Early left ventricular functional alterations in patients with obstructive sleep apnea syndrome

Background: The knowledge regarding myocardial alterations in patients with obstructive sleep apnea syndrome (OSAS) in the absence of any known cardiovascular disorders including hypertension is limited. The aim of this study was to assess the early alterations of left ventricular (LV) functions caused by OSAS before the development of hypertension and other cardiovascular manifestations of OSAS.Methods: Eighty consecutive patients who underwent polysomnography (PSG) were enrolled in the study. Patients with hypertension, diabetes mellitus or any other known cardiac diseases were excluded from the study. Subjects were separated into two groups by their apnea/hypopnea index (AHI) (group 1: AHI < 15, and group 2: AHI ≥ 15). Fourty-three patients with normal polysomnographic examination or mild OSAS (group 1) and 37 patients with moderate to severe OSAS (group 2) were compared. After PSG examination, LV functions were assessed by using the conventional and tissue Doppler echocardiographic methods.Results: The mean age was similar between the groups. The ratio of male patients was higher in group 2 (male/female: 31/12 in group 1 vs. 34/3 in group 2, p = 0.04). Body mass index was higher in group 2 (p = 0.05). Conventional echocardiography showed that interventricular septum thickness was 9.5 ± 1.1 mm in group 1, and 10.5 ± 1.4 mm in group 2 (p = 0.02). Mean left atrial diameter was 35.6 ± 4.1 mm in group 2, and 33.8 ± 3.1 mm in group 1 (p = 0.04). Ratio of early to late transmitral diastolic velocities was lower in group 2 (p = 0.01), indicating that impairment of diastolic function was more frequent in moderate to severe OSAS patients. Tissue Doppler echocardiography showed that early diastolic myocardial velocity was lower ingroup 2 (21.1 ± 5.6 cm/s in group 1 vs. 18.3 ± 5.3 cm/s in group 2, p = 0.01).Conclusions: Left ventricular diastolic dysfunction, LV hypertrophy and left atrial dilatationoccur in patients with OSAS even before the development of hypertension and other cardiovascular diseases

Rheological properties of synthesised additives in hot mix asphalt

Asfaltni kolnik je dio kolničke kostrukcije koji je pod najvećim utjecajem prometnog opterećenja. Stoga se u slojevima asfaltnog kolnika tijekom njegova trajanja javljaju oštećenja poput pukotina, kolotraga, zamora materijala, starenja te oštećenja uzrokovanih vlagom. Uzroci takvih oštećenja većinom su povećanje broja teških vozila, pogreške pri projektiranju i izvođenju te klimatski i okolišni uvjeti. Znanstvenici i inženjeri kontinuirano rade na poboljšanju svojstava asfaltnih kolnika. Nedavna istraživanja usmjerena su na poboljšanje svojstava asfaltnih mješavina kemijskom sintezom novog materijala u laboratoriju. Cilj je ovog rada prikazati pregled stanja u području učinaka kemijski sintetiziranih aditiva na svojstva asfaltnih mješavina i veziva. Rezultati ovog istraživanja pokazuju da su ti novi aditivi pri upotrebi u odgovarajućim omjerima imali značajan učinak na reološka svojstva asfaltnih mješavina, kao što su kolotrazi, elastičnost i otpornost na zamor. Očekuje se da će ovo istraživanje poslužiti kao referenca i vodič za buduća istraživanja o proizvodnji novih sintetiziranih aditiva kao modifikatora asfaltnih mješavina.In civil engineering, pavement, which is a mixture of aggregate and bitumen, is the layer most affected by traffic loads. Thus, problems, such as cracking, rutting, fatigue, aging, and moisture damage occur in the asphalt pavement layer throughout its service life. Such problems are generally caused by the increase in the number of heavily loaded vehicles, design and construction errors, and climate and environmental conditions. Scientists and engineers are continuously working on improving the performance of asphalt pavements. Particularly, recent studies have focused on improving multiple properties of asphalt simultaneously by chemically synthesising a novel material in the laboratory. This study aims to present a review of the effects of chemically synthesised additives on the performance of asphalt binders and mixtures. The findings of this study show that these new additives had a significant effect on the rheological properties of asphalt, such as rutting, elasticity, and fatigue life, when used in appropriate proportions. This study is expected to serve as a reference and guide for future studies on the production of new synthesised additives as asphalt modifiers

