The effectiveness of illness management and recovery program in patients with schizophrenia

AimThis study was conducted to determine the effect of the illness management and recovery program in patients with schizophrenia.MethodsThis study was conducted using a pretest, posttest and follow up experimental design with randomized controlled. The sample of this study consisted of patients with schizophrenia (n = 50). The patients were assigned to intervention (n = 25) and control (n = 25) groups using the randomisation method. The intervention group consisted of 10 modules and 20 sessions of Illness Management and Recovery Program, while in the control group, a face-to-face interview. Data were collected by the Illness Management and Recovery Scale-Patient Form (IMRS-P) and Social Functioning Scale-Patient Form (SFS-P).ResultsThere were significant differences in posttest and 1-month follow-up IMRS-P points between the intervention and control groups. There was no significant difference in post-test and 1-month follow-up SFS-P total points between the intervention and control groups. There were only significant differences for the pro-social activities' subscale of SFS-P.ConclusionThe Illness Management and Recovery Program have a positive effect on illness management and social functionality in patients with schizophrenia. In the light of this study, it was suggested that this structured program should be used by mental health and psychiatric nurses.     

Malignant hyperthermia in a patient with sickle cell anemia

A sixteen-year-old male with sickle cell anemia and congenital strabismus developed malignant hyperthermia a few minutes after the administration of succinylcholine, used as the general anesthetic for corrective eye surgery. The patient's hemoglobin S level was reduced to fifteen percent before the operation. He recovered uneventfully within a few hours. Increased serum creatinine phosphokinase activity and pathological changes observed in the muscle biopsy along with strabismus suggest that the patient had an inherited susceptibility to malignant hyperthermia.     

Craniosynostosis: a review of 143 surgically-treated cases.

In this study, 143 cases of craniosynostosis are presented. There were 109 males and 34 females. The major complaints were skull deformity (92 patients), proptosis (38 patients) and microcephalus (32 patients). Neurological examination revealed the presence of optic atrophy in 24 patients and papilledema in 20 patients. Seventy-four patients (53%) had three or more suture closures, with the sagittal suture being the most commonly involved (20% of patients). All patients underwent surgery. Suture removal was performed in 131 patients (91.7%), suture removal plus orbital decompression in 34 (23.8%), and linear craniectomy plus wrapping in 12 (8.3%). The reoperation rate was 6.2 percent. During the follow-up period, preoperative papilledema and proptosis improved in 88.2 and 78.9 percent of patients, respectively. Skull deformity disappeared in 46.9 percent of patients, but remained unchanged in 16.6 percent.     

Regenerative nodule mimicking hepatocellular carcinoma in a cirrhotic child due to hepatitis B: an imaging dilemma

Viral hepatitis B, post-hepatitic cirrhosis and hepatocellular carcinoma (HCC) is the classical sequence of events in hepatitis B virus (HBV) infected children and serum Alpha-fetoprotein (AFP) and ultrasound (USG) screening is recommended during follow up. We present a 13-yr-old girl with cirrhosis related to chronic HBV infection with normal AFP level and a 4 cm mass appearance by USG. Contrast spiral evaluation computed tomography (CT) study demonstrated a single mass located at 8th segment of the liver. Pre-contrast CT and portal venous phase studies showed heterogeneous liver parenchyma without mass appearance. HCC was suspected based on strong arterial enhancement. Two mediastinal lymphadenopathies, 1 cm under the xyphoid and 2 cm above the pericardium, were detected by thorax CT. Mediastinal exploration was undertaken with living related liver transplant donor in a second operating room. She was transplanted with the right lobe of her ABO compatible mother after evaluation of the lymph nodes revealed reactive histology by frozen section. Histologic evaluation of the explant liver documented cirrhosis with a cirrhotic nodule without histologic malignant evidence. False negative results from screening methods are familiar in the literature; however false positivity of a contrast CT study is rare. The significance of screening methods is discussed.     

Effect of prayer on osteoarthritis and osteoporosis

Prayer is one kind of worship that is composed of repetitive action during praying in Islam. The prayer is performed five times a day, every Friday, bairams and death ceremonies. The aim of this study is to search the role of this repetitive action on knee, hip osteoarthritis and osteoporosis. Forty-six patients who had been performing the prayer at least for 10 years, and 40 patients who had not performed the prayer, were included in this prospective study. Each patient was evaluated with standard questionnaire form, joint examination was done and various laboratory parameters were studied. Anterior–posterior radiography of the pelvis and weight-bearing knees of each patient were examined. Each film was evaluated by two investigators separately and first scored by using Kellgren and Lawrence (K&L) scale, then the width of the joint space of hips and knees were measured directly using a steel ruler and recorded to the nearest half millimeter. Bone mineral density (BMD) of lumbar spine and femur was measured. Patients having Heberden’s nodes, Bouchard’s nodes, and carpometacarpal disease were frequent in worshiper group. Joint space width measurements and assessment according to K&L scale did not differ between worshipers and non-worshipers. BMD of lumbar spine was decreased in worshipers and also decreased with patients having Heberden’s nodes, Bouchard’s nodes, female gender and age. Prayer has no effect on knee and hip osteoarthritis, and may be related with hand osteoarthritis. It seems to have negative effect on lumbar BMD, but further investigations are needed.     

