İstanbul

Taha Toros Arşivi, Dosya No: 120-Saraylarİstanbul Kalkınma Ajansı (TR10/14/YEN/0033) İstanbul Development Agency (TR10/14/YEN/0033)Şehit Ali Paşa'nın Sarayıİstanbul Sevdas

Reversible Anorgasmia with Acetazolamide Treatment for Idiopathic Intracranial Hypertension

Dear Editor, Idiopathic intracranial hypertension (IHH) is a clinical disorder characterized by symptoms and signs of increased intracranial pressure without abnormal cerebrospinal fluid composition and structural parenchymal abnormalities (1,2). There is no related systemic disorder and its etiology is unknown yet. Patients usually present with headache, vomiting, visual loss, and diplopia. Bilateral papilledema is found in most cases as a neurological sign and acetazolamide is an effective drug for the treatment of IIH. Acetazolamide is a carbonic anhydrase inhibitor and has been used for many relatively common disorders such as congestive heart failure, some forms of epilepsy, glaucoma, IHH, and also for some rare diseases such as acute mountain sickness. Paresthesia, fatigue, taste alterations, vomiting, and polyuria are common side effects of the treatment with acetazolamide. Usually acetazolamide is well tolerated, and sometimes this treatment may be associated with anorgasmia and this effect is thought to be dose related. Organic impotence has been reported in glaucoma patient therapy with acetazolamide. In this paper, we report a case admitted to our hospital that developed anorgasmia during treatment with acetazolamide. The patient, a 25-year-old female was admitted to the neurology department of our university hospital due to presence of anorgasmia. Previously, the patient had applied to a center for headache, nausea and vomiting, and visual loss, which had persisted for the past three months. The patient was evaluated with brain magnetic resonance imaging, in addition to examination of the cerebrospinal fluid and the other possible reasons of headache. Other possible causes of bilateral papilledema were ruled out; therefore, she was diagnosed with IIH and was started with appropriate treatment at our center. The patient reported that she was taking acetazolamide for IIH treatment orally during the last 15 days with an onset dosage of 750 mg/day, increased to 1500 mg/day after the 7 th day of usage. She was not using antidepressants, antipsychotics, or any other medications. The patient reported that the anorgasmia appeared during the last 5 days of acetazolamide treatment (three days after the onset of 1500 mg/days dosage). Except for the bilateral papilledema and light visual loss, the physical, psychiatric, gynecological, and neurological examinations as well as the brain magnetic resonance imaging were normal. Routine blood and hormonal tests were also normal. When the acetazolamide was decreased to 1000 mg/day, the anorgasmia resolved within 7 days. Female orgasmic disorder is characterized by the persistent or recurrent delay in, or absence of orgasm following a normal sexual excitement phase. Anorgasmia is defined as failure to achieve orgasm (climax) during sexual intercourse. Anorgasmia has many causes, it is believed that approximately 90% of anorgasmia problems are related to psychological issues, and some cases may result from the use of certain drugs such as serotoninergic drugs including antidepressants (particularly selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors), antiepileptic, and antipsychotic drugs (3,4). The new onset of the patient' s complaints, the lack of any additional drug use, and the absence of previous similar complaints suggested that the present anorgasmia was due to acetazolamide. We believe that acetazolamide treatment produced a dose-related anorgasmia in our patient. To the best of our knowledge, no other case of acetazolamide induced reversible anorgasmia has been reported previously for a female patient. It is difficult to present the precise mechanism between acetazolamide and anorgasmia. Acetazolamide is an enzyme inhibitor that acts on carbonic anhydrase specifically and catalyzes the reversible reaction of hydration of carbon dioxide and dehydration of carbonic acid. Although the underlying neurochemical changes of anorgasmia are not fully understood, orgasm, in both sexes, is particularly controlled by noradrenergic activity. Serotonin and dopamine are also essentia

A Study of Cerebral Performance Categories Based on Initial Rhythm and Resuscitation Time Following In-Hospital Cardiac Arrest in a State Hospital in Turkey

Background: The cerebral performance category (CPC) score is widely used in research and quality assurance to assess neurologic outcome following cardiac arrest. However, little is known about the results of the CPC in Turkey. Objective: This study aimed to determine whether the CPC is associated with the initial rhythm and resuscitation time following resuscitation from in-hospital cardiac arrest. Methods: This study compared the CPCs (CPC 1-2 and CPC 3-4-5) of patients discharged from the hospital after surviving cardiopulmonary arrest (CPA) during a 2-year period between June 2013 and June 2015 (at discharge, and at 6th, 12th, 18th, and 24th months) based on the initial rhythm (asystole/pulseless electrical activity and ventricular fibrillation/pulseless ventricular tachycardia) and resuscitation time (0–14 min and 15–30 min) at the time of arrest. Results: No difference was found between CPC 1-2 and CPC 3-4-5 scores at discharge or at 6th, 12th, 18th, and 24th months in terms of the first rhythm and resuscitation time (P > 0.05). Conclusion: Patients discharged from the hospital following in-hospital cardiopulmonary resuscitation (CPR) were found to have no difference in 2-year CPC scores with respect to cardiac rhythms and resuscitation durations at the onset of resuscitation

