Panoramic Radiography in the Evaluation of the Relationship of Maxillary Molar Teeth and Maxillary Sinuses on the Deep Learning Models Improved with the Findings Obtained by Cone Beam Computed Tomography.

BACKGROUND: Panoramic radiography (PR) is available to determine the contact relationship between maxillary molar teeth (MMT) and the maxillary sinus floor (MSF). However, as PRs do not provide clear and detailed anatomical information, advanced imaging methods can be used. AIM: The aim of this study was to evaluate the diagnostic performance of deep learning (DL) applications that assess the relationship of the MSF to the first maxillary molar teeth (fMMT) and second maxillary molar teeth (sMMT) on PRs with data confirmed by cone beam computed tomography (CBCT). METHODS: A total of 2162 fMMT and sMMT were included in this retrospective study. The contact relationship of teeth with MSF was compared among DL methods. RESULTS: DL methods, such as GoogLeNet, VGG16, VGG19, DarkNet19, and DarkNet53, were used to evaluate the contact relationship between MMT and MSF, and 85.89% accuracy was achieved by majority voting. In addition, 88.72%, 81.19%, 89.39%, and 83.14% accuracy rates were obtained in right fMMT, right sMMT, left fMMT, and left sMMT, respectively. CONCLUSION: DL models showed high accuracy values in detecting the relationship of fMMT and sMMT with MSF.

Validation of the Turkish version of Endometriosis Health Profile questionnaire (EHP-30) to evaluate the quality of life in women with endometriosis.

Background: The Endometriosis Health Profile-30 (EHP-30) is a commonly used tool for assessing the impact of endometriosis on a person's quality of life. The EHP-30 is a 30-item questionnaire that measures various aspects of endometriosis-related health, including physical symptoms, emotional well-being, and functional impairment. Objectives: EHP-30 has not yet been evaluated with Turkish patients. Therefore, we aim to develop and validate the Turkish version of EHP-30 in this study. Materials and Methods: This cross-sectional study was conducted with 281 randomly selected patients from Turkish Endometriosis Patient-Support Groups. The items of the EHP-30 distributed across 5 subscales of the core questionnaire are generally applicable to all women with endometriosis. There are 11 items on the pain scale, 6 on the control and powerlessness scale, 4 on the social support scale, 6 on the emotional well-being scale, and 3 on the self-image scale. The patients were asked to complete the form with brief demographic information and psychometric evaluation included factor analysis, convergent validity, internal consistency, test-retest reliability, data completeness and the determination of floor and ceiling effects. Main outcome measure: The main outcomes measures were the test-retest reliability, internal consistency, and the assessment of construct validity. Results: In this study, 281 completed questionnaires were included with a return rate of 91%. Data completeness was accepted as excellent on all subscales. Floor effects were found in medical profession (37%), children (32%) and work (31%) modules. No ceiling effects were found. Division of the core questionnaire into five subscales identical to the original EHP-30 was confirmed by factor analysis performed. The intraclass correlation coefficient for agreement varied from 0.822 to 0.914. There was agreement between the EHP-30 and EQ-5D-3L on both of the hypotheses that were tested. There was a statistically significant difference in scores between endometriosis patients and healthy women across in all subscales (p<.01). Conclusion: The results of this validation study for the EHP-30 indicated a high level of data completeness, with no significant floor or ceiling effects. The questionnaire demonstrated good internal consistency and excellent test-retest reliability. These findings confirm that the Turkish version of the EHP-30 is a valid and reliable toolfor measuring the health-related quality of life in individuals with endometriosis. What's new?: EHP-30 had not yet been evaluated with Turkish patients and the results of this study demonstrate the validity and reliability of the Turkish translation of the EHP-30 in assessing endometriosis patients' health-related quality of life.

Obturator nerve endometriosis: A systematic review of the literature.

