Predictive factors for Alzheimer’s disease progression: a comprehensive retrospective analysis of 3,553 cases with 211 months follow-up

BackgroundThere is conflicting data regarding the predictors of Alzheimer’s Disease (AD), the most common form of dementia. The main objective of the study is to evaluate potential predictors of AD progression using a comprehensive follow-up dataset that includes functional/cognitive assessments, clinical and neuropsychiatric evaluations, and neuroimaging biomarkers such as hippocampal atrophy or white matter intensities (WMIs).MethodA total of 161 AD cases were recruited from a dementia database consisting of individuals who consulted the Dementia Outpatient Clinic of the Neurology Department at Mersin University Medical Faculty between 2000 and 2022, under the supervision of the same senior author have at least 3 full evaluation follow-up visit including functional, clinical, biochemical, neuropsychological, and radiological screening. Data were exported and analyzed by experts accordingly.ResultsMean follow-up duration of study sample was 71.66 ± 41.98, min 15 to max 211 months. The results showed a fast and slow progressive subgroup of our AD cases with a high sensitivity (Entropy = 0.836), with a close relationship with several cofactors and the level of disability upon admittance. Hippocampal atrophy and WMIs grading via Fazekas were found to be underestimated predictors of AD progression, and functional capacity upon admittance was also among the main stakeholders.ConclusionThe study highlights the importance of evaluating multiple potential predictors for AD progression, including functional capacity upon admittance, hippocampal atrophy, and WMIs grading via Fazekas. Our findings provide insight into the complexity of AD progression and may contribute to the development of effective strategies for managing and treating AD

Clinical and electrophysiological correlation of patients with chronic renal failure: The contributions of quantitative neurological scores

Neuropathy is the most common neurological consequence of uremia and has the scarce symptoms and definition. Therefore the sensitivity/specificity of clinical scores the neuropathy symptom score (NSS) and the neuropathy disability score (NDS) were evaluated for uremic neuropathy in the present study. 38 hemodialysis patients (23 males, 15 females) and 15 age-sex matched healthy subjects were enrolled. Neurological interrogation and examination of the subjects has been performed before neurophysiological examinations. After the usual 2 days interval in dialysis, electrophysiological studies (EPS) have been performed. Before the EPS, blood samples has been taken before a midweek dialysis; hemoglobin, Hct, and albumin concentrations were measured. The Kt/V value was taken as the average of previous 12 sessions Kt/V values. The mean NSS was 1.66 ± 2.2, mean NDS was 5.02 ± 6.9 in the patient group. According to EPS, 25 patients (65.8%) were diagnosed as having neuropathy [Np (+)] and 13 (34.2%) were normal [Np (-)]. The mean values of median, sural nerve sensory, common peroneal and posterior tibial nerve motor conduction velocities were lower in the patient group compared to controls. Np (+) patients was older than that of Np (-) subjects (50.1 ± 13.8 versus 36 ± 13.6; p = 0.006). Age was the only significant predictor of neuropathy (OR = 1.08, 95% CI, 1.017 to 1.150; p = 0.013). Logistic regression analysis revealed that both NSS (OR = 2.651, 95% CI, 1.1 to 6.4; p = 0.03) and NDS (OR = 1.26, 95% CI, 1.001 to 1.6; p = 0.049) were significantly associated with increased risk of neuropathy. The current study showed that both NSS and NDS are sensitive and specific in the diagnosis of uremic neuropathy and could be used at least as a first step before turn towards the elecrophysiologic studies

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 (<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

