Estrogen Receptor 1 Gene rs22346939 and rs9340799 Variants are Associated with Major Depressive Disorder and its Clinical Features.

OBJECTIVE: Major Depressive Disorder (MDD) is a major health problem worldwide. Estrogen interacts with the central nervous system and has been shown to affect anxiety and depressive behavior. Estrogen mediates its effects by connecting its receptors, estrogen receptors 1 and 2. The purpose of this case-control study was to clarify the association between MDD risk and estrogen receptor 1 (ESR1) gene variants. METHODS: This study included 245 individuals (125 MDD patients and 120 healthy controls). Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP) technics were used for genotypingESR1XbaII (rs9340799) and PvuII (rs22346939) variants. RESULTS: There were statistically significant differences between the groups in terms of genotype frequencies of the ESR1PvuII (-397 T > C) variant (p = 0.049) but not for the XbaII (-351 A > G) variant (p > 0.05). However, a correlation was observed between MDD and ESR1XbaII variant after male participants were excluded (p = 0.028). Also, the high pain score of MDD patients was associated with the ESR1PvuII variant, especially in female patients (p = 0.021). According to the results of combined genotype analysis, AA-TC combined genotype was correlated with a decreased risk in patients with MDD compared to controls (p = 0.016), while the combined genotype of GGCC was associated with increased risk in the patients with MDD compared to controls (p = 0.042). CONCLUSION: The two ESR1 variants were associated with MDD risk and its features in both individual and combined forms.

Investigation of the Roles of New Antiepileptic Drugs and Serum BDNF Levels in Efficacy and Safety Monitoring and Quality of Life: A Clinical Research.

OBJECTIVE: We aimed to determine the therapeutic drug monitoring (TDM) features and the relation to Brain-Derived Neurotrophic Factor (BDNF) of frequently used new antiepileptic drugs (NADs) including lamotrigine (LTG), oxcarbazepine (OXC), zonisamide (ZNS) and lacosamide (LCM). Moreover, we investigated their effect on the quality of life (QoL). METHODS: Eighty epileptic patients who had been using the NADs, and thirteen healthy participants were included in this cross-sectional study. The participants were randomized into groups. The QOLIE-31 test was used for the assessment of QoL. We also prepared and applied "Safety Test". HPLC method for TDM, and ELISA method for BDNF measurements were used consecutively. RESULTS: In comparison to healthy participants, epileptic participants had lower marriage rate (p=0.049), education level (p˂0.001), alcohol use (p=0.002). BDNF levels were higher in patients with focal epilepsy (p=0.013) and in those with higher education level (p=0.016). There were negative correlations between serum BDNF levels and serum ZNS levels (p=0.042) with LTGpolytherapy, serum MHD levels (a 10-monohydroxy derivative of OXC, p=0.041) with OXCmonotherapy. There was no difference in BDNF according to monotherapy-polytherapy, drugresistant groups, regarding seizure frequency. There was a positive correlation between total health status and QoL (p˂0.001). QOLIE-31 overall score (OS) was higher in those with OXCmonotherapy (76.5±14.5). OS (p˂0.001), seizure worry (SW, p=0.004), cognition (C, p˂0.001), social function (SF, p˂0.001) were different in the main groups. Forgetfulness was the most common unwanted effect. CONCLUSION: While TDM helps the clinician to use more effective and safe NADs, BDNF may assist in TDM for reaching the therapeutic target in epilepsy.

Efficacy and Safety of S-Amlodipine 2.5 and 5 mg/d in Hypertensive Patients Who Were Treatment-Naive or Previously Received Antihypertensive Monotherapy.

