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Engin Burak Selçuk,1 Lale Gönenir Erbay,2 Özlem Özel Özcan,3 Sükrü Kartalci,2 Kadir Batcioğlu4 1Department of Family Medicine, 2Department of Psychiatry, 3Department of Child and Adolescent Psychiatry, Inonu University Medical Faculty, 4Inonu University Pharmacy Faculty, Malatya, Turkey Background: Stuttering is defined as a disruption in the rhythm of speech and language articulation, where the subject knows what he/she wants to say, but is unable to utter the intended word or phrase fluently. The effect of sex on development and chronicity of stuttering is well known; it is more common and chronic in males. We aimed to investigate the relationship between developmental stuttering and serum testosterone levels in this study.Materials and methods: In this study, we evaluated a total of 50 children (7–12 years of age); eight (16%) were female and 42 (84%) were male. Twenty-five children who stutter and 25 typically fluent peers with the same demographic properties (ages between 7 years and 12 years) were included in this study. The testosterone levels of the two groups were determined in terms of nanogram per milliliter (ng/mL) by enzyme-linked immunosorbent assay. The difference between the means of the two groups was analyzed.Results: The medians of the testosterone levels of the stutterer and control groups were determined as 20 ng/mL (range =12–184 ng/mL) and 5 ng/mL (range =2–30 ng/mL), respectively. Testosterone levels of the stutterer group were significantly higher than in the control group (I=0.001). Besides, there was a significant correlation between the severity of the stuttering and testosterone levels in the stutterer group (I=0.0001).Conclusion: The findings of this study show that testosterone may have an effect on the severity of developmental stuttering and on the clinical differences between sexes. However, further investigations are needed to show that testosterone may play a role in the etiology of developmental stuttering. Keywords: children, stuttering, testosterone

Background: This study is a randomized controlled, biopsychosocial study investigating the effectiveness of pain neuroscience education (PNE) and motor imagery-based exercise protocol (MIEP) on fibromyalgia pain., Methods: Our study has four groups (MIEP n = 12, PNE n = 12, MIEP + PNE n = 14, Control n = 12) and all participants (n = 50) consist of patients diagnosed with fibromyalgia with chronic back pain. The primary outcome measure was pain intensity, and secondary outcome measures were beliefs, kinesiophobia, anxiety-depression, cognitive-mood, self-esteem, and body awareness., Results: A statistically significant decrease in pain intensity was observed in all experimental groups, without any group being superior (Visual Analog Scale [VAS]: MIEP + PNE p = .003, 95% confidence interval [CI], -4.7078 to -0.9922; MIEP p = .003, 95% CI, -5.4806 to -1.0194; PNE p = .002, 95% CI, -3.6139 to -1.5461). There was a significant improvement in organic beliefs in both groups where PNE was applied (MIEP + PNE: p = .017, 95% CI, -7.8211 to -0.3189; PNE: p = .003, 95% CI, -9.7999 to -0.0401). A significant superiority in organic pain beliefs was detected in the MIEP + PNE group compared to the control group (p = .008, 95% CI, 1.7241-9.4959)., Conclusions: According to this study, in which MIEP and PNE were combined, there was a decrease in pain intensity when both applications were applied together and when they were applied one by one. MIEP has improved her motor imagery ability, improved pain and increased body awareness. PNE has improved people's organic pain beliefs; removed people from fears, catastrophizing, and negative thoughts about pain; improved easier management of psychological processes and cognitive-emotion regulation ability., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Introduction: Parkinson disease is the world's second most prevalent neurological disease. In this disease, intracytoplasmic neuronal inclusions are observed in enteric neurons in the gastrointestinal tract, and the composition of the intestinal microbiome is altered. These changes correlate with the motor phenotype. A systematic review was conducted to determine the effect of using probiotics in Parkinson disease., Methods: Scopus, PubMed, Web of Science, the Cochrane Library, ScienceDirect, and Ovıd-LWW were searched until April 2021. A total of 27395 records were found according to inclusion and exclusion criteria with the following outcomes: Parkinson disease rating, oxidative stress, and gastrointestinal system markers. Data search, article selection, and data extraction assessments were performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The Jadad scale was used to rate the evidence's quality., Results: Our study information was gathered from 5 randomized controlled trials involving 350 individuals with Parkinson disease receiving probiotic supplements. Parkinson disease rating and non-motor symptoms test were performed in the samples. Also, oxidative stress (glutathione, malondialdehyde) and gastrointestinal system symptoms (bowel opening frequency, gut transit time, complete bowel movement, spontaneous bowel movements) were evaluated during 4-12 weeks of using probiotics in these patients., Conclusion: While all high-quality studies demonstrate improvement in disease symptoms of the patients, currently sufficient data are not available to recommend the use of probiotics for people with Parkinson disease in clinical practice., (Copyright© 2024 Iranian Neuroscience Society.)

