Hatice Altun

Decreased levels of G protein-coupled estrogen receptor in children with autism spectrum disorders

Sex hormones, specially estrogen, and ıt is receptors plays a critical role in the pathogenesis of psychiatric disorders including autism spectrum disorders (ASD). The aim of this study was to investigate the relationship between ASD and G protein-coupled estrogen receptor (GPER), a recently discovered estrogen receptors, and also to study the relation of serum GPER levels with the severity of autistic symptoms. The present study included 45 children with drug naive ASD diagnosed by DSM-V criteria, aged between 3 and 12 years and 40 age- and gender-matched healthy controls. The severity of ASD was evaluated with the Childhood Autism Rating Scale (CARS) total score. The GPER levels in the serum were measured using the quantitative sandwich enzyme immunoassay technique. The serum GPER level was significantly lower in the ASD patients than in the controls. There was a negative significant correlation between the GPER level and the CARS score. There were no significant correlations between GPER level with estradiol and age. In conclusion, this study demonstrated that the decreased serum GPER levels were associated with ASD and GPER may play an important role in the etiology of ASD.

Assessment of malondialdehyde levels, superoxide dismutase, and catalase activity in children with autism spectrum disorders

ABSTRACT OBJECTIVE: Blood biomarkers for diseases have recently become a topic of great interest. Many studies of Autism Spectrum Disorder (ASD) have been made to date looking for biomarkers in peripheral tissues, but no specific biomarker has yet been found. The aim of this study was to examine oxidative stress parameters including malondialdehyde (MDA) levels, superoxide dismutase (SOD), and catalase (CAT) activity and to determine both their sensitivity and specificity as biomarkers associated with oxidative stress in ASD. METHODS: This study measured the plasma MDA levels, SOD, and CAT activities in erythrocyte in 52 patients with ASD (aged 3–6 years) and in 48 age- and gender-matched healthy controls. ASD severity was rated using the Childhood Autism Rating Scale (CARS). RESULTS: MDA levels, SOD, and CAT activity were significantly higher in patients with ASD in comparison to the controls (p < .001). The receiver operator characteristic curve analysis showed a high diagnostic value for MDA, SOD, and CAT. Their areas under curve (AUC) were 0.937, 1.0, and 1.0, respectively (p < .001). A positive statistically significant correlation was determined between the total CARS score and MDA levels in ASD patients (r = 0.368, p = 0.007). CONCLUSION: This study shows that oxidative stress is higher in children with ASD. Increased vulnerability to oxidative stress may contribute to the development of ASD. Given the high sensitivity and specificity results, it is thought that these selected oxidative stress parameters could be important as biomarkers for ASD. Future studies should focus on the sensitivity and specificity of oxidative stress biomarkers in larger ASD populations.

Vitamin D and vitamin D receptor levels in children with attention-deficit/hyperactivity disorder

Objective In this study, we aimed to evaluate vitamin D and vitamin D receptor levels in children with attention-deficit/hyperactivity disorder (ADHD). Patients and methods In this cross-sectional study, a total of 80 children including 40 ADHD patients (aged 6–12 years; 28 males and 12 females) and 40 age-, sex-, and season of blood collection-matched controls (aged 6–12 years; 25 males and 15 females) were enrolled. Serum vitamin D and vitamin D receptor levels and calcium, phosphorus, and alkaline phosphatase were measured. The vitamin D receptor levels in the serum were measured using the quantitative sandwich enzyme immunoassay technique. Results Serum vitamin D and vitamin D receptor levels were found to be significantly lower in children with ADHD compared to healthy controls. No significant differences were found in serum calcium, phosphorus, and alkaline phosphatase levels. No significant differences were found among the ADHD subtypes in terms of serum vitamin D, vitamin D receptor, calcium, phosphorus and alkaline phosphatase levels. Conclusion This study suggests that children with ADHD have lower levels of vitamin D and vitamin D receptor. According to the authors’ knowledge, this is the first study to describe vitamin D receptor levels in ADHD.

