post-traumatic stress disorder (PTSD) and not trauma itself in earthquake survivors

The traumatic life events, including earthquakes, war, and interpersonal conflicts, cause a cascade of psychological and biological changes known as post-traumatic stress disorder (PTSD). Malondialdehyde (MDA) is a reliable marker of lipid peroxidation, and paraoxonase is a known antioxidant enzyme. The aims of this study were to investigate the relationship between earthquake trauma, PTSD effects on oxidative stress and the levels of serum paraoxonase 1 (PON1) enzyme activity, and levels of serum MDA. The study was carried out on three groups called: the PTSD group, the traumatized with earthquake exercise group, and healthy control group, which contained 32, 31, and 38 individuals, respectively. Serum MDA levels and PON1 enzyme activities from all participants were measured, and the results were compared across all groups. There were no significant differences between the PTSD patients and non-PTSD earthquake survivors in terms of the study variables. The mean PON1 enzyme activity from PTSD patients was significantly lower, while the mean MDA level was significantly higher than that of the healthy control group (p < 0.01 for both measurements). Similarly, earthquake survivors who did not develop PTSD showed higher MDA levels and lower PON1 activity when compared to healthy controls. However, the differences between these groups did not reach a statistically significant level. Increased MDA level and decreased PON1 activity measured in PTSD patients after earthquake and may suggest increased oxidative stress in these patients. The nonsignificant trends that are observed in lipid peroxidation markers of earthquake survivors may indicate higher impact of PTSD development on these markers than trauma itself. For example, PTSD diagnosis seems to add to the effect of trauma on serum MDA levels and PON1 enzyme activity. Thus, serum MDA levels and PON1 enzyme activity may serve as biochemical markers of PTSD diagnosis.

Somatosensory Amplification, Anxiety, and Depression in Patients With Hepatitis B: Impact on Functionality

In the present study, we aimed to determine the differences in body image along with anxiety and depression levels, and also to evaluate their impact on disability parameters in patients with hepatitis B.Our study comprised 77 patients with hepatitis B (n = 41, chronic active patients; n = 36, patients with inactive hepatitis B) and 53 healthy individuals (control group). Enrolled patients responded to several questionnaires, including a sociodemographic form, Sheehan Disability Scale (SDS), Hospital Anxiety and Depression Scale (HADS), and Somatosensory Amplification Scale.Patients with chronic active hepatitis B (CAHB) had higher levels of somatosensory perception than patients with inactive hepatitis B (IHB) and control group (P < 0.001, P = 0.001, respectively). Patients with CAHB had high scores on all the 3 domains of SDS (work/school, P < 0.001; social life, P < 0.001; and family life, P < 0.001). Also, patients with CAHB had a significantly higher HADS total score, HADS anxiety score, and HADS depression score than control group (P < 0.001, P < 0.001, P < 0.001, respectively). No significant difference was noted between patients with CAHB and patients with IHB with regard to HADS depression score; however, HADS anxiety and HADS total scores were significantly higher in the CAHB group (NS, P = 0.027, P = 0.035, respectively). Moreover, the IHB group exhibited higher scores for the work/school and social life domains of SDS than those of the control group (P = 0.008, P = 0.047).Although patients with CAHB may present with somatosensory amplification, anxiety, and depression, patients with IHB do not exhibit such symptoms. However, functionality is affected in both carrier and active patient groups. We believe that routine health checks of patients with hepatitis B should include psychiatric evaluation, psychiatric examination, and follow-up.

The retinal nerve fiber layer, choroidal thickness, and central macular thickness in morbid obesity: an evaluation using spectral-domain optical coherence tomography

OBJECTIVE

To assess the effect of morbid obesity on retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), retinal ganglion cell (RGC), choroidal thickness (CT), central corneal thickness (CCT), and intraocular pressure (IOP).

PATIENTS AND METHODS

Sixty-seven patients defined as having morbid or class III obesity (BMI ≥ 40; Group 1) scheduled to undergo sleeve gastrectomy surgery and 29 nonobese patients (BMI 18.50-24.99; Group 2) underwent complete ophthalmic examination for measurement of IOP, CT, RNFL thickness, CMT, RGC, and CCT. RNFL thickness, CMT, and RGC were measured using spectral-domain optical coherence tomography (SD-OCT). CT measurement was performed using the enhanced depth imaging technique of the SD-OCT. The group data were analyzed and compared using the Mann-Whitney U test and Student's t-test. The relationship between the clinical ocular variables and obesity was analyzed using the Spearman's rank correlation test.