Background: Sleep deprivation (SD) impairs pre-stimulus inhibition, but the effect of quetiapine (QET) remains largely unknown., Objective: This study aimed to investigate the behavioral and cognitive effects of QET in both naïve and sleep-deprived rats., Materials and Methods: Seven groups ( n  = 49) of male Wistar Albino rats were used in this study. SD was performed using the modified multiple platform technique in a water tank for 72 h. Our study consists of two experiments investigating the effect of QET on pre-pulse inhibition (PPI) of the acoustic startle reflex. The first experiment tested the effect of short- and long-term administration of QET on PPI response in non-sleeping (NSD) rats. The second experiment used 72 h REM sleep deprivation as a model for SD-induced impairment of the PPI response. Here, we tested the effect of QET on the % PPI of SD rats by short- and long-term intraperitoneal injection at the last 90 min of sleep SD and immediately subsequently tested for PPI., Results: 72 h SD impaired PPI, reduced startle amplitude, and attenuated the PPI% at + 4 dB, + 8 dB, and + 16 dB prepulse intensities. 10 mg/kg short and long-term QET administration completely improved sensorimotor gating deficit, increased startle amplitude, and restored the impaired PPI% at + 4 dB, + 8 dB, and + 16 dB after 72 h SD in rats., Conclusion: Our results showed short- and long-term administration of QET improved sensorimotor gating deficit in 72 h SD. Further research is required for the etiology of insomnia and the dose-related behavioral effects of QET., Competing Interests: Conflict of interestAll authors declare that they have no conflicts of interest., (© The Author(s), under exclusive licence to Japanese Society of Sleep Research 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Aim: To summarize the nutritional supplementation on biochemical parameters, cognition, function, Alzheimer's Disease (AD) biomarkers and nutritional status., Materials and Methods: PubMed, Web of Science, Korean Journal Database, Russian Science Citation Index, SciELO Citation Index, Cochrane Library and Scopus databases were searched until 16 April 2021. 22.193 records in total were reached according to inclusion and exclusion criteria. Included Studies were evaluated through the Modified Jadad Scale and gathered under four subheadings., Results: Forty-eight studies with a total of 7009 AD patients were included. Souvenaid, ONS (368 ± 69 kcal), Vegenat-med, 500 mg Resveratrol, ONS (200 mL) were effective nutritional supplements on promoting weight gain and protecting malnutrition status but showed conflicting results in Body mass index, Mid-Upper-Arm Circumference and Triceps Skin Fold Thickness. ONS and a lyophilized whole supplementation Vegenat-med intake made an increase in MNA scores. While all nutritional supplements showed controversial results in biochemical parameters but caused a decrease in Hcy levels which caused reductions in brain Aβ plaque (increase serum Aβ), p-Tau and cognitive improvement. Folic acid and vitamin D decreased serum APP, BACE1, BACE1mRNA. Resveratrol, Hericium erinaceus mycelia, vitamin D and Betaine supplements improved cognitive, functional prognosis and quality of life unlike other nutritional supplements had no effect on cognitive scales., Conclusions: Better designed trials with holistic measures are needed to investigate the effect of nutritional support on the AD biomarkers, cognitive status, biochemical parameters and functional states. Also, more beneficial results can be obtained by examining the simultaneous effects of nutritional supplements with larger sample groups.

