Ultrasonography Accurately Evaluates the Dimension and Shape of the Pilonidal Sinus

PURPOSE: To study the benefits of ultrasonography for detecting the borders of pilonidal sinus tissue. The correlation between physical and ultrasonographic examination was used for surgical planning. METHOD: Between April and December 2004, 73 patients were recruited for this study. All patients were examined, and the borders of the sinus tissue were marked on the skin according to palpation before surgery. The surgeon also made a treatment plan considering the diseased tissue and marked a possible incision line. Patients were subsequently examined with ultrasonography. According to the ultrasonographic evaluation, the margins, extensions, and openings of pilonidal sinus tissue were determined and marked on the patient in a different color by a radiologist prior to surgery. The most suitable surgical treatment was decided according to the information obtained by ultrasonography. RESULTS: The average age was 23.03 ± 3.05 (range 18-39) years. We found 81 lesions in 73 patients. Ultrasonographic borders of sinus tissue were similar to the borders marked by the surgeon in 56 patients (76.7%). In the remaining 17 patients (23.3%), ultrasonography detected branches or borders that distinctly exceeded the planned incision line. After ultrasonographic examination, the surgeon changed his incision line in 14 patients and the surgical intervention in 3 patients. CONCLUSION: Palpation and methylene blue injection do not provide appropriate information in many patients. Our study revealed that pre-operative ultrasonography can improve the identification of the sinus tract and its branches when compared to palpation and methylene blue injection

Ultrasonography accurately evaluates the dimension and shape of the pilonidal sinus

PURPOSE: To study the benefits of ultrasonography for detecting the borders of pilonidal sinus tissue. The correlation between physical and ultrasonographic examination was used for surgical planning. METHOD: Between April and December 2004, 73 patients were recruited for this study. All patients were examined, and the borders of the sinus tissue were marked on the skin according to palpation before surgery. The surgeon also made a treatment plan considering the diseased tissue and marked a possible incision line. Patients were subsequently examined with ultrasonography. According to the ultrasonographic evaluation, the margins, extensions, and openings of pilonidal sinus tissue were determined and marked on the patient in a different color by a radiologist prior to surgery. The most suitable surgical treatment was decided according to the information obtained by ultrasonography. RESULTS: The average age was 23.03 ± 3.05 (range 18-39) years. We found 81 lesions in 73 patients. Ultrasonographic borders of sinus tissue were similar to the borders marked by the surgeon in 56 patients (76.7%). In the remaining 17 patients (23.3%), ultrasonography detected branches or borders that distinctly exceeded the planned incision line. After ultrasonographic examination, the surgeon changed his incision line in 14 patients and the surgical intervention in 3 patients. CONCLUSION: Palpation and methylene blue injection do not provide appropriate information in many patients. Our study revealed that pre-operative ultrasonography can improve the identification of the sinus tract and its branches when compared to palpation and methylene blue injection

Težina ruksaka i načini nošenja ruksaka učenika u osnovnoj školi: Trebamo li biti zabrinuti?

Improper backpack use can cause various health problems, such as lower back, back, and shoulder pain and postural distortion in children. These problems reduce the quality of life of children and affect their success in their educational lives. This study aimed to determine the weights of primary school students’ backpack and their backpack use status. The results of this study offer a guide for the educational practitioners oriented at gaining positive behaviors by using the right backpack. This descriptive cross-sectional study was carried out in the fall semester of 2017. The sample comprised 374 students from three different schools in Ankara, aged 6-11. Data collection was done using a personal information form and checklist for backpack use, which was developed based on the related literature. The study used descriptive statistics, independent group t-test and one-way variance analysis (ANOVA) for data analysis. The mean backpack weight was 4.03 kg. The study found that 96.2% of the children wore their backpacks using both shoulder straps, 54.2% of their backpacks were not in full contact with their backs, and 42.1% of the children wore their backpacks below their back and did not use a waist belt. The study determined the mean rate of the children’s backpack weight to their body weight as 14.4%. The study found that backpack weight increases in parallel with the child’s age and grade. The study reported that backpack weights and improper backpack use among primary school students were high and most of the children carried backpacks that were heavier than 10% of their body weight.Nepravilno nošenje školske torbe, točnije, ruksaka može uzrokovat različite zdravstvene probleme kao što su bolovi u donjem dijelu leđa, u leđima, u ramenima te iskrivljeno držanje djece. Ti problemi smanjuju kvalitetu života djece i utječu na njihov uspjeh u obrazovanju. Cilj ovoga istraživanja je odrediti težinu ruksaka te način na koji učenici nose torbe. Rezultati ovoga istraživanja nude smjernice za donošenje pozitivnih postupaka kod nošenja dobre torbe. Ovo deskriptivno, transverzalno istraživanje provedeno je u jesen 2017. godine. Uzorak je činilo 374 učenika iz tri različite škole u Ankari u dobi od 6 do 11 godina. Podaci su prikupljeni koristeći obrazac za osobne informacije i kontrolni list za nošenje ruksaka koji je nastao oslanjajući se da povezanu literaturu. Za obradu podataka u istraživanju je korištena deskriptivna statistika, nezavisni grupni t-test i jednosmjerna analiza varijance (ANOVA). Srednja vrijednost težine ruksaka bila je 4,03 kg. Istraživanje je pokazalo da 96,2 % djece nosi ruksak koristeći obje naramenice, a 42,1 % djece nosi školsku torbu ispod leđa i ne koristi pojas oko struka. Istraživanjem je određeno da je omjer srednju vrijednost školske torbe u odnosu na učeničku tjelesnu težinu 14,4 %. Također se pokazalo da se težina ruksaka povećava s djetetovom dobi i razredom. Istraživanje je pokazalo da je težina ruksaka i nepravilno nošenje ruksaka prilično visoka među učenicima osnovne škole te da većina učenika nosi ruksak koji je teži od 10 % njihove tjelesne težine.

