Lamotrigine-induced obsessional symptoms in a patient with bipolar II disorder: a case report

Lamotrigine is an anticonvulsant that appears to have a mainly antidepressant effect and is indicated for the maintenance treatment of bipolar depression. Literature associated with obsessional symptoms related to lamotrigine treatment is limited. We report the emergence of obsessive symptoms during treatment with lamotrigine in a patient who subsequently experienced significant improvement after dose reduction and stopping of this medication. The obsessive symptoms associated with lamotrigine treatment were observed after the lamotrigine dose was increased to 100 mg/day. The possible mechanisms, including inhibition on the presynaptic release of glutamate and alteration of striatal dopamine uptake, are discussed. It is unclear why lamotrigine induces obsessions in some patients. Controlled studies are necessary to identify the population at risk for obsessionality in bipolar illness following treatment with lamotrigine and to investigate a possible dose-response relationship between obsessive symptoms and lamotrigine.

CLINICAL, ANDROLOGICAL AND GENETIC CHARACTERISTICS OF PATIENTS WITH CONGENITAL BILATERAL ABSENCE OF VAS DEFERENS (CBAVD)

Congenital bilateral absence of the vas deferens (CBAVD) is a form of infertility with an autosomal recessive genetic background in otherwise healthy males. In this study, we examined the clinical and cystic fibrosis transmembrane-conductance regulator (CFTR) gene mutations in sixty patients with bilateral absence of vas deferens that applied to andrology clinic due to male factor infertility. Urogenital anomalies of vas deferens, seminal vesicle and epididymis were detected in our patient group. CFTR gene mutations, which are known to be frequent among cystic fibrosis patients, could not be detected in our patient group with that high frequency. Delta F508 mutations were detected in only 6% of patients. IVS8 polyT alleles were positive in 68% of patients. No 1677delTA mutations and M470V variants were detected in our patient group. However, sperm retrieval is almost always possible from CBAVD patients; secondary pathologies may also result defective spermatogenesis.

Effect of eNOS and ET-1 Polymorphisms in Thromboangiitis Obliterans

Thromboangiitis obliterans (TAO), or Buerger disease, is a segmental occlusive inflammatory disorder of the arteries and veins, and etiopathogenesis is still obscure. It is strongly connected to the use of tobacco products, especially smoking. Smoking cessation is obligatory for success of the medical treatment. In the current study, we investigated the prevalence of endothelial nitric oxide synthase (eNOS) 894 G→T and endothelin-1 (ET-1) 8000 T→C polymorphisms in association with TAO to reveal any possible involvement in the TAO pathophysiology. The T allele of the eNOS 894 G→T polymorphism was found to be associated with the prevention of TAO.

Recurrent bullous lesions associated with familial Mediterranean fever: a case report

Familial Mediterranean fever (FMF) is an inherited, recurrent, inflammatory disease. Of its various cutaneous features, erysipelas-like erythema is the best known and most common skin lesion. We present a new case of FMF with recurrent bullous lesions. A 41-year-old woman was admitted to our clinic with tense bullae, 20 x 20 mm in diameter on the left shin. The patient had a history of fever, abdominal pain, peritonitis attacks and infertility. A lesional skin biopsy revealed subepidermal bullae and neutrophilic infiltration around dermal vessels. Direct immunofluorescence analysis was negative. Over the period of investigation, the lesion regressed spontaneously; 1 month later, a similar lesion appeared on the right wrist. Diagnosis of FMF was made according to the Tel-Hashomer criteria. Recognition of this peculiar skin lesion may lead to an earlier diagnosis of the disease.

A case of adult-onset Still's disease complicated with diffuse alveolar hemorrhage

Adult-onset Still's disease (AOSD) is an inflammatory disease that presents with a variety of clinical symptoms. Pulmonary involvement is well-known in AOSD and is seen in up to 53% of AOSD cases, with the most common pulmonary diseases being pleural effusion and transient pulmonary infiltrates. We present the first case of chronic AOSD complicated with diffuse alveolar hemorrhage during the acute flare of the disease.

Polymorphisms of 5,10-methylenetetrahydrofolate reductase and cystathionine beta-synthase genes as a risk factor for neural tube defects in Sétif, Algeria

BACKGROUND

Neural tube defects (NTD) are severe congenital malformations due to a failure in neural tube formation at the beginning of pregnancy. The etiology of NTD is multifactorial, with environmental and genetic determinants. We suggest a study of gene-gene interactions regarding the possible association of NTD with specific mutations of 5,10-methylenetetrahydrofolate reductase (MTHFR) and cystathionine beta-synthase (CBS) genes.

