Tümer Türkbay

Acute effect of methylphenidate on QT interval duration and dispersion in children with attention deficit hyperactivity disorder.

Among childhood psychiatric disorders, attention deficit hyperactivity disorder (ADHD) is of greatest interest to practitioners. Methylphenidate (MPH) is a drug that is widely used in the treatment of children in whom ADHD has been diagnosed. Although this treatment has been used for years, its effects on the heart remain the subject of debate. The QT interval comprises the ventricular activation and recovery periods as seen on electrocardiogram (ECG). The acute effect of MPH on QT interval dispersion is unknown. Researchers in the present study sought to investigate the acute effects of MPH on QT interval as seen on ECG. A total of 25 patients with ADHD (mean age, 9.4±2.1 y) who were treated with MPH were enrolled in the study. Twelve-lead derivation ECGs were taken before and 2 h after administration of 10 mg of MPH. Maximum QT interval, minimum QT interval, and interval durations were measured, and QT dispersion was calculated, for each ECG. QT dispersion measured after medication administration decreased significantly from 59.6±16.3 ms to 50.8±10.9 ms (P=.016); corrected QT dispersion decreased significantly from 70.9±17.6 ms to 61.3±13.3 ms (P=.011). Maximum QT interval duration decreased from 373.7±21.8 ms to 361.8±29.0 ms (P=.006); minimum QT interval duration rose from 317.0±23.3 ms to 322.3±21.6 ms (P=.312). In conclusion, the findings of this study show that MPH reduces QT dispersion during the acute period shortly after its administration.

DNA damage in children treated with imipramine for primary nocturnal enuresis.

Background : Despite the fact that primary nocturnal enuresis (PNE) is self‐limited and pathologically benign, the emotional stress and inconvenience that it produces, warrants treatment. Imipramine is one of the widely used drugs in PNE treatment. Although some mutagenic effects were suggested in imipramine administration, this toxicity has never been investigated in enuretic patients. The aim of this study was to evaluate the association of exposure to imipramine with DNA damage.

Bone mineral density in children with nocturnal enuresis.

In enuretic children there is a significantly higher incidence of fine and gross motor clumsiness, delayed developmental milestones, slower and poor linear growth, and these patients are shorter than normal children. Skeletal maturation of enuretic children has been determined with bone age in only two studies before, but to our knowledge bone mineral content of enuretic children has not previously been determined by bone mineral density measurement. Bone mineral density was measured by the dual-energy x-ray absorptiometry method in children with nocturnal enuresis and compared with that of a control group to detect whether there were any delay in bone development and any decrease in bone mass. Thirty enuretic children were compared with a control group of 40 healthy children with respect to body height and weight measurements, daily calcium intake, serum calcium, phosphorus and ALP levels, chronological and bone ages, and bone mineral density measurements. Of the parameters compared, bone age was significantly retarded, and bone mineral density was significantly reduced in children with enuresis (8.3 ± 1.9 vs 9.7 ± 2.3 years; p = 0.01, and 0.5476 ± 0.07 vs 0.6077 ± 0.05 g/cm2; p = 0.001, respectively). Chronological ages demonstrated a significant correlation with the bone ages in both the study and control groups (r = 0.852, p < 0.001, and r = 0.844, p < 0.001, respectively). However, the mean chronological age was significantly greater than the mean bone age in the study group (p < 0.001), whereas the mean chronological age was not significantly different from the mean bone age in the control group (p = 0.514). To clarify the exact mechanism responsible for these manifestations of skeletal maturation retardation, the relationship between the maturational delay of the central nervous system connections or the effect of any perinatal insult and the retardation in skeletal maturation remains to be determined.

Selenium and zinc levels in volatile substance abusers

Plasma and erythrocyte levels of selenium (Se) and zinc (Zn) have not been investigated in volatile (inhalant) substance abusers previously, although changes in the activities of antioxidant enzymes resulting from oxidative damage caused by various constituents of volatile substances have been shown in a few animal and human studies. Concentrations of these two elements in erythrocytes and plasma of 37 adolescents with inhalant abuse were measured by atomic absorption spectrophotometry and compared with those of 37 age-matched healthy controls. Erythrocyte and plasma levels of Se and plasma level of Zn were significantly lower in the study group when compared to the control group. Chronic inhalation of volatile substances can decrease the plasma levels of Se and Zn and, thus, may lead to a decrease in the activity of antioxidant enzyme systems in adolescent abusers. The role of Se and Zn supplementation in children with inhalant abuse remains to be determined considering the reduced antioxidant activity resulting from deficiency of these trace elements.

Substance use disorders in men with antisocial personality disorder: a study in Turkish sample.

This study investigated the prevalence of substance use disorders (SUDs) and “substance of choice” in 500 male Turkish psychiatric outpatients manifesting a DSM-IV diagnosed antisocial personality disorder (APD) and a SUD diagnoses (the Structured Clinical Interview for DSM-IV). Lifetime SUDs were diagnosed in 86% of APD subjects. Alcohol, cannabis, and inhalant use disorders were the most frequent among substance use, 75.6%, 67.4%, and 35.6%, respectively. This samples “substance of choice” differed from reported Western populations; a result which may be influenced by socio-cultural variations. The studys limitations are noted.

