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The Feasibility of Sparing the Hippocampus and Hypothalamic -Hypophysial Axis During Whole Brain Radiotherapy: A Dosimetric Study
No full textWe aimed to investigate the feasibility of simultaneously sparing the hippocampus and hypothalamic-hypophysial axis (HHA) during whole brain radiotherapy (WBRT) using helical tomotherapy. Images of totally 12 patients were analyzed. Hippocampi and HHA were delineated according to available guidelines. First, radiotherapy plans were analyzed according to dose constraints of the Radiation Therapy Oncology Group-0933 for 30 Gy (3 Gy/fr). Second, dose constraints were decreased by 1/6 to simulate the 25 Gy prophylactic cranial irradiation practice. The mean D98% and D2% was 25.9 +/- 0.85 Gy and 35.0 +/- 1.32 Gy, and 21.4 +/- 0.40 Gy and 30.5 +/- 1.33 Gy for planning target volumes in the original and modified protocol plans, respectively. The D loo96 and Dmax for the hippocampus was 8.1 +/- 0.47 Gy and 15.7 +/- 0.84 Gy in the original and 7.1 +/- 0.68 Gy and 13.2 +/- 1.08 Gy in the modified protocol, respectively. The mean doses for the hypothalamus and hypophysis was 12.6 +/- 0.76 Gy and 11.4 +/- 1.22 Gy in the original and 10.8 +/- 1.38 Gy and 9.8 +/- 1.50 Gy in the modified plans, respectively. This study demonstrated the feasibility of sparing the hippocampus and HHA simultaneously during WBRT with helical tomotherapy regarding target dose coverage and dose constraints suggested by the literature
The Assessment of Efficiency of Traditional and Complementary Medicine Practices in Neurology
No full textTraditional, complementary, and alternative medicine practices are used in the prevention, diagnosis, and treatment of a wide variety of diseases in the world. Such practices in Turkey are regulated by the "Regulation of Traditional and Complementary Medicine Practice" issued by the Ministry of Health in the Official Gazette of the Republic of Turkey (Issue: 29158, 27th October 2014). The appendix of this regulation defines 15 practices that can be applied in units and practice centers. These applications include; 1. Acupuncture, 2. Apitherapy, 3. Phytotherapy, 4. Hypnosis, 5. Leech therapy (Hirudotherapy), 6. Homeopathy, 7. Chiropractic, 8. Cupping, 9. Maggot therapy, 10. Mesotherapy, 11. Prolotherapy, 12. Osteopathy, 13. Ozone therapy, 14. Reflexology, and 15. Music therapy. In this review, the indications of these 15 applications in the field of neurology are examined and current opinions of the evidence-based medical data are summarized
Clinical practices of the management of nonvalvular atrial fibrillation and outcome of treatment: A representative prospective survey in tertiary healthcare centers across Turkey
No full textObjective: The goal of this study was to define clinical practice patterns for assessing stroke and bleeding risks and thromboprophylaxis in nonvalvular atrial fibrillation (NVAF) and to evaluate treatment outcomes and patient quality of life.
Methods: A clinical surveillance study was conducted in 10 tertiary healthcare centers across Turkey. Therapeutic approaches and persistence with initial treatment were recorded at baseline, the 6th month, and the 12th month in NVAF patients.
Results: Of 210 patients (57.1% male; mean age: 64.86 +/- 12.87 years), follow-up data were collected for 146 patients through phone interviews at the 6th month and 140 patients at the 12th month. At baseline, most patients had high CHADS(2) score (>= 2: 48.3%) and CHA(2)DS(2)-VASc (>= 2: 78.7%) risk scores but a low HAS-BLED (0-2: 83.1%) score. Approximately two-thirds of the patients surveyed were using oral anticoagulants as an antithrombotic and one-third were using antiplatelet agents. The rate of persistence with initial treatment was approximately 86%. Bleeding was reported by 22.6% and 25.0% of patients at the 6th and 12th month, respectively. The proportion of patients with an INR of 2.0-3.0 was 41.8% at baseline, 65.7% at the 6th month, and 65.9% at the 12th month. The time in therapeutic range was 61.0% during 1 year of follow-up. The median EuroQol 5-dimensional health questionnaire (EQ-5D) score of the patients at baseline and the 12th month was 0.827 and 0.778, respectively (p<0.001). The results indicated that patient quality of life declined over time.
