Exposure to domestic violence and its effects on adolescents: A survey among Turkish students.

PROBLEM: Exposure to domestic violence is an important social problem. What remains unknown are the effects of domestic violence on Turkish adolescents. METHODS: This study was performed in Kirikkale, Turkey, to determine the state of verbal and/or physical domestic violence and its effects on adolescent behavior. A total of 1,807 students (44.4% female and 55.6% male) with a mean age of 15.1 ± 1.6 years at two high schools and five elementary schools were enrolled in the study and completed questionnaires that surveyed their exposure to domestic violence and its possible relationship to their disruptive behaviors. FINDINGS: Twenty-three percent of the students were exposed to violence. Among those, 75% had been exposed to violence within the family, 53% by their friends and 17% by their teachers. Of those exposed to domestic violence, 70% were exposed only verbally and 24% only physically. The economic level of the family, gender, marital status of the parents, and education level of the father were significant factors on violence exposure within the family. The results showed that the rates of being involved in a fight, getting injured at a fight, using a gun, bringing knives (mostly pocket knives) to school and using it were higher in children exposed to domestic violence than with the children who were not. CONCLUSIONS: To address the impact of domestic violence on teens and possibly decrease the adolescent's violent behavior and its consequences, policies aiming to reduce violence in the social environments of adolescents are needed.

Does Generalized Linear Model Support Functional Default Mode Network Studies.

INTRODUCTION: A growing body of research has emerged on the resting state and the default mode of the brain. Functional connectivity studies, which lately dominate this research area, have confirmed that regions such as the cortical mid-line structures, as well as parietal-temporal regions are tightly interconnected within the default mode network (DMN). However, little is known about the activity patterns of resting state related brain regions detected in fMRI studies using the generalized linear model (GLM) in a whole brain analysis. The aim of the current study was to investigate the activity changes among brain regions identified through GLM during the transition from task to rest and the prolongation of rest. METHODS: A picture imagination task, as a controlled thought content task, was used in order to minimize confounding factors such as a visual stimulus or a motor response. RESULTS: The present study revealed a consistent fluctuating activation pattern of the dorsal anterior cingulate cortex (dACC), the posterior cingulate cortex (PCC), thalamus, primer motor area (PMA), insula, brain stem and bilateral putamen during the transition from task to the early phase of the resting state and the prolongation of the resting state. All regions showed increased activation during the detachment from task. However, this increased activation was not sustained during the extension of rest, replaced with a decreased activation at the late phase of rest. The increased activation of resting state regions might help with the detachment from the current task. Among these regions dACC, insula and putamen were correlated in all conditions. CONCLUSION: These findings underline the importance of the activation increase of the cortical mid-line regions and insula in the transition from task to the resting state.

Apelin-13: A Promising Biomarker for Multiple Sclerosis?

OBJECTIVES: Recent studies have shown that Apelin 13 may have a neuroprotective property. Therefore it can be used as a biomarker for multiple sclerosis. Our purpose to assess serum apelin-13 levels in adult patients with multiple sclerosis and healthy controls. PATIENTS AND METHODS: Subjects consisted of 42 relapsing remitting multiple sclerosis patients and 41 controls. Demographic characteristics including age, gender, duration of disease and Expanded Disability Symptom Scale (EDSS) were recorded. In serum samples obtained from the patients and controls, serum apelin-13 levels were measured with Enzyme Linked Immunosorbent Assay (ELISA) method. RESULTS: Serum apelin-13 levels were significantly higher in the patients groups than the healthy controls (P = 0.003). Pearson analysis did not show any significant correlation between EDSS, disease duration and apelin-13 levels. CONCLUSION: The results of our study have been showed statistically significant higher levels of serum apelin-13 in multiple sclerosis patients compared to controls. Further studies with larger patients populations and healthy controls should be done to clarify to use serum apelin levels as a biomarker for multiple sclerosis.

Psychological characteristics of patients with asthma.

