Medical Science and Discovery

A neurological approach to fear of falling in patients with stroke

2019-12-30T19:55:43+03:00

Objective: The present study aimed to investigate the factors that affects the fear of falling, also known basophobia, in patients with stroke and the aspects of life quality.

Material and Methods: Stroke patients in the physical therapy were included in this study. Demographic data of the patients were recorded. Patients were asked whether they fell after the stroke and experienced fear of falling. Itaki Fall Risk Scale, Functional Ambulatory Categories, Functional Independence Measure, Beck Depression Inventory and Stroke Specific Quality of Life scale (SS-QoL) have been used. The data of the study were analyzed with SPSS 15 package program.

Results: This study was conducted on 102 patients with stroke. Of these, 36 (35.3%) patients were female with a mean age of 60.97. There was a fear of falling in 65 (63.7%) of the patients. 48 patients (47.1%) fell at least once after the stroke. Falls were significantly high with the ones who were experiencing fear of falling (p = 0.006). Fear of falling was significantly high in females, patients with ischemic stroke, elderly and the patients with coexistent systemic diseases (p <0.05). The total score and sub-units of SS-QoL was significantly low (p <0.05) in the group with the fear of falling. The depression score was significantly high in patients with fear of falling (p = 0.00).

Conclusion: Fear of falling in patients with stroke negatively affects many sub-units of the quality of life-related to movement, participation, and mood. Thus, the classic rehabilitation program for patients with stroke should include falling prevention training.

Is there any association between antibiotic resistance and virulence genes in Enterococcus isolates?

2019-12-30T19:55:41+03:00

Objective: In this study, we aim to determine the frequency of antibiotic resistance and five virulence genes in Enterococcus species and the relationship between antibiotic resistance and virulence genes.

Material and Methods: A total of 86 Enterococcus strains isolated from inpatients between 2015 and 2016 were included. Identification and antibiotic susceptibilities of strains were determined using a BD Phoenix fully automated system. The presence of virulence-associated genes (esp, gel E, asa1, hyl, and cyl) were investigated by using PCR method.

Results: Of the 86 Enterococcus strains, 53 (61.6%) and 33 (38.4%) were Enterococcus faecium and Enterococcus faecalis, respectively. Vancomycin and high-level gentamicin resistance (HLGR) in E. faecalis strains were 0.6% and 60.6%, respectively. Furthermore, 52 of the 53 E. faecium strains were both vancomycin-resistant and HLGR. The frequency of esp, gel E, asa1, cyl, and hyl was 91.9%, 60.5%, 54.7%, 43%, and 26.7%, respectively. The asa 1, cyl, and gel E genes were detected at high frequencies in vancomycin-susceptible and non-HLGR strains, whereas hyl gene was detected at high frequencies in vancomycin-resistant and HLGR strains.

Conclusion: Virulence genes were more frequent in vancomycin-susceptible and non-HLGR Enterococcus strains than in the resistant strains. Although infections caused by multidrug-resistant strains are difficult to treat, it should be considered that susceptible strains have more virulence genes. This may reduce the in vivo efficacy of drugs and lead to treatment failures. Therefore, in addition to the in vitro susceptibilities of drugs, clinical efficacy should be monitored.

The effect of various treatment modalities in idiopathic sudden sensorineural hearing loss: A retrospective evaluation

2019-12-30T19:55:40+03:00

Objective: In this study, we retrospectively evaluated the effects of treatment modalities on healing in patients diagnosed with idiopathic sudden sensorineural hearing loss.

Material and Method: In this study, we retrospectively reviewed the records of 65 patients diagnosed with idiopathic sudden sensorineural hearing loss and treated as inpatients. The treatment modalities applied to the patients were determined randomly.

Results: The effect of intra-tympanic steroid and / or hyperbaric oxygen therapy in addition to intravenous steroid on 500, 1000, 2000 and 4000 Hz frequencies and improvement in bone conduction was not statistically significant.

Conclusion: Although intra-tympanic steroid or hyperbaric oxygen therapy in addition to intravenous steroid therapy, which is the standard treatment of idiopathic sudden sensorineural hearing loss, does not increase the rate of improvement and speed, it may help to reduce the undesirable effects of the steroid dose.

The Evaluation of Upper Airway: Point of Care Ultrasound vs. Conventional Tests

2019-12-30T19:55:38+03:00

Objective: The ultrasound-guided interventions have gained widespread popularity in several aspects of anesthesia practice. In this study, we aimed to compare the preoperative evaluation tests and sonographic measurements of the upper airway for the prediction of a potentially difficult airway.

Material and Methods: In this prospective observational study, we enrolled 136 adult patients undergoing elective surgery under general anesthesia. The Modified Mallampati classification, thyromental distance, sternomental distance, and Cormack-Lehane scores were recorded. Sonographic measurements included pre-epiglottic space (PES), the distance between the midpoints of vocal cords and epiglottis (EVC). The ratio was interpreted. Main outcome is to determine the sensitivity and specificity of the upper airway ultrasound for the prediction of a potentially difficult airway.

Results: There was no statistically significant relationship between body mass index value and thyromental distance, Thyromental/Sternomental Ratio and PES/EVC ratio, Cormack-Lehane, Mallampati classification and thyromental/sternomental distance ratio (p>0.05). The sonographic measurements of airway have no significance to predict the difficult intubation and the comparison between PES, EVC and the PES/EVC ratio and assessment tests (Cormack-Lehane, Mallampati classification, thyromental and sternomental distances) was insignificant. The sternomental distance measurement was predictive for the difficult airway only in patients having body mass index more than 31.6 kg m-2.

Conclusion: Ultrasound is a useful tool for identifying the upper airway prior to anesthesia but the validity for the prediction of difficult airway is not clear. By increasing the clinical experiences and further investigations, a greater insight into its use will be gained.

