Abuse and addiction in gabapentinoid drug users for neuropathic pain.

OBJECTIVE: Gabapentinoids are gamma-aminobutyric acid analogue agents used in the treatment of neuropathic pain. They are increasingly being abused to achieve euphoric and dissociative effects. This study aimed to determine drug misuse/abuse and related factors in patients who used gabapentinoids for neuropathic pain. PATIENTS AND METHODS: This study included 140 patients over the age of 18. Patients were excluded from the study if they had aphasia, dementia, or diseases that led to aphasia or cooperative and cognitive dysfunction. They were also excluded if they lacked sufficient information about how long or at what dosage they had been using the drug. The Beck Depression Inventory and Beck Anxiety Inventory were used to evaluate depression and anxiety states. The patients' levels of drug abuse were determined according to the definitions provided in the terminology for misuse, abuse, and related events. RESULTS: The mean age of the patients was 56.78 ± 14.45 years, and 52.1% of them were females. While 57.9% of the patients used pregabalin, 42.1% of the patients used gabapentin. For the median (min-max) of the dataset, the pregabalin dose was 300 (50-600) mg/day, and the gabapentin dose was 900 (300-2,400) mg/day. Abuse was present in 17.9% of the patients. Risk factors for gabapentinoid abuse were smoking, alcohol, and antidepressant use, anxiety and depression, living alone, and drug dose and duration of use. CONCLUSIONS: Before prescribing drugs and managing the treatment process in a controlled manner, questioning patients about their risk factors can reduce the rate of abuse.

Bilateral Talus and Navicular Fractures accompanied with Unilateral Calcaneal Fracture: A Case Report.

An 18-year old male patient, with a history of paragliding accident, sustaining a coronal shear fracture of the body of the talus, an anterior process fracture of the calcaneus extending to the calcaneocuboid joint and a nondisplaced navicular body fracture at the right foot and a displaced fracture of the navicular body accompanied with posteromedial process fracture of the talus at the left side was referred to our emergency clinic. For the right foot, the coronal plane fracture of the talar body was anatomically reduced and fixed with screws. For the left foot, screw fixation was performed through the lateral aspect to fix the large posteromedial fragment. Small bone fragments were removed from the left navicular fracture, and the main fragments were also fixed with screw. The talo-navicular joint was stabilised with a Kirschner wire. At 36 months follow-up, bilateral foot and ankle functions were satisfactory, Maryland scores of the right and left foot were 85 (good) and 90 (excellent), respectively, and the patient regained his full activity level by the 5th month postoperatively. With reference to the number and types of fractures in this one patient, we present a standard protocol for treatment of isolated talus, navicular and calcaneal fractures presenting together in a single foot injury.

Bilateral Talus and Navicular Fractures accompanied with Unilateral Calcaneal Fracture: A Case Report

@#An 18-year old male patient, with a history of paragliding accident, sustaining a coronal shear fracture of the body of the talus, an anterior process fracture of the calcaneus extending to the calcaneocuboid joint and a nondisplaced navicular body fracture at the right foot and a displaced fracture of the navicular body accompanied with posteromedial process fracture of the talus at the left side was referred to our emergency clinic. For the right foot, the coronal plane fracture of the talar body was anatomically reduced and fixed with screws. For the left foot, screw fixation was performed through the lateral aspect to fix the large posteromedial fragment. Small bone fragments were removed from the left navicular fracture, and the main fragments were also fixed with screw. The talo-navicular joint was stabilised with a Kirschner wire. At 36 months follow-up, bilateral foot and ankle functions were satisfactory, Maryland scores of the right and left foot were 85 (good) and 90 (excellent), respectively, and the patient regained his full activity level by the 5th month postoperatively. With reference to the number and types of fractures in this one patient, we present a standard protocol for treatment of isolated talus, navicular and calcaneal fractures presenting together in a single foot injury.

Tp-e interval and Tp-e/QT ratio in patients with celiac disease.

