Patients with asthma develop pulmonary hypertension due to recurrent hypoxia and chronic inflammation, leading to right heart enlargement with ventricular hypertrophy. Patients with severe asthma can experience cor pulmonale later in life, but little is known about ventricular function during the early stages of the disease. This study aimed to investigate ventricular functions in asymptomatic children with asthma as detected by conventional echocardiography and tissue Doppler echocardiography (TDE). Fifty-one pediatric patients (mean age 10.4 ± 2.2 years) with asthma and 46 age- and sex-matched healthy children (mean age 10.9 ± 2.4 years) were studied. All subjects were examined by conventional echocardiography and TDE, and they had pulmonary function tests on spirometry. The right-ventricular (RV) wall was statistically (p = 0.01) thicker among asthmatic patients (4.7 ± 1.5 mm) compared with healthy children (3.6 ± 0.4 mm). However, conventional pulsed-Doppler indices of both ventricles did not differ significantly between asthmatic patients and healthy children (p > 0.05). The results of TDE examining RV diastolic function showed that annular peak velocity during early diastole (E'), annular peak velocity during late diastole (A') (16.4 ± 1.8 and 5.1 ± 1.4 cm/s, respectively), E'/A' ratio (3.2 ± 0.7), isovolumetric relaxation time (67.7 ± 10.2 ms) and myocardial performance index (48.1 % ± 7.0 %) of the lateral tricuspid annulus among asthmatic patients differed significantly (p = 0.01) from those of healthy children (13.2 ± 2.3, 8.2 ± 2.0 cm/s, 1.6 ± 0.5, 46.2 ± 8.7 ms, and 42.0 % ± 5.7 %, respectively). Only peak expiratory flow (PEF) rate from the pulmonary function tests was negatively correlated with the E'/A' ratio of the tricuspid annulus (r = -0.38, p = 0.01). This study showed that although the findings of clinical and conventional echocardiography were apparently normal in children with asthma, TDE showed subclinical dysfunction of the right ventricle, which is negatively correlated with PEF. These findings signify the diagnostic value of TDE in the early detection and monitoring of such deleterious effects among asthmatic patients.

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Araştırmalar / ResearchesÖZET Panik bozukluk hastalarında çocukluk çağı travmatik yaşantılarının cinsel işlev üzerine etkileri Amaç: Bu araştırmanın amacı, çocukluk çağı cinsel ve fiziksel istismarının (ÇÇCİ/ÇÇFİ), intihar girişimlerinin ve kendine zarar verme davranışlarının, panik bozukluk tanısı almış hastalarda cinsel işlevle ilintisinin incelenmesidir. Yöntem: 81 panik bozukluk hastası bu çalışmaya alındı. Katılımcılar, Çocukluk Çağı Travma Anketi, sosyodemografik form ve Arizona Cinsel Yaşantılar Ölçeği (ACYÖ) ile değerlendirildi. Bulgular: Katılımcıların %48.1'inde fiziksel istismar ve %9.9'unda cinsel istismar öyküsü vardı. Fiziksel istismara uğramış olan kadın katılımcıların toplam ACYÖ puanları ile cinsel istek, uyarılma, orgazma ulaşabilme ve orgazm tatmini puanları, fiziksel istismar öyküsü olmayan katılımcıların puanlarından yüksekti. Cinsel istismar öyküsü bulunan kadın katılımcıların puanları; uyarılma, orgazma ulaşabilme ve toplam ACYÖ puanları açısından, cinsel istismar öyküsü bulunmayanların puanlarıyla karşılaştırıldığında, anlamlı olarak daha yüksek bulundu. Erkek katılımcılar için böyle bir farklılık saptanmadı. Regresyon analizine göre, çocukluk çağındaki istismar yaşantılarından ziyade, depresyon komorbiditesi cinsel işlev bozukluğunda yordayıcı olarak belirlendi. Sonuç: Çocukluk çağı cinsel ve fiziksel istismar öyküsü bulunan panik bozukluk hastalarının cinsel istekleri, uyarılmaları ve orgazmları inhibe olmaktadır. Panik bozukluk hastalarında gözlenen cinsel işlev sorunları, çocukluk çağı taciz yaşantılarının yanı sıra depresyon komorbiditesinden etkilenmektedir. Anahtar kelimeler: Panik bozukluk, çocukluk çağı travması, intihar, kendine zarar verme davranışı, cinsel işlev bozukluğu ABSTRACT The effects of childhood trauma on sexual function in panic disorder patientsObjective: The aim of this study is to investigate the relationship between childhood physical/sexual abuse, suicide attempts, self-harming behavior and sexual functioning in patients with panic disorder. Method: 81 patients with panic disorder were included in the study. Participants were evaluated by using Childhood Trauma Questionnaire, sociodemographic form and Arizona Sexual Experiences Scale (ASEX). Results: The frequency of physical abuse history was 48.1% and the frequency of sexual abuse was 9.9% in the sample. Female participants with a history of physical abuse had significantly higher scores in the items of sexual desire, arousal, ability to reach orgasm, satisfaction from orgasm and total ASEX scores than those without a history of physical abuse. Female participants with a sexual abuse history also had higher scores in the items of arousal, ability to reach orgasm and total ASEX scores. No significant difference was found between male participants with regard to physical/sexual abuse history. In a regression model, comorbid major depressive disorder rather than abuse history was found to be a predictor of poor sexual functioning. Conclusion: Female patients with panic disorder who have physical/sexual abuse hist...

