Acute onset isolated abducens paralysis after exposure to arc welding

Exposure to welding is associated with many diseases, especially some of the eye injuries. We present a 49-year-old male patient applied to us with the complaints of double vision and blurred vision for a week. The symptoms started after looking welding machine light for a few minutes without protective glasses. After excluding another cause, the diagnosis of idiopathic abducens paralysis was made. As a result of exposure to metals and ultraviolet radiation, conjunctival disorders, presbyopia, refractive errors, corneal damage, and retinal pathologies can be seen in patients. It is also known that UV is a stress factor that will initiate reactions that lead to apoptosis of neurons. We think that exposure to UV rays may have played a role in the possible etiological process in our case. The patient was followed up with conservative treatment and all symptoms resolve within a month

Restless Legs Syndrome: From Diagnosis to Treatment

Restless legs syndrome (RLS) can be described by an urge to move limbs that typically coincides with an uncomfortable sensation. When at rest or inactivity, signs may start or develop worse; they usually go away when one moves or gets up for a walk. RLS can be both idiopathic or secondary to many kinds of health conditions, such as deficiency of iron, diabetes, obesity, hypothyroidism, and chronic renal failure. At the admission, secondary causes and iron tests, such as transferrin saturation and ferritin, must be evaluated. Assessments should be repeated when symptoms worsen, or when augmentation develops. Augmentation is a significant adverse effect of therapy by levodopa and dopamine agonists. More severe signs, early appearance of symptoms, and spreading of symptoms from the legs to other body parts are indicative of augmentation. Non-pharmacological treatments help some RLS patients control their symptoms. Iron-replacement therapy is a first-line treatment option for patients with indications of low body iron stores. The use of α2δ ligands as initial treatments instead of dopamine agonists has been recommended recently

A Case of Oxcarbazepine-Induced Severe Hyponatremia

Oxcarbazepine is a keto-analogue of carbamazepine. Hyponatremia seen in the patients treated with oxcarbazepine is usually asymptomatic and rarely severe which leads to drug withdrawal. Here we presented a 51-year old female patient with epilepsy under oxcarbazepine and valproate treatment, who presented to our outpatient neurology clinic with vertigo, nausea and vomitting after the usage of her antiepileptic drugs. Routine biochemistry evluations revealed a decresed serum sodium level with increased urine sodium and osmolarity levels. Renal ultrasonography was normal. The patient was pre-diagnosed as inappropriate antidiuretic hormone secretion syndrome. Three days after the oxcarbazepine withdrawal, serum and urine sodium levels were found to be normal

Identifying the care behavior perception of nursing students and the time they allocated to the direct care practices

