Comparison of the harmonic scalpel with scissors in women who experience obturator nerve injury during lymph node dissection for gynaecological malignancies

Objectives: Lymphadenectomy is crucial for accurate staging in most gynecological malignancies. Serious complications can occur during the surgery. The present study aimed to present the early and late findings associated with obturator nerve injury, which is rarely observed during lymphadenectomy but can result in serious sequela if not noticed. Material and methods: The files of the patients who underwent lymphadenectomy at our clinic between 2012 and 2018 were examined. Patients with obturator nerve incisions were identified retrospectively. Results: In total, 287 women patients underwent lymphadenectomy at our clinic between 2012 and 2018. Examination of surgical notes revealed that nine patients underwent obturator nerve incisions using a scissor or a harmonic scalpel (energy- activated ultrasonic scissors). With respect to management of obturator nerve damage, no significant difference was found between the use of a harmonic scalpel and scissors (p < 1.000) and the trendelenburg and lithotomy positions (p < 0.167). In addition, no significant difference was found between laparoscopy and laparotomy in terms of surgical type (p < 0.167). At 6 months post-operatively, sensory-motor examinations and EMG findings of the patients were completely normal. Conclusions: Surgeries performed for gynaecological malignancies have high mortality and morbidity rates. Moreover, in the event of a complication such as nerve damage during laparoscopy, successful management of the complication before the patient undergoes laparotomy allows the patient to continue benefitting from the advantages of the laparoscopy. The results of our study show that these high-risk surgeries should be performed in advanced and well-equipped medical centres by teams experienced in gynaecological oncology

Effect of Online Learning During the COVID-19 Pandemic on Tension-Type Headache, and Anxiety Among Medical Students

Aim:Screen exposure can lead to numerous health problems, such as headaches, in students. This study aimed to investigate the impact of online learning on tension-type headache (TTH) and its association with anxiety among medical students who attended online classes during the novel coronavirus disease-2019 pandemic.Methods:This cross-sectional study was conducted between June 1 and 15, 2021, among preclinical medical students at the Ataturk University Faculty of Medicine in Erzurum. The data were collected via an online survey. Sociodemographic features and characteristics of online classes and headaches were collected. Anxiety levels were measured using the generalized anxiety disorder test-7 (GAD-7) scale. Questions for the preliminary diagnosis of TTH were prepared based on the International Classification of Headache Disorder Diagnosis.Results:The mean age of the participants was 20.6±3.0 years, and 52.2% (n=297) were women. Tension-type headaches affected 323 (56.8%) students, while 246 (43.2%) had no headaches. In addition, 41.3% (n=135) of the participants with TTH reported experiencing headaches after online classes, and 47.1% (n=154) of those with TTH stated that their headache intensity increased after online classes. The mean GAD-7 score was 11.2±5.2 among the participants with TTH, compared to 8.7±5.2 among those with no headache (p<0.01). Significant differences were observed between the groups in terms of daily screen time (p=0.019), GAD-7 score (p<0.001), and gender (p<0.001).Conclusion:The study findings indicate that TTH is common in medical students during online learning. Efforts should be made to educate students on screen use, and stress reduction programs should be included in the curriculum

