Melatonin levels are low in COVID-19 positive patients and these levels are associated with depression, death anxiety and insomnia.

In this study, we aimed to measure the melatonin levels in COVID-19 positive patients and to investigate the relationship of these levels with depression, death anxiety and insomnia. COVID-19 positive pneumonia group, COVID-19 negative pneumonia group and healthy control groups were included in the study. Melatonin ELISA kit was used. Blood samples were taken at 23:00 h (h), 02:00 h and 06:00 h. Beck Depression Inventory (BDI), Templer Death Anxiety Scale (TDAS), Insomnia Severity Index (ISI) were employed to collect data from the participants. The melatonin levels of COVID-19 positive patients at 23:00 h were lower than the control group. In addition, and the melatonin levels of COVID-19 positive patients at 02:00 h and at 06:00 h were lower than both the COVID-19 negative patient group and the control group. It was observed that the peak melatonin concentration of COVID-19 positive patients occurred at 06:00 h. BDI, TDAS and ISI scores of COVID-19 positive patients were higher than other groups. There was a negative correlation between BDI, TDAS, ISI scores of COVID-19 positive patients and their melatonin levels. The correlation between all scale scores and melatonin levels was higher at 02:00 h. Adding melatonin to the treatment of COVID-19 positive patients may be beneficial for these patients experiencing high levels of depression, anxiety and insomnia.

Genistein suppresses the inflammation and GSK-3 pathway in an animal model of spontaneous ovarian cancer

Background/aim: Numerous studies show that cancer risk is reduced by consumption of soy-based foods containing genistein, but its effects on the glycogen synthase kinase-3 pathway (GSK-3) in ovarian cancer is unknown. Therefore, we tested the properties of genistein on inflammatory biomarkers and GSK-3 signaling pathways in the ovaries of old laying hens with ovarian cancer. Materials and methods: A total of 300 laying hens were distributed into three groups as follows: group 1, animals fed a standard diet (comprising 22.39 mg of genistein/kg of diet); groups 2 and 3, animals fed a standard diet reconstituted with supplementation of 400 mg or 800 mg of genistein/kg of diet, respectively. Results: Genistein modulated the inflammatory biomarkers by decreasing serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL- 6), interleukin-8 (IL-8), and vascular endothelial growth factor (VEGF) compared with control (p < 0.001). Moreover, it upregulated insulin receptor substrate-1 (p-IRS-1) and protein kinase B (p-AKT), but downregulated GSK-3α and ß after treatment. It acts in a dose-dependent manner. Conclusion: Genistein exhibited an anticancer effect by reducing proinflammatory biomarkers levels and inhibiting GSK-3 expression in the ovaries of old laying hens. It is a potential candidate in the chemoprevention and/or treatment of ovarian cancer.

Low α-N-acetylgalactosaminidase plasma concentration correlates with the presence and severity of the bipolar affective disorder.

OBJECTIVES: Believing that a neurodevelopmental pathology may cause bipolar affective disorder (BAD), we aimed to measure the concentrations of α-N-acetylgalactosaminidase (α-NAGAL), a lysosomal enzyme. METHODS: The study included 32 patients with BAD and 32 healthy controls. The Young Mania Rating Scale was used to measure the severity of the disease. Serum α-N-acetylgalactosaminidase concentrations were measured in all blood samples using the human α-N-acetylgalactosaminidase ELISA Kit. RESULTS: A statistically significant difference was found in the α-NAGAL values between the groups. The mean α-NAGAL values of BAD patients are lower than the mean α-NAGAL values of the control group. A strong negative and statistically significant relationship was found between the α-NAGAL values of patients with BAD and their Young Mania Rating Scale scores. And a positive strong correlation was found between the age of onset of the disease and α-NAGAL levels. CONCLUSIONS: Low α-N-acetylgalactosaminidase concentrations may cause the accumulation of some glycoproteins in the lysosomes in the brain during the gestational period, producing the clinical symptoms of BAD. α-N-acetylgalactosaminidase deficiency may not be the only cause of BAD, but it may be an important factor in the aetiology of this disease.

Could low α-N-acetylgalactosaminidase plasma concentration cause schizophrenia?

