Subclinical immune reactions to viral infections may correlate with child and adolescent diagnosis of attention-deficit/hyperactivity disorder: a preliminary study from Turkey

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neuro-developmental disorders of childhood and adolescence. Studies focusing on the relationship of infectious agents and ADHD are scarce. It is also known that cerebellar injury may lead to hyperactive behavior. This study aimed to evaluate the relationship between viral agents of cerebellitis and the diagnosis of ADHD.

METHODS

The study group was formed of 60 consecutive ADHD patients and 30 healthy children. IgG levels for VZV; HSV-1, CMV, Measles, Mumps, Rubella and EBV were evaluated.

RESULTS

Males were significantly higher among patients with ADHD (65% vs. 40%, p=0.025). Patients with ADHD displayed significantly higher positivity for measles IgG (80% vs. 60%, p=0.044). When patients with ADHD were classified according to their pubertal status, adolescents with ADHD displayed higher positivity for mumps (100% vs. 74.4%, p=0.043). Most of the patients were diagnosed with ADHD-Combined or Hyperactive/Impulsive Subtypes (56.6%) while 43.3% were diagnosed with ADHD-predominantly inattentive type. When patients with subtypes of ADHD were compared in terms of seropositivity, it was found that patients with ADHD-Combined/ Hyperactive-Impulsive subtypes had significantly elevated reactions for Rubella (100% vs. 88.5%, p=0.044).

CONCLUSION

Although limited to a single center and may be prone to sampling biases, our results may support the notion that immune reactions may be related with ADHD among children and adolescents. Further, prospective studies from multiple centers are needed to support our findings and establish causality.

Reboxetine may cause amenorrhea in female patients

Objective. Reboxetine is a selective noradrenaline reuptake inhibitor (NaRI), a study on the effects of reboxetine on amenorrhea has not been reported in the literature up to now. This report describes a patient with symptoms of amenorrhea which is thought to be caused by reboxetine. Case. A female patient with major depressive disorder was given reboxetine 8 mg/day. She had experienced secondary amenorrhea for 3 months. The patient had no periodic irregularity before reboxetine use, and after reboxetine was discontinued menstruation resumed. After another trial with reboxetine at the optimal dose (8 mg/day, increased gradually), the patient reported amenorrhea again for 2 months. On discontinuing reboxetine, her menstrual cycle became regular again. Discussion. FSH, LH, E2 and prolactin levels were normal in our patient. Because amenorrhea was temporally related with reboxetine trials, we posit that this phenomenon may be due to side effects of reboxetine. This may be due to noraderenergic effects on hormonal function.

Positive lymph node ratio as a prognostic factor for gastric cancer patients: Is it going to supersede positive lymph node number in guidelines?

Gastric malignancies constitute the sixth most common cancer with regards to incidence and have the fifth most mortality rates. Extended lymph-node dissection is the surgical modality of choice while treating advanced stage gastric cancer. It is yet a topic of debate, whether or not the amount of positive lymph nodes after a pathological examination following the surgical intervention is of prognostic value. In this study, it is aimed to evaluate the prognostic significance of positive lymph nodes following the surgery. A total of 193 patients who underwent curative gastrectomy between January 2011 and December 2015 have been considered for a retrospective data collection. The cases with R1-R2 resections, palliative or emergent surgeries are excluded. Metastatic to total number of lymph nodes, corresponded a ratio which was analyzed in this survey and practiced as a predictive parameter of disease outcome. This survey includes 138 male (71.5%) and 55 female (28.5%) patients treated between 2011 and 2015 in our clinic. The survey follow-up duration of the cases range between 0, 2, and 72 months, corresponding an average of 23.24 ± 16.99 months. We calculated cutoff value of 0.09 with, sensitivity is 76.32% for positive to total number of lymph nodes ratio, whereas specivity applies for 64.10%, positive predictive value for 58% and negative predictive value for 80.6%. Positive lymph node ratio has a prognostic value in terms of predicting the prognosis of the patients with gastric adenocarcinoma following a curative gastrectomy. This might in long term contribute to the prognostic analysis of patients if integrated in the current staging system.

Conservative approach for the management of bilateral pneumothorax and pneumomediastinum after laparoscopic totally extraperitoneal inguinal hernia repair

Laparoscopic totally extraperitoneal inguinal hernia repair is considered a common and safe procedure. Here, we present the case of a 31-year-old male with right indirect inguinal hernia and no medical history. The patient underwent laparoscopic totally extraperitoneal inguinal hernia repair and the operation was completed successfully. During extubation, subcutaneous emphysema was noted at the neck, chest, and above the nipples. Tracheal injury was excluded by the anaesthesiologists and otorhinolaryngologists. On arterial blood gas, the patient's oxygen saturation was 95% with nasal oxygen support. The patient was followed-up closely in the general surgery inpatient clinic. Computed tomography was performed, on which bilateral pneumothorax and pneumomediastinum were noted. Conservative management was planned and the patient was discharged on the fourth postoperative day. Laparoscopic totally extraperitoneal inguinal hernia repair is considered a routinely applied safe procedure, however, appropriate care should be taken to avoid possible complications. Keywords: Laparoscopy, Inguinal Hernia, Pneumothorax, Pneumomediastinum.