Chronic Intermittent Hypoxemia in Patients with Obstuctive Sleep Apnea Syndrome Causes Reduction of Peripheral Nerve Motor Fibers (Unit Number)

Objective:Obstructive Sleep Apnea syndrome (OSAS) is a chronic intermittent hypoxic process. In this study, we aimed to investigate electrophysiologically the changes in number of skeletal muscle motor unit due to chronic intermittent hypoxemia in cases followed up with the diagnosis of OSAS.Materials and Methods:According to the apnea-hypopnea index (AHI), patients divided into two groups (group 1: AHI 0.5). Maximum M mean area of nerve medianus was 50.8±20.4 (16.1-121.7) in group 1 and 48.6±20.05 (10.5-111.4) in group 2 (p=0.55). The mean MUNE values were 155.3±41.17 (46.6- 251.7) in group 1 and 127.7±40.2 (22.8-235) in group 2 (p<0.00).Conclusion:The MUNE method demonstrates that chronic intermittent hypoxemia during sleep causes reduction of the motor unit number in OSAS patients and is an independent risk factor for subclinical polyneuropathy

Hypokalemic periodic paralysis due to renal tubuler asidosis

Distal renal tubüler asidoz; hipokalemi, hiperkloremik metabolik asidoz ve idrar pH'sının 5.8'in üzerinde olması ile karakterize metabolik bir hastalıktır. Bu bulgulara hiperkalsüri, nefrokalsinozis, nefrolitiazis, sağırlık, osteomalazi veya rikets bulguları eşlik edebilir. Renal tübüler asidozda laboratuvar bulgusu olarak hipokalemi sık görülmesine karşın, bu eksikliğin klinik bulgusu olan güçsüzlük nadir görülmektedir. Bu makalede polikliniğimize güçsüzlük yakınması ile başvuran ve etyolojik taramalar sonucu distal renal tübüler asidoza sekonder hipokalemi tesbit edilen sporadik bir olgu sunulmuştur.Distal tubular acidosis is a metabolic disorder which is characterized by hypokalemia, hyperchloremic metabolic acidosis, urine pH above 5.8. These findings may be accompanied by hypercalciuria, nephrocalcinosis, nephrolithiasis, deafness, osteomalacia, or rickets. Whereas hypokalemia is frequently seen in renal tubular acidosis weakness due to hypokalemia is rarely seen. In this article, a sporadic case who was admitted to our clinic with the complaint of weakness and diagnosed as hypokalemia secondary to distal renal tubular acidosis was presented

Current Views on the Use of Valproic Acid in Women

WOS: 000474456600002Vaiproic acid (VPA) is one of the most frequently prescribed antiepileptic drugs for idiopathic generalized epilepsy, chronic or migraine headache, and bipolar disorder; however concerns about teratogenic effects have resulted in limited usage of the drug in women of childbearing potential. The aim of this review was to assess the current status of recommendations for the use of VPA according to international drug commissions and other recent reports

The Follow-Up of Epileptic Patients in the Birth and Postpartum Periods

WOS: 000438304900009Women diagnosed with epilepsy must be followed by a neurologist as well as an obstetrician in the pre-pregnancy, pregnancy, birth, and puerperal periods. There are no indications for cesarean section or induced birth in epileptic patients, with the exception of some special cases, but in daily practice, cesarean section is routinely performed and these cases are referred to tertiary epilepsy centers. Likewise, with-drawal or unnecessary dose adjustment of antiepileptic drugs in breastfeeding mothers can cause adverse effects in the infant and the mother. The aim of this article is to minimize misjudgments that affect the quality of life of patients by increasing awareness of the genuine needs of pregnant women diagnosed with epilepsy during the birth and postpartum periods

Sleep-Wake Cycle Rhythm of the Seizures and Correlation with Clinic and Neuroimaging Findings

