Prevalence, comorbidities and mediators of childhood anxiety disorders in urban Turkey: a national representative epidemiological study.

PURPOSE: The aim of this study is to evaluate the prevalence of anxiety disorders, its correlation with sociodemographic characteristics, its comorbidities with other psychiatric disorders and its predictors in school-aged children. METHODS: This study is part of a representative, multi-centered national study that is planned by the Turkish Association of Child and Adolescent Mental Health to evaluate the prevalence of psychopathology among elementary school students in Turkey between the years 2014-2015. Children are screened via Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version. Impairment is assessed by a 3-point Likert type scale independently by the parent and the teacher. The final sample included 5842 children with the mean age of 8.7 years. RESULTS: The prevalence of any anxiety disorder without considering impairment is 16.7% and considering impairment is 5.2% in children according to our study. We found significant differences for comorbid Attention Deficit Hyperactivity Disorder, Disruptive Behavior Disorder, Mood Disorders, Tic Disorders, Obsessive Compulsive Disorder, Enuresis Nocturna, Encopresis, and Intellectual Disability. Having a history of paternal physical disorder, living in the regions of Marmara, Mediterranean and Black Sea were found to be the main predictors of having childhood anxiety disorders according to the logistic regression analysis. CONCLUSION: Better understanding of childhood anxiety disorders, comorbid conditions and predictors will result in earlier diagnosis and more appropriate treatment.

Comparison of the Effect of Ketamine and Dexmedetomidine Combined with Total Intravenous Anesthesia in Laparoscopic Cholecystectomy Procedures: A Prospective Randomized Controlled Study.

This randomized prospective clinical study aimed to investigate the effects of dexmedetomidine or ketamine administration to total intravenous anesthesia (TIVA) on postoperative analgesia in subjects undergoing elective laparoscopic cholecystectomy procedures. 90 adults, American Society of Anesthesiologists (ASA) physical status 1 and II patients, who underwent elective laparoscopic cholecystectomy procedures were included in the study and randomized into three groups equally. Remifentanil, propofol, and rocuronium infusions were used for TIVA guided by the bispectral index. In group KETA, 10 µg/kg/min ketamine was added to TIVA before surgery, and in group DEX, 0.5 µg/kg/h dexmedetomidine was added to TIVA before surgery. Normal saline infusions were infused in the control group. Postoperative analgesia was provided with intravenous patient-controlled analgesia (PCA) morphine (1 mg bolus morphine, 5 min lockout time). Hemodynamic parameters, scores of visual analogue scale (VAS) for pain, rescue morphine requirements, and side effects such as sedation, nausea, and vomiting were recorded for 48 hours after surgery. Postoperative first analgesic requirement time was longer in group KETA (P < 0.001), and it was longer in group DEX than in the control group (P < 0.001). Pain scores were lower in group KETA and group DEX than in the control group at all corresponding times throughout the 48 h period of observation. Intravenous PCA morphine consumptions were higher in the control group than in group KETA (P < 0.001 for all followed-up times), and they were higher in group DEX than in group KETA (P < 0.001 for all followed-up times). It is concluded that the use of dexmedetomidine or ketamine infusions can be suitable as an additive for TIVA in the intraoperative period. Furthermore, the addition of both drugs to the TIVA protocol may improve postoperative pain relief and decrease opioid consumption.

Quantum transport through a Coulomb blockaded quantum emitter coupled to a plasmonic dimer.

We study the electron transmission through a Coulomb blockaded quantum emitter coupled to metal nanoparticles possessing plasmon resonances by employing the time-dependent non-crossing approximation. We find that the coupling of the nanoparticle plasmons with the excitons results in a significant enhancement of the conductance through the discrete state with higher energy beyond the unitarity limit while the other discrete state with lower energy remains Coulomb blockaded. We show that boosting the plasmon-exciton coupling well below the Kondo temperature increases the enhancement adding another quantum of counductance upon saturation. Finite bias and increasing emitter resonance energy tend to reduce this enhancement. We attribute these observations to the opening of an additional transport channel via the plasmon-exciton coupling.

A study of Staphylococcus aureusnasal carriage, antibacterial resistance and virulence factor encoding genes in a tertiary care hospital, Kayseri, Turkey.

