Role of long-term vestibular rehabilitation in a patient with posterior fossa tumor: A case report with 2 years of follow-up

Objective: Unusual clinical courseBackground: Lhermitte-Duclos disease (LDD) is caused by a rare slow-growing mass in the cerebellum. LDD generally is experienced by young adults, but also it has been encountered in the pediatric population. Lhermitte and Duclos first described cerebellar dysplastic gangliocytoma in 1920. The first case they described included occipital headache, paroxysmal vertigo, falls, hearing problems, and memory deficits. Our patient had typical symptoms of the disorder such as headache, nausea, vomiting, blurred vision, and imbalance. The purpose of this case report was to describe the outcome of a computerized dynamic posturography (CDP) vestibular training program combined with home-based exercises designed to improve balance function and reduce the risk of falling by an individual with a posterior fossa tumor.Case Report: A 36-year-old male patient was diagnosed with dysplastic gangliocytoma/ganglioglioma according to magnetic resonance imaging, computed tomography, and pathology reports on March 28, 2016. The patient was treated by partial cerebellar tumor resection on April 7, 2016. After the operation, he reported severe imbalance, nausea, and vomiting for 1 month and visited the Audiology Department on October 20, 2016. The patient was evaluated with the CDP-sensory organization test (SOT) and his composite equilibrium score of this examination was 48, 31% below normal. We administered a 6-week posturography-assisted vestibular rehabilitation (VR) protocol (extending an hour per week) combined with a home-based exercise program twice in 2 years. In the second evaluation we applied in 2018, SOT composite equilibrium score increased to 72 after VR, reaching normal limits. After 2 years, his complaints slightly alleviated and his SOT scores were better when we compared the VR results in 2016.Conclusions: We demonstrated that long-term VR may affect a patient with dysplastic cerebellar gangliocytoma (LDD) presenting imbalance or dizziness

Physicochemical Analysis of Pomegranate Sours Produced by Traditional Method in Türkiye and The Investigation of Antioxidant Properties

In this study, the physicochemical properties and antioxidant activities of the commercially produced 15 pomegranate sour samples and one control sample were determined and their compliance with the TS 12720 (traditional sour pomegranate concentrate standard) was evaluated. Antioxidant activity values of pomegranate sours extracts were determined using 6 different methods. The samples had strong antioxidant capacity, except for N10 and N15. In addition, glucose, fructose, sucrose, HMF and acidity measurements of the same samples did not show compatibility with TS 12720. The pH values of the samples of N7, N8, N10, N11, N14 and N15 were not in accordance with the standard values (2.4-4.0) The titratable acidity values measured in samples of N1, N3, N4, N6, N10, N13, N15 were below the value ( gt;6.0% (m/m)) in the standard. While the brix values of the samples were measured between 59.20-75.70, the brix values of the N12, N13 and N14 samples were determined below the standard brix value ( gt;68%). The highest HMF value of the samples were determined as 8117.66. According to TSE 12720, the HMF content should be not exceed 50 mg/kg. However, the HMF values of the samples were detected above the maximum limit value except for N8 and N16

Investigation of the effects of narrowband and wideband noise on central inhibition in pure tone audiometry in individuals with hearing loss

Amaç: Bu çalışmada dar bant ve geniş bant gürültü kullanımının işitme kayıplı bireylerde santral inhibisyon değerlerine olan etkilerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: 37 kişiye öncelikli olarak otoskopik bakı, saf ses odyometrisi, konuşma odyometrisi ve timpanometrik değerlendirmeleri yapılarak işitme kaybının lokalizasyonu, tipi ve derecesi belirlenmiştir. Ardından katılımcıların saf ses işitme eşiklerindeki değişiklikler test edilmeyen kulağa sırasıyla gürültü verilmeden, dar bant ve geniş bant gürültü verilerek test edilmiştir. Bulgular: Sensörinöral işitme kayıplı olgularda 250, 500, 2000 ve 8000 Hz frekanslarında; iletim tipi işitme kayıplı olgularda ise 250,500 ve 1000 Hz frekanslarında geniş bant gürültü kullanımı, eşik kaymasını azaltarak eşiklerde istatistiksel olarak anlamlı değişikliğe neden olmuştur (p<0,05). Sonuç: Çalışmamızda iletim tipi ve sensörinöral tip işitme kayıplarında geniş bant gürültünün kullanımının eşik kaymasını azaltarak daha güvenilir eşik tayinine neden olduğu tespit edildi.Objective: This is a study which compares the effects of narrowband noise versus wideband noise on central inhibition values in individuals with hearing loss. Material and Methods: Thirty-seven subjects were primarily examined for otoscopic examination, pure tone audiometry, speech audiometry, and tympanometric evaluations; then demonstrated localization of hearing loss, type and degree of hearing loss. Similarly, pure tone thresholds were tested in three different conditions while applying narrowband and wideband noise as well as without any masking noise using contralateral route. Results: In cases with sensorineural hearing loss, at frequencies of 250, 500, 2000 and 8000 Hz; In cases with conductive hearing loss, the use of wideband noise at frequencies of 250,500 and 1000 Hz reduced the threshold shift, causing a statistically significant change in the thresholds (p<0.05). Conclusion: In our study, it was found that the use of wideband noise in conductive and sensorineural hearing losses decreased threshold shift and caused more reliable threshold determination