Conclusion: In atrial fibrillation, despite a high rate of persistence with initial treatment, the outcomes of stroke prevention and patient quality of life are not at the desired level. National health policies should be developed and implemented to better integrate international guidelines for the management of NVAF into clinical practice
Lomber spinal anjiyolipom: a case report
No full textLumbar spinal angiolipomas are rarely seen tumors which present with progressive spinal cord and/or root compression symptoms. Definitive diagnosis with magnetic resonance imaging (MRI) is possible because of their unique signal characteristics. However, probable misdiagnosis is likely due to the infrequency of these tumors. This article reports the case of a 53-year old woman with progressively worsening low back and hip pain in last 6 months. MRI demonstrated a sharply demarcated extradural mass which was hyperintense to cerebrospinal fluid and hypointense to epidural fat on T1-weighted images. The signal was suppressed in fatsaturated images and the mass showed diffuse enhancement after contrast administration
The Effects of Proanthocyanidin on Vasospasm After Experimental Subarachnoidal Hemorrhage in Rats
No full textAIM: Delayed ischemic neurological deficit (DIND) and cerebral vasospasm (CV) remain the most common and debilitating neurological complications following aneurysmal subarachnoidal hemorrhage (SAH). Many reports demonstrate the importance of proanthocyanidins (PR) on the vascular system, including endothelium-dependent relaxation of blood vessels. These effects of PR on the cerebral vascular system were examined in this study.
MATERIAL and METHODS: Fifty-two adult Sprague-Dawley male rats were used for the experimental double hemorrhage model. They were divided to control, sham, pre- and post-interventional treatment groups. 100 mg/kg PR was administered for the treatment for respect to groups. Basilar artery diameter (BAD) and arterial wall thickness were measured and the apoptosis ratio of the endothelial cells was calculated. Arterial walls were examined electron microscopically (EM).
RESULTS: There were significant differences between the groups except control and pre-SAH (p=0.37) and post-SAH and preSAH groups (p=0.15) with respect to BAD. According to arterial wall thickness, apoptosis ratio, and grading, there were significant differences between the groups except control and pre-SAH (p=0.85, p=0.49 and p=0.18 respectively) and SAH and post-SAH (p=0.08, p=0.21 and p=0.24 respectively) groups. EM findings revealed that pro-apoptotic and pro-necrotic degenerated endothelial cells with seldom vacuolization in post-SAH treatment group which were more serious in SAH group.
CONCLUSION: Pre-SAH administration of PR induces better vasodilatation and protection of basilar artery (BA) from vasospasm (VS), which could yield neuroprotective and vasodilatator effects. In addition, PR appears to be involved in relieving oxidative damage, with an antioxidant-antiapoptotic-antinecrotic effect that may contribute to vascular dilation
Comparison of Depression and Burnout Levels of Mothers of Children with Attention-Deficit Hyperactivity Disorder before and after Treatment
No full textObjective: This study aimed to compare the depression and burnout levels of mothers of children having attention-deficit/hyperactivity disorder (ADHD) between the child's pre- and posttreatment periods. Method: The study sample consisted of 40 children aged between 4 and 10 years and their mothers. Initially, 40 cases participated, but during the follow-up, 19 cases dropped out. The Beck Depression Inventory (BDI), the Maslach Burnout Inventory (MBI), and the Turgay DSM-IV Based Child and Adolescent Behaviour Disorders Screening and Rating Scale (T-DSM-IV-S) were used. Results: Among the mothers, posttreatment BDI scores, MBI-emotional exhaustion, and personal accomplishment were significantly lower than the pretreatment scores. In the treatment's second month, all T-DSM-IV-S subscale scores showed a statistically significant decrease. Conclusions: It was concluded that treatment of children with ADHD would have a favorable impact on their mothers' depressive symptoms, which would consequently decrease negative parental attitudes, hence reducing the risk of behavioral disorder in children with ADHD and exerting a positive effect on their treatment. © 2018 Mary Ann Liebert, Inc
Feature selection and multiple classifier fusion using genetic algorithms in intrusion detection systems
