Risk Factors for Exacerbations in School-Age Children with Asthma.

INTRODUCTION: Awareness of risk factors for asthma exacerbation can reduce the morbidity and mortality of the disease. The current study aimed to investigate the risk factors associated with current asthma exacerbations in school-age children. METHODS: This study enrolled children who were admitted to a tertiary outpatient paediatric allergy and asthma department and were diagnosed with asthma. Patients and their caregivers underwent an interviewer-administered questionnaire, which obtained information regarding the demographic features and parameters to determine environmental exposures along with previous disease history. Laboratory examinations, including complete blood count with differential, total IgE levels, skin prick tests, and pulmonary function tests, were also performed. RESULTS: A total of 431 children (288 male, 66.8%) with a median age (interquartile range) of 8.1 (6.3-11.2) years were included, among whom 265 (61.5%) had aeroallergen sensitization. Asthma was controlled, partially controlled, and uncontrolled in 154 (35.7%), 53 (12.3%), and 143 (33.2%) patients, respectively. A total of 81 patients (18.8%) experienced asthma exacerbation. Multivariate logistic regression analysis revealed that a history of asthma exacerbation within the last year (odds ratio [confidence interval]) (20.73 [9.95-43.20]; p < 0.001), a shorter asthma duration (<2.5 years) (2.58 [1.44-4.61]; p = 0.001), and a lack of regular controller therapy (4.12 [1.54-10.98]; p = 0.005) were associated with current asthma exacerbation. DISCUSSION/CONCLUSION: Awareness of risk factors for asthma exacerbation may help physicians treat school-age children with asthma by providing prompt and rational interventions in order to prevent asthma exacerbations.

Mosquito hypersensitivity may be associated with atopic background in children.

BACKGROUND: Many children encounter unusual or "exaggerated" reactions such as large local, atypical or systemic reactions after mosquito bites. OBJECTIVE: The aim of this study was to document the clinical features of children with mosquito allergy and investigate the possible associations between demographic features and type of reactions in this population. METHODS: Children with large local or unusual reactions after mosquito bites who attended to our outpatient pediatric allergy department were enrolled in the study along with control subjects. RESULTS: A total of 180 children (94 with mosquito allergy and 86 age and sex-matched control subjects) with a median age of 6.8 years (IQR 5.5-9.3) were enrolled. Atopy (35.1% vs. 11.6%, p < 0.001) and grass pollen sensitization (28.7% vs. 8.1%, p < 0.001) were significantly more frequent in children with mosquito allergy. Skin prick test with mosquito allergen was positive in only 6 children (6,4%). Grass pollen sensitization was most common in children (28.7%) followed by sensitization to house dust mite (9.6%). 30 children (31.9%) had an accompanying atopic disease such as allergic rhinitis, asthma or atopic dermatitis. Bullae were significantly more frequent in children with asthma (41.7% vs.15.9, p = 0.034). The median duration of symptoms after onset were significantly longer in patients with ecchymosis, with immediate wheals and in children whose symptoms start in 20 min to 4 hours after mosquito bites. CONCLUSION: There is an association between unusual, large local or exaggerated reactions after mosquito bites and allergic diseases in children. The severity of reactions increases with age and particularly in children with atopic background.

Long-Term Omalizumab Treatment: A Multicenter, Real-Life, 5-Year Trial.

BACKGROUND: Omalizumab has demonstrated therapeutic benefits both in controlled clinical trials and real-life studies. However, research concerning the long-term effects and tolerability of omalizumab is needed. The main objective of this study was to evaluate the effectiveness and tolerability of treatment with omalizumab for up to 5 years. METHODS: A multicenter, retrospective, chart-based study was carried out to compare documented exacerbations, hospitalizations, systemic steroid requirement, FEV1, and asthma control test (ACT) results during 1 year prior to omalizumab treatment versus at 1, 3, and 5 years of treatment. Adverse events and reasons for discontinuation were also recorded at each time point. RESULTS: Four hundred and sixty-five patients were enrolled in the study. Outcome variables had improved after the 1st year and were sustained after the 3rd and 5th years of treatment with omalizumab. Omalizumab treatment reduced the asthma exacerbation rate by 71.3% (p < 0.001) at 1 year, 64.3% (p < 0.001) at 3 years, and 54.8% (p = 0.002) at 5 years. The hospitalization rate also decreased; by the 5th year of the treatment no patients were hospitalized. ACT results had also improved significantly: 12 (p < 0.001) at 1 year, 12 (p < 0.001) at 3 years, and 12 (p = 0.002) at 5 years. Overall, 12.7% of patients reported adverse events (most of these were mild-to-moderate) and the overall dropout rate was 9.0%. CONCLUSION: Omalizumab had a significant effect on asthma outcomes and this effect was maintained over 5 years. The drug was found to be generally safe and treatment compliance was good.