The aim of the present study was to evaluate the efficacy and safety of S-amlodipine 2.5 and 5 mg/d in patients with hypertension who were treatment-naive or previously received antihypertensive monotherapy. During the 8-week treatment period, all patients received S-amlodipine 2.5 mg/d for the first 4 weeks, followed by S-amlodipine 5 mg/d for the second 4 weeks. For efficacy assessments, ambulatory and office blood pressure (BP) measurements were performed during the baseline, fourth-week, and eighth-week visits. For safety assessments, all adverse events and abnormal laboratory findings were recorded. This study is registered with ClinicalTrials.gov (NCT03038451). Of 43 patients evaluated at the screening visit, 33 were enrolled. In the treatment-naive arm, significant reductions in both office and ambulatory systolic BP (SBP) and diastolic BP (DBP) were observed with S-amlodipine 2.5 mg/d and additional significant reductions were achieved with dose titration (S-amlodipine 5 mg/d). At the end of the study, the rate of the treatment-naive patients with BP under control (SBP/DBP <140/90 mm Hg) was 53% with S-amlodipine 2.5 mg and increased to 78% with S-amlodipine 5 mg. For the noninferiority evaluation, S-amlodipine 2.5 and 5 mg/d treatments were generally noninferior to both office and ambulatory BP levels achieved with the medications that the patients received before participating in the study. Five nonserious adverse events likely to be associated with the study drug were observed. No serious adverse event was encountered. Consequently, S-amlodipine can be suggested as an effective and safe treatment option for patients with hypertension.

An 18-year-old man with recurrent pneumothorax since he was 10-year-old.

An 18-year-old male patient was referred to the department of pediatric pulmonology with a history of recurrent pneumothorax. Initial pneumothorax occurred at the age of 10. Following diagnosis of congenital lobar emphysema, he had five episodes of pneumothorax and subsequently underwent right-lower lobe anterobasal segmentectomy. Based on thoracic computed tomography (CT) and clinical manifestation, Birt-Hogg-Dube (BHD) syndrome was suspected and confirmed following genetic testing. BHD syndrome is a rare tumor predisposition syndrome first described in 1977. The syndrome is characterized by skin fibrofolliculomas, lung cysts, recurrent spontaneous pneumothorax, and renal cell cancer. The underlying cause is a germline mutation in the folliculin (FLCN) gene located on chromosome 17p11.2. Clinical manifestation usually appears after the age of 20 years. In this case, we report a case of BHD with episodes of recurrent pneumothorax, the first of which occurred at the age of 10 years. Pulmonologists should be aware of this syndrome in patients with a personal and family history of pneumothoraces and CT findings of multiple pulmonary cysts as additional evaluation and testing may be warranted. Pediatr Pulmonol. 2016;51:E41-E43. © 2016 Wiley Periodicals, Inc.

Expressed emotion in panic disorder: Relationship with demographic and clinical variables and quality of life.

OBJECTIVE: Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety disorders. We aimed to investigate the relationship between EE and demographic and clinical characteristics of patients with panic disorder (PD), to determine whether there is a difference between PD, major depressive disorder (MDD) patients and healthy controls (HC) in terms of EE and to investigate the effect of EE on quality of life (QOL) in patients with PD. METHODS: Our study involved a total of 150 participants (50 patients in each group). All participants were given the Level of Expressed Emotion (LEE) scale and the short-form health survey (SF)-36 . Furthermore, the EE scale was completed by the participant's key relatives. RESULTS: EE was associated with some sociodemographic and clinical variables in patients with PD. There was no significant difference between PD and MDD and between PD and HC in terms of the LEE and the EE and their subscale scores. It was also demonstrated that EE had no effect on the QOL in patients with PD. CONCLUSION: EE was not different in PD compared to MDD and HC. Additionally, EE was not related to QOL in PD.

Effects of Blood Pressure Lowering With Different Antihypertensive Agents on Cognitive Function and Plasma Brain-derived Neurotrophic Factor Levels: A Comparative Study.

PURPOSE: Hypertension is a risk factor for cognitive impairment (CI). However, the specific effect of antihypertensive therapy on cognitive function is still controversial. We aimed to investigate the effect of antihypertensive agents targeting the renin-angiotensin system (RAS) on CI and brain-derived neurotropic factor (BDNF). METHODS: We included 62 patients who had been using the same antihypertensive agent for at least 3 months. Patients who had relevant conditions that could contribute to CI were excluded. After subjects were divided into 3 groups according to their current antihypertensive medication, the cognitive status of each patient was assessed by the mini-mental state examination (MMSE). BDNF and plasma renin activity were evaluated. RESULTS: There was a negative association between systolic blood pressure and MMSE independent of medication (rho = -0.251, P = 0.049). There was no significant correlation between MMSE and BDNF. The MMSE score was slightly higher in the non-RAS group, but the difference did not reach statistical significance (P = 0.09). There was also no significant difference in BDNF levels between study groups (P = 0.32). Mean plasma renin activity levels were significantly lower in the non-RAS group compared with the angiotensin converting enzyme inhibitor and angiotensin receptor blocker groups (P = 0.007). CONCLUSIONS: We suggest that the essential intervention for CI in hypertensive patients is appropriate for blood pressure control.

