Effect of vitamin B12 on methotrexate-induced cardiotoxicity in rats.

Objectives: Methotrexate (MTX) is a drug with anti-inflammatory and immunosuppressive effects and is also a folic acid antagonist. Our aim in this study is to determine the molecular mechanisms of cardiotoxicity caused by MTX, a chemotherapeutic drug, and to evaluate the protective effects of vitamin B12 on this toxicity. Materials and Methods: A total of 32 rats were used in our study and 4 groups were formed. Control group, Vit B12 group (3 µg/kg B12 for 15 days, IP), MTX group (20 mg/kg MTX single dose on day 8 of the experiment, IP), MTX +Vit B12 group (3 µg/kg, IP ), Vit B12 throughout the 15 days, and a single dose of 20 mg/kg MTX (IP) on day 8 of the experiment. Immunohistochemically, expressions of hypoxia-inducible factor 1α (HIF1-α), vascular endothelial growth factor receptor-2 (VEGFR-2), erythropoietin (EPO), and interleukin-6 (IL-6) were evaluated in the heart tissue. Total catalase (CAT), superoxide dismutase (SOD), and malondialdehyde (MDA) levels were measured in the heart tissue. At the same time, ANP and NT-proBNP levels were measured in the blood serum. Results: In the study, the expression of HIF1-α and VEGFR-2 increased significantly in the MTX group, while IL-6 and EPO significantly decreased. At the same time, CAT and SOD levels were significantly decreased and MDA levels increased significantly in the MTX group. While vitamin B12 significantly corrected all these values, it also greatly reduced the increases in ANP and NT-proBNP levels caused by MTX. Conclusion: It is important to use Vit B12 before and after MTX administration to replace the folate that MTX has reduced.

Prevalence of suicide attempt, suicide ideation and self-harm at diagnosis in adolescents with eating disorders.

BACKGROUND: Data concerning the suicide prevalence of eating disorder (ED) subtypes and predictive factors are lacking in youth. This study aimed to examine suicide attempts (SA), suicide ideation (SI) and self-harm (SH) upon diagnosis in adolescents with EDs. METHODS: The prevalence of SA, SI and SH in ED subtypes was evaluated by retrospectively assessing the Home, Education/Employment, Eating, Activities, Drugs, Sexuality, Suicidal ideation and Safety (HEEADSSS) instrument of adolescents diagnosed with an ED. Clinical predictors of SI in anorexia nervosa (AN) and atypical AN (AAN) were assessed. RESULTS: Among all participants (398), 41 (10.3%) reported SA, 126 (31.7%) SI and 60 (15.1%) SH. While SA did not differ statistically between ED subgroups (p = .123), they were two times more prevalent in the bulimia nervosa (BN) group (17.5%) than in the AN group (8.5%). In the BN group, SI was 2.3 times more prevalent than in the AN group (p = .001). The AN and ARFID groups exhibited substantially less SH (p = .036). Having a higher body mass index (BMI) was the only significant predictor of SI. CONCLUSIONS: This study demonstrates that adolescents with EDs are at an increased risk for suicidality, highlighting the need for close screening, particularly in those with BN, AN-BP and AN with a higher BMI.

Adolescents with eating disorders have higher rates of suicidality than the general population.Bulimia nervosa had the highest risk for a suicide attempt, suicide ideation and self-harm at diagnosis.A higher body mass index (BMI) percentage was associated with an increased risk of suicidality in the anorexia nervosa group.

Drug delivery systems of CoFe2O4/chitosan and MnFe2O4/chitosan magnetic composites.

The study consists of three parts. In the first part, synthesis and characterization of core-shell magnetic composite beads based on chitosan and containing two different magnetic nanoparticles were carried out. The beads were formed from CoFe2O4/chitosan and MnFe2O4/chitosan. TGA and SEM were used for the characterization of core-shell materials. In the second part, swelling experiments of magnetic beads were performed. In the third part, 5-Fluorouracil was encapsulated at different rates in two different magnetic materials, release experiments were carried out at pH 7.4, pH 6.8, and pH 1.2, and the model of drug release was determined. Korsmeyer-Peppas, Higuchi, first-order, and zero-order models were used for mathematical modeling. Both prepared systems were found to be suitable for controlled release for 5-Fluorouracil.

