35 results on '"Ak AK"'
Search Results
2. Cross-sectional, hospital-based analysis of headache types using ICHD-3 criteria in the Middle East, Asia, and Africa: the Head-MENAA study.
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Genc, H., Baykan, B., Bolay, H., Uluduz, D., Unal-Cevik, I., Kissani, N., Luvsannorov, O., Togha, M., Ozdemir, A. A., Ozge, A., on behalf of Head-MENAA study group, Cakan, M., Ak, AK, Celik, F, Orun, MO, Seker, D, Kucuk, A, Ozkan, S, Kiraz, M, and Sirin, TC
- Subjects
MEDICATION overuse headache ,RESEARCH ,KRUSKAL-Wallis Test ,STATISTICS ,NOSOLOGY ,COVID-19 ,CROSS-sectional method ,MIGRAINE ,ONE-way analysis of variance ,POPULATION geography ,MANN Whitney U Test ,T-test (Statistics) ,HEADACHE ,DATA analysis - Abstract
Background: Headaches are frequent neurological disorders that are yet to be unveiled and treated comprehensively worldwide. Bearing in mind that the distribution of headache subtypes in neurology clinics (NC) is essential for planning appropriate diagnostic and therapeutic approaches, the primary goals of this multi-centric study are to carry out inter-regional comparisons by using current diagnostic criteria with evaluations of neurologists to delineate headache burden. Methods: A cross-sectional study between April 1 and May 16, 2022 was conducted with the participation of 13 countries from the Middle East, Asia, and Africa. Patients were included in the study on a specific day each week during five consecutive weeks. All volunteers over the age of 18 and whose primary cause for admission was headache were examined. The patients admitted to NC or referred from emergency services/other services were evaluated by neurologists by means of the International Classification of Headache Disorders (ICHD-3) criteria. Results: Among the 13,794 patients encountered in NC, headache was the primary complaint in 30.04%. The headache patients' mean age was 42.85 ± 14.89 (18–95 years), and 74.3% were female. According to the ICHD-3 criteria, 86.7% of the main group had primary headache disorders, 33.5% had secondary headaches, 4% had painful cranial neuropathies along with other facial and headaches, and 5.2% had headaches included in the appendix part showing some overlapping conditions. While the most common primary headache was migraine without aura (36.8%), the most common secondary headache was medication-overuse headache (MOH) (9.8%). Headaches attributed to COVID-19, its secondary complications, or vaccines continue to occur at rates of 1.2%-3.5% in current neurology practice. Pain severity was significantly lower in Ivory Coast and Sudan than in Türkiye, Turkish Republic of Northern Cyprus, Iran, Egypt, Senegal, Tatarstan, and Azerbaijan (p < 0.001). Conclusions: The study showed that migraine is still the most common motive for admissions to NC in different regions. Furthermore, MOH, an avoidable disorder, is the most common secondary headache type and appears to be a significant problem in all regions. Remarkably, pain perception differs between regions, and pain intensity is lower in Africa than in other regions. [ABSTRACT FROM AUTHOR]
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- 2023
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3. Integrated Nutrient Management Package for Field Cultivation of Makhana in North Bihar
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Sp Singh, Is. Is. Singh, Ak. Ak. Thakur, Manish Kumar, and Sm. Sm. Raut
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Toxicology ,Farmyard manure ,Crop production ,Nutrient management ,Yield (wine) ,Crop yield ,Soil fertility ,Mathematics ,Field conditions - Abstract
Makhana (Euryale ferox Salisb.) cultivation in field conditions has just begun, making it imperative to develop an integrated nutrient management (INM) package for realizing the yield potential of makhana in north Bihar. A three year experiment was carried out. Application of NPK @75:45:30 kg ha-1 led to a yield improvement of 10% over control, with an additional improvement of 8.2% by NPK @100:60:40 kg ha-1, which was 19% higher than the yield under control. No yield increment was recorded with further increase in NPK i.e. @125:75:50 kg ha-1. However, T3 in combination with FYM @20 t ha-1 caused 22% yield enhancement over NPK @100:60:40 kg ha-1 and 45.2% over control. Even the sole application of FYM @20 t ha-1 resulted in 28% higher yield compared to control and 7.6% yield advantage over NPK @100:60:40 kg ha-1. Clearly, makhana yield was boosted by both NPK and FYM, applied alone or in combination. However, the effect of FYM was more pronounced than that of NPK, implying that the yield of makhana was not limited as much by NPK availability as by the factors contributed by FYM application. FYM-induced increases in organic C and micronutrients could be credited for better yield boosting effect of FYM. To conclude, an INM package consisting of NPK @100:60:40 kg ha-1 with FYM @20 t ha-1 is recommended for materializing the yield potential of makhana in field conditions of north Bihar.
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- 2020
4. Trust in Nurse Scale Developed on the Basis of the Standardized Trust in Physician Scale by Anderson and Dedrick
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Elzbieta Ku, ak ak, Wojciech Ku, Mateusz Cybulski, Krystyna Kowalczuk, Andrzej Guzowski, Cecylia Cecylia, ukaszuk ukaszuk, Jolanta Lewko, Pallav Sengupta, Joanna Chili, ska ska, and Marek Sobolewski
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Original Paper ,Medical treatment ,nurse ,trust ,scale ,Nursing care ,Health services ,Patient satisfaction ,Nursing ,General level ,Scale (social sciences) ,patient ,Construct (philosophy) ,Psychology ,Rank correlation - Abstract
Introduction: Nursing care is one of the most important areas of health services, taking place in direct contact with the patient, constituting a subsystem deciding about the general level of services. Aim: The aim of the study was to construct the Trust in Nurse Scale on the basis of the standardized Trust in Physician Scale by Anderson and Dedrick. Methods: The study included a group of 1,200 people selected at random, 600 each from surgical and medical treatment wards. Patients did not report any problems with understanding the statements on the scale. Results: The internal accuracy scores were excellent, all Cronbach’s a values were well above 0.70. The Spearman’s rank correlation coefficient values were highly statistically significant (p 0.90). Conclusion: We suggest that The Trust in Nurse Scale, developed on the basis of the standardized Trust in Physician Scale by Anderson and Dedrick, can be used in studies on patient satisfaction with nursing care.
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- 2019
5. Trust in Nurse Scale Developed on the Basis of the Standardized Trust in Physician Scale by Anderson and Dedrick
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Ku, Elzbieta, primary, ak, ak, additional, Ku, Wojciech, additional, Cybulski, Mateusz, additional, Kowalczuk, Krystyna, additional, Guzowski, Andrzej, additional, Cecylia, Cecylia, additional, ukaszuk, ukaszuk, additional, Lewko, Jolanta, additional, Sengupta, Pallav, additional, Chili, Joanna, additional, ska, ska, additional, and Sobolewski, Marek, additional
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- 2019
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6. Zonal Changes in the Ultrastructure of the Epididymal Principal cell of the Greater Cane Rat (Thryonomys swinderianus)
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Adebayo, Adebayo, primary, AO, AO, additional, Akinloye, Akinloye, additional, AK, AK, additional, Ihunwo, Ihunwo, additional, Taiwo, Taiwo, additional, VO, VO, additional, Oke, Oke, additional, and BO, BO, additional
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- 2016
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7. Reliability, Validity and Factor Structure of the Persian Translation of General Health Questionnire (GHQ-28) in Hospitals of Kerman University of Medical Sciences
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M Nazifi, HR Mokarami, AK Akbaritabar, M Faraji Kujerdi, R Tabrizi, and A Rahi
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General Health Questionnaire ,Factor Analysis ,Reliability and Validity ,Medicine (General) ,R5-920 - Abstract
Background & Objective: The 28-item General Health Questionnaire (GHQ-28) consists of 4 subscales.Validation of this questionnaire has been carried out by several studies conducted in Iran. Despite the multiplicity of researches which investigated the sensitivity, specificity and reliability of this questionnaire in Iran, few studies have investigated its factor structure. However, it is important to consider if Persian translations of GHQ-28 will indicate the same 4 factors as demonstrated in forign investigations. the aim of the current research was to assess the reliability, validity and the factor structure of the Persian version of GHQ-28.Materials & Methods: The current study was designed based on a survey method. A sample of 415 employees in Kerman hospitals participated in this study and completed the questionnaires.Results: The results showed that GHQ has an appropriate internal consistency for assessing the general health in this sample. Factor analysis using principal component method identified 4 factors in participants’ responses, and these 4 factors accounted for 60% of the total variance. The correlation between GHQ total scores and the Pitsburg sleep quality index was significant at a level smaller than 0.001.Conclusion: According to the evidence of this research it is concluded that explorative factor analysis identifies four factors in the participants’ responses and the fact that this questionnire has an appropriate internal consistency and an adequate validity for the assessment of general health in this sample.
