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Misophonia is described as a condition in which negative emotions and negative physical reactions are triggered by particular sounds. The patients with misophonia demonstrate hatred and extreme intolerance against specific non-dominant and repetitive sounds. It is a severe psychiatric disorder rather than a mere obsession. Its symptoms may vary from mild to severe. Although some patients can dissemble and passed out, some may lose their control. In severe cases, involuntary physical violence may be observed. Although it is usually perceived as a spoil by the society, it may cause the patient's life become unbearable. In this paper, the physical violence of a misophonia patient directed to a dinner guest who smacks his mouth during eating was reported. Unfortunately, the patient could not achieve to exclude himself from the source of disturbance before exhibiting the adverse physical reaction. Therefore, this case becomes important in demonstrating the extreme involuntarily reactive nature of misophonia.

Introduction: We aimed to introduce the prognostic value of simultaneously calculated fragmented QRS and Zwolle scores as a new scoring system in primary PCI of the STEMI patients. Method: Two hundred fifty-nine STEMI patients were classified as fragmented QRS complex group (fQRS) and non-fragmented QRS complex group (non-fQRS) according to the fragmentation of QRS complex in electrocardiography. These two groups according to whether Zwolle score ≥3 were also classified as high Zwolle score with fQRS complex, high Zwolle score with the non-fQRS complex, the low Zwolle score with fQRS complex, and low Zwolle score with the non-fQRS complex group. The hospitalization data of the patients were analyzed. Results: In the fQRS group compared with the non-fQRS group, wider QRS (105.2±9.7 vs. 88±7.1, p<0,001) as well as the higher Creatin Kinase-MB [med (IQR): 174 (123-199) vs. 102 (96-147), p<0,001] and creatinine (0.99 (0.87-1.2) vs. 0.83 (0.78-0.83), p<0.001) levels were detected. Killip scores of<1 [18(69.2) vs. 8(30.8),p<0.001] were more frequent. Adverse cardiac events were significantly higher in high Zwolle score with fQRS complex group. Conclusion: Clinically, fQRS was associated with high adverse cardiac events ratio. Thus, utilization of Zwolle score along with the fragmented QRS is prognostically significant in primary PCI patients admitted with STEMI.

OBJECTIVE: Conformational change in the last four amino acid of the albumin's N-terminus is called ischemia-modified albumin (IMA). Metabolic stress factors such as ischemia, hypoxia, acidosis or endothelial injury may cause these conformational modifications. In this study, we hypothesized that the plasma IMA level changes might help to determine the global metabolic risk in bipolar disorder (BD), unipolar depression (UD), and schizophrenia (SZ). Therefore, it was aimed to investigate metabolic risk factors affecting IMA levels in this study. Modification of the albumin molecule might be a marker of global metabolic risk in schizophrenia and mood disorders. METHOD: The study included 32 patients with BD, 32 patients with UD, 28 patients with SZ and 34 healthy individuals. For determining the IMA levels, standard amounts of cobalt ions were added to the serums, and the quantity of disengaged cobalt ions was measured by colorimetric assay. RESULTS: IMA (F = 3.04, p = 0.032) levels differed between the groups. IMA levels of the BD group were significantly higher than the healthy control group (p = 0.048). White blood cell count in the BD group (p = 0.034) and total oxidant status (TOS) in the SZ group (p < 0.001) were the determinants of IMA levels with linear regression analysis. CONCLUSION: Elevation of IMA levels may indicate a global metabolic risk, and IMA levels are elevated in the BD group in this study. Determinants of IMA levels may indicate the significant metabolic risk in patient groups. Oxidative stress (OS) was the determinant of IMA levels in the SZ, and white blood cell count was the determinant of IMA levels in the BD group. Although the IMA levels were higher in all patient groups, the statistical significance appeared only in the BD group. Elevated IMA level was due to elevated OS in the SZ group, whereas the immunity in the BD group.

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