Background: Symptomatic obturator nerve endometriosis is a rare condition. In this paper, we aim to review and discuss the characteristics of obturator nerve endometriosis in light of current literature. Methods: An electronic search was conducted using the PubMed/Medline database. Results: Symptomatic obturator nerve endometriosis is rare; only 8 cases have been reported in the literature. Symptoms including difficulty walking, weak thigh adduction and pain in the inner thigh, which are all related to obturator nerve function, could be seen in the case of the entrapment of the nerve by endometrial nodules. A history of recurrent symptoms during menstrual cycles and physical examination, combined with appropriate radiologic imaging, led to a suspicion of obturator nerve involvement. Conclusion: Early diagnosis and surgical treatment of obturator nerve endometriosis is essential to minimise the nerve damage caused by recurrent cycles of bleeding and fibrosis, which are characteristics of endometriosis. The laparoscopic minimally invasive technique is feasible for the surgery of obturator nerve endometriosis. It offers the advantage of precise discrimination of vital structures and excellent access to deep anatomic sites. What is New?: Obturator nerve endometriosis may be a severe cause of chronic pelvic pain in women of reproductive age. Treatment may be achieved surgically and in experienced hands, laparoscopic surgery would be the preferred choice.

Surgical Treatment of Catamenial Chest Pain: Excision of diaphragmatic endometriosis during robot-assisted laparoscopic surgery.

Background: 10% of women of reproductive age are affected by endometriosis, and diaphragmatic endometriosis represents 1-1.5% of these cases. Diaphragmatic endometriotic lesions often require surgical treatment. Objective: This video aims to demonstrate the appearance of diaphragmatic endometriosis and describe our experience with robot-assisted laparoscopic excision of full thickness diaphragmatic endometriosis. Materials and Methods: The patient was a 37-year-old female with the complaint of cyclical right shoulder pain (for 1 year). She previously had caesarean section scar and umbilical endometriosis excision procedures. The magnetic resonance imaging (MRI) of the abdomen highlighted three endometriotic nodules, one of which was described as full thickness on the right hemi-diaphragm. The patient underwent a robot-assisted laparoscopic endometriosis surgery as a joint procedure between the gynaecology and general surgery teams. The falciform ligament was completely divided to obtain full views of the endometriotic lesions on the diaphragm. Superficial diaphragmatic lesions were first excised. The larger deep nodule, which was described on the MRI, was then excised with the full thickness of diaphragm. Pleural cavity was entered intentionally to achieve complete excision of the nodule. Laparoscopic assessment of the right lower pleural cavity through this opening did not show any endometriotic lesions. After the excision, the diaphragm was repaired with a barbed suture. Negative pressure suction of the pleural cavity was performed at the end of this repair instead of using a chest tube. Results: The patient was discharged on the 3rd day with no complications encountered. Histopathological examination confirmed endometriosis. The patient was asymptomatic three months after surgery. Conclusion: Robotic-assisted surgery is an easy and safe choice especially in such challenging dual compartment surgeries by providing a 3D view that abolishes sensory loss and increases depth perception, providing better manoeuvrability with tremor absence.

Risk factors for diabetic foot ulcers in metreleptin naïve patients with lipodystrophy.

