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Objective Music is a very crucial art form that can evoke emotions, and the harmonious presence of the human voice in music is an impactful part of this process. As a result, vocals have had some significant effects on contemporary music. The mechanism behind the cochlear implant (CI) recipients perceiving different aspects of music is clear; however, how well they perceive vocal tuning within music it is not well known. Hence, this study evaluated the mistuning perception of CI recipients and compared their performance with normal-hearing (NH) listeners. Study Design, Setting, and Patients A total of 16 CI users (7 cisgender men, 9 cisgender women) and 16 sex-matched NH controls with an average age of 30.2 (±10.9; range, 19-53) years and 23.5 (±6.1; range, 20-37) years, respectively, were enrolled in this study. We evaluated the mistuning ability using the mistuning perception test (MPT) and assessed self-perceived music perception and engagement using the music-related quality-of-life questionnaire. Test performance was measured and reported on the item-response theory metric with a z score ranging from -4 to +4. Results A significant difference in the MPT scores was found between NH and CI recipients, whereas a significant correlation was noted between the music-related quality-of-life questionnaire-frequency subscale and MPT scores. No significant correlations were found between age, CI age, and CI usage duration and MPT performance. Conclusions This study revealed that musical mistuning perception is a limitation for CI recipients, similar to previously evaluated aspects of music perception. Hence, it is important to consider this aspect in the assessment of music perception, enjoyment, and music-based auditory interventions in CI recipients, as vocals are paramount in music perception and recreation. The MPT is a convenient and accessible tool for mistuning assessment in CI and hearing-aid users.

© 2022 American Academy of Hospice and Palliative MedicineContext: The COVID-19 pandemic has highlighted variability in intensity of care. We aimed to characterize intensity of care among hospitalized patients with COVID-19. Objectives: Examine the prevalence and predictors of admission code status, palliative care consultation, comfort-measures-only orders, and cardiopulmonary resuscitation (CPR) among patients hospitalized with COVID-19. Methods: This cross-sectional study examined data from an international registry of hospitalized patients with COVID-19. A proportional odds model evaluated predictors of more aggressive code status (i.e., Full Code) vs. less (i.e., Do Not Resuscitate, DNR). Among decedents, logistic regression was used to identify predictors of palliative care consultation, comfort measures only, and CPR at time of death. Results: We included 29,923 patients across 179 sites. Among those with admission code status documented, Full Code was selected by 90% (n = 15,273). Adjusting for site, Full Code was more likely for patients who were of Black or Asian race (ORs 1.82, 95% CIs 1.5–2.19; 1.78, 1.15–3.09 respectively, relative to White race), Hispanic ethnicity (OR 1.89, CI 1.35–2.32), and male sex (OR 1.16, CI 1.0–1.33). Of the 4951 decedents, 29% received palliative care consultation, 59% transitioned to comfort measures only, and 29% received CPR, with non-White racial and ethnic groups less likely to receive comfort measures only and more likely to receive CPR. Conclusion: In this international cohort of patients with COVID-19, Full Code was the initial code status in the majority, and more likely among patients who were Black or Asian race, Hispanic ethnicity or male. These results provide direction for future studies to improve these disparities in care.

Giriş ve Amaç: Parkinson hastalığı (PH) beyinde dopaminerjik kayıpla giden nörodejeneratif bir hareket bozukluğudur. Spontan göz kırpma sıklığı (SGKS) da beynin dopamin kaynakları hakkında bilgi veren bir belirteç olduğu bilinmektedir. Bu bağlamda, Türkiye’deki Parkinson hastalarında spontan göz kırpma sıklığının ortaya konması, bu sıklığa etki eden faktörlerin araştırılması ve bir biyoelirteç olarak klinik PH alt tiplerini belirlemede SGKS’nin değerinin belirlenmesi için bu çalışmayı tasarladık.Gereç ve Yöntemler: Çalışmamız için Temmuz 2016-Temmuz 2021 tarihleri arasında Koç Üniversitesi Nöroloji Bölümüne başvuran ve en az bir dakikalık muayene videosu mevcut olan 168 hasta retrospektif olarak taranmıştır. Dosyalarından PH teşhisi olan 119 hasta çalışmaya dahil edilmiştir. Hastaların 1 dakikadaki göz kırpma sayıları ile takip bilgileri arasındaki ilişki için analizler gerçekleştirilmiştir. Bulgular: Çalışmamıza katılan hastaların medyan yaşı 60 (52-69) olarak saptanmıştır. Katılımcılardan 41 tanesi (%35) kadındır. Grubumuzun spontan göz kırpma sıklığı 12 (6-25)/dk olarak ölçülmüştür. Göz kırpma sıklığı ikili lojistik regresyon analizlerinde, cinsiyet, hastalık süresi, hastalık klinik tipi ve l-dopa eşdeğer dozu ile beraber değerlendirildiğinde yaşla ilişkili bulunmuştur (p=0,021).Sonuç: Sonuç olarak SGKS yaşla beraber düşüş göstermektedir. Parkinson hastalarında spontan göz kırpma sıklığı, cinsiyet, hastalık süresi, hastalık klinik tipi ve kullanılan dopaminerjik ilaçların l-dopa eşdeğer dozundan bağımsız olarak hastanın yaşı ile ilişkilidir. Bu nedenle SGKS, Parkinson hastalığı popülasyonunda kategorizasyon için güçlü bir biyobelirteç olarak kullanılamaz., Objective: Parkinson's disease (PD) is a neurodegenerative movement disorder with dopaminergic loss in the brain. Frequency of spontaneous eye blink (FSEB) is also known to be a marker that provides information about the brain's dopamine sources. In this context, we designed this study to reveal the frequency of spontaneous eye blink in Parkinson's patients from Turkey and to investigate the factors affecting this frequency. And also, we would like to show the power of FSEB in the differential diagnosis of PD clinical subtypes.Materials and Methods: For our study, 168 patients who applied Koc University Neurology Department between 2016 July and 2021 July and had at least one-minute examination video were retrospectively scanned. One hundred nineteen patients diagnosed with PD from their files were included in the study. Analyzes were performed for the relationship between the patients' number of spontaneous eye blinks in 1 minute and the follow-up information.Results: The median age of the patients participating in our study was 60 (52-69) years. Forty-one (35%) were women. The frequency of spontaneous eye blink of our group was measured as 12 (6-25)/min. In regression analysis for blink frequency, age was found to be the predictor when evaluated together with sex, disease duration, clinical subtype, and l-dopa equivalent dose (P=0.021).Conclusion: As a result, the frequency of spontaneous eye blink decreases with age. The frequency of spontaneous blink in patients with Parkinson's disease is associated with age, regardless of gender, disease duration, disease clinical subtype, and the l-dopa equivalent dose of dopaminergic drugs used. Therefore, FSEB cannot be used as a potent biomarker for categorization in the PD population.

BackgroundDespite the primary myelin-related pathophysiology, small fiber neuropathy (SFN) and axonal degeneration are also considered to be involved and associated with disabling symptoms and impaired quality of life in chronic inflammatory demyelinating polyneuropathy (CIDP). Demonstration of SFN usually requires complex or invasive investigations.ObjectsIn vivo corneal confocal microscopy (IVCCM) has evolved as a non-invasive, easily applied method for quantification of small fiber involvement in peripheral nerve disorders. We aimed to investigate the potential role of IVCCM in CIDP.MethodsIn this cross-sectional study, 15 patients with CIDP underwent assessment with clinical disability scales, neuropathic pain (NP) and autonomic symptom questionnaires, nerve conduction studies, and IVCCM. IVCCM parameters were analyzed and compared to those from 32 healthy controls.ResultsCorneal nerve fiber density (CNFD) and corneal nerve fiber length (CNFL) were significantly decreased in the CIDP group, compared to those in controls (p = 0.03 and p = 0.024, respectively). Langerhans cells and fiber tortuosity were increased in CIDP patients (p = 0.005 and p = 0.001, respectively). IVCCM parameters were significantly lower in patients with NP compared to those in patients without NP.ConclusionIVCCM shows promise as a non-invasive complementary biomarker in the assessment of demyelinating polyneuropathies, providing insights into the potential pathophysiology of these non-length-dependent neuropathies.

Giriş ve Amaç: Akut inmeye bağlı mortalite ve morbidite oranları yüksek olduğundan bu hastaların erken prognoz öngörüsünü yapmak önemlidir. Acil serviste iskemik ya da hemorajik inme tanısı alan hastaların Ortalama trombosit hacmi (MPV), Platelet (PLT) ve MPV/PLT değerleri ile hastaların demografik özellikleri, triaj kodu, sonlanımı, hastaların vital parametreleri ve Glaskow Koma Skalası (GKS) arasındaki ilişki değerlendirilmeye çalışılmıştır.Gereç ve Yöntemler: Bu çalışma 3. Basamak Üniversite Hastanesi Acil servisine başvuran 18 yaş üstü, yapılan tetkikler neticesinde iskemik veya hemorajik inme tanısı alan 200 hasta üzerinde retrospektif olarak yapılmıştır.Bulgular: Çalışmamıza 116 (%58)’sı erkek olmak üzere toplam 200 hasta dahil edilmiştir. Hastaların yaş ortalaması 68 yıl olarak tespit edilmiştir. Hastaların 178 (%89)’inin iskemik, 22 (%11)’sinin hemorajik inme tanısı aldığı görüldü. Hastaların yaşı ve MPV/PLT oranları arasında korelasyon bulunmuştur (p, Objective: Since mortality and morbidity rates due to acute stroke are high, it is important to predict early prognosis in these patients. The relationship between mean platelet volume (MPV), Platelet (PLT) and MPV/PLT values of patients diagnosed with ischemic or hemorrhagic stroke in the emergency department, and demographic characteristics, triage code, outcome, vital parameters of patients, and Glasgow Coma Scale (GCS) were tried to be evaluated.Materials and Methods: This study was carried out retrospectively on 200 patients over the age of 18 who applied to the 3rd Stage University Hospital Emergency Department and were diagnosed with ischemic or hemorrhagic stroke as a result of the examinations.Results: A total of 200 patients, 116 (58%) of whom were men, were included in our study. The mean age of the patients was 68 years. It was seen that 178 (89%) of the patients were diagnosed with ischemic stroke and 22 (11%) with hemorrhagic stroke. A correlation was found between the patients'age and MPV / PLT ratios (p

Introduction:Muscle weakness and easy fatigability are the clinical hallmarks of myasthenia gravis (MG). However, fatigue perception, which can be seen quite often in myasthenic patients, and its effect on the quality of life, irrespective of motor deficit, has not been elucidated yet. The aim is to evaluate the frequency of fatigue in myasthenic patients with nearly full muscle strength and the effect of fatigue on quality of life by assessing its correlation with other symptoms.Methods:Fifty-three patients with ocular or mild generalized MG in remission or minimal manifestations completed the questionnaires measuring the severity of MG and quality of life (MG Composite Scale and MG-Activities of Daily Living Profile). Both patient group and control group (53 healthy volunteers)completed the scales assessing fatigue [Fatigue Assessment Scale (FAS) and Fatigue Impact Scale (FIS)], depression [Beck Depression Inventory (BDI)] and sleep (Epworth Sleepiness Scale). Disease severity was assessed using MG Foundation of America (MGFA) and MGFA Post-Intervention Status classifications.Results:FAS, FIS physical and BDI scores were significantly higher in patients compared to the control group (p = 0.003, p = 0.001, and p = 0.003, respectively) and fatigue was associated with depression and daytime sleepiness. Inpatient group, depressive symptoms and daytime sleepiness were higher in females (p = 0.019 and p = 0.013). The mean values of FIS total and cognitive scores were higher in patients with generalized MG (p = 0.033 and p = 0.045). Fatigue scores correlated with motor signs.Discussion:Fatigue can be seen in MG independently from muscle weakness and is an important symptom worsening the quality of life.

