Diagnostic value of repeated Dix-Hallpike and roll maneuvers in benign paroxysmal positional vertigo [Valor diagnóstico da repetição das manobras de Dix-Hallpike e roll-test na vertigem posicional paroxística benigna]

Introduction Benign Paroxysmal Positional Vertigo (BPPV) is the most common peripheral vestibular disorder. The Dix-Hallpike and Roll maneuvers are used to diagnose BPPV. Objective This study aims to investigate the diagnostic value of repeated Dix-Hallpike and Roll maneuvers in BPPV. Methods We performed Dix-Hallpike and roll maneuvers in patients who admitted with peripheral vertigo anamnesis and met our criteria. The present study consists of 207 patients ranging in age from 16 to 70 (52.67 ± 10.67). We conducted the same maneuvers sequentially one more time in patients with negative results. We detected patients who had negative results in first maneuver and later developed symptom and nystagmus. We evaluated post-treatment success and patient satisfaction by performing Dizziness Handicap Inventory (DHI) at first admittance and two weeks after treatment in all patients with BPPV. Results Of a total of 207 patients, we diagnosed 139 in first maneuver. We diagnosed 28 more patients in sequentially performed maneuvers. The remaining 40 patients were referred to imaging. There was a significant difference between pre- and post-treatment DHI scores in patients with BPPV (p < 0.001). Conclusion Performing the diagnostic maneuvers only one more time in vertigo patients in the first clinical evaluation increases the diagnosis success in BPPV. Canalith repositioning maneuvers are effective and satisfactory treatment methods in BPPV. © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facia

Differences in clinical features, etiology, types, and risk factors for complications between young and older patients with skin and soft tissue infections [Deri ve yumuşak doku enfeksiyonlu genç ve yaşli hastalar arasinda klinik özellikler, tip, etiyoloi ve komplike edici risk faktörleri açisindan farkliliklar]

Introduction: This study investigated differences in clinical features, types, etiology, and risk factors for complications between young and older patients with skin and soft tissue infections. Futhermore, age-related differences in healthcare-associated and complicated infections were identified. Materials and Method: This retrospective study included 206 skin and soft tissue infection patients hospitalized during an 8-year period. Data were collected using a form: patients’ characteristics, clinical features, laboratory values, prior antibiotic use, causative microorganisms, and antibiotic treatment. For cases with clinically diagnosed, samples were taken from the suspected infection sites. Gram staining, deep swab, deep tissue and blood culture results were evaluated. Results: The incidence of diabetes mellitus was significantly higher among patients aged ?65 years. Among these old patients, Escherichia coli (11/31, 35.5%) and Pseudomonas aeruginosa (8/31, 25.8%) were the most frequently isolated pathogens. Approximately half of the Staphylococcus aureus and Staphylococcus epidermidis strains isolated from patients with health care-associated infection were resistant to methicillin (8/15, 53.3%), and these patients produced higher levels of extended-spectrum beta-lactamase. Venous insufficiency (p=0.008) and prior hospitalization (p=0.001) were identified as risk factors for complication in patients aged ?65. The median time- to -clinical response was 7 days in older patients with non-complicated infection (p=0.007). Conclusion: Diabetes mellitus was the most common co-morbid factor in older patients. Risk factors for complication may differ by age. Gram-negative pathogens were more commonly isolated in older patients. The time- to -clinical response was significantly longer in older patients with non-complicated infection than young patients. © 2018 Geriatrics Society. All rights reserved

Is induced sputum a useful noninvasive tool in the diagnosis of pulmonary sarcoidosis?

In patients with pulmonary sarcoidosis, the provocation of sputum expectoration through the inhalation of hypertonic saline has been investigated as an alternative diagnostic tool for invasive procedures. We aimed to assess the diagnostic value of induced sputum (IS) by observing its cell distribution in patients with a confirmed histopathological diagnosis of sarcoidosis

An unusual cause of urinothorax

Urinothorax is a rare complication of blunt renal trauma, ureteral instrumentation or ureteral surgery. A leakage from the urinary tract causes urinoma, a retroperitoneal collection of fluid, which can lead to urinothorax. We report a patient with solitary kidney who underwent extracorporeal shock wave lithotripsy (ESWL) for nephrolithiasis. Four days after ESWL, she had right-sided pleural effusion which demonstrated as urinothorax. Urinoma occurring after ESWL, as in our case, is a situation that has not been reported before as a cause of urinothorax. Urinothorax should be taken into consideration in patients with pleural effusion who recently underwent ESWL. Copyright © 2002 S. Karger AG, Basel

A new scoring system to predict mortality in community-acquired pneumonia: CURB (S)-65

