Effectiveness of virtual reality-based vestibular rehabilitation in patients with peripheral vestibular hypofunction

Indexed keywords Metrics Abstract Background/aim: The rehabilitation of classical peripheral vestibular disorders is long and costly. Recently, interactive systems based on virtual reality (VR) technology have reduced the cost of vestibular rehabilitation therapy (VRT) and made the process more enjoyable. This study aims to investigate the effects of VR-based VRT in patients diagnosed with peripheral vestibular hypofunction (PVH). Materials and methods: In this study, a VR-based VRT program that utilized Sony Playstation®4 VR Head Mounted Display was applied to 25 patients (between 18–60) diagnosed with PVH. PVH was diagnosed by evaluating the patients’ clinical histories, the findings in the “Micromedical Technologies VisualEyes Spectrum” videonystagmography (VNG) and the “Micromedical Aqua Stim” model bithermal water caloric tests. VR-based VRT program was applied to the patients for 4 weeks, 2 sessions per week, 8 sessions in total. Each session lasted around 30 to 40 min. All patients underwent the Dizziness Handicap Inventory (DHI), Sensory Organization Test (SOT), Adaptation Test (ADT), Limits of Stability (LOS), and Rhythmic Weight Shift (RWS) before, after, and 8-week follow-up of the VRT program. In addition, the Cybersickness Survey was applied to the patients at the end of the VR-based VRT session every week. Results: The DHI mean scores of the patients were 54.60, 19.20, and 16.84, respectively, before, just after, and at the 8-week follow-up VRT (p < 0.001). The mean SOT composite score of the patients was obtained as 58.08 before VRT; 77.16 after VRT and 76.40 at 8-week after VRT (p < 0.000). On the other hand, the values in the ‘movement velocity’ and “direction control” parameters of the patients in LOS and RWS showed a significant improvement after VRT compared to before VRT (p < 0.000). From before VRT to 8 weeks after VRT, the patient’s oscillation averages in the ‘toes up’ and ‘toes down’ positions in ADT reduced progressively (p < 0.000). Conclusion: This study demonstrates that implementing a VR-based VRT protocol may be an efficient option to improve posture stability and the quality of life in patients with PVH. In addition, VR-based vestibular rehabilitation therapy has shown to be effective for PVH patients in the mid-term

Betahistin dihidroklorür kullanımı pozisyonel nistagmusu etkiler mi?

Aim: In this study, we aimed to investigate the effect of betahistine dihydrochloride (BD) use on positional nystagmus as an objective criterion for the diagnosis of benign paroxysmal positional vertigo (BPPV). Methods: The retrospective study included 59 patients (15 males, 44 females) who were aged between 18 and 80 years and referred with suspected BPPV to the otorhinolaryngology clinic of the Istanbul Training and Research Hospital. Only patients who had no central pathology on oculomotor tests were included. Of the patients included, those not using BD were classified as Group I and those using BD medication (24 mg/day) within the last 48 hours as Group II. The positional nystagmus latency, duration, and slow-phase velocity (SPV) values were compared using videonystagmography. Results: There was no significant difference between the two groups in terms of oculomotor gains (p>0.05). While there was no difference between the two groups in terms of positional nystagmus latency and SPV values, nystagmus duration was found to be significantly longer in Group II. Conclusion: Although the BD use appears to prolong the duration of nystagmus in BPPV, it does not affect the other parameters of nystagmus, including SPV, and the prolonged duration is still within normal limits. Positional nystagmus can be investigated in patients with a history of suspected BPPV and BD prescription.Amaç: Bu çalışmada betahistin dihidroklorür (BD) kullanımının benign paroksismal pozisyonel vertigo (BPPV) tanısında objektif kriter olan pozisyonel nistagmus üzerine etkisini incelemek amaçlanmıştır. Yöntem: Retrospektif çalışmamız yaşları 18–80 yıl aralığında değişen ve BPPV şüphesiyle İstanbul Eğitim ve Araştırma Hastanesi’nin kulak–burun–boğaz polikliniğine yönlendirilen 59 (15 erkek, 44 kadın) hasta içerdi. Çalışmaya yalnızca okülomotor testlerde santral patoloji görülmeyen hastalar dahil edildi. Dahil edilen hastalardan BD kullanmayanlar Grup I, son 48 saat içinde BD grubu ilaç (24 mg/gün) kullananlar ise Grup II olarak tasnif edildi. Pozisyonel nistagmus latans, süre ve yavaş faz hızı (YFH) değerleri videonistagmografi kullanılarak karşılaştırıldı. Bulgular: İki grup arasında okülomotor kazançlar bakımından anlamlı bir fark bulunmadı (p>0,05). Yine iki grup arasında pozisyonel nistagmus latans ve YFH değerleri açısından fark saptanmazken nistagmus süresi Grup II’de anlamlı olarak daha uzun bulundu. Sonuç: BD kullanımı BPPV’de pozisyonel nistagmus süresini uzatıyor gibi görünse de YFH dahil diğer nistagmus parametrelerini etkilememektedir ve süredeki uzama halen normal sınırlar içindedir. BPPV şüphesi ve BD reçeteleme öyküsü olan hastalarda pozisyonel nistagmus araştırılabilir

