Burnout in Turkish Adult Neurology Specialists

Aim:Burnout in medical doctors may worse affect patient care or physical performance of clinician. We aimed to investigate the burnout ratio and the factors associated with burnout in Turkish neurology specialists.Materials and Methods:The neurology specialists in Turkey were included in the study. The participants were asked to fill a questionnaire comprised of 33 questions regarding various thoughts and experiences. The participants gave a response to the questions as follows: strongly disagree, slightly agree, moderately agree, strongly agree, completely agree. According to the meaning value of the question (negative or positive meaning), the answer was given a point in a range of 1-5. Sum of points divided by the maximum point (165) gave a burnout ratio.Results:The mean age was 38.78 (±8.42) years, and the female/male ratio was 461/255. The mean burnout ratio was found to be 46.73% (±8.95). Male sex, academic membership, higher academic degree, working in medical faculty hospital, lower salary, being single or nonparent, nightshift, absence of on call work, or working in the intensive care unit were detected to be associated with a higher burnout ratio. Burnout ratio was in positive correlation with age, number of patients examined, and duration of working hours, but in negative correlation with number of auxiliary staff or neurologists in hospital.Conclusion:Our study is the first study to demonstrate a high burnout ratio in a large sample of Turkish adult neurology specialists. Being male, older, academician, professor, single or nonparent, working in medical faculty hospital or in intensive care, low salary, nightshift, and high patient number or working hours seem to be associated with burnout

Evaluation of Diffusion Tensor Imaging Findings in Clinically Isolated Syndrome and Relapsing-Remitting Multiple Sclerosis Patients

Objective: To compare diffusion tensor imaging (DTI) findings of the normal-appearing white matter (NAWM) and corpus callosum (CC) in patients with clinically isolated syndrome (CIS) and relapsing-remitting multiple sclerosis (RRMS) and a healthy control (HC) group. Materials and Methods: The CIS (n = 10), RRMS (n = 29), and HC (n = 13) groups were evaluated by DTI in this retrospective study. Mean diffusion (MD) and fractional anisotropy (FA) maps as well as MD and FA measurements were made from the corpus callosum genu (CCG), corpus callosum splenium (CCS), and NAWM areas from the frontal, parietal, occipital and temporal lobes. Results: The mean FA values of the NAWM in the temporal lobes were bilaterally lower in both the CIS and RRMS groups than in the HC group. However, no difference was found between the CIS and RRMS groups. In addition, the CIS group had lower FA values in the CCG, whereas the RRMS group had lower FA values in the CCS compared with the HC group. The MD values were significantly different in the CCG between the RRMS and HC groups. Conclusion: DTI contributes to detecting early changes in the NAWM and CC in patients diagnosed with CIS and RRMS. Additionally, DTI can aid in the follow-up care and management of these patients

Left Atrial Function Is Improved in Short-Term Follow-Up after Catheter Ablation of Outflow Tract Premature Ventricular Complexes

Background: Association of premature ventricular complexes (PVC) with left ventricular systolic dysfunction (LVSD) and efficacy of catheter ablation treatment have been demonstrated in studies. The role of left atrial (LA) mechanics in the etiopathogenesis of PVC-induced cardiomyopathy (PVC-CMP) as well as changes in LA mechanics with catheter ablation have not been studied before. Methods: A total number of 61 patients (Mean Age 43 ± 3) with idiopathic outflow tract (OT) PVCs undergoing radiofrequency catheter ablation (RFCA) were enrolled. ECG, 24 h Holter, and echocardiographic evaluation with left ventricular (LV) diastolic functions and LA volumetric assessments were performed before and three months after RFCA. Results: Along with a marginal increase in left ventricle ejection fraction (LVEF), improvement in diastolic functions and left atrial mechanics were observed in the study (LVEF 53 ± 7 versus 57 ± 6, p < 0.01) in short-term follow-up. The frequency of LV diastolic dysfunction (LVDD) decreased with catheter ablation (n = 5 to 0, p = 0.02). The overall LA function improved. Left atrium passive and overall emptying fraction (LAEF) increased significantly (0.32 ± 0.04 to 0.41 ± 0.04, p < 0.05 and 0.62 ± 0.04 to 0.65 ± 0.004, p < 0.05, respectively). Active LAEF decreased significantly (0.29 ± 0.005 to 0.24 ± 0.006, p < 0.05). Conclusions: The results of this study are indicative of "PVC-induced atriomyopathy" which responds to RFCA in short-term follow-up. Atrial dysfunction might play a role in symptoms and etiopathogenesis of LVSD

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Diffusion tensor imaging evaluations of visual pathways with acute and chronic optic neuritis and assessments of superiority and correlations with the other evaluation techniques