Evaluation of estrogen and G protein-coupled estrogen receptor 1 (GPER) levels in drug-naïve patients with attention deficit hyperactivity disorder (ADHD)

Estrogen has a crucial role in the regulation of reproductive and neuroendocrine function and exerts its effects through two classes of receptors, nuclear and membrane estrogen receptors (mERs). G protein-coupled estrogen receptor 1 (GPER) is a member of mERs, and despite limited research on the levels of GPER in patients with psychiatric diseases, a role of GPER in such conditions has been suggested. Here we evaluated serum estrogen and GPER levels in children with attention deficit hyperactivity disorder (ADHD) in relation to their age- and gender-matched healthy controls. A total of 82 children were included in the study, 47 drug- naïve patients with ADHD (age: 6-12 years; male/female: 34/13) and 35 healthy controls (age: 6-12 years; male/female: 19/16). The subgroups according to ADHD types were inattentive, hyperactive/impulsive, and combined. Serum estrogen was measured using an immunoassay system, while serum GPER was determined using a commercial sandwich enzyme-linked immunosorbent assay kit. Estrogen levels in children with ADHD were similar as in control group, while GPER levels were significantly lower in ADHD group compared to controls (p < 0.05). Logistic regression analysis showed a significant association between GPER levels and ADHD (p < 0.05), and no association between estrogen levels and ADHD (p > 0.05). No significant differences were found in GPER and estrogen levels between ADHD subgroups (p > 0.05). To the best of our knowledge, this study is the first to investigate estrogen and GPER levels in ADHD. Our preliminary findings suggest a relationship between serum GPER levels and ADHD, and this should be further investigated.

Cyclic vomiting syndrome treated successfully with fluoxetin.

Cyclic vomiting syndrome (CVS) is defined as severe vomiting attacks which initiate suddently, recur with certain intervals, may last for hours and days and generally limit themselves. During attacks, signs including nausea, abdominal pain, photophobia, fever, palor, dehydratation, excessive saliva secretion and social isolation may accompany vomiting. Patients are completely healthy during the period between attacks. There is no laboratory or radiological finding which can explain the disease. It has been reported that the attacks may last for hours and days and the disease may last for months and years (1-3). The reasons of cyclic vomiting syndrome have not been elucidated fully yet. Hypersensitivity of the hypathalamo-pituitary-adrenal system and autonomic dysfunction in the autonomic system, disorders related with ion channels and mitochondrial disorders (like in migraine) and psychological factors have been blamed in the etiology (2-4). There is no clear consensus on the treatment of the disease. Life-style changes which target a decrease in the triggering factors, supportive therapies during attacks and prophylactic drug therapies are used (5). The information related with especially prophylactic treatment is limited, though various pharmacological agents are used. In this article, a patient who was treated successfully with fluoxetine which is a selective serotonin reuptake inhibitor used in prophylactic treatment of CVS was presented.

Increased Serum G Protein-coupled Estrogen Receptor 1 Levels and Its Diagnostic Value in Drug NaÏve Patients with Major Depressive Disorder

Objective The facts that depression is more prevalent in females than in males and females are exposed to depression more commonly during certain hormonal fluctuating periods indicate the role of sex hormones in physiopathology. Estrogen acts over estrogen receptors alpha and beta and recently identified G protein-coupled estrogen receptor 1 (GPER1). The present study aimed, for the first time, to evaluate serum GPER1 levels in drug-naïve major depressive disorder (MDD) patients. Methods The study included 56 newly diagnosed drug-naïve MDD patients aged between 18 and 50 years and 42 age- and gender-matched healthy volunteers. Medical history was obtained and physical examinations, laboratory tests, and the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A) were performed. The serum GPER1 levels were measured. Results The HAM-D score was significantly higher in the MDD patients than in the controls. The GPER1 level was significantly higher in the MDD patients than in the controls. A positive correlation was found with GPER1 levels and depression scores. The receiver operating characteristic analysis revealed sensitivity, specificity, positive predictive value, and negative predictive value as 82.1%, 90.5%, 92.0%, and 79.2%, respectively, for the presence of depression, when the serum GPER1 value was ≥0.16. Conclusion This study demonstrated significantly higher serum GPER1 levels in the MDD patients than in the controls, a positive correlation was found between GPER1 levels and depression scores and serum GPER1 level was valuable in predicting the presence of depression.

Tramadol Abuse in the Elderly

The abuse of opioid drugs, including tramadol, is becoming a more prevalent health problem in the aging population. Tramadol is often used in elderly patients with moderate to severe acute and chronic pain. The prevalence of tramadol abuse in the elderly is unknown and may be higher than expected. Previous studies indicate that both the incidence and prevalence of tramadol abuse is more common in younger persons than in the elderly. However, tramadol abuse in the elderly is underestimated. Physicians should cautiously prescribe tramadol, especially in the elderly. Furthermore, special approaches may be necessary for the treatment of tramadol abuse in older adults with multiple comorbidities and/or functional impairment. The most effective way to treat abuse is often through the integration of psychotherapeutic and pharmacological therapies. The aim of this chapter is to review the risk factors, prevention, withdrawal symptoms, and treatment approaches of tramadol abuse in the elderly.