OBJECTIVES: Celiac disease is a chronic immune-mediated disease of the small intestine. It has been known that dilated cardiomyopathy and ischemic coronary artery disease have become more frequent in patients with celiac disease. The aim of the study was to assess Tp-e interval and Tp-e/QT ratio in patients with celiac disease. MATERIAL AND METHODS: This study was conducted at a single center in collaboration with gastroenterology and cardiology clinics. Between January 2014 and June 2015, a total of 76 consecutive patients were enrolled (38 patients with celiac disease and 38 control subjects). Tp-e interval, Tp-e/QT and Tp-e/QTc ratio were measured from the 12-lead electrocardiogram. RESULTS: Tp-e interval (64.2±11.0 vs. 44.5±6.0; p<0.001), Tp-e/QT ratio (0.18±0.02 vs. 0.13±0.02; p<0.001) and Tp-e/QTc ratio (0.16±0.02 vs. 0.11±0.01; p<0.001) were significantly higher in patients with celiac disease than control subjects. There was a significant positive correlation between Tp-e/QTc ratio and disease duration in patients with celiac disease (r=0.480, p=0.003) and also there was a significant positive correlation between Tp-e/QTc ratio and erythrocyte sedimentation rate (r=0.434, p<0.001). CONCLUSIONS: Our study showed that Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were increased in patients with celiac disease. Whether these changes increase the risk of ventricular arrhythmia deserve further studies.

Long term efficacy of pegylated interferone in the treatment of delta hepatitis: a single center experience.

BACKGROUND AND AIM: Currently there is no satisfactory treatment of chronic HDV. We aimed to evaluate the long term efficacy of PEG-interferones. PATIENTS METHODS: Patients who received PEG-interferone for chronic delta hepatitis during a 7-year period were retrospectively analysed. End of treatment response, virologic response at 6 months after treatment, and long term efficacy were evaluated. Predictors of treatment response were determined. RESULTS: The study group consisted of 31 patients. Twenty-three patients received either PEG-interferone alfa-2a (n=8) or PEG-interferone alfa-2b (n=15) for at least 48 weeks. Thirteen patients had an end of treatment virologic response (ITT:56.5%, PP:68.4%). HDV RNA negativity after 6 months off PEG-interferone treatment was achieved in 12 patients (ITT:52.1%, PP:63.1%). The patients were followed for a median duration of 36 months after PEG-interferone treatment (min-max:12-120 months). Four patients (33.3%) relapsed during the follow-up. Sustained virologic response (ITT) was 34.8% in the long term. Undetectable HDV RNA level at week 24 of treatment and biochemical response were independent predictors of end of treatment response and sustained virologic response in the long term, respectively. CONCLUSION: PEG-interferones have an unsatisfactory efficacy on the treatment of HDV because of a considerable relapse in the long term. (Acta gastro-enterol. belg., 2016, 79, 329-335).

The rate of mucosal healing by azathioprine therapy and prediction by artificial systems.

BACKGROUND/AIMS: We aimed to assess the effect of azathioprine on mucosal healing in patients with inflammatory bowel diseases (IBD). Artificial neural networks were applied to IBD data for predicting mucosal remission. MATERIALS AND METHODS: Two thousand seven hundred patients with IBD were evaluated. According to the computer-based study, data of 129 patients with IBD were used. Artificial neural networks were performed and tested. RESULTS: Endoscopic mucosal healing was found in 37% patients with IBD. Male gender group showed a negative impact on the efficacy of azathioprine (p<0.05). Responder patients with IBD were older than the nonresponder (p<0.05) patients. According to this study, the cascade-forward neural network study provides 79.1% correct results. In addition to a 0.16033 training error, mean square error (MSE) was taken at the 16th epoch from the feed-forward back-propagation neural network. This neural structure, used for predicting mucosal remission with azathioprine, was also validated. CONCLUSION: Analyzing all parameters within each other to azathioprine therapy were shown that which parameters gave better healing were determined by statistical, and for the most weighted six input parameters, artificial neural network structures were constructed. In this study, feed-forward back-propagation and cascade-forward artificial neural network models were used.

Colonic tuberculosis or Crohn's disease? An important differential diagnosis.