Purpose: Arteriovenous malformations with basal ganglia, brainstem, and thalamic locations represent complex vessel anomalies with critical areas. Treatment of these central lesions is related to high morbidity and mortality rates. This retrospective study aims to examine the results of our clinic's patients with basal ganglia, brainstem, and thalamic arteriovenous malformations remedied with gamma knife radiosurgery (GKS).Method: The results of patients with basal ganglia, thalamus, and brainstem located AVM who underwent GKS from May 2005-December 2020 were analyzed in the Gazi University Gamma Knife Unit.Results: A total of 859 patients with intracranial AVM were treated at the Gamma Knife Unit of the Gazi University Neurosurgery Clinic between May 2005-December 2020. Seventy-three patients with basal ganglia, brainstem, and thalamic locations were recorded. In a total of 73 patients who were included in the study, the lesion was located in the basal ganglia in 14 (19.2%), the brainstem in 13 (17.8%), and the thalamic region in 46 (63%) patients. The mean volume of AVMs was 4565,54 mm3. The patients who underwent embolization before gamma knife surgery treatment were found to be 19.2%. The mean of AVMs' obliteration time after SRS is 38.4 months. We detected that there was no significant statistical rate relationship between obliteration rate and AVMs volume, Spetzler - Martin Grading Scale, nidus type, gender, and prior embolization (p>0.05).Conclusions: GKS is one of the effective choice treatment methods used for cerebral AVMs today. Furthermore, it has been accepted as the first choice treatment method, especially in central AVMs, which are risky in terms of mortality and morbidity, and also with good outcomes., Amaç: Bazal gangliyon, beyin sapı ve talamik yerleşimli arteriovenöz malformasyonlar (AVM) kritik bölgede yerleşmiş kompleks damar anomalileridir. Bu santral yerleşimli lezyonların tedavisi yüksek morbidite ve mortalite riski taşır. Çalışmamızda bazal ganglion, beyin sapı ve talamik yerleşimli AVM nedeniyle kliniğimizde gamma knife radyocerrahi uygulanmış hastaların sonuçları retrospektif olarak incelenmesi amaçlandı.Gereç ve yöntem: Mayıs 2005-Aralık 2020 tarihleri arasında Gazi Üniversitesi Gamma Knife Ünitesinde tedavi edilmiş bazal gangliyon, talamus ve beyin sapı yerleşimli AVM hastalarının sonuçları incelendi.Bulgular: Mayıs 2005-Aralık 2020 tarihleri arasında Gazi Üniversitesi Gamma Knife Ünitesinde toplam 859 intrakraniyal AVM hastası tedavi edildi. Bazal ganglion, beyin sapı ve talamik lokalizasyonu olan 73 hasta çalışmaya dahil edildi. Çalışmamıza dahil edilen toplam 73 hastanın 14'ü (%19,2) bazal ganglionda, 13'ü (%17,8) beyin sapında ve 46'sı (%63) talamik bölgede yer alıyordu. Ortalama AVM hacmi 4565,54 mm3 olarak hesaplandı. Gamma knife cerrahisi tedavisinden önce embolizasyon uygulanan hastaların oranının %19.2’idi. SRS sonrası AVM'lerin ortalama tam kapanma sürelerinin 38,4 aydı. AVM hacmi, Spetzler Martin derecelendirme ölçeği, nidus tipi, cinsiyet ve önceki embolizasyon ile kapanma oranı arasında istatistiksel olarak anlamlı ilişkisi saptanmadı (p>0.05).Sonuç: GKS günümüzde serebral AVM tedavisinde kullanılan etkin bir tedavi yöntemidir. GKS özellikle tedavisi yüksek morbidite ve mortalite riski içeren santral yerleşimli AVM tedavisinde başarılı sonuçları ile öncelikli tercih edilen tedavi yöntemlerindendir.

Background Trunk stabilization, which is a factor that directly afects the performance of afected upper-limb movements in stroke patients, is of critical importance in the performance of selective motor control. Aims This study aimed to investigate the efects on upper-limb motor function of the addition of robotic rehabilitation (RR) and conventional rehabilitation (CR) to intensive trunk rehabilitation (ITR). Methods A total of 41 subacute stroke patients were randomly allocated to two groups: RR and CR. Both groups received the same ITR procedure. Following ITR, a robot-assisted rehabilitation program of 60 min, 5 days a week, for 6 weeks, was applied to the RR group, and an individualized upper-limb rehabilitation to the CR group. Assessments were made at baseline and after 6 weeks using the Trunk Impairment Scale (TIS), Fugl-Meyer Upper Extremity Motor Evaluation Scale (FMA-UE), and Wolf Motor Function Test (WMFT). Results Improvements were obtained in the TIS, FMA-UE, and WMFT scores for both groups (p0.05). The RR group scores were relatively high, but not to a statistically signifcant. Conclusions When added to intensive trunk rehabilitation, the robot-assisted systems, which are recommended as a standalone therapy method, produced similar results to conventional therapies. This technology can be used as an alternative to conventional methods under appropriate conditions of clinical opportunity, access, time management, and staf limitations. However, when RR is combined with traditional interventions such as intensive trunk rehabilitation, it is essential to investigate if the real efect is due to the robotic rehabilitation or the accumulation of positive efects of excessive movement or force spread associated with trained muscles. Registration This trial was retrospectively registered in the ClinicalTrials.gov with NCT05559385 registration number (25/09/2022).

Purpose: Publications have shown that playing massively multiplayer online role-playing games (MMORPGs) can increase the risk of depression, social withdrawal, and anxiety. In the current study, we compared adolescents who play MMORPGs to those who do not on anxiety and depression symptoms, sleep disturbances, and anger-related problems. Methods: The participants included 52 adolescents (aged 12–18 years) who play MMORPGs and a control group of age and gender-matched adolescents. Subjects completed the State-Trait Anger Scale (STAXI), Children’s Depression Inventory (CDI), Pittsburgh Sleep Quality Index (PSQI), and Screen for Child Anxiety Related Emotional Disorders Child Version (SCARED) questionnaires. Results: Anxiety, depressive symptoms, and anger-related problems were higher in adolescents who played MMORPGs than those who did not. The scores of trait anger, anger in, and anger-out subscales showed a positive correlation with the CDI scores, while the anger control scores showed a negative correlation (p < 0.05). Subjective sleep quality, sleep disturbances, sleep functionality subscale, and total PSQI scores of adolescents who played MMORPGs showed a significant relationship with SCARED scores (p < 0.05). The sleep latency showed a positive correlation with the scores on CDI scales. Conclusions: Consequently, as anxiety problems increase, subjective sleep quality decreases, frequent sleep disturbances impair adolescents\" daily functioning and the risk of sleep disturbances increases in adolescents who play MMORPGs. In addition, an increase in depressive symptoms prolongs sleep latency and decreases total sleep time. When depressive symptoms increase in adolescents who play MMORPGs, they also have more anger problems.

© 2023 Wiley Periodicals LLC.Aim: The aim of the study is to compare the intra- and inter-observer interpretations of the same uroflowmetry study at two different times. Materials and Methods: Two-hundred children with a voided volume of 50% above the expected bladder capacity were included. All traces were asked to be evaluated by 11 observers two times in a time span of 1 month. These observers consist of pediatric urologists (n = 2), pediatric urology fellows (n = 2), urology residents (n = 5), and certified urodynamics nurses (n = 2). Each uroflowmetry was asked to be assessed for three domains: voided volume (VV), detrusor sphincter dyssynergia (DSD), and flow curve pattern (FCP). Results: Of the 200 patients with a median age of 10 (4–18) years, 128 (64%) were girls and 72 (36%) boys. The maximum flow rate and the median voided volume were found to be 20 (4–61) mL/s and 232 (116–781) mL. The Fleiss\" kappa coefficient of VV, DSD, and FCP in the first assessment was 0.510, 0.501, and 0.346. In the second assessment, κ values were 0.530, 0.422, and 0.373. The best-agreed findings were similar at both times. These were found to be low VV (0.602 and 0.626) and intermittent pattern (0.500 and 0.553). Interpreters were found to have a statistically significant difference in agreement with their own interpretation at different times. Conclusion: Both inter- and intra-observer reliability of the agreement point out the problem in the standardization of uroflowmetry. Inter- and intra-observer reliability of uroflowmetry interpretation can be increased by defining precise numbers and numerical algorithms.

Background/Aim: As coronavirus infectious disease 2019 (COVID-19) spreads worldwide, there is increasing evidence of an association between COVID-19 and vascular diseases. However, there are limited data on the clinical characteristics, stroke mechanisms, and prognosis of stroke patients with COVID-19. We aimed to evaluate the clinical and laboratory features and prognosis of patients with COVID-19 who were followed up due to acute ischemic stroke.Methods: Fifty-six patients with a confirmed diagnosis of COVID-19 and acute ischemic stroke were included in this retrospective study. The demographic characteristics, medical history, symptoms, clinical, laboratory and imaging findings of the patients were evaluated retrospectively. The patients were divided into two groups according to the modified Rankin Scale (mRS) score in the first month, as those with good or poor prognosis. Results: There were forty (71%) males, 16 (29%) females, and their overall mean age was 69.21 (8.77) (55-90) years. Fifty (89.2%) of 56 patients had pneumonia findings in chest computed tomography. The mortality rate was 35.7% (n=10) and 26 patients (46.4%) had a poor prognosis according to the mRS scores. Increased C-reactive protein and D-dimer levels were associated with mortality in the COVID-19 positive acute ischemic stroke patients (P=0.035, P=0.023).Conclusion: The COVID-19–associated coagulopathy increases mortality and grossly affects the course of the infectious process. Inflammation markers may be associated with poor prognosis in stroke patients with COVID-19.

