Menstrually related symptom changes in women with treatment-responsive bipolar disorder

OBJECTIVE: In the present study, we aimed to evaluate menstrually related symptom changes in euthymic women with treatment-responsive bipolar disorder (BD) compared with healthy control subjects and investigate the presence of premenstrual dysphoric disorder (PMDD). METHODS: Thirty-four euthymic women with treatment-responsive BD on mood-stabilizers (lithium and/or valproate) for at least 6 months and 35 control subjects with no history of medical/mental disorder between ages of 18 and 35 years with regular menstrual cycles were prospectively followed up for at least two consecutive menstrual cycles using the Daily Record of Severity of Problems-Short Form (DRSP). Each subject was administered the retrospective self-report questionnaire, Premenstrual Assessment Form (PAF), in the first postmenstrual phase of the menstrual cycle. Venous blood samples were collected between 19 and 22 days of menstrual cycle to evaluate ovulation by measuring the serum progesterone levels. RESULTS: The differences in mean age, age of onset of menses, cycle length and bleeding length did not appear to be significantly meaningful between groups. In the retrospective assessment of premenstrual symptom changes, controls complained more than women with BD. More controls showed a 30% change in DRSP and in depressive and physical sub-groups than the women with BD. Controls demonstrated a significant increase compared with treatment-responsive BD patients in total, depressive, anxiety and attention sub-group scores of DRSP from the postmenstrual to the premenstrual phase, whereas the scores of vegetative symptoms of controls and women with BD did not differ significantly during one cycle or both. Significant menstrual cycle effect was observed in both groups. CONCLUSION: Within the limitations of the study, the results suggest that ongoing mood-stabilizing treatment may have a prophylactic effect against premenstrual symptom changes in women with treatment-responsive BD.     

Gender-related differences among Turkish patients with obsessive-compulsive disorder

The purpose of the present study was to investigate gender-related sociodemographic and clinical differences among Turkish patients with obsessive-compulsive disorder (OCD). A total of 169 patients diagnosed with OCD by DSM-III-R or DSM-IV criteria were included in this study. Male (n = 73) and female (n = 96) OCD patients were compared with respect to the demographic variables and the scores obtained from the Hamilton Rating Scale for Anxiety (HRSA), the Hamilton Rating Scale for Depression (HRSD) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). We found a significantly earlier age at onset in male patients. No significant difference in terms of HARS, HDRS, and Y-BOCS scores was detected between the two groups. We observed a significantly higher frequency of contamination obsessions in females, and that of aggression and sexual obsessions in males. There was no significant difference in terms of the frequency of compulsions between the two groups. We also found that compulsion severity on obsessions/compulsions was higher in females and comorbidity rates of social phobia and schizophrenia were higher in males. Considering our results in combination with those of other studies, similarities rather than differences in gender-related sociodemographic and clinical characteristics of OCD patients across different populations seem to be present.     

Importance of the liver ultrasound scores in pubertal obese children with nonalcoholic fatty liver disease

AimThe purpose of our study was to determine the relationship between liver ultrasound scores and insulin sensitivity in a population of obese children with nonalcoholic fatty liver disease (NAFLD) and the relationships between other metabolic features and ultrasound scores.MethodsOne hundred sixty-nine obese adolescents, 96 girls, and 73 boys (mean age: 12.7±1.3 years, mean body mass index: 26.3±4.6) were enrolled the study. The obese subjects were divided into 2 groups based on their pubertal status. Ultrasonography findings were scored in this study included hepatorenal echo contrast, liver brightness, deep attenuation, and vascular blurring. Scores ranged from 0 to 6 points, and NAFLD was defined if ultrasound score was ≥ 1. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR) from fasting samples.ResultsPrevalence of NAFLD in pubertal children (61.9%) had significantly higher than pre-pubertal children (40.8%) (P= .008). Transaminases ratio was significantly correlated in both prepubertal (r= 0.231; P= .03) and pubertal (r= 0.628, P= 0.017) groups. HOMA-IR values were elevated in both groups; however, liver ultrasound score was positively correlated with HOMA-IR (r= 0.735, P= .014) in pubertal children.ConclusionNAFLD prevalence among obese children is quite high, especially pubertal adolescents than prepubertal children. We demonstrated an association between insulin resistance and NAFLD ultrasound scoring in pubertal obese children. We suggested that ultrasound examination of the liver be included in the routine check-up of the pubertal obese children with insulin resistance to allow the detection of NAFLD at an early stage.     

Effects of extraction and nonextraction treatment on class I and class II subjects

This study aims to examine the profile as well as the dentoalveolar and skeletal effects of extraction or nonextraction treatment in a wide range of patients including Class I and Class II, division 1 cases. Results achieved with extraction and nonextraction modalities have also been compared. The study was performed on pretreatment and posttreatment lateral cephalograms of 87 orthodontic patients. There were no significant differences between the pretreatment values of extraction and nonextraction Class I groups, whereas SN-GoGn (degrees), maxillary incisor to A-Po (degrees), mandibular incisor to A-Po (mm), Co-Gn (mm), overjet (mm), and overbite (mm) measurements of extraction Class II group were significantly higher before the treatment. After treatment, these differences were eliminated in the Class II group; however, incisors were significantly protruded in both nonextraction groups. No other differences in profile or lip position were found between the extraction and nonextraction groups. The results of this study indicate that in successfully treated cases, whether by extraction or nonextraction, the same soft and hard tissue profile posttreatment end points were reached except for the incisor positioning, which is rather easier to anticipate than profile and soft tissue changes. The simple statement that extraction means a more retrusive or dished-in profile seems to be unacceptable. It seems that a more thorough assessment and investigation including pretreatment extent of crowding and factors related to anchorage, soft tissue thickness, and strain should be carried out.     