Abdominal tuberculosis can mimic any disease affecting the gastrointestinal tract such as infectious processes, tumors, periappendiceal abscess, and Crohn's disease. The differential diagnosis of Crohn's disease and intestinal tuberculosis is a dilemma to clinicians and pathologists as both are chronic granulomatous disorders with similar clinical features. Lower gastrointestinal bleeding is an infrequent presentation of both intestinal tuberculosis and Crohn's disease. Herein, we report a 56-year-old woman presenting with massive hematochezia due to isolated colon tuberculosis in whom the initial diagnostic work-up suggested Crohn's disease and review the current literature. Our report highlights the need for awareness of colonic tuberculosis in the differential diagnosis of massive hematochezia from Crohn's disease, especially before initiating treatment with immunosuppressive agents.

Plasma transforming growth factor-beta1 level in inflammatory bowel disease.

BACKGROUND/AIMS: The aim of this study was to evaluate plasma transforming growth factor-B1 concentration in patients with inflammatory bowel disease at different stages of disease activation and to compare these values with those of healthy controls. METHODS: A total of 70 patients (31 women) evaluated in the Inflammatory Bowel Disease Clinics of TUrkiye YUksek Ihtisas Hospital, Gastroenterology Department, and 20 healthy controls (10 women) were enrolled in the study. Serum samples were obtained from 40 patients with ulcerative colitis (female/male: 18/22, mean age: 41.5+/-12), 30 patients with Crohn's disease (female/male: 17/13, mean age: 36.9+/-1.9) and 20 healthy controls (female/ male: 10/10, mean age: 32.1+/-1.7). The control group included normal blood donors without gastrointestinal complaints or a familial history of inflammatory bowel disease. Clinical activity in Chron's disease was measured by Crohn disease activity index and in ulcerative colitis patients by Rachmilewitz endoscopic index. Chron's disease patients with a Chron's disease activity index >150 and ulcerative colitis patients with a Rachmilewitz index > or =4 were accepted to have active disease. Determination of transforming growth factor-B1 level was performed with the enzyme- linked immunosorbent assay. RESULTS: Serum transforming growth factor-B1 levels were measured as: Chron's disease 1133.3+/-766.5 pg/ml, ulcerative colitis 1362.5+/-880.6 pg/ml and control group 1230.0+/-572.7 pg/ml. There were no significant differences between the three groups. In patients with active disease in ulcerative colitis, transforming growth factor-B1 level was measured as 1952.5+/-543.7, while this value was 772.5+/-750.5 in patientsin remission in ulcerative colitis. There was a significant difference between patients with active ulcerative colitis and remission ulcerative colitis. CONCLUSIONS: In inflammatory bowel disease, transforming growth factor-B1 can be used as a marker for differential diagnosis of active ulcerative colitis patients and remission ulcerative colitis patients. Nevertheless, more studies with larger patient groups are necessary.

Effects of polymorphism in G2677T/A triallelic region of MDR1 gene in Turkish patients with inflammatory bowel disease.

BACKGROUND/AIMS: Crohn's disease and ulcerative colitis are both chronic inflammatory disorders of the gastrointestinal tract, the main causes of which remain unknown. Crohn's disease and ulcerative colitis are characterized by cell-mediated immune response against the luminal bacteria. It is suggested that expression levels and function of P-glycoprotein, encoded by the MDR1 gene, are important for protection of the gut against xenobiotics and bacterial toxins. Therefore, the mutations of the MDR1 gene are thought to be related with the pathogenesis of inflammatory bowel disease. The aim of this study was to investigate the G2677T/A polymorphism in the MDR1 gene in Turkish patients with inflammatory bowel disease and a healthy control group. METHODS: In our study, the genotypes of endoscopically or histopathologically diagnosed Crohn's disease (n: 35; 14 F, 21 M) and ulcerative colitis (n: 82; 36 F, 46 M) patients and of 70 healthy individuals (39 F, 31 M) were compared. In the patient and control groups, polymerase chain reaction restriction fragment length polymorphism analysis was performed for two polymorphisms (G2677T and G2677A) of the MDR1 gene. RESULTS: In this study, the frequency of alleles at position 2677 of the MDR1 gene, which has a triallelic polymorphism, was not found to be significantly different between the patient and the healthy control groups. Moreover, the 2677A allele was not detected in either the patient group or the healthy control group. CONCLUSIONS: In this study, the G2677T/A polymorphism observed in the MDR1 gene was not found to be a risk factor for Crohn's disease or ulcerative colitis.

