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The aim of this study is to clinically and histopathologically evaluate the efficiency of different applications of medical ozone on corneal healing in the treatment of experimentally induced corneal alkali burns with sodium hydroxide (NaOH) in rabbits. For this purpose, 6 mm diameter filter paper impregnated with 1 N NaOH was applied to the central cornea of only the right eyes of 32 New Zealand rabbits for 1 min. The rabbits were randomly divided into four groups. The treatment continued for 21 days at three-day intervals. The first group was left as the control group (K) and was not applied medical ozone. The control group received no treatment. Subconjunctival ozonated blood was applied to the second group (M). Subconjunctival medical ozone was applied to the third group (S). Major autohemotherapy was applied to the fourth group (O). As a result of clinical and histopathological evaluations, highest degree of regeneration and healing findings in corneal tissues were in the M group. This was followed by O and S groups, respectively. The highest corneal tissue damage was observed in the cases belonging to group K. The cases closest to normal stromal thickness belonged to group M. It was noted that the K group had the highest stromal thickness and the farthest value from normal. In the light of the clinical, statistical and histopathological findings, different application techniques of medical ozone treatment in corneal alkali burn were found to significantly reduce complications compared to the control group and accelerate corneal reepithelization. [ABSTRACT FROM AUTHOR]

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening conditions with a high mortality rate. SJS and TEN denote a group of disorders closely related to each other, characterized by extensive epidermal necrolysis and usually induced by drugs. Keratinocyte apoptosis is the main reason for widespread epidermal detachment. Its etiology usually depends on drugs. Drugs or their metabolites can act as a hapten after binding to the keratinocyte surface and initiate a cytotoxic immunological attack. In this article, a 16-year-old male patient diagnosed with SJS and turned into SJS/TEN overlap with the characteristics of skin lesions during the follow-up, whose complaints improved with treatment and later developed drug-related fever, is presented. Early diagnosis and withdrawal of suspected drugs are some of the most important steps in the treatment. SJS/TEN should be excluded from other diseases similar to SJS/TEN. Although various topical and systemic treatments have recently been used, supportive care is still the most important and effective therapeutic approach. This paper aimed to review clinical findings, with advances in etiopathogenesis and treatment of SJS/TEN and drug fever in light of current literature. [ABSTRACT FROM AUTHOR]

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis that can affect all organs and tissues. The clinical forms of primary cutaneous tuberculosis are tuberculosis primary complex (tuberculosis chancre) and tuberculosis cutis miliaris (miliary cutaneous tuberculosis). Secondary cutaneous tuberculosis includes lupus vulgaris, tuberculosis cutis verrucosa, scrofuloderma, tuberculosis cutis orificialis, and metastatic tubercular abscesses. The most common form is lupus vulgaris. Cutaneous tuberculosis is a rare form of tuberculosis presenting with nonspecific lesions. It is difficult to diagnose due to its non-spesific clinical characteristics thus it can be confused with many other diseases. In this paper, we reviewed five patients with cutaneous tuberculosis who presented to our clinic within the past one year and we aimed to emphasize that cutaneous tuberculosis can manifest in different clinical forms. [ABSTRACT FROM AUTHOR]

Introductıon: Congenital diaphragmatic hernia (CDH) is a rare abnormality with high mortality and long-term comorbid conditions. Our aim, in this paper, was to describe demographics and birth characteristics, treatment, and outcomes of consecutive patients with CDH treated at our institution. Methods: The present study represents a retrospective cohort study of neonates with CDH who were treated at Uludag University Medical Faculty, Neonatal intensive care unit, Bursa. We identified the medical records of all patients with CDH who were admitted for treatment to our neonatal intensive care unit from January 2007 to December 2016. We reviewed the medical, surgical records, demographics and birth characteristics. We also recorded presence of pulmonary hypertension, whether or not the liver and, stomach also herniated into the thorax, other associated congenital malformations, and type of mechanical ventilation. Results: Forty patients were included in this study. The overall mortality was 67.5% (27/40). Survival for those who had surgical correction of CDH was 61% (13/21). Low birth weight, low gestational age, low APGAR scores and, high oxygen need at baseline was found to be associated with mortality, in patients with CDH. Among survivors, the median duration of hospitalization was 23 (14--35) days. Chronic gastrointestinal, pulmonary disorders and, failure to thrive were the most comorbid conditions after discharge. Dıscussıon And Conclusıon: KDH still has high mortality and morbidity. The birth of patients with prenatal diagnosis at appropriate centers will increase their chances of successful intervention. [ABSTRACT FROM AUTHOR]

Myasthenia gravis is an autoimmune disease affecting nearly one million individuals worldwide. Myasthenia gravis develops due to antibodies against the nicotinic acetylcholine receptoror othe r postsynaptic antigens. Hyperplasia and tumours of the thymus can cause the abnormal production of these autoantibodies. Diagnosis of myasthenia gravis could be made through recognition of the cardinal clinical features of fatigable, painless muscle weakness with confirmatory serum autoantibody analysis and electromyographic evidence of disordered neuromuscular transmission, thereby excluding other differential diagnoses. Symptomatic improvement may be achieved through the use of anticholinesterase drugs, although usually immune-directed treatments are required to control the disease. The disease does not affect fertility in women and patients can have children. In this paper management to pregnant myasthenia gravis patients will be discussed in detail. [ABSTRACT FROM AUTHOR]