WOS: 000276284400025Objective: We evaluated clinical, electrophysiological and radiologic findings of seizures according to sleep-wake cycle properties. Material and Methods: Six hundred and eighty five patients (325 women, 360 men) with a mean age of 29.3 +/- 15.1 (9-81) years that were followed up in the epilepsy outpatient clinic between the years of 2000-2006 were included in the study. Results: The mean age of the seizure onset was 20.5 +/- 16.9 (0-81) years, the mean duration of the disease was 9.22 +/- 9.05 (0-45) years. Seizures were seen in sleep period in 13.4% of the patients (Group 1), in wake period in 41.5% (Group 2) and in diffuse period in 45.1% (Group 3) of the patients. The seizures were classified as partial epilepsy in 83.6% and as primary generalized epilepsy in 16,4% of the patients. Neurologic examination revealed normal findings in 81.5% of the Group 1, in 70.8% of the Group 2 and 58.3% of the Group 3. Type of seizures according to sleep-wake cycle were secondary generalized in 63% of the Group 1, in 43% of the Group 3, and complex partial type in 45.8% of the Group 2 (p<0.001). In respect of electroencephalography the most frequent finding was focal epileptic activity, and the normal finding was the most frequent finding of Group 1 (p=0.015). According to prognosis the seizures were completely taken under control mostly in Group 1 (63%) and lowest success was obtained in Group 3 (35.3%) (p<0.01). Conclusion: The prognosis were bad in patients whose seizures took place in diffuse period

A family with Hypokalemic periodic paralysis

Hipokalemik periyodik paralizi, periyodik kas güçsüzlüğü veya paralizi atakları ile karakterize konjenital bir hastalıktır. Ataklar, günde veya yılda bir olup birkaç saat veya birkaç gün sürebilir. Atak sırasında serumdaki potasyum seviyesi düşüktür. Ama ataklar arasında serum potasyum seviyesi normaldir. Vücutta potasyum eksikliği yoktur. Burada, ilk ailesel hipokalemik periyodik paralizi atağını, viral ve/veya üst solunum yolu enfeksiyonunu takiben birinci dekadta geçiren, bir anne ve iki oğlu klinik ve laboratuvar özellikleri ile sunulmuştur.Hypokalemic periodic paralysis is a congenital disorder which is characterized by intermittent episodes of muscle weakness or paralysis. The attacks can occur everyday or once a year may last for a few hours or for several days. The potassium level of serum is low during the attack. But the serum potassium levels are normal between two attacks. There is no potassium deficiency in the whole body. In this paper, a mother and two sons who had first attack of familial hypokalemic periodic paralysis at 1st decade following viral and/or upper airway infections were presented according to the clinical and laboratory features

TERATOGENIC EFFECT OF ANTIEPILEPTIC DRUGS ON EPILEPSY PATIENTS

29th International Epilepsy Congress -- AUG 28-SEP 01, 2011 -- Rome, ITALYWOS: 000294217200070

Birinci Basamak Sağlık Hizmetlerinde Epileptik Nöbet ve Non Epileptik Psikojen Nöbet Ayırıcı Tanısı

Epileptik nöbet (EN) ve non epileptik psikojen nöbet (NEPN), nöroloji pratiği içerisinde tanı karmaşasının en sık yaşandığı klinik durumlardan biridir. Yanlış tanı, uzun yıllar sürebilen yanlış tedavi rejimlerine, ilaç yan etkilerine, ek mali yüklere ve sosyal yaşamda olumsuz etkilere yol açmaktadır. EN ve NEPN ayırıcı tanısı, nöroloji kliniklerinin yanı sıra aile sağlığı merkezlerinde de sıkça karşılaşılan problemlerin başında gelmektedir. Hasta ve yakınlarından alınan dikkatli öykü, ayrıntılı nörolojik muayene doğru tanı ve tedaviye ulaşmada oldukça önemlidir. Bu derlemede, aile sağlığı merkezlerinde EN ve NEPN ayırıcı tanısında kullanılabilecek semptom ve bulguların güncel literatür bilgisi ışığında gözden geçirilmesi amaçlanmıştırEpileptic seizure (ES) and non-epileptic psychogenic seizure (NEPS) are one of the clinical situations where diagnostic confusions are experienced most frequently in neurology practice. Diagnostic errors lead to wrong treatment regimes that may take many years, drug side effects, additional financial burdens and negative effects in social life. ES and NEPS differential diagnosis are also the most common problems encountered at family health centers as well as at neurology clinics. Careful history taken from patient and his relatives, detailed neurologic examination are very important in reaching a correct diagnosis and treatment. In this study, it was aimed to review symptoms and results that may be used in EN and NEPS differential diagnosis at family health centers in the light of current literatur