Safety of subcutaneous immunotherapy with inhalant allergen extracts: a single-center 30-year experience from Turkey.

CONTEXT: Although subcutaneous allergen immunotherapy (SCIT) is effective in allergic rhinitis (AR) and asthma, it carries a risk of local and systemic adverse reactions. OBJECTIVE: The aim of this study was to evaluate the rates and clinical characteristics of local and systemic reactions (LR and SR), and to identify their relation of demographic features, allergen extracts and diagnosis. MATERIALS AND METHODS: This study analyzed the administration of SCIT from 1983 to 2013; involving 1816 patients affected by allergic asthma and/or AR. RESULTS: The rates of SR from SCIT were 0.078% per injection and 9% per patient. According to the World Allergy Organization 2010 grading system, 91 grade 1 reactions (44%), 67 grade 2 reactions (32.3%), 33 grade 3 reactions (16%) and 16 grade 4 reactions (7.7%) were seen. There was no fatal outcome from any of the SRs. Risk factors for a SR included: aluminium-adsorbed extract, pollen-containing vaccines, large LR and recurrent (≥2) LRs. The total LR rates were 0.062% per injection and 5.2% per patient; the small LR rates were 0.027% per injection and 2.3% per patient, and the large LR rate were 0.035% per injection and 2.9% per patient. Female gender, depot extracts, calcium phosphate-adsorbed extract and pollen vaccines were identified as risk factors for LR. CONCLUSION: The analysis of our data over a 30-year period confirmed that SCIT with inhalant allergens conducted strictly according to the standard protocols and when administrated by experienced staff is a safe method of treatment with only a few side-effects.

The Effects of Fluoxetine and Agomelatine on Neurocognitive Functions and Sleep in Patients with Major Depressive Disorder.

Background: We aimed to evaluate the effects of 6 weeks of agomelatine versus fluoxetine treatment on cognition and sleep. Methods: Agomelatine 25 mg/day and fluoxetine 20 mg/day were administered to major depressive disorder (MDD) patients. Assessments were conducted before the treatment and at the sixth week of treatment via psychometric measures and comprehensive neurocognitive assessments of various functions, including executive skills, attention, memory, verbal fluency, and speed of processing. Results: They both improved the evaluated neurocognitive test scores (P < .05), except for the scores of the Digit Span Test (P > .05), but only fluoxetine significantly improved the scores of the Controlled Oral Word Association Test (P = .018). Only in relation to the subjective sleep quality part of the Pittsburgh Sleep Quality Index (P = .035) and the Trail Making Test-B (TMT-B) (P = .046) was there an important difference between the study groups, and agomelatine showed better effects than fluoxetine in these measures. Conclusion: Both drugs improved the neurocognitive functioning in the participants. However, the better effect of agomelatine in improving the TMT-B scores suggests that it is a suitable option for MDD patients with noticeable executive disturbances.

Mirtazapine protects against cisplatin-induced oxidative stress and DNA damage in the rat brain.