The long-term effects of lamivudine treatment in patients with HBeAg-negative liver cirrhosis.

INTRODUCTION: In hepatitis B virus (HBV)-related liver cirrhosis, patients with HBV replication show a higher mortality rate than those without. We aimed to investigate the long-term effects of lamivudine on HBV DNA suppression, Child-Pugh score, and survival in patients with hepatitis Be antigen (HBeAg)-negative liver cirrhosis. METHODS: Sixty-eight patients (51 male, 17 female) diagnosed with HBV-positive liver cirrhosis, who were monitored by the hepatology and liver transplantation outpatient clinics of our hospital between June 1999 and May 2007, were included in the study. Lamivudine (100 mg/day) was administered orally. Follow-up visits were scheduled monthly during the first 3 months, and every 3 months thereafter. Complete blood count, haemostasis, biochemistry (aspartate aminotransferase [AST], alanine aminotransferase [ALT], amylase, urea, creatinine, total bilirubin, direct bilirubin, total protein, albumin), and alpha-foetoprotein were recorded every 3 months. HBV DNA levels, abdominal ultrasound and the Child-Pugh score were evaluated every 6 months. RESULTS: Sixty-eight patients (mean age, 52.05+/-12.6 years) were monitored for 49.51+/-18.51 months. Basal ALT, HBV DNA levels and Child-Pugh scores were 103.9+/-73.9 IU/ml, 4133+/-121,94 IU/ml, and 7.6+/-2.4, respectively. The ALT normalisation was 59.7% during the first year, 68.2% during the second year and 44.4% during the fifth year. There was a significant decrease in Child-Pugh scores in the first 3 follow-up years when compared with the baseline score (P<0.05). During the treatment, HBV DNA positivity and YMDD mutations were determined in 20 of 68 (29.4%) patients at 46+/-17.9 months. Nine patients (13.2%) developed hepatocellular carcinoma at 44.8+/-21.5 months. Thirteen patients (19.1%) died during the treatment due to liver failure or variceal bleeding. CONCLUSION: Lamivudine is beneficial in patients with HBeAg-negative liver cirrhosis in terms of improvement in liver function and enhancement of survival and quality of life. An HBV DNA suppressive effect and improvement in Child-Pugh score were seen especially in the first years. It is important to be aware of YMDD mutation early, as addition of new antivirals is necessary to overcome unwanted results of the mutation.

Antineutrophil cytoplasmic autoantibodies and anti-Saccharomyces cerevisiae antibodies in inflammatory bowel diseases.

BACKGROUND/AIMS: Perinuclear antineutrophil cytoplasmic autoantibody is a marker for ulcerative colitis, and anti-Saccharomyces cerevisiae antibody is known to be associated with Crohn's disease. The purpose of this study was to search the value of detecting perinuclear antineutrophil cytoplasmic autoantibody and anti-Saccharomyces cerevisiae antibody for the diagnosis of Turkish inflammatory bowel disease patients. METHODS: Serum samples were obtained from 80 patients with ulcerative colitis, 61 patients with Crohn's disease and 40 healthy controls. Determination of both anti-Saccharomyces cerevisiae antibody and antineutrophil cytoplasmic autoantibody was performed with the standardized enzyme-linked immunosorbent assay. RESULTS: In cases with ulcerative colitis, 65% tested seropositive for antineutrophil cytoplasmic autoantibody, whereas the controls showed 2.5% positivity. In cases with Crohn's disease, 63.9% tested seropositive for anti-Saccharomyces cerevisiae antibody, whereas the controls showed 2.5% seropositivity. The combination of a positive anti-Saccharomyces cerevisiae antibody test and a negative antineutrophil cytoplasmic autoantibody yielded a sensitivity and specificity of 32.0% and 97.5%, respectively. The combination of a positive perinuclear antineutrophil cytoplasmic autoantibody and a negative anti-Saccharomyces cerevisiae antibody test yielded a sensitivity and specificity of 44.2% and 97.5%, respectively. CONCLUSIONS: Both serologic tests may aid in the differential diagnosis of inflammatory bowel disease.