PATIENTS AND METHODS

The genetic analysis of the MTHFR C677T polymorphism was performed by real-time polymerase chain reaction (PCR) on a Light Cycler, the CBS genotype was analyzed by PCR in a thermal cycler. Ninety-two mothers who had conceived NTD children and 48 fathers were investigated. A group of 147 adults, including 82 apparently healthy women, was used as control.

RESULTS

Among control mothers, 35 (43%) were heterozygous for the C677T variant and 14 (17%) were TT homozygous. Among the cases, 25 (52%) out of 48 mothers and 22 (46%) out of 48 fathers carried the T allele; 9 mothers (19%) and 5 fathers (10%) had the TT genotype. A homozygous C677T mutation was not an NTD risk factor in this preliminary study in an Algerian population; a possible gene-gene interaction between the MTHFR C677T polymorphism and the CBS 844ins68 has also been examined in relation to NTD, but no such association has been shown. There was a statistically significant difference between the heterozygosity genotype frequency of CBS polymorphisms in mothers with a previous child with NTD compared with the mother controls (odds ratio: 3.72; 95% CI: 1.59-8.73).

CONCLUSION

Our results with Algerian NTD mothers did not show a significant association for any group, suggesting that the thermolabile variant C677T in the MTHFR gene is not a risk factor for a mother to have NTD offspring; rather, folic acid supplementation or fortification should become mandatory for all women of reproductive age in Algeria.

Complete remission of psoriasis following bevacizumab therapy for colon cancer

Bevacizumab is a monoclonal antibody against vascular endothelial growth factor (VEGF), which is used to treat several cancers. Currently, experience with anti-VEGF treatment for psoriasis is limited, and no published reports on this use exist. We describe a patient with metastatic colon cancer and psoriasis who experienced complete remission of psoriasis during treatment with bevacizumab and combination chemotherapy without any other treatment for psoriasis. These data suggest that bevacizumab may be a promising therapeutic agent for the treatment of psoriasis.

MEFV mutations in systemic onset juvenile idiopathic arthritis

OBJECTIVES

Autoinflammatory diseases constitute a large spectrum of monogenic diseases like FMF or cryopyrin-associated periodic syndromes (CAPS) and complex genetic trait diseases such as systemic onset juvenile idiopathic arthritis (SoJIA). An increased rate of MEFV mutations has been shown among patients with PAN and HSP, in populations where FMF is frequent. The aim of the study is to search for MEFV mutations in our patients with SoJIA and see whether these mutations had an effect on disease course or complications.

METHODS

Thirty-five children with the diagnosis of SoJIA were screened for 12 MEFV mutations. The control data were obtained from a previous study of our centre determining the carrier frequency in Turkish population.

RESULTS

Two patients were homozygous and three patients were heterozygous for the M694V mutation. One patient was a compound heterozygote for the M680I/V726A mutations. Heterozygous V726A mutation was found in one patient. The overall mutation frequency of patients was 14.28%. This figure had been compared with the previously published rate of disease-causing mutations in this country, which is 5%. Disease-causing mutations were found to be significantly more frequent in the SoJIA patients than the population (P < 0.01). Among these, M694V was the leading mutation with a frequency of 10% in SoJIA. Six patients carrying MEFV mutations were among the most resistant cases requiring biological therapy.

CONCLUSION

SoJIA patients had a significantly higher frequency of MEFV mutations but clinical studies with large number of patients are needed to confirm the association of MEFV mutations with SoJIA and its course.

Urethral erosion of a bone screw after internal urethrotomy: a rare complication after pelvic trauma

BACKGROUND

Although screw breakage or loosening are rarely encountered, they were reported to occur after instability of the internal fixation.

METHODS

A man with a history of traumatic pelvic fracture 6 months ago presented to our clinic with inability to void. An anterior urethral meatotomy was made and a calcified but intact screw was removed from the urethra.

CONCLUSIONS

Screw migration with urological manifestations are extremely rare and usually include bladder migration with a subsequent voiding of the screw. We present a case in which internal urethrotomy for posterior urethral stricture caused erosion of a bone screw into the urethra which was subsequently removed by anterior meatotomy.

Relationship Between Functional Promoter Polymorphism in the XBP1 Gene (-116C/G) and Obesity

Endoplasmic reticulum stress is a central feature of obesity, insulin resistance, and type 2 diabetes. A polymorphism of the XBP1 gene (-116C/G), a transcription factor that modulates the endoplasmic reticulum stress response, causes an impairment of its positive feedback system. The authors examined a role of the polymorphism in the development of obesity. The polymorphism was investigated in clinically obese children and compared with controls. Significant difference of genotype distribution was observed, which suggested that the -116C/G genotype may be a risk factor for at least pediatric obesity.