AIM: Patients with lipodystrophy are at high risk for chronic complications of diabetes. Recently, we have reported 18 diabetic foot ulcer episodes in 9 subjects with lipodystrophy. This current study aims to determine risk factors associated with foot ulcer development in this rare disease population. METHODS: Ninety metreleptin naïve patients with diabetes registered in our national lipodystrophy database were included in this observational retrospective cohort study (9 with and 81 without foot ulcers). RESULTS: Patients with lipodystrophy developing foot ulcers had longer diabetes duration (p = 0.007), longer time since lipodystrophy diagnosis (p = 0.008), and higher HbA1c levels (p = 0.041). Insulin use was more prevalent (p = 0.003). The time from diagnosis of diabetes to first foot ulcer was shorter for patients with generalized lipodystrophy compared to partial lipodystrophy (p = 0.036). Retinopathy (p < 0.001), neuropathy (p < 0.001), peripheral artery disease (p = 0.001), and kidney failure (p = 0.003) were more commonly detected in patients with foot ulcers. Patients with foot ulcers tended to have lower leptin levels (p = 0.052). Multiple logistic regression estimated significant associations between foot ulcers and generalized lipodystrophy (OR: 40.81, 95% CI: 3.31-503.93, p = 0.004), long-term diabetes (≥ 15 years; OR: 27.07, 95% CI: 2.97-246.39, p = 0.003), and decreased eGFR (OR: 13.35, 95% CI: 1.96-90.67, p = 0.008). CONCLUSIONS: Our study identified several clinical factors associated with foot ulceration among patients with lipodystrophy and diabetes. Preventive measures and effective treatment of metabolic consequences of lipodystrophy are essential to prevent the occurrence of foot ulcers in these high-risk individuals.

The importance of Dentistry in COVID-19 pandemic and the role of saliva as a diagnostic tool / A importância da Odontologia na pandemia do COVID-19 e o papel da saliva como meio diagnóstico

ABSTRACT News of the symptoms caused by a coronavirus in humans began to be documented in December 2019, when several cases of pneumonia caused by the virus occurred in China. Studies are showing the increasing role of saliva and oral cavity in the transmission of the virus, because the receptors of epithelial cells in this region play a critical role by allowing the virus to enter those cells. The standard method to diagnose the coronavirus is based on the collection of samples in the nasopharynx and oropharynx to detect viral RNA. However, this method results in the interaction between health care professionals and patients, which increases risk of transmission; moreover, this collection can be painful for the patient and cause bleeding. As an alternative, diagnosis can be made using saliva, which only requires patients to deposit the saliva sample in a sterile container. Thus, the objective of this literature review is to present the main forms of contagion and to describe the diagnosis tools, emphasizing the risk that dental professionals are exposed to and, therefore, the growing need for better and faster diagnostic methods for coronavirus, especially using saliva. Medline, PubMed, SciELO, and Bireme databases were used for the literature search with the descriptors: Salivary diagnosis, COVID-19, and Contagion. The review explored the scientific race to develop more effective forms of diagnosis, including saliva tests, and prevention methods taking into account time, accessibility, and cost-benefit and, as a consequence, the role of dentistry has been continuously increasing.

RESUMO As notícias dos sintomas causados pelo coronavírus nos seres humanos começaram a ser documentadas em Dezembro de 2019, quando vários casos de pneumonia causados pelo vírus ocorreram na China. Estudos mostram o papel crescente da saliva e cavidade oral na transmissão do vírus, pois os receptores das células epiteliais nessa região desempenham um papel crítico ao permitir que o vírus entre nas células. O método padrão de diagnóstico do coronavírus se dá a partir da coleta de amostras na nasofaringe e orofaringe para detectar o RNA viral. Entretanto, esse método resulta na interação entre profissional e paciente, levando ao risco de transmissão e, além disso, essa coleta pode ser dolorida para o paciente e causar sangramentos. Como solução, surgiu o diagnóstico através da saliva, que necessita apenas que os pacientes a depositem em um recipiente estéril. Assim, o objetivo do presente trabalho é explicar, através de uma revisão da literatura, as principais formas de contágio e diagnóstico, enfatizando o alto risco que o profissional odontológico sofre e, por isso, a crescente necessidade de melhores e mais rápidas formas de diagnóstico do coronavírus, especialmente através da saliva. Para a busca da literatura foram utilizadas os descritores: Diagnóstico salivar, COVID-19 e Contágio, com busca nas bases de dados Medline, Pubmed, Scielo e Bireme. Foi concluído que existe atualmente uma corrida científica para a criação de formas mais eficazes de diagnóstico e prevenção, levando em consideração tempo, acessibilidade e custo-benefício e, como consequência, a importância da odontologia vem crescendo continuamente.

