Prognostic value of optic nerve sheath thickness in patients with central and peripheral vertigo

Aim: To evaluate the role of the diameter of the optic nerve sheath (ONSD) in the differential diagnosis of the central and peripheral vertigo in patients, who had applied with the complaints of vertigo. Method:  Our study had a prospective design and 113 vertigo patients were included in the study. The demographic characteristics, vital signs, symptoms accompanying vertigo and findings of the imaging examinations were evaluated. Results: The median age of our patients was 43 years (IQR: 17) and 44.2 % of them were males. 19.5 % of the patients were diagnosed with central and 80.5 % with peripheral vertigo. In our study, the median ONSD was 4.88 mm (IQR=0.86) in patients with central vertigo and 4.65 mm (IQR=0.20) in patients with peripheral vertigo. The median value of ONSD in patients with central vertigo was significantly higher (p=0.030). In our study, the area under the curve was 0.654 (95 % CI=0.498-0.810) and the sensitivity and specificity for the cut-off value of 4.65 mm were 68.2 % and 61.5 % respectively. Conclusion: We determined that ONSD was larger in patients with central vertigo. Further studies with larger subject size are needed on this topic

Prognostic value of the optic nerve sheath thickness as an indicator of intracranial pressure among acute stroke patients

Aim: To evaluate the clinical value of optic nerve sheath thickness (ONST) in stroke patients. Method: The present study was prospectively performed on 386 stroke patients who were admitted to Emergency Department, and 75 healthy volunteers of similar age and gender groups. The following criteria were evaluated for each patient: age, gender, comorbidities, neurological deficit levels [Glasgow Coma Scale (GCS), the National Institute of Health Sciences Scale (NIHSS)], tomography findings (hemorrhagic / ischemic), ONST diameter in ultrasound scan (USS), hospitalization and mortality rates. Results: The median ONST value was 5.5 mm (IQR: 0.30) for the hemorrhagic stroke patients, and 5.25 mm (IQR: 0.20) for the ischemic stroke patients. The median ONST value of the stroke patients was significantly higher. Also, the ONST values of the hemorrhagic stroke patients were found to be significantly higher. In our study, the area below the curve was 0.865. For the 4.5 mm cut-off value, the sensitivity was 96.1% and specificity was 82.7%. Conclusions: The results of our study showed that the ONST increased in the stroke patients and this increase was higher in the hemorrhagic stroke patients. We suggest that the treatment can be considered to decrease intracranial pressure if there is an increase in ONST in stroke patients

Investigation of the reasons and frequency of geriatric patients applying to the emergency department

Aim: To determine the reasons for choosing the emergency department in patients aged 65 and over who applied to the emergency department and investigate the effect of their use of primary health care services on the frequency of emergency department visits. Methods: The study is a prospective cross-sectional study. It was performed in the emergency department of a university tertiary hospital between 1 November 2017 and 30 April 2018. Demographic characteristics of patients aged 65 and over who applied to the emergency department, the reasons for applying to the emergency department and their use of primary health care services were evaluated with a questionnaire. The data were statistically analyzed. Results: 242 patients were included in the study. 57.9% (n: 140) of the patients were male. 82.2% of the patients stated that they applied to the emergency department at least three times in a year. When the reasons for applying to the emergency department were examined, it was seen that the most common reason (35.5% n: 86) was not wanting to wait in line in the outpatient clinic. 33.5% (n: 81) of the patients did not know their family doctor and 41.3% (n: 100) did not use primary health care services. Conclusion: It has been observed that the problems experienced during outpatient services in patients aged 65 and over and the status of benefiting from primary health care services in this age group are effective factors on the frequency of emergency department visits

Türkiye'de ülke içinde yerinden edilme sorunu: tespitler ve çözüm önerileri = The problem of internal displacement in Turkey: assessment and policy proposals

Bu rapor, Doç. Dr. A. Tamer Aker (psikiyatr, Kocaeli Üniversitesi), Yrd. Doç. Dr. A. Betül Çelik (siyaset bilimci, Sabancı Üniversitesi), Dilek Kurban (hukuk doktoru, TESEV), Doç. Dr. Turgay Ünalan (nüfusbilimci, Hacettepe Üniversitesi) ve Yrd. Doç. Dr. H. Deniz Yükseker'den (sosyolog, Koç Üniversitesi) oluşan TESEV Ülke İçinde Yerinden Edilme Araştırma ve İzleme Grubu tarafından hazırlanmıştır. Grup, yerinden edilmeyi çatışma ortamının keskinleştirdiği devlet merkezli düşünüşün ve çeşitli ideolojik kamplaşmaların ötesinde, yurttaşlık haklarının yeniden tesisi ve toplumsal rehabilitasyon eksenlerinde ve insani boyutları bağlamında ele almaktadır