Locomotor differences in Mongolian gerbils with the effects of midazolam administration in the form of eye drops

Background: Midazolam is a sedative-hypnotic agent with amnestic and anticonvulsant properties that can be administrated to mammals through various routes, such as intravenous, intramuscular, oral, intrathecal, rectal, and buccal. Midazolam administration in the form of eye drops through the conjunctiva is not reported in the literature. Aim:This study aims to demonstrate the possible central nervous system effects of midazolam administration as eyes drops in Mongolian gerbils. Materials and Methods: Fourteen gerbils were randomly assigned to one of two equal sized groups. The active arm received 2 ml of 10 mg midazolam as eye drops in both eyes. Control group received a total of 2 ml of physiological saline(0.9% NaCl). We subjected the gerbils to an adapted “Open Field” to determine the possible effects on central nervous system of midazolam. Gerbils were allowed to move freely in the open field. Before and after the drug administration, locomotor activities of each gerbil have been recorded. Frequency of loss of righting reflex was quantified. Results: Conjunctival Midazolam administration resulted with the transient loss of righting reflex (p=0.017) and suppressed exploration motion (p=0.018) in the open field test compared to control subjects. Conclusions: In the present study, administration of conjunctival midazolam as an eye drop may affect gerbil’s locomotor activities and open field behaviors. We argue that, using a sedative and anticonvulsive drug such as midazolam via conjunctival route may be useful in some clinical situations. Therefore, it could be beneficial to develop a new conjunctival formulation of midazolam. Also, there is a need for trials in humans with pharmacokinetic studies.Keywords: Righting reflex; Conjunctival Midazolam; Gerbillinae; Midazolam; Eye drop; New administration routeAfrican Health sciences Vol 14 No. 1 March 201

Minimally invasive repair of pectus excavatum (MIRPE) in adults: is it a proper choice?

Introduction : The Nuss procedure is suitable for prepubertal and early pubertal patients but can also be used in adult patients. Aim : To determine whether the minimally invasive technique (MIRPE) can also be performed successfully in adults. Material and methods : Between July 2006 and January 2016, 836 patients (744 male, 92 female) underwent correction of pectus excavatum with the MIRPE technique at our institution. The mean age was 16.8 years (2–45 years). There were 236 adult patients (28.2%) (> 18 years) – 20 female, 216 male. The mean age among the adult patients was 23.2 years (18–45 years). The recorded data included length of hospital stay, postoperative complications, number of bars used, duration of the surgical procedure and signs of pneumothorax on the postoperative chest X-ray. Results: MIRPE was performed in 236 adult patients. The average operative time was 44.4 min (25–90 min). The median postoperative stay was 4.92 ±2.81 days (3–21 days) in adults and 4.64 ±1.58 (2–13) in younger patients. The difference was not statistically significant (p = 0.637). Two or more bars were used in 36 (15.8%) adult patients and in 44 (7.5%) younger patients. The difference was not statistically significant either (p = 0.068). Regarding the overall complications, complication rates among the adult patients and younger patients were 26.2% and 11.8% respectively. The difference was statistically significant (p = 0.007). Conclusions : MIRPE is a feasible procedure that produces good long-term results in the treatment of pectus excavatum in adults

