Effect of clinical autonomic dysfunction on cognitive functions in Parkinson’s disease

Objective: Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder characterized by tremor, rigidity, bradykinesia, and postural instability. PD also involves nonmotor manifestations such as autonomic failure, cognitive disorders, and sleep disorders. These clinical characteristics are not identical in severity, frequency, and onset time in all PD patients. We assessed whether there is a negative effect on cognition of clinical autonomic dysfunction in PD patients. Methods: This prospective study includes 37 PD patients with autonomic failure. From each patient, a questionnaire (SCOPA-AUT) including symptoms associated with clinical autonomic dysfunction such as constipation, urinary incontinence, orthostatic hypotension, and hyperhydrosis was obtained and the patient’s clinical condition was rated on the Hoehn and Yahr (H-Y) scale in the ON-medication state. The patients’ cognitive function was assessed by the Mini-Mental State Examination (MMSE), Blessed score, Frontal Assessment Battery (FAB), and Digid Span Test (DST) (forward, reverse). Cognitive test scores were compared with SCOPA-OUT scores. Results: Mean age was 66,5±11.2 years. There was no correlation between cognitive test scores and SCOPA -OUT scores (p>0.05). However, H-Y scores were negatively correlated with the DSTf, DSTr, FAB, and MMSE scores (p50.005, r:-0.451; p50.025, r: -0.367; p50.040, r: -0.340; p50.044, r5-0.333, respectively). Conclusions: According to our results, clinical autonomic dysfunction did not seem to ha ve an effect on cognition. In addition, severity of cognitive dysfunction showed a strong negative correlation with the stage of disease

Prevalence of depression among Turkish University Students and related factors

Objective: This investigation was performed to determine the prevalence rate of depression and its correlates in students at Erciyes University. Method: A total of 1003 university students at the Medical, Theology and Engineering Faculties of Erciyes University in Kayseri, Turkey were included in the study. A socio–demographic questionnaire and a Beck Depression Inventory were completed by the students. An unpaired t test, a one way ANOVA test and a logistic regression analysis were used for the statistical analyses. Results: Total numbers of male and female students in the study group were similar and the mean age was 20.3±1.8. The mean Back Depression Inventory Beck Depression Inventory score was 11.3±8.6 points and prevalence rate of depression (Beck Depression Inventory ≥17) was 21.2%. The Mean Beck Depression Inventory score and depression prevalence were found higher among the students who had a physical illness, who were not satisfied with their body image or their faculty and who rated the economic level of their families as poor. Conclusion: It was concluded that approximately one–fifth of the students had depression. For the students, studying in a faculty which they are not satisfied is a major factor affecting depression. A better leadership should be provided for the students during the faculty selection procedure. Key Words: University student, depression, Beck Depression Inventory Üniversite öğrencilerinde depresyon prevalansı ve ilişkili faktörler Amaç: Bu çalışma, Erciyes Üniversitesi öğrencilerinde depresyon prevalansını ve bununla ilişkili faktörleri belirlemek amacıyla yapılmıştır. Yöntem: Erciyes Üniversitesinin Tıp, İlahiyat ve Mühendislik fakültelerinde okuyan toplam 1003 öğrenci araştırma kapsamına alındı. Öğrencilere sosyo-demografik anket ve Beck Depresyon Ölçeği uygulandı. Verilerin istatistiksel analizinde unpaired t testi, tek yönlü ANOVA testi ve logistik regresyon analizi uygulandı. Bulgular: Araştırma grubundaki erkek ve kız öğrenci sayıları birbirine yakındı ve yaş ortalaması 20.3±1.8 olarak belirlendi. Ortalama BDÖ puanı 11.3±8.6 ve depresyon prevalansı (Beck Depresyon Ölçeği puanı ≥17) % 21.2 bulundu. Fiziksel hastalığı olanlarda, beden görünümünden memnun olmayanlarda, okuduğu fakülteden memnun olmayanlarda ve ailesinin ekonomik durumunu kötü olarak belirtenlerde ortalama Beck Depresyon Ölçeği puanı ve depresyon prevalansı daha yüksek bulundu. Sonuç: Öğrencilerin yaklaşık beşte birinde depresyon vardır. Öğrencilerin, hoşlanmadığı bir fakültede okumaları depresyon sıklığını etkileyen en önemli faktörlerden biridir. Fakülte seçimi sırasında öğrencilere daha iyi rehberlik hizmeti sağlanmalıdır. Anahtar Kelimeler: Üniversite öğrencisi, depresyon, Beck Depresyon Ölçeği </p

Preincisional infiltration of tonsils with ropivacaine in post-tonsillectomy pain relief: double-blind, randomized, placebo-controlled intraindividual study