INTRODUCTION: Psychological distress of patients with asthma may be reduced when they learned to live with their illness. Asthma can change the psychological and personality characteristics. We aim to investigate the psychological and personality characteristics of patients with asthma using MMPI (Minnesota Multiphasic Personality Inventory). METHODS: Thirty-three adult patients with asthma (23 female and 10 male) and 20 healthy controls (14 females and 6 males) were enrolled in this study. Psychometric evaluation was made with the Turkish version of the MMPI. The patients were separated into two groups according to the duration of symptoms (recent-onset asthma < 10 years, long-standing asthma ≥10 years). RESULTS: Patients with asthma compared with control group had significantly higher the rate of clinical elevation on depression, hysteria, psychasthenia and social introversion. Patients with recent-onset asthma compared with long-standing asthma have significantly higher the rate of clinical elevation on depression, hysteria, psychopathic deviate, psychasthenia and social introversion. MMPI mean t score in patients with recent-onset asthma was higher than patients with long-standing asthma. MMPI mean t score in patients with asthma was negatively associated with the symptom duration in multivariate model. CONCLUSIONS: Patients with asthma have relatively more inactivity, anergia, guilt, pessimism, nonspecific physical complaints, irrational fears and introvert. Patients with long-standing asthma have less psychological distress, suggesting that learned to cope with his illness.

The evaluation of temperament and quality of life in patients with polycystic ovary syndrome.

AIMS: To evaluate the temperament and quality of life (QoL) of patients with PCOS. MATERIALS AND METHODS: Fifty-three adult patients with PCOS and 38 healthy controls were enrolled in the study. Demographic characteristics including age, education and body mass index (BMI) were recorded. Affective temperaments were assessed by the temperament evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) scale. The general health-related quality of life (HRQoL) instrument used in this study was short Form 36. Hospital anxiety and depression scale (HADS) were also performed. RESULTS: The patients with PCOS had significantly higher rates of depressive, anxious and hyperthymic scores compared to controls. The PCOS patients had significantly lower mean SF-36 health summary scores. CONCLUSIONS: TEMPS-A seems to be an easy and reliable test to evaluate temperament in PCOS patients.

Autonomic dysfunction in patients with essential tremor.

The aim of this study was to evaluate the autonomic function in patients with essential tremor (ET). Thirty-one adult patients with ET and 26 healthy controls were enrolled in the study. The electrophysiological evaluations of the autonomic nervous system function were performed by sympathetic skin response (SSR) and R-R interval variation (RRIV) tests. The mean latency of SSR in ET patients was significantly delayed compared with the controls (P = 0.01). The mean amplitude of sympathetic skin response was significantly lower in ET patients in comparison to the controls (P = 0.001). No differences were found in mean RRIV values in both group subjects. Sympathetic dysfunction may occur in patients with ET. This may be easily demonstrated by SSR tests.

Factors Influencing Cognitive Function in Subjects With COPD.

BACKGROUND: The aim of this study was to assess the association between cognitive function and age, pulmonary function, comorbidity index, and the 6-min walk distance in subjects with COPD as well as to compare the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in terms of their ability to identify cognitive dysfunction in subjects with COPD. METHODS: A total of 52 individuals with stable COPD were included in this study. Cognitive function was assessed using MMSE and MoCA. Age, body mass index, the Modified Cumulative Illness Rating Scale, 6-min walk distance, arterial blood gases, and pulmonary function tests were assessed and recorded. RESULTS: The range and SD of scores in subjects with COPD were larger with MoCA than with MMSE. MMSE and MoCA scores are associated with 6-min walk distance and comorbidity index in subjects with COPD. General cognitive function measured by MoCA was negatively correlated with the comorbidity index but was positively associated with 6-min walk distance in subjects with COPD after controlling for possible confounding factors in the multivariate model. However, general cognitive function measured by MMSE was not correlated with the comorbidity index and 6-min walk distance in subjects with COPD, after controlling for possible confounding factors in the multivariate model. CONCLUSIONS: MoCA may be a more reliable screening test than MMSE in detecting cognitive impairment in subjects with COPD. The addition of cognitive tests on assessment of subjects with COPD can provide further benefit.

Validity and Reliability of Turkish Translation of Neuropathic Pain Impact on Quality-of-Life (NePIQoL) Questionnaire.

OBJECTIVES: The aim of this study was to adapt the "Neuropathic Pain Impact on Quality-of-Life Questionnaire" (NePIQoL) into Turkish and to test its validity and reliability in neuropathic pain patients. METHODS: We enrolled 200 chronic pain patients who admitted to the Neurology Department of Kirikkale University, Faculty of Medicine, in our study. Patients were diagnosed with neuropathic or nociceptive pain based on medical history, physical examination, electromyography and nerve conduction studies, laboratory examinations, and imaging techniques. Discriminant analysis was used to diagnose the neuropathic pain regarding sensitivity and specificity. The original version of the NePIQoL was translated into Turkish by standard procedures. RESULTS: Total NePIQoL scores were statistically different between neuropathic and nociceptive pain patients in both the first and second NePIQoL applications (P < 0.001). Cronbach's alpha coefficient of total 12 items of the first and second applications was 0.95. These results suggest a high validity level for the Turkish version of the NePIQoL. CONCLUSIONS: The Turkish version of NePIQoL appears to be reliable and valid for neuropathic pain impact on quality of life in patients with neuropathic pain.

Autonomic dysfunction in patients with polycystic ovary syndrome.

OBJECTIVE: To assess the autonomic system in patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: Thirty-seven adult patients with PCOS and 33 healthy controls were enrolled in the study. The electrophysiological assessments of the autonomic nervous system function were performed using sympathetic skin response and R-R interval variation tests. RESULTS: The mean latency of sympathetic skin response in PCOS patients was significantly delayed compared with the controls (p = 0.001). The mean amplitude of sympathetic skin response was significantly lower in comparison with the controls (p = 0.01). Mean R-R interval variation during deep breathing was also significantly delayed (p = 0.04). CONCLUSION: There are parasympathetic dysfunction and sympathetic dysfunction in patients with PCOS. This may be easily demonstrated with sympathetic skin response and R-R interval variation tests.

Atypical eclampsia and postpartum status epilepticus.

Preeclampsia is an entity that may present from 20th week of gestation up to 48 hours postpartum and is associated with hypertension and proteinuria. Eclampsia is emergence of convulsions pre-eclampsia in pregnant women with signs and symptoms. Recent studies showed that in some women, preeclampsia and even eclampsia may occur without hypertension or proteinuria. Here, we present a case of 26 years old women who had an uneventful pregnancy until 30 weeks' of gestation. She had only proteinuria in laboratory tests and was diagnosed as status epilepticus in early postpartum period. Preeclampsia and eclampsia is related with serious fetal and maternal morbidity and mortality and may present with atypical course. The awareness of atypical cases of preeclampsia enhances early diagnosis and management which are critical to avoid feto-maternal complications.

Personality profile in patients with polycystic ovary syndrome.

AIM: To investigate the personality traits of patients with polycystic ovary syndrome (PCOS). METHODS: Forty-nine patients with PCOS and 34 healthy controls were enrolled in the study. Psychometric evaluation was made with the Minnesota Multiphasic Personality Inventory. Additionally, Short Form-36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) were also performed. RESULTS: Polycystic ovary syndrome patients had significantly higher absolute and clinical elevation scores on depression, hysteria, psychasthenia and hypomania compared with the controls. Patients with PCOS had lower SF-36 physical and mental health summary scores and higher HADS anxiety and depression subscale scores. CONCLUSION: Polycystic ovary syndrome patients seem to have depressive, hysterical, psychasthenic and hypomanic personality traits.

Minnesota Multiphasic Personality Inventory profile in patients with restless legs syndrome.

INTRODUCTION: Restless legs syndrome (RLS) is associated with psychiatric disorders. We aim to investigate the personality traits of RLS patients using the Minnesota Multiphasic Personality Inventory. METHODS: Twenty adult patients with RLS (14 females and 6 males) and 20 healthy controls (14 females and 6 males) who were referred to university neurology were enrolled in the present study. Diagnosis of RLS was established using International Restless Legs Syndrome Study Group. Psychometric evaluation was made with the Turkish version of the Minnesota Multiphasic Personality Inventory. RESULTS: RLS patients have significantly higher absolute and clinical elevation scores on hypochondriasis and hysteria, and clinical elevation scores on psychasthenia, compared with the controls. Absolute scores on depression were higher at the border in RLS patients compared with the controls. DISCUSSION: RLS patients have hypochondriac, hysterical, depressive, and anxious personality traits.

ADC evaluation of the corticospinal tract in multiple sclerosis.

Apparent diffusion coefficient (ADC) values derived from diffusion-weighted MR imaging (DWI) provide important information about tissues. The goal of this study was to evaluate the ADC values in the corticospinal tract regions in multiple sclerosis (MS). The ADC values of 42 patients with multiple sclerosis and 46 healthy people were measured. The ADC values in the corticospinal tract at the capsula interna posterior crus from six points and mesencephalon from three points bilaterally in MS patients were compared with those of controls. An ANOVA post hoc test was used to analyse the differences in mean ADC values between the MS and control groups. The mean ADC values of the right (p = 0.008) and left internal capsules (p = 0.000) and right (p = 0.002) and left mesencephalons (p = 0.044) in MS patients were significantly lower than in the control group. There was no significant difference between the right and left side ADC values in MS (p = 0.313 vs. p = 0.223) and control groups (p = 0.756 vs. p = 0.105), respectively. The mean ADC values of the corticospinal tract in MS patients were significantly lower than in the control group. This decreased diffusion may be the result of cellular infiltration due to inflammation, cytotoxic oedema, demyelination or remyelination processes.