An under-diagnosed geriatric syndrome: sleep disorders among older adults.

Introduction: Sleep disorders are commonly under-diagnosed in the geriatric population. We aimed to determine the prevalence of sleep problems among older adults admitted to the geriatrics out-patient clinic. Methods: Two hundred and three patients (136 female) older than 75 years of age were included in the study. Patients underwent comprehensive geriatric assessment, including identification of sleep problems using the Sleep Disturbance Scale, Rapid eye movement (REM) sleep behavior disorder (RBD) Single-Question Screen questionnaire (RBD1Q) and The Johns Hopkins Restless Leg Syndrome Severity Scale. Demographic and clinical data including age, sex, medications, comorbid diseases, body mass index and functional scores was noted. Results: The mean age of the patients was 80.92\ub14.3 years. 35.5% of the patients had findings of REM-SBD and 32.5% of the patients had restless legs syndrome. Ninety-seven percent of the patients answered \u2018yes\u2019 to at least one of the sleep disturbance scale questions. There was no significant difference between male and female groups. Conclusion: We observed that sleep disorders were common among older adults. For this reason, the course and quality of sleep should be examined in all patients as a routine part of comprehensive geriatric assessment

The Causes of Acute Fever Requiring Hospitalization in Geriatric Patients: Comparison of Infectious and Noninfectious Etiology

Introduction. Infectious diseases may present with atypical presentations in the geriatric patients. While fever is an important finding of infections, it may also be a sign of noninfectious etiology. Methods. Geriatric patients who were hospitalized for acute fever in our infectious diseases unit were included. Acute fever was defined as presentation within the first week of fever above 37.3°C. Results. 185 patients were included (82 males and 103 females). Mean age was 69.7 ± 7.5 years. The cause of fever was an infectious disease in 135 and noninfectious disease in 32 and unknown in 18 of the patients. The most common infectious etiologies were respiratory tract infections (n = 46), urinary tract infections (n = 26), and skin and soft tissue infections (n = 23). Noninfectious causes of fever were rheumatic diseases (n = 8), solid tumors (n = 7), hematological diseases (n = 10), and vasculitis (n = 7). A noninfectious cause of fever was present in one patient with no underlying diseases and in 31 of 130 patients with underlying diseases. Conclusion. Geriatric patients with no underlying diseases generally had infectious causes of fever while noninfectious causes were responsible from fever in an important proportion of patients with underlying diseases

Heterozygous Cc2d1a mice show sex-dependent changes in the Beclin-1/p62 ratio with impaired prefrontal cortex and hippocampal autophagy

Autism Spectrum Disorders (ASD) are a group of neurodevelopmental disorders characterized by repetitive behaviors, lack of social interaction and communication. CC2D1A is identified in patients as an autism risk gene. Recently, we suggested that heterozygous Cc2d1a mice exhibit impaired autophagy in the hippocampus. We now report the analysis of autophagy markers (Lc3, Beclin and p62) in different regions hippocampus, prefrontal cortex, hypothalamus and cerebellum, with an overall decrease in autophagy and changes in Beclin-1/p62 ratio in the hippocampus. We observed sex-dependent variations in transcripts and protein expression levels. Moreover, our analyses suggest that alterations in autophagy initiated in Cc2d1a heterozygous parents are variably transmitted to offspring, even when the offspring's genotype is wild type. Aberration in the autophagy mechanism may indirectly contribute to induce synapse alteration in the ASD brain

Prevalence of potentially inappropriate prescribing among older adults: A comparison of the Beers 2012 and Screening Tool of Older Person's Prescriptions criteria version 2

