Evaluation of stroke risk factors and characteristics in the comorbidity of cancer

Aim: Stroke and cancer can be followed together and in the presence of cancer, there may be changes in classical stroke characteristics. The aim of this study was to determine the effect of cancer on stroke risk factors, radiological and clinical features. Materials and Methods: Patients who were hospitalized with the diagnosis of stroke between 2014-2020 were included in the study retrospectively. By examining the stroke and cancer characteristics of the patients; The differences in demographic findings, stroke risk factors, and radiological features of stroke between patients with and without cancer were examined. The anti-cancer treatments used and the characteristics of cancer were evaluated in stroke patients. Results: 281 stroke patients were evaluated and cancer was detected in 52 patients. There was no significant difference in terms of demographic characteristics of the patients. No significant difference was observed in stroke patients with cancer in terms of risk factors except smoking and alcohol use. Multiple ischemic lesions were more evident on magnetic resonance imaging (MRI) in stroke patients with cancer. The most common cancer was lung cancer. Conclusion: Stroke and cancer are increasingly common comorbidities. As the time between stroke and cancer development decreases, while the risk factors for cancer are more prominent, classical risk factors for stroke are observed less frequently

Re-evaluation of the symptoms of Hirayama disease through anatomical perspective

Hirayama disease is a rare disease of the anterior horn motor neuron caused by compression of the cervical spinal cord when the neck is flexed. Cervical myelopathy may accompany the disease. It is characterized by symmetrical or asymmetrical muscle weakness and atrophy of muscles innervated by lower cervical and upper thoracic motor neurons. We recorded two male cases of Hirayama disease between the ages of 15 and 21 based on magnetic resonance imaging (MRI) features obtained from the cervical neutral state and from the flexion position which appeared in the right upper extremity. Loss of strength and atrophy in the right upper extremities was existent in clinical findings of these patients. When MRI was taken in the flexion position, there were dilated veins as hypointense signal void on T2 weighted series in posterior epidural area. The contrast enhancement was seen on these veins. It was observed that the posterior dura was displaced anteriorly and the anterior subarachnoid space was narrow. In cases which show clinical findings such as atrophy and loss of strength, having normal MRI results obtained in the neutral position makes it difficult to diagnose Hirayama Disease. In case of a suspicion of Hirayama disease the diagnosis can be made more easily by MRI taken in the flexion position. These case reports aim to bring Hirayama disease to mind and optimize the management of affected individuals

Mezial temporal lob epilepsili olgularda wada testi ve ameliyat öncesi/amaliyat sonrası bellek ilişkisi

Objectives: To study the correlation between Wada memory test and neuropsychometric tests which were applied preoperatively to mesial temporal lobe epilepsy patients associated with hippocampal sclerosis (MTLE-HS) who had undergone selective amygdalohippocampectomy and find out the effects of early onset epileptic seizures on atypical memory dominance. Methods: Drug-resistant 27 patients (16 left, 11 right MTLE-HS) had video EEG, cranial MRI and Wada test preoperatively. Weschler visual subtest and verbal memory processing tests were applied to all patients before surgery and the first year after the operation. Results: The number of left hemisphere memory dominant patients was 6 (22.2%) and the number of atypical memory dominant patients was 21 (77.8%) according to the Wada test. There was a significant difference between the two groups when compared for epileptic seizure onset age; (p=0.042), and also a significant diffference when compared for HS (right/left) side (p=0.002). When we analyzed the correlation between preoperative and postoperative verbal and nonverbal tests and left memory Wada dominance; in verbal memory processing tests ‘delayed recall’ scores between groups were significant (p=0.042), on the other hand in patients with atypical memory dominance ‘total learning’ scores between groups were significant (p<0.001). Conclusion: As a result, we found that the earlier the onset of seizures, the more atypical the memory dominance (right or bilateral). The Wada test was effective for assessing verbal memory; on the other hand, it was inadequate for assessing visual memory dominance. If the scores of ‘delayed recall’ in verbal memory were high in the patients with typical verbal dominance and ‘total learning’ scores in the patients with atypical verbal dominance, the scores also tended to rise after the operation.Amaç: Selektif amigdalohippokampektomi yapılan hipokampal sklerozla ilişkili mesial temporal lob epilepsili (HS-MTLE) hastalarda ameliyat öncesi dönemde yapılan Wada testi ile nöropsikometrik testler arasındaki ilişkiyi inceleyerek erken yaşta başlayan epilepsi nöbetlerinin belleğin atipikleşmesi üzerindeki etkilerini araştırmak. Gereç ve Yöntem: Medikal tedaviye dirençli 27 hastaya (16 sol, 11 sağ HS-MTLE) cerrahi oncesi video EEG, kranial manyetik rezonans görüntüleme, Wada testi ile ameliyat öncesi ve sonrası birinci yılda Weschler görsel subtest ve sözel bellek süreçleri testleri uygulanmıştır. Bulgular: Wada bellek testinde sol hemisfer dominant bulunanlarn sayısı 6 (%22.2), atipik yerleşimli olanların sayısı 21 (%77.8) idi. Bellek dominansı sol ve atipik olanlarda nöbet başlama yaşı (p=0.042), ve HS (sağ/sol) tarafı açısından karşılaştırıldığında da anlamlı fark saptanmıştır (p=0.002). Yine sol bellek dominant olanlar ile ameliyat öncesi ve sonrası verbal ve nonverbal testler arasındaki korelasyona bakıldığında sözel bellek süreçleri testlerinden ‘gecikmeli hatırlama’ puanları arasında anlamlı ilişki bulunurken (r=0.829; p=0.042) atipik bellek dominansı olanlarda ‘toplam öğrenme’ puanları arasında anlamlı ilişki bulunmuştur (r=0.731; p<0.001). Sonuç: Nöbet başlama yaşı ne kadar düşükse bellek dominansı o kadar atipiktir (sağ veya bilateral). Wada testi sırasında yapılan bellek değerlendirmesi verbal belleği değerlendirmede etkili ancak görsel belleği değerlendirmede yetersizdir. Tipik bellek dominansı olanlarda ‘gecikmeli hatırlama’, atipik olanlarda ‘toplam öğrenme ’ puanları başlangıçta yüksek ise, ameliyat sonrası dönemde de yükselme göstermektedir

Use of the Modified Visual Magnetic Resonance Rating Scale in alzheimer’s disease and ıts correlation with cognitive decline

Amaç: Alzheimer hastalığı (AH) araştırmaları için daha ileri nörogörüntüleme teknikleri geliştirilmiş olsa da, yapısal manyetik rezonans görüntüleme (MRG) AH’nin klinik tanısında önemini korumaktadır. Birçok parametreyi değerlendiren kapsamlı görsel MRG derecelendirme ölçeklerinin, hastalığın kognitif ve davranışsal görünümleriyle ilişkisi yeterince araştırılmamıştır. Bu çalışmada, Modifiye Görsel Manyetik Rezonans Derecelendirme Skalası’nın (MGMRDS) 7 alt bölümünün, AH tanısı almış hastaların demografik, kognitif ve davranışsal verileri ile korelasyonunu değerlendirmek amaçlanmıştır. Gereç ve Yöntemler: Retrospektif çalışmamıza beyin MRG ve nöropsikometrik test (NPT) verileri olan, Ruhsal Bozuklukların Tanısal ve Sayımsal Elkitabı (DSM-IV-TR) ölçütleri ile Ulusal Nörolojik ve İletişimsel Bozukluklar ve İnme Enstitüsü & Alzheimer Hastalığı ve İlişkili Bozukluklar Derneği (NINCDS–ADRDA) kriterleri temelinde AH tanısı almış, 50 yaş ve üzeri toplam 42 hasta dahil edildi. Beyin MRG verileri, hasta yaş, cinsiyet ve tanı verilerine kör bir nöroradyolog tarafından MGMRDS kullanılarak değerlendirildi. MGMRDS verilerinin kognitif ve davranışsal test sonuçlarıyla korelasyonu incelendi. Bulgular: Hastaların %61,9’u kadın, yaş ortalaması 75,19±9,26 (53–92) yıl idi. Ortalama eğitim süresi 5,02±4,84 (0–15) yıl, ortalama hastalık süresi 4,52±2,94 yıldı. Ortalama Mini Mental Durum Testi skoru 18,51±5,43 (4–30) iken, ortalama Klinik Demans Derecelendirmesi (KDD) skoru 1,07±0,42 (0,5–2,0) idi. Sulkal atrofi puanları uzun süreli hatırlama ve yüz tanıma ile negatif korele idi; ventriküler atrofi skorları ise öğrenme puanları, meyve–insan ve yüz tanıma değişkenleri ile ters korelasyon gösterdi. Anlık hatırlama, öğrenme puanı, kendiliğinden hatırlama, meyve–insan ve KDD değişkenleri ile mediyal temporal atrofi değişkeni arasında anlamlı ilişki gözlendi. Tartışma ve Sonuç: Beyin MRG’ye dayalı görsel derecelendirme skalaları kullanmak, demans değerlendirmelerinde tanıyı doğrulayıcı, ucuz ve pratik bir yaklaşımdır. MGMRDS, kognitif (yürütücü işlevler, bellek, dikkat, dil) verilerle de anlamlı korelasyon göstermektedir. Bu ölçeği daha geniş hasta gruplarında değişik kognitif bozukluklarda değerlendirecek çalışmalar klinik açıdan faydalı olacaktır.Aim: Although more advanced neuroimaging techniques have been developed for research on Alzheimer’s disease (AD), structural magnetic resonance imaging (MRI) remains important in the clinical diagnosis of AD. The relationship between comprehensive MRI visual rating scales evaluating many parameters and cognitive and behavioral appearances of the disease has not been adequately investigated. In this study, we aimed to evaluate the correlation of the 7 subsections of the Modified Visual Magnetic Resonance Rating Scale (MVMRRS) with demographic, cognitive, and behavioral characteristics of patients diagnosed with AD. Materials and Methods: The retrospective study included a total of 42 patients aged 50 years and older whose brain MRI and neuropsychometric test results were available and who were diagnosed with AD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSMIV-TR) and of the National Institute of Neurological and Communicative Disorders and Stroke & the Alzheimer’s Disease and Related Disorders Association (NINCDS–ADRDA). By use of the Modified Visual Magnetic Resonance Rating Scale (MVMRRS), the brain MRI data were evaluated by a neuroradiologist blinded to the patient age, sex, and diagnosis data. Correlation of MVMRRS data with cognitive and behavioral test results was analyzed. Results: The mean patient age was 75.19±9.26 (53–92) years and 61.9% of all patients were female. The mean education level was 5.02±4.84 (0–15) years and the mean illness duration was 4.52±2.94 years. The mean Mini-Mental State Examination score was 18.51±5.43 (4–30) while the mean Clinical Dementia Rating (CDR) score was 1.07±0.42 (0.5–2.0). Sulcal atrophy scores were negatively correlated with longterm recall and facial recognition while ventricular atrophy scores were inversely correlated with the learning scores and fruit–human and facial recognition parameters. A significant relationship was observed between the immediate recall, learning score, spontaneous recall, fruit–human, and CDR variables and the medial temporal atrophy variable. Discussion and Conclusion: In dementia assessment, the use of MRI-based visual rating scales is an inexpensive and practical approach that also improves the diagnostic accuracy. Furthermore, the MVMRRS shows significant correlation with cognitive (executive functions, memory, attention, and language) data. Further studies to evaluate this scale in larger groups of patients with different patterns of cognitive impairment would be of clinical benefit

Propuesta de guía de implementación de un sistema de gestión de seguridad y salud en el trabajo basado en la norma INTE/ISO 45001:2018 para la empresa Corporación de Profesionales en Ingeniería S.A.

Proyecto de Graduación (Licenciatura en Ingeniería en Seguridad Laboral e Higiene Ambiental) Instituto Tecnológico de Costa Rica, Escuela de Ingeniería en Seguridad Laboral e Higiene Ambiental, 2019.The project was carried out in the company Corporación de Profesionales en Ingeniería S.A., dedicated to the construction sector. The objective was to develop a guide for the implementation of a Work Health and Safety Management System based on the INTE/ISO 45001: 2018 standard. For the development of the proposal, the current management of the company was initially analyzed through a review of documents, the application of the checklist based on NTP 308, a survey for managers and another for collaborators. Subsequently, the analysis of the organization's context, internal and external, is carried out through an analysis of PESTEL and finally the information is synthesized in a SWOT. Then an assessment of risks and opportunities is carried out by means of a non-participatory observation and the guidelines for the verification of conditions in the construction sector are applied in the projects to be subsequently evaluated through the risk evaluation matrix according to the standard INTE 31-06-07: 2011. After analyzing the tools, results were obtained such as the absence of a formal written commitment from management, the lack of documentation and the presence of important risks for workers in the activities they carry out. This is summarized in the current management of the company in health and safety has great opportunities for improvement and shows the need for immediate intervention measures to improve the situation, which leads to the implementation guide of a health and safety system in work to improve the working conditions of the organization.El proyecto se realizó en la empresa Corporación de Profesionales en Ingeniería S.A., dedicada al sector construcción. El objetivo fue desarrollar una guía de implementación de un Sistema de Gestión de Salud y Seguridad en el trabajo basada en la norma INTE/ISO 45001:2018. Para el desarrollo de la propuesta se analizó inicialmente la gestión actual de la empresa por medio de una revisión de documentos, la aplicación de la lista de verificación basada en la NTP 308, una encuesta para los gerentes y otra a los colaboradores. Posteriormente se realiza el análisis del contexto de la organización, interno y externo por medio de un análisis de PESTEL y por último se sintetiza la información en un FODA. Luego se realiza una evaluación de riesgos y oportunidades por medio de una observación no participativa y se aplica en los proyectos la guía de verificación de condiciones en el sector construcción para posteriormente ser valorados mediante la matriz de evaluación de riesgos según la norma INTE 31-06-07:2011. Tras el análisis de las herramientas se obtuvieron resultados como la ausencia de un compromiso formal por escrito de parte de la dirección, la inexistencia de documentación y la presencia de riesgos importantes para los trabajadores en las actividades que desarrollan. Esto se sintetiza en que la gestión actual de la empresa en salud y seguridad tiene grandes oportunidades de mejora y muestra la necesidad de medidas de intervención inmediatas para mejorar la situación, lo que conlleva a la guía de implementación de un sistema de salud y seguridad en el trabajo para mejorar las condiciones laborales de la organización

Metaproteogenomic analysis of saliva samples from Parkinson's disease patients with cognitive impairment

Cognitive impairment (CI) is very common in patients with Parkinson's Disease (PD) and progressively develops on a spectrum from mild cognitive impairment (PD-MCI) to full dementia (PDD). Identification of PD patients at risk of developing cognitive decline, therefore, is unmet need in the clinic to manage the disease. Previous studies reported that oral microbiota of PD patients was altered even at early stages and poor oral hygiene is associated with dementia. However, data from single modalities are often unable to explain complex chronic diseases in the brain and cannot reliably predict the risk of disease progression. Here, we performed integrative metaproteogenomic characterization of salivary microbiota and tested the hypothesis that biological molecules of saliva and saliva microbiota dynamically shift in association with the progression of cognitive decline and harbor discriminatory key signatures across the spectrum of CI in PD. We recruited a cohort of 115 participants in a multi-center study and employed multi-omics factor analysis (MOFA) to integrate amplicon sequencing and metaproteomic analysis to identify signature taxa and proteins in saliva. Our baseline analyses revealed contrasting interplay between the genus Neisseria and Lactobacillus and Ligilactobacillus genera across the spectrum of CI. The group specific signature profiles enabled us to identify bacterial genera and protein groups associated with CI stages in PD. Our study describes compositional dynamics of saliva across the spectrum of CI in PD and paves the way for developing non-invasive biomarker strategies to predict the risk of CI progression in PD.FEMS Research and Training Gran