Compared to adult studies, there are a limited number of pediatric studies exploring the effects of hypercalciuria on bone mineral density. The aim of this paper was to report a case of low-energy multilevel vertebral fracture in a pediatric patient during follow-up for idiopathic hypercalciuria (IH); it was also attempted to remind clinicians that IH-induced fractures may also occur in children. A 10-year-old male child presented to our outpatient clinic with back pain after jumping off from a height of approximately 50 cm. History of the patient showed that the patient had been followed-up for idiopathic hypercalciuria for 8 years and his father had renal stones and hypercalciuria. There was no abnormality on physical examination, with an exception for tenderness and limitation of movement in lower thoracic and lumbar vertebrae. Complete blood count and biochemical parameters were normal except for an elevated alkaline phosphatase level. Dorsal and lumbar lateral plain graphs showed compression fractures of T4, T6, T8, and L3 vertebrae, therefore, lumbar and dorsal vertebral magnetic resonance imaging (MRI), bone mineral densitometry (BMD), and vitamin D level measurement were ordered. MRI revealed acute compression fracture and medullary edema in L3; there were also chronic osteoporotic fractures in T4, T6, and T8. BMD showed a lumbar total Z score of -2.9 and the Vitamin D level was 13.7 ng/mL (10-24 ng/mL indicates moderate deficiency). A control renal ultrasonography revealed no kidney stones or calcification. The patient was prescribed polyethylene mold thoracolumbar corset and vitamin D support at a dose not to enhance hypercalciuria and nephrocalcinosis. His pain was alleviated at follow-up. Considering that most of the total bone mass is acquired at childhood, identification of causative factors and taking necessary measures at an early stage may prevent future complications of IH. [ABSTRACT FROM AUTHOR]

In the neonatal period, upper gastrointestinal system (GIS) bleeding may be due to benign disorders which do not require any treatments or may be relevant to serious conditions requiring urgent intervention. There are two major causes of upper GIS bleeding developed in the newborns; vitamin K deficiency-induced hemorrhagic disease of the newborn and maternal blood swallowed during birth. Other causes of this type of bleeding include gastritis, esophagitis, peptic ulcus (PU), coagulopathy, sepsis, vascular malformations, trauma, and esofageal-gastric duplications. Rarely, gastric erosion or perforation due to oro/naso gastric tube might cause severe upper GIS bleeding. Hemodynamic resuscitation, bleeding control, and prevention of the recurrence form the basis of the management. However, a somatostatin analogue (ocreotide) may be helpful by reducing the splanchnic blood flow, if bleeding is caused by a known vascular lesion or arterial erosion. In this paper, a case of newborn with upper GIS bleeding developed within the first 24 hour life and probably caused by arterial erosion due to oro/gastric tube and treated by ocreotide was presented in the light of literature. [ABSTRACT FROM AUTHOR]

Salbutamol, a drug with short-acting inhaled beta 2 mimetic effect, is very frequently used in cases of bronchospasm and respiratory distress; however, its intake for suicide purposes is rare in Turkey. Salbutamol-induced complications are well established and may be seen at therapeutic doses. When drug-related intoxication develops, hyperactivity, tremor, convulsion, hyperglycemia, hypokalemia, hypomagnesemia, lactic acidosis, hypotension, hypertension, congestive heart failure, myocardial ischemia, atrial and ventricular ectopic heart beats, atrial arrhythmias, QT prolongation and arrhythmias such as ventricular tachycardia and sudden cardiac death may occur. This paper presents a 15-year-old patient who used 200 mg salbutamol in tablet form for suicide purposes and discusses the approach to salbutamol intoxication with a review of the literature information. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to report a patient who diagnosed with acute zonal occult outer retinopathy (AZOOR). A 31-year-old female referred with a chief complaint of headache and photopsia of her right eye for 2 years. At her detailed ophthalmologic examination, her best-corrected visual acuities were 20/20 and intraocular pressures were 16 mm-Hg bilaterally. Biomicroscobic examination showed no pathological view in anterior segment, ocular media and retina. Bilateral optical coherence tomography (OCT) showed no abnormalities. Humphrey visual field examination (full threshold 30-2) revealed periferic arcuat visual field defect at inferior temporal quadrant of the right eye. No visual field defect was seen in her left eye. ERG and multifocal ERG were abnormal. [ABSTRACT FROM AUTHOR]

Try to identify and eliminate the causative allergen plays an important role in the management of allergic diseases and asthma. It is particularly essential in anaphylaxis which may lead to life-threatening consequences. When evaluating a patient with history of asthma or anaphylaxis, spreading of allergens, routes of allergen exposure and allergen induced clinical symptoms should be review in detail with respect to current literature. In this paper, we report a case with periodic asthma attacks and recurrent anaphylaxis. [ABSTRACT FROM AUTHOR]