OBJECTIVE: The first decision to be made in the case of community-acquired pneumonia (CAP) is whether hospitalization of the patient is mandatory. In this study, we aimed to investigate whether the addition of oxygenation parameters to CURB-65 has diagnostic value in predicting mortality in CAP. PATIENTS AND METHODS: A total of 903 CAP patients were included in the study. Patients with a CURB-65 score of 0 and 1 were classified as Group 1 and patients with a CURB-65 score of 2 or more were classified as Group 2. The prediction of mortality through Pneumonia Severity Index (PSI), CURB-65 and CURBS-65/CURBP- 65 with the addition of SaO(2) and PaO2 values; hence the four different models, was compared among all patient groups. RESULTS: As a result, 3.3% of the cases in Group 1 and 12.7% of the cases in Group 2 died. In both CURB-65 groups, it was noted that the frequency of patients with SaO(2) 90% was significantly higher in the dead group than in the alive patient group (p= 0.009 and p= 0.001, respectively). In the univariate analysis, PaO260, and SaO(2)90 were significantly associated with mortality. Model 2 (CURBS-65) and Model 3 (CURBP-65) were examined, SaO(2) 90 (OR 2.08) was found to have an effect on death. In predicting mortality by the receiver operating characteristics (ROC) analysis, it was understood that the CURBS-65 score had a slightly higher area under the curve (AUC) value than CURB-65. CONCLUSIONS: As a result, it has been shown that the use of CURBS-65 scoring instead of CURB-65 clinical scoring may be more useful in predicting mortality

Assessment of relation between subjecti{dotless}ve memory complai{dotless}nts and objective cognitive performance of elderly over 55 years old age [Elli beş yaş üstü popülasyonda subjektif bellek yaki{dotless}nmasi{dotless} ile objektif kognitif performans arasi{dotless}ndaki i·lişkinin belirlenmesi]

Introduction: This study investigated the frequency of forgetfulness in elderly individuals over 55 years of age and examined the association of subjective memory complaints (SMCs) with objective cognitive functions, depression and other risk factors. Met hods: We recruited 405 patients over 55 years of age who were referred to Neurology, Cardiology, or Physical Therapy and Rehabilitation outpatient clinics. All subjects were questioned regarding forgetfulness and then were administered the Subjective Memory Complaint (SMC) Scale, Mini Mental Test (MMT), Verbal Fluency Test (VFT), Clock Drawing Test (CDT) and the Geriatric Depression Scale (GDS). Subjects with SMC were compared with those without SMC in terms of cognition, depression and some laboratory parameters. re sults: Of the patients, 42.5% complained of forgetfulness. None of these patients had been admitted to hospital for this complaint. Women and patients with low education had more forgetfulness as well as poorer results on the SMC Scale, MMT, VFT, and GDS. Patients with SMC had lower hemoglobin, ferritin and free T4 levels. Female gender and depression was found to be a risk factor for SMCs. conc lu si on: SMCs are common in people over 55 years of age. Being a woman as well as depression was found to be a risk factor for SMC. Since depression is a treatable condition, these people should be assessed carefully in terms of depressive symptoms. Laboratory parameters, such as hemoglobin, ferritin and free T4 levels should be investigated in patients with SMC. Unlike the other cognitive tests, CDT performance is independent of subjective memory complaints. Elderly patients rarely visit hospital with complaint of SMC, therefore, clinicians should be watchful for this problem. © Archives of Neuropsychiatry, published by Galenos Publishing

Is there any relationship between pulmonary function tests and post-transplant complications of allogeneic hematopoetic stem cell transplantation?

PubMedID: 22653099Aim. Pulmonary function tests (PFT) have an important role in the assessment of pulmonary and nonpulmonary complications of hematopoetic stem cell transplantation (HSCT). In this study the relationship between PFTs and DLCOadj values and the complications of HSCT was investigated. The possible role of iron overload in the deterioration of the PFTs after HSCT was also searched. Methods. One hundred and fifty one patients who had undergone allogeneic HSCT between years 2003 through 2008, and had the records of PFTs prior to and at 1, 3, 6, 9 and 12 months after transplantation were included in the study. Prospectively collected data of these patients were analysed retrospectively. Results. Although no significant difference was identified in other PFT parameters, a significant decrease in DLCOadj was determined after 1st and 3rd months of HSCT. A significant correlation was found between pretransplant DLCOadj value 600 ng/mL were the independent risk factors for pretransplant DLCOadj <%70 (OR: 0.970, %95 CI: 0.941-0.999 and OR: 2.355, %95 CI: 1.058-5.241 respectively). Conclusion. Although a significant correlation exists between pretransplant DLCOadj values and post-transplant SOS development, pretransplant DLCOadj was not an independent predictor of SOS. Increased serum ferritin levels were common both for pretransplant DLCO decrease and post-transplant SOS development. Iron induced endothelial damage may be the common pathophysiologic mechanism causing lung and liver vulnerability, and DLCOadj may be a non-invasive method of demonstrating this vulnerability