Preliminary Study: The Test Technique for the Evaluation on Spatial Navigation in the Absence of Visual Data in Healthy Individuals

Background and Aim: Path integration refers to the capability of utilizing self-motion information produced by one’s own bodily movements to accurately determine and maintain one’s position in space. Typically, path integration mechanisms come into play when visual information is limited or absent. The objective of this study was to develop a path integration test that relies solely on self-motion cues derived from body movements, without the involvement of visual cues. Methods: The study involved 157 volunteers (86 females and 71 males) aged between 18 and 70 years. Participants were asked to walk on a coordinated ground with their closed eyes and follow the six different commands. They were, after that, requested to return their initial position. Movement time was manually measured by the stopwatch. The distance between the original reference point and estimated starting point was recorded. Results: The second command that showed the lowest standard deviation out of the six commands given to the participants was observed as the more reliable test among the other commands (47.51±33.75). In addition, the completion time of the second command increased with increasing age (p<0.001). Conclusion: This study introduces an innovative spatial navigation approach utilizing the second command set. As an alternative, this command can be used to assess the human spatial navigation system

Sonography and Magnetic Resonance Imaging Characteristics of Testicular Adrenal Rest Tumors

Summary Background: The aim of this study was to describe the gray-scale and color Doppler ultrasonography (US) and magnetic resonance (MR) imaging features of testicular adrenal rest tumors (TART) in patients with congenital adrenal hyperplasia. Material/Methods Forty-one patients with congenital adrenal hyperplasia were evaluated by gray-scale and color Doppler ultrasonography. Totally eighteen adrenal rest tumors in 9 patients were diagnosed TART on US and MR imaging. Gray-scale and color Doppler US and MR findings of the patients were documented. Results: A total of eighteen masses were evaluated in nine patients. The mean age of these patients was 14.3±4.5 (range 10.1–23.3) years. US revealed hypoechoic lesions around the mediastinum testis with hypervascularity dispersing in ten patients and hypovascularity in two patients. In six patients, the lesions were hyperechoic with poor vascularity. Lesions exhibited homogeneous (n=8) and heterogeneous (n=10). Testicular microlithiasis was present in 4 of 9 patients with TART. Doppler ultrasound showed normal testicular vessels passing through the mass which were undisturbed, not displaced and not change in caliber. MRI features were the following: all lesions were hypointense on T2- and hyperintense (n=12) and isointense (n=6) on T1-weighted images. All masses revealed homogeneous contrast enhancement on postcontrast T1-weighted images. Conclusions: Ultrasonography and MRI are good methods for detecting and monitoring TART. US is the first preferable modality because it is quick and cheap than MRI. Bilateral mostly hypoechoic lesions depicted around the mediastinum testis with no mass effect is highly suggestive for the diagnosis of testicular adrenal rest tissues on ultrasonography. Normal testicular vessels coursing through the lesions undisturbed and not change in caliber is described specific for this kind of tumors

The research of the primary care clinic doctors’ awareness levels about the national hearing screening program