Since botulinum toxin might have a therapeutic effect on pain, many studies investigating the efficiency of botulinum toxin in headache treatment have been done. The most satisfying results were achieved by botulinum toxin type A (BoNT/A) in the treatment of chronic migraine. In this paper, we reviewed the clinical effectiveness of BoNT/A in migraine and included our clinical experience. In our ongoing pilot study, where we have repeated BoNT/A injections every 12 weeks, The difference in the Migraine Disability Assessment (MIDAS) scores between the first and the second injections was 61.1%; and between the first and the 3rd injections was found to be 65.72%. [ABSTRACT FROM AUTHOR]

Carnitine is an important essential cofactor in transfer of long chain fatty acids across the inner mitochondrial membrane. In humans, 75% of carnitine is obtained from the diet, and the remainder is endogenously synthesized by kidney, liver and brain. Plasma concentration of free carnitine is in dynamic balance with acylcarnitines with the acyl to free carnitine ration of ≤0.4 being considered normal. Acetyl-L-carnitine is the principal acylcarnitine ester. Acetyl-L-carnitine participates in both anabolic and catabolic pathways in cellular metabolism. It is reported that especially treating minimal hepatic encephalopathy with carnitine exhibited recovery of symptoms and signs of the disease. In this paper, carnitine metabolism and its relations with liver diseases are reviewed. [ABSTRACT FROM AUTHOR]

Intranasal corticosteroids and oral antihistamines, and leukotriene receptor antagonists in selected cases are the most preferred drugs for pharmacothe- rapy of allergic rhinitis. Alternative pharmacothera- peutic approaches are needed in cases which those drugs can not be used for various reasons; in cases which resulted in side-effects, not effective, or not preferred. In this paper, other pharmacotherapy options and alternative treatment methods in the treatment of allergic rhinitis are described based on "Allergic Rhinitis and its Impact on Asthma (ARIA)" guidelines and current literature. [ABSTRACT FROM AUTHOR]

Tumor lysis syndrome is a clinical situation which occurs with the lysis of malignant cells and causes metabolic abnormalities that threatens life. These metabolic abnormalities are caused by the release of intracellular ions, nucleic acids, proteins and their metabolites from the instant degraded tumor cells. These fast released metabolites can blemish the body's normal homeostatic mechanism and cause uraemia, hyperuricaemia, hyperkalaemia and hyperphosphaetemia. Hypocalcaemia, which is commonly seen in tumor lysis syndrome is seconder to hyperphosphaetemia. Generally, tumor lysis syndrome occurs after the initiation of chemotherapy but rarely it is observed in fast growing tumours before the treatment duty to spontaneous lysis of malignant cells. There is a high incidence of tumor lysis syndrome in tumours with high proliferative rates and tumour burden like Burkitt's lymphoma and acute lymphoblastic leukemia. The principle of tumour lysis syndrome, prophylaxis/treatment includes virgous hydration, adequate diuresis, control of hyperuricemia with rasburicase or allopurinol, regulation of serum electrolytes and dialysis should be the treatment options. If the necessary measures are not taken or the clinal situation is not treated properly, metabolic abnormalities can cause renal insufficiency, cardiac arythmia, neurologic complications and probably sudden death in patients with cancer. Alkalisation of urine was applied to all patients previously, but it is not any longer recommended, and this issue is still open to debate. In this paper, new approaches and innovations in the treatment of tumor lysis syndrome are discussed. [ABSTRACT FROM AUTHOR]

Eruptive vellus hair cyst (EVHC) is a rare skin disease and is characterized by asymptomatic comedone-like papules on the anterior chest and limbs. EVHC is more common among children and young adults. Its etiology is not fully known, and it may occur sporadically or be inherited as an autosomal dominant gene. In this paper, we present a 28-year-old female patient with EVHC who presented with a large number of dense, grayish-yellow colored papules on frontal and cheek regions of the face. Due to the location of the lesions on the face and their dissimilar appearances, differential diagnosis and treatment alternatives are evaluated in the light of the literature. [ABSTRACT FROM AUTHOR]

Serotonin syndrome is a drug side effect resulting from serotonergic hyperactivity. At times the severity of its symptoms can be mild and overlooked, but sometimes it might cause life-threatening serious consequences. It usually occurs while using high doses or combinations of serotonergic drugs. However, it might also be observed during the use of low dose of serotonergic agents, even it is rare. In this paper, it is aimed to present a case with serotonin syndrome which is thought to be developed after the use of 5 mg of escitalopram, and to discuss this case in terms of differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: Descemet's Stripping Automated Endothelial Keratplasty (DSAEK) results in corneal endothelial dysfunction was reported in this paper. Methods: Twenty-five eyes of 25 patients having endothelial dysfunction were included in this study. Preoperatively and postoperatively complete ophthalmic examinations were performed including uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness (CCT), endothelial cell density (ECD) and complications were recorded. Results: 19 eyes (76%) had bullous keratopathy, 4 eyes (16%) had Fuch's endothelial dystrophy and 2 eyes (8%) had corneal graft fail-ure. The mean follow up period was 20.8±7.8 months (6-36 months). The mean UCVA was improved from 0.11 ±0.11 (range, hand motion-0.3) to 0.52±0.23 (range, 0.1-0.9) (p<0.05). At the last visit the mean BCVA was improved from 0.12±0.12 (range, hand motion-0.3) to 0.65±0.26 (range, 0.1-1.0) (p<0.05). In 20 (75%) eyes, the mean BCVA was 0.3 or better at the last control visit. The mean ECD of donor corneas were 2378.24±250.34 cell/mm² preoperatively. At the first month the mean ECD was 1783.34±256.93 cell/mm² (range, 75-2017.43). At the last control visit the mean ECD was 1671.98±235.54 cell/mm² (1497.45-1954.34). The mean IOP was 15.12±2.24 mmHg (range, 11-21 mmHg) preoperatively. At the last control visit the mean IOP was 14.83±1.34 mmHg (range, 13-17 mmHg). CCT was 640.36±14.82 μ (range, 624-678 μ) at the first control and it was 639.54±15.76 μ (range, 621-679 μ) at the last control visit. Conclusion: DSAEK surgery was found to be safe and effective in corneal endothelium diseases. This method is expected to be used more frequently in the future with advances in technique. [ABSTRACT FROM AUTHOR]

Microorganisms have an important role in the development and continuation of pulpal and periapical inflammation. The success of root canal treatment depends on the exclusive elimination of microbial contamination from the root canal system. Although mechanical instrumentation of root canals provide a decrease in bacterial population, a complete success in bacterial elimination cannot be achieved without the use of antimicrobial irrigants and drugs. In this paper antimicrobial effects of the root canal irrigants which are in use or under investigation are reviewed based on the current literature. [ABSTRACT FROM AUTHOR]

Depressive disorders are among the most common psychiatric disorders currently affecting individuals. Yet, available data indicate that fewer than one third of adults with depression obtain appropriate professional treatment. Depression and anxiety disorders frequently co-occur. This type of co-morbidity is associated with higher severity, suicidality, chronicity and treatment resistance. However, available treatment guidelines mainly focus on treatment for singular disorders. The current paper describes diagnostic and treatment issues relevant for adequately addressing patients with depression and an anxiety disorder, using information from both guidelines and a search of recent literature. [ABSTRACT FROM AUTHOR]

Conventional immunosuppressive agents have been traditionally used for the treatment of noninfectious uveitis. Recent developments in genetic engineering have made it possible to synthesize proteins that target specific molecules playing role in the inflammatory response. These agents are generally in protein structure and are named biologic agents. While there is limited experience with biologies in the field of ophthalmology, they are commonly used in other disciplines such as rheumatology and dermatology. Although considerable data have accumulated in the uveitis literature regarding the use of biologic agents, including mainly interferon, infliximab, and adalimumab, their use for this indication is still off-label. Moreover, there are certain precautions that have to be taken into account, as well as important safety issues associated with their use. The purpose of this paper is to present an updated comprehensive review of biologic agents that may be used for the treatment of refractory uveitis. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension (PAH) is a clinical syndrome that is often diagnosed late and is associated with a progressive clinical deterioration and death. However, over the past ten years there has been a dramatic increase in the number of effective therapies. Identification of dysfunctional pathways in the pulmonary circulation provided novel therapeutic targets with the goal of reducing pulmonary vascular resistance and death from right ventricular failure. Treatment strategies are determined according to current guidelines. Pulmonary artery vasoreactivity, functional class and response to treatment are important concepts for initiation of medical therapy. With the availability of medications that target different pathologic processes, combination therapy has become a frequently used therapeutic option in PAH. In this paper, we aimed to review the therapeutic algorithms in pulmonary hypertension based on current guidelines. [ABSTRACT FROM AUTHOR]

Neuroleptic malignant syndrome (NMS) is a potentially fatal syndrome which is rarely seen during treatment with antipsychotic medications. In this paper, the treatment of NMS that developed after a dose increase in oral antipsychotic drug therapy with depot antipsychotics in a patient with schizoaffective disorder, who has used antipsychotic medications for a long time and was hospitalized many times was reported and the treatment approach and bromocriptine use in NMS was discussed. [ABSTRACT FROM AUTHOR]

AIM: Keeping health records regularly is important for determining the health status of the population and planning health services. It is observed that the existing health record systems in Istanbul are insufficient in determining the number of pregnant women, puerperants, newborns and preschool children. METHODS: Therefore, an intervention study was planned by Istanbul Directorate of Health in order to provide systematic monitoring of pregnant women, puerperants, newborns and preschool children, and ensure that equity in the distribution of qualified prenatal and postnatal health care is maintained. This project called GEBLIZ has been started to be used since September 2008. RESULTS: According to this project all public and private health centers in which pregnant and child care are given have the responsibility to transfer necessary information about the patients to an electronic database. Through this computerized system, a connection between primary, secondary and tertiary health care settings has been maintained, and deficiencies of paper records have been completed. Health records have become more consistent. CONLUSION: Compared to one year before the start of the intervention, there have been important increases in the number of pregnant women, puerperants, newborns and infants detected by primary health care units. Besides, "home visits" which have been neglected were started actively by primary health care personnel, and preventive health service who stayed in the shadow of therapeutic health services came to life again. [ABSTRACT FROM AUTHOR]