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Assimilation policies applied to Turks in Bulgaria between 1984-1989 with verbal lectures

Bulgaristan kurulduğu 1878 yılından itibaren homojen bir ulus oluşturmayı hedefledi. Bu amaçuğruna ülkesinde Osmanlı yönetimi altında asırlarca huzur içinde yaşayan azınlıkları asimileçabasına girişti. Bulgaristan’daki bu asimilasyon politikası planlı ve sinsice yürütüldü. Makedon,Pomak ve Roman gibi küçük azınlıkların asimilasyonu gerçekleştikten sonra en büyük nüfusa sahipolan Türklerin asimilasyonuna başlandı. İlk olarak Türklerin okulları devletleştirildi, topraklarıellerinden alındı, okullarda din dersleri kaldırıldı, camiler kapatıldı. Türkler gelenek vegöreneklerinden uzaklaştırılmaya çalışıldı. Bu zorbalıklarla karşılaşan Türkler, 1950 ve 1969-1978yılları arasında iki kez kitlesel olarak Türkiye’ye göç etti. 1984 yılının Aralık ayında Bulgar KomünistParti yöneticileri Bulgaristan’daki Türklerin aslının Bulgar olduğunu iddia eden Yeniden DoğuşSürecini /Soya Dönüş Süreci’ni başlattılar. 1985 yılının Mart ayına kadar Bulgar nüfusunun yaklaşık%10’unu oluşturan tüm Türklerin isimlerini Bulgar isimleri ile değiştirdiler. Türkçe konuşmak,camiye gitmek, çocukları sünnet ettirmek, kurban kesmek, kısacası Türklere ait olan tüm diniritüeller, gelenekler ve görenekler yasaklandı. Asimilasyon politikalarına direnen Türklercezaevlerine, toplama kamplarına ve sürgünlere gönderildiler. Türkiye Bulgaristan’da yaşanan buzalimliğe tepki gösterdi. Halkımız ülkemizin büyük illerinde gösteriler ve protesto mitingleridüzenledi. Türkiye Cumhuriyeti Devleti birçok uluslararası kuruluşa başvurarak Bulgaristan’dasoydaşlarımıza yapılan asimilasyonu durdurmak için girişimlerde bulundu. 1989 Mayıs ayındaBulgaristan’da yapılan haksızlıklara karşı protestolar başladı ve kısa bir süre sonra Bulgar KomünistParti yöneticileri soydaşlarımıza Türkiye’ye göç etme izni verdi. 2 Haziran 1989 tarihinden itibarensoydaşlarımız yüzlerce yıldır vatan bildikleri toprakları terk ettiler ve Türkiye’ye göç ettiler.Since its establisment in 1878, Bulgaria has aimed to create a homogeneous nation. For this purpose, Bulgaria strived to assimilate the minorities in the country who lived peacefully under Ottoman rule for centuries. This assimilation policy in Bulgaria was carried out in a planned and insidious manner. After the assimilation of minor minorities such as Mecedonians, Pomaks and Romany, the assimilation of Turks with the largest population started. First of all, the schools of the Turks were nationalized, their lands were taken away, religion courses were removed in schools and mosques were closed. Turks were tried to be removed from their traditions and customs. Facing this despotism, Turks migrated to Turkey massively twice in 1950 and between 1969-1978. In December 1984, the leaders of the Bulgarian Communist Party launched the Re-birth Process/, which claims that the Turks in Bulgaria were originally Bulgarians. Until March 1985, they changed the names of all the Turks, who made up about 10% of the Bulgarian population, with Bulgarian names. Speaking Turkish, going to the mosque, circumcising the children, sacrificing, in short, all the religious rituals, traditions and customs belonging to the Turks were banned. The Turks who resisted the assimilation policies were sent to prisons, concentration camps and exiles. Turkey reacted to the brutality that occurred in Bulgaria. Our people organized demonstrations and protest demonstrations in the major provinces of our country. The Republic of Turkey has made attempts to stop the assimilation of our compatriots in Bulgaria referring to many international organizations. In May 1989, protests against the injustice in Bulgaria began and shortly after Bulgarian Communist Party officials gave permission for our compatriots to emigrate toTurkey. Since June 2, 1989, our compatriots have abandoned the land they know as their homeland for hundreds of years and emigrated to Turkey

