Case Report: Treatment of a Comorbid Attention Deficit Hyperactivity Disorder and Obsessive–Compulsive Disorder With Psychostimulants

Introduction: Attention deficit hyperactivity disorder (ADHD) is a common disease in childhood and adolescence. In about 60% of pediatric patients, the symptoms persist into adulthood. Treatment guidelines for adult ADHD patients suggestmultimodal therapy consisting of psychostimulants and psychotherapy.Many adult ADHD patients also suffer frompsychiatric comorbidities, among others obsessive–compulsive disorder (OCD). The treatment of the comorbidity of ADHD and OCD remains challenging as the literature is sparse. Moreover, the impact of psychostimulants on obsessive–compulsive symptoms is still unclear. Case Presentation: Here, we report on a 33-year-old patient with an OCD who was unable to achieve sufficient remission under long-term guideline-based treatment for OCD. The re-examination of the psychological symptoms revealed the presence of adult ADHD as a comorbid disorder. The patient has already been treated with paroxetine and quetiapine for the OCD. Due to the newly established diagnosis of ADHD, extendedrelease methylphenidate (ER MPH) was administered in addition to a serotonin reuptake inhibitor. After a dose of 30mg ER MPH, the patient reported an improvement in both the ADHD and the obsessive–compulsive symptoms. After discharge, the patient reduced ER MPH without consultation with a physician due to subjectively described side effects. The discontinuation of medication led to a renewed increase in ADHD and obsessive– compulsive symptoms. The readjustment to ER MPH in combination with sertraline and quetiapine thereafter led to a significant improvement in the compulsive symptoms again. Conclusion: The present case shows that in ADHD and comorbid obsessive–compulsive disorder, treatment with psychostimulants can improve the obsessive–compulsive symptoms in addition to the ADHD-specific symptoms. To our knowledge, this is only the second case report describing a treatment with ER MPH for an adult patient with OCD and ADHD comorbidity in the literature. Further research, especially randomized controlled trials, is needed to standardize treatment options

Incorporating cellulose nanocrystals into waterborne acrylic coatings towards eco-friendly formulations

Waterborne coatings are primarily produced with hard acrylic polymers to provide adequate hardness and strength. Hard acrylic latexes cannot form a continuous polymer film at ambient conditions; therefore, coating formulations include volatile organic compounds (VOCs) as coalescents to ensure film formation. However, VOCs evaporate during drying of the coatings, resulting in environmental and health concerns. Successfully balancing hardness while reducing VOCs and ensuring proper film formation is challenging. This dissertation explores the incorporation of cellulose nanocrystals (CNCs) as performance additives to improve the hardness and strength of ambient film-forming latex coatings. CNCs could be placed in either the aqueous phase or the polymer phase as an additive to acrylic latex particles. This research aims to determine optimal methods of CNC addition to acrylic latexes, identify the challenges in controlling the CNC location in the latex system, and characterize film formation and properties of final dried films. Three major studies were conducted and presented as three main chapters (Chapter 2, Chapter 3, and Chapter 4). Chapter 2 highlighted the potential of CNC to be used as an aqueous additive in the acrylic binders and encouraged further investigations for reformulating waterborne acrylic products with CNCs. Chapter 3 demonstrated a framework to functionalize the CNC surface with acryloyl groups and acrylic polymers. This framework expands the use of CNCs by offering a versatile modification route and macromonomer functionality. Chapter 4 explored the incorporation of functionalized CNCs into the polymer phase of latex via miniemulsion polymerization. This chapter underlined the importance of the compatibility of CNCs with the monomer phase to enable the partition of CNCs into the polymer phase in miniemulsion. Overall, the findings in this dissertation are expected to guide researchers in the paint, coating, and cosmetic industries to extend the use of CNCs in waterborne formulations.Ph.D

More Depressive Symptoms, Alcohol and Drug Consumption: Increase in Mental Health Symptoms Among University Students After One Year of the COVID-19 Pandemic

Background: As the majority of studies examining mental health during the pandemic are cross-sectional, little is known about the changes in mental health during the pandemic, especially in university students. Most studies indicate a worsening of mental health conditions. This study aimed to evaluate the mental health status of German university students during the third wave of the pandemic in 2021 and to compare the results to a sample of a congruent cross-sectional study from 2020. Methods: Two cross-sectional and anonymous online surveys among university students were conducted (first survey: July-August 2020, N = 3,382; second survey: March-April 2021, N = 5,642). Mental health status was assessed with standardized measures (depressive symptoms, alcohol and drug consumption, and eating disorder symptoms), and social and emotional aspects of the COVID-19 pandemic were assessed. In addition to descriptive statistics and group comparisons of the two survey samples from 2020 and 2021, respectively, risk and protective factors related to mental health were analyzed. Results: There were significant differences in severities of depressive symptoms and alcohol and drug consumption between the two online surveys from 2020 and 2021. Findings suggest an increase in the severity of depressive symptoms as well as alcohol and drug consumption. Significantly more respondents reported suicidal ideation in the survey from 2021. Lower self-efficacy, less social support and lower resilience as well as higher perceived stress and more loneliness were reported by the participants of the survey from 2021 compared to 2020. Regarding factors predicting mental health symptoms, being female was a positive predictor for hazardous alcohol use and anorexia nervosa in comparison to men. Further, younger age, being diverse, higher perceived stress and loneliness were positive predictors for all mental health outcomes. Conclusion: This study reveals an increase in severities of depressive symptoms, including suicidal ideation, drug and alcohol consumption among students. Being diverse, younger age, higher perceived stress and loneliness were mutual risk factors for higher depressive and eating disorder symptoms as well as alcohol consumption. Universities and health care policy should recognize and address mental health issues of young adults during ongoing times of crisis and invest in easy-to-access interventions