Association of the angiotensinogen M235T and angiotensin-converting enzyme insertion/deletion gene polymorphisms in Turkish type 2 diabetic patients with and without nephropathy

OBJECTIVE: Recent studies have suggested an association between a deletion variant of the angiotensin-converting enzyme (ACE) gene and diabetic nephropathy. However, this finding has not been confirmed by all investigators. Furthermore, an M235T variant of the angiotensinogen (AGT) gene has been associated with hypertension, an important risk factor for the development and progression of diabetic nephropathy. RESEARCH DESIGN AND METHODS: We investigated the relationship of the ACE insertion/deletion (I/D) and AGT M235T gene polymorphisms in Turkish patients with type 2 diabetes mellitus (DM) with and without diabetic nephropathy. A total of 102 individuals were screened for the presence of the ACE I/D and AGT M235T polymorphism: 46 individuals who had type 2 DM with diabetic nephropathy and, as controls, 56 individuals who had type 2 DM without diabetic nephropathy. Gene polymorphisms were determined by the specific melting temperature (T(m)) values of the resulting amplicons after real-time online polymerase chain reaction and melting curve analysis. RESULTS: The frequencies of the ACE DD, ID, and II genotypes were 34.8%, 37.0%, and 28.3%, respectively, among type 2 diabetic patients with nephropathy, and 33.9%, 42.9%, 23.2%, respectively (P=.788), in the control subjects without diabetic nephropathy. On the other hand, the frequencies of the AGT MM, MT, and TT genotypes among the same groups were 26.1%, 52.2%, 21.7% and 26.8%, 57.1%, 16.1%, respectively (P=.758). CONCLUSIONS: There were no differences in the frequencies of the AGT M235T and ACE I/D genotypes between Turkish patients with type 2 DM with and without nephropathy.     

Biomechanical evaluation in osteoporosis: ovariectomized rat model

The aim of our study was to investigate the effects of ovariectomy on rat femur biomechanical parameters. Bone mineral density (BMD) and histological investigation were also evaluated. Fourteen female Sprague–Dawley rats (seven ovariectomized, seven control) were used. BMD was measured by dual-energy X-ray absorbsiometry. Bone biomechanical parameters were measured in femoral midshaft with tensile test using a biomaterial testing machine and maximum load, stiffness, energy absorption capacity (structural properties), ultimate stress, ultimate strain, and elastic modulus (material properties) were calculated. Diaphyseal cortical bone thickness was measured by using histological method. The ovariectomized (OVX) rat femur’s BMD was 14% lower than control rats (p=0.006). Mean maximum load was 55% less than the control group’s (p=0.0001). Stiffness was 72% less in OVX rats (p=0.05). Femurs of rats with OVX had 32% less absorbed energy than controls (p=0.09). From the stress–strain curve ultimate stress, ultimate strain and elastic modulus was calculated. Elastic modulus was 53% less than controls (p=0.05). Ultimate stress decreased 21% in OVX rats (p=0.097). Ultimate strain was 25% less than controls in OVX rats. Cortical thickness was significantly decreased in OVX rats than in controls (p<0.05). In conclusion, femur biomechanical parameters are decreased in osteoporosis.     

Coexistence of fibromyalgia,temporomandibular disorder,and masticatory myofascial pain syndromes

The purpose of this study was to determine the association of fibromyalgia (FM) with temporomandibular disorder (TMD) and masticatory myofascial pain (MMP). Thirty-one consecutive women diagnosed as having FM according to American College of Rheumatology criteria and 21 consecutive women diagnosed as having TMD were included in this prospective study. All patients were examined by a dentist and a physiatrist to identify the coexistence of FM and TMD. In the FM group, TMD was found in 25 (80%) patients, and only 6 (19%) patients had arthrogenous origin with MMP, whereas 19 (81%) patients had only MMP without arthrogeonous orgin of those 25 women exhibited TMD. In the TMD group, the prevalence of FM was 52%, which was significantly higher in those with TMD of arthrogenous origin with MMP. Our results indicate that coexistence of FM and TMD with MMP is high. Pain and tenderness in the masticatory muscles appear to be an important element in FM, so in some patients it may be the leading complaint. This study was supported financially by Baskent University Research Fund.