A review of stem cell therapy:An emerging treatment for dementia in Alzheimer's and Parkinson's disease

AIM: This article aims to study the benefits and disadvantages of stem cell therapy, especially for patients who have dementia. METHODS: The databases PubMed, Google Scholar, and the National Library of Medicine were searched for literature. All papers on Alzheimer's disease, Lewy body dementia, Parkinson's disease, stem cell therapy, and its effect on dementia treatment were considered. RESULTS: Stem cell treatment has demonstrated promising outcomes in animal studies by positively modifying the degenerative alterations in dementia. However, it is not without drawbacks, such as ethical concerns while using embryonic stem cells and the danger of developing cancer if the cells undergo uncontrolled differentiation. CONCLUSION: Although stem cell therapy has its risks, it has the potential to be a viable therapeutic option for patients with dementia if developed appropriately. Hence, more research and clinical trials are needed to establish its efficacy in this context

The impact of COVID-19 on patients with neurological disorders and their access to healthcare in Africa:A review of the literature

INTRODUCTION: The coronavirus disease 2019 (COVID‐19) pandemic has hampered the progress of neurological healthcare services for patients across Africa. Before the pandemic, access to these services was already limited due to elevated treatment costs among uninsured individuals, shortage of medicines, equipment, and qualified personnel, immense distance between residing areas and neurological facilities, and a limited understanding of neurological diseases and their presentation by both the health workers and the African population. METHODOLOGY: The databases PubMed, Google Scholar, Science Direct, and the National Library of Medicine were searched for literature. All articles on neurological disorders in Africa were considered. AIM: This review article explores the challenges of providing the best services for patients suffering from neurological disorders in Africa amid the COVID‐19 pandemic and provides evidence‐based recommendations. RESULTS: As Africa's governments made more resources available to support patients affected by COVID‐19, neurological care received less priority and the capacity and competency to treat patients with neurological disorders thus suffered substantially. Both short‐term and long‐term strategies are needed to improve the quality of neurological services after the pandemic in the region. CONCLUSION: To strengthen Africa's neurological services capability during and after the COVID‐19 pandemic, African governments must ensure appropriate healthcare resource allocation, perform neurology management training, and increase health security measures in medication supply. Long‐term strategies include incorporating responsible finance and resource procurement and advancement of tele‐neurology. International collaboration is essential to promote the sustainable improvement of neurological services in Africa

The burden of monkeypox virus amidst the Covid-19 pandemic in Africa:A double battle for Africa

The Coronavirus Disease - 19 (COVID-19) pandemic has put additional strain on Africa's fragile healthcare systems and has impacted the rise of emerging and re-emerging infectious diseases. Currently, there is a rise in cases of Monkeypox Disease, a zoonotic viral disease caused by the Monkeypox virus, which was first documented in 1970 in the Democratic Republic of the Congo. Most of the clinical symptoms of Monkeypox resemble that of smallpox, whose virus also belongs to the same genus. Initial symptoms include headache, fever, and fatigue, followed by lymphadenopathy and a rash. This study aims to provide more insight into Monkeypox by exposing its current burden and efforts to combat it amidst COVID-19 in Africa. Since Monkeypox disease is re-emerging and is less contagious than COVID-19, prevention and treatment are much more manageable. Still, African countries face several crucial challenges in responding to the Monkeypox in times of the covid-19 pandemic. These include lack of a well-functioning surveillance system for early detection of the disease, lack of awareness and knowledge of the monkeypox disease across the general population, lack of healthcare facilities already burdened by COVID-19 cases, and shortage of trained healthcare professionals. On the other hand, one significant factor contributing to the minimized risk in Africa was the smallpox vaccination done before 1980. However, a declining cross-protective immunity is seen in those inoculated with the smallpox vaccine and the ever-increasing risk to the unvaccinated population. Thus, focusing on vaccination and disease surveillance operations and diligent monitoring, as well as cross-border collaborations with international sectors, including One Health, FOA, OIE, and WHO is critical to achieving the ultimate eradication of monkeypox in Africa

Comparison of ultrasound guided transversus abdominis plane block (tap) and local infiltration analgesia during laparoscopic cholecystectomy surgery