RESULTS

The mean IOP and CCT of Group 1 were found to be significantly higher (p < 0.001) and the mean RNFL, RGC, and CT significantly lower (p < 0.05) than those of Group 2. While Group 2 was found to have a slightly larger cup-to-disc ratio and Group 1 to have a thinner CMT, the differences between Groups 1 and 2 regarding these variables were not found to be statistically significant (p = 0.322 and p = 0.072, respectively). The results of Spearmen correlation analysis indicated the existence of a moderately positive correlation between IOP and BMI (p < 0.001; r = 0.5-0.6).

CONCLUSIONS

We have demonstrated by SD-OCT that morbid obesity may have a significant influence on RNFL, RGC, and CT. Morbid obesity may induce inflammatory, hormonal, and metabolic changes.

The investigation of factors related to suicide attempts in Southeastern Turkey

BACKGROUND

Suicide is an important health problem in Turkey as it is in all regions of the world. Suicidal behavior has multiple causes, which are broadly divided into those related to proximal stressors and those due to predisposition. Suicide statistics may be associated with mental health disorders, which are among the foremost predictors of suicide attempts. More than 90% of patients who commit suicide have a diagnosable psychiatric disorder, usually a major depressive disorder. Other major risk factors for suicide attempts are history of suicide attempts in the family, stressful life events, sleep disturbances, poor income, unemployment, severity of symptoms of depression, and anxiety. Sleep is a complex phenomenon. Sleep disturbances can therefore be contributed to the emergence of suicidal behavior allowing for the possibility of predicting future suicides.

METHODS

We evaluated 106 patients who were admitted after suicide attempts to the Department of Psychiatry at Dicle University Faculty of Medicine. The recruited subjects were assessed by Structured Clinical Interview for DSM-IV Axis I disorders, and the intensity of symptoms was evaluated using the Beck Anxiety Inventory, Hamilton Depression Rating Scale, and Pittsburgh Sleep Quality Index. The mean values of the subjects attempting multiple and single suicides were compared using appropriate inferential statistical tests.

RESULTS

Most suicide attempts are believed to be preventable. Our results revealed that a great variety of risk factors are associated with an increased risk for multiple suicide attempts. Most of these attempts appeared to be spontaneous and impulsive rather than planned. In particular, this study highlights the importance of previous suicide attempts, history of suicide in the family, history of stressful life events in the previous 6 months, poor income, unemployment, sleep disturbances, severe hopelessness with depression, and coexisting symptoms of anxiety as risk factors.

CONCLUSION

The first step in prevention of suicides is doubtlessly strong and reliable communication, due to the fact that the majority of subjects who commit suicide have had contact with a health professional during the month before the suicide.

Clinical and functional outcomes and treatment options for paediatric elbow dislocations: Experiences of three trauma centres

Although elbow dislocations are seen rarely in children, their management remains controversial. In this study, over a 7 years period, we evaluated retrospectively the clinical and functional results of paediatric elbow dislocations managed in three different trauma centres. Pure dislocations and dislocations with associated injuries were evaluated separately. In total 56 patients met the inclusion criteria. The number of patients without additional injury was 22 out of which according to the Robert's criteria, 15 children (68%) had an excellent, four (18%) a good, one (5%) a fair, and two (9%) a poor outcome. From the thirty-four patients that had associated injuries, two (6%) had an excellent, 6 (18%) a good, 10 (29%) a fair and 16 (47%) a poor result. Overall, patients with pure dislocation were found to have a better range of motion compared to patients with dislocation and associated injuries. Prolonged follow ups, and effective rehabilitation programs are required in order to expect good outcomes.

Evaluation of heart rate recovery in patients with primary nephrotic syndrome

BACKGROUND/AIM

Abnormal heart rate recovery after an exercise stress test is a strong predictor of cardiovascular death in healthy subjects and various patient groups. The aim of the present study was to investigate heart rate recovery (HRR), a cardiovascular risk factor, in patients with primary nephrotic syndrome (NS).

MATERIAL AND METHODS

Forty patients with primary NS (mean age 39.6 ± 9.3 years) and 42 healthy subjects (mean age 36.0 ± 7.9) were included in the study. HRR was calculated by subtracting the heart rates in the first, second, and third minutes of the recovery period from the maximum heart rate, reached during the exercise stress test.

RESULTS

The HRR in the first minute was significantly slower in the NS group compared with the control group (25.5 ± 10.1 and 32.4 ± 11.1, respectively; p =0.004). The HRR in the second and third minutes was also slower in the NS group, but the difference was not statistically significant. When a comparative analysis of HRR and the etiology of NS was carried out, no difference was found at any time point.

CONCLUSIONS

Impaired first minute HRR was identified in patients with NS. This suggests that primary NS patients should be monitored due to the potential increased risk of cardiovascular disease. Hippokratia 2015; 19 (2):109-113.

