ABSTRACTS FROM THE 1ST BALKANS CLINICAL NEUROSCIENCE SYMPOSIUM

ABSTRACTS FROM THE 1ST BALKANS CLINICAL NEUROSCIENCE SYMPOSIU

THE EVALUATION OF ADMISSION SIGNS AND TREATMENT RESPONSE OF PATIENTS WITH ACUTE GASTROENTERITIS

Amaç: Akut gastroenteritler, hastaneye başvuru yakınmaları arasında sıklıkla yer almakta ve tedavilerdeki gelişmelere rağmen yüksek mortalite ve morbidite oranları ile seyretmeye devam etmektedir. Bu çalışmada Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesi Çocuk Acil polikliniğine akut ishal yakınması ile başvuran çocuk olguların başvuru özelliklerinin değerlendirilmesi amaçlandı. Gereç ve yöntem: Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesi Çocuk Acil polikliniğine akut ishal yakınması ile başvuran 541 olgu [291 (%53,8) erkek] retrospektif olarak değerlendirildi. Hastalar yaş, cinsiyet, dehidratasyon varlığı ve derecesi, tedavi şekli ve süresi, komplikasyonların varlığı açısından araştırıldı. Bulgular: Hastaların başvuru anındaki yaşı ortalama 4,7 ± 4,1 yıl (1 ay-16 yaş, ortanca: 3 yaş) idi. Otuzüç hasta (%6) kanlı dışkılama, 508 hasta sulu dışkılama yakınması ile başvurdu. İshal süresi ortalama 2,0 ± 1,6 gün (min:1- maks: 9 gün), günde yapılan dışkı sayısı ise ortalama 5,2 ± 2,9 (min: 3- maks:15) idi. Hastaların % 70'inde (383 hasta) kusma yakınması da mevcuttu. Hastaların 206'sı (%38,4) hastaneye başvurmadan önce antibiyotik kullanmaya başlamıştı. Hastaların %84'ünde (450 hasta) dehidratasyon yok iken, %16'sında (91 hasta) değişik derecelerde dehidratasyon mevcuttu. Onsekiz hasta (%3,3) hastaneye yatırıldı. Yatış nedenleri elektrolit imbalansı, ağır dehidratasyon ve asidoz, ağır kusma, konvulzyon geçirme ve ailenin sosyal endikasyonu idi. Dehidratasyonu olan hastalara oral veya parenteral yolla rehidratasyon tedavisi verildi. Akut ishal yakınması ile başvuran hastalar arasında kaybedilen hasta olmadı. Sonuç: Çocuklarda akut gastroenteritlerin büyük çoğunluğunu viral gastroenteritler oluşturmaktadır. İshal tedavisinin en önemli komponenti dehidratasyonun tespiti ve tedavisidir. Bu nedenle tüm hastalarda biyokimyasal incelemeler yapılmamalı, antibiyotik tedavisi gerektirecek özellikleri olmayan hastalara ampirik antibiyotik tedavisi başlanmamalıdır. Objective: Diarrhea is a frequent symptom at hospital admission, and acute gastroenteritis is a major cause of childhood morbidity and mortality, despite improvements in therapy. In this study, we aimed to evaluate patients who were seen at Dokuz Eylül University Hospital's Pediatric Emergency Department with complaint of diarrhea. Eylül University Hospital's Pediatric Emergency Department with complaint of diarrhea were retrospectively evaluated. Age and gender of patients, presence and severity of dehydration, type and duration of therapy and complications were screened. Results: The mean age of patients was 4.7 ± 4.1 years (range: 1 month-16 year, median: 3 years). Thirty three (6%) and 508 patients had bloody or watery stools, respectively. The mean duration of diarrhea was 2.0 ± 1.6 days (range:1- 9 days) and, number of stool per day was 5.2 ± 2.9 (range: 3-15). Seventy per cent (383) of patients also had vomiting. Antibiotics had already been started in 208 patients (38.4%) at the time of the hospital visit. While there was no sign of dehydration in 84% of patients (450 patients), 16% of patients had dehydration with varying severity. Eighteen patients (3.3%) required hospitalization. Electrolyte imbalance, severe dehydration and acidosis, severe vomiting, convulsions and social conditions were the reasons of hospitalization. Dehydrated patients were rehydrated with both oral and parenteral routes. No death occured among the patients. Conclusion: Viral etiologies are the major cause of acute gastroenteritis in children. Detection and therapy of dehydration are the most important components of gastroenteritis management. Therefore, biochemical investigations should not be made routinely in all of the patients and empirical antibiotic therapy should not be started without clear indications