Changes in MAP-2 and GFAP immunoreactivity in pup hippocampus during prepubertal and pubertal periods caused by maternal subclinical hypothyroidism

An absence of the thyroid hormone during the critical period of brain development causes delayed maturation of glial cells and neurons and decreases the number of hippocampal cells. This study aims to examine the impact of maternal subclinical hypothyroidism (SCH) on pup hippocampus during the prepubertal and pubertal periods by means of assessing the histopathological changes in astrocytes and neurons.Twelve Wistar albino pregnant rats were divided into two groups, Group H and Group C. Group C was designated as the control group and nothing was added to their drinking water. SCH was induced in Group H by administering 6-propyl-2-thiouracil (PTU) at a final concentration of 0.01% in the drinking water of pregnant rats for 21 days. Male pups for each group were divided evenly and evaluated on either day 15 (prepubertal) or 60 (pubertal) (7 pups in each group). At the end of the experimental period, the rats were sacrificed for analysis of brain tissue. Immunoreactivity intensities of MAP-2 and GFAP were evaluated in hippocampus tissue. Thyroid function was determined using ELISA. The structure of hippocampus was evaluated by hematoxylin-eosin staining. Finally, the TUNEL method was utilized to show apoptosis of hippocampus tissue. The results were analyzed statistically.The findings show that maternal SCH causes disruption in hippocampal cytoskeleton and dendritic organization, especially during the pubertal period, as well as a decrease in MAP-2 expression. We observed structural deformation in astrocytes, reduced astrocyte survival and GFAP expression. Finally, we found that the number of neuronal apoptotic cells tended to increase in the pubertal period

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Cystatin C, a novel cardiometabolic risk marker in women with polycystic ovary syndrome.

OBJECTIVE: To investigate the impact of urinary albumin excretion (UAE) and cystatin C on the metabolic components of polycystic ovary syndrome (PCOS). METHODS: Seventy-five women with PCOS were divided into two groups according to metabolic syndrome as MetS + and MetS-. Clinical, metabolic and renal parameters were compared between the groups. Correlation analyses were performed between cystatin C, microalbuminuria and clinical and metabolic parameters in women with PCOS. RESULTS: Waist/hip ratio (WHR), body mass index, LDL cholesterol, triglyceride, total cholesterol, cystatin C, UAE were significantly higher in the MetS + group compared with the MetS - one. HDL cholesterol was significantly higher in the MetS - group than the MetS + one. The UAE positively correlates with LDL cholesterol, triglyceride and total cholesterol levels. Cystatin C positively correlates with UAE, WHR, LDL cholesterol, triglyceride, total cholesterol levels. CONCLUSIONS: Evaluating UAE and cystatin C may be important for the detection of target subjects at high risk for future metabolic syndrome and cardiovascular disease.

Expression of Ghrelin and GHSR-1a in Long Term Diabetic Rat's Kidney

The aim of this work was to study the relative ghrelin and growth hormone secretagogue receptor (GHS-R)1a gene expression in the kidney of long-term diabetic rats. Forty male Wistar albino rats were divided into four groups: C- control group, DI- one month diabetic rats group, DII- two months diabetic rats group, and DIII- three months diabetic rats group. Diabetes was induced by streptozotocin STZ (40mg/kg i.p). The rats were decapitated under ketamine anesthesia and their kidney tissues were removed. Tissue GHS-R mRNA levels, ghrelin expression, and histopathological damage scores were compared. Dilatation in the distal tubules, epithelial desquamation into the lumen of the tubules and transparent tubules showing glycogen vacuolation were observed in all the diabetic groups. Ghrelin immunoreactivity was significantly higher in group DI compared to group C, whereas in groups DII and DIII, ghrelin immunoreactivity was similar with group C. GHSR-1a mRNA level in group DIII was significantly lower than in group C. As a result, ghrelin immunoreactivity increased at the beginning of diabetes; however, with increase in the duration of diabetes ghrelin immunoreactivity approached to the control values. The expression of GHSR-1a mRNA decreased with increase in diabetes duration. It seemed that down-regulation of GHSR-1a contributed to the renal damage induced by long-term diabetes.