[Alexithymia and Pathological Gambling: The Mediating Role of Difficulties in Emotion Regulation]. / Aleksitimi ve Patolojik Kumar: Duygu Düzenleme Güçlügünün Araci Rolü.

OBJECTIVE: The main objective was to determine the prediction level of alexithymia and difficulties in emotion regulation on pathological gambling. Secondly, this study aimed to examine the mediating role of difficulties in emotion regulation on the relationship between alexithymia and pathological gambling. METHOD: The sample was consisted of 246 male gamblers. The average age was 33.30 with a standard deviation of 11.62. In addition to socio-demographic form, The South Oaks Gambling Screen (SOGS), Toronto Alexithymia Scale (TAS-20) and Difficulties in Emotion Regulation Scale (DERS) were used to collect data. RESULTS: Regression analyses revealed that amount of money bet, total score of TAS-20 and DERS significantly predicted pathological gambling. In addition to these, difficulties in emotion regulation have a partial mediator role in the relationship between alexithymia and pathological gambling. CONCLUSION: It is argued that individuals high in alexithymia become prone to addiction behavior through emotion dysregulation. In addition to the alexithymia level, difficulties in emotion regulation are seen to play an important role in pathological gambling. In this context, this study contributes to the relevant literature by discussing alexithymia, emotion regulation and pathological gambling together.

A Fully Functional Drug-Eluting Joint Implant.

Despite advances in orthopedic materials, the development of drug-eluting bone and joint implants that can sustain the delivery of the drug and maintain the necessary mechanical strength in order to withstand loading has remained elusive. Here, we demonstrate that modifying the eccentricity of drug clusters and the percolation threshold in ultrahigh molecular weight polyethylene (UHMWPE) results in maximized drug elution and in the retention of mechanical strength. The optimized UHMWPE eluted antibiotic at a higher concentration for longer than the clinical gold standard antibiotic-eluting bone cement while retaining the mechanical and wear properties of clinically used UHMWPE joint prostheses. Treatment of lapine knees infected with Staphylococcus aureus with the antibiotic-eluting UHMWPE led to complete bacterial eradication and to the absence of detectable systemic effects. We argue that the antibiotic-eluting UHMWPE joint implant is a promising candidate for clinical trials.

Is early embryo cleavage a factor to increase success in all types of ICSI indications?.

PURPOSE: The authors aimed to compare early embryo cleavage with pregnancy rates in intracytoplasmic sperm injection/embryo transfer (ICSI/ET) cycles due to male infertility or tubal factor infertility (TFI). MATERIALS AND METHODS: 412 ICSI/embryo transfer cycles undergoing treatment for over two years were prospectively analyzed; 337 of the cycles were due to male infertility, whereas 75 suffered from tubal factors. Non-early cleaved (NEC) embryos were used for ET in 271 male factor and 67 tubal factor cycles, whereas early cleavage embryos were used for embryo transfer in 66 male factor and eight tubal factor cycles. RESULTS: In 66 out of 337 cycles (19.58 %) in male factor group and in eight out of 75 tubal factor cycles (10.66%), early cleavage (EC) embryos were obtained (p = 0.069). The clinical pregnancy rate was significantly elevated in EC subgroup (34.8%) compared to NEC subgroup (20.6%) (p = 0.015) in the male factor infertility group. The clinical pregnancy rate was non-significantly elevated in EC subgroup (37.5%) compared to NEC subgroup (23.8%) (p = 0.410) in the TFI group. CONCLUSIONS: The authors found that the implantation and pregnancy success of EC embryos vary with the therapeutic indication. The success rate would be low even with usage of EC embryos in untreated cycles of TFI.

Comparison of follitropin alfa and urinary gonadotropins in IVF cycles.

