İNMEDE BEYİN ÖDEMİ VE KAFA İÇİ BASINÇ ARTIŞI: TÜRK BEYİN DAMAR HASTALIKLARI DERNEĞİ UZMAN GÖRÜŞÜ

Beyin ödemi inmeden sonra sık karşılaşılan bir sorundur. İntrakranial basınç artışı serebral perfüzyonu bozarak veserebral herniasyona yol açarak mortalite ve morbiditeyi artırır. İnme hastası takip eden nörologların, hangi inmedensonra beyin ödemi gelişeceğini kestirebilmesi, beyin ödemi gelişmemesi için önlemler alabilmesi, gelişirse intrakranialbasınç artışı ve serebral herniasyonu klinik ve radyolojik olarak tanıyabilmesi, ve önlenemezse beyin ödemi veintrakranial basınç artışını hızlı ve etkin şekilde tedavi edebilmesi gerekir. Bu uzman görüşü Türk Beyin DamarHastalıkları Derneği bünyesinde aktif olarak çalışan 60 uzmanın ortak görüşü ile hazırlanmış bir klinik rehberniteliğindedir

Normal pressure hydrocephalus in a patient presented with gait disturbance

Yürüyüş bozukluğunun santral nedenler arasında diğer önemli nedeni olan normal basınç hidrosefali hastalarda olduğu gibi ventriküler genişlemedir. Bu çalışmamızda 63 yaşında acil servise yürüme güçlülüğü ile başvuran görüntüleme tetkiklerinde ventiküler genişlemenin olduğu normal basınçlı hidrosefali olgusu sunmak istiyoruz. 63 yaşında kadın hasta yürüyeme güçlüğü ve baş ağrısı şikayeti ile acil servise başvurdu. Nörolojik muayenesinde alt ekstrmiteler bilateral parezik (1/5-1/5). Hastanın kognitif etkilenmesi de mevcuttu. İdrar kaçırması şikayeti eşlik ediyordu. Hastanın diğer sistem muayenesi doğaldı. Çekilen BT’sinde ventikülerde belirgin gelişme ve hidrosefaliye sekonder parankim alanlarının inceldiği tespit edildi. Çekilen hastanın torakal ve servikal MRG'si normal olarak yorumlandı. Serebral MRG’da hidrosefali tespit edilmesi üzerine nöroloji kliniğine konsülte edildi ve nöroloji tarafından normal basınçlı hidrosefali olarak yatırıldı. Hastaya beyin cerrahisi tarafından ventriküloperitoneal şant takıldı. Hastanın yürüme güçlüğünde belirgin değişiklik olmadı, ancak ajitasyonları, konuşma bozukluğunda düzelme görüldü. Hasta yaklaşık 3 hafta takip ve tedavinin sonunda önerilerle nöroloji polikliniğine gelmek üzere taburcu edildi. Yürüyememe veya yürüme güçlüğü ile acil servise başvuran özellikle yaşlı hastalarda altta yatan sekonder santral patoloji (kafa travması, stroke vb.) olmadığı durumda normal basınçlı hidrosefali akla getirilmeli ve buna göre ileri görüntüleme tetkikleri ve tedavileri planlanmalıdır.Another important neurological cause among the central causes of gait impairment is ventricular dilatation as in patients with normal pressure hydrocephalus. In this study, we would like to present a 63-year-old patient with normal pressure hydrocephalus presented to emergency department with gait disturbance and whose imaging studies showed ventricular dilatation. A 63-year-old woman was admitted to the emergency department with a complaint of gait disturbance and headache. In her neurologic examination, lower extremities exhibited bilateral paresis (1/5-1/5). The complaint of urinary incontinence was accompanying. The other system examination of the patient was natural. Significant dilatation in the ventricles and thinning of parenchymal areas secondary to hydrocephalus were observed on CT performed. Patient’s thoracic and cervical MRI images were interpreted as normal. Upon hydrocephalus was detected in cerebral MRI, consultation was carried out with neurology clinic and the patient was admitted as normal pressure hydrocephalus by the neurology department. Ventriculoperitoneal shunt was attached to the patient by neurosurgery department. There was no significant change in the patient's gait disturbance, but there was improvements in her agitations and speech impairment. The patient was discharged at the end of follow-up and treatment processes for 3 weeks with recommendation as to come to the neurology