Clinical results and importance of next-generation sequencing (NGS) in detecting targeted mutations in the treatment of metastatic Lung Cancer: Single center initial results

2019-12-30T19:55:37+03:00

Objective: In Lung cancer (LC), which is one of the most deadly cancers, longer survival has been achieved with targeted agents. For this reason, it is important to find the patients who are suitable for targeted therapies. Next-generation sequencing (NGS) is a method that allows multiple genetic variants to be detected simultaneously by performing massive parallel DNA sequencing at the same time. We wanted to reveal the clinical effects and benefits of genetic variant analysis with NGS for our patients.

Material and Methods: Patients with stage 4 non-squamous and not otherwise specified (NOS) Non-small cell LC who underwent genetic variant analysis with NGS were included in the study, retrospectively.

Results: Total of the 51 patients, 41 (80.4%) were male and the median age was 64 (35-85) years. According to TNM, 21 (41.2%) patients were stage 4A, 30 (58.8%) patients were stage 4B and 39 (76.5%) patients had adenocarcinoma and 12 (23.5%) had NOS histology. NGS analyzes were performed in median 14 days (8-43) and determined 24 pathogenic variants in 17 (%25) patients: 9EGFR (%17,6), 6PIKC3A (%11,7), 5KRAS (%9,8), 2PTEN (%3,9), 1BRAF (%1,9), 1MET (%1,6) (7 of them concomitantly). Cytotoxic chemotherapy was recommended in 41, anti-EGFR agents in 8 (afatinib in 4, erlotinib in 4 patients) patients and anti-BRAF+MEK inhibitor agent (dabrafenib+trametinib) in 1 patient.

Conclusion: With the NGS, in just two weeks, both target and resistance genetic variants of our patients were detected at the same time and individualized treatments were applied. In this way, both time and cost were saved.

A comparison of two supraglottic airway devices in general anaesthesia: baska mask® vs. I-gel®

2019-12-30T19:55:35+03:00

Objective: The aim of this was to compare the Baska® mask and the I-gel® airway in paralyzed patients during general anaesthesia in terms of clinical performance, the risk of aspiration, and intraoperative and postoperative characteristics.

Material and Methods: The two devices were compared in 100 paralyzed anesthetized adult patients. Primary outcomes of the study were to evaluate the characteristics of the airway devices within respect to the success of first insertion attempt, the insertion time, the ease of insertion, leak volume, and peak airway pressure. The blood staining on the mask, and the presence of gastric reflux or sore throat two hours postoperatively were evaluated. Hemodynamics, end-tidal CO2 and the peripheral oxygen saturation measurements were secondary outcomes.

Results: No statistically significant difference was observed between the groups in the criteria of first attempt success rate, ease of insertion, blood staining upon removal of the masks, gastric regurgitation, or sore throat two hours after the procedure. The insertion time was significantly longer for the Baska® mask compared with the I-gel® airway. The leak volume was significantly higher in the Baska® mask patients throughout the surgical procedure. The heart rate and mean arterial pressure measurements were significantly higher in the Baska® mask patients.

Conclusions: Both the Baska® mask and the I-gel ® device can be used effectively for selected paralyzed patients under general anaesthesia. The insertion time was significantly longer for the Baska® mask compared with the I-gel® device.

An investigation of the protective effects of Dehydroepiandrosterone (DHEA) in chemotherapatic Cyclophosphamide (CP) induced ovarian damage on rats

2019-12-30T19:58:49+03:00

Objective: We aimed to investigate whether cyclophosphamide-induced damage to rat ovary can be prevented by DHEA.

Material and Method: Group 1 (the control Group): no treatment was administered. Intact ovarian tissue was removed and blood samples were taken for anti-mullerian hormone (AMH) test. Group 2 (the Cyclophosphamide Group): Rats received Cyclophosphamide intraperitoneally at a single dose of 150 mg / kg. Group 3 (the Cyclophosphamide + DHEA Group): Rats received Cyclophosphamide intraperitoneally at a single dose of 150 mg / kg at baseline and DHEA subcutaneously for 10 days at a dose of 60 mg / kg daily. Rats in groups 2 and 3 were sacrificed at the end of 10 days, ovarian tissues were removed and blood samples were taken for AMH test.

Results: While normal ovarian tissue damage scores were zero, cyclophosphamide showed significant damage and histopathological changes in all rats. Cyclophosphamide group had higher vascular congestion (p=0.004) and total damage scores (p=0.010) than normal ovarian group. Cyclophosphamide + DHEA group had higher edema (p<0.001), vascular congestion (p<0.001) and total damage scores (p<0.001). Cyclophosphamide group had a decrease in primordial (p = 0.001), primary (p = 0.043) and preantral follicles(p = 0.006). Cyclophosphamide + DHEA group showed a decrease in primordial (p = 0.001) and antral follicles(p = 0.018). AMH levels did not decrease in both groups.

Conclusions: It was found that the use of DHEA to prevent Cyclophosphamide-induced ovarian damage in rats did not produce significant changes in antral follicle counts, ovarian volume, and AMH levels, which were important for clinical practice.

A cervical paravertebral schwannoma: A case report

2019-12-30T19:55:32+03:00

Objective: Paraspinal schwannomas arise from the dorsal nerve root. Symptoms of schwannomas may depend on their locations and sizes. This case was presented by a female patient with a dorsalgia for 10 years. She had not any specific symptoms but pain and a thick spot on the neck (cervical area). Paraspinal schwannomas involve the dorsal nerve roots, affecting people in the fourth and fifth decades of life. Paraspinal schwannomas are frequently asymptomatic and diagnosed incidentally on imaging of the spine. Total excision is mostly possible and the recurrence rate is low.