AIM: Cisplatin chemotherapy is associated with neurotoxicity, and oxidative stress might play an important role in the pathogenesis. Mirtazapine may be a preventative agent via its less-known antioxidant properties. The aim of this study was to examine the potential chemoprotective effects of mirtazapine against cisplatin-induced oxidative stress and DNA damage. METHODS: Twenty-four rats were divided equally into four groups: control; cisplatin (10 mg/kg i.p.); cisplatin plus mirtazapine (10-30 mg/kg, respectively i.p and p.o.); and mirtazapine (30 mg/kg p.o.). The rats were killed at the end of the 14th day of treatment. Brain tissue was examined with regard to antioxidant/oxidant biochemical parameters. RESULTS: Although glutathione (tGSH) and nitric oxide (NO) end product mean scores were found to be statistically higher in the control group when compared with the cisplatin group (72.44% and 61.99% percentage change [PC], respectively), malondialdehyde (MDA), myeloperoxidase (MPO), and 8-hydroxyguanine (8-OH-GUA) mean scores were statistically lower in the control group in comparison with the cisplatin group (-55.48%, -67.99%, and -48.81% PC, respectively; P < 0.01). Finally, tGSH and NO end product levels were restored to normal (85.90% and 55.30% PC, respectively), and MDA, MPO, and 8-OH-GUA were significantly reduced by treatment with mirtazapine (-60.50%, -78.59%, and -38.10% PC, respectively; P < 0.01). CONCLUSION: Mirtazapine has chemoprotective effects against cisplatin-induced oxidative stress and DNA damage in the rat brain, which may be attributed to its antioxidant capabilities. It would be useful to investigate whether cisplatin at the desired doses can be given concurrently with mirtazapine.

Maternal age and number of children are risk factors for depressive disorders in non-perinatal women of reproductive age.

OBJECTIVE: It remains unclear whether or not the vulnerability of depression in women of reproductive age is related with pregnancy or perinatal period. The aim of the study was to determine the prevalence of depressive disorders and related factors in a large sample of non-perinatal women of reproductive age. METHOD: This study involved 589 women of reproductive age. At baseline, sociodemographic data and premenstrual assessment forms were completed, and screening tests for the assessment of the severity of depressive symptoms were administered to all of the participants. Participants who had over scale scores of the cut-off point in the screening instruments were assessed with module A of the Structured Clinical Interview for DSM Disorders (SCID-I) to determine DSM IV Axis I disorders. RESULTS: The prevalence of depressive disorders was 32.8%. Depressive disorders had high rates in women who were married at younger ages and who had three or more children. Although the prevalence of depressive disorders was 32.8%, only 10.4% of the women had follow-up and treatment in a psychiatric outpatient clinic. CONCLUSION: Low education levels, early maternal age, and having more than three children and higher premenstrual symptom scores were risk factors for depressive disorders in non-perinatal reproductive age.

Seasonality of self-destructive behaviour: seasonal variations in demographic and suicidal characteristics in Van, Turkey.

OBJECTIVE: Seasonality is one of the most interesting but still elusive issue in suicide research. Linkages of seasonality in suicides to possible contributors such as gender, type of method used, and climatic factors have received attention in different cultures. We aimed at evaluating seasonal trends in suicidal behaviour according to demographic characteristics, reasons for self-destructive behaviour and means preferred in suicide. METHODS: Our aim was to assess the seasonal variation in self-destructive behaviour in terms of completed and attempted suicides in a 3-year time period from 2008 to 2010 in Van, Turkey. A total of 1448 cases were registered over a 3-year time period in the city. Seasonal deviations in demographic characteristics, reasons for suicide, and methods of suicide were evaluated. RESULTS: Seasonal distribution of both completed and attempted suicides by gender did not significantly deviate. On the other hand, we found a significant decline in self-destructive behaviours among those who were single and student in the spring. We found a peak in self-destructive behaviours in the autumn among Individuals who suffer from psychological problems. CONCLUSIONS: Subjects with psychological difficulties were more prone to commit suicide in autumn. Seasonal differences in methods of suicide used by suicidal subjects were not significant.

Compromised T-cell immunity in patients with spinal cord injury and its relationship with injury characteristics.

