Annelerin 0-24 Aylık Çocuklarını Besleme Davranışları: Kırıkkale İli Örneği

Amaç: Bu çalışmanın amacı, Kırıkkale İl sınırları içinde yaşayan 0 -24 aylık çocukların anne sütü alma ve ek besinlere başlama duru-munda annelerin davranışlarını belirlemektir.Yöntem: Tanımlayıcı tipte olan bu çalışma, Kırıkkale İli merkez ve köylerinde yaşayan, 0-24 aylık çocuğu olan ve araştırmaya katılma-yı kabul eden 200 anneye 36 soru ve 5 bölümden oluşan bir anket formu uygulanmıştır.Bulgular: Annelerin %52’si kent merkezinde yaşamaktadır. Araştır-maya katılan annelerin %72.5’inin doğum sonrası ilk besin olarak bebeğine anne sütü verdiği, %57.5’inin çocuklarına ilk 6 ay anne sütü verdiği, annelerin %92.5’i anne sütü hakkında bilgi aldığı sap-tanmıştır. Annelerin %47.5’nin hemşire/ebelerden bilgi aldığı be-lirlenmiştir. Annelerin %36’sının 6 ay ve üzeri zamanda ek gıdaya başladığı saptanmıştır. Sonuç: Sonuç olarak, annelerin yarıdan fazlasının çocuklarına ilk altı ay sadece anne sütü verdiği, 6. aydan sonra ek gıdalara başla-dığı saptanmıştır

CD4(+) T cells of myasthenia gravis patients are characterized by ıncreased IL-21, IL-4, and IL-17A productions and higher presence of PD-1 and ICOS

Myasthenia gravis (MG) is an autoimmune disease mediated by autoantibodies predominantly against the acetylcholine receptor (AChR). Specific T cell subsets are required for long-term antibody responses, and cytokines secreted mainly from CD4(+) T cells regulate B cell antibody production. The aim of this study was to assess the differences in the cytokine expressions of CD4(+) T cells in MG patients with AChR antibodies (AChR-MG) and the effect of immunosuppressive (IS) therapy on cytokine activity and to test these findings also in MG patients without detectable antibodies (SN-MG). Clinically diagnosed AChR-MG and SN-MG patients were included. The AChR-MG patients were grouped as IS-positive and -negative and compared with age- and sex-matched healthy controls. Peripheral blood mononuclear cells were used for ex vivo intracellular cytokine production, and subsets of CD4(+) T cells and circulating follicular helper T (cTfh) cells were detected phenotypically by the expression of the chemokine and the costimulatory receptors. Thymocytes obtained from patients who had thymectomy were also analyzed. IL-21, IL-4, IL-10, and IL-17A productions in CD4(+) T cells were increased in AChR-MG compared to those in healthy controls. IS treatment enhanced IL-10 and reduced IFN-gamma production in AChR-MG patients compared to those in IS-negative patients. Increased IL-21 and IL-4 productions were also demonstrated in SN-MG patients. Among CD4(+) T cells, Th17 cells were increased in both disease subgroups. Treatment induced higher proportions of Th2 cells in AChR-MG patients. Both CXCR5(+) and CXCR5(-) CD4(+) T cells expressed higher programmed cell death protein 1 (PD-1) and inducible costimulatory (ICOS) in AChR-MG and SN-MG groups, mostly irrespective of the treatment. Based on chemokine receptors on CXCR5(+)PD-1(+) in CD4(+) T (cTfh) cells, in AChR-MG patients without treatment, the proportions of Tfh17 cells were higher than those in the treated group, whereas the Tfh1 cells were decreased compared with those in the controls. The relevance of CXCR5 and PD-1 in the pathogenesis of AChR-MG was also suggested by the increased presence of these molecules on mature CD4 single-positive thymocytes from the thymic samples. The study provides further evidence for the importance of IL-21, IL-17A, IL-4, and IL-10 in AChR-MG. Disease-related CD4(+)T cells are identified mainly as PD-1(+) or ICOS+ with or without CXCR5, resembling cTfh cells in the circulation or probably in the thymus. AChR-MG and SN-MG seem to have some similar characteristics. IS treatment has distinctive effects on cytokine expression.Istanbul Universit