Amaç Son yıllarda yapılan çalışmalarda difüzyon tensor görüntüleme'nin(DTG), optik nevrit(ON) ve multipl skleroz(MS)'un patofizyolojisini daha iyi kavramamızı sağlayabileceği bildirilmiştir. Bu çalışmada, akut ve kronik ON?li hastalarda ON tanısında ve takibinde kullanılan farklı yöntemlerle afferent görme yollarının ayrıntılı bir şekilde incelenmesi, gruplar arasında farklı yöntemlerle saptanan bulguların değerlendirilmesi, DTG?nin diğer inceleme yöntemlerine üstünlüğünün ve bu yöntemlerle korelasyonlarının değerlendirilerek klinik pratikte sağlayabileceği yararların ve patofizyolojik sürecin anlaşılmasına yapacağı katkıların değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem Bu çalışmada, toplam 26 hasta (17 gözde akut ON, 20 gözde kronik ON, 15 göz sağlam) ve 13 sağlıklı kontrol, farklı inceleme yöntemleri(nörooftalmolojik değerlendirme, görsel uyarılmış potansiyeller/GUP, optik koherans tomografi/OKT, orbital ve beyin MRG, difüzyon tensor görüntüleme/DTG) ile değerlendirilmiştir. Bulgular Difüzyon tensor görüntüleme incelemelerinde, optik sinirlerden ölçülen fraksiyonel anizotropi(FA) değerlerinde akut ve kronik ON'li hastalarda, kontrollere göre anlamlı olarak azalma(p&lt;0,05), mean diffüzyon(MD) değerlerinde ise artma saptandı(p&lt;0,05). Hasta ve sağlıklı gruplarda ölçülen optik kiyazma FA değerleri arasında anlamlı fark saptanmazken(p&gt;0,05), MD değerleri hasta grupta artmış bulundu(p&lt;0,05). Optik traktuslardan ölçülen FA değerleri hasta grupta kontrol grubuna göre azalmış(p&lt;0,05), MD değerleriyse artmış saptanmıştır(p&lt;0,05). Retinal sinir lifi tabakası(RSLT) kalınlıkları, P100 amplitud ve latansları ve görme keskinlikleri(GK) hasta ve kontrol grupları arasında anlamlı olarak farklı saptanmıştır(p&lt;0,01). Orbita MRG?lerinde ON acısından anlamlı patoloji saptanan grupta, normallere gore FA değerleri (p&lt;0,05), RSLT kalınlıkları(p&lt;0,05), görme keskinlikleri(p&lt;0,01) ve P100 amplitudlerinde(p&lt;0,05) azalma, MD değerlerinde artma (p&lt;0,01) saptanmıştır. Akut ON?li grupta FA değerleri, P100 latansında uzama ve RSLT kalınlığındaki azalma ile(p&lt;0,05), MD değerleri ise, RSLT kalınlığı ve GK?de azalmayla(p&lt;0,05) korele saptanmıştır. Kronik ON?li grupta FA?daki azalma ile MD artışı ve GK?deki azalma korele(p&lt;0,05) bulunmuştur. Kronik ON?li grupta ayrıca MD değerleriyle P100 amplitudleri ve GK korele bulunmuştur(p&lt;0,05). Çalışmamızda klinik olarak ON olduğu gösterilmiş olan gözlerde yapılan GUP incelemesinde %97 OKT incelemesinde %72, DTG incelemesinde %62, orbita MRG?de %48 oranında anormallik saptandı. Hasta grubun etkilenmemiş gözlerinde anormallik saptanma oranı GUP incelemesinde %46, OKT incelemesinde %13, DTG incelemesinde %26?sında saptanırken orbita MRG?de bu gözlerde anormallik saptanmadı. Sonuç Optik nevritli hastalarda optik sinirlerden ölçülen MD ve FA değerlerindeki anormalik, optik kiyazma ve optik traktuslara göre daha belirgin saptanmıştır. Ayrıca demiyelinizasyon ve aksonal kaybın daha fazla olduğu kronik optik nöritli hastalarda MD değerlerindeki artış ve FA değerlerindeki azalma daha belirgindir. Çalışmamızın sonuçları DTG ile yapılan ölçümlerin vizüel dizabilite ve doku hasarı ile korele olduğunu göstermektedir. DTG bulgularının orbital MRG verileri ile uyumluluğu, DTG?nin, sensitivitesi görece düşük ancak spesifitesi yüksek orbital MRG icin bir alternatif olabileceğini düşündürmüştür. Çalışmamızda özellikle kraniyal MRG?de normal olarak izlenen bölgelerde de FA azalması ve MD artışı gözlenmiştir. Bu bulgu ON?li hastalarda konvansiyonel ve orbita MRG ile gösterilemeyen etkilenmelerin DTG ile gösterebileceğini işaret etmektedir. Çalışmamızda elde edilen sonuçlar DTG?den klinik pratikte yararlanılabileceğini düşündürmektedir. Ayrıca DTG?nin hastalıkta patolojik sürecinin anlaşılmasına ve hastalığa bakış açımızın gelişmesine katkılar sağlayabileceği kanısına varılmıştır. Introduction And Purpose Assessment of the afferent visual pathway using clinical, imaging and electrophysiological methods provides insights into the pathophysiology of MS. In the present study we aim to investigate diffusion tensor imaging(DTI) evaluatıons of visual pathways in patients wıth acute and chronic optic neuritis and assessıng to superiority to other evaluation techniques Subjects and Methods In the present study, we performed DTI in total 26 patients and 12 healthy control subjects. The patients have acute episode of ON in 17 eyes, chronic ON in 20 eyes and 15 unaffected eyes ,based on clinical features. In addition,visual afferent system was evaluated with neuro-opthalmological examinations, OCT, VEP, orbital and cranial MRI in all participants in the study . Moreover in the study we investigated the correlation between applied methods. Results The mean of the measured values of fractional anisotropy (FA) in optic nerve was found to be significantly lower in the patients with acute optic neuritis (p&lt;0.05) and cronic optic neuritis(p&lt;0,05) The average values of mean diffusivity(MD) in patients with acute and chronic optic neuritis were significantly increased compared to unaffected eyes of patients and healthy controls (p&lt;0.05). Peripapillary retinal nerve fiber layer thickness(RNLFT), P100 amplitude and latency measurements and visual acuity was significantly different between groups(P &lt;0.01). The eyes with abnormal orbita MRI findings have statisticaly significant decrease in FA (p&lt; 0.05), increase in MD (p &lt;0.01), prolongation of P100 latency (p &lt;0.01) and decrease P100 amplitude (p&lt;0.05), decrease in RNLFT (p &lt; 0.05) and visual acuity (p &lt;0.01) compared to normal eyes. Mean values of FA measured in optic tract was significantly decreased (p&lt;0,05) and MD significantly was increased (p&lt;0.05) between groups. The mean of the measured values of fractional anisotropy (FA) in optic nerves was correlated with prolongation of P100 latency and decrease in RNLFT.(p&lt;0.05) in the patients with acute optic neuritis. Furthermore mean MD value was correlated with RNLFT, visual acuity(p&lt;0.05) and P100 latency,RNLFT was correlated with visual acuity in the patients with acute optic neuritis. The mean of the measured values of FA was correlated with mean MD value and visual acuity(p&lt;0.05), the mean MD value was correlated with mean P100 amplitude and visual acuity in the patients with cronic optic neuritis.(p&lt;0.05) The mean FA and MD values was found to be correlated in the normal controls.(p&lt;0.05) Conclusion Briefly, the most severe abnormalities for MD and FA in DTI have been seen in the optic nerve compared to chiasm and optic tract abnormalities. Furthermore, the eyes of chronic optic neuritis having more demyelination,gliosis and axonal loss have shown more increase MD values and decrease FA values than the others. MD and FA values of DTI, P100 latencies of VEP, RNLFT in OCT, visual acuity and colour vision all of them were very significantly different between the groups. Our results have suggested that DTI derived measurements correlate with visual disability and tissue injury and then it is important from a clinical point of view and understanding of pathological processes

