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Is the pain in lipedema a neuropathic pain?
No full textObjectives: Pain is a common symptom among patients with lipedema. The mechanism of pain in lipedema is uncertain. The unclear nature of the pain adversely affects the diagnosis and treatment process. There is a lack of studies in the literature investigating whether the pain in lipedema patients is nociceptive or neuropathic. The aim of this study is to investigate whether the pain in lipedema has the character of neuropathic pain and to evaluate the effects of lipedema on patients’ quality of life and psychosocial status. Methods: The study included 43 patients diagnosed with lipedema and complaining of pain who applied to the Physical Medicine and Rehabilitation Outpatient Clinic, as well as a control group consisting of 42 patients diagnosed with acute subacromial impingement syndrome (SIS) and experiencing shoulder pain for less than 3 months as a nociceptive pain model. Patients’ pain characteristics were assessed using the LANSS Pain Scale and the PainDETECT Pain Questionnaire. Quality of life was evaluated using the Nottingham Health Profile. The presence of depression and anxiety was assessed using the Hospital Anxiety and Depression Scale questionnaires. Data were evaluated comparatively between the lipedema and control SIS groups. Results: 65.1% of lipedema patients were type 3 lipedema. 69.8% of patients were classified as Stage 2. There was no statistically significant difference between the groups in terms of age, height, education level, occupation, or presence of comorbidities (p>0.05). The mean BMI was statistically significantly higher in the lipedema group compared to the SIS group (p=0.03). LANSS and PainDETECT scores of lipedema group were found to be statistically significantly higher compared to the SIS group (p<0.001). According to the LANSS Pain Scale and PainDETECT Pain Questionnaire, prevalance of neuropathic pain in the lipedema group was significantly higher (p<0.001). There was no statistically significant correlation between the LANSS Pain Scale, PainDETECT Pain Questionnaire and symptom duration and lipedema stage (p>0.05). Nottingham Health Profile scores were significantly higher in the lipedema group, indicating lower quality of life compared to the SIS group (p<0.001). Conclusions: These findings suggest that neuropathic pain may be present in patients with lipedema, highlighting the importance of accurately identifying pain to improve quality of life and psychosocial well-being, as well as to facilitate diagnosis and treatment processes. Further studies are warranted to confirm these findings and explore potential therapeutic interventions for neuropathic pain in lipedema patients. Keywords: Lipedema, Neuropathic Pain, Acute Subacromial Impingement Syndrome</p
BİRİNCİ BASAMAK SAĞLIK ÇALIŞANLARININ KADINA YÖNELİK ŞİDDETBELİRTİLERİNİ TANIMA DURUMLARI VE ETKİLEYEN ETMENLER
No full textNEURAL NETWORK REORGANIZATION DURING WORD DERIVATION IN LEFT- DOMINANT TEMPORAL LOBE EPILEPSY: A MULTI-MODAL FMRI ANALYSIS
No full textÖzet: Bu çalışma, sol hemisfer baskın temporal lob epilepsisi (TLE) olan bireylerde kelimetüretme sırasında gerçekleşen nöral ağ reorganizasyonunu incelemek amacıylagerçekleştirilmiştir. Katılımcılar task-based ve resting-state fMRI ile değerlendirilmiş, beyinfonksiyonel bağlantısallığı incelenmiştir. Araştırmada varsayılan mod, frontopariyetal, dil vesalience ağlarında belirgin fonksiyonel değişimler saptanmıştır. Sonuçlar, epilepsinin yolaçtığı reorganizasyonun, dil işlevlerini desteklemek için farklı beyin bölgelerini içerdiğinigöstermektedir. Bulgular, preoperatif planlama ve nöropsikolojik rehabilitasyonyaklaşımlarına katkıda bulunabilir.Anahtar Kelimeler: Temporal Lob Epilepsisi, fMRI, Dil İşlevleriAbstract : This study investigates neural network reorganization during word derivation tasksin left-dominant temporal lobe epilepsy (TLE). Utilizing task-based and resting-state fMRI,significant alterations in connectivity patterns across the default mode, frontoparietal,language, and salience networks were identified. Results indicate that TLE inducescompensatory reorganization across distributed cognitive networks. These insights arevaluable for surgical planning and rehabilitation in TLE patients.Keywords: Temporal Lobe Epilepsy, Word Derivation, fMRI, Neural ReorganizationGiriş Temporal lob epilepsisi (TLE), tüm epilepsi vakalarının yaklaşık %60&#39;ını oluşturur ve solhemisfer baskınlığı durumunda dil işlevlerini önemli ölçüde etkileyebilir. Dil lateralizasyonusağlıklı bireylerin çoğunda sol hemisfere lokalize olsa da, TLE hastalarında geniş çaplı nöralreorganizasyon meydana gelir.Yöntem Çalışmaya preoperatif dönemdeki sol hemisfer baskın TLE tanılı 25 hasta katıldı.Katılımcılar task-based ve resting-state fMRI taramalarından geçirildi. Fonksiyonel bağlantıanalizleri seed-to-voxel ve bağımsız bileşen analizi (ICA) yöntemleri kullanılarakgerçekleştirildi. Nöropsikolojik değerlendirmeler yapılarak ilişkilendirildi.Bulgular Seed-to-Voxel analizinde: Default Mode Network (DMN) sol oksipital kutup ve sağ supramarginal girusta artmışbağlanırlık göstermiştir. Frontoparietal Network (FPN) bilateral lingual girus ve precentral giruslarda belirginbağlanırlık göstermiştir. Dil ağı analizi anterior singulat ve bilateral lingual giruslarla bağlantı göstermiştir. Salience Network precuneus ve superior temporal girus ile bağlantılar göstermiştir.Tartışma Sonuçlar, dil işlevlerinin desteklenmesi için farklı bilişsel ağlar arasında geniş çaplıreorganizasyonun gerçekleştiğini göstermektedir. Bu adaptasyonlar, klinik özellikler ve dilperformansı ile ilişkilidir.Sonuç Epileptik reorganizasyonun anlaşılması, cerrahi ve terapötik uygulamalarda yolgösterici olabilir. Gelecek çalışmaların geniş örneklemlerle desteklenmesi önerilir.</p