OBJECTIVES: Using a neurodevelopmental approach to examine the aetiology, we predicted an enzyme deficiency to exist at the cellular level and aimed to measure α-N-acetylgalactosaminidase (α-NAGAL) blood levels. METHODS: The study included 32 patients diagnosed with schizophrenia and 30 healthy controls. The positive and negative syndrome scale (PANSS) was applied to the patients with schizophrenia. Serum α-NAGAL concentrations were measured in blood samples taken from all participants using the human alpha-N-acetylgalactosaminidase ELISA Kit. RESULTS: The mean α-NAGAL values of schizophrenic patients are lower than the mean α-NAGAL values of the control group (p = 0.000 < 0.001). Correlation analysis showed that there was a significant relationship between α-NAGAL values and PANSS scores of patients with schizophrenia. PANSS total (r = -0.708, p = 0.000 < 0.001), PANSS positive (r = -0.627, p = 0.000 < 0.001), PANSS negative (r = -0.386, p = 0.029 < 0.05). And a positive moderate correlation was found between the age of onset of the disease and α-NAGAL levels (r = 0.529, p = 0.002 < 0.05). CONCLUSIONS: Based on the neurodevelopmental hypothesis, the low α-NAGAL concentrations this study found might cause accumulation of glycoproteins in the lysosomes in the central nervous system during the gestational period and then might result in the clinical symptoms of schizophrenia. α-NAGAL may be an important factor in the aetiology of schizophrenia.

High Homocysteine Levels Are Associated with Cognitive Impairment in Patients Who Recovered from COVID-19 in the Long Term.

In this study, we measured the levels of depression and cognition in people recovering from COVID-19. Moreover, we aimed to investigate the relationship between depression and cognition levels by measuring homocysteine concentrations. It included 62 people recovering from COVID-19 (at least 3 months after positive RT-PCR) and 64 people without COVID-19 (control group). At first, the homocysteine levels of participants were measured. Beck Depression Inventory (BDI) and Montreal Cognitive Assessment (MoCA) were performed to collect data. Homocysteine levels of the group recovering from COVID-19 (x- = 19.065 µmol/L) were higher than the control group (x- = 11.313 µmol/L). There was no significant difference between the groups for BDI scores. The MoCA scores of the group recovering from COVID-19 (x- = 20.774) were lower than the control group (x- = 24.297). There was a negative high (r = -0.705, p < 0.001) correlation between homocysteine levels and MoCA scores. Linear regression analysis is shown to be significant, and the MoCA explanatory value of the variables in the model is 58.6% (p < 0.0001). A 1 µmol/L observed increase in homocysteine level constituted a risk for a 0.765-point decrease in MOCA scores. In patients recovering from COVID-19, early interventions to high homocysteine levels may prevent cognitive impairments that may persist in the long term.

Combination of Phycocyanin, Zinc, and Selenium Improves Survival Rate and Inflammation in the Lipopolysaccharide-Galactosamine Mouse Model.

Sepsis is related to systemic inflammation and oxidative stress, the primary causes of death in intensive care units. Severe functional abnormalities in numerous organs can arise due to sepsis, with acute lung damage being the most common and significant morbidity. Spirulina, blue-green algae with high protein, vitamins, phycocyanin, and antioxidant content, shows anti-inflammatory properties by decreasing the release of cytokines. In addition, zinc (Zn) and selenium (Se) act as an antioxidant by inhibiting the oxidation of macromolecules, as well as the inhibition of the inflammatory response. The current study aimed to examine the combined properties of Zn, Se, and phycocyanin oligopeptides (ZnSePO) against lipopolysaccharide-D-galactosamine (LPS-GalN)-induced septic lung injury through survival rate, inflammatory, and histopathological changes in Balb/c mice. A total of 30 mice were allocated into three groups: normal control, LPS-GalN (100 ng of LPS plus 8 mg of D-galactosamine), LPS-GalN + ZnSePO (ZnPic, 52.5 µg/mL; SeMet, 0.02 µg/mL; and phycocyanin oligopeptide (PO), 2.00 mg/mL; at 1 h before the injection of LPS-GalN). Lung tissue from mice revealed noticeable inflammatory reactions and typical interstitial fibrosis after the LPS-GalN challenge. LPS-GalN-induced increased mortality rate and levels of IL-1, IL-6, IL-10, TGF-ß, TNF-α, and NF-κB in lung tissue. Moreover, treatment of septic mice LPS-GalN + ZnSePO reduced mortality rates and inflammatory responses. ZnSePO considerably influenced tissue cytokine levels, contributing to its capacity to minimize acute lung injury (ALI) and pulmonary inflammation and prevent pulmonary edema formation in LPS-GalN-injected mice. In conclusion, ZnSePO treatment enhanced the survival rate of endotoxemia mice via improving inflammation and oxidative stress, indicating a possible therapeutic effect for patients with septic infections.