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- 2014
8. Reliability, Validity and Factor Structure of the Persian Translation of General Health Questionnire (GHQ-28) in Hospitals of Kerman University of Medical Sciences
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M Nazifi, HR Mokarami, AK Akbaritabar, M Faraji Kujerdi, R Tabrizi, and A Rahi
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general health questionnaire ,factor analysis ,reliability and validity ,Public aspects of medicine ,RA1-1270 - Abstract
Background & Objective: The 28-item General Health Questionnaire (GHQ-28) consists of 4 subscales.Validation of this questionnaire has been carried out by several studies conducted in Iran. Despite the multiplicity of researches which investigated the sensitivity, specificity and reliability of this questionnaire in Iran, few studies have investigated its factor structure. However, it is important to consider if Persian translations of GHQ-28 will indicate the same 4 factors as demonstrated in forign investigations. the aim of the current research was to assess the reliability, validity and the factor structure of the Persian version of GHQ-28.Materials & Methods: The current study was designed based on a survey method. A sample of 415 employees in Kerman hospitals participated in this study and completed the questionnaires.Results: The results showed that GHQ has an appropriate internal consistency for assessing the general health in this sample. Factor analysis using principal component method identified 4 factors in participants’ responses, and these 4 factors accounted for 60% of the total variance. The correlation between GHQ total scores and the Pitsburg sleep quality index was significant at a level smaller than 0.001.Conclusion: According to the evidence of this research it is concluded that explorative factor analysis identifies four factors in the participants’ responses and the fact that this questionnire has an appropriate internal consistency and an adequate validity for the assessment of general health in this sample.
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- 2013
9. Bleeding patterns and weight gain in users of injectable progestogen-only contraceptives: A retrospective study
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JO Sotunsa, A Inofomoh, AK Akinseku, FI Ani, and AO Olatunji
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Family planning ,contraception ,Noristerat ,Depoprovera ,amenorrhoea ,weight gain ,Medicine - Abstract
Objective: Modern contraceptive methods have been very effective in family planning and well-being. The injectable contraceptives, though effective, had been discontinued by some users because of side effects like abnormal menstrual bleeding and weight gain. This study compared the pattern of menstrual bleeding and weight gain in users of Depot Medroxyprogesterone Acetate (DMPA) and Norethisterone-Enanthate (Noristerat) in Sagamu. Method: A retrospective study of 323 patients who used either DMPA or Noristerat over a 7-year period (January 2007 to December 2013). Data extracted from case notes included bio-data, parity, previous contraceptive methods and reasons for discontinuation of the contraceptives. Clients' weights, pattern of menstrual cycle and side effects were also documented for the ï€rst, second and third visits, and up to 1 year after commencing the injectable contraceptives. Results: The mean age of the participants was 32.72± 5.47 years. About 13.5% experienced no change in their menstrual cycle, but 55.9% and 58.9% of those who used Noristerat and DMPA respectively, had amenorrhoea by the end of one year. The mean weight was 62.89kg±12.84 for Noristerat group and 0.93kg±9.94 for DMPA group at commencement and 65.15kg±13.70 for Noristerat group and 64.05kg±10.30 for DMPA group at the end of one year. There was significant weight gain (p
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- 2015
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10. Cognıtıve functıons in idiopathic intracranial hypertensıon.
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Ak AK, Sarıtas AS, Batum M, Gemici YI, Karakaş B, and Çelebisoy N
- Abstract
Objective: Cognitive problems in idiopathic intracranial hypertension (IIH) is generally overlooked in the presence of disabling headache and threat to visual function. The aim of this study was to search for cognitive deficits in patients with IIH using neuropsychologic tests in addition to P300 potential recordings to assess cognition related brain activity., Methods: Fifty IIH patients were examined using Montreal Cognitive Assessment Test, Stroop Test and Visual Aural Digit Span Test to measure different domains of cognition at the time of diagnosis. P300 potentials were recorded by using an oddball paradigm. Hospital Anxiety and Depression Scale was used to determine anxiety and depression. Quality of life (QoL) was assessed by SF-36. The results were compared with fifty healthy controls with matching age, gender and body mass index., Results: Neuropsychologic tests revealed wide cognitive impairment including attention, working memory, executive function, naming, language, delayed recall and orientation in IIH patients. In addition, quality of life was affected in the sub-parameters of general health perceptions, emotional role functioning, vitality, mental health and bodily pain. P300 potential latencies were long and the amplitudes were reduced indicating deficits in attention and working memory. Anxiety scores were high, and health-related QoL was low mainly involving vitality, emotional and mental health. Cognitive dysfunction was not correlated with the levels of anxiety and the correlation with headache severity was mild., Conclusion: A multidomain cognitive decline mainly involving attention and working memory was recorded in IIH patients. It was not correlated with anxiety and only a mild correlation with headache severity was present which may indicate a casual relationship between raised intracranial pressure and cognitive deficits. Screening is important as neuropsychological rehabilitation might be relevant in these patients., (© 2024. The Author(s) under exclusive licence to Belgian Neurological Society.)
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- 2024
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11. Adaptation into Turkish and Psychometric Properties of Athens Insomnia Scale.
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Elbi H, Batum M, Öztürk EÖ, Balcan MV, Ak AK, Yılmaz H, and Aydemir Ö
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Introduction: The study aimed to adapt the "Athens Insomnia Scale" developed by Soldatos et al. into Turkish and to conduct validity and reliability analysis., Methods: This research was conducted on 215 patients with insomnia complaints and applied to Family Medicine, Neurology (Sleep Polyclinic), and Psychiatry outpatient clinics. Introductory Information Form, 8-item Athens Insomnia Scale, and Pittsburg Sleep Quality Index were administered to the participants. After the language adaptation of the scale, Cronbach's alpha value was used as the consistency coefficient for reliability analysis. Exploratory factor analysis was examined for structural validity, and correlation coefficients between the Athens Insomnia Scale and its subscales and the Pittsburg Sleep Quality Index were examined for concurrent validity., Results: Cronbach's alpha coefficient was calculated as 0.87. "Kaiser-Meyer-Olkin value was calculated for factor analysis." In the Exploratory Factor Analysis, a two-factor structure with eigenvalues >1.0 and explaining 73.4% of the variance was obtained. According to the Exploratory Factor Analysis results for the Atina Insomnia Scale, the absolute value of the factor loadings of the eight items ranged between 0.650 and 0.865. The correlation coefficients between the total score and sub-dimensions of the Athens Insomnia Scale and the Pittsburg Sleep Quality Index-a scale assessing sleep quality were between 0.489-0.725 (p<0,01). For discriminant validity, Athens Insomnia Scale discriminated well between patients and healthy volunteers (Z=2.630, p=0,009)., Conclusion: The Athens Insomnia Scale has been shown to have adequate reliability and validity in Turkish., Competing Interests: Conflict of Interest: The authors declared that there is no conflict of interest., (Copyright: © 2024 Turkish Neuropsychiatric Society.)
