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

Turner sendromlu ergenlerin multidisipliner yaklaşımla psikometrik ve psikososyal açıdan değerlendirilmesi: Ön çalışma

Introduction: The aim of this study is to compare neurocognitive and psychosocial characteristics in adolescents with Turner Syndrome (TS) and age-matched adolescents with short stature (SS) and normal karyotypes. Materials and Methods: Seven patients with TS and 7 patients with SS and normal karyotypes were included in the study. Their comorbid psychopathologies, cognitive functioning, quality of life, self-esteem, emphatic tendencies, mentalizing abilities and coping strategies were investigated. Results: Although the adolescents with SS had higher levels of anxiety and conduct problems, there were no significant differences between the TS and SS groups in terms of comorbid psychopathologies, social cognition skills, quality of life, self-esteem and coping strategies. However, the cognitive functioning of adolescents with TS was found to be lower than both of the adolescents with SS and community samples. Conclusions: According to this preliminary study, anxiety/conduct problems and cognitive functioning of patients with TS should be evaluated in order to prevent subsequent negative outcomes.Giriş: Bu çalışmanın amacı, TS olan ergenler ile kısa boylu ve normal karyotipi olan benzer yaştaki ergenleri nörobilişsel ve psikososyal olarak karşılaştırmaktır. Gereç ve Yöntem: Çalışmaya TS olan yedi hasta ile kısa boylu ve normal karyotipi olan yedi hasta dahil edilmiştir. Eşlik eden psikopatolojiler, bilişsel işlevsellik, yaşam kalitesi, benlik saygısı, empatik eğilimler, zihinselleştirme becerileri ve baş etme stratejileri araştırılmıştır. Bulgular: Kısa boylu ergenlerde anksiyete ve davranım problemleri daha yüksek olmasına karşın, eşlik eden psikopatolojiler, sosyal biliş becerileri, yaşam kalitesi, benlik saygısı ve başetme stratejileri açısından TS olan ergenler ile kısa boylu ergenler arasında önemli bir fark bulunmamıştır. Bununla birlikte, TS olan ergenlerin bilişsel işlevlerinin hem kısa boylu ergenlere hem de toplum örneklemine göre daha düşük olduğu bulunmuştur. Sonuç: Bu ön çalışmaya göre, ileride gelişebilecek olumsuz sonuçları önlemek için TS’li hastalar anksiyete / davranış sorunları ve bilişsel işlevler açısından değerlendirilmelidir

Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach

The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed “screening and diagnostic” algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN

Metabolic dysfu nctio n-As socia ted fatty liver disease and fibrosis status in patients with Type 2 Diabetes Treated at Internal medicine clinics: Türkiye DAHUDER awareness of fatty liver disease (TR-DAFLD) study

Background/Aims: This awareness study aimed to determine the ultrasound (US) examination rates in relation to US-confirmed metabolic dysfunction-associated fatty liver disease (MAFLD) diagnosis in internal medicine outpatients with type 2 diabetes (T2D) across Turkiye. Materials and Methods: A total of 6283 T2D patients were included in this multicenter retrospective cohort study conducted at 17 internal medicine clinics across Turkiye. The presence and indications for US performed within the last 3 years were recorded along with US-confirmed MAFLD rates, laboratory findings on the day of US, and referral rates. Fibrosis-4 (FIB-4) index was calculated to estimate the risk of advanced liver fibrosis (FIB-4 index ≥ 1.3). Results: Overall, 1731 (27.6%) of 6283 patients had US examination, which revealed MAFLD diagnosis in 69.9% of cases. In addition, 24.4% of patients with US-confirmed MAFLD were at risk of advanced fibrosis (FIB-4 index ≥ 1.3), and the referral rate was 15.5%. Conclusion: In conclusion, our findings emphasize an insufficient MAFLD awareness among clinicians and the likelihood of most of T2D patients to be at risk of living with an unknown status regarding their MAFLD and advanced fibrosis ris

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p < 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