Amaç: Araştırma, hemşirelik öğrencilerinin klinik uygulamalar sırasında doğrudan bakım uygulamalarına ayırdıkları zamanı ve öğrencilerin bakım davranışları algısını belirlemek amacıyla planlanmıştır. Yöntem: Araştırma tanımlayıcı tipte olup araştırmanın örneklemini bir vakıf üniversitesinin hemşirelik bölümünde öğrenim gören birinci sınıflar hariç toplam 80 öğrenci oluşturmuştur. Çalışmanın verileri “Klinik Uygulamada Hemşirelik Öğrencilerinin Aktivitelerini İzlem Formu” ve “Bakım Davranışları Ölçeği” ile toplanmıştır. Veriler gözlem yoluyla elde edilmiştir. Bulgular: Öğrencilerin klinikte bir uygulama gününde doğrudan bakım uygulamalarına harcadıkları süre; ikinci sınıflarda 138,8±57,0 dakika, üçüncü sınıflarda 105,6,7±40,3 dakika, dördüncü sınıflarda 99,8±60,1 dakika olarak belirlenmiştir, Bakım uygulamaları dışındaki faaliyetlere ikinci sınıfların 50,2±40,3, üçüncü sınıfların 6,1±15,6, dördüncü sınıfların 38,4±43,3 dakika harcadıkları belirlenmiştir. Sınıflara göre öğrencilerin doğrudan bakım ve diğer faaliyetlere harcadıkları süreler arasında istatistiksel olarak fark bulunmuştur (p<0,05). Öğrencilerinin Bakım Davranışları Ölçeği-24’ten aldıkları toplam puan ortalaması 5,14±0,59 puan olarak belirlenmiş, mesleği isteyerek seçen öğrencilerin puanları diğerlerine göre yüksek bulunmuştur. (p<0,05). Öğrencilerin bakım davranışları algıları olumlu olmasına rağmen, doğrudan bakım uygulamalarına ayırdıkları sürenin az olduğu belirlenmiştir. Sonuç: Öğrencilerin bakım kalitesi algılarının yüksek olmasına rağmen, doğrudan bakım uygulamalarına ayırdıkları sürenin az olduğu belirlenmiştir.Aim: The research was planned for the purpose of identifying the time allocated by nursing students to direct care practices during clinical practices and the students’ care behavior perceptions. Method: The research was conducted as a descriptive type and the sample of the research consisted of 80 students in total, excluding first-year students studying in the nursing department of a foundation university. The data of study were collected with “Inspection Form for Nursing Students’ Activities in Clinical Practices” and “Care Behaviors Scale”. Data were collected by observation. Results: The time allocated by the students to direct care practices during a practice day in clinic was identified as; 138,8±57,0 minutes on average in second graders, 105,6,7±40,3 minutes on average in third graders, and 99,8±60,1 minutes on average in fourth graders, It was identified that the second graders spend 50,2±40,3 minutes, the third graders spend 6,1±15,6 minutes, and the fourth graders spend 38,4±43,3 minutes for the practices other than care practices. It was statistically found a difference between the times allocated by the students to direct care and other practices with regard to grades (p<0,05). The total average score of the students in Care Behaviors Scale-24 was identified as 5,14±0,59, and the scores of the students who chose the profession voluntarily were found as higher than the other students. (p<0,05). Although the students' perceptions of care behaviors were positive, it was determined that the time they allocated to direct care practices was less. Conclusion: It was identified that although the care quality perception of the students are high, the time they allocated to direct care practices is low

How telemedicine can improve the quality of care for patients with alzheimer’s disease and related dementias? A narrative review

Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer’s disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population

İleri evre Parkinson hastalığında tedavi stratejileri: Literatürün gözden geçirilmesi

Parkinson hastalığı (PH), özellikle substansiya nigra pars kompakta bölgesindeki dopamine salgılayan hücreler olmak üzere bazal gangliayı etkileyen kronik, nörodejeneratif bir bozukluktur. Sıklıkla 50 yaş üzeri kişileri etkiler. Bununla birlikte daha genç başlangıç da bildirilmektedir. Bazal gangliada devam eden bir dopaminerjik hücre ölümü olduğundan, ileri dönemlerde ciddi özürlülüğe yol açabilen ilerleyici bir hastalıktır. PH' nın ileri dönemeleri, motor dalgalanmalar, yürüyüşte donmalar, diskinezi, postüral instabilite, düşmeler, otonomik tutulum, non-motor semptomlar nedeniyle hastalar için olduğu kadar klinisyenler için de zorlayıcıdır. Bu semptomatoloji, sıklıkla ileri evre PH olarak tanımlanan Hoehn and Yahr (H&Y) skalasında evre 4-5' e karşılık gelir. Bu derlemede ileri evre PH olan hastalarda tedavi seçenekleri tartışılmıştır.Parkinson's disease (PD) is a chronic, neurodegenerative disorder affecting basal ganglia, dopamine-secreting cells in the pars compacta region of the substantia nigra, in particular. It commonly affects people above the age of 50, however younger -onset has also been reported. Since there is an ongoing dopaminergic cell death in basal ganglia, it is a progressive disorder leading to severe disability in the late stages of the disease. The advanced stages of PD are the most challenging part of the disease for clinicians, as well as the patients' themselves due to the motor fluctuations, freezing of gait, dyskinesia, postural instability, falls, autonomic involvement, non-motor symptoms. This symptomatology corresponds to the stage of 4-5 on the Hoehn and Yahr (H&Y) scale, which is commonly defined as advanced PD. The treatment options in the patients with advanced PD are discussed in this review