AIM: The aim of this study was to compare human menopausal gonadotropins with recombinant follicle stimulating hormone-follitropin alpha following a long down-regulation protocol in intra cytoplasmic sperm injection cycles in our clinic, and to review the outcomes in the light of preceding studies. METHODS: This was a retrospective study. Among a total number of 2798 patients who had undergone IVF/ICSI applications, 579 eligible patients were included, and their data were evaluated retrospectively. Three hundred eighteen patients were treated with follitropin alpha and 255 patients were treated with hMG. Total units of follitropin alpha preparations used in ovulation induction, total number of meiois-2 phase oocytes, total number of used oocytes in ICSI cycle, fertilization rate and clinical pregnancy rates of both groups were analyzed. RESULTS: Mean duration of stimulation was longer in the group of patients treated with rFSH-α compared to the second group of patients treated with hMG (8.88 days and 8.55 days, respectively; P<0.05). The number of transferred embryos were 3.08 and 2.68 for patients treated with follitropin alpha and hMG, respectively (P<0.05). Clinical pregnancy rates were %28 and %33 in the groups of patients treated with follitropin alpha and hMG, respectively. Even though a greater clinical pregnancy rate was noted in the hMG group, there was no statistically significant difference between the two groups (P>0.05). CONCLUSION: Our results indicate that there is no statistically significant difference between follitropin alpha and human menopausal gonadotropin in terms of the clinical pregnancy rates.

Metabolic syndrome prevalence in different affective temperament profiles in bipolar-I disorder.

OBJECTIVE: Temperament originates in the brain structure, and individual differences are attributable to neural and physiological function differences. It has been suggested that temperament is associated with metabolic syndrome (MetS) markers, which may be partly mediated by lifestyle and socioeconomic status. Therefore, we aim to compare MetS prevalence between different affective temperamental profiles for each season in bipolar patients. METHODS: Twenty-six bipolar type-I patients of a specialized outpatient mood disorder unit were evaluated for MetS according to new definition proposed by the International Diabetes Federation in the four seasons of a year. Temperament was assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego - autoquestionnaire version (TEMPS-A). RESULTS: The proportions of MetS were 19.2, 23.1, 34.6, and 38.5% in the summer, fall, spring, and winter, respectively. Only depressive temperament scores were higher (p = 0.002) during the winter in patients with MetS. CONCLUSION: These data suggest that depressive temperament profiles may predispose an individual to the development of MetS in the winter.

Metabolic syndrome prevalence in different affective temperament profiles in bipolar-I disorder

Objective: Temperament originates in the brain structure, and individual differences are attributable to neural and physiological function differences. It has been suggested that temperament is associated with metabolic syndrome (MetS) markers, which may be partly mediated by lifestyle and socioeconomic status. Therefore, we aim to compare MetS prevalence between different affective temperamental profiles for each season in bipolar patients. Methods: Twenty-six bipolar type-I patients of a specialized outpatient mood disorder unit were evaluated for MetS according to new definition proposed by the International Diabetes Federation in the four seasons of a year. Temperament was assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego - autoquestionnaire version (TEMPS-A). Results: The proportions of MetS were 19.2, 23.1, 34.6, and 38.5% in the summer, fall, spring, and winter, respectively. Only depressive temperament scores were higher (p = 0.002) during the winter in patients with MetS. Conclusion: These data suggest that depressive temperament profiles may predispose an individual to the development of MetS in the winter. .

How olfaction disorders can cause depression? The role of habenular degeneration.