Fahr syndrome unknown complication: overactive bladder.

A 38-year-old male patient was admitted to our outpatient department because of frequency and urgency incontinence. During evaluation it was detected that the patient was suffering from frequency which was progressive for one year, feeling of incontinence, and urgency incontinence. There was no urologic pathology detected in patient's medical and family history. Neurologic consultation was requested due to his history of boredom, reluctance to do business, balance disorders, and recession for about 3 years. Brain computerized tomography (CT) scan revealed that amorphous calcifications were detected in the bilaterally centrum semiovale, basal ganglia, capsula interna, thalami, mesencephalon, pons and bulbus, and the bilateral cerebellar hemispheres. We have detected spontaneous neurogenic detrusor overactivity without sphincter dyssynergia after evaluating the voiding diary, cystometry, and pressure flow study. We consider the detrusor overactivity which occurred one year after the start of the neurological symptoms as the suprapontine inhibition and damage in the axonal pathways in the Fahr syndrome.

Validation of self report version of the Leeds Assessment of Neuropathic Symptoms and Signs score for identification of neuropathic pain in patients from northern Turkey.

BACKGROUND: Diagnosis and treatment of neuropathic pain is an important clinical problem. OBJECTIVES: A self report version of the Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) score provides identification of neuropathic pain without the help and need of a clinician. We targeted validation of the S-LANSS score in the northern Turkish population in this study. MATERIAL AND METHODS: For the linguistic validation of S-LANSS, translation and back-translation method was used to adapt S-LANSS into Turkish and a cognitive-debriefing test was performed. A total of 148 patients were enrolled in the present study. S-LANSS, The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Visual Annalogue Score (VAS) and Neuropathic Pain Questionnaire (NPQ) were performed twice for every patient. The patients were examined and diagnosed as having nociceptive or neuropathic pain by neurologists, who were blind for S-LANSS, LANSS and NPQ scores of the patients. RESULTS: Results of the McNemar test indicated that S-LANSS scores were reliable when the first and the second scores were compared. The sensitivity and specificity of the scale were found to be 98% and 97% respectively. CONCLUSIONS: We believe that using S-LANSS scores for the diagnosis of neuropathic pain may help our colleagues as a tool for a quicker differential diagnosis of pain in daily practice.

Clinical REM sleep behavior disorder and motor subtypes in Parkinson's disease: a questionnaire-based study.

OBJECTIVES: Studies documenting the association between rapid eye movement sleep behavior disorder (RBD) and motor subtypes in Parkinson's disease (PD) are rare. Our hypothesis is that RBD may be more severe in non-tremor dominant (NTD) patients with RBD than those tremor dominant (TD) with RBD. In this study, we investigated the association between motor subtypes and clinical RBD in PD. PATIENTS AND METHODS: We evaluated 104 consecutive patients older than 18 years presenting with PD to the Neurology Clinic of the University Hospital for one year in this study. The clinical diagnosis of RBD was based on the minimal diagnostic criteria of International Classification of Sleep Disorders, revised. The Stavanger Sleepiness Questionnaire was used to rate the severity of clinical RBD. The patients were divided into two subgroups as TD and NTD. The patient and control groups were compared with each other for severity and frequency of clinical RBD, and the Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn-Yahr stage scores. The correlation between severity of clinical RBD and clinical severity of PD was analyzed in the patient groups. RESULTS: Of the patients, 45.2% (n=47) had the NTD subtype of PD and 54.8% (n=57) had the TD subtype of PD. There was no significant difference among the groups in terms of frequency and severity of clinical RBD. For the NTD patients, there was a weak positive correlation between severity of clinical RBD and clinical severity of PD. However, there was no correlation in the TD subgroup. CONCLUSION: In our study, frequency of clinical RBD was unrelated to motor subtypes of PD. However, in the present study, we found a weak correlation between clinical severity (UPDRS and the Hoehn-Yahr) of PD and severity of clinical RBD in the NTD subtype but not in the TD subtype.

Delayed diagnosis of PRES and eclampsia in a concealed pregnancy.

Pre-eclampsia and eclampsia are well-known risk factors of posterior reversible encephalopathy syndrome. Early recognition and proper treatment result in complete reversibility of this disease. Concealed pregnancy obstacles a safe prenatal care and a safe planned delivery, because of latency in the diagnosis. We present a case of unrecognized posterior reversible encephalopathy syndrome, eclampsia and premature delivery due to concealed pregnancy.