Neutrophil-lymphocyte ratio in patients with major depressive disorder undergoing no pharmacological therapy

Studies attempting to clarify the relationship between major depressive disorder (MDD) and the immune system have been increasing in recent years. It was reported that increased production of the main proinflammatory cytokines, such as interleukin-1, interleukin-6, and tumor necrosis factor-alpha, and that of acute phase reactants may play a role in the etiopathogenesis of depression. Stress and depression were reported to increase leukocyte and neutrophil counts and to decrease lymphocyte count. Biological determinants affecting the diagnosis, therapy, and prognosis of depression are quite limited. Therefore, new etiological models are needed to explain the pathophysiology of depression. In recent years, neutrophil-lymphocyte ratio (NLR) was determined to be a good indicator of inflammatory status. There is no study in the literature investigating NLR in MDD. This study aims to examine the role of inflammation in the etiology of depression based on the NLR in MDD patients who are undergoing no pharmacological therapy. A total of 41 patients diagnosed with MDD, who received no antidepressant therapy within the past 1 month, were included in the study, which took place between January and March 2015. The control group consisted of 47 healthy subjects with no psychiatric disorders. A sociodemographic information form and a Beck Depression Scale were administered, and the blood was taken for biochemical analysis. Significant differences were identified in the NLR, neutrophil count, lymphocyte percentage, and leukocyte values of the patient group when compared with the control group (P<0.05). Our study is the first in which NLR was investigated in MDD. The findings of the study reveal that NLR tends to be higher in patients with MDD, and a high NLR value supports the view that inflammation is a critical factor in the etiology of MDD.

Emergency Department Overcrowding in Turkey: Reasons, Facts and Solutions

INTRODUCTION

The purpose of this study was to determine the factors affecting the long waiting times of the patients in a university hospital.

METHODS

This study included 3000 of the adults above 18 years and pediatric trauma patients under 18 years who applied to emergency department between February 2009 and April 2009. The examination period of the physician, length of stay, length of hospitalization, waiting times for hospitalization and follow up times in the emergency department were recorded. Moreover, the patients were divided into four groups according to the reasons for waiting.

RESULTS

In our study, the time period between 4 pm-12 pm was determined as the busiest time for the applications. Average length of stay in the emergency department for 3000 patients was 146.7±160.2 minutes. The length of stay for the patients consulted was longer than the length of stay for the ones who were not consulted. Because of the fact that our hospital did not have appropriate bed capacity, 41.1% of the patients waited less than two hours, 13. 4% of the patients waited more than 8 hours. It was also found that the waiting times of the Group two patients (206,7±145,2 minutes) was longer than Group one (95,5±73,9 minutes) patients and the waiting times of Group three patients (470,7±364,7 minutes) was longer than Group one patients.

CONCLUSIONS

In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.

Latent class analysis of obsessive-compulsive symptoms in a clinical sample

OBJECTIVE

Obsessive-compulsive disorder (OCD) is probably a heterogeneous condition. To date, research investigating the symptom structure of OCD has generally focused on variable-classification approaches, primarily factor analysis. Our aim was to use the latent class analysis, an advanced individual-classification method, in order to define homogeneous sub-groups based on the Yale-Brown Obsessive-Compulsive Scale Check List (Y-BOCS CL) assessments within 193 outpatients with OCD.

METHOD

Latent class analysis of 13 obsessive-compulsive symptom-clusters measured by the Yale-Brown Obsessive-Compulsive Scale Check List was performed. Associations of demographic and clinical features with latent class membership were tested by using logistic regression models. Differences in severity of obsessive-compulsive symptoms, obsessive beliefs, and depressive symptomotology between latent classes were evaluated with the chi-square likelihood test.

RESULTS

Latent class analysis models of best fit yielded 3 latent classes: "autogenous obsessions", "reactive obsessive-compulsive", and "reactive obsessions". Outpatients in reactive obsessive-compulsive group reported significantly higher scores on the Y-BOCS global, obsessions, and compulsions scales than outpatients in other two sub-groups. Participants in reactive obsessive-compulsive group were predominantly female, single, and had a history of family psychopathology; whereas autogenous and reactive obsessions groups were predominantly male. There were no differences in severity of depression and obsessive belief domains.

CONCLUSIONS

The results provide support for the validity of autogenous/reactive distinction for OCD. These three classes may have important implications for research and clinical purposes.

The relationship between the neutrophil-lymphocyte ratio and the coronary collateral circulation in patients with chronic total occlusion

OBJECTIVES

Previous studies showed the association between the major adverse cardiovascular outcomes and both higher neutrophil and lower lymphocyte counts. We aimed to investigate whether there is an association between the neutrophil-lymphocyte ratio (NLR) value and the development of coronary collateral circulation (CCC) in patients with coronary chronic total occlusion (CTO).

METHODS

A total of 274 patients with CTO were included in this study. Patients were then classified according to their Rentrop collateral grades as either poor (Rentrop grades 0-1) or good (Rentrop grades 2-3). Clinical information and analyses of blood samples were obtained from a review of the patients' charts.

RESULTS

Although there was no difference between the two groups with regard to cardiovascular risk profiles, the NLR values were significantly higher in the patients who had poorly developed CCC (2.6 ± 0.5 vs 2.2 ± 0.4, p<0.001). NLR, high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBC), age, diabetes, fasting glucose levels and body mass index were found to have univariate association with poorly developed CCC (p<0.1). In a multivariate logistic regression model, NLR (odds ratio 1.88, 95% confidence interval (CI) 1.37-2.74; p<0.001), high-sensitivity C-reactive protein and WBC were found to be the independent predictors of poor CCC. In receiver operator characteristic curve analysis, the optimal cut-off value of NLR to predict poor CCC was found as 2.17, with 77% sensitivity and 65% specificity.

CONCLUSION

NLR, as a novel cardiovascular risk marker, is an important, simple and inexpensive method which can be used by the cardiologist as a screening inflammation tool to estimate the development of CCC in patients with CTO.

Effect of cardiac rehabilitation on left atrial functions in patients with acute myocardial infarction

BACKGROUND

The objective of this study was to analyze the effects of cardiac rehabilitation (CR) on the atrial function of patients with acute myocardial infarction (AMI) who had been successfully revascularized through percutaneous coronary intervention (PCI).

METHODS

Forty-two AMI patients having undergone CR were enrolled in this observational study. Assessments were performed before and after 6 weeks of CR. Left atrial strain analysis was carried out by two-dimensional speckle tracking echocardiography. Left ventricular ejection fraction (LVEF) was measured by the biplane Simpson's method. Pulsed-wave Doppler at the tip of mitral valve leaflets enabled us to measure early (E) and late (A) diastolic filling velocities, deceleration time (DT) of early filling velocity and isovolumic relaxation time (IVRT). Left ventricle tissue velocity was measured by tissue Doppler imaging of the lateral mitral annulus (e') and E/e' was subsequently calculated. Ratio of E/e' to left atrium (LA) peak strain was used to estimate LA stiffness.

RESULTS

Following CR, LVEF (P=0.010), LA strain (P<0.001) and LA stiffness (P=0.013) all showed improvement, while other parameters remained unchanged.

CONCLUSION

Post-AMI cardiac rehabilitation and revascularization by PCI might have favourable effects on LA function.

Cilostazol decreases total atrial conduction time in patients with peripheral artery disease

Objective:

Total atrial conduction time (TACT) is the most important parameter in predicting the development of new-onset atrial fibrillation. We investigated the effect of cilostazol therapy on TACT in patients with peripheral artery disease.

Methods:

Thirty patients with peripheral artery disease were treated with cilostazol (200 mg/day) for 6 months. The baseline echocardiographic total atrial conduction time parameter was compared with the 6-month follow-up.

Results:

The TACT duration was decreased in all patients compared with the baseline after therapy (121.8 ± 19.3 vs. 109.1 ± 15.9 milliseconds, p<0.001). However, left atrial (LA) diameter was not changed with the therapy. The reduction of TACT duration was correlated with the increase in mitral E wave velocity/mitral A wave velocity ratio (r=-0.48, p<0.003).

Conclusion:

Our results showed that 200 mg cilostazol treatment decreased TACT duration in patients with peripheral artery disease, which may also prevent the development and/or recurrence of atrial fibrillation (AF).

Predictive value of obsessive compulsive symptoms involving the skin on quality of life in patients with acne vulgaris

Acne is one of the most common dermatological diseases, and obsessive compulsive disorder is among the most frequent psychiatric conditions seen in dermatology clinics. Comorbidity of these conditions may therefore be expected. The aim of this study was to measure obsessive compulsive symptoms and quality of life in patients with acne vulgaris, compare them with those of healthy control subjects, and determine whether there is any predictive value of obsessive compulsive symptoms for quality of life in patients with acne. Obsessive compulsive symptoms and quality of life measurements of 146 patients with acne vulgaris and 94 healthy control subjects were made using the Maudsley Obsessive Compulsive Questionnaire and Short Form-36 in a cross-sectional design. Patients with acne vulgaris had lower scores for physical functioning, physical role dysfunction, general health perception, vitality, and emotional role dysfunction. They also had higher scores for checking, slowness, and rumination. The only predictor of physical functioning and vitality dimensions of health-related quality of life in these patients was rumination score. Obsessive compulsive symptoms in patients with acne vulgaris are higher than in controls, and this may correlate with both disease severity and quality of life for patients.