A Rare Cause of Colonic Obstruction: Inflammatory Fibroid Polyp.

Only 5% of all cases of intussusceptions occur in adults. Although it is known to occur frequently due to inflammatory bowel disease, postoperative adhesions, or neoplastic masses, inflammatory fibroid polyps (IFP), which are rare lesions of the gastrointestinal tract, may present this clinical picture. In rare cases of intussusception due to IFP, clinical suspicion should be kept in the foreground and mind in the differential diagnosis. In this article, the purpose was to present the clinical, radiological, and pathological findings and the treatment of obstruction caused by this rare lesion.

Effect of hyperthermic chemotherapy on topical hemostatic agents.

PURPOSE: There is no clear consensus as to which topical hemostatic agent is best used during cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy. The aim of this study was to evaluate the effect of hyperthermic chemotherapy on the biomechanical properties of organic topical hemostatic agents and histologically fibrin formation rates. METHODS: Four topical hemostatic agents (Spongostan™, Surgicel®, Fibrillar™, Arista®) were evaluated. All agents were mixed with 3 ml blood in sterile tubes separately to form clot formation. The resulting clot formations were incubated with 36 °C and 42 °C with saline or cisplatin for 1 h. Strength and flexibility of hemostatic samples were evaluated under weight of 0 g, 50 g, 100 g, 200 g and 300 g. All samples were stained with hemotoxylin-eosin and compared histologically for fibrin clot formation under light microscope. RESULTS: There were no statistically significant differences according to strength and flexibility of topical hemostatic agents on hyperthermic chemotherapy. Histopathologically, the highest fibrin formation was observed in Surgicel®, followed by Fibrillar™. The least fibrin formation was detected in Arista®. CONCLUSIONS: This study demonstrated that exposure to hyperthermic chemotherapy did not significantly affect the biomechanical properties of organic topical hemostatic agents and the fibrin clot formation.

Caregiver burden in cerebral palsy: Validity and reliability of the Turkish version of caregiver difficulties scale.

BACKGROUND: This study aims to translate the caregiver difficulties scale (CDS) into Turkish language and to reveal its reliability and validity in Turkish informal family caregivers of children with cerebral palsy (CP). METHODS: This study included 130 participants (39.9 ± 7.8 years; range 24-58 years; 106 females and 24 males). Demographic properties of participants, relationship with the care recipient, income, caregiving time, CP type and diseases of the child (e.g., epilepsy, hydrocephalus and congenital heart disease) and the caregiver were recorded. The CDS, caregiver well-being scale (CWBS), World Health Organization Quality of Life (WHOQOL-BREF) and Beck depression inventory (BDI) were used for data collection. The internal consistency of the CDS was assessed using the calculation of Cronbach's alpha coefficient. A test-retest interval of 2 weeks was used to assess the reliability. The intercorrelation of variables was evaluated using the Spearman correlation coefficient. The receiver operating characteristic (ROC) analysis was performed to find the predictive power of CDS scores for depression. RESULTS: A total of 130 family caregivers of children with CP completed the test/retest procedures. The Cronbach alpha coefficients were found as 0.878 for the test and 0.852 for the retest. Intraclass correlation coefficient (ICC) value was found between 0.83 and 0.90 for test-retest reliability of the CDS. In addition, the CDS showed a significantly strong correlation with CWBS-activities of living subscale and WHOQOL-BREF psychological, physical and environment domains, as well as a significantly moderate correlation with CWBS basic needs subscale, BDI and WHOQOL-BREF general health and social domains. CDS scores that are >46 resulted in a sensitivity of 81.48% and a specificity of 73.79% for moderate-severe depression. CONCLUSION: The Turkish version of the CDS is a valid and reliable measure for caregiver burden of family caregivers of children with CP.

Detecting the Relationship between the Stress Levels and Perceived Burnout in Law-enforcement Officers during the COVID-19 Outbreak: A Cross-sectional Study.

