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Pelvik Taban Disfonksiyonunda Emg-Biofeedback Etkinliği
Get PDFPelvik taban terimi, kemikli pelvik çıkışı (pelvik outlet) kapatan bileşik yapı ile ilgilidir. Pelvik kaslar terimi pelvik tabanın kas tabakasını ifade eder. Pelvik taban farklı katmanlardan oluşur. Pelvik taban orta
katmanları ağırlıklı olarak kas dokusundan oluşur. Bunların dışında, bu tabakada endo pelvik fasya gibi
fibromüsküler ve fibröz elementler bulunur. Pelvis içindeki pozisyonu bir trambolin gibi düşünülen bu
yapı, pelvik açıklıklara (üretra, vajina ve anüs) yapısal destek verir. Ayrıca işeme, dışkılama, seksüel fonksiyon ve pelvik organların desteklenmesinden de sorumludur. Pelvik taban kaslarının ön, orta veya arka
kompartmanlarının herhangi birinde meydana gelen bir patoloji; alt üriner sistem semptomları, bağırsak
semptomları, prolapsus, seksüel fonksiyon ve ağrı ile ilişkili olan pelvik taban disfonksiyonuna neden olmaktadır. Tüm cinsiyetleri ve her yaş grubundan bireyi etkilemektedir. Pelvik taban disfonksiyonu tedavi
seçenekleri arasında cerrahi, medikal ve fizyoterapi ve rehabilitasyon yaklaşımları yer almaktadır. Fizyoterapi ve rehabilitasyonun amacı semptomları azaltmak, progresyonu önlemek, cerrahiyi önlemek ya da
geciktirmek ve yaşam kalitesini arttırmaktır. Bu amaçlara ulaşmak için pelvik taban disfonksiyonu tedavisinde uygulanan fizyoterapi ve rehabilitasyon yaklaşımları pelvik taban kas eğitimini içermektedir. Pelvik
taban kas eğitimi; manuel terapi teknikleri, davranış ve yaşam şekli değişiklikleri, fonksiyonel egzersiz
eğitimi ile kombine bir eğitim programıdır. Pelvik taban kas egzersizleri; vajinal kon, biofeedback, üç boyutlu realtime ultrasound ve sanal gerçeklik eğitimi ile birlikte uygulanabilir. Bu derleme EMG- Biofeedback’ in pelvik taban kas eğitiminde uygulanabilirliğini ve avantajlarını vurgulamaktadır.The term pelvic floor relates to the composite structure that closes the bony pelvic outlet. The term pelvic
muscles refer to the muscular layer of the pelvic floor. The pelvic floor consists of different layers. The pelvic floor middle layers are predominantly composed of muscle tissue. Apart from these, this layer contains
fibromuscular and fibrous elements such as endopelvic fascia. This structure, whose position in the pelvis
is thought of as a trampoline, gives structural support to the pelvic openings (urethra, vagina, and anus). It
is also responsible for urination, defecation, sexual function, and support of the pelvic organs. A pathology
occurring in any of the anterior, middle, or posterior compartments of the pelvic floor muscles; causes
pelvic floor dysfunction, which is associated with lower urinary tract symptoms, bowel symptoms, prolapse,
sexual function, and pain. It affects all genders and individuals of all age groups. Pelvic floor dysfunction
treatment options include surgical, medical, physiotherapy, and rehabilitation approaches. Physiotherapy
and rehabilitation aim to reduce symptoms, prevent progression, prevent or delay surgery, and improve
quality of life. Physiotherapy and rehabilitation approach applied in the treatment of pelvic floor dysfunction to achieve these goals include pelvic floor muscle training. Pelvic floor muscle training; is a combined
training program with manual therapy techniques, behavioral and lifestyle changes, and functional exercise
training. Pelvic floor muscle exercises; Vaginal cone can be applied together with biofeedback, three-dimensional real-time ultrasound, and virtual reality training. This review highlights the applicability and advantages of EMG-Biofeedback in pelvic floor muscle training
Functional and radiological comparison of three cephalomedullary nails with different designs used in the treatment of unstable intertrochanteric femur fractures of elderly
Get PDFBACKGROUND: The aim of this study to compare three cephalomedullary nails (CMNs) with different designs in terms of complication, reoperation, implant failure, mortality rates, and functional outcomes in the treatment of unstable intertrochanteric fractures (UIFs).