Monocyte/HDL Cholesterol Ratios as a New Inflammatory Marker in Patients with Schizophrenia.

PURPOSE: Monocyte/HDL cholesterol ratio (MHR) is a novel inflammatory marker that is used as a prognostic factor for cardiovascular diseases and has been studied in many diseases. The aim of this study was to investigate the role of inflammatory factors in schizophrenia patients by examining MHR levels and to compare schizophrenia patients and healthy controls in terms of cardiovascular disease risk. METHOD: A total of 135 participants between the ages of 18-65, 85 diagnosed with schizophrenia, and 50 healthy individuals in the control group were included in this cross-sectional study. Venous blood samples were taken from the participants and CBC parameters and lipid profiles were analyzed. The sociodemographic and clinical data form and positive and negative symptoms scale (PANSS) were administered to all participants. RESULTS: Although monocyte levels were significantly higher in the patient group, HDL-C levels were lower at significant levels. MHR was found to be higher in the patient group compared to the control group at significant levels. When compared to the control group, total cholesterol, triglyceride, WBC, neutrophil, basophil, and platelet levels were higher in the patient group at significant levels, and RBC, hemoglobin, and hematocrit levels were significantly lower. CONCLUSION: The elevated MHR in patients with schizophrenia may contribute to our understanding that inflammation plays important roles in the pathophysiology of schizophrenia. Additionally, knowing the levels of MHR and considering the recommendations, such as diet and exercise, in the treatment approaches made us think that it might be beneficial in protecting schizophrenia patients against cardiovascular diseases and early death.

Ferritin and hyperactivity ratings in attention deficit hyperactivity disorder.

BACKGROUND: Iron is a co-factor of tyrosine hydroxylase which is a critical enzyme in dopamine synthesis. Dopamine has been implicated in the pathophysiology of attention deficit hyperactivity disorder (ADHD). Our objective was to investigate the association of ferritin level with parent and teacher ratings and cognitive measures after controlling for age, sex, ADHD subtype, comorbid conditions, hemoglobin, mean corpuscular volume and reticulocyte distribution width in a large sample. METHODS: The study included 713 children and adolescents with ADHD (613 boys; age 7-15 years). Conners' Parent Rating Scale (CPRS) and Conners' Teacher Rating Scale (CTRS) were obtained. In a subgroup of patients we conducted Digit Span, Digit Symbol, Trail-making Tests as measures of attention and executive functioning. RESULTS: Multiple regression analysis indicated that CPRS Hyperactivity score was significantly associated with ferritin level (B =-0.12; t =-3.1; P < 0.01). Other CPRS and CTRS scores as well as cognitive measures were not associated with ferritin level. CONCLUSIONS: Although it is not possible to make an inference on causality in cross-sectional studies, the results of this largest-scale cross-sectional field study to date suggest that lower ferritin level might be associated with parent-reported hyperactivity after controlling for important confounding factors.

Characteristics of DSM-IV attention deficit hyperactivity disorder combined and predominantly inattentive subtypes in a Turkish clinical sample.

Consecutively referred subjects (N = 537) to an outpatient clinic were evaluated to compare the Attention Deficit Hyperactivity Disorder Combined (ADHD-C) and predominantly inattentive (ADHD-PI) subtypes using parent and teacher ratings and neuropsychological variables. Statistical significance was at P < 0.002 adjusted for multiple comparisons. ADHD-PI subjects were older, more likely to be female, higher socioeconomic status, had lower Child Behavior Checklist and Teacher Report Form Aggression, Delinquency and Social Problems scores, and higher Withdrawal and Competence scores, compared to ADHD-C subjects. Comorbid conduct problems were more common among ADHD-C subjects. There were no differences in terms of anxiety/depression, and neuropsychological measures. The study is unique in that it provides data on a broad range of measures from a middle income developing country with important confirmation of similar pattern of differences and similarities between ADHD-C and ADHD-PI subtypes previously reported in North American and Western European samples.

Effect of Ferritin on Short-Term Treatment Response in Attention Deficit Hyperactivity Disorder.

OBJECTIVES: Several studies have shown that iron deficiency and ferritin levels are associated with parent and teacher Attention Deficit Hyperactivity Disorder (ADHD) ratings. Although there are conflicting results, it has also been reported that iron supplementation may help to decrease ADHD symptoms. When all these previous studies are taken into account, it is clear that a large study investigating the effects of iron deficiency and ferritin levels on routine pharmacological treatment of ADHD with stimulants would be helpful to elucidate this treatment from a clinical point of view. METHODS: A total of 345 subjects with combined or predominantly hyperactive-impulsive (PHI) subtypes of ADHD were included. All diagnoses were based on the DSM-IV criteria and ascertained by direct interviews conducted by the authors, who are experienced child psychiatrists certified in the use of the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL) semi-structured interview. The two treatment response criteria were: 1) 25% or more decrease in pre-treatment Conners Parent Rating Scale (CPRS) and Conners Teacher Rating Scale (CTRS) Hyperactivity (HA) and Total Problems scores; 2) CPRS and CTRS HA scores lower than the cut-off point ("very improved"). RESULTS: A total of 255 (73.9%) patients were on OROS-methylphenidate (OROS-MPH) and 90 (26.1%) were on immediate release methylphenidate (IR-MPH). The mean±sd of OROS-MPH and IR-MPH doses were 28.8±8.1 and 20.9±7.1 mg, respectively. More than half (52.5%) of the subjects were previously drug-naive at treatment inception. Two hundred and seventy eight (80.6%) subjects had combined subtype ADHD and the remainder had predominantly hyperactive-impulsive subtype. Only 60 (17.4%) of the subjects had no comorbid disorders, while 38.3% had one comorbid disorder, 32.8% had two comorbid disorders, and 11.6% had three or more comorbid disorders. The most frequent comorbidity was Oppositional Defiant Disorder/Conduct Disorder (ODD/CD, 51.6%), followed by Learning Disabilities (LD, 35.4%) and Anxiety Disorders (AD, 15.9%). Logistic regression analysis showed that subjects with comorbid ODD/CD and LD were less likely to respond to treatment. Ferritin levels and iron deficiency were not associated significantly with outcomes. CONCLUSIONS: In a large sample of subjects with combined or predominantly hyperactive-impulsive subtypes of ADHD, after controlling for several factors, we found that neither iron deficiency (ferritin <12 ng/ml) nor ferritin levels were associated with less favorable short-term treatment outcomes with stimulants. Subjects with comorbid ODD/CD and LD were less likely to have a 25% or more decrease in CTRS Total score. The presence of ODD/CD was also a negative predictor of treatment response in terms of CPRS Total and HA scores. The lack of a negative treatment response in ADHD subjects with iron deficiency and lack of a negative association with ferritin levels suggest that the relationship between iron metabolism and ADHD, a highly heterogeneous disorder, may be more complicated than previously believed.

[Reliability and Validity of the Turkish Version of the Social Communication Scale.] / Sosyal Iletisim Ölçeginin Okul Öncesi Çocuklardaki Geçerlik ve Güvenirligi.

Reliability and validity of the turkish version of the social communication scale. OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the Turkish version of the Social Communication Scale (SCQ). METHOD: Throughout 2010-2011, we evaluated children who were between 18-60 months of age in the outpatient clinic who were diagnosed as having autism (n=49) or pervasive developmental disorder not otherwise specified (n=18) according to the DMS-IV criteria. The control group consisted of 51children with developmental delay (25 mental retardation, 26 speech delay) and 71 children with typical development in the same age group. We used a one way analysis of variance and post-hoc Tukey HSD test to compare the SCQ scores of the groups. For the reliability and validity analysis the Cronbach alpha, item-total score correlations and test-retest correlations were used. Principal components analysis and varimax rotation were used to find the factor solutions. Receiver Operator Characteristic (ROC) curves were utilised to detect cut-off scores, sensitivity, specificity, and negative and positive predictive values. RESULTS: The analysis yielded 3 factors named Language, Reciprocal Social Interaction and Stereotypic Behaviors/Restricted Areas of Interest. The Cronbach alpha value of the total score was 0.88. The test-retest correlation was high (r=0.90, p<0.01). The SCQ Total, Language, Reciprocal Social Interaction and Stereotypic Behaviors/Restricted Areas of Interest scores were significantly different among the groups. The SCQ Total, Reciprocal Social Interaction and Stereotypic Behaviors/Restricted Areas of Interest scores were highest in the autism spectrum disorders group. The SCQ Language and Stereotypic Behaviors/Restricted Areas of Interest scores were not significantly different between the developmental delay and the typical development groups. ROC analysis indicated that the SCQ Total and Reciprocal Social Interaction scores differentiated very well between the autism spectrum and control group (area under the curve 0.89 and 0.91) while the Stereotypic Behaviors/Restricted Areas of Interest score differentiated less (0.72). Using a cut-off score of 14.5 for the SCQ Total score, sensivity was 0.84, specificity was 0.81, positive predictive value was 0.82 and negative predictive value was 0.83. Using a cut-off score of 7.5 for the SCQ Reciprocal Social Interaction score, sensivity, specifity, positive predictive value and negative predictive value were 0.91, 0.82, 0.83, 0.90, respectively. CONCLUSION: The results indicated that in children younger than 60 months of age the SCQ Total score can differentiate subjects with autism spectrum disorders from children with developmental delay and typically developing controls; however, the Reciprocal Social Interactions score was more sensitive and specific. On the other hand, the negative and positive predictive values indicated that there was a fair percentage of false negatives and positives. Our results showed that, particularly in younger children, the Reciprocal Social Interaction items were more specific and were more helpful for differentiation of the children with autism spectrum disorders. The availability of the SCQ as a shorter and more practical form of the Autism Diagnostic Interview, revised in Turkish, is important as both a research and clinical tool.

Ginger extract suppresses the activations of NF-κB and Wnt pathways and protects inflammatory arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) is a disabling inflammatory disorder. Ginger is used for food and medicine to treat arthralgia, sprains, and muscle aches. Anti-inflammatory effects of ginger have been observed. The aim of our study was to detect the effects of ginger on experimentally induced inflammatory arthritis. METHODS: Female Wistar albino rats (n = 21) were randomly separated into three groups (control, arthritis, and arthritis + ginger). Arthritis was generated by an appropriate method using type 2 collagen and Freund's adjuvant (collagen-induced arthritis model). The ginger group was treated starting at the first collagen injection with ginger root extract for 32 days by oral gavage (50 mg/kg/daily). Interleukin (IL)-6, IL-17, tumor necrosis factor-α (TNF-α), sclerostin, dickkopf-related protein-1 (DKK-1), and obestatin serum levels were studied by enzyme-linked immunosorbent assay method. Tissue TNF-α, IL-17, cyclooxygenase-2 (COX-2), and nuclear factor kappa B (NF-κB) levels were detected using the Western blot method. RESULTS: Mean arthritis score and serum levels of TNF-α, IL-6, and IL-17 were significantly decreased in ginger group than in the arthritis group. Increased sclerostin serum level and decreased DKK-1 serum levels were detected in ginger group compared with arthritis group. The decreases of IL-17, TNF-α, COX-2, and NF-κB tissue levels were statistically significant in the ginger group compared with arthritis group. Histopathological evaluation of the ginger group showed a decrease in the inflammation score compared to arthritis group. CONCLUSION: It can be concluded that ginger has protective properties in the development of inflammatory arthritis. The antiarthritic acts of ginger are related to NF-κB activity and Wnt pathway. Thus, it may be suggested that ginger is a candidate to research in human RA treatment.

Effects of zinc and ferritin levels on parent and teacher reported symptom scores in attention deficit hyperactivity disorder.

OBJECTIVE: It has been suggested that both low iron and zinc levels might be associated with Attention Deficit Hyperactivity Disorder (ADHD) symptoms. However, the association of zinc and iron levels with ADHD symptoms has not been investigated at the same time in a single sample. METHOD: 118 subjects with ADHD (age = 7-14 years, mean = 9.8, median = 10) were included in the study. The relationship between age, gender, ferritin, zinc, hemoglobin, mean corpuscular volume and reticulosite distribution width and behavioral symptoms of children and adolescents with ADHD were investigated with multiple linear regression analysis. RESULTS: Results showed that subjects with lower zinc level had higher Conners Parent Rating Scale (CPRS) Total, Conduct Problems and Anxiety scores, indicating more severe problems. CPRS Hyperactivity score was associated both with zinc and ferritin levels. Conners Teacher Rating Scale (CTRS) scores were not significantly associated with zinc or ferritin levels. CONCLUSIONS: Results indicated that both low zinc and ferritin levels were associated with higher hyperactivity symptoms. Zinc level was also associated with anxiety and conduct problems. Since both zinc and iron are associated with dopamine metabolism, it can be speculated that low zinc and iron levels might be associated with more significant impairment in dopaminergic transmission in subjects with ADHD.

Hand Microbial Flora of Hospitalized Children at the Beginning of Hospitalization and Before Discharge: A Cross-Sectional Study.

BACKGROUND: Hospital infections in pediatric units increase the length of hospital stay and the use of antibiotics, and this causes exposure to more procedures. This study was aimed to determine the microorganisms represented in the hand flora of pediatric patients at the beginning of hospitalization and before discharge. METHODS: The study was designed as a prospective cross-sectional study. This prospective study was performed with 124 pediatric patients. After completion of the admission procedures, an initial sample was taken from the hands of the hospitalized patients. Another sample was taken from the patients just before discharging. RESULTS: Growth of coagulase-negative staphylococcus (CNS) was observed in the culture samples of 28 patients. Cultures from 23 patients showed different microorganisms such as Staphylococcus aureus, Escherichia coli, and S. epidermis. Examination of final discharge cultures showed CNS in 43 patients, S. aureus in 5 patients, E. coli in 8 patients, Acinetobacter baumannii in 11 patients, and Kocuria rhizophila, K. kristinae, Candida spp., Pseudomonas spp., and Enterococcus in 1 patient. CONCLUSION: The cultures from samples obtained at discharge showed the presence of antibiotic-resistant pathogenic microorganisms causing healthcare associated infection.

Is there a relationship between epicardial fat tissue thickness and Tp-Te/QT ratio in healthy individuals?

INTRODUCTION: Epicardial fat is a tissue that releases many proinflammatory and atherogenic mediators, with endocrine and paracrine effects on the heart. In this study, the implication of the EFT thickness (EFTt) on transmural dispersion of repolarisation (TDR) was analysed utilizing the T-wave peak to end interval (Tp-Te), the Tp-Te dispersion (Tp-Te (d)), and the Tp-Te/QT ratio. MATERIAL AND METHODS: One thousand seven hundred and thirteen subjects were enrolled in the research. The subjects were chosen to be healthy individuals, without any cardiovascular/systemic disorders or risk factors for atherosclerosis. Transthoracic echocardiography (TTE) was applied to all subjects, and EFTt was measured in both diastole and systole. The ECG measurements were taken from standard 12-lead surface ECG. RESULTS: Correlation analysis revealed that the EFTt is highly associated with the Tp-Te interval, Tp-Te/QT ratio, Tp-Te (d), increasing age, body mass index (BMI), body surface area (BSA), left ventricular (LV) mass, LV mass index, plasma glucose during fasting, triglycerides, and low-density lipoprotein cholesterol. CONCLUSIONS: The study results showed that increased EFTt was associated with increased TDR values of Tp-Te, Tp-Te (d), and Tp-Te/QT ratio, even in the absence of other factors that could increase TDR and EFTt. Therefore, it can be stated that increased EFTt may cause an increase the risk for ventricular arrhythmia.

A new inflammatory marker: elevated eosinophil-tolymphocyte ratio associated with presence and severity of isolated coronary artery ectasia.

OBJECTIVES: The pathophysiology of isolated coronary artery ectasia (CAE) involves atherosclerosis and inflammation. Eosinophils and lymphocytes have been found to play a significant role in inflammation, atherosclerosis and endothelial dysfunction. Many studies have explored the relationship between isolated CAE and systemic inflammation. However, there are no data regarding the relationship between eosinophil-to-lymphocyte ratio (ELR) and isolated CAE. Therefore, this study analysed the relationship between ELR and isolated CAE. METHODS: All patients who underwent coronary angiography between January 2009 and June 2018 were investigated retrospectively. Of 16 240 patients, 232 patients with isolated CAE (141 males) and 247 age- and gender-matched control subjects (130 males) with normal coronary angiography (NCA) were enrolled in this study. Baseline demographic and laboratory data were obtained from the hospital database. The severity of isolated CAE was determined according to the Markis classification, vessel count and diffuseness of ectasia. RESULTS: Patients with angiographic isolated CAE had significantly elevated white blood cell (WBC) and eosinophil counts and ELR values compared to patients with NCA [8.11 ± 1.75 vs 7.49 ± 1.80 × 109 cells/l, p < 0.0001; 0.22 (0.13-0.32) vs 0.19 (0.12-0.28) × 109 cells/l, p = 0.02; 0.11 (0.06-0.17) vs 0.08 (0.05-0.12), p < 0.0001. The ELR value for Markis I was significantly higher than for Markis IV (p = 0.04), and three-vessel isolated CAE was significantly higher than onevessel isolated CAE (p = 0.04). Additionally, the ELR value for diffuse ectasia (Markis class I, II and III) was significantly higher compared to focal (Markis class IV) ectasia (p = 0.02). In receiver operating characteristics (ROC) analyses, it was determined that an ELR value > 0.099, measured in isolated CAE patients at application, had a predictive specificity of 60.3% and a sensitivity of 56.5% (area under the curve: 0.604, 95% confidence interval: 0.553-0.655, p < 0.0001). CONCLUSIONS: Patients with isolated CAE had higher blood eosinophil counts and ELR. Furthermore, the ELR was significantly correlated with severity of isolated CAE. These findings demonstrate that ELR may have a significant role in the aetiopathogenesis of isolated CAE.

Spotlights on some electrocardiographic paradigms: How should we evaluate normal reference values of Tp-Te interval, Tp-Te dispersion and Tp-Te/QT ratio?

BACKGROUND: Experimental and clinical studies evaluating the Tp-Te interval and Tp-Te/QT ratio have reported conflicting data. The overlap between normal Tp-Te/QT ratios (0.17 ±0.02-0.27 ±0.06 ms) and pathological values (0.20 ±0.03-0.30 ±0.06 ms) measured in earlier studies has raised questions about this ECG measurement technique. OBJECTIVES: To analyze normal values of the Tp-Te interval, Tp-Te dispersion Tp-Te(d) and the Tp-Te/QT ratio based on electrocardiographic (ECG) assessment across sex and age groups in a healthy Turkish population. MATERIAL AND METHODS: A total of 1,485 healthy participants (723 men) were enrolled into the study. The age of the participants ranged 17-75 years and they did not have either any cardiovascular/systemic disorders or risk factors for atherosclerosis which were detected with physical examination and laboratory tests. The Tp-Te interval, Tp-Te(d) and Tp-Te/QT ratio were determined from V1-V6 derivations. RESULTS: For the entire study, the median Tp-Te interval was 66.0 (64.0-70.0) ms, the Tp-Te(d) was 15.0 (10.0-20.0) ms, and the Tp-Te/QT ratio was 0.18 (0.17-0.19). The Pearson's correlation test demonstrated that the Tp-Te/QT ratio significantly correlated with older age (r = 0.297; p < 0.0001), left ventricular (LV) end-diastolic diameter (LVEDD; r = 0.481; p < 0.0001), body mass index (BMI; r = 0.421; p < 0.0001), body surface area (BSA; r = 0.191; p < 0.0001), LV end-diastolic volume (LVEDV; r = 0.484; p < 0.0001), LVEDV index (r = 0.450; p < 0.0001), LV mass (r = 0.548; p < 0.0001), and LV mass index (r = 0.539; p < 0.0001). CONCLUSIONS: The reference values for Tp-Te interval, Tp-Te(d) and Tp-Te/QT ratio are associated with age, BMI, BSA, LVEDV, LVEDV index, LV mass, and LV mass index. These structural elements should be considered when using these ECG parameters for assessing repolarization inhomogeneity. These findings may guide further studies assessing healthy and diseased populations.

[Reliability and validity of Turkish translation of the pediatric sleep questionnaire]. / Çocuklarda Uyku Ölçegi'nin Geçerlik ve Güvenirligi.