The present study aimed to determine the effect of burnout and stress levels on law enforcement officers' perceptions and behaviors to emphasize the need for adequate attention and care in these individuals during the COVID-19 outbreak. The research group of this cross-sectional study conducted in July-August 2020 was formed by the law enforcement officers. The Perceived Stress Scale (PSS), Burnout Measure-Short Version (BM-SV) and a personal data form prepared by the researchers were used in the study. Data were analyzed using the IBM SPSS Statistics 16.0 software package program. The PSS scores were higher and significant in the group whose working hours were not increased due to the COVID-19 pandemic and they thought that there was a decrease in crime rates and did not need psychological support (p ≤ .05). The PSS scores were higher and significant in the group who took the warnings about COVID-19 into consideration, were afraid of contracting the virus, did not care about the progress of the epidemic and used the mask correctly. Additionally, the BM-SV scores were higher and significant in the group who stated that they were not afraid of contracting the virus (p ≤.05). A comprehensive crisis prevention and intervention system including epidemiological monitoring/observing, screening, referral and targeted interventions should be established to reduce the perceived level of stress and burnout in law enforcement and prevent further mental health problems.

The Relationship of Intimate Partner Violence With Psychiatric Disorders and Severity of Pain Among Female Patients With Fibromyalgia.

Objectives: This study aims to compare the prevalence of intimate partner violence and comorbid psychiatric disorders among patients with fibromyalgia syndrome (FMS) and healthy controls and also to investigate the relationship of intimate partner violence with psychiatric disorders and severity of pain in FMS patients. Patients and methods: The study group consisted of 136 females including 68 patients with FMS (mean age 43±10.4 years; range, 25 to 70 years) and 68 FMS-free healthy females (mean age 38.5±11.3 years; range, 22 to 70 years). Following a Structured Clinical Interview for Diagnostic and Statistical Manual-IV Axis I Disorders by a psychiatrist experienced in psychological trauma, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Visual Analog Scale (VAS) for the severity of pain and Domestic Violence Against Women Scale (DVAWS) were applied. Results: In FMS group, 85% of the patients were diagnosed with mood or anxiety disorder. Almost half of these patients had major depressive disorder. The total scores of DVAWS and all subscales were significantly higher in the FMS group than in the control group (p<0.01). The severity of domestic violence were related to the presence of any psychiatric disorder only in FMS patients (p<0.01). Almost half of the FMS patients with high DVAWS score had comorbid mood and anxiety disorders. There was a significant positive correlation between the total scores of DVAWS, HDRS, HARS, and VAS (p<0.01). Conclusion: Although the etiology of FMS is still uncertain, psychosocial factors may play role as risk factors. Therefore, a multidisciplinary approach to the treatment should be considered.

The Impact of Perceived Social Support on Anxiety, Depression and Severity of Pain and Burnout Among Turkish Females With Fibromyalgia.

OBJECTIVES: This study aims to assess the impact of perceived social support on burnout, severity of pain and comorbid anxiety and depression among Turkish females with fibromyalgia syndrome (FMS). PATIENTS AND METHODS: A total of 117 females including 65 patients with FMS (mean age 33.5±8.1 years; range 20 to 60 years) and 52 healthy controls (mean age 33.6±7.3 years; range 23 to 48 years) were included between January 2017 and May 2017. Following a semi-structured psychiatric interview by a psychiatrist, Sociodemographic Data Form, Mood and Anxiety Disorders Modules of Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition Axis I Disorders (SCID-I), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Visual Analog Scale (VAS), Maslach Burnout Inventory (MBI) and Multidimensional Scale of Perceived Social Support (MSPSS) were applied to participants. RESULTS: As a result of the semi-structured clinical interview conducted by a psychiatrist, the prevalence of any mood or anxiety disorder was found to be significantly more common in the FMS group. The proportion of patients diagnosed with any mood or anxiety disorder using SCID-I was significantly different among FMS (n=50, 76.92%) and healthy control (n=14, 33.33%) groups (p<0.001). Correlations between these variables were examined within the FMS group. There was a significant negative correlation between VAS and MSPSS. There were significant negative correlations between MSPSS and HDRS, HARS, all subscales of MBI. There were significant positive correlations between VAS and HDRS, HARS, all subscales of MBI. CONCLUSION: In conclusion, perceived social support was found to be strongly associated with depression, anxiety, burnout and severity of pain in patients with FMS. Our study provided support to emphasize the importance of perceived social support among females with FMS. Considering that FMS is associated with many physical and cognitive complaints in addition to pain, it can be considered as a multi-systemic disease requiring a multidisciplinary approach.