The crises and impact of crises an accomadation enterprises: The case of Konya

Yüksek Lisans TeziBeklenilmeyen durumlarda ortaya çıkan ve mevcut durumları tehdit eden krizler, hem turizm sektörünü hem de birçok sektörü olumsuz yönde etkilemektedir. Özellikle talep unsuru doğrultusunda ilerleyen konaklama işletmelerinde, kriz dönemlerine daha dikkat edilmeli ve krizin etkisini en aza indirebilmek için gerekli kriz yönetimi uygulamaları yapılmalıdır. Çalışmanın amacı, krizler ve krizlerin konaklama işletmelerinin üzerinde etkilerinin incelenmesi ve bu etkiler doğrultusunda konaklama işletmelerinde nasıl önlemler alındığının yöneticiler tarafından değerlendirilmesidir. Çalışmanın evrenini, Konya ilinde faaliyet gösteren Turizm İşletme Belgeli ve Belediye Belgeli konaklama işletmeleri oluşturmaktadır. Çalışmanın örneklemini ise, Konya ilin merkez ilçeleri olan, Selçuklu, Meram ve Karatay ilçelerinde bulunan 3, 4 ve 5 yıldızlı konaklama işletmeleri oluşturmaktadır. Bu işletmelerde yönetici pozisyonunda görev alan kişilere nicel araştırma yöntemi olan anket tekniği ile sorular sorulmuş ve cevapları SPSS paket programı ile bilgisayar ortamına aktarılmıştır. Çalışma doğrultusunda konaklama işletmelerinde ne tür krizlerin meydana geldiği ve kriz dönemlerinin konaklama işletmelerini nasıl etkilediği incelenmiştir. Ayrıca çalışmada konaklama işletmelerinde kriz süresi ve kriz yönetimi konusu da ele alınarak uygulanan stratejilere yer verilmiştir.Crises that arise in unexpected situations and threaten the current situation adversely affect both the tourism sector and many other sectors. Particularly in accommodation establishments that progress in line with the demand element, more attention should be paid to crisis periods and necessary crisis management practices should be implemented in order to minimize the impact of the crisis. The aim of this study is to investigate the effects of crises and crises on accommodation establishments and to evaluate how these measures are taken in the accommodation establishments by managers. The population of the study consists of accommodation enterprises with Tourism Operation Certificate and Municipality Certificate operating in Konya. The sample of the study consists of 3, 4 and 5 star accommodation establishments in the central districts of Konya, Selcuklu, Meram and Karatay districts. Questionnaires, which are the quantitative research method, were asked to the people in the managerial positions in these enterprises and their answers were transferred to the computer with SPSS package program. In line with this study, what kind of crises occurred in accommodation establishments and how crisis periods affected accommodation establishments were examined. In addition, the duration of the crisis in crisis management and crisis management issues are also discussed and the strategies implemented

