Quality of life, emotion dysregulation, attention deficit and psychiatric comorbidity in children and adolescents with vitiligo.

BACKGROUND: Vitiligo is an acquired pigmentation disorder, which can have a negative effect on patient quality of life (QoL). AIM: To evaluate QoL and psychiatric comorbidity in paediatric patients with vitiligo. METHODS: In total, 30 patients aged 8-18 years who were diagnosed with vitiligo and 30 age- and sex-matched healthy controls (HCs) were included in the study. The Children's Depression Inventory, Screen for Child Anxiety Related Disorders, State-Trait Anxiety Inventory for Children and Child Somatization Inventory were completed for both patients and controls. The Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) was administered to all patients by a child psychiatrist. Families were also asked to complete the Pediatric Quality of Life Inventory and Emotion Regulation Checklist for children. RESULTS: The K-SADS-PL evaluation showed that 90% of the patients in the vitiligo group had at least one psychiatric diagnosis, whereas this rate was 20% in the HCs (P < 0.001). There were statistically significant differences between vitiligo and HCs in terms of anxiety, state and trait anxiety scores (P < 0.05). Attention deficit and hyperactivity disorder (ADHD) was detected in 36.6% of the patients. CONCLUSION: The most important finding of this study is that anxiety disorders are more prominent than depression in childhood vitiligo. Another important finding of this study is that the prevalence of ADHD is significantly higher than the normal population.

Evaluation of the Dermatological Life Quality Index, sexual dysfunction and other psychiatric diseases in patients diagnosed with vitiligo with and without genital involvement.

BACKGROUND: Because skin lesions affect self-image, vitiligo affects an individual's emotional and psychological well-being, sexual life and relationships with other people. The literature contains a limited number of studies regarding the localization of vitiligo with respect to its effect on certain variables. AIM: To investigate the effects of the presence or absence of genital involvement in vitiligo on sexual dysfunction, dermatological quality of life (QoL), and susceptibility to other psychiatric disorders such as anxiety and depression. METHODS: In total, 90 patients who were admitted to the dermatology outpatient clinic of a tertiary university hospital; the patients included 30 patients with vitiligo with genital involvement, 30 patients with vitiligo without genital involvement and 30 controls (HCs). All groups were evaluated with the Dermatological Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HAD), Arizona Sexual Experience Scale (ASEX) and Golombok-Rust Inventory of Sexual Satisfaction (GRISS). RESULTS: The HC groups exhibited lower total scores on the DLQI, HAD total score, ASEX and GRISS compared with the vitiligo groups (P < 0.05). No statistically significant difference was found between the vitiligo group with genital involvement and the vitiligo group without genital involvement in terms of DLQI, and total scores for HAD, ASEX and GRISS (P > 0.05). CONCLUSION: The presence or absence of genital involvement in vitiligo did not have dissimilar effects on the individual's QoL, or their sexual and psychological state.

Evaluation of hearing function in patients with lichen planus.

Lichen planus (LP) is a chronic, autoimmune, inflammatory disease. We believe that tympanic membrane and outer ear canal can be affected by the disease and since it is an autoimmune disease inner ear involvement may be seen. The aim of this study was to evaluate hearing functions in patients with LP. Thirty patients with LP and 28 healthy controls were involved in the study. Pure tone audiometry, tympanogram and Transient Evoked Otoacoustic Emissions tests were applied to the patients. When the airway hearing thresholds of the patient and control groups in the 125-8000 Hz frequency range were compared, statistically significant differences were found at 4000, 6000 and 8000 Hz frequencies in the right ear and at 125, 4000, 6000 and 8000 Hz frequencies in the left ear. In the LP patient group, 6 patients had sensorineural hearing loss, 3 patients had conductive hearing loss, and 2 patients had mixed hearing loss. Of the 3 patients with conductive hearing loss, 2 had cutaneous and 1 had both mucosal and cutaneous involvement. Of the patients with mixed hearing loss, 1 had cutaneous and 1 had both mucosal and cutaneous involvement. In patients with sensorineural hearing loss, 1 had mucosal, 3 had cutaneous, and 2 had both mucosal and cutaneous involvement. Sensorineural, conductive or mixed hearing loss can be observed in LP patients.

Comparison of cone-beam computed tomography and panoramic radiography for mandibular morphometry.