Background/Aim: Migraine is a common, disabling neurological disorder and cranial nerve blocks (CNB) are used in the treatment of headaches. This study aimed to compare the effectiveness of a CNB with conventional medical treatment in patients with chronic migraine resistant to first-line treatment.Methods: This retrospective cohort study included 102 patients with chronic migraine resistant to first-line treatment who were treated in our outpatient clinic. The patients were divided into two groups as those who underwent CNB (n=67) and the control group, who were only treated with conventional drugs (n=35). Bilateral CNB was performed on the patients at baseline and in the second week. The patients’ Visual Analogue Scale (VAS) scores, number of days in pain, and the number of analgesics taken were recorded at baseline and the second month.Results: The second-month VAS scores and the number of days in pain were significantly lower than baseline in both the CNB and control groups (P

© 2022 European Sleep Research Society.Studies describing paediatric sleep patterns are needed by taking culture into consideration. The aim of this study was to identify parent-reported sleep–wake patterns in young children and explore possible factors influencing sleep problems. The mothers of 2,434 young children enrolled from well-child outpatient clinics in Turkey completed an online survey including sociodemographic variables, Brief Infant Sleep Questionnaire, Edinburgh Postnatal Depression Scale and Generalised Anxiety Disorder scales. Overall, young children in Turkey go to bed late (10:00 p.m.), awaken twice per night for 30 min, and obtain 11.5 h of total sleep, showing no sex-specific differences. Distinct night-time sleep patterns emerged after 18 months of age. Importantly, although currently breastfed healthy children were 3.8-times less likely to sleep through the night, total sleep duration and exclusive breastfeeding duration were higher in children who were not sleeping through the night. Overall, bedsharing was identified in 11.5%, and only room sharing was reported in 52.9%. Parental perception of a child's sleep as problematic was 35.8%. Mothers with higher educational attainment were more likely to perceive their children's sleep as a problem. Maternal depressive and anxious symptoms and a history of excessive infant crying were the determinants predicting the likelihood of both parent-perceived sleep problems and poor sleepers. The present analysis of sleep structure in infancy and toddlerhood provides reference data for well-child visits. These findings highlight the importance of considering maternal anxiety, depression and behaviour management techniques to cope with fussy infants in addressing childhood behavioural sleep problems.

© The Academy of Spinal Cord Injury Professionals, Inc. 2022.Purpose: This study was conducted to determine the dyadic adjustment between individuals with SCI and their spouses and the relationship between their sexual self-consciousness and sexual life and to evaluate it according to the objectification theory. Method: This descriptive and cross-sectional study was conducted with 131 married individuals with SCI registered in the physical therapy and rehabilitation outpatient clinic of a university hospital between February 2020 and April 2021. The data of the study were collected using a Descriptive Information Form, the American Spinal Injury Association Impairment Scale (ASIA), the Dyadic Adjustment Scale (DAS), the Sexual Self-Consciousness Scale (SSCS), and the Arizona Sexual Experiences Scale (ASEX). In the study, the predictors of the sexual life of individuals with SCI were evaluated with the Stepwise Multiple Linear Regression analysis. In addition, predictors of sexual dysfunction in individuals with SCI were evaluated by the logistic regression analysis. The results were discussed within the framework of objectification theory. Results: According to the results of the study,.67.2% of the individuals with spinal cord injuries experienced sexual functionality problems; increased age, falling injuries, and being in ASIA grade A increased sexual self-awareness and sexual dysfunction; and being a male with SCI increased sexual focus. It was found that the adjustment between individuals with SCI and their spouses was a predictor that significantly reduced sexual embarrassment, sexual self-consciousness, and sexual dysfunction and that the strong adjustment between couples was an important factor for the prevention of sexual dysfunction development. Conclusion: It was found that most individuals with spinal cord injuries experienced sexual dysfunction. The importance of dyadic adjustment and sexual self-consciousness has come to the fore in the sexual life of these individuals.

Introduction Patients with Duchenne muscular dystrophy (DMD) have lost their access to on-site rehabilitation due to the COVID-19 pandemic. Telerehabilitation can be a viable approach for these patients to protect their muscle strength and functional status. The aim of this study is to compare telerehabilitation with home-based video exercises. Patients and methods Male, ambulatory DMD patients were randomized into telerehabilitation and video-exercise groups. Nineteen patients were included in the fnal analyses. Telerehabilitation consisted of live online exercises, while video exercise implemented a pre-recorded video as a home-based program. Both programs spanned 8 weeks, three times a week. Patients’ muscle strength with a hand-held dynamometer, Quick Motor Function Test, North-Star Ambulatory Assessment (NSAA), 6-Minute Walk Test (6MWT) and Caregiver Burden were recorded before and after treatment. Results The 6MWT of the telerehabilitation group was391.26±95.08 m before and387.75±210.93 after treatment (p=0.94) and 327.46±103.88 m before treatment and313.77±114.55 after treatment in video group (p=0.63). The mean NSAA score of the telerehabilitation group were26.70±8.04 before treatment and 25.20±11.33 after treatment (p=0.24). In the video group scores were 21.66±6.65 before to 22.00±8.61 after treatment (p=0.87). There were no signifcant changes between groups at the end of the treatments. The telerehabilitation group's neck extension, bilateral shoulder abduction, and left shoulder fexion, bilateral knee fexion and extension, bilateral ankle dorsifexion, and left ankle plantar fexion strength improved signifcantly and were better than the video group (p

Amaç: Genç erişkinlerde serebrovasküler hastalık (SVH) insidansı dünyada yaklaşık 100.000'de 6-26'dır ve bu oran her yıl artmaktadır. Genç erişkinlerde inme etiyolojisi, yaşlılara göre daha çeşitlidir ve kapsamlı tanısal çalışma gerektirir. Çalışmamızın amacı, kliniğimizde son 10 yıldır takip edilen 45 yaş ve altı inme hastalarında risk faktörlerini ve inme etiyolojisini belirlemek ve literatürle karşılaştırmaktır.Gereç ve yöntem: Çalışmaya Pamukkale Üniversitesi Nöroloji Kliniği’nde Ocak 2010-Kasım 2020 tarihleri arasında İskemik SVH ile takip edilen 18-45 yaş arası hastalar dahil edilmiştir. Hastaların klinik ve demografik verileri retrospektif olarak incelenmiştir.Bulgular: En sık görülen risk faktörü sigara (%31,4) iken; hipertansiyon (%20,2), diabetesmellitus (%14,4), hiperlipidemi (%14,4) ve koroner arter hastalığı (%11,6) bunu izlemekteydi. Trial of Org in AcuteStrokeTreatment (TOAST) sınıflamasına göre etiyoloji: %13,4 büyük damar hastalığı, %19,8 küçük damar hastalığı, %16,7 kardiyoembolizm, %11,5 diğer etiyoloji idi ve hastaların çoğunu (%38,6) etiyolojisi belirlenemeyen inmeler oluşturuyordu. Belirlenen diğer etiyolojide en sık neden Antifosfolipid Antikor Sendromu idi.Sonuç: Genç erişkinlerde inme insidansı her yıl artmakta olup, altta yatan nedenlerin belirlenmesi ve etiyolojisine yönelik tedavi verilmesi gerekmektedir. Böylece, bakım maliyetlerinin, işgücü kaybının önüne geçilmesine ve genç hayatların kurtarılmasına katkıda bulunulacaktır., Purpose: The incidence of cerebrovascular disease (CVD) in young adults is approximately 6-26 per 100,000 worldwide, and this numbers are increasing every year. Stroke aetiology among young adults are more diverse than those among older adults and require extensive diagnostic work-up. The aim of our study is to determine risk factors and stroke etiology in stroke patients aged 45 years and younger, followed in our clinic for the last 10 years, and to compare them with literature.Materials and methods: The study is included in the patients between the age of 18-45 years and are followed by Ischemic CVD in Pamukkale University Neurology clinic between January 2010 and November 2020.The clinical and demographic data of the patients were retrospectively analyzed.Results: The most common risk factor was smoking (31.4%); hypertension (20.2%), diabetes mellitus (14.4%), hyperlipidemia (14.4%) and coronary arterial disease (11.6%) were following it. According to Trial of Org in Acute Stroke Treatment (TOAST)classification there were, large vessel disease in 13.4%, small vascular disease in 19.8%, cardioembolism in 16.7%, other determined aetiology in 11.5% and the most frequently stroke of undetermined etiology in 38.6%. The most common reason in other determined aetiology was Antiphospholipid Antibody Syndrome.Conclusion: The incidence of young stroke is increasing every year and it is necessary to determine the underlying reasons to prevent and to give treatment for aetiology. Thus this will contribute to head off major health care costs, loss of workforce and to save young lives.

Cervical radiculopathy and spinal cord indentation caused by vertebral artery loop formation is a rare entity. We report here an 85-year-old woman had a four-year history of neck pain and left arm weakness. Radiologic evaluation showed vertebral artery loop formation compressing the adjacent nerve root and spinal cord. Accurate radiologic diagnosis of this condition is crucial to reduce unexpected surgical complications.

Purpose The aim of the study was to present the systematic review and meta-analysis of the psychometrical analysis of Facial Disability Index (FDI) studies. Methods A literature search was conducted in the relevant electronic databases “PubMed, Scopus, Web of Science (WoS), and Cochrane Library.” A total of 621 articles were obtained by searching the relevant keywords (PubMed: 384, Cochrane Library: 14, Web of Science: 132, Scopus: 91). A total of 8 papers were included. The four-point classifcation and ratingbased “COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)” tools were used to evaluate the bias risk and evidence levels. Results Cronbach’s alpha pooling of FDI total score was (ES): 0.803 (95% CI: 0.73–0.86). Heterogeneity for the Facial Disability Index-Physical Function (FDI-PF) and Facial Disability Index-Social Function (FDI-SF) subscore based on intraclass correlation coefcient (ICC) were I 2=84.2% (ICC: 0.88, 95% CI: 0.81–0.92) and I 2=73.7% (ICC: 0.87, 95% CI: 0.81–0.90), respectively. Correlational results between Sunnybrook Facial Grading System (SFGS) with FDI-PF and FDI-SF were 0.38 and 0.22, respectively. The correlations of FDI-PF with Short Form-12 Physical Component Summary (SF-12-PCS) and Short Form-12 Mental Health Component Summary (SF-12-MCS) were 0.43 and 0.28, respectively. Correlation results of FDI-SF with SF-12-PCS and SF-12-MCS were 0.23 and 0.57. The relationship results of Facial Clinimetric Evaluation with FDI-PF and FDI-SF were 0.71 and 0.57, respectively. Conclusion FDI is a psychometrically valuable questionnaire, especially for the internal consistency, reliability, and validity. In clinical practice, the use of FDI would be valuable, in addition to clinician-based grading, to see more of patients’ social infuences precisely.