Complete right bundle branch block (RBBB) results when normal electrical activity in the His-Purkinje system is interrupted. The most common cause of RBBB is surgical closure of ventricular septal defects, especially in tetralogy of Fallot [1]. Rare cases of isolated, familial RBBB have also been reported [2].Although a large number of intermittent left bundle branch block (LBBB) cases commonly associated with coronary heart disease have been reported in adults, a very small number of intermittent RBBB cases have been reported [3,4]. Unlike adults, pediatric intermittent RBBB cases have not been reported until now. Herein, is presented the first pediatric case of intermittent RBBB in an asymptomatic 8 year old male patient with familial mediterranean fever (FMF). This is the first pediatric case in literature.An 8-year-old boy with FMF was referred for cardiological evaluation, because of heart murmur. When he was 4 years old, he was diagnosed as having FMF according to the clinical findings and heterozygote mutation (M694V). At that time colchicine (0.5 mg) was administered twice a day and he was completely symptom-free for 4 years. On physical examination, general condition was good and his vital signs including a blood pressure 88/58 mmHg, heart rate (HR) 88 bpm, respiratory rate 19 bpm and a temperature 36.5°C were normal. On cardiac examination, the first heart sound and the second heart sound was normal, and no murmur was heard. Laboratory tests were as follows: white blood cell: 4.66 × 10 3 /µ/L, hemoglobin: 13.2 g/dL, platelets: 191 × 10 3 /mm 3 , hepatic, renal and thyroid function tests were normal. Among acute phase reactants, erythrocyte sedimentation rate (ESR) was found to be 12 mm/h and C-reactive protein (CRP) was found to be 0.24 mg/L. Serum amyloid A (SAA) (0.1 mg/dL) and troponin I (0.00 ng/mL) were all within normal limits. On electrocardiogram, it was observed that the normal QRS complexes were followed by the characteristic pattern of complete RBBB. Wide and slurred S in leads I, II, III, aVF, V4-V6, wide and slurred R waves in leads aVR, V1, and V2 were observed. When the HR increased above 85 bpm, the RBBB appeared (tachycardia dependent block or acceleration-dependent block) ( Fig. 1, left side A, B, C). In continuous 24-h ambulatory 3-lead Holter monitoring revealing a narrow QRS complex was observed during the night and all the following day (HR < 85 bpm) whereas during the HR-accelerated (HR > 85 bpm) period, the terminal portion of the QRS complex slurred was observed (RBBB morphology). While in the provocation test with exercise, normal QRS complex was seen at the beginning of exercise in accordance with findings in Holter, when HR increased to 85 bpm RBBB morphology appeared (Fig. 1, right side A, B, C). Both telecardiography and echocardiography results were normal. With these findings intermittent RBBB was diagnosed and because the patient had no complaints, he was admitted to follow-up in the outpatient clinic. Intermittent RBBB persisted at 6 month follow-up.The criteria for com...

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