Background: Antithrombotic therapy in atrial fibrillation is generally managed with the CHA 2 DS 2 -VASc score. Aortic valve sclerosis (AVS) is a focal thickening of the aortic valve without a restriction of motion. AVS is related to several cardiovascular risk factors. Our study was performed to evaluate whether the presence of AVS was associated with the CHA 2 DS 2 -VASc score., Methods: This cross-sectional, observational study comprised 411 patients with AVS grades 1-3 [AVS (+)] and 102 patients with AVS grade 0 [AVS (-)]. We compared CHA 2 DS 2 -VASc scores between the AVS (+) and AVS (-) groups., Results: We determined that the AVS (+) group had a higher CHA 2 DS 2 -VASc score than the AVS (-) group [3 (0-8) vs 1 (0-4), p < 0.001) ]., Conclusions: In our study, the CHA 2 DS 2 -VASc score was found to be higher in patients with AVS than in those without AVS. AVS may predict cardiovascular risk in the general population.

Aim: We aimed to evaluate the awareness of pneumococcal vaccination (PCV13, PPSV23) in general cardiology outpatient clinics and impact of physicians' recommendations on vaccination rates., Methods: This was a multicenter, observational, prospective cohort study. Patients over the age of 18 from 40 hospitals in different regions of Turkey who applied to the cardiology outpatient clinic between September 2022 and August 2021 participated. The vaccination rates were calculated within three months of follow-up from the admitting of the patient to cardiology clinics., Results: The 403 (18.2%) patients with previous pneumococcal vaccination were excluded from the study. The mean age of study population (n = 1808) was 61.9 ± 12.1 years and 55.4% were male. The 58.7% had coronary artery disease, hypertension (74.1%) was the most common risk factor, and 32.7% of the patients had never been vaccinated although they had information about vaccination before. The main differences between vaccinated and unvaccinated patients were related to education level and ejection fraction. The physicians' recommendations were positively correlated with vaccination intention and behavior in our participants. Multivariate logistic regression analysis showed a significant correlation between vaccination and female sex [OR = 1.55 (95% CI = 1.25-1.92), p < 0.001], higher education level [OR = 1.49 (95% CI = 1.15-1.92), p = 0.002] patients' knowledge [OR = 1.93 (95% CI = 1.56-2.40), p < 0.001], and their physician's recommendation [OR = 5.12 (95% CI = 1.92-13.68), p = 0.001]., Conclusion: To increase adult immunization rates, especially among those with or at risk of cardiovascular disease (CVD), it is essential to understand each of these factors. Even if during COVID-19 pandemic, there is an increased awareness about vaccination, the vaccine acceptance level is not enough, still. Further studies and interventions are needed to improve public vaccination rates.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV-2), has rapidly spread worldwide, causing many deaths, the number of which continues to increase. Global public health organizations and governments have advised on the adoption of various handwashing and hygiene guidelines, use of masks, and social distancing, along with isolation or lockdown protocols to prevent SARS-COV-2 spread. There are vaccines and drugs that are confirmed but still many human suffer from this disease. Important risk factors for SARS-COV-2 infection are similar to other viral infectious diseases as including influenza, hepatitis B, acquired immunodeficiency syndrome, and other lung infections. These diseases might be related to poor nutritional support, affecting the patient outcomes against COVID-19. In this review, we discuss some of the nutritional therapies currently being investigated for infectious diseases. Studies have shown that nutrition has the potential to prevent and mitigate viral infections. Micronutrients (vitamins A, B6, B12, C, D, and E, B9, and trace elements, such as iron, zinc, copper, selenium, magnesium, and polyphenols) and macronutrients (carbohydrates, prebiotics, probiotics, protein [amino acids], and lipids [fatty acids]) affect the whole body, including the immune system, preventing viral entry and modulating clinical symptoms. This review discusses the importance of nutrition as a strategy to understand food groups and key nutrients that may affect the clinical outcomes of COVID-19 patients during the ongoing pandemic. Scientists believe that the likelihood of another pandemic is imminent. COVID-19 remains important and scientists believe it will continue will in the future. We emphasize the lack of studies on the nutritional impact of COVID-19 in terms of nutrition, even though nutritional interventions has been shown to have many advantages during the treatment of viral infections.

