Periprocedural, Short-Term, and Long-Term Outcomes of Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A 20-Year Single-Center Experience.

BACKGROUND: Alcohol septal ablation is recommended for hypertrophic obstructive cardiomyopathy patients who had refractory symptoms despite optimal medical treatment. We compared the periprocedural, short-, and long-term clinical outcomes and mortality predictors in hypertrophic obstructive cardiomyopathy patients who underwent alcohol septal ablation. METHODS: Hypertrophic obstructive cardiomyopathy patients aged ≥18 years (63 females and 71 males) who underwent alcohol septal ablation were included. The primary endpoint was all-cause mortality. RESULTS: The mean patient age was 60.0 (standard deviation 13.7) years. The median follow-up time was 13 (7.6-18.5) years. During the procedure, 9, 2, and 1 patients developed ventricular fibrillation, remote site myocardial infarction, and pericardial tamponade, respectively, but none died. One patient died during hospitalization. During the long-term follow-up, 17, 5, 20, and 8 patients developed heart failure, myocardial infarction, chronic atrial fibrillation, and non-fatal stroke, respectively, and 24 died. There was no significant difference between the sexes (all P > .05). Age (hazard ratio=0.69, 95% CI=0.61‒0.78, P < .001), body mass index (hazard ratio=1.20, 95% CI=1.04-1.40, P=.01), age at diagnosis (hazard ratio=1.57, 95% CI=1.34-1.78, P < .001), and time from diagnosis to ablation (hazard ratio=1.57, 95% CI=1.35-1.84, P< .001) predicted all-cause mortality. In Kaplan‒Meier curves, long-term all-cause mortality was similar in men and women (P[log-rank]=.43). CONCLUSION: Alcohol septal ablation has similar short- and long-term outcomes for both sexes in hypertrophic obstructive cardiomyopathy patients. Risk factors for longterm mortality were age, body mass index, diagnosis age, and time delay to operation. Therefore, alcohol septal ablation timing is essential for better clinical outcomes. Our findings may contribute to the increased performance of alcohol septal ablation in hypertrophic obstructive cardiomyopathy patients in our country.

Partial mediator role of physical abuse on the relationship between attention-deficit/hyperactivity disorder symptoms and severity of dissociative experiences in a sample of inpatients with alcohol use disorder.

AIM: This study aimed to evaluate the relationship of attention-deficit/hyperactivity disorder (ADHD) symptoms with dissociative experiences, and the mediator role of childhood traumas on this relationship, while controlling the effect of depression in alcohol use disorder (AUD). SETTINGS AND DESIGN: It was a hospital-based, cross-sectional study. MATERIALS AND METHODS: One hundred and ninety inpatients with AUD were evaluated with the Beck Depression Inventory, the Adult ADHD Self-Report Scale (ASRS), Childhood Trauma Qestionnaire, and Dissociative Experiences Scale (DES). STATISTICAL ANALYSIS: One-way ANOVA, Chi-squared test, and hierarchical linear regression model were performed. RESULTS: The ratio of those who receive 10 points or less from DES was 26.8%, those who receive points between 11 and 30 was 45.3%, and those who receive more than 30 points was 27.9%. The latter group that was considered as a group with high risk of dissociative disorder had higher scores from depression, childhood trauma, and ADHD scores than the other groups. Rate of those with high probability of ADHD was higher among this group. ASRS total score and inattentive subscale scores were moderately (r = 0.552 and r = 0.547, respectively) and hyperactive/impulsive subscale was mildly (r = 0.430) correlated with DES score. Severity of ADHD was related with the severity of dissociative symptoms, and physical abuse had partial mediator effect on this relationship, even after controlling the depressive symptoms. CONCLUSIONS: These findings demonstrate that the presence of severe IN symptoms is an important factor related with dissociative tendency in AUD population with a history of physical abuse.

Reliability and Validity Study of the Turkish Version of the Clinical Opiate Withdrawal Scale.

INTRODUCTION: The aim of the present study was to perform reliability and validity analyses of the Turkish version of the Clinical Opiate Withdrawal Scale which is used to determine the severity of opiate withdrawal. METHODS: Initially, the Clinical Opiate Withdrawal Scale (COWS) was translated into Turkish and subsequently back-translated into English. The originality of the back-translated version was approved by the author who developed the scale. After the translation was completed, the scale was used to assess the withdrawal symptoms of 100 patients with opiate withdrawal and 41 patients with alcohol withdrawal. Cronbach's alpha was used in the reliability assessment; explanatory and confirmatory factor analyses were used in structural validity assessment; and in scale validity, ROC analysis was used among diagnosis groups. RESULTS: The Cronbach's alpha internal consistency coefficient was calculated as 0.74 in reliability analyses. The correlation coefficient was found to be 0.975 (p<0.001) for inter-rater reliability. Factor analysis was conducted for the structural validity of the scale and findings that support the unidimensional structure of the scale were observed. In the confirmatory factor analysis, CFI, GFI and RMSEA values were found to be 0.905, 0.905 and 0.079, respectively. It was detected that COWS was successful in distinguishing between opiate and alcohol withdrawal symptoms and the area under the ROC curve was 0.878. CONCLUSION: This study showed that the Turkish version of COWS can be used reliably and validly for assessing opiate withdrawal.

Neuroprotective effect of alpha-lipoic acid and methylprednisolone on the spinal cord ischemia/reperfusion injury in rabbits.

OBJECTIVE: The aim of this study is to investigate the putative neuroprotective effect of alpha-lipoic acid (LA) on spinal ischemia/reperfusion (I/R) injury in rabbits. METHODS: Thirty-five adult female New Zeland rabbits, weighing 2,000-3,500 g (mean: 2,800), were divided randomly into five groups of seven rabbits each (n: 7) as Group 1: sham, only laparotomy; Group 2 (I/R): I/R; Group 3 (LA): I/R and 100 mg/kg of LA; Group 4 (MP): I/R and 30 mg/kg of methylprednisolone (MP); and Group 5 (LA + MP): I/R and 100 mg/kg of LA plus 30 mg/kg of MP. RESULTS: A statically significant effect of LA, MP, and LA plus MP on lowering malondialdehyde levels both in the blood and in the cerebrospinal fluid (CSF) has been observed. Nitric oxide is significantly decreased in the blood and spinal cord tissues, and also in the CSF but it is not significant. Superoxide dismutase, catalase, and glutathione levels were increased by LA administration. CONCLUSION: LA exhibits antioxidant efficacy in spinal cord I/R injury, but it cannot decrease the oxidative stress. The histopathological result of the present study also demonstrated that LA has neuroprotective effect in spinal cord injury.

Investigation of vitamin D levels in patients with vitiligo vulgaris.

The aim of the study was to investigate serum 25-hydroxyvitamin D (25(OH) D3) levels in patients with vitiligo vulgaris in terms of causal relation and extension of the disorder. This study is a clinical cross-sectional study carried out in order to determine 25-hydroxyvitamin D levels among 25 patients with vitiligo vulgaris and in 41 controls. Fitzpatrick skin phototypes, history of autoimmune disease, family history of vitiligo, and duration of the disease were also evaluated. The mean levels of vitamin D in patient and the control group were 15.2±5.2 ng/dL and 14.4±6.2 ng/dL respectively (P>0.05). In our study, 48% of the patients had insufficient (<30 ng/mL) and 52% had very low (<15 ng/mL) levels of vitamin D. There was no correlation between age, duration of the disease, and body surface area affected with vitamin D levels. There was no significant difference in vitamin D levels between patients who had family history of vitiligo (5 patients, 20%) and those that did not. Vitamin D levels were found to be insufficient (<30 ng/mL) or very low (<15 ng/mL) in most of the patients with vitiligo vulgaris, but not statistically significantly different as a group when compared to the controls. More studies are needed to differentiate between the effects of low vitamin D levels on pathogenesis of vitiligo vulgaris and lower vitamin D levels as a result of the disease.

The severity of attention deficit hyperactivity symptoms and its relationship with lifetime substance use and psychological variables among 10th grade students in Istanbul.

AIM: The aim of this study was to determine the severity of attention deficit hyperactivity symptoms (ADHS) and related psychological and behavioral variables among 10th grade students in Istanbul/Turkey. METHODS: Cross-sectional online self-report survey conducted in 45 schools in 15 districts Istanbul. The questionnaire included sections about demographic data and use of substances including tobacco, alcohol and drugs. Also ADHS, depression, anxiety, anger and sensation seeking subscales of Psychological Screening Test for Adolescents (PSTA) were used. The analyses were conducted based on the 4938 subjects. RESULTS: Mean ADHS score was higher in females and among those with a lifetime use of tobacco, alcohol and drug, and having self-harming behavior and suicidal thoughts. ADHS score was correlated with depression, anxiety, anger and sensation seeking scores. In univariate covariance analysis (ANCOVA); depression, anxiety, anger, sensation seeking, lifetime alcohol use and suicidal thoughts predicted the severity of ADHS. CONCLUSIONS: The findings suggest that, since ADHS is associated with depression, anxiety, anger, sensation seeking, lifetime alcohol use and suicidal thoughts among 10th grade students, clinicians should screen suicidality and comorbid psychiatric symptoms routinely in adolescents with ADHS.

Evaluation of total antioxidant status, total oxidant status and oxidative stress index in patients with alopecia areata.

OBJECTIVES: In this study, we aimed to evaluate total oxidative stress and total antioxidant capacity in serum samples from patients with Alopesia Areata (AA) in our laboratory conditions. METHODS: In this study, 46 subjects with AA (26 females, 20 males) and the control subjects of 36 (20 females, 16 males) age- and sex-matched healthy volunteers from our hospital staffs were enrolled (the mean age was 23.7 ± 11.0 years). Blood samples were obtained following an overnight fasting state, and were collected on ice at 4°C. The serum samples were separated from the cells by centrifugation at 3000 rpm for 15 min and were stored at -80°C and used for the analysis of the Total Antioxidant Status (TAS) and Total Oxidant Status (TOS). RESULTS: Total Antioxidant Status (TAS) and Total Oxidant Status (TOS), Oxidative Stress Index (OSI) (TOS/TAS) levels of AA patients were 1.4777 ± 0.1986; 9.7490 ± 6.0445; 0.6593 ± 0.4069 respectively. TAS; TOS; OSI (TOS/TAS) levels of controls were 1.4028 ± 0.1687; 9.4627 ± 4.2781; 0.6875 ± 0.3232 respectively. TAS, TOS and OSI levels showed no significant difference between the control and AA group (p > 0.05). CONCLUSION: Future studies about AA pathogenesis should be based not only on oxidant/antioxidant balance but also on several other factors. Because it was observed that the disease showed recurrence in different situations. Since the selection criteria of patients is affected from disease severity and environmental and genetical factors, multicentric studies with better sampled patient population and higher patient number is required.

Non-suicidal self-harm behavior within the previous year among 10th-grade adolescents in Istanbul and related variables.

BACKGROUND: Non-suicidal self-harm behavior (SHB), which is a pervasive and dangerous problem, is frequent among adolescents and it is important to evaluate the associated psychological and social factors to better understand its nature and to plan treatment programs. AIMS: Aim of the present study is to determine the prevalence of SHB and the associated variables such as substance use, psychological, behavioral and social factors among 10th-grade students in Istanbul/Turkey. METHODS: Cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul/Turkey. A representative sample of 4957 10th-grade students was studied between October 2012 and December 2012. RESULTS: SHB within the previous year were reported by 14.4% of the students (n = 713). Lifetime suicidal thoughts or behavior, tobacco, alcohol and/or drug use, symptoms of depression, anxiety and impulsive, delinquent and aggressive behaviors were also associated with SHB in Turkish 10th-grade students. CONCLUSIONS: The findings of the present study may be relevant in prevention and management of SHB as well as important problems among students, such as substance use, impulsive, delinquent, aggressive and suicidal behavior.

Relationships of personality dimensions with impulsivity in alcohol-dependent inpatient men.

BACKGROUND: Impulsivity is closely related to substance use and abuse, both as a contributor to use and as a consequence of use. Particular dimensions of temperament and character were reported to be associated with trait impulsivity in different populations. AIM: The aim of the present study was to evaluate the relationship of personality dimensions with impulsivity among men with alcohol dependence. Also we wanted to control the effect of depression and anxiety symptoms on this relationship. METHODS: Participants were consecutively admitted male alcohol-dependent inpatients (n = 94) and healthy controls (n = 63). Patients were investigated with the Barratt Impulsiveness Scale, version 11 (BIS-11), the Temperament and Character Inventory (TCI) and the Symptom Checklist-Revised (SCL-90-R). RESULTS: Severity of impulsivity and dimensions of impulsivity were higher in alcohol-dependent inpatients than in healthy controls. Impulsivity was negatively correlated with reward dependence, persistence, self-directedness and cooperativeness, but positively correlated with novelty seeking, harm avoidance, depression and anxiety. Although high depression and temperament dimensions (high novelty seeking, harm avoidance and low reward dependence) predicted impulsivity, combinations of personality dimensions that predict dimensions of impulsivity differed. CONCLUSIONS: RESULTS may suggest that together with depression when impulsivity is the problem, both dimensions of impulsivity and personality must be evaluated and the treatment should be shaped accordingly for alcohol-dependent inpatients.