AimTo date, there is no study comparing the Beers 2012 and Screening Tool of Older Person's Prescriptions (STOPP) version 2 criteria, nor reporting a comparison of the prevalence of potentially inappropriate Prescribing (PIM) with STOPP version 2. We aimed to evaluate the prescriptions of patients admitted to a geriatric outpatient clinic with these tools, and to document the factors related to PIM use. MethodsOlder patients (aged 65 years) admitted to the outpatient clinic of a university hospital were retrospectively evaluated for PIM with Beers 2012 and STOPP version 2 criteria. Age; sex; chronic disease and number of drugs; and functional, depression and nutritional statuses were studied with regression analysis as possible factors related to PIM. ResultsThe study included 667 participants (63.1% women, mean age 77.6 6.3 years). The mean number of drugs was 6.1 +/- 3.4. PIM prevalence detected by STOPP version 2 was higher than that of the Beers 2012 criteria (39.1% vs 33.3%, respectively; P < 0.001; Z = -3.5) with moderate agreement in between (kappa = 0.44). Antipsychotics, over-the-counter vitamin/supplements, aspirin, selective-serotonin-reuptake-inhibitors and anticholinergics were the leading drug classes for PIM. The extent of polypharmacy (P < 0.001, OR 1.29, 95% CI 1.20-1.38) was the most important variable related to PIM, along with the multiple comorbidities (P = 0.005, OR 1.16, 95% CI 1.05-1.30). Higher level of functionality was inversely associated with PIM (P = 0.009, OR 0.90, 95% CI 0.83-0.97). ConclusionsInappropriate prescription prevalence of similar to 40% by STOPP version 2 was similar to the global worldwide prevalence - yet at the upper end. STOPP version 2 was more successful than Beers 2012 to detect PIM. Patients with multiple drug use, multiple comorbidities and more dependency were more likely to have PIM requiring special attention during prescription. Geriatr Gerontol Int 2017; 17: 1245-1251

Comprehensive geriatric assessment in practice: What do patients say

Objective: Comprehensive Geriatric Assessment (CGA) is one of the cornerstones of geriatric medicine. In this study, we aimed to find out how satisfied patients aged 60 and over with the application of CGA and whether they would express these complaints if geriatric-syndromes were not questioned. Materials and Methods: Patients who applied to the geriatric outpatient-clinic were included. An 18-question survey was applied by the geriatric nurse. The satisfaction and benefit expectations of the patients regarding both the application of CGA and specific sub-areas of CGA (urinary- fecal incontinence, falls, sleep, Mini-Nutritional-Assessment, Mini-Mental-State-Examination) were evaluated. They were asked whether they would express their complaints if these questions were not asked. Results: One-hundred-fifty patients were included in the study. The mean-age was 73.7±7 years. One-hundred-forty-eight patients were satisfied with the CGA and 139 of them thought it was beneficial. Seventy-three (49%) patients had urinary-incontinence, and 29 (19%) patients said that they would not report urinary-incontinence if this question had not been asked. Seventeen patients (11%) had fecal-incontinence and 16% of all patients said that they would not report fecal-incontinence if this question had not been asked. Twenty-nine of 85 patients stated that although they had a history of falling within the last year, they would not have stated this situation if this question was not asked. Ninety-three percent of the patients stated that they were satisfied with the Mini-Mental-State-Examination and that they thought this test would be beneficial for them. Conclusion: Although it takes time and is tiring, CGA is satisfactory for patients and enables the recognition of geriatric-syndromes that may remain hiddenAmaç: Kapsamlı-Geriatrik-Değerlendirme (KGD) geriatrinin temel taşlarındandır. Bu çalışmada 60 yaş ve üzeri hastaların KGD’nin uygulanmasından ne kadar memnun olduklarını ve geriatrik sendromlar sorgulanmasaydı; bu şikayetleri ifade edip etmeyeceklerini öğrenmeyi amaçladık. Gereç ve Yöntem: Geriatri polikliniğine başvuran hastalar dahil edildi. Geriatri hemşiresi tarafından 18 soruluk memnuniyet anketi uygulandı. Hastaların, hem KGD uygulanmasıyla ilgili hem de KGD’nin bazı alt-alanlarından özgün olarak (idrar-dışkı inkontinansı, düşme, uyku, Mini-Nütrisyonel-Değerlendirme) memnuniyet ve faydalanım beklentileri değerlendirildi. Kendilerine bu sorular sorulmasaydı şikayetlerini ifade edip etmeyecekleri soruldu. Bulgular: Çalışmaya 150 hasta dahil edildi. Ortalama yaş 73,7±7 yıl idi. Yüz-elli hastanın 148’i KGD’nin yapılmasından memnun olduğunu, 139’u kendileri için faydalı olduğunu düşündüklerini belirtti. Yüz elli hastadan 73’ünün (%49) üriner inkontinansı vardı ve 150 hastanın 29’u (%19) bu soru kendilerine sorulmamış olsaydı idrar inkontinansı olsa dahi belirtmeyeceklerini söylediler. On yedi hastanın (%11) fekal-inkontinansı mevcuttu ve tüm hastaların %16’sı bu soru kendilerine sorulmasaydı fekal-inkontinansı olsa dahi belirtmeyeceklerini söylediler. Düşme hikayesi olan 85 hastanın 29’u son bir yıl içinde düşme hikayesi olmasına rağmen bu soru kendilerine sorulmamış olsa bu durumu belirtmeyeceklerini belirtti. Hastaların %93’ü Mini-Mental-Testin yapılmasından memnun olduklarını ve bu testin kendilerine faydası olacağını düşündüklerini belirttiler. Sonuç: Vakit alması ve yorucu olmasına rağmen KGD hastalar için memnuniyet vericidir ve gizli kalabilecek geriatrik sendromların tanınmasını sağlamaktadı