Factors associated with suicide attempts in patients with bipolar disorder type I.

BACKGROUND: The aim of this study is to identify the risk factors that are associated with suicide attempts in patients with bipolar disorder type I. SUBJECTS AND METHODS: This cross-sectional study was conducted with inpatients and outpatients with BD type I. Patients who met the study inclusion criteria (n=91) were evaluated in terms of sociodemographic variables, history of childhood trauma, comorbidity of adult attention deficit hyperactivity disorder and posttraumatic stress disorder, and the course of the disease. The patients were divided into two groups: those with a history of suicide attempts and those without a history of suicide attempts. The parameters of the study groups were compared with t and chi-square tests as appropriate. Logistic regression was used to identify the predictors of suicide attempt. RESULTS: Logistic regression analysis of the study parameters suggested that the number of major depressive episodes (odds ratio: 7.18; 95% confidence interval: 1.84-28) and history of emotional neglect (odds ratio: 1.83; 95% confidence interval: 1.15-2.90) were significant predictors of suicide attempt in patients with BD. CONCLUSION: In BD type I patients with a history of suicide attempts, the number of depressive episodes and emotional neglect, a subtype of childhood traumas, were the most remarkable risk factors. Considering the frequency of depressive episodes during the course of the disease and assessing traumas including those in childhood may help predict future suicide attempts in patients with BD.

Assessment of overactive bladder in women antidepressant users.

PURPOSE: The aim of this study was to evaluate the relationship between overactive bladder (OAB) and use of antidepressants in women. METHODS: This is a prospective trial, and in total, 205 consecutive female (113 patient taking antidepressants for various disorders and 92 healthy controls) outpatients from our outpatients were enrolled in this study. The patients were also divided into those with OAB symptoms, OAB-Validated 8 (OAB-V8 score of ≥8), and without OAB symptoms <8. The prevalence of OAB in the antidepressant users and healthy controls was compared. In addition, the prevalence of OAB was compared according to antidepressant type. RESULTS: The mean age of the participants was 36 ± 13 years. The demographic data of the two groups (OAB-V8 ≥ 8 and OAB-V8 < 8) were similar. The Beck Depression Inventory, OAB-V8, and Incontinence Questionnaire--Short Form scores of the antidepressant users were significantly higher than those of the control group (p < 0.001, p < 0.001, and p = 0.001, respectively). The prevalence of OAB was significantly higher in antidepressant users (64 %) than in the control group (33 %) (p = 0.003). The highest prevalence of OAB was detected in patients taking fluoxetine (63.6 %), and the lowest was observed in those taking sertraline (42.3 %) (p = 0.038). CONCLUSION: There were more OAB symptoms in antidepressant users than in control group. Each SSRI and SNRI has a unique pharmacological profile, and this could explain the opposing reports in the literature. We recommend that patients taking antidepressants be carefully monitored for OAB symptoms.

An unusual cause of secondary capillary leak syndrome in a child: rotavirus diarrhea.

Secondary capillary leak syndrome is characterized by loss of fluid and proteins to the interstitial space due to different causes, which are related to endothelial damage. Rotavirus is the most common pathogen of diarrhea in childhood, especially during the first years of life. This virus is generally responsible for severe diarrhea and electrolyte imbalance in children. Some complications can also occur during the course of the rotavirus diarrhea. An eight-month-old girl with rotavirus diarrhea admitted to our clinic with severe dehydration. After restoring the intravascular volume, hypoalbuminemia and generalized edema were seen in the recruitment phase of the treatment, which was attributed to secondary capillary leak syndrome. She was successfully treated with prednisolone and discharged from the hospital without any sequelae. Herein, we report an infant with rotavirus diarrhea complicated with secondary capillary leak syndrome, which is an unidentified complication of the disease. To our knowledge, this is the first such case in the literature.