Lipoprotein subfraction profile and HDL-associated enzymes in sickle cell disease patients.

Although hypocholesterolemia is a reported finding in sickle cell disease (SCD), low-density lipoprotein (LDL)/high-density lipoprotein (HDL) subfractions and HDL-associated enzymes have not been determined in SCD patients. Blood was collected from 38 hemoglobin (Hb)A volunteers and 45 homozygous HbSS patients who had not received blood transfusions in the last 3 months. Serum lipids were measured by automated analyzer while LDL and HDL subfraction analysis was done by continuous disc polyacrylamide gel electrophoresis. Serum levels of cholesteryl ester transfer protein (CETP), lecithin-cholesterol acyltransferase (LCAT), apolipoprotein B (apoB) and apolipoprotein A-1 (apoA-I) were determined by enzyme-linked immunosorbent assay (ELISA). Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels were significantly decreased, while TG levels were significantly increased in SCD patients compared to controls. A significant decrease in intermediate-density lipoprotein (IDL)-C, IDL-B, IDL-A and LDL-1 fractions were seen in SCD patients, while no significant difference was observed in small dense LDL particles. A significant decrease was seen in HDL-large, HDL-intermediate and HDL-small fractions in SCD patients versus controls. Levels of LCAT and ApoA-1 protein measured in SCD patients were significantly lower while no significant difference was observed in CETP and ApoB protein levels compared to controls. The reduction observed in LDL- and HDL-C in SCD patients was reflected as significantly decreased IDL, LDL-1 and HDL-subfractions. Decreased HDL subfractions may possibly lead to the reduced ApoA-1 and LCAT protein levels observed in SCD patients.

Serum adiponectin and resistin levels in patients with obsessive compulsive disorder.

We aimed to investigate the changes in serum adiponectin and resistin levels in patients with obsessive compulsive disorder and control groups. The serum adiponectin and resistin levels of 29 patients (16 females, 13 males) with obsessive compulsive disorder and weight, age and sex-matched 31 healthy controls (17 females, 14 males) were determined. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was applied to all groups. ELISA method was used to measure adiponectin and resistin levels. The mean adiponectin level was 11.92±2.04 ng/ml and resistin level was 13.23±2.78 ng/ml in obsessive compulsive disorder group, while it was 18.81±5.24 ng/ml and 8.17±2.53 ng/ml in control group. Changes in plasma adiponectin and resistin levels in obsessive compulsive disorder may have implications about possible cardiovascular and metabolic abnormalities seen in obsessive compulsive patients.

Dexmedetomidine in cardiac surgery patients who fail extubation and present with a delirium state.

BACKGROUND: We evaluated the use of dexmedetomidine to facilitate the weaning of delirious postoperative patients from mechanical ventilation. METHODS: We included 72 consecutive patients who underwent elective cardiac surgery in this prospective observational study. Each patient had failed at least 1 trial of continuous positive airway pressure (CPAP) and had agitation. Patients were assessed with the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the Intensive Care Unit (CAMICU) 12 to 18 hours after their admission to the ICU. Midazolam and fentanyl were then given to all patients according to the sedation protocol. At 36 hours in the ICU, patients who had agitation and an inability to wean were randomly divided into 2 groups: group M, 34 patients who continued to follow the routine sedative protocol; and group D, 38 patients who were given dexmedetomidine. Arterial blood gas measurements, hemodynamic parameters, and time to extubation were recorded. Statistical analysis was performed with GraphPad InStat (version 2.02 for DOS). RESULTS: All patients tested positive in the CAM-ICU assessment, and all had a delirium diagnosis. The 38 patients in group D tolerated a spontaneous breathing trial with CPAP and were extubated after a mean (±SD) of 49.619 ± 6.96 hours. The 2 groups had significantly different extubation times (58.389 ± 3.958 hours versus 49.619 ± 6.96 hours). The 2 groups had significantly different RASS scores at 48 and 60 hours and significantly different heart rates and PO2 values at 12 and 24 hours. The 2 groups showed no significant differences with regard to hemodynamic parameters. CONCLUSIONS: Dexmedetomidine may help to eliminate the emergence of agitation and can be a good treatment choice for the delirium state after cardiac surgery.