Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

Kör teknik ile supraklavikülar blok uygulanan hastalarda bupivakain ile levobupikainin’in etkilerinin karşılaştırması

Amaç: Bu çalışmada kliniğimizde son zamanlarda sık kullanılmaya başlanan supraklavikular bloğun etkiniğilini değerlendirmeyi düşündük. Yöntemler: Çalışmaya alınan hastalarının tamamı kör teknik ile supraklavikülar blok uygulanan hastalardı. Hastalar iki gruba ayrıldı ve Grup levopubivakain (L); 25 hastaya levobupivakain (%0,5; 5 mg/ml) 20 ml üzerine 20 ml SF ile tamamlanarak 40 ml ve Grupbupivakain (B); 25 hastaya bupivakain (%0,5; 5 mg/ml) 20 ml üzerine 20 ml SF tamamlanarak 40 ml uygulanan hastalar dahil edildi. Hastalar; Amerikan anestezistler birliği (ASA) sınıflaması, yaş, cinsiyet, boy, kilo, motor blok başlama süresi, duysal blok başlama süresi, postoperatifaneljezik ihtiyacı ve komplikasyon açısından değerlendirildi. Bulgular: Her iki grup arasında: yaş, kilo, boy, cinsiyet, ASA açısından fark yoktu. Grup B hastalarında motor blok başlama süresi ortalama ± standart sapma (ort±ss) (5,15 ± 3,55) dakika bulunurken, Grup L deki hastaların motor blok başlama süresi ort±ss(9,3 ± 7,1) dakika bulundu (p=0,01). Bupivakain gruptaki hastaların duysal blok başlama süresi ortalama 19,46 ± 11,10 dakika iken, levobupivakain gruptaki hastaların duysal blok başlama süresi ortalama 25,36 ± 11,15 dakika bulundu (p=0,04). Sonuç: Çalışmamızda bupivakain ile levopubikaine göre daha erken duysal ve motor blok sağlandığını ve kör teknik ile yapılan supraklavikuler bloğun deneyimli kişiler tarafından yapıldığında pnömotoraks açısından da güvenli bir uygulama olabileceğini bulduk

Is hyaluran a biomarker in patients without sepsis-related liver injury?

© 2019, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.The aim of the present study is to evaluate the value of hyaluronan (HA) as a biomarker of sepsis in patients not showing sepsis-associated liver dysfunction and to investigate the relationship between HA level and disease severity. Sepsis patients that had been followed-up between 2015 and 2016 in intensive care units (ICU) of Erciyes University Hospital were included in this prospective study. Sepsis was defined according to the 2013 Sepsis Survival Campaign Guidelines. The patients were classified as sepsis, severe sepsis, and septic shock. Blood samples were collected from the patients on the first and the third days to measure the HA level. The demographic characteristics, the duration of intensive care unit stay, and mortality data of the patient and the control groups were analyzed. A total of 46 patients and 30 control subjects were evaluated. HA levels were found to be higher in the sepsis group than the others. HA was neither a predictor of the disease mortality, nor was it correlated with the inflammatory markers, C-reactive protein (CRP), and procalcitonin (PCT). HA is not a sepsis biomarker in the patients with sepsis who do not show sepsis-associated liver dysfunction

Improving Sleep-Wake Behaviors Using Mobile App Gamification

Gamification can be used to encourage people to perform challenging tasks. Gamification can also be useful in altering unwanted habits and enhancing subjective well-being. Everyday health is affected by sleep-wake habits to a significant extent. Therefore, we can come across gamified products and mobile applications related to subjective well-being and sleep/wake activities. This paper presents a study investigating whether gamification can be used to affect sleep-wake behaviors in a positive way. The paper presents a quantified relationship between wake-up, go-to-sleep, work (start) hours and gamified features. For this purpose, a gamified mobile alarm clock application called the Sleepy Bird was designed, created and tested in a user study. The study included twenty-six participants in an A-B experimental set-up: thirteen participants using a gamified version and thirteen participants using a non-gamified version of the app for two weeks. The participants who used the non-gamified version had a poorer motivation to begin their day at the required times in comparison to those who used the gamified version. It was also observed that gamification made favorable modifications to participants’ sleep-wake behaviors

Should health services be centralized and free in pandemics? The case of Turkey as an example

The scientific board published the prevention and treatment guidelines for COVID-19 in January before the emergence of COVID-19 cases in Turkey. The constantly updated guidelines address all disease stages from the first diagnosis to the intensive care processes in detail. Furthermore, a list of reference hospitals across the country is provided in the guideline. In February, MoH stopped flights to China firstly. Then, MoH banned outbound flights to countries that reporting COVID-19 cases . The Minister of Education announced that schools were closed. It was announced on March 9th, 2020 that the first patient was diagnosed with COVID-19 in Turkey . At the beginning of May, the president announced that controlled social life would begin and that closed facilities and stopped activities would be allowed to start again in a controlled manner. The Turkish government took the necessary precautions early and swiftly. The main payer health care expenditures in Turkey is the social security institution (SSI), and also the SSI belongs to the state. The Turkish health system has already been ready for extraordinary health conditions such as this pandemic.&nbsp;</p

Compliance with the surviving sepsis campaign bundle: A multicenter study from Turkey

Objectives Sepsis bundle compliance is not clear. We evaluated rates of compliance with sepsis bundle protocols among health care providers in Turkey. Methods Our study was carried out retrospectively. Forty-five intensive care units (ICU) participated in this study between March 2, 2018 and October 1, 2018. Results One hundred thirty-eight ICUs were contacted and 45 ICUs agreed to participate. The time taken for the diagnosis of sepsis was less than six hours in 384 (59.8%) patients, while if was more than six hours in 258 (40.2%) patients. The median linterquartile range (1QR)1 times for initial antibiotic administration, culturing, vasopressor initiation, and second lactate measurement were 120.0 (60-300) minutes, 24 (12-240) minutes, 40 (20-60) minutes, and 24 (18-24) hours, respectively. The rale of compliance with tissue and organ perfusion follow-up in the first six hours was 0%. The rates of three- and six-hour sepsis bundle protocol compliance were both 0%. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. Conclusions The rate of compliance with sepsis bundle protocols was evaluated in Turkey for the first time and determined to be 0%