The removal of bilateral olfactory bulbs (OBs) can result in serious behavioral, neurochemical, neuroendocrine, and neuroimmune alterations in depressed patients. However, there is little information on how olfactory bulbectomy (OBX) leads to depression. Habenular nuclei and their connections are important in the regulation of psychomotor and psychosocial behaviors through afferent impulses of the olfactory system. Therefore, we investigated whether OB lesions lead to habenular degeneration. We used a sample of 50 rats (25 female and 25 male) for this study. Of these rats, five male and five female rats were taken as the control group. The remaining 40 rats (20 male and 20 female rats) constituted the study group, and frontal burr holes were performed at the OB level on these rats. OB cauterization was applied to 10 male and 10 female rats (n=10, 10; study group 1), mechanical OBX was applied to five male and five female rats (n=5, 5; study group 2), and no procedure was performed on the remaining 10 rats (n=5, 5). The psychomotor movements; pregnancy rates; and sexual, feeding, maternal, social, and grooming behaviors for both study groups were observed daily for 3 months. Their OBs, olfactory cortices, and habenular complexes were examined using stereological methods. All of the animals in the study groups, especially in the cauterization group, demonstrated anorexia, nutritional disorders, weight loss, psychomotor retardation, sexual aversion, decreased grooming behavior, and reduced social interaction similar to depression symptoms. As compared to the control group, the pregnancy rates, number of offspring per mother rat, and birth weights in the study groups were lower, whereas the number of stillbirths was higher. Gross anatomical examinations revealed that the OBs of all of the animals in the study groups were atrophied. Histopathological examinations detected prominent neuronal loss due to apoptosis in the habenular structures in the study groups. We detected a relationship between a decreased healthy neuronal density of the habenula and depressive symptomatology in rats with OBX. We suggest that olfaction disorders might cause neuropsychiatric disorders by affecting neuronal degeneration in habenular nuclei.

Luteal serum BDNF and HSP70 levels in women with premenstrual dysphoric disorder.

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome characterized by psychological and somatic symptoms commencing in the luteal phase of the menstrual cycle and concludes with menstrual bleeding. PMDD affects 3-8 % of premenopausal women and represents a significant public health problem especially in young women. Decreased brain-derived neurotrophic factor (BDNF) levels are associated with several mental disorders. Heat-shock protein-70 (HSP70) is an important member of the molecular chaperone system, which provides a molecular defense against proteotoxic stress. We hypothesized that there would be changed levels of BDNF and HSP70 in women with PMDD compared with non-symptomatic women, reflecting impaired and/or activated stress-related responses involved in the underlying pathogenesis of PMDD. Female medical students were screened, and 24 women without premenstrual symptoms and 25 women with PMDD were enrolled in the study. Psychiatric evaluation and the Daily Record of Severity of Problems-Short Form were used for two consecutive menstrual cycles to diagnose PMDD. Serum BDNF and HSP70 levels were assessed in the third luteal phase. Participants with PMDD had significantly higher serum BDNF and HSP70 levels compared with controls, and there was a significant positive correlation between serum BDNF and HSP70 levels. Increased HSP70 levels may reflect cellular distress in PMDD. Increased serum BDNF levels in the luteal phase in subjects with PMDD may reflect a compensation process, which results in subsequent improvement of PMDD-associated depressive symptoms in the follicular phase. Thus, increased serum BDNF levels may be indicative of a compensating capacity in PMDD.

The effect of silicon loss and fabrication tolerance on spectral properties of porous silicon Fabry-Perot cavities in sensing applications.

In this paper, we investigate the effect of non-uniformities (enlargement of current passage, non-equal surface current densities, etc.) in axial as well as transverse directions of a porous silicon Fabry-Perot (FP) cavity as well as loss nature of bulk silicon on spectral properties of this cavity, even that cavity is created with an anisotropic etching process. Without correct and comprehensive characterization of such cavities by incorporating these non-uniformities and inherent lossy nature of a cavity, detection and identification of biological and chemical molecules by that cavity may yield unpredictable and misleading results. From our simulations, we note the following two key points. First, effects of the refractive index and the thickness of microcavity region of a lossless or lossy FP cavity on resonance wavelength is more prevailing than those of first and last layers. Second, the effect of some small loss inside the FP cavity is not detectable by the measurement of resonance wavelength whereas the same influence is noticeable by the measurement of reflectivity. We carried out some measurements from two different regions on the fabricated cavities to validate our simulation results. From a practical point of view in correct detection and/or identification of lossy biological or chemical vapor by FP cavities, we conclude that not only the measurement of resonance wavelength as well as its shift but also the reflectivity value at the resonance wavelength or some specific wavelengths should be utilized.