The economic burden of maternal mortality on households: evidence from three sub-counties in rural western Kenya

This study explores the consequences of a maternal death to households in rural Western Kenya focusing particularly on the immediate financial and economic impacts. Between September 2011 and March 2013 all households in the study area with a maternal death were surveyed. Data were collected on the demographic characteristics of the deceased woman; household socio-economic status; a history of the pregnancy and health care access and utilization; and disruption to household functioning due to the maternal death. These data were supplemented by in-depth and focus group discussions. The health service utilization costs associated with maternal deaths were significantly higher, due to more frequent service utilization as well as due to the higher cost of each visit suggesting more involved treatments and interventions were sought with these women. The already high costs incurred by cases during pregnancy were further increased during delivery and postpartum mainly a result of higher facility-based fees and expenses. Households who experienced a maternal death spent about one-third of their annual per capita consumption expenditure on healthcare access and use as opposed to at most 12% among households who had a health pregnancy and delivery. Funeral costs were often higher than the healthcare costs and altogether forced households to dis-save, liquidate assets and borrow money. What is more, the surviving members of the households had significant redistribution of labor and responsibilities to make up for the lost contributions of the deceased women. Kenya is in the process of instituting free maternity services in all public facilities. Effectively implemented, this policy can lift a major economic burden experienced by a very large number of household who seek maternal health services which can be catastrophic in complicated cases that result in maternal death. There needs to be further emphasis on insurance schemes that can support households through catastrophic health spending.     

Psychological distress in chronic obstructive pulmonary disease patients

Stress is defined as the exposure of an individual to a threatening stimulus or overwhelming event. Increased rates of psychological distress have been established in patients with chronic diseases compared to healthy individuals. The objective of the present study is to assess the indicators and correlates of psychological distress in chronic obstructive pulmonary disease (COPD) patients. We evaluated the stress exposure (stressful events that COPD patients and control subjects had been exposed) by a life events checklist and psychological distress by General Health Questionnaire in 74 COPD patients and 30 control subjects. Serum adrenocorticotropic hormone (ACTH) and cortisol levels were measured as biochemical indicators of stress. Distress score was higher in COPD group compared to age‐matched controls, although the stress exposure score were not statistically different; indicating that COPD itself is a source of distress. 92% of COPD patients and 87% of control subjects had varying degrees of distress. Severe distress was more frequent in COPD group. Distress score was further increased in patients with severe COPD and severe hypoxemia.There was no significant difference in serum ACTH and cortisol levels of COPD patients and control subjects and distress scores were not correlated to serum ACTH and cortisol levels. However, serum cortisol was higher in patients with severe hypoxemia. These findings support the importance of screening for psychological distress symptoms in COPD outpatients. Since high degree of distress contributes to impaired quality of life and added morbidity, patients with COPD need a comprehensive care including a psychological evaluation. Copyright © 2008 John Wiley & Sons, Ltd.     

Relation of temperament and character properties with clinical presentation of bipolar disorder

OBJECTIVES: The purpose of this study was to examine the underlying temperament and character properties of patients with bipolar disorder and explore the possible connections between these properties and clinical presentation of the illness. METHODS: The sociodemographic and clinical properties of 90 patients with bipolar disorder, who were euthymic according to Young Mania Rating Scale and Hamilton Depression Scale scores, were recorded. Their temperament and character features were evaluated by using Temperament and Character Inventory and results were compared with 90 age- and sex-matched healthy controls and between patients with different clinical properties. RESULTS: Patients' scores on subscales of self-directedness and cooperativeness were significantly lower compared with controls. Significant associations were found between Temperament and Character Inventory subtitles and comorbid personality disorder, number of episodes, subtype of the first episode, rapid cycling, and previous suicide attempt. CONCLUSIONS: Temperament and character features of patients with euthymic bipolar disorder show some significant differences compared to the healthy population and may vary according to different clinical presentations.     

A rare diagnosis in emergency department: spontaneous spinal epidural hematoma

We report a case of a 32-year-old man who presented to the emergency department (ED) with a sudden onset of paraplegia due to spontaneous spinal epidural hematoma. Although the patient had a poor neurological condition on presentation, he was successfully operated and discharged without any neurological sequel. Spontaneous spinal epidural hematoma is a rarely seen clinical entity, especially in the ED. Magnetic resonance imaging is the best choice for early diagnosis, and urgent surgical decompression is essential to prevent serious neurological deficits.     

Evaluation of mineral content of enamel prepared by erbium, chromium:yttrium–scandium–gallium–garnet laser

The aim of this study was to evaluate the mineral content of enamel etched at two different power settings with an erbium, chromium:yttrium–scandium–gallium–garnet (Er,Cr:YSGG) laser. Buccal, lingual and mesial or distal surfaces of five premolar teeth were cut, and three enamel slabs were obtained from each tooth. Fifteen enamel specimens were divided into three groups (1 W, 2 W and control) of five specimens each and subjected to Er,Cr:YSGG laser. The mean percentage weights of the five elements [calcium (Ca), potassium (K), magnesium (Mg), sodium (Na) and phosphorus (P)] in each slab were measured by inductively coupled plasma-atomic emission spectrometry (ICP-AES). One way analysis of variance (ANOVA) was used to analyze differences among the groups (1 W, 2 W and control). There were no significant differences among the groups (1 W, 2 W and control) for Ca, K, Mg, Na, or P, or for the Ca/P ratio (P > 0.05). Scanning electron microscopy (SEM) photographs indicated that the surface irregularities increased with increased power setting. Laser treatment did not affect the mean percentage weights of Ca, K, Mg, Na, and P, or the Ca/P ratio, in any group.