Electrophysiological changes in iron deficiency anemia

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.YÖK Tez No: 242287Giriş: Demir eksikliği anemisi en sık rastlanan nütrisyonel problem olarakbilinmektedir. Demirin, beyin enerji metabolizması, nörotransmitter fonksiyonu vemiyelin formasyonunda önemli rol oynaması nedeniyle, demir eksikliği anemisinindavranışsal, gelişimsel ve kognitif bozukluklara yol açabileceği bildirilmektedir.Amaç: Çalışmamızda erişkin popülasyonda, demir eksikliği anemisinin periferiksinir sistemi üzerindeki etkilerinin elektrofizyolojik olarak araştırılması ve periferik sinirsitemi tutulumunu destekleyen olası elektrofizyolojik bozuklukların, bu bozuklukların,uygun doz ve sürede uygulanacak demir tedavisi sonrası geri dönüşümlü olupolmadığının incelenmesi amaçlanmıştır.Gereç ve Yöntemler: Yeni tanı almış DEA olan ve etyolojiye yönelik herhangi birtedavi almamış olan 52 hasta ve yaşları eşleştirilmiş sağlıklı kişilerden oluşan 30kişilik kontrol grubuna elektrofizyolojik inceleme yapılmıştır. Hastalara 3 ay boyuncaoral demir tedavisi uygulandıktan sonra elektrofizyolojik incelemeler tekrarlanmıştır.Bulgular: Hastaların 38 (%73.07)' inin normal elektrofizyolojik bulgulara sahipolduğu görülürken, 4 (%7.69)' ünde PNP, 10 (%19.24)' unda elektrofizyolojik olarakKTS bulguları olduğu görülmüştür. Üç aylık oral demir tedavisi sonrasında, buhastaların, 1 PNP hastası ile 1 KTS hastası dışında, tümünde elektrofizyolojikdeğerlerin normale döndüğü saptanmıştır.Sonuç: Yetişkin nüfusta saptanan DEA hastalarında, uygun doz ve sürede demirtedavisiyle düzelen nöropatik süreçlerin (PNP ve KTS) saptanması, demir eksikliğianmisinin periferik sinir sistemi tutulum bulgularına sebep olabileceğinidüşündürmektedir. Bununla birlikte, demir eksikliği anemisi ile periferik sinir sistemitutulumu arasındaki olası ilişkinin daha belirgin bir şekilde ortaya konabilmesi ve içindaha uzun süreli çalışmalara ihtiyaç vardır.Background: Iron deficiency anemia is known as the most common nutritionalproblem. Owing to the important role of iron in brain energy metabolism,neurotransmitter function and myelin formation, iron deficiency anemia may lead tobehavioral, developmental and cognitive dysfunctions.Objective: Our aim was to investigate the electrophysiological effects of irondeficiency anemia on peripheral nervous system, and to evaluate whether thepossible electrophysiological abnormalities are reversible with the appropriate dosesof iron therapy in appropriate durations, or not.Materials and Methods: Electrophysilogical evaluations were performed to 52patients with newly diagnosed iron deficiency anemia and 30 age-matched healthycontrols. Electrophysilogical evaluations were repeated after 3 months of oral irontherapy.Results: Normal electrophysiological findings were determined in 38 (73.07%) ofthe patients, while 4 (7.69%) patients had polyneuropathy and 10 (19.24%) hadcarpal tunnel syndrome findings, electrophysiologically. Except 1 patient withpolyneuropathy and 1 with carpal tunnel syndrome findings, electrophysiologicalfindings of all patients were found to turn into normal ranges after 3 months of oraliron therapy.Conclusions: The detection of iron responsive neuropathic processes (PNP andIDA) in adult iron deficiency anemia patients led us to think that IDA may causeperipheral nervous system involvement. Nevertheless, further studies with longerdurations are required to reveal the association between iron deficiency anemi andperipheral nervous system involvement