Acil servislerde çalışan hemşireler tarafından adli vakaların tanımlanması

Acil servisler, kriminal veya kişiler arası şiddet kullanımı olaylarında kurban ve faillerin sıkça başvurduğu birimlerdir. Bu nedenle, acil servis hemşirelerinin adli kanıtları tespit etme, toplama ve muhafaza etmesi konularındaki rolü önem kazanmaktadır. Bu çalışma, acil servislerde çalışan hemşirelerin karşılaştıkları adli olguların tanılanmasına yönelik uygulamaları ve mevcut durumun değerlendirilmesi amacıyla yapılmıştır. Çalışma, 01.08.2005-01.03.2006 tarihleri arasında acil servislerde çalışan 35 hemşire ve hekim tarafından doldurulan 69 adli raporun incelenmesiyle gerçekleştirilmiştir. Veri toplama aracı olarak literatür bilgisine dayalı hazırlanan 2 farklı anket formu ve semt karakolundaki adli raporlar kullanılmıştır. Yaş ortalaması 27,4±3,0 olan hemşirelerin, %57,1’i lisans mezunudur. Hemşirelerin %97.1’si acil servislerde çalışmaya başlamadan önce adli tıp eğitimi almamıştır. %77,2’si adli hemşireliğin tanımını bilmemektedir. Yine hemşirelerin %57,1’i adli olguları değerlendirmediklerini ifade etmiştir. Sonuç olarak; hemşirelerin adli kanıtların toplanması, saklanması, ilgili mercilere ulaştırılması ve adli olguların değerlendirilmesi konularında uygulama eksikliklerinin olduğu, düzenlenen adli raporların hiçbirinde kadın ve çocuğa yönelik istismar olgusunun olmadığı, hemşirelerin ifadeleriyle adli rapor bilgilerinin genellikle uyuşmadığı, bu sonuçların hemşirelerin adli hemşirelik konusundaki bilgi eksiklerinden, konuyla ilgili standart protokollerin bulunmamasından, hekim ve hemşirelerin ekip anlayışı içerisinde çalışmamasından ve bu konulardaki yasal düzenlemelerden haberdar olmamalarından kaynaklandığı kanatine varılmıştır. SUMMARY DIAGNOSING OF FORENSİC CASES BY THE NURSES WORKING IN EMERGENCY SERVICES Emergency services are the units which victims and offenders often apply in the events of criminal or using interpersonal violence. Therefore, the role of the nurses in emergency services in determining, collecting and keeping the legal evidences has become important. This study has been performed in order to evaluate the applications concerned with diagnosing forensic facts the nurses working in emergency services come across and the existing situation. This study was carried out with analysing 69 forensic reports filled by 35 nurses and doctors working in emergency services between the dates of 01.08.2005 and 01.03.2006. As a data collecting tool, 2 different forms of questionaires based on literature and legal reports in local police station were used. The nurses whose average age is 27,4±3,0 are university graduates. %97.1 of the nurses did not have forensic medicine training before working in emergency services. %77,2 of the nurses do not know the definition of forensic nursing. %57,1 of the nurses have expressed that they do not evaluate the forensic facts. Consequently, it is concluded that the nurses have the lack of application in collecting, keeping, delivering the forensic evidences to the relevant authority and evaluating the forensic facts; none of the forensic facts composed does not have exploitation fact aimed at women and children; the statements of the nurses and the information of the forensic reports generally do not comply with each other; these results are caused by the lack of information of the nurses about forensic nursing, not having standard protocols relating to the subject, nurses and doctors not working in the understanding of team work and not knowing the forensic regulations about the this subject

Changes in Antibiotic Susceptibilities of the Most Frequently Used Empirical Therapies for Nosocomial Uropathogenic Escherichia coli Strains Over Time

Introduction: The aim of this study was to investigate the resistance of Escherichia coli isolates to the most frequently used antibiotics in empirical therapy of urinary tract infections. Materials and Methods: E. coli species were isolated from urine samples using standard isolation and identification procedures between January 2006-December 2008. The antibiotic susceptibilities were determined by disk diffusion tests according to the Clinical and Laboratory Standards Institute (CLSI) criteria. The most frequently used antibiotics for empirical therapy -ciprofloxacin, ceftriaxone, gentamicin, amikacin, trimethoprim-sulfamethoxazole and nitrofurantoin- were investigated for susceptibility and resistance patterns. Results: Five hundred ninety-eight E. coli isolates were investigated in this study. The resistance rates to ciprofloxacin and ceftriaxone were found to increase when compared to 2006 (p= 0.007, p= 0.002 and p< 0.001, p= 0.014, respectively), while increases in the resistance to the other antibiotics were not significant. E. coli isolates were mostly sensitive to amikacin, followed by nitrofurantoin. Conclusion: Each institution should assess resistance profiles with respect to the frequently isolated microorganisms at the related center

Frequency and Risk Factors of Endocrine Complications in Turkish Children and Adolescents with Sickle Cell Anemia