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- 2024
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12. Calcitonin gene-related peptide (CGRP) levels in peripheral blood in patients with idiopathic intracranial hypertension and migraine.
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Ak AK, Gemici YI, Batum M, Karakaş B, Özmen EY, Gökçay F, and Çelebisoy N
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- Humans, Calcitonin Gene-Related Peptide, Headache, Prospective Studies, Migraine Disorders, Pseudotumor Cerebri complications
- Abstract
Background: Calcitonin gene-related peptide (CGRP) plays a dominant role in migraine. This prospective study was designed to investigate CGRP levels in patients with idiopathic intracranial hypertension (IIH) and compare the results of migraine patients and healthy controls (HC). As a second objective, CGRP levels obtained from IIH patients defining sustained headache after the resolution of papilledema were compared with those not defining post-IIH headache., Methods: Thirty-six patients with IIH, 36 with episodic migraine (EM), 18 with chronic migraine (CM), and 36 HC were included in the study. CGRP levels were studied from blood samples obtained from the antecubital vein by using a commercial ELISA kit., Results: Serum CGRP levels of the patient groups were significantly higher than the HC (p < 0.001). As compared with controls, both CM (p Adj<0.001) and IIH (p Adj=0.039) had significantly increased levels of CGRP. Levels recorded from EM patients did not differ from the HC (p Adj=0.661). In 16 IIH patients, persistent headache was reported after the normalization of intracranial pressure (ICP). Twenty patients did not report post-IIH headaches. Comparison of serum CGRP levels of these two groups revealed significantly higher CGRP levels in patients with sustained headaches obtained from blood samples both at the initial and control visit (p Adj <0.001)., Conclusions: CGRP levels of the patient groups were higher than the HC. High levels recorded in patients with IIH indicates the role of CGRP in IIH related headache and even higher levels in patients with sustained headache after normalization of ICP strengthens this finding., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)
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- 2024
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13. Prognostic factors in patients with cerebral sinus venous thrombosis presenting with hemorrhage and papilledema.
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Sarıtaş AŞ, Batum M, Ataç C, Öztürk Ü, Yılmaz H, Mavioğlu H, Selçuki D, and Ak AK
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- Humans, Prognosis, Retrospective Studies, Risk Factors, Hemorrhage complications, Papilledema complications, Sinus Thrombosis, Intracranial complications, Sinus Thrombosis, Intracranial diagnostic imaging, Venous Thrombosis complications
- Abstract
Objective: The thromboinflammatory process is considered to play a role in the pathogenesis and prognosis of cerebral sinus vein thrombosis (CSVT). The purpose of the study was to compare the thromboinflammatory parameters between individuals with CSVT and healty controls. Additionally, the study sought to compare these parameters among CSVT subgroups with and without haemorrhage, as well as with and without papilledema. Furthermore, the investigation also aimed to identify which parameters had a more significant impact on the risk of hemorrhage and the development of papilledema in CSVT., Methods: Thromboinflammatory parameters were compared retrospectively between the CSVT group of 88 patients and 80 age- and sex-matched healthy controls, and in the CSVT subgroups with (n = 35) /without hemorrhage (n = 53) and with (n = 52) /without papilledema (n = 36) after ethics committee approval. In both groups, parameters contributing to the risk of hemorrhage and papilledema development were determined by univariate and multivariate analyses., Results: Regarding the risk of hemorrhage in CSVT patients, the most significant factors included hematocrit of <30.2 (%), mean platelet volume of ≤8.9 fL, neutrophil count of >5600, and hsCRP of >9 mg/L. Regarding the risk of papilledema development, the most important risk factors were age of ≤49, presence of vomiting, presence of blurred vision, HDL of >47 mg/dL, and D-dimer of >178 ng/mL., Conclusion: It was suggested that evaluating serum thromboinflammatory parameters, as well as demographic characteristics and neurological examination findings, had a critical role regarding prognosis and predictive factors in CSVT., (Copyright © 2023 Elsevier B.V. All rights reserved.)
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- 2023
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14. Prognostic predictors of remission in ocular myasthenia gravis.
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Çelebisoy N, Orujov A, Balayeva F, Özdemir HN, Ak AK, and Gökçay F
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- Humans, Adolescent, Young Adult, Adult, Middle Aged, Aged, Aged, 80 and over, Prognosis, Diplopia, Retrospective Studies, Antibodies, Thymoma, Myasthenia Gravis diagnosis, Myasthenia Gravis therapy, Myasthenia Gravis complications, Blepharoptosis etiology, Thymus Neoplasms
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Background: Ocular myasthenia gravis (OMG) constitutes 15% of all myasthenia gravis patients., Methods: One hundred eight patients with OMG followed-up for over 36 months were retrospectively evaluated regarding factors associated with remission. Demographic features, neuro-ophthalmologic findings at onset, acetylcholine receptor (AChR Ab) and muscle-specifc tyrosine kinase antibodies (MuSK Ab), thymic status, single fiber electromyography (SFEMG) results were the variables considered., Results: Median age of disease onset was 57 years (range 18-82 years). Clinical features at onset was isolated ptosis in 55 (50.9%) and isolated diplopia in 33 (30.6%) patients. Combined ptosis and diplopia were present in 20 (18.5%) patients. Among 75 patients with ptosis, it was unilateral in 65 (86.7%) and bilateral in 10 (13.3%). AChR Abs were found in 66 (61.1%) and MuSK Abs in 2 (1.9%) patients. SFEMG abnormality was detected in 74 (68.5%) patients. Thymoma was present in 16 (14.8%) and thymic hyperplasia in 6 (5.6%) patients. Forty-one patients (37.9%) had been treated with pyridostigmine alone. Sixty-seven (62%) patients were given immunosupressive drugs. In 53 (49.1%) prednisone was used and in 14 (12.9%) patients it was combined with azathioprine. Thymectomy was performed in all 16 patients with thymoma. Complete stable remission (CSR) was achieved in 49 (45.4%) patients. Fifty-nine (54.6%) patients had reached minimal manifestation (MM) status; 32 (29.6%) having a status of MM-1 and 27 (25%) a status of MM-3., Conclusions: The presence of AchR Abs (p = 0.034) and an abnormal SFEMG (p = 0.006) at onset as increased risk factors for the presence of ongoing signs necessitating medical treatment., (© 2022. The Author(s) under exclusive licence to Belgian Neurological Society.)
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- 2023
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15. Comparison of clinical features in patients with vestibular migraine and migraine.