Amaç: Ulusal Yenidoğan İşitme Tarama Programı (UYİTP)nın sağlık sistemine entegrasyonu, hasta takiplerinin yapılabilmesi, ailelerin bilgilendirilmesi ve işitme kayıplı bebeklerin, uygun merkezlere sevklerinin sağlanması konusunda aile sağlığı merkezleri (ASM) anahtar pozisyondadır. Programın, amacına uygun ve en verimli şekilde yürütülebilmesi için burada çalışan doktorların UYİTP hakkında bilgi ve ilgi seviyeleri kritik bir öneme sahiptir. Bu merkezlerde çalışan doktorların UYİTP hakkındaki bilgileri, farkındalıkları ve konuyla ilgilenme seviyeleri hakkında bilgilerimiz sınırlıdır. Bu çalışmanın amacı, aile hekimlerinin UYİTP hakkında bilgi ve farkındalık seviyelerini tespit ederek, ihtiyaç duyulan alanlarda nasıl bilgilendirme yapılması gerektiğine dair veri toplamaktır. Gereç ve Yöntemler: Birinci basamak hekimler için 29 sorudan oluşan bir anket oluşturulmuştur. Çalışmaya, İstanbul ilindeki değişik ilçelerde ASM’lerde çalışan 129 hekim katılmıştır. Bu anket kapsamında UYİTP’nin amacı, işleyişi, kullanılan testler ve tedavi yöntemleri hakkında hekimlerin bilgi seviyelerinin ölçülmesi planlanmış ve UYİTP ile ilgili bilgilendirilmek isteyip istemedikleri sorgulanmıştır. Ayrıca UYİTP ile ilgili bilgilerin ailelere doğru şekilde aktarılabilmesi maksadıyla nasıl bir yöntem uygulanması gerektiği de değerlendirilmiş, alternatifler önerilmiştir. Yapılan istatistiksel testlerde anlamlılık seviyesi %5 (0,05) olarak alınmıştır. Bulgular: Yaptığımız çalışmada katılımcıların UYİTP hakkında genel bilgi seviyesinin düşük olduğu saptanmıştır. Anket sonuçlarına göre katılan hekimlerin %71,3 (92)’ü UYİTP hakkında, %76 (98)’sı test yöntemleri hakkında, %69 (89)’u işitme kayıplı bir çocuğun ailesinin bilgilendirilmesi ve yönlendirilmesi hakkında eğitim almak istediğini belirtmiştir. Katılımcıların %25,6 (33)’sı kendilerini değerlendirdiklerinde bilgilerinin yetersiz olduğunu belirtirken, %23,3 (30)’ü bilgilerini yeterli bulduğunu belirtmiştir. Bu 2 grup kendi arasında, tanı basamaklarını içeren sorulara (Soru 11, Soru 12, Soru 13, Soru 16) verdikleri cevaplara bakılarak kıyaslandığında, kendini yeterli görenler ve görmeyenler arasında istatistiksel olarak anlamlı bir fark bulunmamıştır (p=0,180, p=0,360, p=0,08, p=0,115). Sonuç: UYİTP alanında bir ekip anlayışı ile çalışılması gerekliliği ve ekip içerisinde yer alan tüm birimlerin, bilgi seviyelerinin en üst düzeye çekilmesinin önemi ortadadır. Buna bağlı olarak UYİTP’nin daha etkin ve verimli olabilmesi açısından çeşitli kanallar aracılığıyla bilgilendirme faaliyetlerinin yapılması ve artırılmasının uygun olacağı düşünülmektedir.Objective: Primary health care centers are in a central position to integrate National Neonatal Hearing Screening Program (NNHSP) into the health system. Physicians provide patient follow-up, inform families, and refer infants with hearing loss to the appropriate centers. We have minimal information about the knowledge, awareness, and interest levels of the physicians. This study aims to determine the knowledge and awareness levels of family physicians about NNHSP and to collect data on how to inform them in the areas needed. Material and Methods: A questionnaire consisting of 29 questions was prepared for primary care physicians. 129 physicians working in Primary Health Care Centers in different districts participated in the study. During this study, the physicians' knowledge levels about the objective, functioning, tests and treatment methods of the NNHSP were measured. In addition, possible methods regarding informing the families about NNHSP correctly has been proposed. The significance level used in the statistical tests was of 5% (0.05). Results: Our study found that the general level of knowledge of the participants about NNHSP was low. According to the results of the survey, 71.3% of the attending physicians (92 of them) wanted to be informed about NNHSP, 76% (98 of them) wanted to be informed about the test methods, while 69% (89 of them) wanted to be informed about the hearing impaired children and the orientation process. While 25.6% (33) of the participants stated that their knowledge was insufficient when they evaluated themselves, 23.3% (30) stated that they found their knowledge sufficient. When these two groups were compared by looking at their answers to the questions (questions 11, questions 12, questions 13, questions 16) including the diagnostic steps, no statistically significant difference was found between those who felt competent and those who did not (p=0.180, p=0.360, p=0.08, p=0.115). Conclusion: The necessity of working with a team spirit in NNHSP and the importance of maximizing the units' knowledge levels are obvious. Accordingly, it is considered appropriate to carry out and increase information activities through various channels for the UYITP to be more productive and efficient

Gastrointestinal quality of life in patients with asymptomatic cholelithiasis after laparoscopic cholecystectomy