Although the importance of long-term prophylactic treatment is certain in bipolar disorder, there is stil debate on how to which patients and evaluate the treatment response. Efficacious long-term treatment can reduce morbidity and mortality significantly and improve quality of life of bipolar patients. The concept of ideal response should also be defined very clearly in order to discuss the difficulties of measuring the effectiveness of the prophylactic treatment. The aims of this paper are to determine whether our currently methods and criteria are valid, reliable and sensitive evaluating the efficacy of the treatment response and to briefly inform the clinicians about the drugs used in pharmacologic prophylaxis in accordance with relevant data. [ABSTRACT FROM AUTHOR]

This paper aims to determine "The Thermal Spring Tourism in Turkey and Problems". Turkey is rich in thermal springs thanks to the large active lands with volcanic and tectonic formations. Turkey hosts over 900 thermal and mineral spring waters in different locations, with varying qualities and quantities, and with temperatures between 20-102 °C. Springs have some physical and chemical specialities that cause to recover varies illness. Most of them have been known and used by people since the early ages. Recently, thermal springs have been recognized more and more and it has taken its right place among the other tourism varies and they have turned into touristic attractions in some regions of the Turkey. Then in this study tries to evaluate the statue the thermal springs, according to region in Turkey. Moreover, the reasons hindering the spring tourism from achieving the goals set are emphasised. [ABSTRACT FROM AUTHOR]

In the treatment of resistant schizophrenic patients, the preferred monotherapy of clozapine, does not result in sufficient treatment response in 40-70% of the cases. The high rate of treatment unresponsiveness has led clinicians to augment clozapine with other pharmacological agents. To date, many clinical and case studies have been conducted. In related studies, clozapine has been combined with various drugs, such as typical and atypical antipsychotics, several antidepressants, mood stabilizers, bromocriptine and glycine. However, up-to-date research study results are not sufficient to support the augmentation of clozapine therapy approaches. The augmentation of clozapine with pimozide has been a rarely preferred approach. In this paper, a case of a patient is presented, who was followed with the diagnosis of treatment-resistant disorganized schizophrenia and whose clozapine treatment was augmented with pimozide. The presented history reveals that only the combination of clozapine with pimozide was beneficial for this particular patient, whose symptoms relapsed after the cessation of the drugs, and who apparently benefited from treatment when this combination was initiated again. [ABSTRACT FROM AUTHOR]

Behcet disease is a chronic disease of unknown etiology. It is a systemic vasculitis which can affect many systems and the disease course may be severe in young males. The main aim of treatment is to reduce inflammation and control symptoms of the disease. The main principle of treatment is to prevent attacks of inflammation, reduce symptoms and prevent relapses. Anti inflammatory and immunomodulatory drugs are used for these aims. In this paper, double blinded placebo controlled studies, open studies and case reports have been reviewed to form an update of current treatments. Interferon alpha and TNF antagonists are preferred especially for severe eye involvement. TNF alpha inhibitors have been shown to be effective for neurologic involvement, one of the most severe complications of the disease. Besides these, the guidelines of the Behcet Disease Expert Commission of the European Rheumatism Association (EULAR) have been reviewed. A multidisciplinary approach is necessary to assess the patients' clinical and laboratory status and prevent side effects of treatment. [ABSTRACT FROM AUTHOR]

Selective serotonin reuptake inhibitors are generally firstchoice drugs, particularly in the treatment of depression, anxiety disorder, eating disorder and various psychiatric disturbances, such as impulse control disorder. Acathisia, dystonia, parkinsonism and tardive dyskinesia have been reported as the extrapyramidal system findings associated with use of selective serotonin reuptake inhibitors. Acute dystonia is a psychiatric emergency. It develops due to use of antipsychotics. However, it has also been reported to occur due to use of antiemetics and antidepressants. In this paper, we present a case with dystonia which developed during fluvoxamine treatment in the second month during administration of increased dose on the patient with obsessive compulsive disorder. There is case reports related to the use of fluoksetin in the literature. This case was considered to be noteworthy to publish, in that it occurred during use of fluvoxamine and it has not been reported in the Turkish literature so far. Clinicians should always keep in their mind that there may be extrapyramidal side effects of selective serotonin reuptake inhibitors and should be careful when increasing doses. [ABSTRACT FROM AUTHOR]

Vigabatrin, a GABA (gama amino butyric acid) transaminase enzyme inhibitor, used as an antiepileptic agent, may result in visual field loss that may lead to tunnel vision at the end. It may also cause optic neuropathy and damage to the retina nerve fiber layer (RNFL). In this paper we report two cases with optic neuropathy secondary to Vigabatrin use and associated visual field defects and also Optic Coherence Tomography detected RNFL loss. [ABSTRACT FROM AUTHOR]