[Persistent Genital Arousal Disorder Treated with Duloxetine: A Case Report]. / Duloksetin ile Tedavi Edilen Sürekli Genital Uyarilma Bozuklugu: Olgu Sunumu.

Persistent Genital Arousal Disorder is characterized with unwanted, uncontrollable and persistent genital arousal symptoms that occur spontaneously in the absence of simultaneous sexual fantasy, sexual desire or sexual stimulation. The condition may last for hours or days. Patients often find it difficult to share this condition with their health care providers because they are afraid of being diagnosed with hypersexuality and they often get different psychiatric diagnoses such as Obsessive Compulsive Disorder and Major Depressive Disorder. Therefore, little is known about the real prevalence, pathophysiology or etiology of Persistent Genital Arousal Disorder. In addition, since there is no study conducted in this field, our information in this area is limited to case reports. Although there is no consensus about the treatment of Persistent Genital Arousal Disorder in the psychiatric literature, there are some case reports about the use of pregabaline, clomipramine, duloxetine, clonazepam, varenicline, olanzapine, risperidone in addition to the case reports on treatment with hypnotherapy, pelvic floor physiotherapy and electroconvulsive therapy (ECT). In this case report, we aimed to present the detailed description of a successful treatment procedure with duloxetine in a forty two years old female patient diagnosed with Persistent Genital Arousal Disorder. She had been using various antidepressants, antipsychotics, anxiolytics and mood stabilizers for sixteen years with different psychiatric misdiagnoses like Bipolar Disorder, Obsessive Compulsive Disorder, Anxiety Disorder and Major Depressive Disorder and yet, had not shared her symptoms of genital arousal with any psychiatrist previously.

Is There Any Association Between Childhood Traumatic Experiences, Dissociation and Psychotic Symptoms in Schziophrenic Patients?

OBJECTIVE: The aim of this study was to investigate the rates childhood traumatic experiences (CTEs) of schizophrenia patients and to examine relationship between childhood traumatic experiences, dissociation and psychotic symptoms. METHODS: One hundred schizophrenia patients who had 5 or 5 points below in Clinical Global Impression-Severity (CGI-S) and who were not in active psychotic episode and 50 healthy siblings who grew up in the same environment with the patients were included to the study. Structured Clinical Interview for DSM IV, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Dissociative Experiences Scale (DES), CGI-S, Global Assessment of Functioning Scale and Childhood Trauma Questionnaire (CTQ-28) applied to the patients. RESULTS: Childhood abuse subscales and DES scores were statistically higher in the patient group (p<0.001). We determined moderately significant positive correlation between CTQ-28 and DES. We determined moderately significant positive correlation between CTQ total scores and persecutory delusions, delusions of reference, ability to feel intimacy and closeness; relationship with friends and peers. Also, there was a significant positive correlation between persecutory delusions and CTQ-total, DES-total and all subscales of CTQ-28. CONCLUSION: Clinicians should inquire about CTEs to develop comprehensive formulations and treatment plans among schizophrenia.

Hypersexuality Manifesting as Excessive Masturbation in a Female Patient After Temporal Lobe Epileptic Surgery: A Rare Case Report.