YÖK Tez No: 501324ÖZET: Amaç: Laparoskopik kolesistektomi sonrasında ağrı genellikle anterior abdominal duvar insizyonuna bağlı gelişmektedir. Çalışmamızın amacı transversus abdominis plan bloğu (TAP) ile trokar giriş yerlerine lokal anestezik infiltrasyonu yöntemlerinin intraoperatif ve postoperatif analjezik etkinlikleri, opioid gereksinimleri ve yan etkileri bakımından karşılaştırmaktır. Materyal Metod: Laparoskopik kolesistektomi operasyonu geçirecek 75 hasta randomize olarak üç gruba ayrıldı. Grup T 'ye (n=25) cerrahi öncesi ultrason rehberliğinde TAP blok uygulanarak bilateral toplam 30 ml. %0.25 levobupivakain uygulandı. Grup L'ye (n=25) cerrahi öncesi trokar giriş yerleri etrafına toplam 20 ml. %0.5 levobupivakain infiltrasyonu uygulandı. Kontrol grubuna (Grup K; n=25) TAP blok veya lokal anestezik infiltrasyonu uygulanmadı. İntraoperatif fentanil kullanımı, ilk 24 saatteki toplam analjezik tüketimi, postoperatif 1, 2, 4, 8, 12, 16 ve 24. saatlerde VASistirahat, VASöksürük, sedasyon, bulantı, kusma ve omuz ağrısı skorları kaydedildi. Bulgular: Gruplar arasında demografik veriler benzer bulundu. Ölçülen VASistirahat ve VASöksürük değerleri, intraoperatif dönemde yapılan fentanil dozu, 24. saat sonunda toplam verilen analjezik miktarı bakımından her üç grupta istatiksel olarak anlamlı bir fark saptanmadı. Grup T'de 1.saatte gözlenen hafif düzeyde kusma oranı (%20), Grup K'ya (%64) göre anlamlı düzeyde düşük gözlemlendi (p<0,05). Grup T'de 2.saatte gözlenen hafif düzeyde kusma oranı (%12), Grup K'ya (%44) göre anlamlı düzeyde düşük gözlemlendi (p<0,05). Grup T' de 1.saatte uyanık olanların oranı (%80), Grup K'ya (%28) göre anlamlı düzeyde yüksek gözlemlendi (p<0,05). Sonuç: Ultrason eşliğinde bilateral yapılan TAP blok, trokar yerine lokal anestezik infiltrasyonu yapılan hastalarla postoperatif analjezik etkinlik açısından karşılaştırıldığında anlamlı farklılık olmadığı gözlenmiştir. Grup T'de postoperatif 1.saatte uyanık olanların oranının kontrol grubuna göre anlamlı düzeyde yüksek olması nedeniyle bu bloğun erken dönemde hızlı derlenme açısından fayda sağlayabileceğini düşünüyoruz. Ancak bu hasta grubunda insizyonel ağrının visseral ağrıdan ayrımı zor olmaktadır. Her iki yöntemin de özellikle insizyonel ağrı üzerine etki göstermesi ve farklı ağrı komponentlerin varlığı, postoperatif ağrı skorlarında istatistiksel olarak farklılık oluşturmasa da sedasyon ve kusma skorları açısından daha çok sayıda hasta ile yapılmış, farklı volüm ve konsantrasyonda yapılmış çalışmalara ihtiyaç olduğu görüşündeyiz.ABSTRACT: Aim: Pain after laparoscopic cholecystectomy is usually occured by anterior abdominal wall incision. The aim of this study is comparing the intra- and postoperative analgesic efficacy, opioid consumption and side effects of transversus abdominis plane block to port-site infiltration of local anesthesic. Methods: Seventy-five patients undergoing laparoscopic cholecystectomy operation were randomly allocated to three group. Group T (n=25) received total 30 ml 0.25% levobupivacaine with ultrasound guided bilateral TAP block. Before the operation, Group L (n=25) received local anesthetic infiltration to trocar insertion sites with total 20 ml 0.5% levobupivacain. Group Control (Group K; n=25) did not receive the TAP block or local anesthetic infiltration. Intraoperative usage of fentanyl and analgesic consumption for the first 24hrs, the postoperative visual analog scores eveluated in rest position and while coughing at 1,2,4,8,12,16 and 24. hrs, shoulder pain, nause and vomiting scores were also recorded. Results: Demographic characteristics were similar between groups. There was no statistically significant difference in pain scores at rest and movement, intraoperative fentanyl usage and total analgesic consumption during postoperative 24 hr. Patients who recieved TAP block in first hour mild vomiting rate (20%) were significantly lower than Group K (64%) (p<0.05). Also TAP block group's second hour mild vomiting rate (12%) were significantly lower than Group K's (44%) (p<0.05). Patients in TAP group, awakeness (80%) in first hr were significantly higher than Group K (28%) (p<0.05). Conclusion: Bilateral ultrasound-guided TAP block and local anesthetic infiltration of trocar insertion sites were compared for postoperative analgesic efficacy and statistically significant difference was found. We think that awakeness in first hour in Group T makes this block useful for early recovery. Trying to diffirentiate incisional pain from visceral pain in these patients is diffucult. Because of both TAP block and local anesthetic infiltration show effects especially on incisional pain and there are other components of pain, also there were not significantly difference in postoperative pain scores it would be useful in future studies to eveluate the effects with large patient group, different volume and concentrations