Holistic Nursing Care for Hospitalized Type II Diabetes Patient: Case Report

Bu araştırmada dâhiliye kliniğinde yatmakta olan bir tip II diyabet hastası olgu olarak sunulmuştur. Hastaya hemşirelik öğrencileri ve öğretim elemanları tarafından klinik uygulama sırasında Roper, Logan ve Tierney'in geliştirdiği günlük yaşam aktiviteleri modelinden yararlanılarak bütüncül yaklaşımla hemşirelik bakım planı uygulanmıştır. Olguda saptanan sorunlar; kan glikoz düzeyinin yüksek olması, deri bütünlüğünde bozulma ve ayak yarası riski, düşme riski, ağız içi hijyeninde bozulma, iştahsızlık ve sosyal ilişkilerin zayıf olmasıdır. Saptanan sorunlara yönelik ilaç kullanımı, beslenme, egzersiz, ayak bakımı, epilepsi ve düşme riski ile ilgili eğitim verilmiş, deri, ağız ve ayak bakımı uygulanmış ve sosyal ilişkilerini güçlendirmek amacıyla motive edilmiştir. Değerlendirme aşamasında hasta ve aile üyesinden eğitimlere yönelik olumlu geribildirimi alınmıştır. Ancak birey evde takip edilemediğinden eğitimler sonunda davranış gelişip gelişmediği bilinmemektedir. Tip II diyabet bakımı ve tedavisi için klinik ve birinci basamak sağlık ekibinin iletişim kurarak birlikte çalışması önerilirIn this study, a patient with type II diabetes who was hospitalized in an internal medicine clinic was presented as a case. During clinical practice, a holistic nursing care plan developed by utilization of Roper, Logan and Tierney’s Daily Living Activities Model was carried out with the patient by nursing students and their instructors. The problems determined in this case were; high blood glucose level, deterioration of skin integrity and risk of foot wound, risk of fall, deterioration of oral hygiene, loss of appetite, and poor social relations. In order to solve these problems, education were provided regarding drug use, nutrition, exercise, foot care, epilepsy and risk of fall; skin, oral and foot care was provided; and the patient was motivated for strengthening her social relations. In the stage of evaluation, a positive feedback regarding İletişim : [email protected] education was received from the patient and the family member. However, as the patient was not followed up at home, it was not known whether or not the behavior was developed at the end of the education. It is suggested that clinical and primary care team should cooperate by communicating for the care and treatment of type II diabete

Vocal Cord Paralysis and Hypercapnic Respiratory Failure in a Patient with Familial Amyloidotic Polyneuropathy

We herein report a patient case with familial amyloidotic polyneuropathy (FAP) who presented with vocal cord paralysis (VCP). A 60-year-old man with FAP (Gly89Gln) presented with hoarseness and snoring for the previous two years. A chest X-ray demonstrated cardiomegaly and bilateral diaphragmatic elevation. The findings of a restrictive pattern on spirometry and daytime hypercapnia were consistent with respiratory muscle weakness related to neuropathy [ forced expiratory volume (FEV1): 38%, forced vital capacity (FVC): 39%, FEV1/FVC: 77, partial pressure of arterial oxygen (PaO2): 80 mmHg, partial pressure of carbon dioxide in arterial blood (PaCO2): 52 mmHg]. An ear-nose-throat examination showed VCP. Polysomnography revealed severe obstructive sleep apnea (OSA). FAP may cause OSA by VCP and hypercapnic respiratory failure by respiratory muscle weakness. Therefore, an ear-nose-throat examination, spirometry, arterial blood gases analysis and polysomnography are important for these patients