Objectives: The aim of this study was to investigate in vivo and in vitro cellular immune responses in patients with chronic (spinal cord injury; SCI), determine the effects of autonomic dysfunction on cellular immune response, and determine the effect of completeness of the injury at different levels on cellular immune response. Patients and methods: Forty-nine patients (42 males, 7 females; mean age: 35.5±13.4 years; range, 18 to 68 years) with chronic (time since injury >6 months) traumatic SCI were included in this cross sectional study between March 2013 and December 2013. Patients were allocated into two groups: Group 1, patients with an injury at T7 or below, and Group 2, patients with an injury at T6 or above. All patients in Group 2 had a history of autonomic dysreflexia and orthostatic hypotension. Intradermal skin tests were applied to the participants to reveal delayed T-cell responses. The percentages of cluster of differentiation (CD)3+ T cells and CD3+ T cells expressing CD69 and CD25 were analyzed by flow cytometry for the detection of activated T cells including all T-cell subsets. Results: When patients with complete injuries were compared, the CD45+ cell percentage was found to be significantly higher in patients in Group 2. Patients with an incomplete SCI had increased skin response to candida antigens compared to complete SCI patients. Incomplete SCI patients also had higher percentages of lymphocytes and CD3+CD25+ and CD3+CD69+ T cells compared to patients with complete SCI. Conclusion: T-cell activity is impaired in chronic SCI patients with higher levels of injury, and the completeness of injury and autonomic dysfunction gain prominence as compromising factors in T-cell immunity.

Genotoxic evaluation of selective serotonin-reuptake inhibitors by use of the somatic mutation and recombination test in Drosophila melanogaster.

This study evaluated different concentrations of selective serotonin-reuptake inhibitors (citalopram and sertraline) for genotoxicity by use of the somatic mutation and recombination test (SMART) in Drosophila melanogaster. Three-day-old larvae, trans-heterozygous for the multiple wing hairs (mwh) and flare (flr³) genes were treated with these two compounds. Two recessive markers were located on the left arm of chromosome 3, i.e. 'multiple wing hairs' (mwh) in map position 0.3 and 'flare-3' (flr³) at 38.8, while the centromere was located in position 47.7. SMART is based on the loss of heterozygosity, which may occur through various mechanisms, such as mitotic recombination, mutation, deletion, half-translocation, chromosome loss, and non-disjunction. Genetic changes occurring in somatic cells of the wing's imaginal discs, cause the formation of mutant clones on the wing blade. The results of this study show that citalopram had a genotoxic effect in the Drosophila SMART. Sertraline, however, did not show any genotoxic effect in balancer heterozygous wings. This study concluded that more information is needed to be certain regarding the mutagenic effects of sertraline.

Panic disorder and subthreshold panic in the light of comorbidity: a follow-up study.

Especially in the presence of agoraphobia and comorbid conditions, panic disorder causes significant impairment in life quality. Although there are several studies about epidemiology and clinical features, subthreshold symptoms and courses of comorbidity have not been studied sufficiently in panic disorder. The current study assessed the courses of panic disorder and subthreshold panic symptoms in consideration of the major and subthreshold comorbid conditions. Patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-diagnosed panic disorder were assessed using the panic disorder follow-up questionnaire, Panic and Agoraphobia Scale, Hamilton Depression Rating Scale, and State-Trait Anxiety Inventory. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders was used to determine comorbidity, and all participants were received to 1-year follow-up. Comorbidity assessment showed that the threshold comorbidity decreased, while the subthreshold comorbidity increased at 1-year follow-up. Panic disorder symptom severity was decreased, but subthreshold panic symptoms continued to be present within the course of the illness. Presence of agoraphobia and duration of disease were significantly related with higher Panic and Agoraphobia Scale scores in the second assessment, and these relationships were independent from the treatment process. Even if the comorbidity and the severity of panic decrease with treatment, subthreshold panic and comorbid symptoms may still resist in panic disorder.

Relations between childhood traumatic experiences, dissociation, and cognitive models in obsessive compulsive disorder.

OBJECTIVE: Previous studies have indicated that obsessive compulsive disorder (OCD) is associated with childhood traumatic experiences and higher levels of dissociation. Dissociative tendency may arise when individual attempt to incorporate adverse experiences into cognitive schema. METHODS: We investigated the possible links among childhood trauma, dissociation, and cognitive processes. We evaluated 95 patients with OCD using the Beck Depression Inventory (BDI), Thought-Action Fusion Scale (TAFS), Metacognitions Questionnaire (MCQ-30), White Bear Suppression Inventory (WBSI), Dissociative Experiences Scale (DES), and Childhood Trauma Questionnaire (CTQ-28). RESULTS: The CTQ-28 total scores were not associated with Y-BOCS total, Y-BOCS insight, BDI, TAFS, MCQ-30, and WBSI scores. The TAFS Total, MCQ-30, WBSI, and BDI scores were significantly associated with DES scores. Regression analysis revealed that MCQ-30 and WBSI scores significantly predicted the DES scores. CONCLUSIONS: These results suggest that in spite of pathological connotation of dissociative experiences, dissociation may primarily constitute a cognitive trait which is strongly associated with cognitive processes.