Effectiveness of Acupuncture in The Treatment of Migraine

Aim:Migraine is an important cause of disability characterized by recurrent headache, frequently affecting the young productive population. It decreases quality of life in association with frequency of acute attack. pharmacological or non-pharmacogical therapies are used in the treatment. The aim of this study was to asses effectiveness of acupuncture as a non-pharmacogical therapy in patients with migraine.Materials and Methods:35 patients diagnosed as having migraine (mean age, 38.9±11.0 years) were included in the study. The acupuncture was performed one session in a week, lasting 30 minutes, sum of 10 session. Visual analog scale (VAS) pain score, MIDAS (Migraine Disability Assessment Scale), SF-36 (Short Form-36), BDI (Beck Depression Inventory), and count of intake medication for acute pain relief was assessed at the baseline and 3rd months.Results:VAS pain scores decreased significantly at 3rd months after acupuncture treatment (4.4±1.3) compared to baseline (8.2±1.3) (p=0.005). In addition, count of intake medications for acute pain relief was significantly decreased (before treatment, 8.7±6.4; after treatment 2.1±1.7; p 0.001). The significant improvement for MIDAS and BDI scores were found after the treatment (for both p 0.001). Significant increase was shown in SF-36 parameters (p 0.05). No severe adverse effect was detected.Conclusion:Acupuncture may have positive effects on pain, count of intake medication, disability, depression and quality of life in migraine. Acupuncture as an effective modality with low side effect profile may be considered among nonpharmacogical options in the treatment of migraine

Impact of Neuropathic Pain on Health-Related Quality of Life and Disability in Patients with Chronic Low Back Pain

Objective:Low back pain (LBP) is the most common chronic pain disorder worldwide. Chronic LBP is a mixed pain syndrome associated with nociceptive and neuropathic pain mechanisms. Investigation and early treatment of neuropathic pain is important in the management of chronic LBP. The aim of this study is to investigate the frequency of neuropathic pain and determine its impact on health-related quality of life and disability in patients with chronic LBP.Materials and Methods:A total of 120 patients with chronic LBP participated in the study. The presence of neuropathic pain was assessed using Leeds Assessment of Neuropathic Symptoms and Signs pain scale. 10-cm visual analogue scale (VAS) pain score, Oswestry Disability index (ODI) and short form-36 (SF-36) measurements were performed. Predictors for the presence of neuropathic pain were also investigated.Results:Neuropathic pain was detected in 49 (40.8%) of the patients with chronic LBP. ODI score and VAS pain score in patients with neuropathic pain were higher than that in those without neuropathic pain (p<0.001 and p=0.035, respectively). Physical function, body pain, general health and physical component subscales of SF-36 were lower in patients with neuropathic pain (p=0.043, p<0.001, p=0.012, p<0.001, respectively). Advanced age and radicular LBP were found as predictors for neuropathic pain (p=0.016 and p<0.001, respectively).Conclusion:The presence of neuropathic pain in chronic LBP was found relevant with poor health-related quality of life and disability. Advanced age and presence of radicular pain were associated with neuropathic involvement

Are functional assessment questionnaires related with hand function tests in patients with nerve injury at the level of wrist and in patients with tendon injury/fracture at the level of fingers?

Objective: We aimed to research the relationship between functional assessment questionnaires answered by patients and hand function tests in patients with injury on level of wrists or fingers. Materials and Methods: Demographic characteristics of 43 patients with nerve injury at the level of wrists (median/ulnar) (LW group) and patients with fracture or tendon injury at the level of fingers (LF group) were recorded. Functional level detected by examination was evaluated according to the Seddon classification in LW group, and according to Buck-Gramco scores in LF group. The Sollerman Hand Function Test (SHFT) was administered to all patients, and the Quick-DASH (Q-DASH) and Duruöz Hand Index (DHI) were completed by all patients. Hand grip strength was expressed as a percentage of that of the uninjured hand. Results: There was no difference in mean age and distribution of gender between the groups (p=0.429, p=0.229). Three (14.3%) patients had excellent, 10 (47.6%) good, 6 (28.6%) moderate, and 2 (9.5%) patients had poor results according to the Seddon classification in LW group. 1 (4.5%) patient had excellent, 9 (40.9%) good, 4 (18.2%) poor, and 8 (36.4%) patients had bad results according to the Buck-Gramko scores in LF group. In LW and LF groups, SHFT sores were 72.3±16.8, 76.1±5.6, Q-DASH 27.9±19.4, 19.6±15.2, DHI 19.3±21.2, 11.3±10.6, respectively and the injured hand grip strength was 65.4±29.9, 72.5±25.8. The SHFT significantly correlated with the Q-DASH and DHI in both LW and LF groups (p<0.05). The SHFT significantly correlated with the Seddon classification (r=0.449) and grip strength (r=0.585) in LW group. While there was no significant correlation between SHFT and Buck-Gramco, there was a significant correlation between SHFT and grip strength (r=0.463) in LF-group. Conclusion: It was observed that hand function tests had correlations with the functional-questionnaires answered by patients both in patients with nerve injury at the level of wrist and in patients with fracture/ tendon injury at the level of finger. © Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing

Influence of the gut microbiome on IgE and non-IgE-mediated food allergies

Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI) -- MAY 26-30, 2018 -- Munich, GERMANYWOS: 000441690400204Background: The prevalence of food allergy (FA) in children has been increasing in last decade. Recent studies show changes in gut microbiome with FA. However, whether gut microbiome may differ between IgE and non‐IgE‐mediated FA is not defined. The aim of this study is to examine the intestinal microbiome composition in infants with IgE and non‐IgE‐mediated FA and healthy infants. Method: Infants younger than 1‐year‐old, breastfed and diagnosed with FA by a physician were included in the study. DNA was isolated from stool samples of infants with non‐IgE‐mediated FA (n = 25) and IgE‐mediated FA (n = 11) and healthy infants (n = 7). Whole genome shotgun sequencing was applied to identify the composition of microbial DNA (an average depth of 3.1 ± 0.8 million paired end reads and 0.9 ± 0.2 gigabase pairs). Results: There were compositional differences among 3 different groups. Shannon index was significantly higher in IgE‐mediated FA compared to non‐IgE‐mediated FA group (Kruskal‐Wallis test, P = 0.034). Even though β‐diversity was similar, the Sparse Partial Least Square Discriminant Analysis (sPLS‐DA) demonstrated that there were taxa‐level differences among three groups. In species level, Veillonella parvula was in a significantly higher density in healthy infants compared to IgE and non‐IgE‐mediated FA groups. Rahnella aquatilis and Lactobacillus salivarius were significantly lower and Treponema succinifaciens significantly higher in IgE‐mediated FA group compared to other groups. Additionally, Prevotella sp. oral taxon 299 was significantly lower in non‐IgE‐mediated FA group compared to others. Prevotella sp oral taxon 299 was related to mucus in stool whereas urticaria related species were Olsenall uli, Bactreoides thetaiotaomicron, Klebsiella variiocola, Rahnella aquatilis, Treponema succinfaciens, Ethanoligenens harbinenese. Conclusion: Analysis of microbiome differences in FA patients may aid in the understanding of the disease process. The present data suggest that there are compositional variations mostly in species‐ level among infants with FA and healthy ones. Our results suggest that the gut microbiome has a stronger relationship to IgE‐mediated than non‐IgE‐mediated FA. Further functional analysis of the microbiome may help better understand the changes seen in the gut microbiome in FAs and improve our knowledge in the disease etiopathology.European Academy of Allergy and Clinical Immunolog

Vaccination in Individuals with Multiple Sclerosis – Part I

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions should be made by considering the disease process and the drugs used by the patient. Since vaccination can be performed at every stage of life, from childhood to adulthood, immune system activity, except where it is characteristic of the vaccine, should be reviewed in patients with MS. In this review, the applications of different vaccines in individuals with MS are discussed in two separate sections