Morbidities in β-thalassemia intermedia across the spectrum of disease severity: A nationwide study in Türkiye
No full textIntroductionAccumulated data show that anemia caused by ineffective erythropoiesis and iron overload is linked tomultiple morbidities, significantly reducing quality of life in β-thalassemia intermedia (β-TI). The spectrumof β-TI varies from occasional transfusions to more frequent ones, and phenoconversion to a transfusion-dependent (TD) state. We conducted a retrospective cohort study to evaluate the morbidities of β-TIpatients with varying disease severities, using data retrieved from the National HemoglobinopathyRegistry (NHR) of the Turkish Hematology Association in Turkey.MethodsThe NHR is a voluntary, computerized medical record system that standardizes the collection of clinical,laboratory, and imaging data from thalassemia centers across Turkey, serving as a prospective cohortsince 2015. We obtained ethics committee approval and written informed consent from patients at eachcenter for the collection and use of the data.The β-TI patients aged ≥10 years who had not received any red blood cells (RBCs) or had received RBCsoccasionally (1-3 times), frequently (4-7 times), or regularly (≥8 times) within the 12 months preceding thelast observation were included in the analysis. Patients with an intact spleen and no transfusion duringtheir previous year are classified as having a mild phenotype. Patients who have either been occasionallyor frequently transfused or splenectomized, as well as those who have both, are identified as havingmoderate and severe phenotypes, respectively. Regularly transfused patients were also divided intothose with an intact spleen or who had undergone splenectomy. Chelation history, as well as the averagehemoglobin (Hb) and serum ferritin (SF) levels, were documented over a 10-year observation period. Therisk factors that may influence the occurrence of morbidities were evaluated using age-adjusted logisticregression analysis.ResultsA total of 330 β-TI patients (57.3% female), aged 10 years or older, were included in this analysis. 112(34.0%) of patients were transfusion-free, 127 (38.5%) were receiving regular transfusions, while 48(14.5%) and 43 (13.0%) had received RBC transfusions 1-3 times and 4-7 times a year, respectively. 148(45%) of patients had undergone splenectomy. Chelation history was present in 90.6% of the population.In the overall group, skeletal complications were the most common (44.2%), followed by endocrine(22.4%) and cardiovascular (16.4%) complications. In contrast, we did not observe hepatic complications,such as chronic liver disease, cirrhosis, and hepatocellular carcinoma; only one patient had a chronic HBVinfection. Age was a significant determinant of morbidity development (p < 0.001). The disease severityshowed that the mild phenotype had the lowest morbidity rate at 10.5% compared to the moderate(34%) and the severe phenotypes (57.6%), with an odds ratio (OR) of 1.58 (95% CI: 1.36-1.82) (p < 0.001).In the moderate phenotype, non-transfused but splenectomized subjects had a clinically meaningfulhigher morbidity rate (47.2%) compared to those transfused but had an intact spleen (25.8%) (p=0.057). Inpatients receiving regular transfusions, those who had undergone splenectomy experienced significantlyhigher morbidity rates (77.2%) compared to those with an intact spleen (37.5%) (p<0.001). Splenectomyemerged as a significant risk factor for the development of morbidity, with an OR of 4.9 (95% CI: 3.0-8.0)(p< 0.001). On the other hand, the presence of transfusion also significantly increases the risk ofmorbidity (OR 2.89 -95% CI: 1.70-4.92) (p<0.001), but Hb levels did not significantly impact morbidity (OR0.90 (95% CI: 0.75 - 1.08 (p=0.245). Similarly, SF levels also showed no significant effect, with an OR of 1.00(95% CI: 1.00 - 1.00) (p=0.334). This lack of significance may be related to a lower transfusion policy thanwhat is needed for the severity of the disease, as well as relatively well-controlled SF levels across alldisease severities.ConclusionsSplenectomy and transfusion requirements play a significant role in the development of morbidity inpatients with β-TI. Rather than opting for splenectomy, providing adequate transfusion support may helpprotect against lifelong complications. However, this transfusion support should be tailored to theseverity of the disease and accompanied by appropriate chelation therapy. Failing to maintain sufficienttransfusions could increase the risk of additional morbidities.Keywords: Registries, Human, Hemoglobinopathies, Research, Diseases, Clinical Research, Thalassemia,Study Population</p
Transformative Impact of Digital Technologies on Artistic Production: Photography and Visuality
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