The analysis of interleukin-1 receptor antagonist and interleukin-1beta gene polymorphisms in Turkish FMF patients: do they predispose to secondary amyloidosis?

OBJECTIVE

Amyloid development in familial Mediterranean fever (FMF) patients is associated with acute phase response and the acute phase reactant serum amyloid A which is induced by IL-1Beta. Its concentration can increase to more than 1000 fold during inflammation. In view of the inflammatory nature of FMF disease we have investigated whether IL-1Beta and IL-1 receptor antagonist gene polymorphisms may be involved in amyloid development in FMF patients.

METHODS

Ninety-nine FMF patients without amyloidosis; 54 FMF patients with amyloidosis and 60 healthy controls samples were genotyped for IL-1Beta-511 (C/T) and IL-1Beta+3953 (C/T) polymorphisms using PCR-RFLP and for IL-1Ra VNTR polymorphism using PCR.

RESULTS

The allele and genotype frequencies of IL-1Beta-511 (C/T), IL-1Beta+3953 (C/T) and IL-1Ra VNTR polymorphisms in FMF patients with and without amyloidosis were all compared with those in controls. There were no significant differences between FMF patients with and without amyloidosis and healthy control samples for these polymorphisms (all P-values are >0.05). These polymorphisms were not associated with M694V mutation in FMF patients with and without amyloidosis.

CONCLUSION

IL-1Beta-511 (C/T), IL-1Beta+3953 (C/T) and IL-1Ra VNTR polymorphisms are not associated with the development of amyloid in FMF patients.

Loss of the tuberous sclerosis complex tumor suppressors triggers the unfolded protein response to regulate insulin signaling and apoptosis

Mammalian target of rapamycin, mTOR, is a major sensor of nutrient and energy availability in the cell and regulates a variety of cellular processes, including growth, proliferation, and metabolism. Loss of the tuberous sclerosis complex genes (TSC1 or TSC2) leads to constitutive activation of mTOR and downstream signaling elements, resulting in the development of tumors, neurological disorders, and at the cellular level, severe insulin/IGF-1 resistance. Here, we show that loss of TSC1 or TSC2 in cell lines and mouse or human tumors causes endoplasmic reticulum (ER) stress and activates the unfolded protein response (UPR). The resulting ER stress plays a significant role in the mTOR-mediated negative-feedback inhibition of insulin action and increases the vulnerability to apoptosis. These results demonstrate ER stress as a critical component of the pathologies associated with dysregulated mTOR activity and offer the possibility to exploit this mechanism for new therapeutic opportunities.

The levels of depression, anxiety and quality of life in patients with chronic idiopathic urticaria

BACKGROUND

Chronic idiopathic urticaria (CIU) is associated with severely impaired quality of life (QoL).

OBJECTIVE

To determine the levels of depression, anxiety and QoL in CIU patients.

PATIENTS AND METHODS

This study included 73 patients with CIU, and 34 healthy subjects matched for age and sex were used as controls. The levels of depression, anxiety and QoL were assessed with the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the World Health Organization Quality of Life Assessment-Brief (WHOQOL-BREF), respectively. The reliability and validity of the Turkish versions of these instruments have been examined.

RESULTS

When compared with healthy controls, patients with CIU had significantly higher BDI and BAI scores and significantly lower physical health and psychological health subscale scores of the WHOQOL-BREF. BDI, BAI and all domains of WHOQOL-BREF were unrelated to age, duration of illness, urticaria activity score (UAS) and visual analogue score (VAS). There was a negative significant correlation between all domains of WHOQOL-BREF and BDI and BAI.

CONCLUSION

Our data confirm that QoL is markedly reduced in CIU patients. Physical health and psychological health were found to be the areas QoL most affected in CIU patients. And also we have found that CIU patients frequently suffer from depression and anxiety. The severity of these parameters was found to be positively correlated with the extent of QoL decrease.

[Malassezia furfur colonising the respiratory tract of mechanically ventilated neonates]

BACKGROUND

Ventilated neonates are prone to acquire ventilator-associated pneumonia (VAP). Consequently early diagnosis of pneumonia is required. Beside bacteria, fungi are suspected as a cause of VAP. However, fungal colonisation and infection of the lung have not been studied systematically. The purpose of this study was to evaluate pulmonary fungal colonisation in ventilated neonates and premature infants.

MATERIALS AND METHODS

187 tracheal aspirates (TA) from 29 ventilated neonates (23-35 weeks gestational age) were investigated. TAs were evaluated microscopically and by culture. Data were matched with clinical signs of VAP or sepsis.