METHODS: This retrospective study included patients with UIFs (AO/OTA type 31-A2 and 31-A3) who were treated with one of these
CMNs (74 patients with Talon-PFN, 70 patients with PFN-III, and 69 patients with Intertan) between October 2014 and October 2018.
RESULTS: A total of 213 patients (122 females and 91 males) with a mean age of 81.0±9.3 years have participated in this study. The
mean follow-up time was 26.1±6.3 months. Malfixation was the most common complication and the most common reason of reoperation for each type of CMN. Complication and reoperation rates, post-operative functional status, mean union times, and overall
mortality rates were similar between groups. Mean operation/fluoroscopy time and mean blood loss were low in the Talon-PFN group,
whereas the highest means of these parameters were in the PFN-III group. There were six (8.2%) implant failures in the Talon-PFN
group and one (1.5%) in PFN-III group. No implant failure was seen in the Intertan group. The highest rate (58.6%) of anatomic reduction was detected in PFN-III group.
CONCLUSION: Our study results showed that each implant type had its own advantages and disadvantages in the treatment of UIFs
with similar functional and reoperation outcomes. Intertan was advantageous with its absence of implant failures. Talon-PFN decreased
the operation/fluoroscopy time and intraoperative blood loss but had the highest implant failure rate. There was a need for more
anatomic reduction to centralize two separate parallel lag screws in the femoral neck in PFN-III group, and that costs operation/fluoroscopy time and blood loss. Malfixation, which was the most common cause of complications and reoperations, should be avoided
Peritoneal Tuberculosis in an Immunocompetent Patient With Findings of Chronic Liver Disease and Peritoneal Carcinomatosis
No full textPeritoneal tuberculosis (PT) accounts for 1-2% of all tuberculosis cases. Diagnosis of PT can be challenging due to non-specific symptoms, insidious onset, and variable imaging findings. We present a case of PT presenting with ascites and imaging studies suggestive of chronic liver disease (CLD), and peritoneal carcinomatosis.A 48-year-old man presented to our clinic with complaints of increased abdominal girth, weight loss, and night sweats for the past 3 months. Physical exam revealed soft and distended abdomen with shifting dullness. Laboratory tests showed a mild anemia of Hb at 13.0 g/dL (13.1-17.2) and ESR at 34 mm/h (0-15). Abdominal ultrasound (US) revealed the presence of free abdominal fluid, and diffuse heterogenous granular liver parenchyma supporting the diagnosis of CLD. His liver tests were within normal ranges. Ascitic fluid analysis revealed serum ascites albumin gradient (SAAG) of 0.2 g/dL, WBCs of 1.70 × 103 cells/dL (91.8% lymphocytes). Ascitic fluid cytology was negative for malignant cells. Ascitic fluid acid-fast bacilli (AFB) test and mycobacterial culture were negative. Adenosine deaminase (ADA) level in ascitic fluid was 108.5 U/L (0-40). Interferon-gamma release assay (IGRA) test was positive. Contrast-enhanced computed tomography (CT) scan revealed normal liver parenchyma, diffuse thickening and nodularity of the peritoneum, and thickening of omentum with omental cake appearance. CT scan was suggestive of peritoneal carcinomatosis. EGD and colonoscopy were unremarkable. With consistent clinical history, SAAG < 1.1, ascitic fluid with lymphocytic predominance, high ADA levels, and positive IGRA, a diagnosis of PT was made. Anti-tuberculosis treatment was initiated, and the patient’s clinical symptoms have improved. CT scan at the end of treatment showed the resolution of ascites and peritoneal findings. Ascites is the most common presenting symptom of PT. High suspicion of PT is important in the setting of ascites of unknown origin. Despite the US findings were suggestive of CLD in this patient, CT scan revealed normal liver findings. Differing PT from peritoneal carcinomatosis might be challenging due to overlapping findings on imaging. Ascitic fluid analysis of SAAG < 1.1, high ADA levels, positive IGRA test should lead towards the diagnosis of PT. AFB and mycobacterial culture of the ascitic fluid may often have low diagnostic yield in PT. Early diagnosis and treatment are important to prevent complications
Proposing a cnn method for primary and permanent tooth detection and enumeration on pediatric dental radiographs
Get PDFObjective:In this paper, we aimed to evaluate the performance of a deep learning system for automated tooth detection and numbering on pediatric panoramic radiographs. Study Design: YOLO V4, a CNN (Convolutional Neural Networks) based object detection model was used for automated tooth detection and numbering. 4545 pediatric panoramic X-ray images, processed in labelImg, were trained and tested in the Yolo algorithm. Results and Conclusions: The model was successful in detecting and numbering both primary and permanent teeth on pediatric panoramic radiographs with the mean average precision (mAP) value of 92.22 %, mean average recall (mAR) value of 94.44% and weighted-F1 score of 0.91. The proposed CNN method yielded high and fast performance for automated tooth detection and numbering on pediatric panoramic radiographs. Automatic tooth detection could help dental practitioners to save time and also use it as a pre-processing tool for detection of dental pathologies
How prenatal environmental factors affect rat molar enamel formation?