Adaptation is a continuous process between the genes of a particular species and its environment. Although a couple of weeks are long enough to adapt to some environmental changes. sometimes several generations are needed to adapt. Rapid and sustained environmental changes, however, exceed the adaptation capacity of species and cause gene-environment discordance. Genomes of individuals, who live at the beginning of such discordance, are adapted to the previous environment and therefore physiological mechanisms of the organism are influenced by this novel circumstance. The disrupted interaction between individual and environment appears as diseases, increased morbidity, and mortality in the phenotype. Diseases of civilizations which are the reflections of gene-environment discordance tend to accumulate into several main groups such as metabolic (e.g., cardiovascular, diabetes, hypertension, obesity and metabolic syndrome), reproductive (male and female infertility), neurodegenerative (e.g., Alzheimer, dementia) and some psychiatric disorders (e.g., major depression, bipolar disorders). In spite of the fact that the pathophysiology of many neuropsychiatric disorders are not well known, since symptoms including sleep and appetite problems, fatigue, loss of libido and concentration as well as metabolic disorders may coexist, it is considered that neuropsychiatric disorders may have a complex neurobiological basis. Some scientists have referred to this situation as a "neuropsychiatric syndrome" or "type II metabolic syndrome". Data obtained from metabolic syndrome studies may be adapted to type II metabolic syndrome to clarify the biological basis of the disease. As seen in metabolic syndrome, the neuropsychiatric syndrome may also develop in a broken physiological infrastructure. Some of the disrupted physiological mechanisms shown in metabolic syndrome may be summarized as the mismanaged autonomic nervous system (ANS), reduced central and peripheral GABA production, and epigenetic perturbations which have recently become very popular. ANS dysregulation is closely related to recent treatment modalities such as vagal nerve stimulation (VNS) and light therapy (LT). Both modalities are based on the re-regulation of an already dysregulated autonomic rhythm. Secretion of melatonin from the pineal gland is one of the effective mechanisms in the regulation of ANS. Since melatonin is only used for the treatment of jet-lag and sleep problems, the range of treatment indications with melatonin has remained limited for years. Nevertheless, central effects of melatonin play an important role in the treatment of depression and similar disorders. Therefore, melatonin has been recently used to treat neuropsychiatric syndrome. Moreover, a severe familial tendency in neuropsychiatric disorders has long been recognised. Even so, no genetic defects (e.g., mutation, deletion and insertion) have been found to explain the familial tendency. Therefore, it was hypothesized that epigenetic inheritance rather than genetic mechanisms may have a role in the pathogenesis of disease and it was proved that epigenetic disruptions play crucial roles in the pathogenesis of neuropsychiatric syndrome. Melatonin, as an impressive epigenetic regulator may have potential in the treatment of some neuropsychiatric disorders. Articles used for current review were published between 1977 and 2008 and obtained from Pubmed database by using keywords including melatonin, agomelatine, autonomic nervous system, and depression. The purpose of this paper is to find out whether there it a gene-environment discordance in the pathogenesis of neuropsychiatric disorders and to discuss the role of ANS and melatonin in these circumstances. [ABSTRACT FROM AUTHOR]

Purpose: Exposure to solar radiation is a major cause of nonmelanoma skin cancer. Topical application of chemical peeling agents to reverse actinic damage of skin is a well-established, accepted clinical practice. Subclinic malignant lesions are generally seen with skin cancers simultaneously. In this paper, we evaluatedeffectiveness of the tricholoroacetic acid peeling to treatment of subclinic lesions. Material and Methods: Between 1999 and 2004, 102 patients with skin cancer were treated surgically. In addition to the surgical treatment of malignant lesions, full-face chemical peeling with 35-40% trichloroacetic acid was applied during the same operative session to 48 patients whose faces had extensively sun-damaged skin. The ages of patients were varied between 51 and 93. They were followed- up 1-5 years. The effectiveness of the TCA treatment was evaluated with pathologic examinations. Result: Second primary skin cancer was observed in only 3 patients who were applied TCA peeling. TCA peeling causes histologic changes such as correction of epidermal atrophy and atypia as well as deposition of new subepidermal collagen. Conclusion: Trichloroaceticacid peeling provides a prophylactic effect against the development of skin malignancies. [ABSTRACT FROM AUTHOR]

From the earliest description of schizophrenia, amotivational syndrome associated with severe functional impairment is recognised. These symptoms are found to be independent from other symptoms in longitudinal and cross-sectional assesments. The negative symptoms are named as primary or idiopathic if they are present at beginning of the disease or if it is specific to the disease. If they are due to positive symptoms, drug adverse effects or depression they are named as secondary negative symptoms. Treatment approach depends on whether negative symptoms are primary or secondary. Deficit syndrome is described by primary negative symptoms presenting at the beginning of disease, emerging spontaneously and staying stable during the disease course. Recent reports showed that deficit syndrome differ on disease course based on neurocognitive measures, functioning, and structural imaging. The role of negative symptoms in clinical diversity of schizophrenia was aimed to be evaluated in this paper by elobarating negative symptoms in various dimensions such as clinical features, biological measures, quality of life, and response to treatment. [ABSTRACT FROM AUTHOR]

