The effects of long- and short-term interdisciplinary treatment approaches in women with fibromyalgia: a randomized controlled trial

We investigated the effects of long- and short-term interdisciplinary treatment approaches for reducing symptoms and improving health-related quality of life (HRQoL) and physical functions of patients with fibromyalgia and compared the effects of two different interdisciplinary treatment approaches. We conducted a prospective, randomized, controlled trial involving 66 women with fibromyalgia eligible for the study at a university hospital setting. The patients were randomized into three groups (allocation ratio 1:1:1) using a computer-generated random numbers: a long-term interdisciplinary treatment group (LG, n = 22) that participated in 10 sessions (3-h once-weekly session for 10 weeks) of cognitive behavioral therapy (CBT) together with exercise training and other fibromyalgia related educational programs (two full days); a short-term interdisciplinary treatment group (SG, n = 22) that received two full days of educational, exercise, and CBT programs; and a control group (CG, n = 22). The patients were evaluated at baseline and 6 months after treatment using the visual analog scale (pain, fatigue, and sleep), Fibromyalgia Impact Questionnaire, Beck Depression Inventory, Short Form-36, tender point numbers, and pressure algometry as primary outcomes. The statistical analysis was confined to the ‘per-protocol’ set. No blinding was performed. The number of patients analyzed was 21 in the LG, 19 in the SG, and 19 in the CG. The intensity of pain (p < 0.001), severity of fatigue (p = 0.048), number of tender points (p = 0.002), and pressure pain threshold (p = 0.012) decreased significantly in both the LG and SG groups compared with controls. Moreover, physical functions (p = 0.017) and physical components of the HRQoL (p = 0.036) improved significantly in the intervention groups compared with the controls. However, there was no significant difference between intervention groups and the control group at the end of study in terms of quality of sleep (p = 0.055), severity of depressive symptoms (p = 0.696), and mental components of the HRQoL (p = 0.229). Finally, with the exception of the severity of fatigue and physical components of the HRQoL, there was no obvious significant difference between the efficacies of the two treatment approaches when compared with controls; the long-term treatment was found more effective in reducing pain than the short-term. Both, long- and short-term interdisciplinary treatments were effective in reducing the severity of some symptoms and disease activity in patients with fibromyalgia. The short-term program well meets the needs of women with fibromyalgia particularly in relation to pain and health status as measured using FIQ; however, a long-term program may be beneficial in reducing fatigue and improving physical function to a higher extent.     

Turkish women's level of knowledge on and attitude toward sexual health

OBJECTIVE: Sexuality is a basic human function that can affect general well-being and overall life quality. The aim of this study was to assess the level of knowledge on and attitude toward sexuality of a subgroup of Turkish women. METHODS: A cross-sectional survey including 1007 women was carried out concurrently in gynecology and urology outpatient clinics of Gazi University Faculty of Medicine, Turkey, between January 2003 and December 2003. A self-created questionnaire for data collection was administered to the participants, which addressed questions concerning their sexual life, sexual problems and attitudes towards sexuality. Statistical package for the social sciences (SPSS) was used for the data analysis of the study (SPSS ver. 11.0 Inc. Chicago, IL, USA). RESULTS: The data included 1007 patients aged 14-77 (mean: 35.6 +/- 11.1). Among the women assessed, 90.2% were married, 79.8% were premenopausal and 77.1% were currently sexually active. 68.7% entered sexual intercourse 1-2 times per week, while 28.5% had an average of 3-4. 77.8% were aware of experiencing an orgasm and 74.7% had at least one orgasm. Only 21.4% of all women had an orgasm during each sexual intercourse. 2.2% of those who had never experienced an orgasm concurrently applied to a medical center. The average age of first intercourse was 21.3 +/- 4.1 years. CONCLUSIONS: Because there is no national data on sexual health in Turkey, analysis and evaluation of the severity of the problem, and alternatives for international comparisons are not possible. In our opinion, this study presents a valuable perception into the current sexual behavior of Turkish women.     