New molecular therapies are available for the treatment of spinal muscular atrophy (SMA) but early intervention is required. We report two cases that were diagnosed prenatally, where treatment with nusinersen was initiated within 7 h and three days respectively. The children were followed up for 13 months and almost six years respectively. Both children have developed within entirely normal centiles, indicating that initiating treatment immediately after birth, as in these cases, is essential for a good outcome.

Berln Anket, Stop-Bang Anket Yrd. Doç. Dr. Ferda İlgen Uslu Bezmialem Vakıf Üniversitesi Tıp Fakültesi, Nöroloji Anabilim Dalı, İstanbul Obstrüktif uyku apne sendromu (OUAS), her ırk, cinsiyet ve sosyoekonomik düzeyde sık görülen bir uyku bozukluğudur. Tanısı esas olarak anamnez ve polisomnografi (PSG) incelemesinde dayansa da PSG çalışmaları; pahalı, eğitimli eleman ve deneyim gerektiren, zaman alan incelemelerdir. Ayrıca toplumda sık görülen uyku hastalıklarını incelemek için yeterli uyku laboratuvarı da yoktur (Netzer ve ark., 1999; Chung ve ark., 2008a) Bu nedenle hastaları inceleme öncesi taramak hasta seçimi açısından gereklidir ve anketler bu aşamada en önemli yol göstericilerdir. İdeal bir solunumsal uyku bozukluğuna ait hastalıkları tarama anketi, yanlış negatif sonuçlardan kaçınmak için yüksek bir duyarlılığa sahip olmalı, ayrıca düşük riskli hastaların maliyetli ve zaman alıcı incelenmelerini önleyecek kadar da özgün olmalıdır (Marti-Soler ve ark., 2016). Erişkinlerde uykuda apne varlığının anket yolu ile taranması hem pratik olması hem de maliyet etkinliği açısından önemlidir. Bu bölümde günlük pratikte ve klinik çalışmalarda en sık kullanılan iki anket olan Berlin anketi (BA) ve STOPBANG anketinden bahsedilecektir.

© 2022 International League Against Epilepsy.Objective: The link between headache and epilepsy is more prominent in patients with idiopathic/genetic epilepsy (I/GE). We aimed to investigate the prevalence of headache and to cluster patients with regard to their headache and epilepsy features. Methods: Patients aged 6–40 years, with a definite diagnosis of I/GE, were consecutively enrolled. The patients were interviewed using standardized epilepsy and headache questionnaires, and their headache characteristics were investigated by experts in headache. Demographic and clinical variables were analyzed, and patients were clustered according to their epilepsy and headache characteristics using an unsupervised K-means algorithm. Results: Among 809 patients, 508 (62.8%) reported having any type of headache; 87.4% had interictal headache, and 41.2% had migraine. Cluster analysis revealed two distinct groups for both adults and children/adolescents. In adults, subjects having a family history of headache, ≥5 headache attacks, duration of headache ≥ 24 months, headaches lasting ≥1 h, and visual analog scale scores > 5 were grouped in one cluster, and subjects with juvenile myoclonic epilepsy (JME), myoclonic seizures, and generalized tonic–clonic seizures (GTCS) were clustered in this group (Cluster 1). Self-limited epilepsy with centrotemporal spikes and epilepsy with GTCS alone were clustered in Cluster 2 with the opposite characteristics. For children/adolescents, the same features as in adult Cluster 1 were clustered in a separate group, except for the presence of JME syndrome and GTCS alone as a seizure type. Focal seizures were clustered in another group with the opposite characteristics. In the entire group, the model revealed an additional cluster, including patients with the syndrome of GTCS alone (50.51%), with ≥5 attacks, headache lasting >4 h, and throbbing headache; 65.66% of patients had a family history of headache in this third cluster (n = 99). Significance: Patients with I/GE can be clustered into distinct groups according to headache features along with seizures. Our findings may help in management and planning for future studies.

OBJECTIVE The objective of this study was to propose a new skull outline–based method to objectively quantify complex 3D skull shapes and frontal and supraorbital retrusion in metopic craniosynostosis using 3D photogrammetry. METHODS A standard section from 3D photogrammetry, which represents the trigonocephalic shape, was used in this study. From the midpoint of the area of this section, half diagonals were calculated to the skull outline at 5° increments in the anterior half of the head. These half diagonals were used to create a sinusoidal curve, and the area under the sinusoidal curve (AUC) was used to represent the mathematical expression of the trigonocephalic head shape. The AUC from 0° to 180° (90° from the midline to each side) was calculated and is referred to as AUC0→180. The AUC from 60° to 120° (30° from the midline to each side) was also calculated and is referred to as AUC60→120. A total of 24 patients who underwent endoscopic strip craniectomy and 13 age- and sex-matched controls were included in the study. The AUC values obtained in patients at different time points and controls were analyzed. RESULTS The mean preoperative AUC60→120 and AUC0→180 in the patients were significantly lower than those in control individuals. The increase in both AUC60→120 and AUC0→180 values is statistically significant at the discontinuation of helmet therapy and at final follow-up. Receiver operating characteristic curve analysis indicated that AUC60→120 is a more accurate classifier than AUC0→180. CONCLUSIONS The proposed method objectively quantifies complex head shape and frontal retrusion in patients with metopic craniosynostosis and provides a quantitative measure for follow-up after surgical treatment. It avoids ionizing radiation exposure.

Background: Despite acute and preventive treatments for ischemic stroke, it remains a cause of high mortality and morbidity due to recurrence of ischemic stroke. The generally accepted point of view is that the risk factors that caused the initial stroke are also important in the recurrence of ischemic stroke. Our study was conducted to determine the risk factors involved in early ischemic stroke recurrence.Method: We selected ischemic stroke patients from our own stroke database, and among the patients included in this study, 521 patients who could be followed up for 3 months after the first stroke and had complete examinations were included in the analysis.Result: Seventy-one patients (14%) had another stroke within 3 months of the first stroke. The mean time to early stroke recurrence is 21 days. Significant risk factors for early stroke were coronary artery disease (43%, p, Amaç:İskemik inme gelişen akut ve koruyucu tedavilere rağmen, iskemik inmenin tekrarlaması nedeniyle de yüksek ölüm ve morbidite nedeni olarak kalmaya devam etmektedir. Genellikle kabul edilen görüş, ilk inmeye neden olan risk faktörlerinin, iskemik inme tekrarında da önemli olduğudur. Bizim çalışmamız erken dönem iskemik inme tekrarında yer alan risk faktörlerini belirlemek amacıyla yapılmıştır.Yöntem:İskemik inme hastalarını kendi inme veri tabanımızdan seçtik ve bu çalışmaya alınan hastalar içinde ilk inmeden sonraki dönemde 3 ay takip edilebilen ve incelemeleri eksiksiz olan 521 hasta analize dahil edilmişlerdirSonuçlar Yetmiş bir hasta (%14) ilk inmeden sonraki 3 ay içerisinde tekrar inme geçirmişlerdir. Erken inme tekrarı için geçen ortalama süre 21 gündür. Erken inme için belirgin risk faktörleri koroner arter hastalığı (%43, p

Background/Aim: It is controversial whether intravenous recombinant tissue plasminogen activator (IV r-tPA) treatment outcomes in cardioembolic strokes differ from other types of strokes. This study aims to investigate the clinical data of patients with cardioembolic and large-vessel atherosclerosis who received IV r-tPA treatment and compare and discuss the results according to the literature. Methods: The data of the patients who were admitted within the first 4.5 hours following the onset of symptoms, diagnosed with acute ischemic stroke in the Neurology clinic of Kütahya Evliya Çelebi Training and Research Hospital and underwent IV r-tPA were evaluated in this retrospective cohort study. Demographic data, clinical and functional results of patients were compared between the two groups (cardioembolic and large vessel atherosclerosis). Results: Eighty-five patients with ischemic stroke who received IV r-tPA treatment due to cardioembolism and large-vessel atherosclerosis were included in the study. There were 51 patients (60%) in the cardioembolic stroke group and 34 patients (40%) in the large vascular atherosclerotic group. There was no significant difference in terms of functional results between the groups (62.7% vs 44.1%; P=0.09). While symptomatic intracerebral hemorrhage was not detected in the large-vessel atherosclerosis group, it occurred in 3.9% of the cardioembolic stroke group. Conclusion: This study proved that functional and clinical results are similar between cardioembolic and large-vessel atherosclerosis patients who were treated with IV r-tPA treatment. Regardless of the etiology, all suitable patients with acute ischemic stroke should be treated with thrombolytic therapy.