Interictal sexual behavior changes are frequently reported in patients with epilepsy, especially those with temporal lobe epilepsy. Changes in sexual function after temporal lobe epileptic surgery can vary within a wide range, ranging from disappearance of paraphilias existing in preoperative period, decreased libido or sexual activity, sexual arousal and orgasmic disorders, sexual activity arising to a normally acceptable level, or hypersexuality. Hypersexuality can be defined as having excessive sexual arousal and drive in abnormal frequency and intensity. Many hypotheses have been developed to explain etiology in hypersexuality in the literature. But there is no consensus on treatment. Here we aimed to present diagnosis and treatment process of hypersexuality manifesting as excessive masturbation in 38 years old, single female patient who underwent selective hippocampectomy (temporal lobe resection) 11 years ago.

Analysis of 24-Hour Heart Rate Variability among Panic Disorder Patients without Previous Drug Treatment and Comorbid Disorders. / Psikotrop Ilaç Kullanimi, Baska Tibbi Hastaligi ve Psikiyatrik Es Tanisi Olmayan Panik Bozuklugu Hastalarinda 24 Saatlik Kalp Hizi Degiskenliginin Degerlendirilmesi.

OBJECTIVE: One of the METHODS used to assess autonomic nervous system dysfunction in the etiology of panic disorder (PD) is heart rate variability (HRV). HRV is controlled by the sympathetic and parasympathetic (vagal) branches of the autonomic nervous system and reflects the capacity of autonomic stimulation by the parasympathetic system. The aim of this study was to evaluate heart rate variability (HRV) time domain parameters based on twenty four hour holter ECG analysis among drug-naive patients with panic disorder (PD) without any other medical and psychiatric comorbidity. METHOD: The study group consisted of 41 patients with PD and 46 healthy controls. Participants were evaluated with SCID-1 for psychiatric diagnoses. Then Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Panic Disorder Severity Scale (PDSS) and Clinical Global Impression Scale (CGI-S) were applied to participants. Twenty four hour Holter ECG outcomes were analyzed on a computer program and time domain parameters were evaluated. RESULTS: Among the parameters analyzed from HRV, SDANN was significantly higher (p <0.001); duration of RMSSD, NN50 and pNN50 were lower in PD group than the control group (p = 0.003, p = 0.005, p = 0.047, respectively). In the correlation analysis, there was a moderate negative correlation between CGI-S and NN50 and pNN50. In logistic regression analysis, the increase in SDNN was found to increase the probability of PD by 1.11 (95% CI, 1.010-1.209); the increase in SDANN was found to decrease the probability of PD by 0.892 (95% CI, 0.818-0.973), and the increase in pNN50 was found to decrease the probability of PD by 0.523 (95% CI, 0.342-0.801). CONCLUSION: The data obtained in our study confirm that there is a decrease in some HRV parameters like RMSSD, NN50 and pNN50 reflecting parasympathetic activity among patients with PD.

Psychiatric comorbidity and childhood trauma in fibromyalgia syndrome.

OBJECTIVES: In this study, we aimed to compare patients with fibromyalgia syndrome (FMS) and those with myofascial pain syndrome (MPS) and healthy women and to investigate the prevalence of childhood traumatic experiences (CTEs) in relation to comorbid mood and anxiety disorders. PATIENTS AND METHODS: Between February 2014 and May 2014, a total of 136 women including 52 with FMS, 35 with MPS, and 49 healthy controls were included in the study. The Sociodemographic Data Form, Mood and Anxiety Disorders Modules of Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) Axis I Disorders (SCID-I), Fibromyalgia- related Symptom Scale (FSS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Childhood Trauma Questionnaire-28 (CTQ-28) were applied to participants. RESULTS: As a result of the semi-structured clinical interview conducted by a psychiatrist experienced in psychological trauma, the prevalence of any mood or anxiety disorder were found to be significantly more common in the FMS group. Childhood traumatic experiences, not only in general, but also with all subtypes, were also reported to be significantly more in FMS patients. Besides, only in patients with FMS, a significant relationship was found between the psychiatric diagnoses and the presence of CTEs. Furthermore, the CTQ-28 scores were correlated positively with the FSS scores as well as HDRS and HARS. Among the symptoms screened by the FSS, only crying and over-reacting to incidents were significantly associated with CTEs in FMS group. CONCLUSION: Based on our study results, CTEs may play a critical role in the development of fibromyalgia and may be related with comorbid mood and anxiety disorders in FMS patients. Associating psychological symptoms such as crying or over-reacting to incidents in FMS patients should be, therefore, alerting for psychiatric consultation.