Introduction: Outbreaks of infectious diseases have negative effects on mental health. Currently, there is very little information about the psychological effects of the COVID-19 pandemic on adolescents and associated factors affecting their mental health. The aim of the present study is to determine the severity of anxiety, depression and post-traumatic stress disorder (PTSD) symptoms in adolescents during the COVID-19 outbreak, and to investigate the associated factors with these symptoms., Methods: The present study was conducted with a total of 447 adolescents. Psychiatric symptoms were evaluated by the use of DSM-5 Level 2 Anxiety Scale, DSM-5 Level 2 Depression Scale and National Stressful Events Survey PTSD Short Scale. The association between age, gender, residential area, presence of COVID-19 in the participant, presence of COVID-19 in the family or environment and psychiatric symptoms were evaluated with linear regression analysis., Results: The mean age of participants was 15.06, and 38.3% of the participants were men and 61.7% were women. The rate of participants with moderate or high levels of anxiety, depression and PTSD symptoms was 28%, 37.6% and 28.5%, respectively. High age and living in an urban area were associated with increased anxiety, depression and PTSD symptoms. In addition, female gender was associated with increased depression symptoms, and the presence of COVID-19 in the family or environment was associated with increased anxiety symptoms., Conclusion: The present study shows that adolescents have serious levels of anxiety, depression and PTSD symptoms during the COVID-19 pandemic. These results emphasise the need for mental health interventions that are appropriate for the characteristics of this age group., (© 2021 John Wiley & Sons Ltd.)

Various recently reported mutant variants, candidate and urgently approved current vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), many current situations with severe neurological damage and symptoms as well as respiratory tract disorders have begun to be reported. In particular, drug, vaccine, and neutralizing monoclonal antibodies (mAbs) have been developed and are currently being evaluated in clinical trials. Here, we review lessons learned from the use of novel mutant variants of the COVID-19 virus, immunization, new drug solutions, and antibody therapies for infections. Next, we focus on the B 1.1.7, B 1.351, P.1, and B.1.617 lineages or variants of concern that have been reported worldwide, the new manifestations of neurological manifestations, the current therapeutic drug targets for its treatment, vaccine candidates and their efficacy, implantation of convalescent plasma, and neutralization of mAbs. We review specific clinical questions, including many emerging neurological effects and respiratory tract injuries, as well as new potential biomarkers, new studies in addition to known therapeutics, and chronic diseases of vaccines that have received immediate approval. To answer these questions, further understanding of the burden kinetics of COVID-19 and its correlation with neurological clinical outcomes, endogenous antibody responses to vaccines, pharmacokinetics of neutralizing mAbs, and action against emerging viral mutant variants is needed., Competing Interests: CONFLICT OF INTEREST: none declared, (Copyright © 2021 The Author(s).)