Giriş ve Amaç: Çalışmamızın amacı, International Society for Clinical Electrophysiology of Vision (ISCEV) standartlarına göre, aurasız migren hastalarında, iki farklı kontrol boyutu (15 've 62') ile kaydedilen tersine çevrilmiş görsel uyarılmış potansiyellerindeki (PVEP'ler) değişiklikleri interiktal dönemde incelemektir.Gereç ve Yötemler: Hastaların demografik verileri; hastalık süresi, baş ağrısı özellikleri, bir aydaki atak sayısı, ortalama atak süresi, baş ağrısına eşlik eden şikayetler, baş ağrısının ortalama şiddeti gibi hastaların baş ağrısı günlüklerinden görsel analog ölçeğe göre belgelendi. Aurası olmayan yirmi migren hastası ve 14 sağlıklı gönüllü, iki farklı kontrol boyutuyla (15 ’ve 62’) kaydedilen PVEP'ler ile incelendi. Stimülasyon sekansları hem dama tahtasının kontrol boyutu hem de stimülasyon tarafı (sağ-15 ', sağ-62', sol-15 ', sol-62') için randomize edildi. N75, P100 gecikmesi ve N75-P100'ün tepeden tepeye genliği analiz edildi.Bulgular: Her iki kontrol boyutu için PVEP sonuçlarının latans ve amplitüdleri açısından sağlıklı kişiler ile aurasız migren hastaları arasında istatistiksel olarak fark yoktu (p> 0,05).Sonuç: Aurasız migren hastalarında, farklı spatyal frekanslara sahip PVEP'ler ile magnoselüler yol disfonksiyonunu tespit etmedik. Daha geniş hasta grupları ve PVEP'leri psikofiziksel testlerle birleştiren çalışmalara ihtiyaç vardır., Objective: The objective of our study was to investigate changes in pattern reversal visual evoked potentials (PVEPs) of migraine without aura patients recorded with two different check sizes (15’ and 62’) in accordance with International Society for Clinical Electrophysiology of Vision (ISCEV) standards during the interictal period. Materials and Methods: Patients' demographic data were documented from headache diaries of patients, such as duration of disease, headache characteristics, the number of attacks in a month, the average duration of attacks, complaints accompanying headache, mean severity of headache according to visual analog scale. Twenty migraine patients without aura and 14 healthy volunteers were examined with PVEPs recorded with two different check-sizes (15’ and 62’). The stimulation sequences were randomized both for the check-size of checkerboard and the side of stimulation (right-15', right-62', left-15', left-62'). The latency of N75, P100 and peak-to-peak amplitude of N75-P100 were analyzed. Results: There were no statistical difference between healthy subjects and migraine without aura patients in the means of latency and amplitude of PVEPs results for both check-sizes (p>0,05). Conclusion: In migraine patients without aura, we did not detect magnocellular pathway dysfunction by PVEPs with different spatial frequencies. Studies on larger patient groups and combining PVEPs with psychophysical tests are needed.

Aim. Temporomandibular disorders (TMDs) are clinical situations that are characterized by pain, sound, and irregular movements of the temporomandibular joints. The most common method in the treatment of TMDs is arthrocentesis. This study aims to compare the effect of conventional extraoral auriculotemporal nerve block (ANB) and Gow-Gates (GG) mandibular anesthesia techniques on patient comfort in an arthrocentesis procedure. Materials and Methods. We performed this study on 40 patients who underwent TMJ arthrocentesis with ANB (n = 20) or GG (n = 20) mandibular anesthesia techniques at the Marmara University Faculty of Dentistry between 2016 and 2019. The predictor variable was the type of an anesthesia technique, and the outcome variables included were pain, maximum mouth opening (MMO), and protrusive movement (PM). They were compared at the preoperative period and 3rd and 6th month periods. Statistical analysis included means with standard deviations, a one-way ANOVA for continuous data, and the results were evaluated at the significance level of p < 0.05 . Results. No statistically significant difference was observed between the VAS values, MMO, and PM averages of preoperative, 3rd and 6th months of ANB and GG ( p = 0.142 , p = 0.209 , and p = 0.148 ). Conclusion. Both anesthesia techniques have provided effective results in terms of pain and functional jaw movements in the postoperative period in arthrocentesis treatment.

Background & Objective: The aim of this study was to investigate the relationship of neutrophil to lymphocyte ratio (NLR) and other blood cells markers in craniocervical artery dissection patients and the dynamic changes of these biomarkers during the disease course, and effects on prognosis of the patients. Method: Cranial MR imaging, cranial and cervical MR angiography and DSA were examined, and diffusion weighted imaging (DWI) was performed to show the acute lesion(s). Results: Forty-six patients with craniocervical artery dissection were included in this study; they had a mean age of 42 years. Almost 60% of the patients (n=27) were admitted during acute state. Almost 2/3 of cases had extracranial dissection (n=31) and nearly 40% of the patients (n=18) had trauma. Neutrophil to lymphocyte ratio (NLR) was observed to be higher in the acute phase of the disease while the ratio decreased in the chronic phase. Low hemoglobin, high lymphocyte and a high NLR were found to have a negative correlation with the National Institutes of Health Stroke Scale (NIHSS). Conclusion: Elevation of neutrophil was higher in acute craniocervical artery dissection as a marker of acute inflammatory response. High NLR, low hemoglobin and high eosinophil levels were associated with worse prognosis and functional outcomes.

Background: Epidural fibrosis (EF) is one of the leading causes of post lumbar surgery syndrome (PLSS). Although there are studies in the literature suggesting that lumbar epidural steroid injections are an effective method in the pain management of PLSS caused by EF, no study is available comparing the effectiveness and safety of caudal and transforaminal approaches. Objectives: To investigate the efficacy of caudal epidural steroid injection (CESI) versus transforaminal epidural steroid injection (TFESI) in patients with PLSS. Study Design: A prospective, randomized, assessor-blind study. Setting: Interventional pain management center at a tertiary care center. Methods: Patients with low back and radicular pain related to EF following single-level lumbar discectomy were included. The patients were randomly divided into 2 groups: a CESI group and a TFESI group. All patients were assessed before the procedure (baseline) and at one hour, 3 weeks, and 3 months after the procedure using the Numeric Rating Scale (NRS-11) and at baseline, 3 weeks, and 3 months using the modified Oswestry Disability Index (mODI). Treatment success was defined as a ≥ 50% decrease in the NRS-11 scores compared to baseline. Results: A total of 56 patients (n = 26 CESI group; n = 30 TFESI group) were included. NRS-11 and mODI scores showed a significant decline in both groups at all follow-ups (P < 0.001). At 3 weeks, the improvement in the mODI scores was significantly higher in the TFESI group (P = 0.020). In all follow-ups, the NRS-11 scores were similar between the groups. At 3 weeks, the rates of patients with a ≥ 50% decrease in NRS-11 scores were 53.8% and 60% in the CESI group and TFESI group, respectively, while these rates were 30% and 26.7%, respectively, at 3 months. Limitations: This study had no placebo-control group and a relatively short follow-up. Conclusion: Both CESI and TFESI are effective and safe methods in the treatment of PLSS caused by EF following lumbar discectomy. These methods can reduce pain and disability. Although both methods have similar treatment success rates, TFESI seems to be a more effective treatment method in reducing disability at 3-week follow-up. Keywords: Post lumbar surgery syndrome, failed back surgery syndrome, post laminectomy syndrome, epidural fibrosis, epidural steroid injections, transforaminal, caudal, radiculopathy, back pain

Isolated cranial nerve involvement is rarely seen in multiple sclerosis patients. A 17-year-old female patient presented with complaints of numbness in the right half of her face, difficulty in chewing with the right jaw, having the right corner of her mouth drooping to the right, and blurring in both eyes. She had loss of sensation, left central facial paralysis, and frust monoparesis in the left arm in the right trigeminal nerve dermatome. Following systemic steroid treatment, her left central facial paralysis and chewing difficulties regressed, and loss of sensation improved. As in this case, MS may present with multiple instances of cranial nerve paralysis in addition to the involvement in the extremities. The association of the fifth and seventh nerve palsy in MS is rarely seen in the literature.

Objective: In this study it is aimed to investigate the effect of bilateral arm training with rhythmic auditory cueing (BATRAC) on upper extremity functions, daily living activities and pain with chronic stroke patients.Methods: This study was carried out as a randomized controlled experimental study in 28 patients with stroke were included in this study. The patients were randomly assigned into two groups as an BATRAC (n=15) and control group (n=13). The demographic characteristics, Brunnstrom stage, Modified Ashworth Scale (MAS) and pain degree were recorded in all patients. All patients participated in a conventional rehabilitation program for 3 weeks. The BATRAC group received 20 minute BATRAC for upper extremity for 5 days per week during 3 weeks. The plegic upper extremity motor functions were evaluated by Jebsen Taylor Hand Function Test (JTHFT), Box and Block Test (BBT), daily living activities by Modified Barthel Index (MBI) and pain degree by Visual analogue scale (VAS). All of those evaluations are done before treatment and after 3 weeks of therapy. The data were assessed by Mann Whitney U tests and Wilcoxon tests.Results: Significant improvements were recorded in BBT and JTHFT parameters (turning page, lifting of large heavy objects and backgammon stamping) (p0.05 for all parameters). Conclusion: In conclusion, BATRAC treatment was found effective on upper extremity motor functions in stroke patients. These results suggests that BATRAC treatment can use with conventional therapy in stroke rehabilitation., Amaç: Bu çalışma ile kronik inmeli hastalarda uygulanan ritmik işitsel uyarı ile bilateral kol eğitiminin (RİUBKE) üst ekstremite fonksiyonları, günlük yaşam aktivitelerine katılım ve ağrı üzerine etkilerinin incelenmesi amaçlanmıştır.Yöntem: Randomize kontrollü bu çalışmaya 28 hasta dahil edildi. Hastalar RİUBKE (n=15) ve kontrol (n=13) olarak iki gruba ayrıldı. Tüm hastaların demografik verileri, Brunnstrom evreleri, Modifiye Ashworth Skalası (MAS) ve ağrı düzeyleri kaydedildi. Hastaların tümü 3 hafta süreyle konvansiyonel terapi programına alındı. Ek olarak RİUBKE grubundaki hastalara, RİUBKE cihazı ile haftanın 5 günü 3 hafta süreyle bilateral üst ekstremite eğitimi uygulandı. Plejik üst ekstremite motor fonksiyonları Jebsen Taylor El Fonksiyon Testi (JTEFT) ve Box and Block Test (BBT) ile, günlük yaşam aktiviteleri Modifiye Barthel İndeks (MBİ) ile, ağrı düzeyleri Görsel Analog Skala (GAS) ile Tüm değerlendirmeler tedavi öncesi ve tedaviden 3 hafta sonra değerlendirildi. Tüm veriler Mann Whitney U testi ve Wilcoxon testi kullanılarak analiz edildi.Bulgular: BBT ve JTEFT’in bazı parametrelerinde (sayfa çevirme, büyük ağır obje kaldırma ve tavla pulu dizme) (p0,05). Sonuç: RİUBKE ile üst ekstremite bilateral eğitiminin kronik inmeli hastalarda üst ekstremite fonksiyonları üzerine etkili olduğu kanaatine varıldı. Alınan bu sonuçlar inme rehabilitasyonunda RİUBKE ile bilateral eğitimin konvansiyonel tedavilerle birlikte kullanılabileceğini düşündürmektedir.