Cut-off points for weight and body mass index adjusted bioimpedance analysis measurements of muscle mass

Low skeletal muscle mass (LMM) is a criterion to define both sarcopenia and malnutrition. Muscle mass varies with gender, height, weight or fat mass, and many indices of adjusted-muscle mass have been proposed. We aimed to find reference cut-off points of the skeletal muscle mass index (SMMI) adjusted for weight and body mass index (BMI) in Turkish population. Adults between 18 and 39 years of age and community-dwelling older adults of 60-99 years of age were included. Body composition was assessed with bioimpedance analysis (BIA). SMMI adjusted for weight and BMI were calculated [SMMI (weight) and SMMI (BMI)]. Muscle strength was assessed by hand-grip-strength with hand dynamometer. SMMI (weight) cut points were calculated from the healthy young adults' data as mean SMMI-2 standard deviation (SD). SMMI (BMI) cut points that predict low muscle strength were calculated with ROC analysis. To define low muscle strength, we used three currently suggested low muscle-strength thresholds, i.e., 32 kg/22 kg, 30 kg/20 kg, 26 kg/16 kg in males/females, respectively. 301 healthy young adults (187 male, 114 female) and 992 older people (308 male, 684 female) were included. LMM cut points for SMMI (weight) were 37.4% and 33.6% for males and females, respectively. SMMI (BMI) cut points that best predict the low grip-strength for 32 kg/22 kg; 30 kg/20 kg; 26 kg/16 kg thresholds were1.017 kg/BMI and 0.677 kg/BMI; 1.014 kg/BMI and 0.710 kg/BMI; 1.036 kg/BMI and 0.770 kg/BMI for males and females, respectively. Muscle-mass adjustment methods and techniques show diversity among the studies and have impact on the LMM cut-off points. This study presents population specific LMM thresholds for skeletal muscle mass adjusted for weight and BMI aiming to increase and improve the general applicability of the leading sarcopenia consensus definitions

Yaşlıda REM uykusu davranş bozukluğu ve tedavisi

REM uyku davranış bozukluğu (RDB), REM uykusu esnasında atoni kaybına bağlı kişilerin kendilerin ya da yatak partnerlerine zarar verecek şiddet içeren kompleks motor hareketlerin olması ile karakterize bir parasomnidir. 60 yaş üzeri özellikle yaşlı erkeklerde görülme sıklığı artmıştır. RDB olan kişiler nörodejeneratif hastalıklar için riskli bireylerdir. Tanı konulması için hastadan ve/veya yatak partnerinden alınan öykü ile birlikte polisomnografi yapılması gereklidir. Tedavide; davranışsal terapi ve güvenlik önlemleri alınmalı, sebep olan ilaçlar dışlanmalıdır. Yaşlı bireylerde yan etki profili daha güvenli olan melatonin ilk sırada tercih edilmelidir. Klonazepam, melatonin tedavisini tolere edemeyen veya melatonine yanıtsız bireylerde kullanılabilir. Son olarak, RDB olan hastalar, gelecekte nörolojik hastalık gelişme riski konusunda bilgilendirilmeli ve düzenli doktor takibi önerilmelidir. REM sleep behavior disorder (RDB) is a parasomnia characterized by violent complex motor movements that can harm themselves or their bed partners due to the loss of atony during REM sleep. The incidence has increased in individuals over the age of 60, especially in older male. People with RDB are at risk for neurodegenerative diseases. For diagnosis, polysomnography is required with the history taken from the patient and/or bed partner. In treatment; behavioral therapy and safety precautions should be taken, causative drugs should be excluded. Melatonin, which has a safer side effect profile, should be preferred in older people. Clonazepam can be used in individuals who are intolerant of melatonin treatment or who are unresponsive to melatonin. Finally, patients with RDB should be informed of the risk of developing neurological diseases in the future and regular follow-up doctor should be recommended