Get PDFAmelogenin (AMELX) ve ameloblastin (AMBN) emaye oluşumu için çok önemlidir ve bu proteinlerin üretimindeki kesintiler emaye kusurlarına neden olabilir. Doğum öncesi çevresel faktörlerin (kronik stres, bisfenol A (BPA), amoksisilin ve lipopolisakkarit (LPS)) AMELX ve AMBN ameloblast üretimini nasıl etkilediğini araştırdık. On beş hamile Sprague-Dawley sıçanı dört deney grubuna ve bir kontrol grubuna ayrıldı. Kronik stres grubundaki sıçanlar, E18 gününden doğuma kadar 12:12 ışık/ışık döngüsüne (LL) maruz bırakıldı. BPA grubu sıçanlara E1 gününden doğuma kadar günde 5 µg/kg BPA oral olarak uygulandı. Amoksisilin grubu sıçanlara E18 gününden doğuma kadar günde 100 mg/kg amoksisilin enjekte edildi. LPS enfeksiyonu grubu sıçanlarına E18 gününde bir kez 125 µg/kg bakteriyel LPS enjekte edildi. Kontrol grubundan yedi yavruya ve deney grubundan on yavruya P10'da ötenazi uygulandı. Ameloblast aşamalarında boyama yoğunluğunu değerlendirmek için kesitler hematoksilen ve eozin (H&E) ve Gomori'nin tek adımlı trikrom boyaması (GT) ile boyandı ve AMELX ve AMBN'ye karşı tavşan poliklonal antikorları ile inkübe edildi. Yüzey morfolojisi stereomikroskopla değerlendirildi. Tüm grupların AMELX (p = 0,008, p = 0,0001, p = 0,009) ve AMBN (p = 0,002, p = 0,001, p = 0,0001) boyaması, salgı, geçiş ve geçiş gruplarında kontrol grubuna göre anlamlı derecede düşüktü. Tüm deney gruplarının H&E ve GT boyama kesitlerinde anormal mine matriks oluşumu, morfolojik değerlendirmede amoksisilin grubunda sarımsı renklenme gözlendi.Amelogenin (AMELX) and ameloblastin (AMBN) are crucial for enamel formation, and interruptions in the production of these proteins may cause enamel defects. We investigated how prenatal environmental factors (chronic stress, bisphenol A (BPA), amoxicillin, and lipopolysaccharide (LPS)) affect AMELX and AMBN production of ameloblasts. Fifteen pregnant Sprague-Dawley rats were divided into four experimental groups and a control group. Chronic-stress group rats were exposed to a 12:12 light/light cycle (LL) from day E18 until delivery. BPA group rats were orally administered 5 mu g/kg BPA daily from day E1 until delivery. Amoxicillin group rats were injected 100 mg/kg amoxicillin daily from day E18 until delivery. LPS-infection group rats were injected 125 mu g/kg bacterial LPS once on day E18. Seven pups from the control group and ten pups from the experimental groups were euthanized on P10. Sections were stained with hematoxylin and eosin (H&E) and Gomori\"s one-step trichrome staining (GT) and incubated with rabbit polyclonal antibodies to AMELX and AMBN, to evaluate staining intensity at ameloblast stages. The surface morphology was evaluated with a stereomicroscope. AMELX (p = 0.008, p = 0.0001, p = 0.009) and AMBN (p = 0.002, p = 0.001, p = 0.0001) staining of all groups were significantly lower than that of the control group in the secretory, transitional, and maturation stages. Abnormal enamel matrix formation was observed in the H&E and GT staining sections of all experimental groups. Yellowish coloration of the amoxicillin group was observed in morphologic evaluation
The Effect of Diagnosis and Surgical Margin Safety on the Success of Treatment in Endometriomas after Cesarean Section
Get PDFIntroduction: In our study, patients who applied for abdominal wall mass and pain after cesarean section and were examined and
treated and diagnosed endometriosis were evaluated in terms of age, body mass index (BMI), number of cesareans, clinical signs, size
of endometriosis and surgical characteristics, as well as therapy and results.