AIM: This study was to determine the virulence encoding genes, and the antibiotic resistance patterns of the Staphylococcus aureus isolates, which were isolated from the nasal samples of chest clinic patients. MATERIALS AND METHODS: The nasal samples of the in-patients (431) and out-patients (1857) in Kayseri Training and Research Hospital's Chest Clinic, Kayseri, Turkey, were cultured on CHROMagar (Biolife, Italiana) S. aureus, and subcultured on sheep blood agar for the isolation of S. aureus. Disc diffusion method was used for antimicrobial susceptibility testing. The occurrence of the staphylococcal virulence encoding genes (enterotoksins [sea, seb, sec, see, seg, seh, sei, sej], fibronectin-binding proteins A, B [fnbA, fnbB], toxic shock syndrome toxin-1 [tst]) were detected by polymerase chain reaction. RESULTS: Forty-five of the 55 (81.8%) S. aureus isolates from inpatients, and 319 (90.6%) isolates from tested 352 out-patient's isolates were suspected to all the antibiotics tested. methicillin-resistant S. aureus (MRSA) was detected in 1.2% of S. aureus isolates. Rifampin, trimethoprim-sulfamethoxazole, clindamycin, erythromycin, gentamicin resistance rates were 1.2%, 1.7%, 2.0%, 8.8%, and 1.2%, respectively. The isolates were susceptible to teicoplanin and vancomycin. The genes most frequently found were tst (92.7%), seg (85.8%), sea (83.6%), fnbA (70.9%). There was no statistical significance detected between MRSA and mecA-negative S. aureus isolates in encoding genes distribution (P > 0.05). CONCLUSION: Our results show that virulence factor encoding genes were prevalent in patients with S. aureus carriage, whereas antibiotic resistance was low. These virulence determinants may increase the risk for subsequent invasive infections in carriers.

Single dose ivabradine versus intravenous metoprolol for heart rate reduction before coronary computed tomography angiography (CCTA) in patients receiving long-term calcium channel-blocker therapy.

BACKGROUND: In patients with contraindication for beta-blockers who are also under long-term calcium channel-blocker therapy for any reason, ivabradine may be used as an alternative treatment to achieve the target heart rate. PURPOSE: To assess whether single dose oral ivabradine in patients referred for coronary computed tomography angiography (CCTA) is safe and can significantly decrease heart rate compared to intravenous (i.v.) metoprolol in patients receiving long-term calcium channel-blocker therapy. MATERIAL AND METHODS: One-hundred and twenty patients who were under calcium channel-blocker therapy referred for CCTA were randomized to premedication with single dose (15 mg) ivabradine (n = 63) or i.v. metoprolol (5-10 mg) (n = 62). Hearth rate (HR) was assessed at admission (HR1), prescan (HR2), and during CCTA scan (HR3) for all patients. Blood pressure (BP) was measured before medication (BP1) and immediately before CCTA scan (BP2). RESULTS: Although the HR averages of two groups were not significantly different before medication (HRIv1 = 80 ± 7 bpm vs. HRß1 = 81 ± 7 bpm; P = 0.42), significant HR reduction was observed in the ivabradine group (HRIv3 = 62 ± 7 bpm) when compared to the metoprolol group (HRß3 = 66 ± 6 bpm; P = 0.001). Decreases in HR forivabradine (18 ± 6 bpm) was significantly higher than for metoprolol (15 ± 4 bpm; P = 0.003) without relevant side-effects. Ivabradine showed no significant effect on either systolic BP or diastolic BP (siBPIv1, 139 ± 10; siBPIv2, 138 ± 10; P = 0.260; diBPIv1, 81 ± 7; diBPIv2, 81 ± 6; P = 0.59). Nevertheless, metoprolol group demonstrated significant reduction in both SiBP and DiBP (siBPß1, 136 ± 11; siBPß2 130 ± 11; P < 0.001; diBPß1, 81 ± 6; diBPß2, 78 ± 6; P < 0.001). CONCLUSION: Single dose ivabradine is safe and significantly more effective than i.v. metoprolol in decreasing HR in patients under calcium channel-blocker therapy.

The attitudes of menopausal women and their spouses towards menopause.