Idiopathic Intracranial Hypertension: Etiological factors, Clinical Features, and Prognosis

Introduction: Idiopathic intracranial hypertension (IIH) occurs due to increased intracranial pressure (ICP), is most commonly encountered in obese women, and may lead to loss of vision. This study aimed to determine the demographic features, clinical signs and symptoms, and radiological findings of patients with IIH, and to investigate the factors associated with the prognosis

A gaucher patient with bilateral total femoral lytic lesions mimicking malignancy: a case report

Bone involvement in Gaucher disease can afect quality of life. Bone lesions of Gaucher disease can be confused with hematological diseases, infections, and malignancy. Our patient with bilateral femur involvement presented to us with a pathological fracture. After the fracture was treated with a long leg splint and healed, we performed a biopsy because of suspicious radiological fndings. The pathology results confrmed Gaucher disease with bone infltration during the time in which conservative follow-up was taking place, eventually leading to the patient’s mobilization again. Bone fndings of Gaucher disease indicate a difcult process requiring follow-up and treatment. It is crucial to scan patients periodically for possible vertebral and extremity symptoms. Vertebral and extremity fractures undoubtedly require experience on the part of the clinician as they can imitate malignant masses

Effects of Body Temperature Lowering on Visual Evoked Potentials in Patients with Multiple Sclerosis

Objective: Aggravation of neurologic symptoms in patients with multiple sclerosis (MS) due to heating is well known. This phenomenon, known as Uhthoff phenomenon (UP), is explained by transient conduction block in demyelinated nerve fibers and transected axons. The threshold of conduction block dependent on temperature is probably proportional to the degree of demyelination or axonal injury. On the other hand, about half of all patients reported improvement in a cold bath (anti-UP effect). This study aimed to assess the effects of body cooling on clinical parameters lneuro-opthalmologic examination and contrast sensitivity in visual acuity/Sloan letter rest, and the Expanded Disability Status Scale (EDSS)] and electrophysiologic measurements [visual evoked potentials (VEP)] in patients with MS previously clinically affected by optic neuritis