Slip distribution of the 2017 M(w)6.6 Bodrum-Kos earthquake: resolving the ambiguity of fault geometry

SUMMARY The 2017 July 20, Mw6.6 Bodrum–Kos earthquake occurred in the Gulf of Gökova in the SE Aegean, a region characterized by N–S extension in the backarc of the easternmost Hellenic Trench. The dip direction of the fault that ruptured during the earthquake has been a matter of controversy where both north- and south-dipping fault planes were used to model the coseismic slip in previous studies. Here, we use seismic (seismicity, main shock modelling, aftershock relocations and aftershock mechanisms using regional body and surface waves), geodetic (GPS, InSAR) and structural observations to estimate the location, and the dip direction of the fault that ruptured during the 2017 earthquake, and the relationship of this event to regional tectonics. We consider both dip directions and systematically search for the best-fitting locations for the north- and south-dipping fault planes. Comparing the best-fitting planes for both dip directions in terms of their misfit to the geodetic data, proximity to the hypocenter location and Coulomb stress changes at the aftershock locations, we conclude that the 2017 earthquake ruptured a north-dipping fault. We find that the earthquake occurred on a 20–25 km long, ∼E–W striking, 40° north-dipping, pure normal fault with slip primarily confined between 3 and 15 km depth, and the largest slip exceeding 2 m between depths of 4 and 10 km. The coseismic fault, not mapped previously, projects to the surface within the western Gulf, and partly serves both to widen the Gulf and separate Kos Island from the Bodrum Peninsula of SW Anatolia. The coseismic fault may be an extension of a mapped, north-dipping normal fault along the south side of the Gulf of Gökova. While all of the larger aftershocks are consistent with N–S extension, their spatially dispersed pattern attests to the high degree of crustal fracturing within the basin, due to rapid trenchward extension and anticlockwise rotation within the southeastern Aegean

Birinci Trimester MPV/Trombosit ve PDW/Trombosit Oranlarının Abortus İmminens ve Abortusu Öngörmede Etkinliği

Amaç: Bu çalışmanın amacı, gebelerde birinci trimester döneminde yapılan rutin tam kan sayımı ile elde edilen trombosit değeri, ortalama trombosit hacmi (MPV) değeri, platelet dağılım genişliği (PDW) değeri, MPV/trombosit oranı ve PDW/trombosit oranının gebelik süresince oluşabilecek abortus imminens ve abortus durumlarını öngörmedeki rolünü incelemektir. Gereç ve Yöntem: Çalışmaya gebe polikliniklerinde 2018-2020 yılları arasında gebeliğin 6.-12. haftaları arasında tam kan sayımı örneği veren 300 hasta alındı. Hasta dosyalarından hastaların yaşları, abortus sayıları, gebelik haftaları, trombosit değerleri, MPV değerleri, PDW değerleri, MPV/trombosit oranları ve PDW/trombosit oranları kaydedildi. Hastalar düşük, düşük tehdidi ve kontrol olmak üzere 3 gruba ayrıldı. Tüm veriler karşılaştırmalı olarak analiz edildi. Bulgular: Abortus grubu, abortus imminens grubu ve kontrol grubu arasında trombosit değerleri, PDW değerleri, MPV değerleri, PDW/trombosit oranları ve MPV/trombosit oranları açısından anlamlı (p>0,05) bir farklılık gösterilmemiştir. Laboratuvar parametreleri açısından değerlendirildiğinde ise ortalama trombosit değeri 256,7±65,6, PDW değeri 12,2±1,8, MPV değeri 10,2±0,8, MPV/trombosit oranı 0,042±0,011 ve PDW/trombosit oranı 0,051±0,016 olarak saptanmıştır. Sonuç: Birinci trimesterde sağlıklı gebelerin tam kan sayımı testinden elde edilen MPV, PDW ile MPV/trombosit ve PDW/trombosit oranları ileri dönem abortus ve abortus imminens riskini öngörmede etkin değildir

Restless Legs Syndrome Prevalence and Clinical Correlates Among Psychiatric Inpatients: A Multicenter Study.