Background and Design: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe drug reactions characterized by an extensive skin rash with blisters and exfoliation, accompanied by mucositis. The aim of this paper was to evaluate demographic and clinical features, prognosis and treatment in our patient group. Material and Method: A total of 20 consecutive patients with SJS and TEN diagnosed between 2000 and 2008 in our hospital were retrospectively analyzed. Results: Among the 20 cases, 3 had SJS (15%), 5 had SJS-TEN overlap (25%) and 12 had TEN (60%). Oral mucosae was the most commonly affected site (%95) which was followed by conjunctivae ( 85%) while all mucosal surfaces were affected in 2 patients. Causative drugs, anticonvulsive drugs (5 cases), sulfasalazine and non-steroidal anti-inflammatory drugs (6 cases), allopruninol (2 cases), anti-cancer therapy drugs (3 cases), amifostine (1 case) and ampicillin (1 case), were identified in 18 patients. Five of 20 patients died of severe sepsis and irreversible multiple organ failure. The age above 60 years, percentage of epidermal detachment above 70% of body surface area and associated malignancy were found to be statistically correlated with poor prognosis (p=0.035, p=0.005, p=0.015; respectively). Fourteen patients were treated with short courses of medium-dose corticosteroids. An objective response to corticosteroids therapy was observed in all patients and the survival rate was 100%. The mean delay between occurrence of eruption and the withdrawal of suspected drug was 2.2 days and the first dose of corticosteroids was 3.4 days. Conclusion: In our patients, the suspected causative agents were the most frequently implicated high-risk drugs for the disease. Old age, extensive skin lesions and associated malignancy were found to be correlated with poor prognosis. Our treatment results indicate that beside rapid withdrawal of suspected drug short courses of medium-dose corticosteroids may be an effective approach in the management of SJS and TEN patients. [ABSTRACT FROM AUTHOR]

Although surfactant has been one of the basic treatment approaches in respiratory distress syndrome in the last 20 years, an absolute consensus has not been established regarding its way of use and dosing regimens. In this paper, a case with severe respiratory distress syndrome recovering after 5 doses of surfactant administration is presented, and multiple dose surfactant administration which is rarely required in this disease is also discussed. [ABSTRACT FROM AUTHOR]

Second generation antipsychotics are widely used in bipolar disorders both for the treatment of acute mood episodes and for maintenance treatment. Aripiprazole has been proposed as a "third generation antipsychotic". Its unique pharmacological properties are different from other second generation antipsychotic agents. Its efficacy in the treatment of schizophrenia has been established. Efficacy of aripiprazole in manic or mixed episodes and maintenance treatment of bipolar disorder have been studied in several doubleblind, randomized, controlled clinical trials in recent years. Few openlabel studies of aripiprazole in the treatment of bipolar depression have been published. In the present paper clinical trials assessing the efficacy of aripiprazole in the treatment of acute mood episodes and maintenance treatment of bipolar disorder are examined and advantages and disadvantages of aripiprazole are reviewed. Clinical trials of aripiprazole for acute mania or mixed episodes reveal that it is effective in remitting manic symptoms and does not trigger a depressive episode. One double-blind, randomized, placebo controlled clinical trial of 100-week aripiprazole monotherapy which is the longest clinical trial among the trials conducted in bipolar disorder with second generation antipsychotics showed that aripiprazole was effective for relapse prevention in bipolar patients. Aripiprazole for bipolar depression needs double-blind, randomized, controlled clinical trials. It is well known that some second generation antipsychotics are associated with metabolic disturbances. Aripiprazole's effect on metabolic parameters is more favorable compared with other second generation antipsychotics. Akathisia and tremor are the most common extrapyramidal side effects of aripiprazole. Patients with bipolar disorder are more vulnerable to aripiprazole induced akathisia than patients with schizophrenia. In conclusion, aripiprazole is effective for acute mania or mixed episode and maintenance treatment in bipolar disorder. Its different side effect profile from other second generation antipsychotics provides an advantageous position in the treatment of bipolar disorder. [ABSTRACT FROM AUTHOR]

Therapeutic apheresis is a procedure of separation of plasma or other cellular components from whole blood as a treatment modality. Therapeutic plasma exchange (TPE) is a replacement of large volumes of patient plasma by replacement fluids. TPE is a therapeutic apheresis that is used as first line or supportive treatment mainly in hematology, neurology, oncology, rheumatology, immunology, nephrology, endocrinology, toxicology and dermatology. Monoclonal auto-alloantibodies, immune complexes, cryoglobulins, lipoproteins, macromoleculles, protein bound toxins that may cause metabolic or physical problems are removed from the plasma with TPE. In 2007, American Society For Apheresis (ASFA) made some changes in the indications and categories of therapeutic apheresis and TPE with the lights of new evidences. In this paper we will discuss the indications of TPE in hematological diseases, according to new ASFA 2007 guideline. [ABSTRACT FROM AUTHOR]

Cyclothymic disorder is one of the most difficult disorder to be recognized and be detailed in the psychiatric area. Cyclothymia begins usually insidiously early ages and according to DSM-IV-TR it is a form of bipolar disorders that is characterized by frequent and short cycles of subsendromal depression and hypomania. However for diagnosis of cyclothymia, it is considered that changes in affectivity, activity and cognition is more illustrative than DSM-IV-TR criteria. Additionally because of the conceptual confusion in the definition of hypomania, some difficulties are seen in diagnosing. Different models have been suggested in the studies for the etiology of cyclothymic disorder. Recently, genetic and family studies are particulary considerable. Results of etiology*oriented studies to suggest that there are some biological associations between cydothymie disorder and bipolar disorders. Particulary, it has been suggested that cyclothymic mood would be a genetic-familial predisposition for bipolar II disorder. Cyclothymia has been researched insufficiently because of the reasons like as; early onset, the difficulties in diagnosis, variety of the clinical appearance, difficulties in the determination of its symptoms, being accepted as a border disorder and rarely seeking for the treatment. However recently, there has been an increasing number of etiology, diagnose validity and reliability-oriented studies. In Turkish literature there are few studies in which cyclothymia is discussed generally. In this paper, our aim is to evaluate and enlighten the history, epidemiology, etiology, differential diagnosis and treatment of cyclothymia in a holistic way. [ABSTRACT FROM AUTHOR]