Adverse reactions in venom immunotherapy protocols: conventional versus ultra-rush.

BACKGROUND: Venom immunotherapy (VIT) is an effective treatment in the patients at high risk of anaphylaxis or life-threatening systemic reactions due to Hymenoptera venom allergy. But, systemic and large local reactions can be observed, especially during the build-up phase of VIT. We evaluated the safety of conventional and ultra-rush build-up protocols. MATERIALS AND METHODS: Two protocols in 71 patients (39 conventional and 32 ultra-rush protocols) with honeybee and wasp venom allergy were evaluated retrospectively. Patients were diagnosed and selected for VIT according to the criteria established by the European Academy of Allergy and Clinical Immunology. The severity of systemic reactions was evaluated according to the criteria of Mueller. RESULTS: Build-up phases were tolerated in 66.2% (n = 47) without any reaction. Allergic adverse reactions were observed in 33.8% (n = 24): large local reactions 22.5% (n = 16) and systemic reactions 11.3% (n = 8). There was no significant difference in the number of adverse reactions comparing patients receiving conventional and ultra-rush protocol. In addition, no association was found between allergic adverse reactions and the following factors: sex, previous systemic sting reactions, honeybee and wasp venom extract. CONCLUSION: We found that both protocols were tolerated in patients with honeybee and wasp venom allergy. Ultra-rush protocol will be preferred for patients and clinicians because of its advantages in terms of time and costs.KEY MESSAGESVIT is the only curative treatment method that reduces the risk of severe reactions after a bee sting and improves the quality of life in patients with Hymenoptera venom allergy.Ultra-rush VIT protocol has advantages such as few injection and time savings.Both ultra-rush and conventional VIT are safe treatments to prevent potentially life-threatening reactions in patients with honeybee and wasp venom allergy.

Dream anxiety is an emotional trigger for acute myocardial infarction.

OBJECTIVE: The aim of the present study was to investigate the relationship between nightmares and acute myocardial infarction (AMI) occurring during sleep, and also to evaluate the influence of several related factors. METHOD: The sample comprised AMI patients who had been admitted to the coronary care unit. The patients were grouped into two categories; the asleep-AMI group consisted of 36 patients who had the onset of symptoms of AMI during sleep, and the awake-AMI group included 183 patients who had AMI while they were awake. The sleep quality and dream anxiety for the 1-month interval before AMI were assessed with Pittsburgh Sleep Quality Index (PSQI) and Van Dream Anxiety Scale (VDAS), respectively. RESULTS: Asleep-AMI patients reported significantly poorer subjective sleep quality, significantly higher global PSQI scores, and displayed significantly higher nightmare frequency, difficulty in falling asleep after a nightmare, higher autonomic hyperactivity, dream recall frequency, daytime anxiety, psychological problems, and higher global dream anxiety scores than awake-AMI patients. CONCLUSION: The present study suggests that sleep anxiety and related emotions are associated with AMI during sleep.

Risk factors for oral allergy syndrome in patients with seasonal allergic rhinitis.

BACKGROUND: Oral allergy syndrome (OAS) is a unique allergic reaction to food, which is caused by cross-reactivity between proteins in fresh fruits or vegetables and pollens. Predisposing factors for OAS are not well known in patients with seasonal allergic rhinitis. OBJECTIVE: Identify the probable risk factors for OAS in patients with seasonal allergic rhinitis. STUDY DESIGN: One hundred and eleven consecutive patients with seasonal allergic rhinitis were included. Patients were evaluated in terms of symptom scores and skin prick test positivity scores. Prick-by-prick tests with the fresh fruit or vegetable were carried out in patients who describe oral allergy syndrome. Patients with OAS and without OAS were compared statistically. RESULTS: OAS was more frequent in females than males (p=0.01). Odds ratio for gender (male/female) was 3.80 (95% confidence interval: 1.28-11.32). Within nasal symptoms, only nasal itching was related with OAS (P<0.05). The logistic regression analysis revealed a significant association between the prevalence of the OAS and age, asthma, TSS and TSTP (p<0.05). CONCLUSION: Not all patients with seasonal allergic rhinitis develop OAS. It is likely that, patients with OAS have some additional risk factors other than atopy.