Long-term results of diaphragmatic plication in adults with unilateral diaphragm paralysis

<p>Abstract</p> <p>Background</p> <p>In this study we aimed to evaluate the long-term outcome of diaphragmatic plication for symptomatic unilateral diaphragm paralysis.</p> <p>Methods</p> <p>Thirteen patients who underwent unilateral diaphragmatic plication (2 patients had right, 11 left plication) between January 2003 and December 2006 were evaluated. One patient died postoperatively due to sepsis. The remaining 12 patients [9 males, 3 females; mean age 60 (36-66) years] were reevaluated with chest radiography, flouroscopy or ultrasonography, pulmonary function tests, computed tomography (CT) or magnetic resonance imaging (MRI), and the MRC/ATS dyspnea score at an average of 5.4 (4-7) years after diaphragmatic plication.</p> <p>Results</p> <p>The etiology of paralysis was trauma (9 patients), cardiac by pass surgery (3 patients), and idiopathic (1 patient). The principle symptom was progressive dyspnea with a mean duration of 32.9 (22-60) months before surgery. All patients had an elevated hemidiaphragm and paradoxical movement radiologically prior to surgery. There were partial atelectasis and reccurent infection of the lower lobe in the affected side on CT in 9 patients. Atelectasis was completely improved in 9 patients after plication. Preoperative spirometry showed a clear restrictive pattern. Mean preoperative FVC was 56.7 ± 11.6% and FEV1 65.3 ± 8.7%. FVC and FEV1 improved by 43.6 ± 30.6% (p < 0.001) and 27.3 ± 10.9% (p < 0.001) at late follow-up. MRC/ATS dyspnea scores improved 3 points in 11 patients and 1 point in 1 patient at long-term (p < 0.0001). Eight patients had returned to work at 3 months after surgery.</p> <p>Conclusions</p> <p>Diaphragmatic plication for unilateral diaphragm paralysis decreases lung compression, ensures remission of symptoms, and improves quality of life in long-term period.</p

Appraisal of the "pediatric ARDS: consensus recommendations from the pediatric acute lung injury consensus conference" with the AGREE II instrument

WOS: 000425902900015PubMed ID: 29479961Background/aim: The "Pediatric Acute Lung Injury Consensus Conference" (PALICC) was convened in order to develop a taxonomy to define pediatric acute respiratory distress syndrome (ARDS). The Appraisal of Guidelines for Research and Evaluation (AGREE) assesses the quality of guidelines. The aim of this study is to evaluate the new pediatric ARDS guideline using the AGREE II instrument. To the best of our knowledge, this is the first assessment of the new pediatric ARDS clinical practice guideline in the English literature. Materials and methods: Four appraisers assessed the new pediatric ARDS guideline with the AGREE II instrument. At the end of the evaluation each appraiser rated the overall quality of the guidelines. Results: Results of the assessment were editorial independence 100%, clarity of presentation 94%, scope and purpose 89%, stakeholder involvement 78%, rigor of development 78%, and applicability 78%. Conclusion: The new pediatric ARDS guideline received good scores especially with respect to editorial independence and clarity of presentation. Our overall AGREE II review of the PALICC guideline indicates that it has been created using high quality methodology and should be recommended for use and implementation as currently published

Cooccurrence of Darier’s Disease and Epilepsy: A Pediatric Case Report and Review of the Literature

Darier’s disease is a skin disorder characterized by multiple eruptions of hyperkeratosis or crusted papules at seborrheic areas with histologic acantholysis and dyskeratosis. It is caused by mutations in a single gene, being ATP2A2 and that is expressed in the skin and brain. The cooccurrence of various neurologic and psychiatric diseases with Darier's disease has been reported frequently in literature. They include mood disorders, epilepsy, encephalopathy, and schizophrenia. In this study, we report a pediatric case with the cooccurrence of Darier’s disease and epilepsy. We also revised current English literature on this topic