OBJECTIVE: Menopausal experience and symptom reporting of the women was reported to be affected by their attitudes to menopause which in turn is influenced by a range of variables. In this study, we primarily tried to investigate the attitudes of women and their spouses towards menopause. The other aim of the current study was to investigate the relationship between menopausal attitudes and menopausal symptom experience, depression and anxiety scores of the participants. METHOD: The sample included 60 physiological menopausal women and their spouses. Socio-demographic data were obtained with a questionnaire. The menopausal symptoms were measured through the Menopausal Rating Scale (MRS). The women and their spouses were administered the Attitudes Towards Menopause Scale (ATMS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS: Both the menopausal women and their spouses had a positive attitude towards menopause. The women had a mean total score of 16.36 +/- 7.62 on MRS (moderate). The mean somatic, psychological and urogenital sub-scores of MRS were 6.43 +/- 3.23 (moderate), 5.97 +/- 3.33 (moderate), and 3.93 +/- 2.77 (moderate), respectively. There were no significant differences in BDI scores between the women and their spouses. However, the scores of BAI were more likely to be higher in women than their spouses (p < 0.0001). The current study revealed a significant positive correlation between MRS scores and BAI and BDI scores of the women. A significant negative correlation was found with the scores of ATMS, and scores of MRS in women. The scores of ATMS in men were significantly and negatively correlated with the total, somatic, and urogenital subscale scores of MRS in women. CONCLUSION: The main finding of this study was that both the menopausal women and their spouses had a positive attitude towards menopause. We also found that, the women who had more negative attitudes towards menopause reported more severe menopausal symptoms. Our results also demonstrated that the severity of menopausal complaints might be related to the attitudes of the husbands towards menopause.

Emergency contraception: knowledge, attitudes and practice of the pharmacy staff in Aydin, Turkey.

OBJECTIVES: This study aimed to explore the knowledge, attitudes, and practices related to emergency contraception (EC) among pharmacy staff. METHODS: This descriptive and cross-sectional survey was conducted among 143 pharmacy staff in Aydin city centre who agreed to participate. Data was collected thorough questionnaires that were filled in by face to face interviews between April and June 2007. RESULTS: Remarkably most of the participants (n = 110) did not know the action mechanism of these pills. Forty-four participants reported that these drugs caused mostly hormonal side-effects. Only four participants knew all indications of EC pills. According to 72 participants, contraceptive pills should not be available without a prescription. The number of pharmacy staff who reported giving counseling to clients about family planning methods was low (n = 12). CONCLUSIONS: The current study revealed that pharmacy staff in the region had inadequate knowledge on EC. Pharmacy staff may play a crucial role in women's access to EC, and there is a need for new interventions to improve and update their knowledge on, and to improve their attitudes toward EC methods.

Combination of ultra-low dose bupivacaine and fentanyl for spinal anaesthesia in out-patient anorectal surgery.

This study investigated whether the addition of 25 microg fentanyl to an ultra-low (sub-anaesthetic) dose of intrathecal bupivacaine provides adequate anaesthesia for out-patient anorectal surgery, without increasing side-effects or delaying hospital discharge. Patients were randomly allocated to receive 2.5 mg 0.5% bupivacaine plus 25 microg fentanyl (group BF, n = 18) or 5 mg 0.5% bupivacaine alone (group B, n = 17). There were no significant differences in intra-operative outcomes, but mean recovery and discharge times were significantly shorter in group BF. There were no between-group differences in hypotension, bradycardia or respiratory depression and post-operative complications were comparable, apart from pruritus which was significantly more frequent in group BF. Fewer patients requested analgesic medication in the early post-operative period in group BF than in group B. In conclusion, 25 microg intrathecal fentanyl added to ultra-low dose (2.5 mg) bupivacaine provided good-quality spinal anaesthesia and reduced post-operative analgesic requirement in patients undergoing ambulatory anorectal surgery.

Serodiagnosis of Asian leishmaniasis with a recombinant antigen from the repetitive domain of a Leishmania kinesin.

rK39 is a recombinant product of the 39 amino acid repeats found in a kinesin-like gene of visceral Leishmania spp. This and other antigens were compared for immunodiagnostic potential by enzyme-linked immunosorbent assay with sera from confirmed cases of Asian cutaneous and visceral leishmaniasis. In preliminary trials, rK39 proved superior to 2 purified Leishmania antigens, a cytosolic protein (p36) and a membrane protein (gp63), for immunodiagnosis of visceral leishmaniasis. Of the 53 visceral cases from China and Pakistan assayed, 52 were seropositive (98%) at a 10(-1) dilution with 36 ng of rK39. End point titrations of 27 highly positive samples yielded anti-rK39 antibody titres ranging from c. 10(-3) to beyond 10(-4). Antigen titrations with one positive serum further revealed that rK39 was 25-fold more sensitive than Leishmania whole cell soluble lysates. 31 cutaneous leishmaniasis cases from Turkey assayed for anti-rK39 antibody gave reactions ranging from negative or marginally positive to positive. In Brazil, all cutaneous and mucocutaneous leishmaniasis cases gave negative results in this assay.