BACKGROUND: The aim of this study was to compare the morphological differences in the mandible between patients with six age groups and to detect the correlation between these parameters on panoramic radiography (PR) and cone-beam computed tomography (CBCT). MATERIALS AND METHODS: A total of 121 subjects (50 males and 71 females) were included in the study and were divided into six age groups (10-19, 20-29, 30-39, 40-49, 50-59, and 60-69) on the basis of the chronological age. CBCT and PR methods were used to record the mandibular measurements for the same 121 patients. Differences between male and female mandibular morphometric measurements, between right and left side measurements, and differences in age subgroups compared by using independent samples t-test, paired samples t-test, and one-way ANOVA test, respectively. P < 0.05 value was considered statistically significant for all analysis. RESULTS: Males mostly have higher mandibular measurement values. There were statistically significant differences between CBCT and PR measurements (p < 0.05). PR mostly showed higher values than CBCT measurements. CONCLUSIONS: Based on the fact that PRs showing significant differences from CBCT in the morphometric measurements made on mandible, it is recommended that forensic doctors and anthropologists consider this information in their age and gender prediction studies.

Analysis of the root canal configuration and C-shaped canal frequency of mandibular second molars: a cone beam computed tomography study.

BACKGROUND: Mandibular second molars frequently show variation in root canal configurations. The patients with C-shaped canals are quite challenging in dental practice. C-shaped canals have a poor prognosis in terms of debridement, obturation, and restoration. The aim of this study was to investigate the root canal configuration of mandibular second molar teeth and to determine the frequency of C-shaped canals in mandibular second molars. MATERIALS AND METHODS: We designed a retrospective study using cone beam computed tomography (CBCT) images and 256 CBCT images were retrieved from the archived records of Necmettin Erbakan University Faculty of Dentistry, Konya, Turkey. The root canal configurations were evaluated according to Vertucci's classification and C-shaped canal configurations were identified using the method of Fan et al. The frequency in percentages was calculated for C-shaped canals in CBCT scans. RESULTS: Of the 444 mandibular second molars, the most frequent canal morphology in the mesial roots was Vertucci type IV (40.3%), followed by type II (27.5%). The distal roots were predominantly type I (92.9%), followed by types III (3.5%) and II (2.5%). Forty-seven (10.6%) teeth had C-shaped canals. CONCLUSIONS: Clinicians should be concerned about the different types of canal configurations. Knowledge of these anatomical variations will facilitate the endodontic practice.

Nonspecific abdominal pain: A follow-up survey.

INTRODUCTION: Little data have been published on the outcome of patients discharged from the emergency department (ED) after being diagnosed with nonspecific abdominal pain (NSAP). This study aimed to investigate short-term follow-up of patients discharged with a diagnosis of NSAP from the ED. MATERIALS AND METHODS: This prospective, observational study was conducted in the University-based ED and enrolled all consecutive adult patients who were diagnosed as NSAP out of patients presented with abdominal pain (AP). The main outcome measure was the presence of recurrent AP resulting in referral to the ED and specific diagnoses within the first 3- and 90-day postdischarge. On the 3rd and 90th days, all patients discharged with NSAP from the ED were asked questions, and their response entered into a questionnaire. RESULTS: A total of 684 patients presented with AP, of which 299 (46%) had a diagnosis of NSAP within the 4-month period. Fifty cases (16%) could not be included due to inability to access. Eighty-one out of 249 patients (32.5%) complained of recurrent AP within the first 3 days. Twenty-two cases (8.8%) were readmitted to ED once again in the meantime, and ten received specific diagnoses including three with acute abdomen. Within 90 days, additional nine patients out of 20 (45%) with recurrent AP received specific diagnoses including two with acute abdomen. CONCLUSIONS: Certain specific underlying entities can be missed in patients considered to have NSAP and discharged from the ED. Adherence to timely follow-up and repeated examinations are of vital importance in these patients.

Morphometric analysis of the sella turcica in Turkish individuals with different dentofacial skeletal patterns.

BACKGROUND: The aim of this study was to evaluate the morphometric analysis of sella turcica in a Turkish population according to gender, age, and dentofacial skeletal type and to investigate the prevalence of sella turcica shapes in different dentofacial skeletal types. MATERIALS AND METHODS: The lateral cephalometric radiographs of 362 patients (145 males, 217 females) were included and grouped by age, gender, and dentofacial skeletal patterns. Linear dimensions of sella turcica, which include the length, height, and diameter, were measured, and the shapes of sella turcica were evaluated. RESULTS: The anatomical variants of the sella turcica in this study were normal morphology (39.0%), followed by pyramidal shape (15.5%), double contour of floor (14.6%), oblique anterior wall (14.4%), irregular dorsum sella (8.6%), and sella turcica bridge (8.0%). Significant differences were found between sella turcica shapes and dentofacial skeletal types (p < 0.01). Females had greater diameter size of sella turcica than males (p < 0.01). In addition, the subjects in the 15-21 age group had larger sella turcica depths and diameters than the subjects in the 9-14 age group (p < 0.05 and p < 0.01, respectively). However, no significant differences were found between age groups in terms of sella turcica lengths (p > 0.05). CONCLUSIONS: Results from this study showed that the sample had a higher rate of morphological variation (39% normal, 61% other types) in comparison with other populations or ethnic groups. The class III patients had more irregularity (notching) types in the posterior part of the dorsum sella and fewer oblique anterior wall types than the others. Linear dimensions and morphological types of sella turcica in this study can be used as reference for additional investigators, such as radiologists, orthodontists, maxillofacial surgeons, and neurosurgeons, to interpret and plan surgical procedures involving the sellar region.