Intrabiliary rupture of liver hydatid cyst: a case report and review of the literature

Herein, we report a 66 year old woman who was diagnosed to have intrabiliary rupture of liver hydatid cyst with demonstrative computed tomography, magnetic resonance imaging, and magnetic resonance cholangiopancreatography findings, with a review of the literature

Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID‑19 (Bari‑SolidAct): a randomised, double‑blind, placebo‑controlled phase 3 trial

Background Baricitinib has shown efcacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifcally on severe/critical COVID, including vaccinated participants. Methods Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/ critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures. Results Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modifed intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49–69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute diference and 95% CI −0.1% [−8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (−3.2% [−9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a signifcant interac‑ tion between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated partici‑ pants were on average 11 years older, with more comorbidities. Conclusion This clinical trial was prematurely stopped for external evidence and therefore underpowered to con‑ clude on a potential survival beneft of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these fnd‑ ings warrant further investigation in other trials and real-world studies

Cross-cultural differences in informal argumentation: norms, inductive biases and evidentiality

Cross-cultural differences in argumentation may be explained by the use of different norms of reasoning. However, some norms derive from, presumably universal, mathematical laws. This inconsistency can be resolved, by considering that some norms of argumentation, like Bayes theorem, are mathematical functions. Systematic variation in the inputs may produce culture-dependent inductive biases although the function remains invariant. This hypothesis was tested by fitting a Bayesian model to data on informal argumentation from Turkish and English cultures, which linguistically mark evidence quality differently. The experiment varied evidential marking and informant reliability in argumentative dialogues and revealed cross-cultural differences for both independent variables. The Bayesian model fitted the data from both cultures well but there were differences in the parameters consistent with culture-specific inductive biases. These findings are related to current controversies over the universality of the norms of reasoning and the role of normative theories in the psychology of reasoning

Efficacy and safety of baricitinib in hospitalized adults with severe or critical COVID-19 (Bari-SolidAct): a randomised, double-blind, placebo-controlled phase 3 trial

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.[Background] Baricitinib has shown efficacy in hospitalized patients with COVID-19, but no placebo-controlled trials have focused specifically on severe/critical COVID, including vaccinated participants.[Methods] Bari-SolidAct is a phase-3, multicentre, randomised, double-blind, placebo-controlled trial, enrolling participants from June 3, 2021 to March 7, 2022, stopped prematurely for external evidence. Patients with severe/critical COVID-19 were randomised to Baricitinib 4 mg once daily or placebo, added to standard of care. The primary endpoint was all-cause mortality within 60 days. Participants were remotely followed to day 90 for safety and patient related outcome measures.[Results] Two hundred ninety-nine patients were screened, 284 randomised, and 275 received study drug or placebo and were included in the modified intent-to-treat analyses (139 receiving baricitinib and 136 placebo). Median age was 60 (IQR 49–69) years, 77% were male and 35% had received at least one dose of SARS-CoV2 vaccine. There were 21 deaths at day 60 in each group, 15.1% in the baricitinib group and 15.4% in the placebo group (adjusted absolute difference and 95% CI − 0.1% [− 8·3 to 8·0]). In sensitivity analysis censoring observations after drug discontinuation or rescue therapy (tocilizumab/increased steroid dose), proportions of death were 5.8% versus 8.8% (− 3.2% [− 9.0 to 2.7]), respectively. There were 148 serious adverse events in 46 participants (33.1%) receiving baricitinib and 155 in 51 participants (37.5%) receiving placebo. In subgroup analyses, there was a potential interaction between vaccination status and treatment allocation on 60-day mortality. In a subsequent post hoc analysis there was a significant interaction between vaccination status and treatment allocation on the occurrence of serious adverse events, with more respiratory complications and severe infections in vaccinated participants treated with baricitinib. Vaccinated participants were on average 11 years older, with more comorbidities.[Conclusion] This clinical trial was prematurely stopped for external evidence and therefore underpowered to conclude on a potential survival benefit of baricitinib in severe/critical COVID-19. We observed a possible safety signal in vaccinated participants, who were older with more comorbidities. Although based on a post-hoc analysis, these findings warrant further investigation in other trials and real-world studies. Trial registration Bari-SolidAct is registered at NCT04891133 (registered May 18, 2021) and EUClinicalTrials.eu (2022-500385-99-00).EU-SolidAct is part of the European pandemic preparedness network EU RESPONSE, funded by the EU Horizon 2020 Research and Innovation programme, under grant number 101015736. EU-SolidAct has also received funding from CAPNET (France) and Klinbeforsk (Norway).Peer reviewe