Hareket bozuklukları pratiğinde botulinum toksin polikliniğine bakış: Kişisel deneyim

Aim: Aim of this study is to determine socio-demographic and disease features of patients who underwent Botulinum toxin injections, and to present our clinical experience via documenting intervals of Botulinum toxin injections and effect-side effect profiles. Material and Methods: Socio-demographic features of patients and characteristic features of Botulinum toxin treatment were recorded. The diagnosis of the patients who underwent Botulinum toxin injections, disease durations and the onset of Botulinum toxin treatments were investigated. Possible side-effects were recorded. Results: Thirty-two patients (20 men, 12 women) with the diagnosis of various types of movement disorders were enrolled the study. Mean age of patients was 60.65±14.40 years (range= 22-83 years). Diagnosis of the patients who underwent Botulinum toxin injections were cervical dystonia, blepharospasm, clonic hemifacial spasm, focal hand dystonia/writer’s cramp, oromandibular dystonia, and dystonic tremor. All patients had repetitive Botulinum toxin injections. There were no remarkable adverse effects, other than mild temporary bruises in injection site in two patients with blepharospasm. Conclusion: Botulinum toxin is an important treatment option in patients with focal dystonia. Botulinum toxin as a neurotoxin of Clostridium botulinum bacteria, suppresses muscle contractions via inhibiting acetylcholine release to the synaptic gap. This reversible effect lasts three to four months due to the neuronal sprouting. It is important to share clinical experiences, data of Botulinum toxin outpatient clinics or clinics from the movement disorders perspective to increase awareness of Botulinum toxin effectivity in patients with movement disorders, focal dystonia particularly. © 2019, Duzce University Medical School. All rights reserved