Leukocytosis after Clozapine Treatment in a Patient with Chronic Schizophrenia.

Clozapine is an atypical antipsychotic drug that is approved by the US Food and Drug Administration (FDA) for the treatment of psychotic disorders. Agranulocytosis is a well-established side effect of clozapine; clozapine has also been associated with other blood dyscrasias like leukocytosis, albeit rarely. In this paper, we aim to report a case of possible clozapine-associated leukocytosis in a 41-year-old woman.

Congenital Prepubic Sinus with Remnant Tissue Mimics Corpus Spongiosum: A Rare Case.

A congenital prepubic sinus is a tract that originates in the skin and overlays the base of the penis; however, its embryologic basis is still debated. We herein present a case involving a 3-year-old boy who was admitted for examination of overlying tissue located a few centimeters distal to the dorsal base of the penis. Examination revealed a tiny sinus in the prepubic area, and 3 cm of tissue was attached to the sinus. Pathologic examination showed that the tissue was lined with squamous epithelium and continued along the sinus tract, which was lined with urothelial epithelium. According to Stephens' classification, the sinus appeared to be a variant of type 2 dorsal urethral duplication, and the remnant tissue mimicked the corpus spongiosum of the penis.

Treatment Approach to Sleep Terror: Two Case Reports.

Parasomnias are a group of disorders characterized by abnormal behaviors, physical activities, and autonomic arousal symptoms while transition to sleep or continuation of sleep. Sleep terror (ST) is classified under parasomnias characterized by sudden fear attacks beginning with crying attacks or high-frequency screams and continuing with increased autonomic symptoms. ST occurs in the first few hours of sleep during the delta phase. Further, the lifetime prevalence of ST in adults is less than 1%. It is important to obtain; anamnesis from patients' bed partner for a clinical evaluation of ST. Methods, such as evaluating sleep diaries and video recordings, can help ST diagnosis. It is also important to evaluate patients' medical history, history of substance or alcohol abuse, psychological traumatic experiences, primary or secondary incomes, and detailed neurological aspects. Physician can select some serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCADs) as medical treatment if patients have a high frequency of attacks. Because of addiction and relapse of ST episodes, benzodiazepines are not preferred as the first-line treatment. In this study, we will discuss ST, which is rare in adulthood, and use of long-acting benzodiazepine based on two cases.

Is there an appropriate cutoff age for sampling the endometrium in premenopausal bleeding?

AIM: To determine a cutoff age for endometrial evaluation in premenopausal abnormal uterine bleeding (AUB). METHODS: Histopathology reports of endometrial sampling performed due to AUB in women aged 50 years or less were reviewed retrospectively. Histopathological findings were categorized into three groups as follows: group 1: hyperplasia without atypia + hyperplasia with atypia + malignancy, group 2: hyperplasia with atypia + malignancy, and group 3: malignancy. RESULTS: Data from 2,516 patients were analyzed for this study. Overall, 13.5% of patients had endometrial hyperplasia without atypia, 1% of patients had hyperplasia with atypia and 0.6% of patients had malignant disease. Logistic regression revealed a significant difference in the odds ratios of group 1 in the age ranges of 40-45 and 45-50 years compared with <40 years (p = 0.001 and p = 0.01, respectively). There were no significant differences between the age groups for the odds ratio of group 2 and group 3. CONCLUSION: There is no cutoff age for sampling the endometrium in order to detect hyperplasia with atypia and cancer in premenopausal women with AUB. Therefore, the management of AUB should be tailored to each patient regardless of age, incorporating all risk factors for malignant disease.