Early prediction for the requirement of second or third dose methotrexate in women with ectopic pregnancy, treated with single-dose regimen.

PURPOSE: To investigate the predictive factors for the requirement of additional doses of methotrexate in women with ectopic pregnancy treated with single-dose methotrexate regimen. METHODS: This retrospective cohort study was conducted on women treated with single-dose methotrexate regimen for ectopic pregnancy at a tertiary referral center. Control group included the patients who were treated only with a single dose of methotrexate (n = 131) and study group included the patients who need a second dose or third dose methotrexate (n = 76). The sonographic variables such as size of the ectopic mass, the endometrial thickness and biochemical variables were analyzed via Chi square and student t test. Logistic regression analysis used to determine independent predictors of the additional dose requirement. RESULTS: The size of the ectopic mass and the endometrial thickness were similar in both groups. However, all human chorionic gonadotropin values on day 1, 4 and 7 were significantly higher in study group than the control group (p = 0.0001). Logistic regression analysis revealed that the human chorionic gonadotropin changes between day 1 and 4 is a predictive factor for requirement of additional doses of methotrexate (area under curve: 0.763, p < 0.001) and the cutoff value for human chorionic gonadotropin change was calculated as 22%. The probability of the requirement for an additional dose of methotrexate is 6.45 times more in patients who had less than 22% reduction in human chorionic gonadotropin levels from day 1 to 4 compared to those who had >22% reduction from day 1 to 4. CONCLUSION: Less than 22% reduction in human chorionic gonadotropin levels from day 1 to 4 can be used as a predictive factor for the requirement of an additional dose of methotrexate in single-dose regimen. This cutoff value can be used for patients to inform about the probable longer resolution time and refer to alternative treatment modalities such as two-dose, multiple-dose regimens or surgery.

Primary cutaneous lymphomas: single center experience of dermatology and hematology clinics.

PURPOSE: To present the clinical characteristics, treatments performed, response to treatment, and follow up of 40 patients diagnosed with primary cutaneous lymphoma. METHODS: In this retrospective study included were 23 males and 17 females from our center with confirmed diagnosis of primary cutaneous lymphoma over an 8-year period. Data were retrieved from the patient medical records. RESULTS: The median patient age at diagnosis was 59.5 years (range 33-86). Skin biopsies showed that 31 patients (77.5%) had mycosis fungoides (MF), 2 (5%) had anaplastic large cell lymphoma, 3 (7.5%) had diffuse large B cell lymphoma, 3 (7.5%) had poikilodermic mycosis fungoides, and 1 (2.5%) had non-classified non-Hodgkin lymphoma (NHL). In patients with T cell lymphoma clinical stage IA prevailed (42.5%). The 3 patients with B cell lymphoma had stage IE and 2 of them had B symptoms. Sezary cells were detectable in the peripheral blood of 3 patients. Twenty-three patients (57.5%) used only topical corticosteroids, 2 (5%) were treated with PUVA (psoralen ultraviolet A), 1 (2.5%) was treated with PUVA and chemotherapy, 8 (20%) received combination chemotherapy, 1 patient (2.5%) received PUVA+ interferon+topical nitrogen mustard, and 1 (2.5%) received chemotherapy+topical nitrogen mustard+interferon. Among 16 patients with the valuable response to treatment 5 (33%) showed complete remission (CR) and 9 (60%) partial remission (PR). The median follow up time for all patients was 1.5 months (range 1-135). While mean overall survival (OS) time was 123 months (95% CI 100.6-145.3), the estimated median OS was not reached. CONCLUSION: Early diagnosis of MF is rather favorable in terms of high and long-term response rates to topical treatments.

Assessment of health-related quality of life (HRQoL) of patients with type 2 diabetes in Turkey.