No full textWith the improvements in information systems, intrusion detection systems (IDS) become more important. IDS can be thought as a classification problem. An important step of classification applications is feature selection step. Nowadays, to improve accuracy of classifiers, it is recommended to use classifier fusion instead of single classifiers. This study proposes to use genetic algorithms for both feature selection and weight selection for classifier fusion in IDS. This proposed system called GA-NS-AB, has been applied to NSL-KDD dataset. Number of classifiers used in fusion changes between 2 and 8. Following classifiers have been used: Adaboost, Decision Tree, Logistic Regression, Naive Bayes, Random Forests, Gradient Boosting, K-Nearest Neighbor, and Neural Networks Multi-Layer Perceptron. The results of the proposed method have been compared with simple voting and probability voting fusion methods and single classifiers. In addition, GA-NS-AB is also compared with previous results. GA-NS-AB is a high accuracy classifier fusion that reduces test and training time
Cost analysis and characteristics of the patients admitted to emergency service with poisoning
No full textObjective: To investigate the cost analysis and hospitalization rates and modes of poisoning of patients who applied to Bakent University Ankara Hospital Adult Emergency Service. Methods: Poisoning Patients who applied to emergency service due to suicide attempt between 01.01.2011-31.12.2014 were included in the study. Patients' age, gender, date of admission, definite diagnosis, the rate of hospitalization, and hospital costs were examined. A total of 646 patients were included in the study. 208 (32.2%) of the patients were male. The median age of the patients was 29 years. Results: The most causes of poisoning was drug intake. The median cost of the patients was 75.14 TL (IQR: 66.5). Conclusion: There was a positive correlation between age and cost (P<0.05). The majority of the patients apply to emergency dapartment with drug poisoning and female
Clinical characteristics and outcomes of acute coronary syndrome patients with intra-aortic balloon pump inserted in intensive cardiac care unit of a tertiary clinic
No full textObjective: An intra-aortic balloon pump (IABP) is a mechanical support device that is used in addition to pharmacological treatment of the failing heart in intensive cardiac care unit (ICCU) patients. In the literature, there are limited data regarding the clinical characteristics and in-hospital outcomes of acute coronary syndrome patients in Turkey who had an IABP inserted during their ICCU stay. This study is an analysis of the clinical characteristics and outcomes of these acute coronary syndrome patients.
Methods: The data of patients who were admitted to the ICCU between September 2014 and March 2017 were analyzed retrospectively. The data were retrieved from the ICCU electronic database of the clinic. A total of 142 patients treated with IABP were evaluated in the study. All of the patients were in cardiogenic shock following percutaneous coronary intervention, at the time of IABP insertion.
Results: The mean age of the patients was 63.0 +/- 9.7 years and 66.2% were male. In-hospital mortality rate of the study population was 54.9%. The patients were divided into 2 groups, consisting of survivors and non-survivors of their hospitalization period. Multivariate analysis after adjustment for the parameters in univariate analysis revealed that ejection fraction, Thrombolysis in Myocardial Infarction flow score of <= 2 after the intervention, chronic renal failure, and serum lactate and glucose levels were independent predictors of in-hospital mortality.
Conclusion: The mortality rate remains high despite IABP support in patients with acute coronary syndrome. Patients who are identified as having a greater risk of mortality according to admission parameters should be further treated with other mechanical circulatory support devices
Parvovirus B19 seroprevalence in Turkish blood donors
No full textBackground/aim: Parvovirus risk in blood transfusion has become a popular research topic since there are limited data on parvovirus seroprevalence in blood donors in Trukey. The aim of this study was to investigate parvovirus seroprevalence in blood donors in Turkey.
Materials and methods: Blood samples of 988 blood donors admitted to a university blood bank were obtained for parvovirus B19 IgM and IgG detection. The samples were analyzed using the ELISA method.
Results: IgM positivity of 3.92% and IgG positivity of 58.9% was detected in the blood samples. Parvovirus IgM positivity was found to be the highest in the age group of 41-50 years (P = 0.045) and IgG positivity was detected to be the highest in the age group of 31-40 years (P < 0.001). Parvovirus IgG positivity was significantly higher in women (P = 0.041). However, there was no difference regarding parvovirus IgM positivity in terms of sex (P = 0.245).
Conclusion: Although this study does not represent the whole country, it is still the largest investigation carried out on the topic in Turkey and the obtained results are generally similar to those of European countries. Therefore, it is thought that the results obtained from this study may be supportive for the first steps regarding plasma fractionation, which will soon begin in Turkey