Obstructive Sleep Apnea Syndrome, Periodic Limb Movements and Related Factors

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) is characterized by nocturnal repetitive apnea episodes. Periodic limb movements (PLMs) is nocturnal, stereotypic, repetitive movements of the lower extremities. The aim of this study was to investigate the presence of periodic limb movements in OSAS patients and correlation of PLM with OSAS severity. METHODS: One hundred and forty one OSAS suspected patients was enrolled into the study. All subjects’ blood pressure, heart rate measurements and neurologic examinations were made by the same neurologist. Sociodemographic characteristics were recorded. One night polysomnography (PSG) was performed to all patients and results were analyzed. Apnea Hypopnea Index (AHI) ≥ 5 subjects were accepted as OSAS, and PLM Index (PLMI) ≥ 5 subjects were accepted as having PLM. RESULTS: One hundred and two patients were diagnosed as OSAS. The control group consisted of 39 patients who had normal polysomnographic findings. OSAS patients’ were older and body mass index (BMI) were higher than the control group. Systolic blood pressure was higher in OSAS group. Alcohol use was determined as a risk factor for OSAS. PLM were more common in OSAS group than the control group (% 30,3 - % 10,2). PLM frequency was associated with the severity of OSAS. CONCLUSION: In OSAS patients presence of PLM was related with OSAS severity, higher systolic and diastolic blood pressure and REM sleep depletion. PLM in OSAS patients could be regarded as an indicator of disease severity and also could aware clinician for increased complication rates

Sonographically Guided Corticosteroid Injection for Treatment of Plantar Fasciosis

Objectives-The purpose of this study was to prospectively investigate the effect of sonographically guided corticosteroid injection on the clinical and radiologic responses in patients with proximal plantar fasciosis. Methods-Thirty-one consecutive patients with unilateral plantar fasciosis were enrolled. A 4-cm 21-gauge needle was positioned in a caudocranial oblique manner, and the needle was withdrawn to the near edge of the fascia so that the solution dispersed around the edge. Two milliliters (20 mg/mL) of lignocaine/prilocaine, 1%, and 0.5 mL (20 mg) of methylprednisolone acetate solutions were injected separately. The plantar fascia and fat pad thickness, fascial echogenicity, and perifascial edema were assessed with a 10-5 MHz linear array transducer. The American Orthopedic Foot and Ankle Society midfoot scale was used to assess function, alignment, and pain. The initial radiologic and clinical measurements were compared with data obtained not less than 6 weeks after the injections. Results-A statistically significant decrease in the mean plantar fascia thickness was detected after treatment (P .1). Plantar fascia rupture was detected in 1 patient. Conclusions-Sonographically guided corticosteroid injection enables real-time imaging of the plantar fascia during needle insertion. A caudocranial oblique injection beneath the fascia may have an incremental value in the treatment response in patients with plantar fasciosis

A study of polymer-derived erbia-doped Bi2O3 nanocrystalline ceramic powders

In this study, erbia (Er2O3)-doped Bi2O3 ceramics were prepared from sol-gel derived nanocrystalline powders. The morphological properties were investigated by scanning electron microscopy. X-ray diffraction (XRD) analysis was carried out in order to characterize the phase and crystal structure of the powder samples. Temperature dependent electrical properties were determined by thermogravimetry/differential thermal analyzer (TG/DTA) and 4-point probe techniques. The stable fluorite face centered cubic delta-type phase was observed at room temperature from the XRD result, which was supported by the DTA and temperature dependent electrical conductivity measurements. Electrical conductivity results indicate that there is a transition approximately at 650 A degrees C, which can be attributed to an order-disorder transition (ODT). The activation energy values obtained from the Arrhenius approach for heating and cooling process were presented. Two regimes, corresponding to high temperature region (HTR) and low temperature region (LTR), were observed. As a result of morphological changes during the ODT, the electrical conductivity modifies and the activation energies are different for studied sample at HTR and LTR

Hemoglobin A(1C) can differentiate subjects with GCK mutations among patients suspected to have MODY.

Objectives The aim of this study is to determine the clinical and molecular characteristics enabling differential diagnosis in a group of Turkish children clinically diagnosed with MODY and identify the cut-off value of HbA(1c), which can distinguish patients with GCK variants from young-onset type 1 and type 2 diabetes. Methods The study included 49 patients from 48 unrelated families who were admitted between 2018 and 2020 with a clinical diagnosis of MODY. Clinical and laboratory characteristics of the patients at the time of the diagnosis were obtained from hospital records. Variant analysis of ten MODY genes was performed using targeted next-generation sequencing (NGS) panel and the variants were classified according to American Collage of Medical Genetics and Genomics (ACMG) Standards and Guidelines recommendations. Results A total of 14 (28%) pathogenic/likely pathogenic variants were detected among 49 patients. 11 variants in GCK and 3 variants in HNF1A genes were found. We identified four novel variants in GCK gene. Using ROC analysis, we found that best cut-off value of HbA(1c) at the time of diagnosis for predicting the subjects with a GCK variant among patients suspected to have MODY was 6.95% (sensitivity 90%, specificity 86%, AUC 0.89 [95% CI: 0.783-1]). Most of the cases without GCK variant (33/38 [86%]) had an HbA(1c) value above this cutoff value. We found that among participants suspected of having MODY, family history, HbA(1c) at the time of diagnosis, and not using insulin therapy were the most differentiating variables of patients with GCK variants. Conclusions Family history, HbA(1c) at the time of diagnosis, and not receiving insulin therapy were found to be the most distinguishing variables of patients with GCK variants among subjects suspected to have MODY

Effects of Climate Change on the Habitat Suitability and Distribution of Endemic Freshwater Fish Species in Semi-Arid Central Anatolian Ecoregion in Türkiye

Climate change is affecting freshwater ecosystems globally, particularly those in semi-arid and arid regions. The Central Anatolian Ecoregion (CAE) in Türkiye has a semi-arid climate and is home to numerous endemic fish species. We used species distribution modelling to elucidate the distribution of sixteen endemic fish species in CAE and predicted their potential distributions for 2041–2060 and 2081–2100 based on the CMIP6 climate model. Half of the species are predicted to experience a significant loss of climatically suitable areas. Anatolichthys fontinalis, Gobio gymnostethus, Gobio hettitorum, and Pseudophoxinus burduricus will face a complete loss of suitable areas by 2081–2100 under a high emissions climate scenario, whereas Cobitis bilseli, Egirdira nigra, Gobio intermedius, and Squalius anatolicus will experience a significant loss. The other eight species can potentially benefit from climate warming if all other stressors remain equal. Anthropogenic stressors, such as water abstraction for irrigation, pollution, invasive species introductions, and dam construction, are already putting endemic fish populations in CAE under extreme pressure. Climate change is expected to exacerbate these threats. Regular monitoring of freshwater ecosystems and fish fauna in the CAE and protecting the region from key anthropogenic stressors are recommended to successfully conserve these endemic freshwater fishes under climate change

Increased Water Abstraction and Climate Change Have Substantial Effect on Morphometry, Salinity, and Biotic Communities in Lakes: Examples from the Semi-Arid Burdur Basin (Turkey)

Global warming and altered precipitation patterns are predicted to intensify the water loss in semi-arid and arid regions, and such regions in Turkey will be particularly affected. Moreover, water abstraction, not least for irrigation purposes, is expected to increase markedly, posing major threats to the water balance of the lakes and thus their biodiversity. Among the closed basins in Turkey, the Burdur Closed Basin (BCB), located in the southwest of Turkey, is expected to be most affected. The BCB includes several types of aquatic ecosystems which support high biodiversity, including one Ramsar site, six Important Bird Areas, and a considerable richness of native and endemic fish species. Therefore, it is essential to analyze the potential environmental impacts of climate change and increased water abstraction on BCB lakes and their biotic communities. Here, we combined historical data on ecosystems as well as meteorological, remote sensing, and ground-truth data to analyze the changes in the temperature and precipitation of the BCB, water surface areas, and land use, as well as the potential effects on waterbird and fish communities. We calculated the water budget to elucidate water availability in the basin over the last few decades and predicted future conditions based on rainfall and temperature forecasts using climate models. The Standardized Precipitation–Evapotranspiration Index (SPEI) was used to relate the water surface area to precipitation and temperature change in the basin. Crop-farming irrigation in the BCB has increased notably since 2004, leading to intensive water abstraction from the lakes and their inflows, as well as from ground water, to meet the increased demand for irrigation. The water abstraction from the lakes, inflows to the lakes, and the groundwater in the basin has increased the water loss in the catchment substantially. Remotely sensed data on lake surface areas showed a major shrinkage of shallow lakes in the last 40 years. Moreover, the largest lake in the basin, Lake Burdur, lost nearly half of its surface area, which is worrisome since the shallower areas are the most suitable for supporting high biodiversity. Climate models (CNRM-ESM2-1GCM for temperature and GFDL-ESM4-GCM for precipitation) suggest that from 2070, the BCB will face long-term, moderate-to-severe dry periods. This, and the increased demand for water for irrigation, along with climate change, may accelerate the drying of these lakes in the near future with devastating effects on the lake ecosystems and their biodiversity