Many parameters included in the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) and CHA 2 DS 2 -VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex category) scores also predict coronary artery disease (CAD). We modified the ATRIA score (ATRIA-HSV) by adding hyperlipidemia, smoking, and vascular disease and also male sex instead of female. We evaluated whether the CHA 2 DS 2 -VASc, CHA 2 DS 2 -VASc-HS, ATRIA, and ATRIA-HSV scores predict severe CAD. Consecutive patients with coronary angiography were prospectively included. A ≥50% stenosis in ≥1epicardial coronary artery (CA) was defined as severe CAD. Patient with normal CA (n = 210) were defined as group 1, with <50% CA stenosis (n = 178) as group 2, and with ≥50% stenosis (n = 297) as group 3. The mean ATRIA, ATRIA-HSV, CHA 2 DS 2 -VASc, and CHA 2 DS 2 VASc-HS scores increased from group 1 to group 3. A correlation was found between the Synergy between PCI with Taxus and Cardiac Surgery score and ATRIA ( r = 0.570), ATRIA-HSV ( r = 0.614), CHA 2 DS 2 -VASc ( r = 0.428), and CHA 2 DS 2 -VASc-HS ( r = 0.500) scores ( P s < .005). Pairwise comparisons of receiver operating characteristics curves showed that ATRIA-HSV (>3 area under curve [AUC]: 0.874) and ATRIA (>3, AUC: 0.854) have a better performance than CHA 2 DS 2 -VASc (>1, AUC: 0.746) and CHA 2 DS 2 -VASc-HS (>2, AUC: 0.769). In conclusion, the ATRIA and ATRIA-HSV scores are simple and may be useful to predict severe CAD.

Introduction: Coronary artery ectasia (CAE) is one of the uncommon cardiovascular disorders and its prognosis is still debated., Objective: We aimed to review long-term follow-up data in patients with CAE and to evaluate the prognosis of CAE patients with coronary slow flow phenomenon (CSFP)., Methods: This study had a prospective design and 143 patients with CAE were included. The angiographic and demographic characteristics were reviewed in detail. The patients were categorized, based on concomitant coronary artery stenosis detected by angiography, as CCAE group (n=87, ≥30% luminal stenosis) and ICAE group (n=56, <30% luminal stenosis) and also categorized by the coronary flow as CSFP group (n=51) and normal flow coronary ectasia - NCEA group (n=92). All patients were re-evaluated at 6-month intervals. Followup data, cardiovascular (CV) mortality, hospitalization and major adverse cardiac events (MACE) were collected. The level of statistical significance was set at 5%., Results: Patients were followed up for an average of 56.9±7.4 months. During the follow-up, statistically significant differences were found in hospitalization, CV mortality and MACE between the CCAE and ICAE groups (P=0.038, P=0.003, P=0.001, respectively). The CSFP and NCEA groups were also compared. There was a statistical difference with respect to hospitalization between the CFSP and NCEA groups (P=0.001), but no difference was observed in terms of MACE and CV mortality (P=0.793 and P=0.279)., Conclusion: CSFP accompanying CAE may be a predictor of hospitalization. Significant atherosclerotic plaques coexisting with CAE may be predictive for MACE.

Objective: Previous studies have shown cesarean section (C-section) and antibiotic use in the infantile period lead to chronic diseases in later life. It is also known that breastfeeding, which forms the basal system of immunity, is a protector in neonates. In this study, we aimed to investigate the association between breastfeeding, antibiotic use, C-section, and premature atherosclerosis., Methods: A total of 100 patients who underwent coronary angiography and had stenosis in at least 1 epicardial vessel and 100 controls with normal coronaries were included in the study. In addition to traditional risk factors, type of delivery, breast milk intake and duration, and antibiotic use and frequency were evaluated for each participant. Lipid profile was added to the study procedure. Angiographic images of the study groups were examined to calculate the Gensini score., Results: Smoking, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and family history were different between the groups. In the control group, 3 were born via C-section, whereas 26 were born via C-section in the atherosclerosis group (p<0.001). Breast milk intake and duration was also significantly higher in the control group (p=0.018). Antibiotic use was less in the control group, but there was no statistically significant difference (p=0.099). In multivariate logistic regression analysis, diabetes mellitus, smoking, and C-section were predictors of atherosclerosis (p=0.036, p=0.001, and p=0.003, respectively). In receiver operating characteristics curve analysis, the ability of C-section to predict premature atherosclerosis was superior to diabetes but not to smoking (area under curve, 0.607; p=0.023)., Conclusion: Mode of delivery and breast milk intake should be evaluated and considered among the risk factors of premature atherosclerosis.