Methods: January 2001-December 2021 in our clinic after cesarean section, surgery due to a painful mass in the abdominal wall
and pathologically diagnosed endometriosis cases were retrospectively investigated. Age, number of cesareans, clinical signs, size of
endometriosis and surgical characteristics and therapy results were recorded. Four patients were diagnosed with endometriosis with
a tru-cut biopsy. All patients underwent primary mass excision.
Results: A total of 14 patients were identified. The average age of the patients was 35.9 and the average BMI was 26.81. All patients
were admitted with a painful mass at the cesarean site. Only four patients had multiple cesarean sections. Ultrasonography and
abdominal computed tomography were evaluated. Desmoid tumor, foreign body reaction, granuloma, abscess and endometriosis
were identified in their preliminary diagnosis. Endometriosis was established by tru-cut biopsy in four patients. Primary mass excision
was performed for all the patients. In one patient, prolene mesh repair was performed, while in other patients primary repair was
performed. In all patients, pathological diagnosis was reported as endometriosis ekstarna.
Conclusion: The diagnosis of endometriosis should be kept in mind when diagnosing patients with pain and/or mass complaints at
the site of surgery after cesarean section
Does the effect of comprehensive respiratory physiotherapy home‑program differ in children with cystic fibrosis and non‑cystic fibrosis bronchiectasis?
Get PDFBronchiectasis is a form of airway damage as a consequence of endobronchial infection and infammation and may be present in diferent diseases. The underlying aetiologies include both cystic fbrosis (CF) and a group of non-cystic fbrosis diseases (NCFB) such as immunodefciency, primary ciliary dyskinesia, or severe pulmonary infection. Although children with CF and non-cystic fbrosis bronchiectasis (NCFB) have many similar clinical features, their responses to exercise may be diferent. The aim of this study was to compare the efcacy of a comprehensive respiratory physiotherapy (CRP) home-program in children with CF and NCFB. Thirty children with CF and thirty children with NCFB were included in the study. Both groups performed the CRP home-program twice daily for 8 weeks. Pulmonary function, exercise capacity, and respiratory and peripheral muscle strength were assessed at baseline and after 8 weeks of training. Both groups experienced signifcant improvements in pulmonary function, exercise capacity, and respiratory and peripheral muscle strength (p<0.001). Maximum expiratory pressure, exercise capacity, and peripheral muscle strength were further improved in NCFB group compared to CF (p<0.05); however, there was a great variability in the improvements for each variable. Conclusion: CRP is benefcial both for children with CF and NCFB and adherence to the program was high in both group
A novel adaptive momentum method for medical image classification using convolutional neural network
Get PDFBackground: AI for medical diagnosis has made a tremendous impact by applying convolutional neural networks
(CNNs) to medical image classifcation and momentum plays an essential role in stochastic gradient optimization
algorithms for accelerating or improving training convolutional neural networks. In traditional optimizers in CNNs, the
momentum is usually weighted by a constant. However, tuning hyperparameters for momentum can be computationally complex. In this paper, we propose a novel adaptive momentum for fast and stable convergence.
Method: Applying adaptive momentum rate proposes increasing or decreasing based on every epoch’s error
changes, and it eliminates the need for momentum hyperparameter optimization. We tested the proposed method
with 3 diferent datasets: REMBRANDT Brain Cancer, NIH Chest X-ray, COVID-19 CT scan. We compared the performance of a novel adaptive momentum optimizer with Stochastic gradient descent (SGD) and other adaptive optimizers such as Adam and RMSprop.