IN-HOSPITAL STROKE RECURRENCE OF ACUTE ISCEMIC STROKE

BACKROUND: Stroke survivors are athigh risk of recurrent stroke, communitybasedstudies show that this risk is about30%. Recurrent strokes tend to be moredeadly than the first stroke and lead tofurther neurological impairment. In thissudy, in-hospital stroke recurrence ina university hospital stroke unit settingwere investigated.PATIENTS AND METHODS: Strokeregistry data of 2128 patients hospitalizedat the Istanbul Faculty of Medicine,Department of Neurology, Edip AktinStroke Unit between 1994-2007 wereevaluated. Recurent stroke was definedas a new neurological deficit not causedby neurological complications such asedema, mass effect or hemorrhagic transformationor progression of the indexevent. Clinical, laboratory and neuroimagingfindings of 67 recurrent ischemicstroke patients were compared with ischemicstroke patients (n = 1658) withoutany recurrence. Statistical methods usedwere; chi-squared test for parametricvariables, t-test for continuous variablesand univariate and multivariate analysisusing SPSS version 15.0.RESULTS: In- hospital stroke reccurencerate was 3.9% (n = 83/2128) inall stroke patients and %4 in ischemicstroke (IS) patients. There were no statisticallysignificant differences betweenIS patients with and without recurrencein terms of demographic features, andmost traditional risk factors. Only peripheralvascular disease frequency wassignificantly higher in the recurrent stroke group (p = 0.05, 95% CI = 0.98 to5.524). Posterior circulation syndrome(POCS) and was significantly more frequentlyencountered in the recurrentstroke group (p = 0.012).The most importantfactor in determining the recurrenceof IS was large artery atherosclerosis(LAS) (p <0.001, 95% CI = 0.062 to0.44).CONCLUSION: In a stroke unit whereacute stroke treatments were mostly unavailable,a higher in-hospital stroke recurrencerate associated with LAS in ISpatients may be indicative of the importanceof early theraputic intervention

Facial and Skeletal Muscle Magnetic Resonance Imaging In Oculopharyngodistal Myopathy

OBJECTIVE: Oculopharyngodistal myopathy (OPDM) has been reported as a rare, adult-onset hereditary muscle disease. Patients show progressive oculopharyngeal and distal limb muscle involvement. As the genetic defect underlying OPDM is not known yet, the diagnosis currently rests upon clinical and histopathological features. This study aimed at investigating patterns of muscle alterations of OPDM patients by MRI and to search for possible clues to make differential diagnosis by using a non-invasive method. METHODS: Facial, upper and lower extremity muscles of 10 patients with OPDM, followed by the Neuromuscular Unit, Department of Neurology, Istanbul Faculty of Medicine, who had undergone detailed evaluation with manual muscle testing and who had different disease severity were evaluated with a 1.5-Tesla Philipps Achieve MR scanner using conventional T1 and T2 weighted axial images. The degree of muscle involvement on MRI was evaluated according to a modified 5-point scale. RESULTS: The mean age of onset was 20.1± 8.2 years (range 7- 39 years) and the mean disease duration was 14.5± 12.4 years (range 2-41 years). Seven patients showed dominantly distal (mild to severe/wheelchair bound), one patient dominantly proximal weakness and two patients had no weakness. The patients without weakness had normal imaging, but facial muscle MRI from one of them revealed mild involvement. Zygomatic and nasal muscles were the most severely and earliest involved muscles. MRI of all patients with muscle weakness showed a consistent selective muscle involvement pattern. Distal extremity muscles were more affected than proximal muscles. Earliest and most sever changes were found in semimembranous, biceps femoris and medial head of gastrocnemius and soleus muscle. Interestingly, sartorius, gracilis and semitendinous muscles and the lateral head of gastrocnemius were well-preserved in OPDM. CONCLUSION: Muscle MRI by showing selective involvement of exteremity muscle may be a non-invasive tool in the differential diagnosis of OPDM

Four Individuals with a Homozygous Mutation in Exon 1f of thePLECGene and Associated Myasthenic Features

We identified the known c.1_9del mutation in thePLECgene in four unrelated females from consanguineous families of Turkish origin. All individuals presented with slowly progressive limb-girdle weakness without any dermatological findings, and dystrophic changes observed in their muscle biopsies. Additionally, the neurological examination revealed ptosis, facial weakness, fatigability, and muscle cramps in all four cases. In two patients, repetitive nerve stimulation showed a borderline decrement and a high jitter was detected in all patients by single-fiber electromyography. Clinical improvement was observed after treatment with pyridostigmine and salbutamol was started. We further characterize the phenotype of patients with limb-girdle muscular dystrophy R17 clinically, by muscle magnetic resonance imaging (MRI) features and by describing a common 3.8 Mb haplotype in three individuals from the same geographical region. In addition, we review the neuromuscular symptoms associated withPLECmutations and the role of plectin in the neuromuscular junction