The impact of obsessive beliefs on pharmacological treatment response in patients with obsessive-compulsive disorder.

OBJECTIVE: The present study examined whether obsessive beliefs change over time in the OCD patients receiving selective serotonin reuptake inhibitors (SSRIs) and the impact of obsessive beliefs in treatment response. METHODS: In the first part of a two-stage study comparing the efficacy of antipsychotics as augmenting agent in SSRI-resistant OCD patients, 57 patients were interviewed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS) and Obsessive Beliefs Questionnaire-44 (OBQ-44) before and after 12-week of SSRI treatment period. RESULTS: All OBQ-44 subscale scores significantly decreased with SSRI treatment. The mean changes in OBQ-44 Importance and Control of Intrusive Thoughts (I/CT) subscale and HDRS total scores of responders were significantly higher than those of SSRI-resistant patients. The baseline OBQ-44 P/C and Y-BOCS obsession subscale scores significantly predicted the treatment resistance in a logistic regression model. CONCLUSIONS: The alleviation of negative mood by SSRIs may help the sufferer to disengage from dysfunctional appraisals. Since individuals with highly obsessive beliefs about P/C are more likely to be resistant to SSRI treatment, the treatment of OCD can be made more effective when focusing on altering appraisals about P/C.

Effect of Adjunct Psychosocial Skills Training on Social Functioning of Schizophrenia Patients Who Get Occupational Therapy in a Community Mental Health Center: A Comparative Study.

INTRODUCTION: Antipsychotic drugs are effective in relieving symptoms in the treatment of schizophrenia, but decreased social functioning is resistant to drugs. In this study, the effect of adjunct Psychosocial Skills Training (PSST) on social functioning for schizophrenia patients who receive service in the community mental health center (CMHC) was investigated. METHOD: Schizophrenia patients who received routine case management and occupational therapy in CMHC (n=22), patients receiving PSST in addition to CMHC service (n=21) and patients who were followed up in the Psychotic Disorders Outpatient Clinic as control group (n=21), three groups were formed. In the initial evaluations of the participants, the sociodemographic data form was filled. Social functioning and severity of clinical symptoms were evaluated at the beginning and at end of three-month follow-up period with the Social Functionality Scale (SFS), Personal and Social Performance Scale (PSP), Positive and Negative Syndrome Scale (PANSS). RESULTS: At the end of the follow-up period, there was a significant decrease in PANSS total scores, a significant increase in PSP and SFS total scores in the last test evaluations of the study groups. There was not any statistically significant change in the control group. The decrease in PANSS total score in PSST group is significantly higher than CMHC group. There was no significant difference between PSP and SFS scores between intervention groups. CONCLUSION: The psychiatric rehabilitation in CMHC has a positive effect on the social functioning and clinical symptoms of schizophrenic patients. Adjunct PSST to routine service seems to help relieving clinical symptoms.

Nightmares, suicide attempts, and melancholic features in patients with unipolar major depression.

OBJECTIVES: Recently, there has been a growing interest in the relationship between sleep disturbances and suicidality in major depression. Sleep disturbances are one of the 'modifiable risks' for suicide in major depression. The present study examines whether there is a relationship among nightmares, suicide attempts, and melancholic features in unipolar major depressed patients. METHODS: One hundred (49 males and 51 females) depressed patients with melancholic features and 49 (23 males and 26 females) patients without melancholic features were included in the study. All patients were classified as those who attempted suicide at least once during current depressive episode and as those who never attempted. RESULTS: Melancholic attempters had higher rates of nightmares, middle, and terminal insomnia than melancholic non-attempters. There was no significant difference between non-melancholic patients with and without suicidal attempts in terms of the frequency of all types of insomnia and nightmares. LIMITATIONS: This study does not have polysomnographic records for sleep variables. CONCLUSIONS: Feeling worse in the morning than later in the day may be related to the intervening dream content and affect and predict suicidal tendency. Melancholia may be associated with increased risk of suicide attempts due to repetitive and frightening dreams.