Background: Understanding the existence of a cycle, where psychological disturbances cause skin diseases and in turn, skin diseases cause psychological disorders, provides the basis for good dermatological practice., Objective: The aim of this case-control study is to examine the psychiatric morbidity of dermatological disorders in children and adolescents with no history of psychiatric disorders., Method: In this study, 502 participants (251 patients and 251 healthy individuals) were evaluated according to DSM-IV criteria. All participants were interviewed and evaluated using the Turkish version of the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version (K-SADS-PL) and the State-Trait Anxiety Inventory for Children (STAI-1 and STAI-2), the Childhood Depression Inventory (CDI), adolescent and parent forms of the Strengths and Difficulties Questionnaire (SDQ-A and SDQ-P) and a questionnaire evaluating child's level of school success., Results: Our results indicated that the rates of general psychiatric comorbidity, mood disorders, anxiety disorders, and adjustment disorders were significantly higher in the study group compared to the control group. The CDI, STAI-1, STAI-2, and SDQ (and subscales) scores were significantly higher in the study group. Moreover, psychiatric comorbidity was higher in inflammatory and allergic dermatoses compared to other dermatological subgroups. Having a dermatological disease restricts physical activity thus increasing the risk of psychiatric comorbidity., Conclusions: Investigating the education, attitudes, and awareness of dermatologists about psychocutaneous disorders might contribute to the development of new educational strategies and elicit appropriate biopsychosocial approaches., Competing Interests: Conflict of interest The authors report no conflicts of interest.

Attention-deficit hyperactivity disorder (ADHD) is one of the most common childhood-onset psychiatric disorders. Although the etiology is complex and has not yet been clarified, dopamine is thought to play a role in the etiology. Methylphenidate (MPH) is a psychostimulant drug used as first-line treatment for ADHD and it inhibits dopamine and norepinephrine reuptake transporters. Dopamine also has an effect on retina and contrast sensitivity. Despite evidence indicating the effects of dopamine on contrast sensitivity, the results of studies examining contrast sensitivity in ADHD patients are inconsistent. Also, no studies have been encountered examining the possible effect of MPH on contrast sensitivity. The hypotheses of this study are that children with ADHD who have not used MPH will have lower contrast sensitivity levels than the members of the control group, that contrast sensitivity levels increase after the use of MPH, and that contrast sensitivity is a potential physiological marker for ADHD. The study was conducted with 30 children with ADHD and 30 children without ADHD. Psychiatric evaluations of the participants were conducted with the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime-Turkish version, Conner's Parent Rating Scale-Revised Short form and the Turgay DSM-IV-based Child and Adolescent Behavioral Disorders Screening and Rating Scale. Photopic contrast sensitivity was measured using the Functional Acuity Contrast Test (FACT). Results showed that FACT mean values of the control group were significantly higher than those of the ADHD group (pre-treatment) in all spatial frequencies. In four spatial frequencies (CPD 1.5, 3, 12 and 18), the FACT mean values of the control group were significantly higher than the ADHD group (during the OROS-MPH treatment). At all spatial frequencies, the mean values of the ADHD group during the OROS-MPH treatment were significantly higher than before the OROS-MPH treatment. In conclusion, the present study showed that contrast sensitivity is low in children with ADHD and increases significantly after OROS-MPH medication, but still did not reach the levels of the children without ADHD. Our findings suggest that contrast sensitivity may be a potential physiological marker in ADHD., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Low threshold of dissatisfaction and frustration in child and adolescent patients with ADHD lead to changes in dietary pattern with contribution to the development of obesity and other nutritional disorders., Methods: A total of 362 patients with the diagnosis of ADHD and 390 children without any chronic disease were included to the study. We evaluated the anthropometric measurements for all cases., Results: The overweight/obese cases according to weight for height (WFH) and body mass index scores were more likely in ADHD cases than control group. Malnourished cases according to WFH were more common in ADHD cases. Patients with weight standard deviation scores between <-2 and >2 were significantly higher in ADHD cases than the control group patients., Conclusion: Frequency of malnutrition and overweight/obese patients was found higher in ADHD cases compared with control group, and this situation suggested that ADHD is a risk factor for the development of eating disorders., (© The Author(s) 2013.)