Background There are only limited reports on the prevalence of restless legs syndrome (RLS) in patients with psychiatric disorders. The present study aimed to evaluate the prevalence and clinical correlates in psychiatric inpatients in Germany and Switzerland. Methods This is a multicenter cross-sectional study of psychiatric inpatients with an age above 18 years that were diagnosed and evaluated face-to-face using the International RLS Study Group criteria (IRLSSG) and the International RLS severity scale (IRLS). In addition to sociodemographic and biometric data, sleep quality and mood were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ-9). In addition to univariate statistics used to describe and statistically analyze differences in variables of interest between patients with and without RLS, a logistic model was employed to identify predictors for the occurrence of RLS. Results The prevalence of RLS in a sample of 317 psychiatric inpatients was 16.4%, and 76.9% of these were diagnosed with RLS for the first time. RLS severity was moderate to severe (IRLS ± SD: 20.3 ± 8.4). The prevalences in women (p = 0.0036) and in first-degree relatives with RLS (p = 0.0108) as well as the body mass index (BMI, p = 0.0161) were significantly higher among patients with RLS, while alcohol consumption was significantly lower in the RLS group. With the exception of atypical antipsychotics, treatment with psychotropic drugs was not associated with RLS symptoms. Regarding subjective sleep quality and mood, scores of the PSQI (p = 0.0007), ISI (p = 0.0003), and ESS (p = 0.0005) were higher in patients with RLS, while PHQ-9 scores were not different. A logistic regression analysis identified gender (OR 2.67; 95% CI [1.25; 5.72]), first-degree relatives with RLS (OR 3.29; 95% CI [1.11; 9.73], ESS score (OR 1.09; 95% CI [1.01; 1.17]), and rare alcohol consumption (OR 0.45; 95% CI [0.22; 0.94] as predictors for RLS. Conclusions Clinically significant RLS had a high prevalence in psychiatric patients. RLS was associated with higher BMI, impaired sleep quality, and lower alcohol consumption. A systematic assessment of restless legs symptoms might contribute to improve the treatment of psychiatric patients

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Use of hydrogen peroxide, citric acid and sodium hypochlorite as sanitizer for minimally processed table grapes

The objective of this study was to explore two local table grape cultivars, one is white and the other one red colored, as a minimally processed produce, and to identify the most effective sanitizers (hydrogen peroxide, citric acid or sodium hypochlorite) to control microbial growth. The table grape cultivars indigenous to Elazig province of Turkey ‘Agin Beyazi’ and ‘Agin Kirmizisi’ were tested in the present experiment. Grape clusters were washed by dipping in tap water as control, in citric acid (20 g/L), with sodium hypochlorite (50 mg/L), or with hydrogen peroxide (20 g/L), solutions for 1 minute. Grape berries were then placed into PET clamshells and kept at 4 °C for 10 days. The berries were subject to quality assessments during the storage, and to total aerobic microbial and fungal count at the end. Washing with hydrogen peroxide- or sodium hypochlorite-diluted water was very effective controlling both aerobic microbial and fungal growth. Citric acid treatment however represented no significant effect on microbial growth. It is concluded that both hydrogen peroxide and sodium hypochlorite are strong sanitizers for table grapes tested, with no detection of undesirable effects

Case Report: Treatment of a Comorbid Attention Deficit Hyperactivity Disorder and Obsessive–Compulsive Disorder With Psychostimulants

Introduction: Attention deficit hyperactivity disorder (ADHD) is a common disease in childhood and adolescence. In about 60% of pediatric patients, the symptoms persist into adulthood. Treatment guidelines for adult ADHD patients suggestmultimodal therapy consisting of psychostimulants and psychotherapy.Many adult ADHD patients also suffer frompsychiatric comorbidities, among others obsessive–compulsive disorder (OCD). The treatment of the comorbidity of ADHD and OCD remains challenging as the literature is sparse. Moreover, the impact of psychostimulants on obsessive–compulsive symptoms is still unclear. Case Presentation: Here, we report on a 33-year-old patient with an OCD who was unable to achieve sufficient remission under long-term guideline-based treatment for OCD. The re-examination of the psychological symptoms revealed the presence of adult ADHD as a comorbid disorder. The patient has already been treated with paroxetine and quetiapine for the OCD. Due to the newly established diagnosis of ADHD, extendedrelease methylphenidate (ER MPH) was administered in addition to a serotonin reuptake inhibitor. After a dose of 30mg ER MPH, the patient reported an improvement in both the ADHD and the obsessive–compulsive symptoms. After discharge, the patient reduced ER MPH without consultation with a physician due to subjectively described side effects. The discontinuation of medication led to a renewed increase in ADHD and obsessive– compulsive symptoms. The readjustment to ER MPH in combination with sertraline and quetiapine thereafter led to a significant improvement in the compulsive symptoms again. Conclusion: The present case shows that in ADHD and comorbid obsessive–compulsive disorder, treatment with psychostimulants can improve the obsessive–compulsive symptoms in addition to the ADHD-specific symptoms. To our knowledge, this is only the second case report describing a treatment with ER MPH for an adult patient with OCD and ADHD comorbidity in the literature. Further research, especially randomized controlled trials, is needed to standardize treatment options