We measured the health-related quality of life (HRQoL) in a sample of 376 type 2 diabetes patients in Turkey using the Diabetes Quality of Life (DQOL) instrument and examined which patient socio-demographic and diabetes-related clinical characteristics are associated with better quality of life (QoL). The influence of patient socio-demographic and clinical characteristics on QoL was examined using independent sample t-tests and one-way analysis of variance. Diabetes significantly affected the HRQoL of patients included in this study. The mean score of the total DQOL measure was higher among patients who were less than 40 years of age, male, married, had less than 8 years of education, lived with their family and had no family history of diabetes (p<0.05). Similarly, patients with less than 5 years of disease duration, no complications or prior hospitalization, receive insulin, and with HbA(1)c<7 reported significantly better overall HRQoL (p<0.05). Patients with BMI<24 had higher levels of satisfaction with diabetes than those with BMI>or=24 (p<0.05). Diabetes-related HRQoL information is clearly of supreme importance to family physicians and policy makers to identify and implement appropriate interventions for achieving better management of diabetes and ultimately improving the QoL of diabetes patients.

Translation, cultural adaptation, cross-validation of the Turkish diabetes quality-of-life (DQOL) measure.

OBJECTIVE: The aim of this study was to test the validity and reliability of the Turkish version of the diabetes quality of life (DQOL) questionnaire for use with patients with diabetes. METHODS: Turkish version of the generic quality of life (QoL) scale 15D and DQOL, socio-demographics and clinical parameter characteristics were administered to 150 patients with type 2 diabetes. Study participants were randomly sampled from the Endocrinology and Diabetes Outpatient Department of Dr. Lutfi Kirdar Kartal Education and Research Hospital in Istanbul, Turkey. RESULTS: The Cronbach alpha coefficient of the overall DQOL scale was 0.89; the Cronbach alpha coefficient ranged from 0.80 to 0.94 for subscales. Distress, discomfort and its symptoms, depression, mobility, usual activities, and vitality on the 15 D scale had statistically significant correlations with social/vocational worry and diabetes-related worry on the DQOL scale indicating good convergent validity. Factor analysis identified four subscales: satisfaction", impact", "diabetes-related worry", and "social/vocational worry". CONCLUSION: Statistical analyses showed that the Turkish version of the DQOL is a valid and reliable instrument to measure disease related QoL in patients with diabetes. It is a simple and quick screening tool with about 15 +/- 5.8 min administration time for measuring QoL in this population.

Turkish version of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration: a preliminary study.

BACKGROUND: The Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration is an established instrument to measure the perceived work relationship between physicians and nurses. The survey addresses areas of autonomy and decision making, interprofessional education and relations, psychosocial care, teamwork, and shared responsibility. The aim of this prelimiary study was to adapt the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration for use in Turkey and test its psychometric properties and utility in clinical and research practice. METHODS: The process of cross-cultural adaptation and validation followed the guidelines provided in the existing literature. First, three bilingual health professionals independently translated the original questionnaire into Turkish and a consensus version was generated. Then, three other translators, blind to the original questionnaire, performed a back translation into English to confirm the accuracy of the translation. This version was then compared with the original English questionnaire. Discrepancies were discussed and solved by a panel of two nurses and two physicians. The field-testing for face validity was done in a group of ten monolingual physicians and nurses. Reliability was assessed with test-retest reliability and construct validity was confirmed with factor analysis. RESULTS: The mean time of questionnaire administration was 3 minutes and 45 seconds. The test-retest reliability was 0.75, and Cronbach's coefficient alpha was 0.71 for the entire sample. The findings of the factor analysis indicated that the Turkish version of Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration was comprised of the following four factors: 'physician-nurse relationships', 'shared education', 'nursing role in patient care', and 'accountability and responsibility of nurses.' CONCLUSION: The overall findings of this study indicate that the Turkish version of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration is a psychometrically sound tool with satisfactory measurement characteristics including construct validity and internal consistency reliability. This instrument may be useful in assessing the effectiveness of educational programs designed to enhance collaboration between physicians and nurses, whether these programs are aimed at residents and graduate nursing students or practicing physicians and nurses.

[Psychopathology and personality patterns in the first-degree relatives of bipolar patients]. / Bipolar bozuklugu olan hastalarin birinci derece akrabalarinda psikopatoloji ve kisilik orüntüleri.