Ergotamine tartrate in migraine attack and tolerance development

ÖZET Bilimsel zemin: Migren, nörolojik, otonomik ve gastrointestinal değişikliklerin çeşitli kombinasyonlarının eşlik ettiği primer epizodik bir baş ağrısı bozukluğudur..Bireyin yaşam kalitesinde ve sosyoekonomik düzeyinde düşüşe yol açan ciddi migren ataklarının akut tedavisinde nonsteroid antiinflamatuar ilaçlar, basit veya kombinasyon analjeziklerinin yetersiz kalması nedeniyle triptan, dihidroergotamin ve ergotamin gibi migren spesifik ajanlar önerilmektedir. Amaç: Bu çalışmanın amacı migren tanısı almış ve ergotamin tartarat kullanmış hastaların retrospektif olarak değerlendirilerek, ergotamin kullanımına bağlı görülebilecek olası yan etkilerin ve tolerans gelişiminin incelenmesidir. Gereç ve yöntemler: Fakültemiz baş ağrısı polikliniğinde IHS kriterlerine göre migren tanısı almış ve hayatlarının bir döneminde ergotamin tartarat kullanmış olan 205 hasta retrospektif olarak değerlendirilmiştir. Bu hastalarda ergotamin tartarat kullanımına bağlı tolerans gelişimi, aşırı kullanım ve yan etkiler incelenmiştir. Sonuçlar: Hastaların ortalama hastalık süreleri 10.835.02 yıl (3-30 yıl), ortalama ergotamin tartarat kullanım süreleri 2.461.29 yıldır (1-10 yıl). Hastaların 118'inde (%57.5) ortalama 1.961.04 (1-7) yılda tolerans geliştiği saptanmıştır. Bu hastaların 76'sının (%64.4) kullandıkları dozu artırırken, geri kalan 42' sinin (%35.6) ise ihtiyaç duymalarına rağmen kullandıkları dozu artırmadıkları görülmüştür. Doz artışına giden hastaların başlangıçta kullandıkları ortalama doz 5.922.12 (1-10) tablet iken, tolerans gelişimi sonrası kullandıkları ortalama doz 20.638.21 (8-30) tablet olarak bulunmuştur. Hastaların 87'si (%42.5), ortalama 1.961.10 yılda (1-5 yıl) yan etkiler nedeniyle, doz artışı yapmaksızın ergotamin tartarat kullanımını bırakmışlardır. Saptanan yan etkileri bulantı-kusma (%14.6), sedasyon (% 10.2), hipertansiyon (%6.3), miyalji (%4.8), miyokard infarktüsü (%2.9), diyare (%2.4) ve bradikardi (%1.3) olarak özetlemek mümkündür. İzlenimler: Migren tekrarlayan baş ağrısı atakları ile seyreden kronik bir hastalıktır. Atak tedavisi gereksinimi olan ve basit analjeziklere yanıt vermeyen hastalarda tedaviye direnç, rekürren baş ağrıları ve kronik günlük baş ağrısına dönüşüm daha sıktır. Bu tür potansiyel risk altında olan hastalarda atak tedavisi planlarken, sık kullanıma bağlı olarak tolerans gelişimi ve yan etki riskinin artabileceği göz önünde bulundurulmalıdır. Triptanların kullanımından önceki dönemlerde iyi bir tercih olan ergotaminlerin, özellikle sık hekim kontrolü olmayan hastalarda geri dönüşü zor karmaşık tablolara neden olabileceğini göz önünde bulundurmak önemlidir.ABSTRACT Use of Ergotamine Tartarate in Migraine Attack and Tolerance Development Background: Migraine is a primary headache disorder with accompanying combinations of neurological, autonomic and gastrointestinal manifestations. Migraine spesific agents such as triptans, dihydroergotamine and ergotamine are recommended in the acute treatment of severe migraine attacks that cause a decline in individual's quality of life and socioeconomic level, in which nonsteroid antiinflammatory drugs, simple or combination analgesics are insufficient. Objective: The aim of this study is to evaluate the patients with the diagnosis of migraine that used .ergotamine tartrate retrospectively, and to investigate the possible side-effects, tolerance development due to ergotamine tartrate. Material and Methods: Two hundred and five patients who attended to the headache polydinic of our faculty with the diagnosis of migraine due to IHS (International Headache Society) criteria who used ergotamine tartrate once in their lifetimes were evaluated retrospectively. Tolerance development, overuse and side-effects were investigated in these patients. &#8226; . Results: Mean illness duration of the patients was 10.83±5.02 years (3- 30 years) and the mean duration of ergotamine tartrate usage was 2.46±1.29 years (1-10 years). Ergotamine tartrate tolerance wasdetermined in the 118 (57.5%) of the patients at the mean duration of 1.96±1.04 years (1-7 years). Seventy six (64.4%) of these patients increased the ergotamine tartrate dosage, while the remaining 42 (35.6%) did not increased the dosage despite its necessity. The mean initial ergotamine tartrate dosage of the patients who increased the dosage was found to be 5.92±2.12(1-10) tablets, while the mean dosage was found to be 20.63±8.21 (8-30) tablets after tolerance development. Eighty seven (42.5%) of the patients withdrew ergotamine tartrate without dose increasement due to its side-effects, on an average of 1.96± 1.10 years (1 -5 years). It is possible to summarize the side-effects as nausea-vomiting (14.6%), sedation (10.2%), hypertension (6.3%), myalgia (4.8%), myocardial infarction (2.9%), diarrhea (2.4%) and bradycardia (1.3%). Conclusions: Migraine is a chronic disease coursing with recurrent headache attacks. Resistance to treatment, recurrent headaches and transformation to chronic daily headache is more frequent at the patients in need of attack treatment and unresponsive to simple analgesics. While planning the attack treatment of the patients under such potential risk, tolerance development and the increased risk of side-effects due to drug abuse has to be considered. It is important to consider that ergotamines which were a good.choice in the times prior to the usage of triptans, may lead to-complex, irreversible situations, particularly in the patients without frequent doctor control