RESULTS

Candida species were not detected in TA or culture. In contrast, Malassezia furfur (Mf), a lipophilic fungus, was detected from the 10th, 21st and 31st postnatal days onwards in TAs of 3 out of 17 extremely prematures (gestational age at birth < 25 weeks). The presence of Mf was associated with clinical deterioration either immediately or a few days after the first positive Mf smear. Topic steroids were more frequently applied to Mf-positive ELBW infants (p = 0.03). In vitro, natural surfactant was demonstrated to be a sufficient substrate for Mf in culture.

CONCLUSION AND DISCUSSION

This is the first report on Mf lung colonisation of ELBWI during mechanical ventilation. Because Mf is generally not detected in standard cultures it appears to be an overlooked, potentially pathogenic fungus in prematures. Mf must be considered in the differential diagnosis of VAP in ELBWI exposed to topical steroids, especially when natural surfactant was administered.

Expression of ALS1, HWP1 and SAP4 genes in Candida albicans strains isolated from women with vaginitis

Total mRNA of Candida strains( isolated form whole vaginal swabs) was investigated and the in vivo expression of C. albicans secreted aspartyl proteinase (SAP4), aglutinin-like sequence (ALS1) and hyphal wall protein (HWP1) genes was determined. A spectrum of gene expression profiles of strain isolated from vulvovaginal candidiasis(VVC) cases consisting of 10 pregnant, 4 postmenopausal, and 15 reproductive age (12 primary and 3 recurrent) 9 women with different estrogen level. Expression of SAP4, ALS1 and HWP1 genes was evaluated by reverse-transcriptase polymerase chain reaction using specific primer sets. The expression of ALS1, HWP1, and SAP4 was detected as 69, 62, and 38 %, respectively, in all cases. In pregnant, postmenopausal, and reproductive age women with VVC, the expression of ALS1 was observed as 70, 75, 67%, and HWP 60, 25, 73% respectively . Expression of SAP4 was found in pregnant, postmenopausal, and reproductive age women as 40, 50, and 33% respectively. Expression of teh adhesion genes in VVC does not correlate with estrogen level of patients.

The role of plasminogen activator inhibitor-1 polymorphism, factor-V-Leiden, and prothrombin-20210 mutations in pulmonary thromboembolism

Polymorphism in plasminogen activator inhibitor-1 gene is suggested to be associated with an increased risk of venous thromboembolism. The aim of this study was to investigate the association of plasminogen activator inhibitor-1 gene polymorphism and its coexistence with factor-V-Leiden and prothrombin-20210 mutations in pulmonary thromboembolism. The authors investigated plasminogen activator inhibitor-1 4G/5G polymorphism, factor-V-Leiden, and prothrombin-20210 mutations in 143 pulmonary thromboembolism patients and 181 controls. Plasminogen activator inhibitor-1 4G/4G, 4G/5G, and 5G/5G gene polymorphisms and prothrombin-20210 mutations were not different between cases and controls. Factor-V-Leiden mutation was present in 21.0% and 7.7% of the cases and controls, respectively, P = .001. Neither different plasminogen activator inhibitor-1 genotypes and 4G allele nor coexistence of the allele with factor-V-Leiden or prothrombin-20210 was associated with the risk of recurrence. As a result, plasminogen activator inhibitor-1 gene polymorphism or its concomitant presence with mentioned mutations was not found to be associated with increased risk for pulmonary thromboembolism or recurrent disease in this study.

Cerebral cavernomas and human leukocyte antigens: preliminary clinical results

BACKGROUND

Although cavernomas are the most common brain vascular malformations, the etiology and risk factor(s) are still not entirely known. Recent publications focusing on the molecular basis suggest that genetic factors may play a role in the development of the brain vascular malformations. We aimed to show HLA typing in brain cavernoma in a group of Turkish patients.

METHODS

This study compared HLA types of 30 patients who had brain cavernoma with 30 healthy controls.

RESULTS

The analysis of HLA distribution in the patients, compared with healthy control data, revealed some statistically significant differences, even after the more rigid Bonferoni correction (P(c)). In the patients group, the frequency of following HLA antigens was significantly increased compared with the control group: HLA-A1 (P(c): .005), HLA-A24 (P(c): .02), HLA-A32 (P(c): .01), HLA-B51 (P(c): .00001), HLA-DR1 (P(c): .02), and HLA-DR4 (P(c): .004).

CONCLUSION

These preliminary data suggest that brain cavernoma susceptibility may be associated with HLA antigens. Further studies should be designed to include a larger population of patients with brain cavernoma in order to expose whether there is association between HLA typing and occurrence of cavernoma more accurately.