OBJECTIVE: This is a cross-sectional study designed to assess psychopathology and personality patterns in a group of high-risk subjects for bipolar disorder compared to a control group. As high-risk subjects first-degree relatives of bipolar patients were selected. METHOD: Ninety-five first-degree relatives of 54 bipolar patients and 93 first-degree relatives of 54 subjects without any psychiatric disorder were recruited in the study. Control subjects were matched to bipolar patients according to age, gender and educational status. SADS-L (Schedule for Affective Disorders and Schizophrenia-Lifetime Version) was used both to ascertain the psychiatric status of the patient and control subjects, and to evaluate the psychopathology in probands' and controls' relatives. MMPI-2 (Minnesota Multiphasic Personality Inventory-2) profiles of relatives of patient and control groups were compared as well. RESULTS: In the relatives of bipolar patients the SADS-L diagnoses of hypomania, minor depression and schizotypal personality were statistically more prevalent than in the relatives of the control group. MMPI-2 profiles of both relatives of bipolar patients and controls were within "normal" range, whereas relatives of patients were more defensive in disclosing psychopathology. Any specific profile characteristic for relatives of bipolar patients could not be described. CONCLUSION: Minor mental disorders were more prevalent in the relatives of bipolar patients group. A personality pattern specific to high risk group for bipolar disorder couldn't be detected.

Physician-nurse attitudes toward collaboration in Istanbul's public hospitals.

The need for greater collaboration between nurses and physicians in clinical practice is essential to improve patient care and worker satisfaction. This study used t-tests and logistic regression to test four research hypotheses concerning attitudes toward physician-nurse collaboration in Istanbul, Turkey. The study found that nurses express more positive attitudes toward collaboration than physicians. Noteworthy was the finding that male physicians expressed more positive attitudes toward collaboration than female physicians. Residents and those employed in secondary institutions were also more likely to express more positive attitudes toward collaboration than permanent physicians and those employed in tertiary hospitals.

Translation, cultural adaptation, initial reliability, and validation of Turkish 15D's version: a generic health-related quality of life (HRQoL) instrument.

This article describes the adaptation of the Finnish 15D standardized measure of health-related quality of life (HRQoL) instrument for use in Turkey and assesses its psychometric properties. The HRQoL is measured in a sample of 75 patients with Type 2 diabetes using both 15D and Nottingham Health Profile (NHP) instruments. The internal consistency within the domains of 15D was high, with Cronbach's alpha values 0.89 for 15D scale and 0.89 for NHP. Significant correlations were observed between the scores of similar domains of 15D and the NHP in general health perception supporting the construct validity of the new 15D Turkish version. Overall, the results indicated that the adaptation of the 15D for use in Turkey was successful. The Turkish version was found to be a reliable and valid instrument. It is suitable and applicable to both clinical and population-based studies for the measurement of HRQoL in Turkey.

Serum and gingival crevicular fluid levels of ciprofloxacin in patients with periodontitis.

BACKGROUND: The use of antibiotics as an adjunctive therapy in the treatment of periodontal diseases is of special interest to dental practitioners. In addition to using an appropriate antibacterial agent, clinicians may find it useful to determine the local and systemic concentrations of antibiotics in infected periodontal sites to reduce the levels of bacteria. The purpose of this study was to determine the serum and gingival crevicular fluid, or GCF, concentrations of systemic ciprofloxacin in patients with periodontitis. METHODS: Ten subjects with chronic periodontitis received ciprofloxacin (500 milligrams) twice daily for five days. The authors collected GCF and serum samples immediately after administering the first dose (baseline = 0 hours) and at consecutive time points. The orifice method was used for GCF sampling, and 5 milliliters of venous blood was drawn for serum analysis. The authors used high-performance liquid chromatography to determine ciprofloxacin concentrations in GCF and serum. RESULTS: The authors found that ciprofloxacin concentrations in GCF were significantly higher than concentrations in serum at two, four, seven, 24 and 120 hours. Ciprofloxacin reached the maximum concentration, or Cmax (3.72 micrograms/ mL), in GCF two hours after the initial dose was administered. The concentration decreased to 2.06 microg/mL 24 hours after the initial administration of the drug. Serum Cmax was 2.58 microg/mL at 1.5 hours, and the concentration decreased to 0.26 microg/mL at 24 hours. CONCLUSION: The results of this clinical study show that ciprofloxacin is found in GCF and its concentration in GCF is significantly higher than that in serum. CLINICAL IMPLICATIONS: Ciprofloxacin may be useful in treating patients with periodontitis because it reaches higher concentrations in GCF than in serum.