The purpose of this study was to examine gender-based differences in abuse-related characteristics and post-abuse psychiatric disorders among sexually abused children and adolescents. The researchers retrospectively examined files, judicial reports, and social examination reports of 1,250 sexually abused youth cases. Results showed that boys were more often victimized by penetration, force, and physical violence. Incidence of sexual abuse by family members, familiar persons, and multiple persons was higher among girls. In addition, a higher rate of major depressive disorder as well as alcohol consumption and cigarette smoking were found in sexually abused girls. No difference was observed between boys and girls in terms of post-traumatic stress disorder, conduct disorder, and other mental disorders. Intellectual disability was more frequent in boys.

In this report, we present a 37-year-old male with ruptured right sinus of Valsalva. He was treated by percutaneous closure of the rupture using the retrograde approach. The procedure was performed successfully within 26 minutes. We think this approach may be used in future instead of the antegrade approach.

Acute coronary syndrome plays a major role in the treatment of acute coronary syndrome. New agents have been developed and introduced into clinical practice while dual antiplattelet therapy has been limited with clopidogrel until recently. In this review we summarize the efficacy of ticagrelor, a new antiplatelet agent.

Introduction: Trauma is one of the leading reasons for emergency department (ED) visits in children. Hyperactivity, inattentiveness and impulsiveness may contribute to injury proneness. The aim of this study was to evaluate the prevalence and role of attention deficit hyperactivity disorder (ADHD) in children with trauma., Methods: Trauma patients aged 3-17 attending the ED were included in the study group. Parents were informed after medical care had been given to their children, and demographic data and information about the trauma were collected. Later, parents were asked to complete the Conners' Parent Rating Scales-Revised questionnaire for ADHD symptoms. The control group consisted of children of similar age and sociocultural characteristics who attended the hospital for reasons other than trauma. Cases in which the child apparently had no active role in the trauma or where the parents did not complete the Conners' Parent Rating Scales-Revised questionnaire were excluded from the study., Results: Fifty-five children were included in the study group (mean age 7.49 (range 3-14; SD 3.3); 33 (60%) were male). The control group was statistically similar to the study group. The most common trauma mechanism was falls (n=31, 56.4%). All the subscale scores were significantly higher in the study group, and previous trauma-related ED visits were associated with significantly higher subscale scores., Conclusion: The data suggest that children who make repeated trauma-related ED visits have a predisposition to ADHD, and they may benefit from screening for this disorder while in the ED.

We report on a 42-year-old female patient with inappropriate sinus tachycardia (IST), in whom an effective sinus node modification was made by using the noncontact mapping system. The patient was admitted with palpitations and a heart rate between 90-110 beats per minute (bpm). Her heart rate increased to 150 bpm during minimal exercise. After confirming the diagnosis of IST by an electrophysiological study, radiofrequency catheter ablation was performed. A color-coded isopotential map was created when the heart rate was 95 bpm and the initial breakthrough of the sinus node (SNB) was labeled. After administration of isoproterenol, a new color-coded map recording was created when the heart rate reached 160 bpm, showing a new breakthrough 24 mm away from the SNB. Radiofrequency was delivered to this region and the heart rate decreased to 120 bpm. After another infusion of isoproterenol, the maximum heart rate reached 140 bpm and another isopotential map recording was created, which demonstrated migration of the breakthrough 16 mm away from the SNB. Radiofrequency was delivered to the second site and the heart rate decreased to 90 bpm and increased to a maximum of 120 bpm after a new isoproterenol infusion. A subsequent infusion caused no increase in the heart rate, and the ablation procedure was terminated. During a follow-up of one year, the patient was in sinus rhythm with a mean heart rate of 80 bpm.