OBJECTIVE: Aim of this study was to investigate the validity and reliability of the Turkish translation of Pediatric Sleep Questionnaire (PSQ)-the extended version. The Pediatric Sleep Questionnaire (PSQ) has two versions: a shorter one, which has been validated for sleep-related breathing disorders, and an extended version, which deals with a wider range of sleep disturbances. METHOD: After translation and back-translation of the PSQ, it was filled in by the parents of 99 patients with Attention Deficit Hyperactivity Disorder (ADHD), 34 patients with Upper Airway Resistance and Snoring (UARS), and 42 healthy controls. Cronbach alpha was computed as a measure of internal consistency along with test-retest reliability and item-total score correlations. We used principal components analysis and varimax rotation to investigate the factor structure. The Receiver Operator Characteristic (ROC) curves were used to determine cut-off points, sensitivity, specificity, and negative and positive predictive values. RESULTS: Cronbach alpha coefficient was 0.77 for the whole questionnaire. Similar to the original PSQ study, we found four factors, namely "Snoring," "Behavioral Problems," "Breathing Problems," and "Other Problems.". However, different items loaded to these factors. While the first three factors were reliable and valid, this was not the case for the last factor. ADHD patients had higher "Breathing Problems" score than the controls, while all sleep related problems were higher in the UARS group than the other two groups. Cut-off points obtained from the ROC curves indicated that when a PSQ total score of 6 points was used as a cut-off, UARS group and the controls could be discriminated easily. In order to discriminate the ADHD and UARS groups, using the "Total Sleep Problems Score", which did not include the "Behavioral Problems" factor, resulted in greater specificty and sensitivity. DISCUSSION: These results indicated that the Turkish version of the PSQ was a valid and reliable measure, that the PSQ total score could discriminate patients with primary sleep disorder from healthy controls, and that the "Total Sleep Problems Score", which was obtained by omitting the Behavioral Problems factor score, could be used to discriminate primary sleep problems from secondary sleep problems associated with ADHD.

Relationship of ferritin to symptom ratings children with attention deficit hyperactivity disorder: effect of comorbidity.

Our aim was to investigate the relation between behavioral symptoms and hematological variables which are related with iron deficiency and anemia, ferritin, hemoglobin, mean corpuscular volume (MCV), and reticulosite distribution width (RDW) in children and adolescents with pure Attention Deficit Hyperactivity Disorder (ADHD) or ADHD comorbid with other psychiatric disorders. The sample consisted of 151 subjects with ADHD, 45 of these subjects had other comorbid conditions. Conners Parent (CPRS) and Teacher Rating Scales (CTRS) were obtained. Comorbid ADHD subjects had lower mean hemoglogin and MCV. In the ADHD group in general, CPRS and CTRS Total scores were significantly negatively correlated with ferritin level. When only pure ADHD subjects were taken into account, the correlations did not reach statistical significance. Overall, these results suggested that lower ferritin level was associated with higher behavioral problems reported by both parents and teachers. Presence of comorbid conditions might increase the effect of lower iron stores on behavioral measures.

[Comparison of cerebral blood flow in children with obsessive compulsive disorder and attention deficit hyperactivity disorder]. / Obsesif kompulsif bozukluk ve dikkat eksikligi hiperaktivite bozuklugu olan çocuklarin serebral kan akimlarinin karsilastirilmasi.

OBJECTIVE: It has been reported that both obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) might be related to impairments in frontal-striatal brain circuits. Besides, these two disorders are frequently comorbid. However, there are no published studies directly comparing the neurobiological findings in these two disorders. The objective of the study was to investigate the differences in cortical blood flow between patients with OCD and ADHD. METHOD: Thirteen drug-naive OCD subjects (mean age +/- SD: 10.4 +/- 2.8), and 13 drug-naive ADHD subjects (mean age +/- SD: 10.5 +/- 2.2) were included in the study. Cerebral blood flow (CBF) was evaluated with Tc-99m-hexamethylpropyleneamine oxime (Tc99m HMPAO) brain single photon emission tomography (SPECT) during standard resting conditions in all cases. P value was set to <.006 after Bonferroni correction. RESULTS: OCD cases had significantly higher right prefrontal (p=.003) CBF than ADHD cases. There were no significant CBF differences in other brain regions. OCD symptom severity was not related to CBF. DISCUSSION: This is one of the very few studies which directly investigated brain imaging in pediatric OCD subjects. Results are consistent with previous studies reporting increased prefrontal CBF in OCD subjects. We also found that, consistent with the previous literature, ADHD subjects had lower prefrontal cortex CBF. Studies which compare subjects with comorbid ADHD and OCD with pure forms of these disorders are necessary to have a better understanding of similarities and differences of these two disorders.