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Breakage of a Lag Screw of Cephalomedullary Nail: A Technique of Removal
Direk Tantigate,Kongkhet Riansuwan,Banchong Mahaisavariya,Kitichai Sukjaitham 대한정형외과학회 2015 Clinics in Orthopedic Surgery Vol.7 No.2
A broken lag screw of the cephalomedullary nail is a rare condition. Removal of the retained lag screw from the femoral head is also very challenging. This article describes a surgical technique and the modified instrument that was available in the operating room for removing the broken implant by closed technique.
Serotonin Syndrome after Clomipramine Overdose in a Child
Meltem Çobanoğulları Direk,Veli Yıldırım,Serkan Güneş,Gülçin Bozlu,Çetin Okuyaz 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.4
Serotonin syndrome (SS) is a potentially life-threatening condition associated with increased serotonergic activity in central nervous system and may occur during the use of serotonergic drugs. Although increasing frequency of serotonergic drug use in children, pediatricians, emergency medicine and pediatric intensive care specialists have not enough knowledge and experience about SS that is a potentially life-threatening condition. A 12-year-old girl patient was admitted to our emergency room with the history of involuntary contractions on her extremities and alteration of consciousness. Her physical examination showed agitation, hyperthermia, dilated pupils, tremor, increased deep tendon reflexes, positive spontaneous clonus, agitation, flushed skin and diaphoresis, excessive perspiration, and continuous horizontal ocular movements. The patient diagnosed as SS by clinical history, physical and laboratory findings. In this paper, we will discuss SS occurred in a 12-year-old girl after concurrent clomipramine and risperidone use.
Neuroleptic Malignant Syndrome Associated with Valproate in an Adolescent
Veli Yıldırım,Meltem Çobanogulları Direk,Serkan Güneş,Çetin Okuyaz,Fevziye Toros 대한정신약물학회 2017 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.15 No.1
Neuroleptic malignant syndrome (NMS) is a life-threatening idiosyncratic reaction that usually occurs after the administration of antipsychotic drugs. Antidepressants, benzodiazepines, and antiepileptic drugs are also suggested to be associated with NMS. It is believed to result from a dopaminergic blockade in the central nervous system. NMS is manifested by hyperthermia, muscle rigidity, autonomic dysfunction, altered mental status, leukocytosis, and elevated serum creatinine phosphokinase. Valproate is commonly used in the treatment of many psychiatric and neurologic disorders. Valproate can precipitate NMS, especially when used with antipsychotic drugs concurrently. A 17-year-old male patient, who presented with fever, muscular rigidity, confusion, sweating, and tachycardia was admitted to the emergency room. He had been taking only valproate for the last two months for bipolar disorder. His laboratory analyses revealed raised serum hepatic enzymes, creatinine phosphokinase, and myoglobin levels. Considering fever, rigidity, autonomic dysfunction, cognitive alteration, and high creatinine phosphokinase levels, the patient was diagnosed with NMS. In this paper, we aim to discuss the association between valproate and NMS.
Manic Symptoms Due to Methylphenidate Use in an Adolescent with Traumatic Brain Injury
Ozalp Ekinci,Meltem Çobanoğullari Direk,Nuran Ekinci,Cetin Okuyaz 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.3
Almost one-fifth of children who sustain a traumatic brain injury (TBI) are under the risk of attention problems after injury. The efficacy and tolerability of methylphenidate (MPH) in children with a history of TBI have not been completely identified. In this case report, MPH-induced manic symptoms in an adolescent with TBI will be summarized. A male patient aged 17 years was admitted with the complaints of attention difficulties on schoolwork and forgetfullness which became evident after TBI. Long-acting MPH was administered with the dose of 18 mg/day for attention problems. After one week, patient presented with the complaints of talking to himself, delusional thoughts, irritability and sleeplessness. This case highlights the fact that therapeutic dose of MPH may cause mania-like symptoms in children with TBI. Close monitarization and slow dose titration are crucial when considering MPH in children with TBI.
Risperidone Induced Pisa Syndrome in a Male Adolescent
Serkan Güneş,Özalp Ekinci,Meltem Çobanoğulları Direk,Veli Yıldırım,Çetin Okuyaz,Fevziye Toros 대한정신약물학회 2016 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.14 No.1
Pisa syndrome, a rare dystonic reaction resulting from prolonged exposure to antipsychotic medications, is characterized by persistent dystonia of trunk muscles and abnormal posture. It is called Pisa syndrome, because the abnormal posture resembles the Leaning Tower of Pisa. Different from other types of dystonic reactions, Pisa syndrome is more prevalent in females and in older patients with organic brain changes. A 15-year-old male patient with mental retardation was admitted to pediatric neurology clinic for the complaint of abnormal posturing. He had been taking only risperidone for the last four years. Over the last month, the patient gradually developed tonic flexion of trunk and head toward left and was diagnosed with Pisa syndrome. In this paper, we aimed to discuss the association between risperidone use and Pisa syndrome in light of the available literature.
Determinants of Social Expenditure in Sri Lanka
S. R. Sepalika N. Sudasinghe,Direk Patmasiriwat 한국사회복지학회 2014 Asian Social Work and Policy Review Vol.8 No.1
The study examines the determinants of social expenditure in Sri Lanka for the period 1970–2010. The data are from a new data set assembled by the authors. The social spending data are collectedfrom the Central Bank of Sri Lanka on education, health, and also on welfare spending. The studyexplains the determinants of social spending considering the demand-side and the supply-side drivingforces and finds that inequality issues have been a major concern of social policy in Sri Lanka. Similarly, this study implies the influence of political behavior to satisfy voters as explained by thefiscal illusion theory. The globalization is not significant for social expenditure as commonlyassumed in developed countries. Even the consequences of the self-interested behavior of bureaucratsare not evident in the Sri Lankan welfare sector.
A current perspective on antimicrobial resistance in Southeast Asia
Zellweger, Raphaë,l M,Carrique-Mas, Juan,Limmathurotsakul, Direk,Day, Nicholas P. J,Thwaites, Guy E,Baker, Stephen Oxford University Press 2017 The Journal of antimicrobial chemotherapy Vol.72 No.11
<P><B>Abstract</B></P><P>Southeast Asia, a vibrant region that has recently undergone unprecedented economic development, is regarded as a global hotspot for the emergence and spread of antimicrobial resistance (AMR). Understanding AMR in Southeast Asia is crucial for assessing how to control AMR on an international scale. Here we (i) describe the current AMR situation in Southeast Asia, (ii) explore the mechanisms that make Southeast Asia a focal region for the emergence of AMR, and (iii) propose ways in which Southeast Asia could contribute to a global solution.</P>