TEZİN ADINA ULAŞILAMADI

Ağır sepsis ve septik sok yoğun bakımlarda halen en önemli ölüm nedenlerindendir. Bu nedenle günümüzde tanı ve prognoz göstergesi olabilecek belirteçlerin arastırmaları ve yeni tedavi seçenekleri önem kazanmaktadır. Sepsis ağır bir stres durumudur. Strese karsı yanıtta hipotalamo-pituiter-adrenal aks önemli yer tutar. Kortizol seviyesindeki artıs vasküler reaktivitenin korunmasında, immün yanıtın düzenlenmesinde ve akut hastalık sırasında vücut dengesinin devamlılığının sağlanmasında önemlidir. Adiponektin yağ dokusundan salınan anti-inflamatuvar, insülin duyarlılastırıcı ve anti-aterosklerotik etkileri olan; günümüzde diabetes mellitus, ateroskleroz, malignite ve sepsis gibi hastalıkların patogenezinde rol aldığı düsünülen bir adipositokindir. Bu çalısmada amacımız sepsis tanısı alan hastalarda vücudun stres cevabında etkili olan kortizol ve anti-inflamatuvar etkili adiponektinin metabolik parametreler, inflamasyon ve prognoz ile iliskisini arastırmaktı. Bu nedenle Gazi Üniversitesi Tıp Fakültesi Đç Hastalıkları Yoğun Bakım ünitesine ağır sepsis ve septik sok tanıları ile yatırılan 29 hasta, sepsis dısı bir nedenle yatırılan 23 hasta ve benzer yasta ayaktan sağlıklı 24 kisi çalısmaya alındı. Üç grup arasında serum adiponektin düzeyi bakımından istatistiksel olarak farklılık yokken, ortalama adiponektin düzeyi septik sok grubunda bir miktar daha yüksekti. Sepsisten çıktıktan sonra bakılan serum adiponektin düzeyleri tanı anında bakılan düzeyine göre anlamlı artmıs bulundu. Buna göre, adiponektinin inflamasyonu baskılamak ve vücuttaki dengeyi sağlamak için serum düzeylerinin arttığı kanısına vardık. Serum adiponektin düzeylerinin mortaliteye anlamlı bir etkisi olmadığını saptadık. Ancak, glukoz düzeyleri 200 mg/dl üzerinde olduğunda sağkalımı olumsuz etkilediğini bulduk. Sepsisli hastalarda sepsis olmayanlara göre serum kortizol düzeyleri istatistiksel olarak anlamlı düzeyde yüksekti. Ek olarak, serum adiponektin düzeyi ile kortizol arasında pozitif bir korelasyon saptandı. Ayrıca, serum adiponektin düzeyi ile CRP düzeyi arasında negatif korelasyon mevcuttu. Tüm bu bulgular adiponektinin sepsiste inflamatuvar ve metabolik yanıtın bir parçası olarak rol oynadığını düsündürmektedir. Bulgularımız sepsisli hastalarda adiponektinin prognostik bir belirteç olarak kullanılabileceği kanısını uyandırsa da adiponektinin sepsiste prognostik bir belirteç ve tedavi seçeneği olarak kullanılabilmesi için daha fazla insan çalısmasına ihtiyaç olduğunu düsünmekteyiz.Sepsis and septic shock are still the most important causes of mortality in intensive care units. For this reason, there is on-going research about new theurapeutic options and markers for diagnosis and prognosis of sepsis. Adiponectin is an adipocytokine which is secreted by adipose tissue and has anti-inflammatory, insulin sensitizing, anti-atherosclerotic effects and plays role in pathogenesis of diseases such as diabetes mellitus, metabolic syndrome, atherosclerosis, malignancy and sepsis. Our study was conducted with 29 patients who were being treated in internal medicine intensive care unit because of sepsis and septic shock, together with 23 patients still in intensive care, but hospitalized for an other reason than sepsis and healthy 24 controls who were being followed in outpatient clinics. Blood samples for clinical tests were taken at the time of admission to intensive care unit before any therapy. There was not any statistically difference in serum adiponectin levels between three groups but adiponectin levels were slightly higher among the patients with septic shock. In patients who recovered from septic shock, adiponectin levels were significanyly higher than the levels measured at the time of admission. According to this information, it was thought that adiponectin might have increased in order to supress the inflammation and restore homeaostasis and patients whose adiponectin levels didn’t increase enough might represent with worse clinical consequences. Moreover, it has been shown in our study that adiponectin levels and mortality don’t have a statistically significiant correlation. Serum adiponectin level had a positive correlation with serum cortisol levels and a negative correlation with serum CRP levels. All these findings have shown that adiponectin is playing role in sepsis as a part of immune and inflammatory response and it may be interpreted as a prognostic marker in septic shock. Our findings also show that we need more clinical studies to validate adiponectin as a prognostic marker and therapeutic target

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

TERATOGENIC EFFECT OF ANTIEPILEPTIC DRUGS ON EPILEPSY PATIENTS

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

Reactivation risk of Hepatitis B Virus in both HBsAg negative and HBcIgG positive patients with solid malignancy. Is antiviral prophylaxis really necessary?

Prophylactic antiviral treatment is controversial due to a lack of studies in both HBsAg negative/HBcIgG positive patients who treated conventional chemotherapy with solid malignancy, unlike HBsAg positive. In this cross-sectional and retrospective study, we analyzed that the reactivation risk of Hepatitis B Virus (HBVr) of totally 457 HBcIgG positive patients with solid cancer in archives records between 2011 and 2018 years of two different centers. Totally 217 HBcIgG positive patients with solid cancer were included in the study. Anti-HBs positive and negative patients were 119 (54.8%) and 98 (45.2%), respectively. Frequent diagnosis of the patients was lung (28.1%), colorectal (19.4%), breast (17.5%) and hepatobiliary tract cancers (8.3%), respectively. Most of the study population had stage 4 disease (48.8%) and received palliative chemotherapy. When the patients were stratified due to American Gastroenterological Association Institute (AGA) guideline, HBVr risk of chemo regimen was moderate in 21 patients (17.5%), low in 8 patients (3.7%). The majority of the patients were undefined risk group (78.8%). We did not determine any HBVr in the patients who have received different conventional chemotherapy regimens and have different primer tumor site despite all the patients did not receive the prophylactic antiviral drug. [Med-Science 2019; 8(2.000): 418-21