Plasma concentrations of soluble cytokine receptors in euthymic bipolar patients with and without subsyndromal symptoms.

BACKGROUND: Current evidence suggests that high concentrations of pro-inflammatory markers are associated with bipolar disorder characterized by severe impairment during inter-episodic periods, reduced treatment response and persistent subsyndromal symptoms. We tested whether persistent subsyndromal symptoms in euthymic bipolar patients were associated with markers of an ongoing chronic pro-inflammatory process. METHODS: Forty-five euthymic bipolar patients (22 with subsyndromal symptoms (BD+) and 23 without subsyndromal symptoms (BD-) and 23 well controls (WC) were recruited for assessment of soluble tumor necrosis factor receptor-1 (sTNF-R1), soluble interleukin-6 receptor (sIL-6R) and soluble interleukin-2 receptor (sIL-2R) concentrations. Soluble cytokine receptor concentrations were assessed using enzyme-linked immunosorbent assay. RESULTS: In comparison to WC, sTNF-R1 concentration was higher in both BD- and BD+ (age and sex adjusted standardized ß, respectively: ß = 0.34, p = 0.012 and ß = 0.41, p = 0.003). Similarly, compared to WC, sIL-6R concentration was higher in both BD- and BD+ (age and sex adjusted standardized ß, respectively: ß = 0.44, p = 0.001 and ß = 0.37, p = 0.008). There was no difference between BD- and BD+ in the concentration of either sTNF-R1 or sIL-6R; plasma concentration of sIL-2R was not analyzed as 75% percent of the samples were non-detectable. CONCLUSIONS: Although bipolar patients present with a pro-inflammatory shift compared to well controls, subsyndromal symptoms are not associated with additive increasing effects. Longitudinal studies with larger samples are required to clarify the relationship between illness course and inflammatory markers in bipolar disorder.

Evidence for an association between tumor necrosis factor-alpha levels and lithium response.

BACKGROUND: The role of inflammation in bipolar disorder has recently emerged as a potential pathophysiological mechanism. Tumor necrosis factor-alpha (TNF-α) modulation may represent a pathogenic molecular target and a biomarker for staging bipolar disorder. In this context, the possible association between lithium response and TNF-α level was examined. METHODS: Sixty euthymic bipolar patients receiving lithium therapy were recruited for assessment of TNF-α level. The ALDA lithium response scale (LRS) was used to evaluate longitudinal lithium response in bipolar patients, using cut-offs of poor response, partial response and good response. TNF-α level was assessed using enzyme-linked immunosorbent assay. RESULTS: There was a significant increase in TNF-α level in patients with poor lithium response compared to those with good response, also after controlling for a range of potential confounders (adjusted effect size: 0.47, p=0.011). Partial response showed a directionally similar, but attenuated and statistically inconclusive association (adjusted effect size: 0.16, p=0.326). LIMITATIONS: Assessment of response was retrospective and natural course cannot be separated easily from treatment response in an observational design. Selection of additional inflammatory markers could provide for a better understanding of underlying immune changes. CONCLUSIONS: This study strengthens the hypothesis that TNF-α level may mark or mediate lithium response, and that continuous immune imbalance in poor lithium responders may occasion treatment resistance. Further investigation of immune alterations in treatment-resistant bipolar patients may be productive.

Adherence to Turkish psychiatric association guideline for bipolar depression treatment in a specialized mood disorders outpatient unit.