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Çelebisoy N, Ak AK, Ataç C, Özdemir HN, Gökçay F, Durmaz GS, Kartı DT, Toydemir HE, Yayla V, Işıkay İÇ, Erkent İ, Sarıtaş AŞ, Özçelik P, Akdal G, Bıçakcı Ş, Göksu EO, and Uyaroğlu FG
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- Female, Humans, Retrospective Studies, Vertigo etiology, Vertigo complications, Headache complications, Tinnitus, Migraine Disorders complications, Migraine Disorders epidemiology, Migraine Disorders diagnosis, Motion Sickness epidemiology, Vestibular Diseases complications, Vestibular Diseases epidemiology, Vestibular Diseases diagnosis
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Vestibular migraine (VM) is accepted as the most common cause of spontaneous episodic vertigo. In most patients, vestibular symptoms follow migraine headaches that begin earlier in life. The aim of this multicenter retrospective study was to find out the differences between migraine patients without any vestibular symptoms (MwoV) and VM patients and to delineate the specific clinical features associated with VM. MwoV and VM patients were compared regarding demographic features, migraine headache years, headache attack frequency, intensity, symptoms associated with headache and vertigo attacks, presence of menopause, history of motion sickness and family history of migraine. Four-hundred and forty patients with MwoV and 408 patients with VM were included in the study. Migraine with aura was more frequent in patients with MwoV (p = 0.035). Migraine headache years was longer (p < 0.001) and headache intensity was higher in patients with VM (p = 0.020). Aural fullness/tinnitus was more common in patients with VM (p < 0.001) when all other associated symptoms were more frequent in patients with MwoV (p < 0.001) as well as attack triggers (p < 0.05). Presence of menopause and motion sickness history was reported more frequently by VM patients (p < 0.001). Logistic regression analysis indicated that longstanding history of migraine with severe headache attacks, aural fullness/tinnitus accompanying attacks, presence of menopause, previous motion sickness history were the differentiating clinical features of patients with VM., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
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- 2023
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16. Trigeminal neuralgia following Tolosa-Hunt syndrome.
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Durmaz GS, Ak AK, Gökçay F, and Çelebisoy N
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- Humans, Magnetic Resonance Imaging, Diagnosis, Differential, Tolosa-Hunt Syndrome complications, Tolosa-Hunt Syndrome diagnosis, Trigeminal Neuralgia, Ophthalmoplegia diagnosis, Cavernous Sinus
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- 2022
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17. Comparison of knowledge and awareness of infection control practices among nurses in India: A cross-sectional survey.
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Sodhi K, Arya M, Chanchalani G, Sinha V, Dominic Savio R, Ak AK, Ahmed A, Jagiasi B, Agarwal D, Jagathkar G, Khasne R, Sahasrabudhe SS, Jha SK, Sahoo TK, Mittal V, Hr H, Bansal S, Agarwal C, and Kumar M
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- Humans, Cross-Sectional Studies, Health Knowledge, Attitudes, Practice, Infection Control, Surveys and Questionnaires, COVID-19 prevention & control, Cross Infection prevention & control
- Abstract
Background: Healthcare-associated infections (HAIs) are a significant threat in healthcare settings. Since nurses have the most day-to-day contact with patients, their knowledge about infection control (IC) practices is crucial in preventing HAIs. We therefore conducted a study to assess the knowledge and awareness of IC practices amongst nurses across hospitals in India., Methods: An online survey-based, cross-sectional, descriptive study for nurses was conducted in July-August 2021, through a multiple-choice questionnaire, administered via a web-based link across 13 hospitals from various cities of India. Five different aspects of IC knowledge were assessed including general IC, standard precautions, transmission-based precautions, bundle care knowledge, and COVID-19 related knowledge., Results: Complete data filled by 1,000 nurses was analyzed. The knowledge of nurses varied across different aspects of IC. A statistically significant association was found between the IC knowledge and the years of experience (P = .003) and the area of working (critical vs semi-critical areas) (P < .001) of nurses. A statistically significant difference was also found in the knowledge of nurses from different hospitals depending upon the accreditation (P < .001) and the teaching status (P = .035), but no significant difference based on the city category of hospital (P > .05). Accreditation showed the strongest association {β = 2.499 (95% CI = 1.67-3.32)} while non-teaching status had a negative impact {β = -1.76 (95% CI = 2.543 to -2.543)} on knowledge using multivariate linear regression analysis., Conclusions: Infection prevention and control is the biggest challenge in any hospital and improving the knowledge and awareness of the nurses on the same is fundamental to its success. A multifaceted approach of continuing education programs, training, and feedback should be undertaken towards improving the awareness and compliance to IC practices., (Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)
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- 2022
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18. Evaluation of the visual system with visual evoked potential and optical coherence tomography in patients with idiopathic Parkinson's disease and with multiple system atrophy.
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Batum M, Ak AK, Arı MS, Mayali H, Kurt E, and Selçuki D
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- Electroretinography, Evoked Potentials, Visual, Humans, Quality of Life, Retinal Ganglion Cells, Tomography, Optical Coherence methods, Multiple System Atrophy diagnosis, Parkinson Disease diagnosis
- Abstract
Background: In addition to motor findings, non-motor findings including alterations in visual acuity, decrease in blink reflex, and pupil reactivity cause the impaired quality of life in idiopathic Parkinson's disease (PD) and multiple system atrophy (MSA). Our study aimed to examine possible latency and amplitude changes in pattern visual evoked potentials (pVEP) along with retinal and macular changes in optical coherence tomography (OCT) in PD and MSA groups. We also intended to investigate whether any OCT parameters could be a biomarker for Parkinson's or MSA., Methods: Our study included 50 patients with PD, 15 with MSA, and 50 healthy control subjects. All patients in the study underwent neurological and ophthalmological examination and investigations of OCT to measure the retinal and macular thickness and pVEP to assess visual pathways., Results: When PD, MSA, and control groups were compared, a significant difference was found in all retinal thickness values in average, nasal, and superior retinal nerve fiber thickness (pRNFL), and in all macular thickness values except nasal outer and inferior outer quadrants and in ganglion cell complex (GCC) thicknesses (p < 0.05). Moreover, a significant difference was found in N75, P100, and N145 latencies and N75-P100 amplitude (p < 0.05). The thickness of both pRNFL, inner and outer macular quadrants, was thinner in the MSA group than in PD but GCC thickness was thinner in PD group., Conclusions: The present study compared pVEP and OCT parameters in PD and MSA groups. It was concluded that pVEP and OCT examinations were of importance in that they were easily accessible, affordable, noninvasive biomarkers that might be used in early periods and progression of the disease and in follow-up., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2022
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19. Vestibular migraine and persistent postural perceptual dizziness: Handicap, emotional comorbidities, quality of life and personality traits.
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Ak AK, Çelebisoy N, Özdemir HN, and Gökçay F
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- Dizziness epidemiology, Humans, Personality, Postural Balance, Quality of Life, Vertigo, Medically Unexplained Symptoms, Migraine Disorders complications
- Abstract
Objective: To compare vestibular migraine (VM) and persistent postural-perceptual dizziness (PPPD) regarding dizziness associated handicap, emotional and somatic disorders, health-related quality of life (QoL) and personality traits., Methods: Thirty patients for each group [VM, PPPD and healthy volunteers (HC)] were studied. Dizziness Handicap Inventory (DHI), Beck depression and anxiety scales, Somatic Symptom Scale-8 (SSS-8), Short Form (36) Health Survey (SF 36) and the Big Five Inventory (BFI) were used., Results: DHI sub-scores were significantly high in both patient groups in comparison with the HC (p < 0.001 for all). Emotional (p = 0.001) and functional (p = 0.022) sub-scores of the PPPD patients were worse. Anxiety and somatic symptom scores of VM (p = 0.026 and p < 0.001 respectively) and PPPD (p < 0.001 for both) and depression scores of the PPPD (p = 0.003) were higher than the HC. Both anxiety (p = 0.009) and somatization (p = 0.005) scores of the PPPD patients were higher than the VM. SF-36subscales were affected in both groups (p < 0.05). Vitality (p = 0.002), mental health (p = 0.045) and social role functioning (p = 0.006) of the PPPD group were worse than the VM. Higher scores for neuroticism (p < 0.001) was present for both groups. Scores for extraversion was low in PPPD patients (p = 0.010) in comparison with the HC., Conclusion: Dizziness associated handicap, anxiety and somatic symptom burden is high in both groups, even higher in PPPD with additional depression. Severe impairment in QoL is present with more severe impairment in emotional aspects in patients with PPPD. Neuroticism is a common personality trait for both groups with additional introversion in PPPD., Competing Interests: Competing interests The authors declare that they have no competing interests., (Copyright © 2022. Published by Elsevier B.V.)
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- 2022
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20. The REM-sleep-related characteristics of narcolepsy: a nation-wide multicenter study in Turkey, the REMCON study.
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Akyildiz UO, Tezer FI, Koc G, Ismailogullari S, Demir AB, Ak AK, Sunter G, Kara KA, Berktas DT, Sahin A, Azman F, Akcay BD, Gok DK, Yilmaz H, Agan K, Bekmezci Y, Yetkin S, Aksu M, Karadeniz D, and Senel GB
- Subjects
- Adolescent, Adult, Female, Humans, Male, Orexins, Retrospective Studies, Sleep, Sleep, REM physiology, Turkey, Young Adult, Narcolepsy diagnosis, REM Sleep Behavior Disorder diagnosis
- Abstract
Introduction: Narcolepsy type 1 (NT1) is caused by hypocretin deficiency, the pathophysiology of narcolepsy type 2 (NT2) has not been delineated. Except for the hypocretin deficiency and cataplexy, all clinical and laboratory features used in the diagnosis of NT2 are identical to those used for NT1. The aim of this study was to assess the rapid eye movement (REM) sleep-related characteristics in the patients with narcolepsy; the characteristics of REM sleep in polysomnography (PSG) and multiple sleep latency test (MSLT) recordings, the quantification of REM sleep without atonia (RSWA) and atonia index, and the analysis of rapid eye movements (REMs) during REM sleep., Materials and Methods: This study was planned by the Sleep Medicine Study Group of the Turkish Neurology Society, and conducted in 11 centers in eight cities in Turkey. The analysis of RSWA was analyzed by reviewing all REM sleep periods on nocturnal PSG and MSLT recordings per standard criteria. The total duration of the increased muscle tone during REM sleep in the chin and bilateral leg electromyography (EMG) recordings was calculated as RSWA index. The REMs index was also investigated the relation to the RSWA., Results: A total of 274 patients were involved; 147 patients (53.6%) were males and 127 patients (46.4%) were females; the mean age was 29.1 ± 12.0 years. The diagnosis of NT1 was made in 166 patients (60.6%), and 108 patients (39.4%) were diagnosed as having NT2. The mean Epworth sleepiness scale score was significantly higher in patients with NT1 than the patients with NT2 (P = 0.001). The diagnosis of REM sleep behavior disorder (RBD) was made in 19.3% of the patients with NT1 versus in 2.8% of the patients with NT2 (P < 0.001). The percentage of SOREMP in PSG recordings was significantly higher in patients with NT1 (37.1%) than those with NT2 (18.9%, P = 0.001). MSLT showed that the mean sleep latency was shorter in patients with NT1 compared to those with NT2 (P < 0.001). The total duration of REMs on electrooculography recordings was also significantly higher in patients with RSWA in comparison with the patients without RSWA (P = 0.002). Total duration of REMs was significantly and positively correlated with the duration of RSWA on chin-EMG and leg-EMG recordings (P = 0.001). ROC analyses showed an RSWA index of ≥2% for the RSWA on chin-EMG with a sensitivity of 86.7% and a specificity of 71.3% (P < 0.001). The REMs index ≥20% was associated with the presence of RSWA with a sensitivity of 70.0% and a specificity of 57.1% (P = 0.008)., Conclusions: In this nation-wide study, we identified for the first time that the increase in REMs density during REM sleep may be a major correlate of the RSWA. Significant positive correlations were demonstrated between the total duration of REMs on electrooculography recordings and the mean durations of RSWA in both chin and leg EMG recordings. A REMs index of >20% was demonstrated to have a moderate sensitivity and specificity in the diagnosis of RSWA. As observed in chin RSWA index, REMs index also showed a significantly high association with RBD, in comparison to RSWA per standard criteria., (Copyright © 2022 Elsevier B.V. All rights reserved.)
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- 2022
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21. Herpes Simplex Encephalitis
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AK AK and Mendez MD
- Abstract
Herpetic infections have been well documented even in ancient Greek literature. Herpes viruses are large double-stranded DNA viruses. There are eight different types of herpes viruses affecting humans (human herpes virus (HHV)). Herpes simplex encephalitis is an acute or subacute illness associated with focal or global cerebral dysfunction caused by herpes simplex viruses belonging to either type 1(HSV-1) or type 2(HSV-2). The vast majority of herpes simplex encephalitis is caused by HSV-1, with HSV-2 constituting only less than 10%.[1] Almost all of the herpes encephalitis beyond the neonatal period is caused by herpes simplex type 1(HSV-1), which is identified as the most common cause for fatal encephalitis, occurring in a sporadic and non-seasonal pattern across the globe. Herpes encephalitis in neonates could be either due to HSV-1 or HSV-2 though the latter is more common. HSV-2 can also cause encephalitis in immunocompromised patients. Herpes simplex 1 encephalitis (HSV-1) in adults is associated with significant morbidity and death despite treatment with antiviral therapy. Herpes simplex encephalitis is again a devastating disease in infants and children irrespective of treatment.[2] Neonatal encephalitis caused by HSV-2 involves the brain more globally, and it results in more neurologic sequelae., (Copyright © 2022, StatPearls Publishing LLC.)
- Published
- 2022
22. Rhino-orbital Cerebral Mucormycosis
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AK AK and Gupta V
- Abstract
Taxonomically, the term 'zygomycosis' was used to describe invasive fungal infections caused by Zygomycetes, which are ribbon-shaped (about 5-15 microns in diameter) irregularly branched pauciseptate or aseptate molds that reproduce sexually via the formation of zygospores. Subsequently, a reclassification followed, dividing the above species into two orders, Mucorales and Entomopthorales.[1] The term mucormycosis denotes the acute or subacute rapidly progressing infections caused by the angioinvasive fungi in the order of Mucorales, though there are rare reports of indolent disease.[2][3] The fungus is unique to cause devastating disease in patients with poorly controlled diabetes mellitus and immunocompromised patients, and often causes significant morbidity and mortality. The rare incidence of mucormycosis in apparently immunocompetent patients has also been documented. The commonest clinical manifestation is rhino-orbital cerebral mucormycosis.[4] Though mucormycosis exhibits a variety of clinical syndromes with isolated involvement of the gastrointestinal system, skin, kidney, and central nervous system, the commonest and most devastating manifestations are rhino-orbital cerebral, and pulmonary syndromes. Isolated presentations of mucormycosis have also been reported predominantly involving the middle ear, parotid gland, mediastinum, heart and valves, uterus, urinary bladder, and lymph nodes. Disseminated mucormycosis is reported rarely in immunocompromised patients and premature infants., (Copyright © 2022, StatPearls Publishing LLC.)
- Published
- 2022
23. Role of CD4+ T Cells in Parkinson's Disease.
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Ghanta MK, Nuthalapati P, Merchant N, Chenchula S, Hussain F, Ak AK, and Bhaskar LVKS
- Subjects
- Humans, Brain metabolism, CD4-Positive T-Lymphocytes, Parkinson Disease therapy, Parkinson Disease pathology
- Abstract
Parkinson's disease (PD) is a progressive condition that affects both the central nervous system and other body parts that are controlled by the nervous system. PD is characterized by brain dopaminergic neurons loss and, at present, there are only symptomatic treatments available to alleviate the effects of the disease. With extensive research, new insights have led to defining PD as a multi-system disorder with immune dysfunction playing a dominant part in the disease pathogenesis as well as its progression. Neuroinflammation in PD leads to neurodegeneration, which is, in turn, regulated by the peripheral adaptive immunity, with CD4+ T cells being a significant player. Patients with PD have diverse CD4+ T cell phenotypes and functional profiles. These phenotypes vary, from being proinflammatory (Th1 and Th17) to anti-inflammatory (Th2 and Tregs). This report focuses on reviewing the expression of CD4+ T cells in PD and its role in the prognosis and treatment of PD.
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- 2022
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24. Tracheobronchial Tear
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AK AK and Anjum F
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Tracheobronchial tear or laceration or injury is an uncommon injury to the tracheobronchial tree, usually involving the trachea or both the right and left main stem bronchi, and is associated with significant morbidity and mortality. For this discussion, tracheobronchial tears could be defined as a partial or complete laceration or puncture anywhere in the tracheobronchial tree secondary to a blunt or penetrating trauma or due to iatrogenic interventions. Almost 80% of the tracheobronchial injuries in blunt trauma are expected to cause death on the site or during transport to the hospital, given multiple severe associated injuries. However, outcomes appear to be improving following better pre-hospital management. A high index of suspicion, early diagnosis, and management of tracheobronchial injuries are essential for a favorable outcome., (Copyright © 2022, StatPearls Publishing LLC.)
- Published
- 2022
25. Variation in therapeutic strategies for the management of severe COVID-19 in India: A nationwide cross-sectional survey.
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Jagiasi B, Nasa P, Chanchalani G, Ahmed A, Ak AK, Sodhi K, Mangal K, Singh MK, Gupta N, Bidkar PU, Tyagi RS, Khanikar RG, Tripathy S, Khanzode S, Subba Reddy K, Saigal S, Sivakumar VA, Javeri Y, and Tekwani SS
- Subjects
- Cross-Sectional Studies, Humans, Immunization, Passive, India epidemiology, Pandemics, SARS-CoV-2, COVID-19 Serotherapy, COVID-19 therapy
- Abstract
Aim: During the pandemic of coronavirus disease 2019 (COVID-19), the physicians are using various off-label therapeutics to manage COVID-19. We undertook a cross-sectional survey to study the current variation in therapeutic strategies for managing severe COVID-19 in India., Methods: From January 4 to January 18, 2021, an online cross-sectional survey was conducted among physicians involved in the management of severe COVID-19. The survey had three sections: 1. Antiviral agents, 2. Immunomodulators, and 3. Adjuvant therapies., Results: 1055 respondents (from 24 states and five union territories), of which 64.2% were consultants, 54.3% working in private hospitals, and 39.1% were from critical care medicine completed the survey. Remdesivir (95.2%), antithrombotics (94.2%), corticosteroids (90.3%), vitamins (89.7%) and empirical antibiotics (85.6%) were the commonly used therapeutics. Ivermectin (33%), convalescent plasma (28.6%) and favipiravir (17.6%) were other antiviral agents used. Methylprednisolone (50.2%) and dexamethasone (44.1%) were preferred corticosteroids and at a dose equivalent of 8 mg of dexamethasone phosphate (70.2%). There was significant variation among physicians from different medical specialities in the use of favipiravir, corticosteroids, empirical antibiotics and vitamins., Conclusion: There is a considerable variation in the physicians' choice of therapeutic strategies for the management of severe COVID-19 in India, as compared with the available evidence., (© 2021 John Wiley & Sons Ltd.)
- Published
- 2021
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26. Ischemic chiasmal syndrome associated with posterior communicating artery (PCoA) and tuberothalamic artery (TA) infarction: a case report.
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Ataç C, Ak AK, Batum M, Arı S, Ovalı GY, and Çelebisoy N
- Subjects
- Cerebral Angiography, Cerebral Infarction, Humans, Magnetic Resonance Imaging, Basilar Artery, Circle of Willis
- Abstract
Lesions affecting the body of the optic chiasm typically produce bitemporal hemianopia. The blood supply comes from the anterior communicating artery, anterior cerebral, posterior communicating, posterior cerebral, and basilar arteries. We herein report a young patient admitted to the emergency department with acute confusion, left-sided hemiparesis, hemihypoesthesia, and dysarthria. Bitemporal hemianopia was detected after resolution of confusion. On cranial magnetic resonance imaging (MRI), infarction in the right anterolateral thalamus in the territory of tuberothalamic artery (TA) and in posterior chiasma in the territory of the posterior communicating artery (PCoA) was revealed. Cerebral MR angiography showed luminal irregularity of the PCoA. The patient was presented to draw attention to the rare entity ischemic chiasmal syndrome.
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- 2021
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27. Lymphangitic Carcinomatosis
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AK AK and Mantri SN
- Abstract
Lymphangitis carcinomatosis is the malignant infiltration and inflammation of lymphatic vessels secondary to the metastatic spread of malignancy from a primary site. The carcinomatous infiltration of the lymphatic vessels almost always occurs in the pulmonary interstitial lymphatics (pulmonary lymphangitic carcinomatosis) though rare reports of lymphangitic carcinomatosis of skin, duodenum & kidney(non-pulmonary lymphangitic carcinomatosis) have been described in the literature.[1][2][3] Our focus of attention in this review is about pulmonary lymphangitic carcinomatosis, which almost always represents the clinical form of lymphangitic carcinomatosis. The terms pulmonary lymphangitic carcinomatosis & pulmonary tumor embolism represent end-stage manifestations of malignancies and have been used synonymously in the literature given highly similar clinical & radiological features though the former represents a pathology predominantly restricted to the interstitium with absent tumor cells in pulmonary arteries and or capillaries, whereas the latter demonstrates the presence of tumor cells inside the pulmonary vessels. Dr. Gabriel Andral was the first to describe pulmonary lymphangitic carcinomatosis in 1829 in a case of uterine malignancy.[4] Subsequently, Troissier & Reynaud made a detailed description of the gross anatomy & histopathology in 1874. Although pulmonary lymphangitic carcinomatosis usually represents an end-stage malignancy with poor life expectancy, reports of increased survival have been observed in recent literature.[5] The commonest causes for lymphangitic carcinomatosis include breast, lung, stomach, prostate, pancreas, colon, cervix, & uterine malignancies., (Copyright © 2021, StatPearls Publishing LLC.)
- Published
- 2021
28. Post Intubation Laryngeal Edema
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AK AK and Cascella M
- Abstract
Laryngeal injuries are common after endotracheal intubation, which could manifest as varying degrees of edema, ulceration, granulation, and restricted vocal cord mobility, often resulting in luminal narrowing. Among these conditions, laryngeal edema is a common complication following intubation and usually results from the direct pressure and the inflammatory reaction triggered by the endotracheal tube on surfaces of contact. Nevertheless, although laryngeal edema is documented to be present in almost half of the extubated patients, the majority are asymptomatic or mildly symptomatic. On the other hand, laryngeal edema represents a common cause for breathing difficulty and/or stridor following extubation, thereby makes a common etiology for extubation failure and the need for reintubation. Thus, because reintubation is associated with augmented morbidity and mortality, the issue of post-intubation laryngeal edema is of paramount importance and needs for careful prevention and proper management.[1] Post-intubation laryngeal edema (rather than the term 'post-extubation laryngeal edema') might be a more appropriate term to denote laryngeal edema, which has got the potential to cause respiratory difficulty and/or stridor following extubation. The pathologic process, which results in edema, indeed, starts soon after intubation though it becomes clinically evident only after removal of the endotracheal tube. The prompt recognition and management of post-intubation laryngeal edema before extubating a patient is extremely important, given the fact that any reintubation event could increase the morbidity and mortality of the patients.[2] In this chapter, we discuss the etiology, epidemiology, clinical evaluation, and management of post-intubation laryngeal edema, highlighting the need for identification in high-risk patients with a prompt institution of preventive and treatment measures. The interprofessional team strategies for improving care coordination and communication and, in turn, outcomes will also be addressed., (Copyright © 2021, StatPearls Publishing LLC.)
- Published
- 2021
29. Ventilator-Induced Lung Injury (VILI)
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AK AK and Anjum F
- Abstract
Ventilator-induced lung injury (VILI) is the acute lung injury inflicted or aggravated by mechanical ventilation during treatment. Ventilator-induced lung injury could occur during invasive as well as non-invasive ventilation and might contribute significantly to the morbidity and mortality of critically ill patients. Though mechanical ventilation potentially injures both normal and diseased lungs, the injury will be much more severe in the latter due to higher microscale stresses. Ventilator-induced lung injury (VILI) has been used synonymously with ventilator-associated lung injury (VALI). However, the latter terminology is more appropriate when the lung injury is strongly presumed to be due to ventilation but lacking any strong evidence to confirm the same. The concept of injury by mechanical ventilation dates back to 1744 when John Fothergill, after successful resuscitation of a patient by mouth to mouth respiration, expressed the view that mouth to mouth ventilation might be a better option than machine bellows in resuscitation since the latter could potentially harm the lungs with the uncontrolled push of air. Investigators during the 1952 polio epidemic had documented structural lung damages caused by mechanical ventilation.[1] In 1967, the term “respirator lung” was coined to describe the post mortem lung pathology of patients who had undergone mechanical ventilation and whose lungs showed extensive alveolar infiltrates and hyaline membrane formation.[2] Further confirmatory evidence for ventilator-induced lung injury comes from the landmark ARDS Nett trial, where low tidal volume ventilation was proved to be superior to high tidal volume ventilation in ARDS patients.[3], (Copyright © 2021, StatPearls Publishing LLC.)
- Published
- 2021
30. Fever In the Intensive Care Patient
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Achaiah NC and AK AK
- Abstract
Temperature is one of the most important vital signs to be monitored in all patients, including intensive care units (ICU). Fever or hypothermia often necessitates further physical evaluations, investigations, and change in treatment in the ICU. The definition of fever in the ICU is different from the usual definition of fever. Fever in an ICU patient is defined as a single temperature of ≥101 degrees F or ≥38.3 as per the American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) joint task force.[1] Also, the ACCCM and IDSA recommend that fever in ICU should be investigated only if the temperature is ≥101 degrees F. Hyperpyrexia or hyperthermia is defined as a temperature of more than 105.8 degrees F (or 41 degrees C) and is uncommonly encountered in intensive care settings. In immunocompromised or neutropenic patients, a lower threshold should be considered for fever diagnosis as these patients do not mount an appropriate febrile response. Also, the clinical, laboratory and radiological, manifestations of inflammation/infection would be scanty or absent in these patients, at least in the initial stages. Fever in a neutropenic ICU patient is defined as a single temperature more than 101 degrees F (38.3 degrees C), or a temperature more than 100.4 degrees F (38.0 degrees C) sustained for more than one hour in a patient with an absolute neutrophil count (ANC) less than 500 cells/mm.[2][3] One also needs to be aware that extracorporeal therapies, including continuous renal replacement therapy or extracorporeal membrane oxygenation, could mask or alter the febrile response. Fever is expected to provide a protective effect and help the host eliminate the invading organisms. Also, fever is associated with increased mortality and morbidity in ICU patients and forms part of mortality prediction scores, including APACHE II & III. However, studies on fever and mortality in ICU patients have been unequivocal. A large 2008 epidemiological study had shown that a temperature more than ≥ 39.5 degrees C was associated with increased mortality in critically ill patients, and the mere presence of temperature ≥38.3 degrees C failed to produce any association with mortality.[4] A subsequent study (FACE) published in 2012 reported that higher 28-day mortality observed with temperature more than ≥ 39.5 degrees C occurred in non-septic patients and not in patients with sepsis.[5] Certain studies have also shown an inverse relation between fever and mortality in ICU and emergency patients.[6][7] The fever in the ICU could merely be a continued manifestation of the disease/disorder that prompted the ICU admission or could result from certain unique etiologies in the ICU, and very rarely due to the flare-up or manifestation of an underlying dormant disease or disorder. The fever unique to the ICU settings could result from interventions or therapies provided during ICU care or the patient manifesting new-onset fever due to SIRS, septic, metabolic or neuroendocrine response. In this review, we are predominantly discussing the fever in non-neutropenic or non-immunocompromised ICU patients. However, clinical and/or management-related overlaps between different patient groups are not unexpected., (Copyright © 2021, StatPearls Publishing LLC.)
- Published
- 2021
31. Hypoplastic Lung Disease
- Author
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Tisekar OR and AK AK
- Abstract
Pulmonary hypoplasia is a rare congenital anomaly characterized by incomplete development of the lung tissue. There are impaired gaseous exchange and respiratory insufficiency due to a decrease in the number of airways and alveoli.[1] Primary forms of idiopathic lung hypoplasia are rare, with the vast majority of cases occurring due to other developmental fetal abnormalities. In 1912, Schneider classified abnormal development of lung into three types, modified by Boyden in 1955 as: Type 1 (Agenesis): The complete absence of pulmonary parenchyma, bronchus, and vessels. Type 2 (Aplasia): The complete absence of pulmonary parenchyma but the presence of a rudimentary bronchus on the affected side. Type 3 (Hypoplasia): The presence of variable amounts of pulmonary parenchyma with a decrease in the number of lung cells, airways, and alveoli.[2]. The extent of hypoplastic pulmonary tissue depends on the timing of the insult during the stages of fetal lung maturation. The maturation arrest happens during the pseudo glandular stage between 5 to 17 weeks of gestation. During this stage, lung development depends on mechanical stimuli. An imbalance of the pressure between the extraluminal space and intraluminal airway results in compression of the lung(s) tissue and resultant hypoplastic lung tissue. The clinical course ranges from fatal respiratory insufficiency in neonates (severe form) to chronic lung disease with recurrent respiratory infections (mild form) in adulthood.[3], (Copyright © 2021, StatPearls Publishing LLC.)