Aim: In recent years, inflammatory markers such as red blood cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), and C-reactive protein to albumin ratio (CAR) have been investigated in spontaneous intracerebral hemorrhage (ICH). However, they were not analyzed together in ICH. In the present study, we examined whether neutrophil, neutrophil to eosinophil ratio (NER), and white blood cell (WBC) levels along with the above-mentioned markers predict the intrahospital mortality in patients diagnosed with spontaneous ICH at admission.Methods: We conducted this retrospective cohort study by examining spontaneous ICH patients hospitalized in our clinic between April 2015 and March 2019. We divided patients into two groups, as survivors and non-survivors. The receiver operating characteristics (ROC) curve analysis test was used to evaluate the predictive value of laboratory variables for mortality and to calculate cut-off values.Results: A total of 130 patients, 82 survivors and 48 non-survivors, were included in the study. The patients who were non-survivors at the hospital had significantly higher median hemorrhage volume, WBC, and neutrophil levels compared to those of survivors (P, Amaç: Son yıllarda, spontan intraserebral hemorajide (ICH) kırmızı kan hücresi dağılım genişliği (RDW), nötrofil/lenfosit oranı (NLO) ve C-reaktif protein/albümin oranı (CAO) gibi inflamatuar belirteçler araştırılmıştır. Ancak, bunlar ICH’de birlikte incelenmemiştir. Bu çalışmada, spontan ICH tanısı alan hastalarda başvuru sırasında yukarıda belirtilen belirteçlerle birlikte nötrofil, nötrofil/eozinofil oranı (NEO) ve beyaz kan hücresi (WBC) düzeylerinin hastane içi mortaliteyi tahmin edip etmediğini araştırdık. Yöntemler: Bu retrospektif kohort çalışmasını, Nisan 2015 - Mart 2019 tarihleri arasında kliniğimizde yatan spontan ICH hastalarını inceleyerek gerçekleştirdik. Hastaları hayatta kalanlar ve hayatta kalmayanlar olarak iki gruba ayırdık. Mortalite için laboratuvar değişkenlerinin prediktif değerini değerlendirmek ve kesme değerlerini hesaplamak için, alıcı çalışma karakteristikleri (ROC) eğrisi analizi kullanılmıştır.Bulgular: Çalışmaya, 82’si hayatta kalan ve 48’i hayatta kalmayan olmak üzere 130 hasta dahil edildi. Hastanede ölen hastaların medyan hemoraji hacmi, WBC ve nötrofil değerleri yaşayanlara göre anlamlı olarak yüksekti (sırasıyla P

It is thought that the loss of conduction that causes clinical findings in multiple sclerosis (MS) attack may be the result of loss and damage of myelin, as well as the substances that activate autoimmune cascades affect axonal conductivity. Only some of the inflammatory processes that occur are manifesting and are reflected as an attack. The effects of these changes can also be seen in the serum of the patients during the attack period, when the inflammatory changes are intense. In this study, we aimed to compare the laboratory findings of MS patients during the attack and non-attack periods. The data of 61 patients between 18-65 years of age, who had liver function tests, lipid parameters, vitamin D levels, thyroid function tests, ferritin, folate and vitamin B12 levels studied both during and after the attack, were analyzed retrospectively. The attack period and non-attack data of the patients whose age, gender, height, weight, duration of diagnosis and EDSS (expanded-disability status scale) scores were recorded were compared. There was no significant difference in lipid parameters, ferritin, folate, vitamin B12 levels and liver function tests measured in the attack period and in the non-attack period, while the patients had significantly lower vitamin D levels and high thyroid function tests. VitD, Thyroid function tests and changes in cholesterol levels, which are easily accessible laboratory tests, are thought to give an idea about disease activity and attack status. More specific studies with the greater number of samples are needed to evaluate the possible effects of thyroid hormone on remyelination., Multipl skleroz (MS) atağında klinik bulguların ortaya çıkmasına neden olan ileti kayıplarının; myelin kaybı ve hasarlanması sonucu olabileceği gibi, otoimmünkaskadları aktive eden maddelerin aksonal iletkenliği etkilemesiyle de ortaya çıkabileceği düşünülmektedir. Ortaya çıkan inflamatuar süreçlerin yalnızca bir kısmı bulgu vermekte ve atak olarak kliniğe yansımaktadır. İnflamatuar değişikliklerin yoğun görüldüğü atak döneminde hastaların serumlarında da bu değişikliklerin yansımaları görülebilmektedir. Bu çalışmada, MS hastalarının atak döneminde ve atak dışı dönemdeki laboratuvar bulgularını karşılaştırmayı amaçladık. Hem atak döneminde hem de atak dışı dönemde karaciğer fonksiyon testleri, lipit parametreleri, D vitamini düzeyleri, tiroid fonksiyon testleri, ferritin, folat ve vitamin B12 düzeyleri kayıtlı olan, 18-65 yaş aralığında, 61 hastanın verileri retrospektif olarak incelendi. Yaş, cinsiyet, boy, kilo, tanı süresi ve hastalık şiddetini gösteren EDSS (expanded disability status scale) skorları kayıt edilen hastaların atak dönemi ve atak dışındaki verileri karşılaştırıldı. Hastaların atak döne-minde ve atak dışı dönemde ölçülen lipid parametreleri, ferritin, folat, vitamin B12 düzeyi ve karaciğer fonksiyon testlerinde anlamlı farklılık saptanmazken hastaların atak döneminde Vitamin D düzeylerinin anlamlı olarak daha düşük, tiroid fonksiyonlarının da yüksek olduğu gözlendi. Hastaların takip sürecinde, kolay ulaşılabilir laboratuvar tetkikleri olan vitamin D, tiroid fonksiyon testleri ve kolesterol seviyelerinde-ki değişikliklerin hastalık aktivitesi ve atak durumu ile ilgili fikir verebileceği düşünülmektedir. Tiroid hormonunun remiyelinizasyon üzerine olası etkilerini değerlendirecek örneklem sayısının daha fazla olduğu daha spesifik çalışmalara ihtiyaç vardır.

AIM: To investigate the effects of subthalamic deep brain stimulation (STN DBS) therapy on sleep quality of Parkinson\"s Disease (PD) patients and the relationship between sleep, motor symptoms, depression, and adverse effects of dopamine replacement therapies. MATERIAL and METHODS: A total of 26 PD patients have been included and assessed using various tools both 1 week before and 8 months after the STN DBS therapy. The data collection tools were the Unified Parkinson\"s Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), Parkinson\"s Disease Questionnaire (PDQ-39), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and Polysomnography. RESULTS: PSQI, ISI, and ESS scores were found to have significantly improved after the STN DBS therapy (p=0.002, p=0.006, p

Background: Although fluoroscopy-guided interventional therapies have declined in recent years, radiation exposure remains a critical issue for both patients and medical staff. Radiation exposure varies according to the physicians’ experience, procedure time, patients’ body mass index (BMI), imaging techniques, and the type of procedure performed. Objective: The purpose of this study is to report procedure times and calculate the radiation doses for 4 different approaches of fluoroscopy-guided epidural injections per procedure and BMI to provide radiations doses for potential use in future dose reduction strategies. Study Design: Retrospective, observational study. Setting: A university hospital, pain management center. Methods: A retrospective evaluation was performed of patients who received epidural steroid injections between January 2015 and December 2020 in a university hospital interventional pain management center. This observational study was conducted with patients aged ≥ 18 who underwent 3,711 epidural injections including cervical interlaminar, lumbar interlaminar, lumbar transforaminal, and caudal approaches. If more than one level or bilateral injections were performed, total dose and times were divided by the number of sites injected to attain procedure time and mean dose per injection. Provided doses for each patient were also divided by patients’ BMI to obtain dose per BMI. Results: The highest radiation dose per procedure was found in caudal epidural injection with 0.218 mGy·m2 , and the lowest dose was found in cervical interlaminar epidural injection with 0.057 mGy·m2 . The radiation dose per procedure was 0.123 mGy·m2 for lumbar transforaminal and 0.191 mGy·m2 for lumbar interlaminar epidural injection. The shortest procedure time was determined in transforaminal (37.3 seconds) injections, and the longest was in lumbar interlaminar (46.7 seconds) injections. Caudal epidural injection also had the highest radiation dose per BMI which was 0.00749, and cervical interlaminar epidural injection had the lowest radiation dose per BMI, which was 0.00214. Limitations: Firstly, injections were performed by first- or second-year fellows in pain medicine. Moreover, patient-related factors (previous surgery, scoliosis, etc.) affecting radiation exposure were ignored. Conclusions: Radiation dose levels and procedure times of 4 approaches of epidural injections were obtained from 3,711 procedures performed in a university hospital pain medicine clinic. BMI of patients was taken into account with the dose levels of injections given per BMI. Multicenter research with standardized techniques will assure more reliable reference levels, which will guide pain physicians to self-assess their own levels of radiation exposure.

© 2022 Elsevier B.V.Objective: Joubert syndrome is a neurodevelopmental disorder with a distinctive hindbrain malformation called molar tooth sign, causing motor and cognitive impairments. More than 40 genes have been associated with Joubert syndrome. We aim to describe a group of Joubert syndrome patients clinically and genetically emphasizing organ involvement. Methods: We retrospectively collected clinical information and molecular diagnosis data of 22 patients with Joubert syndrome from multiple facilities. Clinical exome or whole-exome sequencing were performed to identify causal variations in genes. Results: The most common variants were in the CPLANE1, CEP290, and TMEM67 genes, and other causative genes were AHI1, ARMC9, CEP41, CSPP1, HYLS1, KATNIP, KIAA0586, KIF7, RPGRIP1L, including some previously unreported variants in these genes. Multi-systemic organ involvement was observed in nine (40%) patients, with the eye being the most common, including Leber\"s congenital amaurosis, ptosis, and optic nerve coloboma. Portal hypertension and esophageal varices as liver and polycystic kidney disease and nephronophthisis as kidney involvement was encountered in our patients. The HYLS1 gene, which commonly causes hydrolethalus syndrome 1, was also associated with Joubert syndrome in one of our patients. A mild phenotype with hypophyseal hormone deficiencies without the classical molar tooth sign was observed with compound heterozygous and likely pathogenic variants not reported before in the KATNIP gene. Conclusion: Some rare variants that display prominent genetic heterogeneity with variable severity are first reported in our patients. In our study of 22 Joubert syndrome patients, CPLANE1 is the most affected gene, and Joubert syndrome as a ciliopathy is possible without a classical molar tooth sign, like in the KATNIP gene-affected patients.