Alvanlar Resistance Against the Assimilation Policies of Bulgaria (17-18-19 January 1985)

1984-1989 yılları arasında Bulgaristan Komünist Parti yönetimi ülkede yaşayan Türklerin asıllarının Bulgar olduğunu iddia eden Yeniden Doğuş (Soya Dönüş) Süreci olarak tanımladıkları bir kampanyayı başlattı.Bu kampanya ile birlikte Bulgaristan’da yaşayan soydaşlarımızın Türkçe konuşması, Türk müziği dinlemesi, kurban kesmesi, çocuklarını sünnet ettirmesi, cenazelerinde veya düğünlerinde dinsel ve gelenekseluygulamaları, Türklüğün simgesi gibi görülen bazı kıyafetleri giymeleri yasaklandı. Bu yasakların yanısıra, 1984 yılının Aralık ayı itibariyle Bulgaristan’da yaşayan soydaşlarımızın isimleri Bulgar isimleri iledeğiştirilmeye başlandı. İsim değiştirme uygulaması, 17-18-19 Ocak günlerinde İslimye (Sliven) iline bağlıKazan (Kotel) ilçesinin bir köyü olan Alvanlarda (Yablanovo) uygulamaya konuldu. Ancak Alvanlar (Yablanovo) köyü halkı isimlerini değiştirmeye gelen Bulgar Komünist Partisi yöneticilerine toplu bir şekildedireniş gösterdi. Gerlovo bölgesindeki diğer köyler de Alvanları (Yablanovo) bu direnişte yalnız bırakmadılar. Bulgar komünist idarecileri 17 ve 18 Ocak’ta giremedikleri köye 19 Ocak sabahı Bulgaristan’ın enbüyük zırhlı birliği olan İslimye (Sliven) Zırhlı Birliği’nin yardımı ile girebildiler. Bulgar ordusunun tanklarına karşı ellerindeki taş ve sopalarla üç gün direnerek büyük bir kahramanlık örneği gösteren AlvanlılarBulgaristan Türklerinin tarihinde çok önemli bir iz bıraktılar.Between 1984 and 1989, the Communist Party of Bulgaria launched a campaign called the Rebirth (Back To Basics) Process, which claimed that the Turks living in the country were originally Bulgarian. With this campaign, Turks in Bulgaria were prohibited from speaking Turkish, listening to Turkish music, slaughtering sacrifices, circumcising their children, religious and traditional practices at their funerals or weddings, and wearing wearing certain clothes that were seen as symbols of Turkishness. In addition to these prohibitions, as of December 1984, the names of our citizens living in Bulgaria began to be replaced with Bulgarian names. The name change was implemented in Alvanlar (Yablonova), a village of Kazan (Kotel) district of Islimye (Sliven) province on 17-18-19 January. However, the people of the village of Alvanlar (Yablanovo) massively resisted the leaders of the Bulgarian Communist Party who came to change their names. Other villages in the Gerlovo region did not leave the Alvanlar alone in this resistance. On January 17 and 18, the Bulgarian communist rulers could not enter the village, and on the morning of January 19, they were able to enter the village with the help of the Sliven Armored Unit, the largest armored unit in Bulgaria. Resisting the tanks of the Bulgarian army with stones and sticks in their hands for three days, the Alvanlar people showed a great example of heroism and left a very important mark in the history of the Bulgarian Turk