Objective: To define frequency and risk factors of abnormalities in growth, puberty, thyroid function, and bone and carbohydrate metabolisms in children and adolescents with sickle cell disease (SCD). Materials and Methods: Endocrine problems including short stature, puberty and thyroid disorders, and carbohydrate and bone metabolisms in 50 Turkish children and adolescents with SCD were evaluated. Relationships among sex, disease type, blood transfusions, exchange and exacerbation frequency, ferritin levels, and endocrine pathologies were investigated. Results: The mean age of the study group was 13.1±2.9 years. Weights and heights of 12 participants (24%) were below -2 standard deviations and 4 participants (8%) had malnutrition. Mean difference (±standard deviation) between bone and chronological age of patients was -1.73±1.86 years. Fifty percent of patients had at least one endocrine abnormality other than vitamin D deficiency and insufficiency. Hypergonadotropic hypogonadism in 3 patients (6%), hypogonadotropic hypogonadism in 1 female patient (2%), and small testicular volume in respect to age in 3 male patients (8.5%) were seen. Growth hormone deficiency was detected in 1 (2%) female patient, and hypothyroidism was diagnosed in 3 patients (6%; 1 central case, 2 cases of primary hypothyroidism). At vertebral level, 5 patients (11.1%) had osteopenia and 1 patient (2.2%) had osteoporosis, while 5 patients (11.1%) had osteopenia at femur neck level. The most common endocrine abnormality was vitamin D deficiency. 25-Hydroxyvitamin D was deficient in 63.2% and insufficient in 18.4% of patients. Sex, disease type, blood transfusion frequency, exacerbation frequency, and ferritin levels were not related to endocrine pathologies. As the age was increased, standard deviation scores of femur neck bone mineral density was decreased (r =-0.56; p<0.05). Vitamin D was lower in patients whose weights and/or heights were below -2 standard deviations from the mean (p<0.05). Conclusion: Endocrine organ dysfunctions are commonly detected in children and adolescents with SCD, and vitamin D deficiency is the most commonly encountered endocrine disorder. Regular follow- ups of patients for endocrine complications, starting from early ages of patients, and initiation of appropriate treatments will elongate expectancy and quality of life

Sınıflamada Daha Güçlü Bir Yaklaşım Olan Boosting Ağacı: Karpal Tunel Sendromu Uygulaması

Amaç: Boosting ağaç yöntemi topluluk birleştirme yöntemlerinden en başarılı olanıdır. Birleştirme algoritmalarının temel amacı, zayıf sınıflayıcıların kombinasyonundan tahmin hatası düşük güçlü sınıflayıcılar oluşturmaktır. Gereç ve Yöntemler: Bu çalışmada Karpal Tunel Sendromu vakaları boosting metodunu kullanılarak sınıflanmıştır. Mersin Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalının Elektrofizyoloji Laboratuvarına 2006-2010 tarihleri arasında Karpal Tünel Sendromu (KTS) ön tanısı ile başvuru yapan bireyler çalışmaya alınmıştır. Boosting Tree uygulaması Statistica 7.0 paket programında yapılmıştır. Bulgular: Test verisi kullanıldığında ise modelin genel doğru sınıflama başarısı %87.67 olarak hesaplanmıştır. Test verisi kullanıldığında son modelin sensitivite ve spesifitesi ise sırasıyla %85.65 ve %92.36 olarak hesaplanmıştır. Sonuç: Kullanılan modelin KTS tanısının konulmasında başarılı bir yöntem olarak kullanılabilir.Aim: The Boosting Tree, one of the most successful combining methods. The principal aim of these combining algorithms is to obtain strong classifier with small estimation error from the combination of weak classifiers. Material and Methods: We used boosting method to classify patients with Carpal Tunnel Syndrome. The individuals, who applied to Mersin University's Medical School's Neurology Main Scientific Branch's Electrophysiology Laboratory between the years of 2006 and 2010, with a pre-diagnosis of Carpal Tunnel Syndrome (CTS) were included in the study. Boosting Tree application was conducted in Statistica 7.0 software package. Results: General success of the model in accurate classification according to the test data was found as 87.67%. Sensitivity and specificity of the latest model, when the test data were used, were calculated respectively as 85.65% and 92.36% . Conclusion: The model can be used in CTS diagnosis as a successful method