Relation of inflammatory markers with both presence and severity of hyperemesis gravidarum

Objectives: The aim of our study is to determine the newly introduced systemic inflammation marker, neutrophil lymphocyte ratio (NLR) in hyperemesis gravidarum (HG) patients and to investigate the association between severity of the disease and NLR. Method: The study population consisted of 55 pregnant patients with HG and 50 pregnant women without complaints matched for gestational age as a control group. The HG patients were grouped as mild (n=16), moderate (n=19) and severe (n=20) according to Modified Pregnancy- Unique Quantification of Emesis and Nausea Scoring Index Questionnaire. Furthermore, hsCRP, neutrophils, lymphocytes, and NLR were evaluated with complete blood count. Results: The HG group had significantly higher NLR values compared to the control group (2.69±1.81 vs 1.97±1.34, p=0.004). HsCRP levels were significantly higher among HG patients compared to the control group (1.95±2.2 vs 0.56±0.30,

Multiple Skleroz’lu Hastalarda Üst Ekstremite Ataksisinin Bilgisayar Analizi İle Değerlendirilmesi

Objective: Neurological and neurophysiologic disorders such as Multiple Sclerosis (MS) and disorders with disabilities need to be evaluated thoroughly and thoroughly. In MS we developed a new test (Multiple Sclerosis Ataxia Test) (MSAT) to evaluate the upper extremity coordination problem. This test provides a computer-based evaluation platform to fully assess the severity of the upper extremity coordination problem. Method: (MSAT) was tested on 23 patients (MS) with 18 MS in EDSS groups with different (Expanded Disability Status Scale) MS disease. The amount of deviation of the following patient by the spiral line pen on the tablet is given as a percentage. Since the same practices were applied in healthy group, dominant and non dominant hand were compared in MS and healthy group. Results The Ataxia Ratio Scale (UAQ) was compared with the upper extremity kinetic functions section. Findings: No statistically significant correlation was found between EDSS and patients' dominant hand (right h and). (p>0.05). There was no significant correlation between ICAR variance and dominant and non-dominant hand (p>0.05). There was a statistically significant difference between the two groups in the analysis of right hand comparison of patients and healthy subjects (p<0.05). Conclusion: MSAT evaluates upper extremity ataxia more objectively and can give information about the functional status of the patient before and after treatment. This method may have the same transformative effect on clinical evaluation and research in MS, as does standardized computerized tests in the field of education, which have a clear potential to accelerate progress in clinical evaluation and research

Delirium in patients with acute ischemic stroke admitted to the non-intensive stroke unit: Incidence and association between clinical features and inflammatory markers

Background Stroke patients with development of delirium have unfavorable outcomes, higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Studies suggest that delirium is associated with abnormal immunological responses and a resultant increase in inflammatory markers. Objective Our aim was to determine whether there is an entity relationship between delirium, inflammation and acute ischemic stroke (AIS). Methods Sixty AIS patients admitted to the hospital were consecutively recruited. Delirium was diagnosed with the clinical assessment according to the Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of Interleukin-1 beta (IL-1 beta), Interleukin 18 (IL-18), Tumor Necrosis Factor-alpha (TNF-alpha), Brain-Derived Neurotrophic Factor (BDNF), and Neuron Specific Enolase (NSE) at admission. Results Eleven (18.3%) of 60 patients were diagnosed with delirium, and the majority (n=8, 72.7%) was the hypoactive type. Delirious and non-delirious patients had similar demographic and clinical features. Delirious patients had significantly higher lengths of hospital stay, National Institutes of Health Stroke Scale (NIHSS) at admission and discharge compared to non-delirious patients. In addition, there was no significant statistical difference between delirious and non-delirious patients with AIS in respect of levels of TNF-alpha, IL-1 beta, IL-18, BDNF and NSE. This study suggests that delirium is not scarce in patients with AIS admitted to the non-intensive stroke unit, and that delirium developing after AIS seems not to be associated with serum TNF-alpha, IL-1 beta, IL-18, BDNF and NSE but is associated with length of hospital stay and stroke severity

Does the presence of anhydramnios affect the duration of medical abortion?

Objectives: The aim of the study was to determine whether anhydramnios affected the duration of medical abortion in cases with various indications as compared to cases with normal amniotic fluid volume. Material and methods: Patients who were admitted to our clinic because of medical abortion between January 2010–December 2013 were included in this retrospective study. A total of 32 pregnant women with anhydramnios (study group) and 67 pregnant women with normal amniotic fluid volume but with fetal abnormality (control group) were included in the study. Patient age, gravidity, parity, gestational age, previous delivery route, and duration of the abortion were recorded. Results: Mean duration of the abortion in the study group was 71.93 ± 47.51 h as compared to 79.08 ± 52.62 h in the control group. There were no statistically significant differences between the two groups in terms of duration of the abortion (p = 0.516). Also, we found no statistically significant differences in duration of the abortion with regard to previous delivery route (p = 0.220). Conclusions: There were no statistically significant differences between the study group and controls in terms of duration of the abortion. In addition, neither parity nor previous delivery route affected the duration of the abortion