Evaluation of a five-year Bloomberg Global Road Safety Program in Turkey.

OBJECTIVE: Turkey was included in the Bloomberg Philanthropies funded Global Road Safety Program (2010-14) with Ankara and Afyonkarahisar (Afyon) selected for interventions to manage speed and encourage seat-belt use. The objectives of this study are to present the monitoring and evaluation findings of seat-belt use and speed in Afyon and Ankara over the five years and to assess overall impact of the program on road traffic injury, and death rates in Turkey. STUDY DESIGN: Quasi-experimental before after without comparison. METHODS: In collaboration with the Middle East Technical University, roadside observations and interviews were coupled with secondary data to monitor changes in risk factors and outcomes at the two intervention sites. RESULTS: The percentage of seat-belt use among drivers and front-seat passengers in Afyon and Ankara increased significantly between 2010 and 2014 with increased self-reported use and preceded by an increase in tickets (fines) for not using seat belts. There were uneven improvements in speed reduction. In Afyon, the average speed increased significantly from 46.3 km/h in 2012 to about 52.7 km/h in 2014 on roads where the speed limits were 50 km/h. In Ankara, the average speed remained less than 55 km/h during the program period (range: 50-54 km/h; P < 0.005) for roads where the speed limits were 50 km/h; however, the average speed on roads with speed limits of 70 km/h decreased significantly from 80.6 km/h in 2012 to 68.44 km/h in 2014 (P < 0.005). CONCLUSION: The program contributed to increase in seat-belt use in Afyon and Ankara and by drawing political attention to the issue can contribute to improvements in road safety. We are optimistic that the visible motivation within Turkey to substantially reduce road traffic injuries will lead to increased program implementation matched with a robust evaluation program, with suitable controls.

Delayed diagnosis of bullous pyoderma gangrenosum with acute myelogenous leukemia.

Pyoderma gangrenosum (PG) is a rare, but serious neutrophilic dermatosis characterized by recurrent painful cutaneous ulcerations. It is commonly associated with inflammatory bowel disease, rheumatoid arthritis, and hematological malignancies. Because laboratory evaluations and histologic features of PG are nonspecific, diagnosis is based on the clinical features of the ulcer and requires exclusion of other conditions that cause such ulceration. The disease responds to glucocorticoids, immunosuppressives, and anti-inflammatory drugs. We present a 30-year-old man with acute myelogenous leukemia (subtype M5) and bullous PG. Treatment with high-dose prednisolone was successful.

Oxidative stress parameters in localized scleroderma patients.

Localized scleroderma (LS) (morphea) is a chronic, inflammatory skin disease with unknown cause that progresses with sclerosis in the skin and/or subcutaneous tissues. Its pathogenesis is not completely understood. Oxidative stress is suggested to have a role in the pathogenesis of localized scleroderma. We have aimed to determine the relationship of morphea lesions with oxidative stress. The total oxidant capacity (TOC), total antioxidant capacity (TAC), paroxonase (PON) and arylesterase (ARES) activity parameters of PON 1 enzyme levels in the serum were investigated in 13 LS patients (generalized and plaque type) and 13 healthy controls. TOC values of the patient group were found higher than the TOC values of the control group (p < 0.01). ARES values of the patient group was found to be higher than the control group (p < 0.0001). OSI was significantly higher in the patient group when compared to the control (p < 0.005). Oxidative stress seems to be effective in the pathogenesis. ARES levels have increased in morphea patients regarding to the oxidative stress and its reduction. Further controlled studies are required in wider series.

The evaluation of MCI, MI, PMI and GT on both genders with different age and dental status.