BACKGROUND: Bipolar patients spend up to one third of their lives in depression however, acute treatment guidelines mainly focused on the manic phase of illness. With recent attention to the importance of evidence-based medicine in psychiatry, a number of treatment guidelines have emerged to aid clinicians in clinical decision making. Here, we aim to measure concordance with the Turkish Psychiatric Association Treatment Guideline for Bipolar Disorders (TPATGBD) for the depressive phase of illness. SUBJECTS AND METHODS: Bipolar patients attending the Rasit Tahsin Mood Disorders Outpatient Unit of Istanbul Bakirköy Research and Training Hospital for Psychiatry, Neurolgy & Neurosurgery, were assessed using standardized forms based on a nation-wide mood disorders follow-up program. Concordance of implementations with the TPATGBD were evaluated step by step for each level of depression severity. RESULTS: Concordance rates with the first step recommendations of the guideline were 29.4%, 27.4% and 87.5% for mild-moderate, moderate-severe (without psychosis) and severe depression (with psychosis), respectively. Concordance rates with the second step recommendations of the guideline were lower for bipolar depressions without psychosis. Overall, adherence to the guideline did not impact on time to remission (p=0.19). CONCLUSIONS: Despite considerable efforts to develop and disseminate evidence-based guidelines, they are not widely followed by clinicians and important opportunities clearly exist to educate clinicians about the feasibility and utility of clinical guidelines for bipolar disorder. Systematic studies in the future are required to clarify our understanding of clinicians' attitudes to the use of guidelines and to explain the discrepancy between guidelines and clinical practice.

Labial fusion first diagnosed during pregnancy with voiding difficulty and its management: a case report.

INTRODUCTION: Labial fusion is described as partial or complete adherence of the labia minora. Adhesions of the labia are extremely rare in the reproductive population with only a few cases described in the literature and none reported with pregnancy. CASE PRESENTATION: A 24-year-old woman who had extensively fused labia with a pinhole opening at the upper midline with menstrual delay was diagnosed at six weeks of pregnancy. The case and its management are presented. CONCLUSION: The condition was treated surgically with complete resolution of the urinary symptoms.

A survey of verbal and physical assaults towards psychiatrists in Turkey.

BACKGROUND: Assaults on health professionals have been an area of burgeoning clinical and political interest in recent years. There is now a body of literature suggesting that violence towards psychiatrists is more common than to other doctors. Thus far the vast majority of research in this area has been conducted in Western European and North American clinical settings. For the first time, this study examines this issue in the context of Turkish psychiatric settings. OBJECTIVE: (i) The study aims to detect the prevalence of verbal and physical assaults towards psychiatrists in Turkey. (ii) It aims to compare the experience of verbal and physical assaults according to the gender and training experience of psychiatrists. (iii) The paper intends to investigate how psychiatrists reacted to and appraised the experience of violence. METHODS: A questionnaire was prepared to evaluate violence towards psychiatrists (adapted from the Overt Agression Scale). The questionaire was administered to psychiatric specialists and residents working in state hospitals, research and training hospitals, mental health hospitals and university psychiatry clinics. A response rate of 93% was achieved with 186 out of 200 psychiatrsits approached completing the study questionnaire. RESULTS: Of all the psychiatrists who responded, 71% reported having experienced verbal or physical assaults during their professional life (verbal assaults only (19.9%), physical assaults only (2.7%) and both (48.4%)). Of these, 26% suffered injury to at least a mild degree. There was no statistically significant difference in terms of gender and workplace. In spite of the extremely high rates of aggression and violence towards psychiatrists, roughly 50% perceived these acts a normal part of their job and only 5% formally reported the violent incident. CONCLUSION: The majority of psychiatrists described having been victims of verbal and physical assaults although half perceived aggression and violence as a normal part of their job. Levels of reporting of violence were very low in the context of this study. Studies such as this provide evidence to inform the development of improved management of violence and may encourage psychiatrists to report violence.