Neuroborreliosis

Lyme hastalığı, Borrelia burgdorferi’nin etken olduğu, artropod aracılı bir hastalık olup, multisistemik tutulum gösteren klinik bulguları ile tüberküloz, bruselloz, sifiliz gibi ‘büyük taklitçi’ enfeksiyon hastalıkları arasındadır. Hastalık esnasında görülen çok sayıda nörolojik belirtinin varlığı "nöroborrelyoz" adlı antitenin ortaya çıkmasına neden olmuştur. Spirokete karşı immünolojik yanıt ve etkenin direkt hasarı hastalığın klinik bulgularını da belirlemektedir. Etken menenjit, kraniyal nörit, fasiyal paralizi, kronik ensefalomiyelit, spastik paraparezi ve hatta mental değişiklikler ile seyreden pekçok farklı nörolojik tablodan sorumlu tutulabilir. Erken tanı ve tedavi, hastalığın ilerlemesinin yanı sıra, bakterinin persiste etmesini de önler. Vektör olan kene türlerinin ülkemizde de bulunması nedeni ile nöroborrelyoz ayırıcı tanımızda yer almalıdır.Lyme disease, that&amp;#8217;s causative agent Borrelia burgdorferi, is an arthropod-borne disease. This disease is among the &amp;#8220;great imitator&amp;#8221; infec- tious diseases like tuberculosis, brucellosis and syphilis, due to it&amp;#8217;s multisystem clinical involvement. The presence of multiple neurological signs during the disease has led the entity named as &amp;#8220;neuroborreliosis&amp;#8221;. The immunological response against the spirochete and direct dam- age of the agent determines the clinical manifestations of the disease. The agent may be responsible for many different neurological diagno- sis as meningitis, cranial neuritis, facial paralysis, chronic encephalomiyelitis, spastic paraparesis, and even mental changes. Early diagnosis and treatment prevents the persistence of the bacteria as well as the progression of the disease. Because of the presence of the tick vector species in our country, the neuroborreliosis should be included in our differential diagnosis

A case of acute dystonia induced by metoclopramide

Metoklopramid D2 dopamin reseptörlerini antagonize eden bir antiemetiktir. Metoklopramid kullanımına bağlı gelişen akut distoni; çocuklarda, genç bayanlarda ve aile öyküsü pozitif olanlarda daha sık görülen nadir bir hastalıktır. Doğru tanıyı koymak için ilaç kullanım anamnezi ve tipik klinik prezentasyonun olması gereklidir. Bu olguda ilk başta ayırıcı tanıda zorlandığımız, tedavisinde tekrarlayan biperiden enjeksiyonlarının etkili olduğu metoklopramid kullanımına bağlı gelişen akut distonisi olan bir vakayı sunmaktayız.Metoclopramide is an antiemetic drug that antagonizes dopamine D2 receptors. Acute dystonia induced by metoclopramide is a rare disease which is more common in children, young women and patients with a positive family history. The history of the drug intake and typical clinical presentation are essential for the correct diagnosis. In this case, we would like to present a patient with metoclopramide induced acute dystonia that we were first confused about the diagnosis and that recurrent biperiden injections were effective for the therapy

Nocturnal blood pressure changes in Parkinson's disease: Correlation with autonomic dysfunction and vitamin D levels

Nocturnal blood pressure (BP) changes are an indicator of autonomic dysfunction. We aim to investigate the correlation between nocturnal blood pressure (BP) variability, vitamin D levels and Parkinson's disease severity (PD) in this study. Thirty-five patients with PD participated in the study. Disease severity was evaluated by United Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr Scale (HYS). Equivalent levodopa dose was calculated and 25-hydroxyvitamin D levels were measured. The Non-Motor Symptom Questionnaire (NMSQ) was applied to all patients. Ambulatory BP monitoring for 24 h was established. Patients were divided into three groups according to nocturnal BP results: dippers (normal finding-a decline in mean nighttime BP of more than 10%); non-dippers (pathological-a decline in mean nighttime BP of less than 10%); reverse dippers (pathological-an increase in mean nighttime BP) .The mean score of the NMSQ was higher in the group with HYS > 2 (p = 0.050). Four patients were dipper, 17 patients were non-dipper and 16 patients were reverse dipper. There was no significant difference between the three groups in terms of age, gender, disease duration, age of the disease onset, disease stage, disease duration, dopamine agonist usage, levodopa equivalent dose, vitamin D level and NMSQ scores. NMSQ scores are high in advanced PD. Ambulatory BP monitoring is useful in detecting autonomic dysfunction. The number of patients with non-dipping and reverse dipping is high in PD, independent from PD severity, drug dose, vitamin D and the other NMS symptoms