OBJECTIVES: The aim of this study was to measure the mandibular cortical index (MCI), mental index (MI), panoramic mandibular index (PMI) and cortical bone thickness in the zone of the gonial angle (GT) in panoramic radiographies from a large sample of males and females and to determine how they relate to patients' age, gender and dental status. METHODS: 910 panoramic radiographs were obtained and grouped into age, dental status and gender. The MCI, MI, PMI and GT were analysed. RESULTS: Remarkable differences were observed for MCI and GT regarding gender, age groups and dental status on both sides (p < 0.05). While age and dental status had an effect on the MI and PMI in females, dental status had an effect on the MI and PMI in males (p < 0.05). Also, gender had an effect on the MI and PMI (p < 0.05). CONCLUSIONS: The effects of age and tooth loss are different in females and males. In females, the harmful effects of tooth loss and age are more prominent according to the PMI and MI measurements. The effects of age and tooth loss in the GT and MCI measurements are similar, and these indices can be accepted as more reliable in studies including both genders.

Evaluation of total oxidant and antioxidant status in localized and generalized vitiligo.

BACKGROUND: Vitiligo is an acquired depigmentation disorder, and oxidative stress is suggested to have a major role in its aetiopathogenesis. AIM: To assess whether oxidative stress has a greater role in generalized than in localized vitiligo. METHODS: We assessed 31 patients with active vitiligo (17 localized, 14 generalized) and 38 healthy controls. Serum total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were determined. RESULTS: Patients with vitiligo had significantly lower TAS and higher TOS and OSI values than controls. Both localized and generalized vitiligo were associated with lower TAS and higher TOS and OSI values, compared with controls, and all three did not differ with vitiligo type. CONCLUSIONS: A systemic oxidative stress exists in patients with vitiligo. These results indicate that the global antioxidant capacity of patients might have been exhausted through a defence mechanism against oxidative processes. The imbalance in TOS/TAS status may have an important role in the aetiopathogenesis of vitiligo, regardless of the clinical variant of the disease.

The interaction between actin and FA fragment of diphtheria toxin.

Actin protein has many other cellular functions such as movement, chemotaxis, secretion and cytodiaresis. Besides, it have structural function. Actin is a motor protein that it has an important role in the movement process of toxin in the cell. It is known that F-actin gives carriage support during the endosomal process. Actin is found in globular (G) and filamentous (F) structure in the cell. The helix of actin occurs as a result of polymerisation of monomeric G-actin molecules through sequential rowing, is called F-actin (FA). Actin interacts with a great number of cellular proteins along with cell skeleton and plasma membrane. It is also known that some bacterial toxins have ADP-ribosylation affect on actin. Diphteria toxin is the part which has the FA enzymatic activity corresponding the N-terminal section of the toxin, which inhibits the protein synthesis by ADP-ribosylating the elongation factor 2 in the presence of NAD. FA, taken into the cell by endocytosis inhibits protein synthesis by ADP-ribosyltransferase activity and breaks the cytoskeleton. In the studies both in vitro and in vivo, actin with interaction FA of diphteria toxin has been yet to be fully elucidated. The aim of this study was to determine the three dimensional structures of actin with interaction FA of diphteria toxin by the amprical methods and in paralel with the computing technology, theoretical methods have gained significant importance. In our study, actin with interaction FA of diphteria toxin has been determined as the most possible interaction area with the theoretical method; analogy modelling. This area has been closed in the presence of polypeptides and FA-actin interactions have been tested with the gel filtration chromatography techniques. As a result of the findings, we found that 15 amino acid artificial peptides (DAMYETMAQACAGNR) corresponding to 201-215 amino acid residues of FA interacts with G-actin and closes this area. Secondly, in the model formed with the analogy modelling, it appears that the most possible interaction area is between FA (tyr204) and G-actin (gly48). Results obtained from both theoretical and experimental data support the idea that the interaction occurs in this area.

Neuromonitoring in traumatic brain injury.

Current approaches to monitoring in severe traumatic brain injury (TBI) include a wide array of modalities, providing insight into pressure parameters, oxygenation, perfusion, electrophysiology and metabolism of the brain. The intent of "multimodality monitoring" is to obtain a better understanding of what is going on within the brain of an individual patient in order to target treatment more appropriately. In this review we highlight the current status of neuromonitoring for TBI with a specific focus on how advanced analysis and integration of these parameters may be used to implement more personalized treatment approaches. In particular, combining information from different parameters and performing dynamic testing offers the potential to better understand the pathophysiological mechanisms active in the brain of a particular patient. Rather than persisting in a standardized "one size fits all" approach to therapy or continuing down the separate tracts of goal directed therapy, we suggest to think more in terms of "individualized therapeutic strategies" more focused on the specific requirements of each patient. Given the considerable data overload in multimodality monitoring and the complexity in interpretation of signals from multiple sources, specific attention needs to be directed to data processing and user-friendly displays. Intense collaboration and interaction between clinicians, basic researchers, IT-experts, nurses and industry will be required to further advance the fields towards more personalized approaches.