To assess the outcome of laparoscopic cholecystectomy for asymptomatic cholelithiasis before and after laparoscopic cholecystectomy using a specific quality of life instrument for gastrointestinal disorders in adults : The Gastrointestinal Quality of Life Index (GIQLI) was used to study the quality of life in patients before and after laparoscopic cholecystectomy : Seventy one patients completed the GIQLI questionnaire both preoperatively and after a minimum postoperative follow-up of three months. Mean preoperative score was 126.8±14.07 out of a theoretical maximum score of 144.After three months, the score had significantly improved to 136.6±9.31, close to the range for the normal population. Not only items assessing gastrointestinal symptoms but also the domains of physical, social, and emotional function improved significantly. The most marked improvements were achieved in patients with the lowest preoperative scores. Laparoscopic cholecystectomy significantly improves the quality of life in patients with cholelithiasis who are asymptomatic or have nonspecific gastrointestinal symptoms that cannot be explained by another gastrointestinal pathology.Bu çalısmada asemptomatik kolelitiyazis olgularının ameliyat öncesi ve ameliyat sonrası hayat kalitesi degerlendirilmistir. Hastaların ameliyat öncesi ve sonrası hayat kalitelerinin ölçümü gastrointestinal hayat kalitesi indeksi parametreleri kullanılarak belirlenmistir. Çalısmaya alınan 71 hasta ameliyat öncesi ve ameliyattan en az 3 ay sonra gastrointestinal hayat kalitesi indeksine göre sorgulanmıstır. Preoperatif dönemde ortalama skor 126.8±14.07, 3 ay sonra yapılan sorgulamada ise ortalama 136.6±9.31 olup normal populasyona yakın bir oranda saptanmıstır. (toplam skor 144). Gastrointestinal semptomlarının yanı sıra fiziksel, sosyal ve duygusal durumlarında da anlamlı düzelme gözlenmistir.Düsük skorlu hastalarda bu iyilesmedaha belirgindir. Asemptomatik kolelitiyazisli hastalarda baska gastrointestinal patolojilerle açıklanamayan nonspesifik semptomların laparoskopik kolesistektomiyle iyilesme gösterdigi, hastaların hayat kalitelerinde anlamlı bir artıs oldugu görülmektedir

The Relationship Between Serum Asymmetric Dimethylarginine Levels and Cardiovascular Risk Factors in Children with Nephrotic Syndrome

Aim:Nephrotic syndrome is a common type of kidney disease during childhood characterized by proteinuria, edema and hypoalbuminemia. Serum asymmetric dimethylarginine (ADMA) inhibits vascular nitric oxide production and may be an independent risk factor for coronary heart disease. The aim of this study was to investigate the relationship between ADMA and atherosclerotic risk factors in children with nephrotic syndrome.Methods:Forty-one children with nephrotic syndrome and 33 healthy children were included in the study. Patients’ demographic and anthropometric characteristics, biochemical tests, serum homocysteine, ADMA and carotid intima-media thickness (CIMT) were assessed. The patients were divided into three groups: group 1 - steroid-free remission; group 2 - steroid-induced remission, still on steroid therapy; and group 3 - active proteinuria.Results:The patient and control groups were similar in terms of age, sex, weight, height, body mass index, and systolic blood pressure (p>0.05). Diastolic blood pressure was significantly higher in children with nephrosis than in controls. Serum ADMA, homocysteine and CIMT measurements were not different between the two groups (p>0.05). There was a positive correlation between diastolic blood pressure and CIMT measurement in patients. In group 3, ADMA was positively correlated with total cholesterol and low density lipoprotein cholesterol.Conclusion:Children with idiopathic nephrotic syndrome did not show signs of endothelial damage assessed by ADMA and CIMT

The efficacy of cinacalcet in the treatment of hyperparathyroidism in Turkish hemodialysis patient population

WOS: 000393291900012OBJECTIVE: Cinacalcet reduces parathyroid hormone levels by increasing the sensitivity of the parathyroid gland to calcium. in this study, we firstly aimed to evaluate the efficacy of cinacalcet in Turkish hemodialysis patients. MATERIAL and METHODS: 4483 hemodialysis patients were screened and 469 patients who had used cinacalcet were included in the study. the patients were divided into 4 groups according to drug usage durations (Group 1: 3 months, Group 2: 6 months, Group 3: 9 months and Group 4: 12 months). the patients' Parathormone, Ca, P and CaxP levels at the 3rd, 6th, 9th and 12th months were compared to the start of treatment and previous months. RESULTS: the levels of Parathormone, Ca, P and CaxP significantly decreased compared to their initial levels in all groups (from 1412 pg/ml to 1222 pg/mL for Parathormone, p< 0,001) in the 3rd month. However, this reduction was not continued in the subsequent months (Parathormone: 1381 pg/ml for the 12th month). CONCLUSION: Cinacalcet may not provide adequate benefit in control of hyperparathyroidism in Turkish hemodialysis patient population

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (&lt;4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs