Can the Gut Microbiota Serve as a Guide to the Diagnosis and Treatment of Childhood Epilepsy?

BACKGROUND

To investigate the activity of the gut-brain axis in the pathogenesis of childhood epilepsy and to define biomarkers capable of assisting with determining new strategies in that context.

METHODS

Twenty children with epilepsy of "unknown etiology" and seven healthy controls in the same age group were included in the study. The groups were compared using a questionnaire. Stool samples were stored in tubes containing DNA/RNA Shield (Zymo Research) with a sterile swab. Sequencing was carried out using the MiSeq System (Illumina). The 16S rRNA sequencing of samples using next-generation sequencing involved V4 variable region polymerase chain reaction amplification concluded by 2 × 250-bp paired-end sequencing of amplicons and at least 50,000 reads (>Q30) per sample. DNA sequences were classified at the genus level using the Kraken program. Bioinformatics and statistical analysis were then performed.

RESULTS

Individuals' gut microbiota relative abundance values differed between the groups at the genus, order, class, family, and phylum levels. Flavihumibacter, Niabella, Anoxybacillus, Brevundimonas, Devosia, and Delftia were seen only in the control group, whereas Megamonas and Coriobacterium were observed only in the epilepsy group. The linear discriminant analysis effect size method identified 33 taxa as important in differentiating the groups.

CONCLUSIONS

We think that bacterial varieties (such as Megamonas and Coriobacterium) that differ between the two groups can be employed as useful biomarkers in the diagnosis and follow-up of epileptic patients. We also predict that, in addition to epilepsy treatment protocols, the restoration of eubiotic microbiota may increase the success of treatment.

Comparison of mothers of adolescents diagnosed with type 1 diabetes mellitus and mothers of healthy adolescents in terms of difficulty in emotion regulation, depression and anxiety levels and clinical variables

BACKGROUND

The aim of our study was to evaluate the difficulty in emotion regulation, depression and anxiety levels of mothers with a child diagnosed with type 1 diabetes mellitus (T1DM) compared to mothers of the non- T1DM control group.

METHODS

Our study included 72 adolescents followed up with T1DM and 72 healthy adolescents and their mothers. Psychiatric evaluation of children was performed according to DSM-IV diagnostic criteria. All mothers were administered the `Difficulties in Emotion Regulation Scale-Brief Form (DERS-16)` and the `Hospital Anxiety-Depression Scale (HAD)`.

RESULTS

The most common psychiatric diagnoses in the T1DM group were attention deficit and hyperactivity disorder and anxiety disorders. The total and subscale scores of the DERS-16 and HAD scales of the mothers in the T1DM group were significantly higher than the control group. There was a statistically significant positive correlation between the DERS-16 total score and the HAD total and subscale scores of the mothers in the T1DM group. In the multivariate model found to be significant (p < 0.001), only HbA1c levels an indicator of metabolic control, had significant and negative effects on emotion regulation, anxiety and depression (p < 0.05), while sociodemographic characteristics did not have a significant effect (p > 0.05) Conclusions. Difficulty in emotion regulation and depression-anxiety levels were found to be higher in mothers of adolescents with T1DM compared to the control group. Difficulties in emotion regulation, depression and anxiety symptoms in the parent may reduce the treatment compliance of the adolescent with T1DM, which may result in worse metabolic control. Therefore, both adolescents and their parents should be evaluated in terms of psychiatric symptoms and necessary guidance should be given.

Should isoniazid prophylaxis be prescribed to the patients under tumor necrosis factor-alpha antagonists independent of tuberculin skin test?

INTRODUCTION

The aim of this study was to present the follow-up results of 110 patients who were given anti-tumor necrosis factor alpha (TNF-α) therapy for rheumatic and dermatologic diseases in a country with a high rates of active and latent tuberculosis bacillus infection.

MATERIAL AND METHODS

Between February 2008 and January 2015, 110 cases in the age range of 23-77 who are using anti-TNF-α were included in the study retro-prospectively.

RESULTS

52.7% of them (n = 58) were male. The most common diagnoses were rheumatoid arthritis (42.7%) and ankylosing spondylitis (38.2%). Most frequently given treatment were infliximab 37.3% and etanercept 30.9%, respectively. The 65 patients whose first tuberculin skin test (TST) value "5 mm and above" was started daily 300 mg INH prophylaxis for 9 months but 3 patients had not been started because of refusing treatment. In only one case chemoprophylaxis has had to be interrupted because of high liver function test due to the INH prophylaxis. TST conversion was observed in 14 patients. Further follow-up, it was observed that 4 patients had TST's positivity. Isoniazide (INH) prophylaxis was started these 18 patients (42.9%). Although INH prophylaxis has been given in two patients, they developed active tuberculosis in follow-up.

CONCLUSION

Considering the INH resistance in our country, all patients especially the ones with residual lesion and history of previous exposure, should be followed up closely during the anti-TNF-α treatment.

Internipple Distance and Internipple Index in Prepubertal Turkish Girls

OBJECTIVE

To determine internipple distance and internipple index in prepubertal Turkish girls.

METHODS

The internipple distance and chest circumference of 667 healthy prepubertal Turkish girls aged 6 to 11 years were measured in a school screening program in Düzce. Measurements were performed at the end of expiration with a standard non-stretch tape measure graduated in millimeters with the arms hanging in a relaxed position on the sides of the body. The internipple distance was measured between the centers of both nipples, and chest circumference was measured across the internipple line. The internipple index was calculated by dividing the internipple distance (cm) x100 by the chest circumference (cm). Age specific internipple index reference curves were constructed and smoothed with the Lambda-Mu-Sigma method. Mean and standard deviations of internipple distance and internipple index were calculated according to decimal ages.

RESULTS

Age was found to be positively correlated with internipple distance and chest circumference, while it was negatively correlated with internipple index. The reference values of internipple index, including 3^rd, 10^th, 25^th, 50^th, 75^th, 90^th, and 97^th percentiles, and standard deviations were calculated for prepubertal girls.

CONCLUSION

The reference ranges provided by this study might be helpful for the evaluation of syndromic cases by serving as normative data for internipple index in prepubertal girls aged 6-11 years in Turkey although ethnic differences may affect applicability to other countries.

Effects of climate and air pollution factors on outpatient visits for eczema: a time series analysis

Eczema resulting from external and internal factors accounts for the biggest global burden of disability owing to skin disease. This study aimed to determine an association between environmental factors and outpatient clinic visits for eczema. We collected data on dermatology clinic outpatient visits for eczema between January 2013 and July 2019. Data concerning environmental factors during this period were collated using national air quality network and air monitoring measurement parameters, namely barometric pressure, relative humidity, air temperature, and air pollutant concentrations, such as sulfur dioxide (SO₂) and particulate matter (PM₁₀). A distributed lag nonlinear model was used to investigate the relationship among eczema, environmental factors, and lagged effects. In total, 27,549 outpatient visits for eczema were recorded. In both single-factor and multiple-factor lag models, the effects of a 10-µg/m³ increase in PM₁₀ and SO₂ values had significantly positive effects on the number of daily outpatient visits over a total 5 days of lag after adjusting for temperature, the number of daily outpatient visits increased with 0.87%, 7.65% and 0.69%, 5.34%, respectively. Relative humidity (RR = 1.3870, 95% CI 1.3117-1.4665) and pressure (RR = 1.0394, 95% CI 1.0071-1.0727) had significantly positive effects on the number of daily outpatients in single-factor lag models. However temperature had a significantly negative effect on them in the number of daily outpatients (RR = 0.9686, 95% CI 0.9556-0.9819). Exposure to air pollution exacerbated eczema. Outpatient visits for eczema were found to have strong positive associations with changes in PM₁₀ levels.

Analysis of HPV Genotypes and Liquid-Based Cervical Cytology: Results from a Tertiary Academic Center in Northwestern Turkey

High-risk human papilloma virus (hrHPV) plays an important role in cervical cancer. The aim of this study was to investigate the distribution of HPV genotypes in the region and to correlate it with liquid-based-cytology (LBC) and colposcopic biopsy results. Furthermore, the potential relationship between HPV infections and bacterial vaginosis (BV) was investigated. HPV genotypes were determined using real-time PCR. LBC, biopsies, and BV examinations were performed by the Pathology and Cytology. Consecutive cervical specimens of 409 women who underwent both cytology and HPV-DNA tests were included in the study. A total of 172 (42.1%) patients were positive for HPV-DNA; of these, 107 (26.2%) had hrHPV. The most common HPV genotypes were HPV 59, 16, 33, 52, and 51, at 16.6%, 15.9%, 13.4%, 13.4%, and 8.9%, respectively. Epithelial cell abnormality was detected in 11.5% of LBC test results. The genotypes of HPV 33, 56, 66, and 68 were found at a higher rate in patients with epithelial cell abnormalities than in those with no detected abnormalities. Bacterial vaginosis was found in 24 patients (5.9%). HPV-DNA positivity was observed to be statistically higher in patients with BV than in those without BV.

The Role of Clozapine as a Mood Regulator in the Treatment of Rapid Cycling Bipolar Affective Disorder

OBJECTIVE

In this study, we aimed to investigate the effect of the clozapine on the course of the rapid cycling Bipolar Affective Disorder.

METHOD

The study group was formed with the patients aged between 18 and 65 years of age, who met the criteria for the diagnosis of Bipolar Affective Disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition, with rapid cycling characteristics. Variables like the number of mania and depressive episodes, the days spent in mania and in depression and the number of hospitalization and attempted suicide, in the year before starting clozapine were determined and compared with the annual data after starting the clozapine.

RESULTS

Eleven female and two male patients who met the inclusion criteria were included in this study. The group`s average daily use of clozapine was 180 mg (25-600 mg). There was a statistically significant difference in the number of days spent in the depression, the days spent in the mania, the number of depressive episodes and manic episodes, the number of hospitalizations and the suicide attempts after the clozapine use.

CONCLUSION

In this study, it was determined that clozapine was effective as a mood stabilizer in Bipolar Affective Disorder treatment. The results show that clozapine reduces the episode frequency and the duration in rapid cycling Bipolar Affective Disorder which does not respond to all conventional treatments, including lithium, valproic acid, carbamazepine and antipsychotic drugs.