Electromyographic biofeedback-controlled exercise versus conservative care for patellofemoral pain syndrome.

OBJECTIVE: To determine the effects of electromyographic biofeedback treatment in patients with patellofemoral pain syndrome. DESIGN: Randomized controlled trial. SETTING: A physical medicine and rehabilitation department in a research hospital of a university referral center. PATIENTS: Sixty patients with patellofemoral pain syndrome. Patients were randomly placed into 2 groups: biofeedback group (n = 30) and a control group (n = 30). INTERVENTION: The biofeedback group received electromyographic biofeedback training and a conventional exercise program, whereas the control group received a conventional exercise program only. MAIN OUTCOME MEASURES: Maximum and mean contraction values of the vastus medialis and the vastus lateralis muscles were assessed with the biofeedback device. Pain and functional status of the patients were measured by a visual analog scale (VAS) and the Functional Index Questionnaire (FIQ), respectively. RESULTS: Contraction values improved significantly at the end of the first month, compared with the pretreatment values in both groups. Mean contraction values in the biofeedback group of the vastus medialis muscles in all 3 monthly measurements, and the vastus lateralis muscles at the end of the first month, were significantly higher than those of the control group. Significant improvements were shown for both the VAS and the FIQ in both groups. Monthly follow-ups showed no VAS and FIQ differences between the groups. CONCLUSION: Electromyographic biofeedback treatment did not result in further clinical improvement when compared with a conventional exercise program in patients with patellofemoral pain syndrome.

Relationships between the children and the parents for coronary risk factors.

BACKGROUND: We aimed to investigate the relation of coronary risk factors in children to coronary heart disease (CHD) or coronary risk factors in their parents. METHODS: A sample of 252 parents of 164 children with two or more coronary risk factors were included in this study. The control group consisted of 175 parents of 114 children with no risk factors. Both groups were evaluated for coronary risk factors and CHD. The children in the groups were separated into sex and age groups consisting of 7 to 11-years-olds, 12 to 15-years-old and 16 to 18-years-old. RESULTS: Many lipid parameters related with coronary risk factors in the mothers of 7 to 11-year-old girls, in the fathers of 7 to 11-year-old girls and 16 to 18-year-old boys were at higher levels than in the control group. Anthropometric parameters, especially those of reflecting body fatness such as skinfold thickness measurements and total bodyfat percentage values were at higher levels in the fathers of 12-15- and 16 to 18-year-old girls. The higher levels of most of the anthropometric and biochemical parameters in the fathers of 16 to 18-year-old boys were striking. Hyperlipidemia prevalences in the fathers of 7 to 11-year-old girls and boys were higher than the control parents. In the study group, the girls positively correlated with both their parents for total cholesterol levels and positively correlated with only their mothers for height, bodyfat percentage, triglycerides and low-density lipoprotein- cholesterol (LDL-C) levels. However, the boys positively correlated with their mothers for weight and with their fathers for bodyfat percentage, diastolic blood pressure (BP) values and serum LDL-C levels. The proportion of individuals who had ischemic findings on treadmill exercise testing was significantly greater than control group in only the fathers of 12 to 15-year-old boys (P<0.05). CONCLUSIONS: The parents, especially the fathers of children with coronary risk factors have higher levels of coronary risk factors than those in the control group. There is a familial aggregation of body fatness and adverse lipid levels in the families of the children with coronary risk factors. The parents of children recognized as having coronary risk factors should be evaluated for these risk factors too.

trans-2,4,4,6,8,8-Hexamorpholino-2,6-bis(n-propylamino)cyclo-2lambda5,4lambda5,6lambda5,8lambda5-tetraphosphazatetraene.