Vortioxetine treatment for major depressive disorder with the co-morbidity of irritable bowel syndrome with diarrhoea: a case report

Irritable bowel syndrome (IBS) is a complex condition that involves problems with bowel movements and belly pain, bloating, and gas. It is not life threatening, but can be a long-lasting problem that changes life quality. Several studies have shown that up to 70–90% of patients with IBS who seek treatment have psychiatric co-morbidity, most notably mood and anxiety disorders. There are different approaches in the medication for IBS. Antidepressants such as tricyclic antidepressants and selective serotonin reuptake inhibitors are shown to be useful in the treatment. Vortioxetine may become a possible new agent in the treatment of patients with major depressive disorder and IBS with diarrhoea co-morbidity

Fatal valproate overdose in a newborn baby

Valproate is a widely used drug in the treatment of epilepsy in children and adults. However, it is not safe for patients under two years of age, especially during the newborn period. This study presents a case of fatal valproate overdose in a 26-day-old female newborn, who is the youngest patient in the literature

The clinical features of anxious depression [Anksiyöz depresyonun klinik özellikleri]

Objective: Evidence suggests that anxiety is one of the most prevalent symptoms in clinical depression and that assessing and treating severe, persistent anxiety are of great importance in the successful treatment of depression. When considering anxious depression term, it should be recognized that patients can manifest symptoms of depression and symptoms of anxiety in three separate ways; as comorbid depression and anxiety, as depression with subthreshold anxiety, and as subthreshold depression with subthreshold anxiety. The nature of the link between depression and anxiety remains uncertain; however, based on the evidence to date, the term anxious depression should be reserved for patients who meet diagnostic criteria for depression have subthreshold symptoms of an anxiety disorder. In depressed patients anxiety is a marker of severity, poor outcome, response to treatment, and suicide risk. Depressed patients who have higher ratings for anxiety are more severely ill, take longer to recover, and show a poor response to antidepressants. The aim of this study was to investigate the clinical features of anxious depression. Methods: In anxious depressive group, 18 women and 10 men, within an age range of 18 and 60 (mean age 43.0±12.0 years) and in non-anxious depressive group 26 women and 9 men (mean age 40.2±10.7 years) were included in this study. The study consisted of a total of 63 cases. All patients have been informed of the study and gave informed consent before participating into this study. Sociodemographic data form, Hamilton Depression Scale, Clinic Global Impression, Hamilton Anxiety Scale, Suicide Thoughts Scale, Beck Depression Scale, State and Trait Anxiety Scale were administered to all subjects. Results: We found that anxious patients have higher depression severity, higher tendency for suicide, higher functional impairment rate and higher genetic loading for affective disorders than non-anxious depressive patients. Conclusion: In conclusion, anxious depression may be a different subtype of depression. While evaluating the depression patients, attention must be paid to anxiety symptoms and treatment plan should be made accordingly