bilgi işleme ve çalışma belleği yetersizliği ile karakterizedir. Bu çalışmada; KİS’li bireylerdeki bilişsel etkilenmenin özelliklerini ve sıklığını sağlıklı kontrollerle karşılaştırarak araştırmak amaçlanmıştır.Gereç ve Yöntem: Hastalara PASAT, COWAT, Stroop testi, RAVLT, Benton Çizgi Yönünü Belirleme testi, iz sürme testi, sayı dizileri testi uygulandı. Ayıca depresyon, yorgunluk ve yaşam kaliteleri de ölçeklerle değerlendirildi.Bulgular: Çalışmaya yaş ortalaması 36.3 olan 25 KİS hastası, yaş ve cinsiyet olarak eşleştirilmiş 22 sağlıklı kontrol alındı. Sağlıklı kontroller ile karşılaştırıldığında hastaların %52’si Stroop testinde başarısız oldular. COWAT’ta bu oran %60 olarak saptandı. RAVLT, BJLO, iz sürme testi ve sayı dizileri testi için bilişsel bozulma sıklığı göreceli olarak daha düşüktü. PASAT’da ise bu oran %20 olarak saptandı. Hastaların %21’inde en az iki testte bilişsel bozukluk saptandı. En az bir testte bozulma saptanan hasta oranı -1 SD ile %64, -2 SD ile %48 olarak saptandı. Yorgunluk ile KİS hastalarındaki bilişsel etkilenme arasında anlamlı bir ilişki saptandı. Sonuç: Çalışma grubunun % 21’inde, iki ya da daha fazla alt testte bilişsel bozulma görülmüştür. En belirgin olarak dikkat ve yürütücü işlevlerin etkilendiği saptanmış olup, bilişsel yorgunluk; Stroop, PASAT ve COWAT ile bağıntılıydı. KİS aşamasında, sosyal hayat ve hastalık seyri üzerine etkisi bilenen bilişsel etkilenme varlığı, sıklığı ve ayrıntılı tanımlanması belki de tedaviyi düzenleme aşamasında göz önünde bulundurulmalıdır., Purpose: The cognitive profile in clinically isolated syndrome (CIS) is frequently characterized by deficit in processing speed and working memory. In this study, we aimed to investigate the characteristics and frequency of cognitive impairment in patients with CIS by comparing with healthy controls.Materials and Methods: All participants were tested with PASAT, COWAT, Stroop test, RAVLT, JLO, Trail Making Test, Digit Span. Depression, fatigue and life quality were assessed by the scales.Results: In this study, 25 patients with CIS and 22 healthy controls matched by age and sex were included. Fifty-two percent of patients were failed at Stroop test in comparison to healthy controls, and this rate was indicated as 60% in COWAT. The frequency of cognitive impairment for the RAVLT, JLO, Trail Making Test, and Digit Span was relatively lower. Moreover, this rate was 20% in PASAT. The cognitive impairment was found in two subtests of BICAMS at least, in 21% of patients. Those with at least one abnormal tests were shown 64% (-1SD), 48% (-2SD). There was a significant relationship between the fatigue and cognitive impairment in patients with CIS.Conclusion: Cognitive impairment was found in two or more sub-tests of BICAMS; in 21% of our group. Attention and executive functions were distinctly found to be impaired in CIS, and cognitive fatigue was related to Stroop, PASAT and COWAT. The existence, frequency and detailed description of the cognitive impairment that has an impact on social life and disease course in the course of CIS should be taken into consideration.

Paraneoplastik nörolojik sendromlar (PNS), metastazlar, metabolik ve beslenme eksiklikleri, enfeksiyonlar, koagülopati veya kanser tedavisinin yan etkileri dışındaki mekanizmaların neden olduğu heterojen bir hastalık grubudur. Bu sendromlar serebral korteksten nöromüsküler kavşak ve kasa kadar sinir sisteminin herhangi bir bölümünü etkileyebilir. Paraneoplastik nörolojik sendrom şüphesi olan hastalar altta yatan malignite ve paraneoplastik antikorlar açısından araştırılmalıdır. Bu vaka bildirisinde, denge ve istemsiz kilo kaybı sebebiyle araştırılan ve testis tümörüne bağlı paraneoplastik serebellar sendrom tanısı konulan hasta sunulmuştur.

Obstrüktif Uyku apne sendromu (OUAS), yetişkin popülasyonda oldukça sık görülen önemli bir halk sağlığı problemidir. Obezite bu send-romun gelişimi için en önemli risk faktörüdür. OUAS şiddeti beden kitle indeksi (BKİ), uyku evresi, pozisyonu ve cinsiyete göre değişiklik göstermektedir. Bu çalışmada OUAS şiddetine BKİ, uyku evresi, uyku pozisyonu yanında cinsiyetin etkisinin değerlendirilmesi amaçlanmıştır. Çalışmaya polisomnografi incelemesi sonrasında OUAS tanısı alan 93 (%61,58) erkek, 58 (%38,41) kadın olmak üzere toplam 151 hasta alınmıştır. Hastaların demografik özellikleri, polisomnografi parametreleri ve risk faktörleri retrospektif olarak kaydedilmiştir. OUAS tanısı üçüncü Uluslararası Uyku Bozuklukları Sınıflama Klavuzuna göre koyulmuştur. Kadın cinsiyette yaş, BKİ, diabet ve hipertansiyon gibi kardiyovasküler risk faktörleri erkek cinsiyete göre anlamlı yüksek bulunmuştur (p=0,001, p=0,001, p=0,034, p=0,001). Buna rağmen OUAS şiddeti erkek cinsiyette anlamlı bulunmasa da daha yüksek bulunmuştur (p>0,05). Bu yükseklik sırtüstü pozisyonda istatistiksel olarak anlamlı bulunmuştur (erkeklerde AHİSIRT: 44,34±28,07/saat, kadınlarda AHİSIRT: 35,09±26,76/saat, p=0,048). REM uyku evresinde ise OUAS şiddeti kadınlarda fazla bulunmuştur (p=0,016). Bu çalışmada OUAS risk faktörlerinden olan yaş, BKİ, hipertansiyon ve diabet mevcudiyeti, kadın cinsiyette erkek cinsiyete göre istatistiksel olarak anlamlı yüksek bulunmuştur. Buna rağmen OUAS şiddeti erkek cinsiyette daha yüksek bulunmuştur. Bu yükseklik sırtüstü pozisyonda istatistiksel olarak anlamlı bulunmuştur. REM uyku evresinde ise OUAS şiddeti kadın cinsiyette daha fazla bulunmuştur. Bu durum cinsiyetler arasında yağ dağılımındaki farklılıkları düşündürmekte ve genel bir obeziteden ziyade bölgesel yağ birikiminin OUAS için daha önemli bir prediktör olduğunu düşündürmektedir., Obstructive Sleep Apnea syndrome (OSAS) frequently seen in the adult population is an important public health problem. Obesity is an important risk factor of OSAS. Severity of sleep apnea syndrome may differ according to sleep position, sleep stage, gender and body mass ındex (BMI). Therefore, we aimed to evaluate the relationship between the severity of Obstructive Sleep Apnea Syndrome and sleep stage, sleep position with gender. One hundred fifty-one subjects (93 (61,58 %) men, 58 (38,41%) women) were analyzed. Recorded demographic features, over-night polysomnographic data and risk factors of the subjects were reviewed retrospectively. Diagnosis of OSAS was made according to the 3. edition of International of Sleep Disorders Classification. Famele subjects had signicantly higher age, BMI, diabetes and hypertension (p=0.001, p= 0.001, p= 0.034, p= 0.001). The severity of OSAS was higher in male subjects. It was significantly in supin position (AHI: 44.34±28.07/hour in males, AHI: 35.09±26.76/hour in females, p=0.048). The severity of OSAS in REM stage was higher in female subjects (p=0.016). Although age, BMI, hypertension and diabetes was signicantly higher in females than males in this study, OSAS severity in male patients was higher. The difference was significantly in supin position in sleep. The severity of OSAS in REM sleep stage was higher in females than males. This condition suggests that regional fat accumulation is a more important predictor for OSAS than general obesity due to differences in fat distrubution by gender.

Objectives Cytotoxic lesions of the corpus callosum (CLOCCs) are secondary lesions associated with entities like infection manifested by restricted diffusion on diffusion-weighted cranial magnetic resonance imaging. Our objectives are to evaluate the clinic-radiological spectrum of pediatric patients with cytotoxic lesions of the corpus callosum (CC). Methods Children (0–18 years) admitted between February 2017 and May 2020 with splenial lesions showing diffusion restriction on MRI, either isolated or within involvement of other parts of the brain, were included retrospectively. The primary lesions of the CC (e.g. acute disseminated encephalomyelitis, acute ischemic infarction, and glioblastoma multiforme) were excluded. CLOCCs were divided into infection-associated, metabolic disorder–associated, and trauma-associated lesions, as well as CLOCCs involving other entities. Data were collected from the medical databases. Results Forty-one patients were determined to have CLOCCs. Twenty-five (61%) were infection-associated, nine (22%) were trauma-associated, and three (7%) were metabolic disorder–associated cases, including 2 inherited disorders of metabolism. There were four (10%) patients with other entities, three with epilepsy, and one had an apparent life-threatening event. Six patients had a known etiology among the infection-associated group; one had multisystem inflammatory syndrome caused by COVID-19 and one had been infected by COVID-19 without any complications. All the infection-associated patients with isolated splenial lesions recovered totally, although six patients required intensive care hospitalization. Four trauma-associated patients had sequela lesions. Conclusions CLOCCs are associated with a spectrum of diseases, including the new coronavirus, COVID-19 infection. Infection-associated CLOCCs has the best prognosis, although severe cases may occur. Sequelae are possible based on the etiology.