- Published
- 2021
32. High Frequency Ventilation
- Author
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Murthy PR and AK AK
- Abstract
High-frequency ventilation (HFV) is a type of ventilation that is utilized when conventional ventilation fails. It is a technique where the set respiratory rate greatly exceeds the normal breathing rate. In this rescue strategy, the tidal volume delivered is significantly less and can also be less than dead space ventilation.[1] A few stated advantages of this technique are: It reduces the risk of volutrauma and thus helps prevent ventilator-induced lung injury. It also maintains constant alveolar inflation and thus prevents the inflate - deflate cycle and improves oxygenation. There are mainly four types of HFV.[2]: 1. High-frequency oscillatory ventilation (HFOV). 2. High-frequency positive pressure ventilation (HPPV). 3. High-frequency jet ventilation (HJV). 4. High-frequency percussive ventilation (HFPV). HFOV (High-Frequency Oscillatory Ventilation) This is one of the most common methods of HFV. It is most often used as a rescue strategy when conventional ventilation fails in severe ARDS. In this technique, the tidal volume set is less than dead space ventilation, and respiratory rates are very high, ranging from 300 to 900 /minute. The technique uses a reciprocating diaphragm to deliver very high respiratory rates and is connected to a standard endotracheal tube. The primary setting is mean airway pressure (MAP) as the flow oscillates around a constant MAP due to high respiratory rates (frequency). The settings involved are respiratory rate (or frequency), which is set directly, and MAP, which most often is set by adjusting inspiratory flow rates and expiratory valve (PEEP). In some machines, the MAP is set directly. The tidal volume delivered is very low and is less than anatomical dead space. The tidal volume is also known as amplitude and is determined by various factors like the size of the endotracheal tube used and respiratory rate/ frequency set.[3] The mechanism of maintaining constant mean airway pressure helps in alveolar recruitment and improvement of oxygenation. The low tidal volumes prevent volutrauma and ventilator-induced lung injury (VILI). It is used as one of the rescue methods in patients with severe ARDS when conventional ventilation has failed. In neonatal patients, HFOV can be used in premature lungs as the first line to prevent lung injury by conventional ventilation. HJV (High-Frequency Jet Ventilation) This method is mainly used in neonates. In this technique, a jet of gas is delivered via a 14 -16 gauge cannula inserted in the endotracheal tube. It delivers a respiratory rate of about 100 to 150 per minute. It provides very low tidal volumes of less than 1ml per kg. Exhalation is passive. It is often combined with conventional ventilation for the reinflation of lungs. Taylor dispersion is the most common method of gas exchange in HFJV.[4] HFPPV (High-Frequency Positive Pressure Ventilation) It is delivered using a conventional ventilator in which the respiratory rates are set at maximum limits. This technique is obsolete and is rarely used. HFPV (High-Frequency Percussive Ventilation) This involves a combination of high-frequency ventilation and conventional ventilation (pressure control mode). It can be described as HFOV oscillating between two different pressure levels. It is presumed to have lesser risks of barotrauma and also improve oxygenation when compared to conventional ventilation alone. The general requirements of sedation and paralysis are lesser in this mode compared to other methods of HFV. It is also more efficient in clearing secretions.[4], (Copyright © 2021, StatPearls Publishing LLC.)
- Published
- 2021
33. Relationships Between Components of Emotional Intelligence and Suicidal Behavior in Alcohol-dependent Patients.
- Author
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Kopera M, Jakubczyk A, Klimkiewicz A, Suszek H, Krasowska A, Brower KJ, and Wojnar M
- Subjects
- Adult, Affect, Depression, Female, Humans, Logistic Models, Male, Middle Aged, Neuroticism, Poland, Psychiatric Status Rating Scales, Risk Factors, Self Report, Alcoholism psychology, Emotional Intelligence, Suicide, Attempted psychology
- Abstract
Objectives: The importance of investigating various emotional skills in assessment of suicide risk in alcohol-dependent (AD) individuals has recently become the focus of increasing interest. The objective of this study was to explore the relationships between self-reported components of emotional intelligence and lifetime prevalence of suicide attempts in a clinical sample of AD subjects., Methods: A group of 80 inpatients entering an alcohol treatment program in Warsaw, Poland, was recruited. Baseline information about demographics, psychopathological symptoms, personality, and severity of alcohol problems was obtained. The Schutte Self-Report Emotional Intelligence Test was utilized for assessment of emotional processing. Lifetime history of suicide attempts was obtained from the MINI International Neuropsychiatric Interview., Results: After accounting for affect-related suicide risk factors (severity of depression, anxiety, neuroticism), and also other significant predictors (eg, age, sex, history of childhood abuse), mood regulation/optimism deficits remained a significant correlate of lifetime suicide attempts in AD patients. In the mediation models, mood regulation appeared to fully mediate the relationship between history of suicide attempts and depression, and also neuroticism., Conclusions: The results of this study support the evidence that poor mood regulation might be related to the risk for suicidal behavior in AD individuals. These findings point towards the significance of addressing the issue of emotion-related skills in the therapy of those AD subjects who are at risk for suicide.
- Published
- 2018
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34. An Experimental Study to Evaluate the Effect of Memantine in Animal Models of Anxiety in Swiss Albino Mice.
- Author
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Bagewadi HG, Ak AK, and Shivaramegowda RM
- Abstract
Background: Due to the adverse effects produced by the present conventional medicines for anxiety disorders, research for newer drugs is still desirable. From the literature it is evident that NMDA receptors play a key role in animal models of anxiety., Aim: The present study is done to evaluate the antianxiety effect of memantine in swiss albino mice., Materials and Methods: The experimental study was conducted from November 2014 to January 2015. Animals were divided into four groups. Twelve mice were randomly allotted in each group. Animals in the first group received normal saline as a control 10ml/kg, lorazepam 0.5mg/kg was administered to second group, memantine 3mg/kg as a test drug was given to the third group and memantine 3mg/kg + lorazepam 0.5mg/kg was administered to the fourth group. All the drugs were given for 7 consecutive days by intraperitoneal route., Results: Results were analyzed by one-way ANOVA followed by Post-hoc Tukey's test. On the 1(st) day, memantine treated group did not show statistical significant anxiolytic effect in both the behavioural paradigms when compared to control group. On the 8(th) day, the animals showed significant decrease p<0.001 in step down latency period in shock free zone (185.4±3.87 Vs 278.3±5.49), significant increase p<0.001 in step down errors (6.8±0.78 Vs 1.4±0.19) and significant increase p<0.001 in total time spent in shock zone (32.1±2.22 Vs 5.6±0.6). In open field test, on 8(th) day the animals treated with memantine when compared to control group, showed significant increase p<0.001 in number of squares crossed (112.7± 2.69 Vs 83.2±2.96), time spent in central square (11.5±1.26 Vs 3.4±0.65), no. of rearings (32.4±2.61 Vs 17±1.81) and significant decrease p<0.001 in freezing time (15.2±1.12 Vs 20.2±2.29). Memantine showed synergistic antianxiety effect when combined with lorazepam., Conclusion: Memantine showed significant anxiolytic effect in open field and passive avoidance response tests which are commonly used experimental models to assess anxiety states in animals.
- Published
- 2015
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35. Leukocytoclastic vasculitis induced by subcutaneous injection of human insulin in a patient with type 1 diabetes and essential thrombocytemia.
- Author
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Mandrup-Poulsen T, Mølvig J, Pildal J, Rasmussen AK AK, Andersen L, Skov BG, and Petersen J
- Subjects
- Diabetes Mellitus, Type 1 blood, Female, Glycated Hemoglobin analysis, Humans, Immunosuppressive Agents therapeutic use, Injections, Subcutaneous, Insulin administration & dosage, Leukocytes drug effects, Middle Aged, Skin pathology, Vasculitis, Leukocytoclastic, Cutaneous drug therapy, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 1 drug therapy, Insulin adverse effects, Leukocytes pathology, Thrombocythemia, Essential complications, Vasculitis, Leukocytoclastic, Cutaneous chemically induced
- Published
- 2002
- Full Text
- View/download PDF
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