Osteoarthricular involvement of brucellosis in Turkey.

The aim of this study was to determine the rates, types, clinical features and treatment of osteoarthricular involvement of brucellosis in Turkey. In a restrospective study in adults, we investigated 238 patients diagnosed with brucellosis over a period of 6 years. A diagnosis of brucellosis was established by isolation of Brucella species in blood or by a compatible clinical picture together with a standard tube agglutination titre of > or = 1/160 of antibodies for brucellosis and/or demonstration of an at least four-fold rise in antibody titre in serum specimens taken over 2 or 3 weeks. Osteoarthricular involvement was defined by inflammatory signs in peripheral joints or by unrelieved pain at rest together with radiological alterations and/or radionuclide uptake in any deep joint. Eighty-seven patients (36.5%) had osteoarthricular involvement (58.6% female, 41.4% male), 47 (54.1%) of whom were reported to consume unpasteurised dairy products. The mean age was 32.3 +/- 16 years. Sacroiliitis was the most common involvement (n = 53, 60.9%) followed by peripheral arthritis (n = 17, 19.5%), spondylitis (n = 12, 13.8%) and bursitis (n = 5, 5.7%). During the observation period, 60 (69%) patients with osteoarthricular involvement and radiographic abnormalities. A bone scan was positive in 15 patients with no radiographic abnormalities. All patients received merely medical treatment and relapse occurred in five (5.7%) patients. Sacroiliitis has been determined as the most frequently observed type of osteoarthricular involvement in brucellosis in Turkey.

Leptospirosis: twelve Turkish patients with the Weil syndrome.

Twelve cases of leptospirosis followed by the Infectious Diseases Clinic of the Cukurova University Medical School, Adana, Turkey, between January 1994 and November 1995 are reported. Included are their clinical manifestation, laboratory findings and serotype. Nine men and three women with an average age of 40.4 years were studied. Symptoms, clinical manifestations, laboratory findings and treatment of the disease are evaluated. All of the patients had fever and chills and the following symptoms: nausea and vomiting (91.6%), lower back pain and myalgia (58.3%), headache (50%), epistaxis (16.6%) and confusion (25%). The predominant clinical findings were jaundice (91.6%), hepatomegaly (41.6%), dyspnea (25%), conjunctival suffusion (33%), and nuchal rigidity (33%). Diagnosis was based on dark-field examination of the blood, cerebrospinal fluid and urine specimens. Also, microscopic agglutination tests (MAT) were carried out for serodiagnosis. MAT showed L. interrogans serovar icterohaemorrhagiae in 11 cases and L. interrogans serovar grippomosocova in one case. There was cross reaction with L. biflexa patoc in all cases. Agglutinations were tested in the same specimens twice and confirmed in the Microbiology Laboratory of the Etlik Veterinary Research Institute in Ankara. All cases were treated with penicillin and doxycycline. In the end; 83.3% of the patients were cured and 16.6% died due to hepatorenal failure.

[Case report: foreign body causing a penetrating neck injury]. / Olgu sunumu: yabanci cisme bagli penetran boyun yaralanmasi.

A 30 year old man is admitted to the emergency section with the complaint of bleeding from the neck after an industrial explosion. A laceration, 5 cm's in length, is seen on 'zone II', near the medial border of the anterior jugular triangle. The patient was hemodynamically stable, but there was active bleeding from the laceration. A round mass is detected with palpation adjacent to the bifurcation of carotis. The wound is explored under anesthesia with endotracheal intubation. Major vessels and other vital structures found to be undamaged. Many authors suggest mandatory exploration for the neck wounds that penetrated the platysma, while others prefer exploration for selected cases on the basis of diagnostic studies. Immediate exploration is indicated in the presence of active bleeding, and diagnostic studies should be reserved for haemodynamically stable patients. Injury of major vessels might be tamponaded by foreign bodies, therefore blind removal of the objects may cause life-threatening hemorrhage. Endotracheal intubation is appropriate in the management of airway, as for convenient surgical approach.