Purpose: Kidney transplant recipients are prone to metabolic bone diseases and consequent fractures. This study aimed to evaluate the incidence of incipient vertebral fractures, osteopenia, osteoporosis, and the clinical factors associated with incipient vertebral fractures in a group of kidney transplant patients. Methods: Two hundred sixty-four patients (F/M:124/140, 45.3±13 years) who had undergone kidney transplantation between 2008 and 2018 and who were followed up at least one year in third care centers were included in this multicenter retrospective study. Bone mineral densitometry was performed using dual-energy X-ray absorptiometry. Vertebral fractures were assessed semi-quantitatively using conventional thoracolumbar lateral radiography in 202 of the patients. Results: Vertebral fractures were observed in 56.4% (n=114) of the study group. Severe vertebral fractures were observed in 30.7% (n=62) of the patients in vertebral X-ray evaluation. The frequency of osteoporosis was 20.0% (53 of 264 patients), and osteopenia was 35.6% (94 of 264 patients). BMD levels were in the normal range in 40.3% (n=46) of the subjects with vertebral fractures. It was in the osteoporotic range in 20.1% (n=23) and the osteopenic range in 40.3% (n=46). Serum calcium, parathormone vitamin, and creatinine levels were similar between the patients with and without vertebral fractures. Femoral neck BMD was negatively correlated with age (r: −0.21, p

Background/Aim: It is known that sleep disorders and headaches are related. However, there are only very few studies examining this correlation in chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the association between sleep disorders, headaches, and hypoxia in COPD patients.Methods: This study was designed as a prospective case-control study with 120 COPD and 83 controls patients of similar age/gender. International classification of headache disorders - version 3 (ICHD III) was used for the diagnosis of headache. Pain intensity was calculated using the visual analog scale (VAS). For the effect of headache, headache activities of daily living index (HADLI) questionnaire was applied. Pulmonary function tests were performed with a PC-based spirometry device. Blood pressure and blood oxygen saturation were measured by fingertip pulse oximetry. Sleep quality was assessed using the Pittsburgh sleep quality index (PSQI). Dyspnea severity was graded according to the modified medical research council (mMRC) scale. Results: Headache was detected in 54 patients (45%) with COPD. The most common type of headache was tension type (66.7%). Patients with headache had higher diastolic blood pressure, severity of dyspnea score, and lower forced expiratory volüme-1 (FEV1), forced vital capacity (FVC) (P = 0.037, P = 0.001, P = 0.001, P = 0.001 respectively). Sleep disturbance was quite common in COPD patients (79.2%). PSQI score was higher in patients with headache (P = 0.006). Patients with poor sleep quality had higher pain severity (P = 0.006). Female gender, high diastolic blood pressure and low forced expiratory volume-1 second (FEV1) increased the risk of headache (P = 0.004, P = 0.02, P = 0.032, respectively).Conclusion: Headache is a complex symptom in patients with COPD and associated with higher diastolic blood pressure and pulmonary dysfunction. These parameters should be evaluated in COPD patients with headache.

Background/Aim: Anti-epileptic drugs are long-term medications; thus, side-effects are frequently seen. An important but insufficiently known side-effect is the emergence of metabolic bone diseases. The mechanism of this entity is not clearly known, but it is usually seen with the use of cytochrome P450 enzyme-inducing anti-epileptics. However, recent studies demonstrated that non-enzyme-inducing molecules also cause bone mineral impairment. The aim of this study was to shed light on the pathogenesis of anti-epileptic metabolic bone disease using bone turnover markers.Methods: This comparative, prospective case-control study included 37 patients followed-up in our outpatient clinic and 39 healthy control subjects. All the patients were female, aged over 18 years and in the premenopausal period, and had received the same anti-epileptic treatment for at least 3 months. Male patients, females who were

Amaç: İnternal karotid arter (İKA) darlığını belirlemede, dupleks Doppler ultrasonografi (DUS) ile dijital subtraksiyon anjiyografi (DSA) arasında tutarsızlık bildirilmiştir. DUS hız değerleri ile eğitilmiş makine öğrenme algoritmalarının (MÖA), İKA darlığını tahmin etme performansını araştırmayı amaçlıyoruz.Gereç ve yöntem: İKA darlığı olan 159 karotid bifurkasyonunun, ortak karotid arter (OKA) ve İKA'dan elde olunmuş DUS hız değerleri (pik sistolik hız (PSH) ve diyastol sonu hızı) ve DSA tetkikleri retrospektif olarak incelendi. Darlık derecesi her modaliteye göre, Purpose: There is a discrepancy between duplex Doppler ultrasonography (DUS) and digital subtraction angiography (DSA) for determining internal carotid artery (ICA) stenosis. We aim to train machine learning algorithms (MLAs) with DUS velocity values for predicting ICA stenosis and comparing their success to DUS criteria.Materials and methods: DUS values (peak systolic velocity (PSV) and end-diastolic velocity of the common carotid artery (CCA) and ICA) and DSA studies of 159 ICA stenoses were reviewed retrospectively. Stenoses were classified as

Aneurysmal bone cyst is a benign, tumor-like, highly vascular, locally aggressive and relatively rare osteolytic lesion of unknown etiology. Aneurysmal bone cysts of the spine account for 12%–30% of all aneurysmal bone cyst cases. They mostly occur in the lumbar vertebrae, followed by the thoracic, cervical, and sacral vertebrae. Torticollis, a condition characterized by an abnormal tilted position, rotation, and flexion of the head and neck is considered a sign rather than a specific diagnosis. To our knowledge, the presentation of torticollis in children with aneurysmal bone cysts in the thoracic vertebrae has not been reported in the literature. We should keep in mind that acquired torticollis can be a sign of underlying life-threatening conditions. Here we present the case of a 9-year-old boy with muscle spasm, progressively increasing pain, and right torticollis (lasting for 45 days) who presented to the emergency department with paraplegia., Anevrizmal kemik kisti, etiyolojisi bilinmeyen, iyi huylu, tümör benzeri, oldukça vasküler, lokal olarak agresif ve nispeten nadir osteolitik bir lezyondur. Omurganın anevrizmal kemik kistleri, tüm anevrizmal kemik kisti vakalarının% 12 ila 30'unu oluşturur. Çoğunlukla lomber vertebralarda, ardından torasik, servikal ve sakral vertebralarda görülürler. Doğal olmayan bir baş ve boyun eğik pozisyonu, rotasyonu ve fleksiyonu olan tortikolis, spesifik bir tanıdan çok bir işaret olarak kabul edilir. Bildiğimiz kadarıyla, literatürde, çocuklarda torasik vertebrada oluşan anevrizmal kemik kistleri tortikollis ile birlikte bildirilmemiştir. Edinilmiş tortikollisin altta yatan yaşamı tehdit eden koşulların bir işareti olabileceğini aklımızda tutmalıyız. Bu rapor, acil servise parapleji ile başvuran; kas spazmı, giderek artan ağrı ve 45 gündür süren sağ tortikolisi olan 9 yaşında bir erkek çocuğu tanımlamaktadır.

The aim of this study was to assess vitamin D serum levels in autoimmune thyroid disease, Hashimato thyroiditis in the Turkish population. the subjects with Hashimato thyroiditis (HT, n=67, mean age 45.1±10.9,F/M-61/6), control subjects (mean age 42.1±15.7, n=29, F/M-26/3) were recruited for the study. Thyroid function tests, thyroid antibodies (AntiTg, AntiTPO, TSHRAb), ultrasound features, demographic and antropometric variables were recorded. Vitamin D level was not different between the HT and the control groups (53.1±24.7 nmol/L and 54.1±19.8 nmol/L, as mean, respectively, p = 0.482) in the HT group, 35.8% of subjects had vitamin D insufficiency, only 16.4% of subjects with HT were vitamin D sufficient. There was no significant difference between the HT and the control groups according to the vitamin D classification status (p = 0.666). Vitamin D levels were significantly higher in the subjects who were taking replacement compared to subjects who were not (58.7 ± 26.0 vs. 46.0 ± 23.3, as mean, respectively, p = 0.033). There was no significant correlation between vitamin D levels and TgAb and TPOAb levels in HT group (p = 0.754 r = -0.039, p = 0.134 r = -0.290, respectively). in both HT and control groups, vitamin D levels were significantly correlated only with the fT4 levels (p

The achievement of euthyroid state has been suggested in patients with thyrotoxicosis undergoing surgery to reduce the risk of thyroid storm. However, euthyroid state could not always be achieved by antithyroid drugs. Therefore, therapeutic plasma exchange (TPE) is an option in this condition. A 58-year-old male patient with a history of type-2 diabetes using 200 mg amiodarone per day, admitted for diabetic ketoacidosis (DKA), induced by thyrotoxicosis. with palpitation, sweating, polyuria, and polydipsia. Euthyroid state could not be achieved, despite all apropriate treatments for thyrotoxicosis. Therefore, preparation with TPE followed by total thyroidectomy was planned. A 35% decrease in fT3 (free T3) and fT4 (free T4) levels were achieved, after two sessions of TPE. A 74-year-old male patient, admitted for acute anterior myocardial infarction (AMI) induced by thyrotoxicosis due to Graves disease. Multiple vessel disease was detected on primer percutanous coronary angiography, and an emergency coronary artery bypass grafting (CABG) was planned. Therefore, preperation with TPE was planned before surgery. A substential decrease in fT4 and fT3 levels (45% and 72%, respectively) levels were achieved, after one session of TPE. Most of the studies evaluating the efficacy of TPE in patients with thyrotoxicosis are including patients with Graves disease and toxic multinodular goiter, and TPE was indicated as an effective option for preparation of these patients for surgery. However, as presented in case 1, TPE may not be effective in amiodarone induced thyrotoxicosis (AIT) as in cases with thyrotoxicosis due to Graves disease. [Med-Science 2019; 8(1.000): 233-6]

Gastric cancer comprises 10% of all cancers in the world and is rarely seen before the age of 30. Different genetic interactions or molecular changes like e-cadherin, P16, APC, c-erb B2, c-met, ras, or c-myc have been described in the pathogenesis of the disease. MiRNAs play critical roles in various biological processes such as cell proliferation, cell differentiation, apoptosis, repairing of DNA damage, angiogenesis, stress response, and stem cell division. The aim of this study is to investigate the relationship between miRNA gene expressions and gastric cancer. Method: Sixty-four patients with gastric cancer diagnosed consecutively in our pathology laboratory and 30 consecutive participants with normal gastric tissue, as a control group, were included in our study between 2011 and 2013. Total miRNAs were obtained by using genomic miRNA extraction kit (QIAGEN Sample & Assay Technologies, Hilden, Germany) after the samples had been deparaffinized. MiR-21, 107, 141, 150, 192, 202, 218, 331 gene expressions were evaluated by using real time-PCR (RT-PCR) from the whole miRNA. Results: MiR-331 was downregulated in the stage 2 patients and the rest of the miRNAs were significantly upregulated (p < 0.001). All miRNAs were significantly upregulated in the stage 3a patients (p < 0.001). In the antrum localized tumors, miR-107, -150, -202, -218, and -331 were significantly upregulated, whereas miR-21, -192 were statistically downregulated (p < 0.05). In the cardia localized tumors, miR-21 (p > 0.05) was downregulated and miR-107, -150, -202, -218, and -331 were upregulated (p < 0.05) Different gene expressions of miRNAs according to the different localizations of gastric cancer and different stages suggest that it can be tumor marker to predict the stage and localization of gastric cancer. [Med-Science 2019; 8(1.000): 255-9]