Results: Proposed method improves SGD performance by reducing classifcation error from 6.12 to 5.44%, and it
achieved the lowest error and highest accuracy compared with other optimizers. To strengthen the outcomes of this
study, we investigated the performance comparison for the state-of-the-art CNN architectures with adaptive momentum. The results shows that the proposed method achieved the highest with 95% compared to state-of-the-art CNN
architectures while using the same dataset. The proposed method improves convergence performance by reducing
classifcation error and achieves high accuracy compared with other optimizers
Evaluation of Bone Turnover Markers Such as Osteoprotegerin, Sclerostin and Dickkopf-1 in Subclinical Hyperthyroidism
Get PDFEarly AcsessIn this study, it was aimed to assess effects of subclinical hyperthyroidism (SH) on bone metabolism using osteoprotegerin (OPG), sclerostin, Dickkopf-1 (DKK1) and biochemical parameters. This cross-sectional prospective study included 40 patients with SH and 40 euthyroid controls. Serum OPG, sclerostin, DKK-1, type-1 procollagen, C-terminal polypeptide (CTx) and 24-hours urine N-terminal telopeptide (NTx) were measures using ELISA kit. Bone mineral density measurements were performed using dual energy X-ray absorptiometry (DEXA). Risk for 10-years hip and major fracture was estimated by Turkish version of FRAX. No significant difference was detected in age, gender, body mass index, smoking and menopause rates between SH and control groups. The risk for 10-years hip fracture and major osteoporotic fracture were estimated as 4.45% and 0.55% in SH group, respectively. The OPG levels were significantly lower in patients with SH than controls (P = 0.017). No significant difference was detected in other bone formation and degradation parameters. No significant correlation was detected between OPG level and risk for major osteoporotic fracture (P > 0.05); however, a negative correlation was detected between OPG level and risk for hip fracture (rho = 0.233; P = 0.038). Serum OPG is markedly affected in patients with SH. In addition, OPG seemed to be associated with osteoporotic fracture risk. Available data show that SH is significantly associated with risk for fracture; thus, it is important to assess risk for fracture in patients with SH
Perinatolojide Sağlık Eğitimi: Gelişen ve Değişen Dinamikler
No full textSağlık eğitimi geniş anlamıyla bireylerde sağlıklı yaşam biçimi davranışları oluşturmak için verilen ve amaca yönelik öğrenme eğitimlerini kapsayan bir süreçtir. Sağlık eğitiminin iyi bir şekilde yürütülebilmesi için
planlama, uygulama ve değerlendirme basamaklarına hâkim olmak gerekmektedir. Sağlık eğitiminde
engellerin bilinmesi, önümüze çıkabilecek engellere karşı hazırlıklı olmak ve süreci yönetme konusunda
yardımcı olmaktadır. Günümüzde artan teknoloji kullanımı ve özellikle yapay zekâ alanındaki çalışmalar
sağlık eğitiminde de yerini almaya başlamıştır. Perinatolojide sağlık eğitimi kapsamında, simulasyon uygulamaları ve sanal gerçeklik, yapay zekâ yardımıyla üstün bir öğrenme ortamı geliştirmektedir. Aynı zamanda, hasta eğitim programları da artık bu teknolojiler üzerinden yürütülmektedir. Ülkemizde, klasik
öğrenme modelleri yaygın olarak kullanılmaktadır. Gebe eğitimleri ve değerlendirilmesiyle ilgili çalışmalar
ülkemizde sınırlıdır. Türkiye’de riskli gebelik eğitimi ile ilgili literatürde bir araştırmaya veya derlemeye rastlanmamıştır. Bu derlemenin amacı sağlık eğitiminin temelleri doğrultusunda hem öğrenci eğitimini hem
de hasta eğitimini perinatoloji çerçevesinde açıklamaktır.Health education is a process that encompasses given and goal-oriented learning trainings in order to create
healthy lifestyle behaviors in individuals. In order to carry out health education in a good way, planning,
implementation and evaluation steps should be understood. Knowing the obstacles in health education
helps us to be prepared for the obstacles and to manage the process. Nowadays, the increasing use of
technology and especially in the field of artificial intelligence began to take its place in health education.
Within the scope of health education in perinatology, simulation applications and virtual reality develop a
superior learning environment with the help of artificial intelligence. At the same time, patient education
programs are now carried out through these technologies. In our country, classical learning models are
widely used. Researches related to pregnant education and evaluation are limited in our country. There is
no research or review in the literature on risky pregnancy education in Turkey. The aim of this review is to
explain both student education and patient education within the framework of perinatology in line with the
foundations of health education