Bone mass toxicity associated with inhalation exposure to toluene

The inhalation of a wide range of organic solvents has become popular among young adults. Toluene is one of the most commonly used solvents in industry; it is easily available and conventient to use. Many toxicologic effects on biological systems secondary to deliberate inhalation of toluene have been reported, but investigations on adverse effects associated with bone morbidity is limited. The purpose of this study is to determine bone mineralization and investigate the adverse effects of toluene on bone. The bone mineral density and content of the femoral neck of mice exposed to toluene at 300 ppm for 8 wk were measured by dual X-ray absorptiometry and found significantly reduced compared to the control group. Chronic exposure to toluene was found to affect bone metabolism, and toluene-induced changes could contribute to bone resorption and inhibition of bone formation. Toluene seems to be the responsible component for the demineralizating effects of commonly abused substances, and medical doctors must promote their education about the health hazards in those who abuse solvents especially in areas where inhalant abuse is endemic.

Blood lead levels in glue sniffers

The aim of this study was to investigate blood levels of lead (Pb) among adolescents with glue sniffing in Turkey. Blood Pb levels were measured in 30 adolescent glue sniffers by atomic absorption spectrophotometry and compared with those of the 30 healthy adolescents. The Pb contents of various glue preparations marketed in Turkey and used by the abusers were also measured. Blood Pb levels were significantly higher in the study group when compared to the control group. Pb was detected at considerably high levels in the contents of all the various glue preparations most commonly used by the cases in the study group. The increased blood Pb levels in glue sniffers may be related to the high lead contents of glues marketed in Turkey. The blood Pb levels and signs of Pb toxicity should be investigated in examination of glue sniffers.

Neuropsychological evaluation of children and adolescents with acute carbon monoxide poisoning

Objectives Carbon monoxide (CO) poisoning is a worldwide health problem. We have limited information regarding psychological adversities of CO poisoning in children and adolescents. The aim of this study was (1) to investigate the effects of severe CO poisoning on cognitive functions, mood, and behaviors in children and adolescents and (2) to identify factors related to occurrence of neuropsychological symptoms. Methods This study included pediatric patients, who were evaluated after CO poisoning at the Department of Child and Adolescent Psychiatry between January 2012 and April 2013. The patients were evaluated at 2 time points. The first evaluation was done when they were discharged from emergency department, and the second evaluation was done 1 month after CO poisoning. Turkish versions of internationally recognized tests were used to evaluate anxiety, depressive symptoms, attention, visual-spatial skills, memory, and behaviors of patients. Results Twenty-seven patients were analyzed. The mean age of the patients was 11.8 ± 2.7 years (range, 6–18 years). The mean carboxyhemoglobin level was 31.5% ± 7.8% (range, 19%–51%) dir. Delayed neurological sequel was observed in only 1 patient, who had headache and tinnitus. We found that carboxyhemoglobin level was not correlated with later neuropsychiatric test scores. However, we found a correlation between history of loss of consciousness and anxiety symptom level, hyperbaric oxygen (HBO) therapy session and behavioral problems, and time to HBO therapy and attention problems. Conclusions We suggest that CO exposure duration, history of loss of consciousness, time to HBO therapy, and the number of HBO therapy session affect neuropsychological symptom levels and occurrence of attention and behavioral problems.

Fenobarbital Uygulamasında Intravenöz ve Intraosseöz Yolların Karşılaştırılması

SuleymanDemirel Universitesi TIP FAKULTESI DERGISI: 1999 Aralik; 6(4) Fenobarbital Uygulamasinda Intravenoz ve Intraosseoz Yollarin Karsilastirilmasi Rusen Dundaroz, Turner Turkbay, Ali Sizlan, Tuncer Degim, Faysal Gok, Tahir Ozisik Ozet Status epileptikus klasik olarak 30 dakikadan uzun suren jenaralize tonik-klonik nobet olarak tarif edilir. Uzun suren nobet aktivitesi irreversibl serebral hasar ile sonuclanabilir. Ustelik, nobet aktivitesinin uzun surmesinin kontrol edilebilirligini azalttigi yonunde kanitlar vardir. Damar yolunun saglanmasi nobet esnasinda siklikla zordur. Ote yandan intraosseoz yol (IO) kullanima hazirdir. Bu ca¬lismada, 20 mg/kg dozunda fenobarbital IV ve IO yoldan tavsanlara uygulandi. Fenobarbital kan duzey¬leri olculdu ve sonuclar karsilastirildi. Fenobarbital plazma profilinin IO uygulamada terapotik seviyede oldugu goruldu. IO yolun fenobarbital verilmesinde IV yola alternatif olabilecegi sonucuna varildi. Anahtar Kelimeler: Fenobarbital, kemik iligi infuzyonu, intraosseoz infuzyon, intravaskuler giris, status epileptikus Abstract Comparison of Intravenous and Intraosseous Routes for The Administration of Phenobarbital Status epilepticus (SE) is classically defined as a generalized tonic-clonic seizure lasting longer than 30 min. Prolonged seizure activity can result in irreversible cerebral injury. In addition, evidence suggests that the longer the duration of the seizure, the less likely the activity is to be controlled. IV access, however, is frequently difficult to achieve during the seizure. On the other hand, intraosseous (IO) access is available. In this study, phenobarbital was administered to rabbits using both IV and IO lines at the dose of 20 mg/kg. The levels of phenobarbital in the blood were measured and the results were compared. The plasma profile of phenobarbital was found to be in the therapeutic level when it was administered by IO route. It was concluded that the IO line appeared to be an alternative route to IV access in the administration of phenobarbital. Key Words: Phenobarbital, bone marrow infusion, intraosseous infusion, intravascular access, status epilepticus