WOS: 000238166800003PubMed: 16929992Objective: To determine whether pre-emptive ropivacaine has an influence on postoperative pain in adult patients undergoing tonsillectomy. Design: A prospective, randomized, double-blind, placebo-controlled clinical trial. Setting: University hospital. Patients: The study included 20 adult patients undergoing elective tonsillectomy. Anesthetic induction and maintenance, dissection tonsillectomy, hemostasis techniques, and postoperative analgesic treatment were standardized for all patients. Before the onset of incision, one tonsillar fossa was administered 5 mL of 2% ropivacaine hydrochloride with epinephrine, whereas the other side received 5 mL of 0.9% saline with epinephrine and was designated as the control side. Main Outcomes Measures: For each side, postoperative pain, otalgia, operating time, amount of intraoperative blood loss, and postoperative hemorrhage were assessed. The intensity of postoperative pain was measured at rest and when the patient was drinking and was scored on a visual analogue scale. The patients were followed up for 10 days after surgery. Results: There was no statistically significant difference in the amount of intraoperative hemorrhage and operation time between sides (p >.05). The constant postoperative pain in the ropivacaine side at rest was significantly less than in the placebo side on days 1, 2, 5, and 6 (p <.05). The post-tonsillectomy pain experienced in the ropivacaine side when swallowing was significantly less than that in the placebo side throughout the study period except on day 10 (p <.05). Conclusion: Based on the present findings, preincisional infiltration of ropivacaine 2% appears to be effective against both early and late postoperative pain, especially on swallowing, following tonsillectomy in adults

High-Dose Ropivacaine versus Bupivacaine for Posttonsillectomy Pain Relief in Adults

WOS: 000207463500026PubMed: 19128713Objective: To compare the efficacy and safety of preincisional high-dose ropivacaine with bupivacaine in relieving posttonsillectomy pain. Design: A prospective, randomized, double blind, placebo-controlled clinical trial. Setting: University hospital. Patients: Before the incision, 58 subjects were randomly assigned to receive 10 mL of 10 mg/mL ropivacaine hydrochloride with epinephrine (n = 19, group 1), 10 mL of 2.5 mg/mL bupivacaine with epinephrine (n = 20, group 2), or saline with epinephrine (n = 19, group 3) as a placebo. Main Outcomes Measures: Postoperative pain, additional analgesic drug consumption, otalgia, operating time, amount of intraoperative blood loss, and possible complications were assessed. The intensity of pain was scored on a visual analogue scale. The patients were followed up for 10 days after surgery. Results: There were no statistically significant differences between the demographic and operational characteristics of the patient groups. Statistically significant differences were determined between in the mean intensity of constant and swallowing pain values of group 1 and group 2 or 3, at 4, 8, and 12 hours, and on days 1, 2, 3, and 4, postoperatively. However, no statistical differences were determined between the groups on days 5, 7, and 10. A lower amount of additional analgesic drug was consumed by the ropivacaine group than by the bupivacaine group, and by the bupivacaine group than by the control group, and the differences were statistically significant. Conclusion: Preincisional infiltration of the tonsils with high-dose ropivacaine markedly decreased the intensity of pain after tonsillectomy when compared with bupivacaine or placebo, especially until postoperative day 4 in adults

The effects of preanesthetic, single-dose dexmedetomidine on induction, hemodynamic, and cardiovascular parameters

WOS: 000260134200006PubMed: 18929283Study Objectives: To investigate the hemodynamic, cardiovascular, and recovery effects of dexmedetomidine used as a single preanesthetic dose. Design: Randomized, prospective, double-blind study. Setting: University Hospital of Kirikkale, Kirikkale, Turkey. Patients: 40 ASA physical status I and II patients, aged 20 to 60 years, who were scheduled for elective cholecystectomy. Interventions: Patients were randomly divided into two groups to receive 0.5 mu g kg(-1) dexmedetomidine (group D, n = 20) or saline solution (group C, n = 20). Anesthesia was induced with thiopental sodium and vecuronium, and anesthesia was maintained with 4% to 6% desflurane. Measurements: Mean arterial pressure (MAP), heart rate (HR), (ejection fraction (EF), end-diastolic index (EDI), cardiac index (CI), and stroke volume index (SVI) were recorded at 10-minute intervals. The times for patients to "open eyes on verbal command" and postoperative Aldrete recovery scores were also recorded. Main Results: In group C, an increase in HR and MAP occurred after endotracheal intubation. In group D, HR significantly decreased after dexmedetomidine was given. The EDI, Cl, SVI, and EF values were similar in groups D and C. The modified Aldrete recovery scores of patients in the recovery room were similar in groups C and D at the 15th minute. Conclusions: A single dose of dexmedetomidine given before induction of anesthesia decreased thiopental requirements without serious hemodynamic effects or any effect on recovery time. Crown Copyright (C) 2008 Published by Elsevier Inc. All rights reserved