Huntington koresi olan bir hastada epidural anestezi

Huntington koresi (HK) nadir görülen otozomal dominant geçiş gösteren sinir sistemi bozukluğudur. Semptomları hayatın 3. ve 4. dekatlarında istemsiz koreiform hareketleri, ataksi ve ilerleyici mental bozulma olarak gösterir. HK tanılı olgularda anestezi yönetimi ile ilgili sadece birkaç olgu sunumu yayınlanmıştır. Hastalar bazı intraoperatif komplikasyonlar (regürjitasyon ve pulmoner aspirasyon gibi), zayıf respiratuar fonksiyon, uzamış suksinilkolin ve tiyopental cevabı, midazolama karşı yükselmiş sensitivite, ve rijit spazmlara yol açan titremeler gibi postoperatif komplikasyonlar açısından yüksek risk altındadırlar.Tüm bunlar güvenli geri dönüş ve anestezi sırasında güvenli havayolu sağlamak için ideal anestezi yönetimi gerektirmektedir. Bildiğimiz kadarıyla, literatürlerde HKli hastalarda epidural anestezi uygulanması bulunmamaktadır. Burada, HK tanılı olgumuzda başarılı epidural anestezi deneyimimizi sunmayı amaçladık.Huntington's chorea (HC) is a rare, autosomal, dominant hereditary disorder of the nervous system. Symptoms occur in the third and fourth decade of life and manifest as involuntary choreiform movements, ataxia, and progressive mental deterioration. Only a few case reports have been published describing the anesthetic management of patients with HC. Patients are at greater risk for some intraoperative complications (e.g., regurgitation and pulmonary aspiration), poor respiratory function, prolonged response to succinylcholine and thiopental, increased sensitivity to midazolam, and postoperative shivering leading to rigid spasms. All these factors make an ideal anesthesiological management necessary for this group of patients to guarantee an absolute airway protection during all the anesthesia and a fast and safe recovery. To the best of our knowledge, epidural anesthesia in HC patients has not been reported in the literature. Herein, we present our successful experience using epidural anesthesia in a HC patient

A comparison of transversus abdominis plane block guided with ultrasonography and local anesthetic infiltration in laparoscopic cholecystectomy operations

WOS: 000438284700002PubMed: 29738057Objectives: The aim of this study was to compare a transversus abdominis plane (TAP) block guided with ultrasound (USG) and local anesthetic infiltration (LAI) in terms of the intraoperative and postoperative analgesia efficiency, intraoperative opioid need, and side effects in cases of laparoscopic cholecystectomy. Methods: A total of 75 patients classified as American Society of Anesthesiologists class I or II were included in this randomized, controlled, prospective study and divided into 3 groups. 20 mL of levobupivacaine 0.5% was applied around the trocar entrance site before the operation to group L (n=25), and 30 mL 0.25% levobupivacaine was applied with a USG-guided TAP block to group T (n=25). No TAP block or LAI was applied to the control group (n=25), group K. In the first 24 hours after surgery, an infusion of tramadol was administered with a controlled analgesia device. The intraoperative fentanyl use was recorded, and a visual analogue scale was administered to assess pain while resting (VAS rest) and upon coughing (VAS cough) at 1, 2, 4, 8, 12, 16, and 24 hours postoperative. An evaluation of shoulder pain and the consumption of analgesia in 24 hours were also recorded. Results: The VAS rest and VAS cough values, the dose of fentanyl used intraoperatively, and the total analgesia dose administered in 24 hours were compared between groups and there was no statistically significant difference detected (p>0.05). In group T, the vomiting rate 1 and 2 hours postoperative (20% and 12%, respectively) was significantly lower than in group K (64% and 44%, respectively). Conclusion: The efficiency of the analgesia provided after a laparoscopic cholecystectomy with a bilateral TAP block guided with USG and LAI was determined to be similar

The effect of vitamin D status on different neuromuscular blocker agents reverse time

Background/aim: This study is aimed to investigate the effects of vitamin D levels on sugammadex and neostigmine reversal times. Material and methods: Eighty patients between the ages of 18 and 65 years, with ASA I-III status who were undergoing surgery under general anesthesia were included in the study. A double blind fashion was used to randomly divide all the patients into two groups. At the end of the operation, sugammadex 2 mg/kg was administered to one group (Group sugammadex) and atropine and neostigmine was administered to the other group (Group neostigmine) intravenously. In the data analysis stage, the group was divided into two subgroups according to sugammadex and group neostigmine in itself, with vitamin D levels above and below 30 ng/mL. Statistical analysis was performed on these 4 groups (Group neostigmine and vitamin D < 30 ng/mL), (Group neostigmine and vitamin D ? 30 ng/mL), (Group sugammadex and vitamin D < 30 ng/mL), (Group sugammadex and vitamin D ? 30 ng/mL). When two responses to train of four (TOF) stimulation were taken, the following times were recorded until extubation phase. The time until TOF value 50%, 70%, 90%, and extubation were recorded. Results: There were statistically significant differences between Group sugammadex and vitamin D < 30 ng/mL and Group sugammadex and vitamin D ? 30 ng/mL (P = 0.007) for extubation times and 50% TOF reach times (P = 0.015). However, there was no difference observed between Group neostigmine and vitamin D < 30 ng/mL and Group neostigmine and vitamin D ? 30 ng/mL (P = 0.999). Conclusion: Vitamin D deficiency is important for anesthesiologists in terms of muscle strength and extubation time. Vitamin D deficiency seems to affect sugammadex reverse times but seems not to affect neostigmine reverse times. This conclusion needs further studies