Serodiagnostic value of ELISA in pulmonary tuberculosis in Turkey where tuberculosis is highly prevalent.

We studied the diagnostic utility of ELISA in pulmonary tuberculosis (TBC) using serologically active glycolipid antigens. Twenty-seven patients who were smear positive, and 30 patients who were smear negative, but with evidence of active TBC (sputum culture positive in 10, response to anti-TBC chemotherapy in 20) were included in the study group. Twenty cured patients who had been free of TBC for at least 1 year, 50 TBC-free persons with PPD results of 0-10 mm and more than 10 mm, and 21 patients with active inflammatory diseases other than TBC formed the control groups. Sensitivity and specificity were 96 and 91%, respectively. We think that serologically active glycolipid antigens are as sensitive and specific as other purified antigens, and even superior to them from the point of view of their production: their extraction is quicker and easier.

Plasma levels of tumor necrosis factor alpha during hemodialysis.

Tumor necrosis factor alpha (TNF-alpha) levels were measured by immunoradiometric assay in chronically hemodialyzed patients consisting of 9 males and 3 females aged between 14 and 60 years. TNF-alpha levels were 5.47-15.1 pg/ml (mean 9.76 +/- 6.63) before hemodialysis (HD), and 5.75-58.55 pg/ml (mean 22.15 +/- 15.14) after HD. According to these results TNF-alpha levels in chronically hemodialyzed patients were within normal limits, but after 4 h of HD, higher levels of TNF-alpha were found.

The prevalence of anti-HCV positivity in patients undergoing haemodialysis or with malignant disease.

We studied the occurrence of anti-hepatitis C (HCV) antibodies in patients with malignant disease (53), in patients undergoing haemodialysis (56), and in blood donors (204) as healthy population controls. The study was carried out using the second-generation EIA test. Anti-HCV positivity was 23.2% in haemodialysis (HD) patients, 0.5% in blood donors, and 0% of the patients with malignant disease (MD). There was no association between anti-HCV positivity and the results of AST, ALT and HBsAg tests in patients and controls. But there was significant association of blood transfusion frequency and duration of HD with anti-HCV positivity in patients undergoing HD, and conversely an absence of this association in patients with MD. However, two of the anti-HCV-positive HD patients did not have any blood transfusion history. One HCV-positive blood donor had a history of surgical operation. Nosocomial transmission of HCV infection has replaced blood transfusion as the main risk factor in HD patients, and preventive measures should be performed in this direction to control infection.

An unusual amebic localization on the right hip.

We report the history of a 43-year-old man with a histopathologically confirmed invasive amebic abscess in his right hip. CT scan of the liver was normal. The amebic indirect hemagglutination (IHA) test was positive with a titer of 1/1,024. The patient developed acute renal failure and died within 48 h of admission with multiple organ failure due to sepsis.

Multi-site DNA polymorphism analyses of Leishmania isolates define their genotypes predicting clinical epidemiology of leishmaniasis in a specific region.

Leishmania isolates from 57 cases of human cutaneous (CL), human visceral (VL), and canine visceral (CVL) leishmaniasis in Turkey were grouped by multi-site DNA polymorphism analyses into five genotypes. The initial grouping was based on DNA heterogeneity of the faster-evolving mitochondrion (kinetoplast) minicircles and the intergenic regions of two nuclear repetitive genes. Taxonomic affiliation and phylogenetic relationships of the five genotypes were inferred by comparing them with reference species for sequence heterogeneity in a approximately 1.4 kb conserved single-copy gene, encoding N-acetylglucosamine-1-phosphate transferase (NAGT). Alignment of the available sequences revealed no gap, but up to 7% scattered base substitutions, suggesting that this functionally important gene is a suitable marker. Three genotypes are completely identical to the NAGTs of the reference species, identifying them as L. infantum, L. tropica. and L. major, respectively. The remaining two are recognized as L. major NAGT variants with one and four base substitutions, respectively. As expected, Maximum Likelihood analysis of the NAGT sequences separates them into three clades, corresponding to the three species. The majority of the isolates obtained are L. infantum and L. tropica, which have been known to cause infantile VL and anthroponotic CL in western and southeastern Turkey, respectively. Unexpected is the finding of Leishmania major variants and their dispersal, possibly as previously unrecognized clinico-epidemiologic entities of CL and VL.