The title compound, C(30)H(64)N(12)O(6)P(4), consists of a centrosymmetric chair-shaped cyclic tetrameric phosphazene ring with six bulky morpholino and two n-propylamino side groups. The two n-propylamino side groups are in trans positions. The bulky substituents mainly determine the eight-membered-ring conformation. The endocyclic N-P-N angles around the P atoms having different substituents are not the same as the P-N-P angles of the macrocyclic ring.

Determination of heavy metal contents in human colostrum samples by electrothermal atomic absorption spectrophotometry.

Determination of lead, cadmium, nickel, chromium, manganese and copper levels in colostrum samples (n = 30), collected from middle-class mothers, was carried out by electrothermal atomic absorption spectrophotometer (ETAAS) with Zeeman effect background correction using a tungsten-palladium-citric acid chemical modifier mixture. A wet-ashing procedure was applied to dissolve the samples and to remove the fat. The graphite furnace temperature programme for analytes determined by ETAAS was studied, and the optimum pyrolysis temperatures of Pb, Cd, Ni, Cr, Mn and Cu were determined in the presence of the modifier mixture. Detection limits of Pb, Cd, Cu, Mn and Cr were determined using a modifier mixture solution. Zinc and iron levels were determined by Zeeman flame atomic absorption spectrometer (F-AAS). Heavy metal levels (mean values) found in colostrum samples were 14.6 microg/l of Pb, 2.8 microg/l of Cd, 27.8 microg/l of Ni, 8.6 microg/l of Cr, 43.2 microg/l of Mn, 278 microg/l of Cu, 12.9 mg/l of Zn, and 3.5 mg/l of Fe. These metal levels were compared with results from other studies in different countries.

N-[Bis(2,4,6-trimethylphenoxy)phosphinoyl]-P,P,P-tris(2,4, 6-trimethylphenoxy)phosphazene.

The title compound, C(45)H(55)NO(6)P(2), consists of an acyclic P=N-P(O) monophosphazene chain and five bulky 2,4,6-trimethylphenoxy side groups which predominantly determine the molecular shape. Although the P-N single [1.586 (3) A] and P=N double [1.517 (3) A] bonds are significantly different from each other, both are substantially shorter than the ideal P-N single bond. The P-N-P angle [146.0 (2) degrees ] corresponds to the upper limit reported for acyclic phosphazene derivatives in the literature.

Coronary risk factors in Turkish schoolchildren: randomized cross-sectional study.

BACKGROUND: There is a strong association between the extent of atherosclerotic lesions in aorta and coronary arteries and antemortem risk factors in children and young adults. Cardiovascular diseases are the most common cause of death in adults in Turkey. However, the data about the extent of coronary risk factors in Turkish children is very limited. The aim of this cross-sectional study was to investigate the prevalence of coronary risk factors in Turkish schoolchildren living in Eskisehir, Turkey. METHODS: A randomly selected population of 4026 schoolchildren, aged between 7 and 18 years, residing in urban and rural parts of Eskisehir were evaluated for coronary risk factors, using previously predicted risk threshold values. RESULTS: Hypertension was found in 4.8% of the girls and 3.8% of the boys, 14.9% of the girls and 10.8% of the boys had abnormal lipid values, 18.2% of the girls and 26.4% of the boys had elevated total body fat percentages, 20.7% of the girls and 14.5% of the boys had physical inactivity and 3.8% of the girls and 11.4% of the boys were regular smokers. Urban children had higher rates of hypercholesterolemia; however, rural children had higher rates of physical inactivity. When the modifiable risk factors were considered, excluding family history, 47.7% of the children had at least one risk factor and 11.7% of them exhibited two or more risk factors. CONCLUSIONS: Turkish schoolchildren living in Eskisehir had considerably high levels of coronary risk factors. The interventional measures established in childhood, during which the lifestyle and habits responsible for coronary heart diseases are acquired, will be very effective for preventing and modifying the risk factors predisposing children to coronary heart disease.