Osman Yıldırım

Serum cortisol and dehydroepiandrosterone‐sulfate levels in schizophrenic patients and their first‐degree relatives

Aims:  Alterations in cortisol and dehydroepiandrosterone sulfate (DHEA‐S) levels are thought to play a role in the pathophysiology of neuropsychiatric disorders, including schizophrenia. The aim of this study was to investigate the role of serum cortisol and DHEA‐S in the pathophysiology of schizophrenia.

Case of organic mania associated with stroke and open heart surgery.

ORGANIC MANIA HAS been reported to have multiple causes. Although post-stroke depression is well recognized, post-stroke mania has rarely been reported. There have been few cases in the literature reporting mania secondary to cerebrovascular lesions, one of which followed a lesion in the non-dominant hemisphere. A 27-year-old, right-handed woman presented with symptoms of elevated mood, grandiosity, sleeplessness, and disinhibition with a history of stroke 1 year previously. She had undergone surgery because of mitral valve stenosis 6 months previously. She had no other disease and no family history of psychiatric disorders. At admission, neurological examination was normal except for a mild weakness on the left side. Poststroke magnetic resonance imaging findings of the patient after 6 months were as follows. The lesion was seen on the right insular and frontal cortex. The patient scored 52 out of 60 on the Young Mania Rating Scale. We started treatment with olanzapine (30 mg/day) and valproate (1000 mg/day). Her symptoms significantly improved after three months. The patient provided informed consent to publish this paper. Krauthammer and Klerman described and gave a list of organic causes of mania, such as drugs, infection, epilepsy, cerebral neoplasm and metabolic disturbances. However, mania is a rare complication of stroke with an incidence of <1%. Robinson and colleagues conducted a series of studies with 27 patients with organic mania due to stroke, traumatic injury, or brain tumors. The authors emphasized that mania following brain injury (especially stroke) is associated with a positive family history of mood disorders and lesions involving the right limbic area or subcortical atrophy by increased ventricle-to-brain-size ratio. There have been some cases of mania after heart surgery that may be related to valve replacements or factors complicating surgery, such as macroembolism, microembolism and cerebral hypoperfusion. Although organic mania is generally reported in the elderly, it is also possible in younger patients, like this case.

Vitamin B12 and vitamin B12 supplementation effects on cognitive functions after bariatric surgery.

1. Comajuncosas J, Hermoso J, Gris P, et al. Risk factors for umbilical trocar site incisional hernia in laparoscopic cholecystectomy: a prospective 3-year follow-up study. Am J Surg 2014;207: 1–6. 2. Sørensen LT, Hemmingsen UB, Kirkeby LT, et al. Smoking is a risk factor for incisional hernia. Arch Surg 2005;140:119–23. 3. Sørensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg 2003;238:1–5. 4. Owens M, Barry M, Janjua AZ, et al. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon 2011;9:218–24. 5. Bunting DM. Port-site hernia following laparoscopic cholecystectomy. JSLS 2010;14:490–7. 6. Helgstrand F, Rosenberg J, Bisgaard T. Trocar site hernia after laparoscopic surgery: a qualitative systematic review. Hernia 2011;15:113–21.

Tardive Dyskinesia Associated with Bupropion

Present report describes a 46 year old male patient with a diagnosis of major depression who developed tardive dyskinesia during bupropion therapy. Our patient had no history of neuroleptic use and his laboratory and neurologic examinations were normal. He had no family history of neurologic diseases. Although bupropion induced dyskinesia has been previously reported in the literature, it is rare and our case is the first case regarding tardive dyskinesia.

A new diagnostic tool for masked hypertension: impaired sleep quality

Introduction The aim of this study was to evaluate the relationship between masked hypertension and impaired sleep quality. Additionally, we evaluated the diagnostic role and prevalence of poor sleep quality among patients with newly diagnosed masked hypertension. Material and methods A total of 112 individuals, 72 patients with newly diagnosed masked hypertension and 40 normotensive healthy volunteers, were included in this study. All patients underwent evaluation comprising 12-lead electrocardiography, transthoracic echocardiography, 24-hour Holter ECG, and basic laboratory tests. Additionally, all participants completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI). Results The total PSQI score was significantly higher in the masked hypertension group than in the normotensive healthy volunteers (4.13 ±2.43 vs. 2.33 ±1.67, p < 0.001). A PSQI score > 5 was found in 45.8% (n = 33) of patients in the masked hypertension group and 15% (n = 6) of patients in the normotensive group (p < 0.001). The non-dipper pattern was found in 17.5% of the healthy volunteer group and 59.94% (n = 41) of the masked hypertension group (p < 0.001). When we compared the dipping pattern of the masked hypertension groups, there was a significant difference in PSQI score between the dipper and non-dipper groups (4.87 ±3.21 vs. 3.58 ±2.33, p < 0.001). Multiple logistic regression analyses showed that masked hypertension, LV mass, and LV mass index score were independent predictors of poor PSQI. Conclusions This study demonstrates impaired sleep quality in subjects with masked hypertension, particularly those with a non-dipper pattern. Additionally, this study indicates that impaired sleep quality may help diagnose masked hypertension, particularly in the non-dipper group.