Melatonin protects against epirubicin-induced cardiotoxicity

We investigated the cytoprotective effect of melatonin in epirubicin-induced cardiotoxicity using four experimental groups of male Wistar rats: untreated control rats, epirubicin-treated rats, epirubicin+melatonin-treated rats, and melatonin-treated rats. We examined the histopathological and biochemical effects of melatonin on the epirubicin-induced changes and measured the levels of the lipid peroxidation end-product (malondialdehyde, MDA), an indicator of nitric oxide (NO) synthesis (nitrite/nitrate production), and reduced glutathione (GSH) in the heart. We also studied the extracellular matrix components (fibronectin, laminin) in the heart. Vacuole formation, mitochondrial deformation and degeneration, and disordered myofibrillary structures were detected ultrastructurally in the epirubicin-treated group. The degeneration was reduced in the heart tissues of the epirubicin+melatonin group. Epirubicin increased the nitrite/nitrate production, but did not change the MDA and GSH levels significantly. Melatonin treatment lowered the nitrite/nitrate concentrations, while increasing the GSH levels, which exceeded the levels in epirubicin+melatonin-treated rats. We conclude that the epirubicin increased the nitrozative stress, not the oxidative stress, in heart tissue, and the cardioprotective effect of melatonin was partially attributed to the suppression of epirubicin-induced nitrozative stress. These results suggest that melatonin partially protects against epirubicin-induced cardiotoxicity.     

Rectum mucinous adenocarcinoma metastasis to bilateral breast in a male patient: A case report

A 47‐year‐old male presented to our clinic with complaints of mass in both breasts. In the patient's history, he had undergone low anterior resection for rectum mucinous adenocarcinoma 2 years ago. The masses in both breasts of the patient were excised. Mucinous adenocarcinoma metastases were reported in the pathologic evaluation of the masses. Metastasis should be considered in patients with bilateral breast mass and previously diagnosed cancer even if the patient is male.     

Prospective neurobiological effects of the aerial and root extracts and some pure compounds of randomly selected Scorzonera species

Context: Scorzonera L. species (Asteraceae) are edible and as medicinal plants are used for various purposed in folk medicine.

Objective: The methanol extracts of the aerial parts and roots from 27 Scorzonera taxa were investigated for their possible neurobiological effects.

Materials and methods: Inhibitory potential of the Scorzonera species was tested against acetylcholinesterase (AChE), butyrylcholinesterase (BChE), and tyrosinase (TYRO) at 100?µg?mL^?1 using ELISA microtiter assay. Antioxidant activity of the extracts was tested with radical scavenging activity, metal-chelation capacity, ferric- (FRAP), and phosphomolibdenum-reducing antioxidant power (PRAP) assays. Chlorogenic acid, hyperoside, rutin, and scorzotomentosin-4-O-β-glucoside were also screened in the same manner. Total phenol and flavonoid quantification in the extracts were determined spectrophotometrically.

Results: The aerial parts of Scorzonera pisidica (40.25?±?0.74%) and chlorogenic acid (46.97?±?0.82%) displayed the highest TYRO inhibition, while the remaining samples showed only trivial inhibition against cholinesterases (2.08?±?1.35%–25.32?±?1.37%). The same extract of S. pisidica was revealed to be the most potent in scavenging of all three radicals and FRAP assay.

Discussion and conclusion: Out of 27 taxa, S. pisidica, in particular, may deserve further investigation for its neuroprotective potential.     

Risk of vasovagal syncope and cardiac arrhythmias in children with mitral valve prolapse

OBJECTIVE: Postural phenomena, cardiac arrhythmias and autonomic dysfunction are responsible for presyncope and syncope in patients with mitral valve prolapse (MVP). In this study, arrhythmia and vasovagal syncope incidence were investigated in children with MVP. METHODS: Between April 2005 and December 2006, 37 children with MVP and 26 healthy children were evaluated.Telecardiography, electrocardiography (ECG), echocardiography, Holter monitoring, exercise test and head-up tilt test were performed. RESULTS: The MVP group consisted of 19 boys and 18 girls with a mean age of 11.8 years. The control group was similar with respect to age and gender. Telecardiography, ECG, Holter monitoring, exercise test and QTc of all children were within normal limits.There was a statistically significant difference between the two groups in terms of QT dispersion. The tilt table test was positive in 11 of 37 (29.7%) children with MVP and in 1 of 26 (3.8%) normal healthy children. This difference was statistically significant (P < 0.01). CONCLUSION: Arrhythmia and syncope frequency was found to be higher in children with MVP than in the normal population. The risk of vasovagal syncope indicated by a positive tilt test was found to be increased in children with MVP. Therefore, patients and families must be informed about the conditions that may predispose to vasovagal syncope and caution should be recommended in these patients.