Collective Guilt Antecedets Outcomes and Ways of Avoding

Bu makalenin amacı gruplar arası ilişkiler bağlamında diğer gruba zarar verme sonucunda bireylerin grup üyeliklerine bağlı olarak hissedebilecekleri kolektif suçluluk duyma ve bu duygudan kaçınmak için kullanılan stratejileri kapsayan çalışmaları derleyerek alana tanıtmaktır. Bu kapsamda öncelikle kolektif suçluluk duyma kavramı tanımlanmaktadır. Bu tanımlamada kolektif suçluluk duymaya alternatif olarak kullanılan bazı psikolojik süreçlere değinilmekte ve kolektif suçluluğun kişisel suçluluk ve kolektif utançtan farklılıkları sunulmaktadır. Daha sonra dünyada kolektif suçluluğun görülüp görülemeyeceği ele alınmakta ve araştırmacılar tarafından bu duyguyu oluşturabileceği öne sürülen sosyal psikolojik unsurlar üzerinde durulmaktadır. Bu unsurlar zarar veren grubun bir üyesi olarak kendini sınıflandırma; verilen zararda iç grubun sorumluluğu olduğunu kabul etme; zarar verici hareketlerin uygunsuz olduğunu algılama ve zararın düzeltilmesinde iç grubun ödemesi gereken bedel miktarı olarak sıralanmaktadır. Belirtilen unsurlara bağlı olarak ortaya çıkan kolektif suçluluk ve bu suçluluğu takip edebilecek çıktıların neler olduğu hakkında yürütülen araştırma bulguları paylaşılmaktadır. Son olarak, genel bir sonuç ve öneriler bölümü sunulmaktadır.The aim of this article is to present the studies that illustrate collective guilt- a common phenomenon observed in the context of intergroup relations as a consequence of harming another group and stems from sharing group membership with the harm-doers. First of all, collective guilt is defined. In this description some psychological processes used as alternatives for collective guilt are mentioned and differences of collective guilt from personel guilt and collective shame are presented. Then, whether collective guilt can be experienced on the world stage is discussed and four social psychological factors that are asserted by researchers to generate collective guilt are elaborated. These factors are self categorization as a member of a group that has harmed another group, accepting one’s group to be responsible for the harm done to another group, perceiving the damaging behaviours done by ingroup as illegitimate and the cost of making reperations in terms of ingroup. Findings related to collective guilt experienced depending on mentioned four main factors and consequences of feeling collective guilt are shared. Finally, a general conclusion and future directions are presented

Venöz Sinüs Trombozu ile Prezente olan Nörobehçet: Olgu Sunumu

Behçet hastalığı etiyolojisi bilinmeyen, multisistem tutulumlu enflamatuar bir hastalıktır. Santral sinir sistemi (SSS) tutulumu nadir olmakla birlikte bazen diğer sistem tutulumlarından önce olabilir. SSS tutulumu vakaların %5-15’inde görülmektedir. Erken teşhis ve tedavi, sekelleri önlemek açısından önemlidir. SSS tutulumu, Behçet hastalığı tanısı için gerekli kriterleri taşıyan, ancak henüz tanı almamış vakalarda hastaneye ilk başvuru nedeni olabilir. Bu yazıda, şiddetli baş ağrısı ve çift görme nedeniyle hastaneye başvuran ve tetkiklerinde serebral venöz sinüs trombozu tesbit edilip etiyolojide Behçet hastalığı çıkan nörobehçet olgumuzu sunduk. Venöz sinüs trombozunda etiyolojik neden tedaviyi şekillendirdiği ve hastamız Behçet hastalığıdan önce nörobehçet tanısı aldığı için sunmaya değer bulduk

Collective Guilt: Antecedets, Outcomes, and Ways of Avoding

The aim of this article is to present the studies that illustrate collective guilt- a common phenomenon observed in the context of intergroup relations as a consequence of harming another group and stems from sharing group membership with the harm-doers. First of all, collective guilt is defined. In this description some psychological processes used as alternatives for collective guilt are mentioned and differences of collective guilt from personel guilt and collective shame are presented. Then, whether collective guilt can be experienced on the world stage is discussed and four social psychological factors that are asserted by researchers to generate collective guilt are elaborated. These factors are self categorization as a member of a group that has harmed another group, accepting one’s group to be responsible for the harm done to another group, perceiving the damaging behaviours done by ingroup as illegitimate and the cost of making reperations in terms of ingroup. Findings related to collective guilt experienced depending on mentioned four main factors and consequences of feeling collective guilt are shared. Finally, a common conclusion and future directions are presented