The consequences of immobility and bed rest in the elderly are multiple, severe, quick to develop and difficult to reverse. In the elderly with limited functional reserve, immobility may quickly lead to impairments in activities of daily life and disability. Misconceptions on indications and health consequences of bed rest are not uncommon both among health care professionals and in the society. Unfortunately our knowledge on health effects of bed rest as a treatment modality are based on a limited number of studies and there is a paucity of emphasis on the topic in the classical health care curriculum. However, health care workers need to be well-aware of diverse consequences of bed-rest and immobility so that they can actively participate in prevention and education of others. In this paper following a case presentation, we review consequences of bed rest and immobility and emphasize some important aspects in diagnosing the underlying problems, prevention and treatment of immobility. [ABSTRACT FROM AUTHOR]

Obsessive-compulsive disorder (OCD) is on illness that usually manifests itself in the second or third decade of the life. Onset of OCD after age 70 has been rarely reported in the literature. Late-onset OCD is generally associated with an underlying cerebrovascular disease. The current consensus regarding choice of treatment(s) for idiopathic OCD includes cognitive behavioral therapy and serotonin reuptake inhibitors. However, the effectiveness of cognitive behavioral therapy or medications in cases with obsessive-compulsive symptoms due to general medical conditions has remained unclear. In this paper, an elderly patient who had late-onset obsessions and compulsions following chronic cerebral ischemia is presented with special emphasize made on specific issues about rate-onset OCD cases and the application of standard therapeutic methods to these patients. [ABSTRACT FROM AUTHOR]

Achilles tendinopathy is a painful condition that often develops as a result of overloading to tendon. There are many factors in etiology like tendon ischemia, micro-tears and metabolic events. Non-insertional tendon region of the Achilles tendon that has poor vascularity is a common localization for tendinopathy. In this paper, we presented a 55 year old man, who had pain and swelling in the right heel and we discussed the importance of ultrasound. [ABSTRACT FROM AUTHOR]

The calcaneus is a rare location for Ewing's sarcoma. This paper aims to present a case of Ewing's sarcoma of the calcaneus which was treated with previously unreported technique of liquidnitrogen cryopreservation and reimplantation of the calcaneal apophysis. [ABSTRACT FROM AUTHOR]

In this paper, splenic abscess due to Brucella sp., a rare complication, in a 49-year-old male with pemphigus treated by azathioprine for five years, is presented. The rose Bengal and Brucella tube agglutination tests were positive and Brucella sp. grew in blood culture. Abdominal tomography revealed hepatosplenomegaly and a few microabscesses in the spleen. A combination of doxycycline, rifampin and co-trimoxazole was started. Azathioprine treatment was stopped. As in our patient, use of immunosupressive drugs or any immunosupressive disease or condition may facilitate the emergence of complications due to brucellosis. Therefore, patients with brucellosis need to be closely followed for possible complications, especially in the era of increasing immunosuppressive usage. Therapeutic modifications such as discontinuation or dose adjustment of immunosuppressive drugs need to be considered,where appropriate. [ABSTRACT FROM AUTHOR]

In spite of the increasing number of case reports of selective serotonin reuptake inhibitor (SSRI) induced Parkinsonism symptoms; the underlying mechanism is not clearly established. Evidence of Parkinson's disease (PD) symptoms prior to the treatment or a positive family history must be considered as predicting factors in the appearence as well as the prognosis of parkinsonism symptoms. In the first case presented, PD developed during paroxetine treatment in a patient, who had slowness of motion along with social withdrawal since her childhood. In our second case, parkinsonism symptoms developed with essitalopram within three months. While there are no reports of first presentation of PD with paroxetine, there is only one case to date that reported parkinsonism symptoms with essitalopram. In this paper, we aimed to present two cases and discuss the possible underlying mechanisms of the development of parkinsonism symptoms and PD associated with SSRIs. [ABSTRACT FROM AUTHOR]

Regional anaesthesia has advantages such as, control of postoperative pain, early mobilization, and does not affect respiratory function. In recent years, regional anaesthesia had improved by the application of the peripheral nerve stimulator and ultrasound guided blocks, new local anaesthetic drugs with the use of additional adjunctive agents. Especially in emergency conditions, combination of regional anaesthesia may avoid the complications of general anesthesia in patients with chronic disease who suffer from upper and lower extremity injuries. In this paper, we present two cases who underwent combined regional anaesthesia techniques for the lower and upper extremity surgery. [ABSTRACT FROM AUTHOR]