Segmental tuberous sclerosis in a patient presenting as unilateral facial angiofibromas, periungual fibromas and Shagreen patch.

Tuberous sclerosis (TS) known as Epiloia and Bourneville's disease is an autosomal dominant inherited disorder that can affect many organ systems. Tuberous sclerosis has many forms of clinical presentation. Rarely, multiple facial angiofibromas of unilateral distribution have been reported. We describe a patient with unilateral facial angiofibromas, periungual fibromas and Shagreen patch.

Mandibular cortical index evaluation in masked and unmasked panoramic radiographs.

OBJECTIVES: The first aim of this study was to evaluate intra- and interobserver agreement in evaluating the mandibular cortical index (MCI) in masked and unmasked panoramic radiographs. The second aim was to evaluate the effect of previous experience of MCI classification on the observers' performance. METHODS: Three observers separately evaluated MCI, twice in masked and twice in unmasked panoramic radiographs, with 2 week intervals. The observations were repeated more than 9 months later. The second and third observers were inexperienced in evaluating MCI. Weighted kappa statistics were used to evaluate the inter- and intraobserver agreement. RESULTS: In the first session of the study, the kappa values for intraobserver agreements in masked panoramic radiographs were between 0.565 and 0.789; in unmasked panoramic radiographs, they were between 0.420 and 0.732. The kappa values for interobserver agreement were between 0.131 and 0.392 in masked radiographs and between 0.043 and 0.225 in unmasked radiographs. In the second session of the study, the kappa values for intraobserver agreements in masked panoramic radiographs were between 0.586 and 0.786. The kappa values for intraobserver agreements in unmasked panoramic radiographs were between 0.558 and 0.781. The kappa values for interobserver agreement were between 0.146 and 0.510 in masked radiographs and between 0.174 and 0.568 in unmasked radiographs. CONCLUSIONS: Masking has no effect on the evaluation of panoramic radiographs for MCI. Previous experience causes higher intraobserver agreement. Intra- and interobserver agreement increases along with the increased experience in MCI evaluations.

Case of the month: rivastigmine (Exelon) toxicity with evidence of respiratory depression.

Rivastigmine, which has been approved by the US Food and Drugs Administration for the treatment of Alzheimer's disease, is a non-competitive reversible inhibitor of acetylcholinesterase. We present a case of rivastigmine toxicity at a dose of 90 mg, with evidence of respiratory depression. To our knowledge, this case report provides evidence of the highest rivastigmine ingestion recorded (90 mg) that caused respiratory depression but requiring only supportive intervention without the need for ralidoxime. Emergency physicians should strongly consider cholinesterase inhibitor (rivastigmine, galantamine, and tacrine) ingestion in patients who present with short and temporary organophosphate-like toxidromes.

Scapular manipulation technique for reduction of traumatic anterior shoulder dislocations: experiences of an academic emergency department.

BACKGROUND: Shoulder dislocations account for almost 50% of all joint dislocations, which are most commonly anterior (90-98%) and occur due to trauma. This prospective study was conducted to report our experiences of using the scapular manipulation technique (SMT) to reduce traumatic anterior shoulder dislocations. METHODS: Between March 2002 and March 2003, SMT was applied to 41 patients who presented with traumatic anterior shoulder dislocation to the Gulhane Military Medical Academy, Department of Emergency Medicine, Ankara, Turkey, which is a level 1 trauma centre with an annual attendance of 85,000 patients. The technique was applied to patients in the prone position by a single operator. Where necessary, a procedural sedation/analgesia (PSA) protocol was followed. RESULTS: The study population consisted of 26 (63.4%) male patients aged between 17 and 76 years (SD 15.6). History of recurrent shoulder dislocations at the same site were taken from seven (17.1%) of the patients. Mean (SD) trauma to reduction time was approximately 61.5 (72) minutes (range 10-480). Five patients (12%) had a greater tuberosity fracture. SMT was attempted twice to only four (9.8%) patients by a standard PSA protocol. We experienced a success rate of 90.2% at the first attempt and 100% overall. None of the patients encountered any complication. CONCLUSIONS: We report the successful use of SMT in the prone position for the reduction of traumatic anterior shoulder dislocations, mainly without requirement of any sedatives or opiate analgesics. We believe that SMT may also be applied by inexperienced physicians, as it is simple, applicable, and easily understood. As no single method has a 100% success rate, SMT is a useful one to know.