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Down sendromlu bireylerde odyolojik bulgular ile artikülasyon becerileri arasındaki ilişki
No full textAMAÇ: Bu çalışmada Down Sendromlu çocuklarda saf ses odyometri,
timpanometri ve multifrekans timpanometri değerleri ve artikülasyon becerilerinin
normal gelişim gösteren çocukların verileri ile karşılaştırarak belirlenmesi
amaçlanmıĢtır.
MATERYAL & METOD: Başkent Üniversitesi Kulak Burun Boğaz
Anabilim Dal‟ında 6-12 yaş arasında Down Sendromu tanısı almış 19 hasta, işitme
ve konuşma bozukluğu şikayeti olmayan 21 gönüllü çocuk çalışmaya dahil
edilmiştir. Her iki gruba saf ses odyometri, timpanometri, multifrekans timpanometri
ve Ankara Artikülasyon Testi yapılmıştır. Elde edilen değerler iki grup arasında
karşılaştırılmıştır.
BULGULAR: Çalışmaya dahil edilen Down Sendromlu çocukların her iki
kulak saf ses odyometri değerleri ile artikülasyon testinden elde edilen değerleri
kontrol grubuna göre anlamlı derecede düĢük bulunmuĢtur (p<0,05). ÇalıĢma grubu
saf ses odyometri değeri sağ kulakta 14,53 dB, sol kulakta 12,74 dB olarak
bulunmuştur. Kontrol grubu sağ kulak saf ses odyometri değeri ortalaması 2,95 dB,
sol kulak saf ses odyometri değeri ortalaması 3,14 dB olarak bulunmuştur. Ankara
Artikülasyon Testi skorlarına göre çalışma grubunda sadece 1 çocuk kendi yaş aralığı
düzeyinde skora sahipken geri kalan hiçbir çocuğun kendi yaş aralığına uygun
skorları elde edememiştir. Kontrol grubundaki bütün çocuklar kendi yaşlarına uygun
düzeydeki skorları elde etmiştir. Multifrekans timpanometri değerleri ile artikülasyon
becerileri arasında her iki grup arasında anlamlı bir fark elde edilememiştir (p>0,05).
Bunun dışında her iki grup arasında saf ses odyometride bütün frekanslarda anlamlı
fark bulunmuştur, timpanometri ve akustik refleks testlerinde her iki grup arasında
istatistiksel olarak anlamlı sonuçlar elde edilmiştir (p<0,05).SONUÇ: Odyolojik bulgular, Down Sendromlu bireyler için konuşma seslerini etkileyen bir unsurdur. Bu çocuklarda sık görülen iĢitme kayıpları konuşma
anlaşılırlıklarını etkilemektedir. Bu nedenle Down Sendromlu çocuklarda küçük
yaştan itibaren daha sık aralıklarla Kulak Burun Boğaz muayenesi ve odyolojik
testlerin yapılması önerilmektedir.
AIM: In this study, it was aimed to determine articulation skills by comparing
pure tone audiometry, tympanometry and multifrequency tympanometry values of
children with Down syndrome to those of normal developing children. It is aimed to
determine the audiological findings specific to Down Syndrome and to investigate
the effect of these findings on speech voices. In addition; age, gender, pure audio
average, multifrequency tympanometry values were examined and it was researched
whether these findings affect articulation skills.
MATERIAL & METHOD: 19 patients who were diagnosed as Down
Syndrome between the ages of 6 and 12 in the Department of Otorhinolaryngology,
BaĢkent University and 21 voluntary children with no hearing and speech
impairment were included in the study. Both groups were subjected to pure sound
audiometry, tympanometry, multifrequency tympanometry and the Ankara
Articulation Test. Obtained values were compared between two groups.
FINDINGS: Pure audio averages and articulation skills for both ears of
children with Down Syndrome were significantly lower than control group (p<0, 05).
The pure tone average value of the study group was found 14.53 dB for the right ear
and 12.74 dB for the left ear. It was found that the control group had a right ear
average of 2.95 dB and a left ear average of 3.14 dB. According to the Ankara
Articulation Test scores, only 1 child in the study group was at the level of their own
age, while the rest of the children did not appear in their age range. All children in
the control group achieved appropriate scores for their age. There was no significant
difference between multifrequency tympanometry values and articulation skills
between the two groups (p>0, 05). Additionally, there was a significant difference for
pure tone audiometry in all frequencies between the two groups, statistically significant results were obtained between the two groups in tympanometry and
acoustic reflex tests (p<0, 05).
RESULTS: Audiological findings are a factor which affects speech sounds
for children with Down syndrome. The common hearing loss and tympanum
pathologies in these children greatly affect children's speech intelligibility. The use
of multifrequency tympanometry, which is also advantageous in many respects, is
not common in Down syndrome and the number of studies is very limited. For this
reason, there is not enough data yet. In this respect, ear-nose-throat examination and
audiologic tests are recommended to children with Down Syndrome more frequently
since the young age
Motosiklet kullanan bireylerde pozisyonel testler, vemp testi, statik ve dinamik denge skorlarının değerlendirilmesi
No full textMotosiklet kullanımının işitme üzerine negatif etkileri daha önceki
çalışmalarda gösterilmiştir. Bu çalışmanın amacı motosiklet kullanan kişilerde
vestibüler sistemdeki olası değişiklikleri araştırmaktır.
Çalışmamıza Başkent Üniversitesi Ankara Hastanesi Kulak Burun Boğaz
Anabilim Dalında motosiklet kullanan ve kullanmayan toplam 60 sağlıklı birey
alınmıştır. Çalışmaya katılan tüm bireylere kulak burun boğaz muayenesi, pozisyonel
testler, VEMP testi, statik ve dinamik denge testleri yapılmıştır.
Motosiklet kullanan katılımcıların yaş ortalamaları 39.76 ± 9.46, kullanmayan
bireylerin yaş ortalaması ise 31.96 ± 7.03‟dir. Motosiklet kullanan bireyler
motosiklete 14.36 ± 8.12 yıl ve haftada 5.03 ± 1.90 gün bindiklerini belirtmişlerdir.
Motosiklet kullanan bireylerde yapılan statik denge ölçümü skoru 212.70 ± 188.80
iken; kullanmayan bireylerde skor 164.10 ± 81.57 olarak ölçülmüştür. İki grup
arasında elde edilen sonuçlar istatistiksel olarak anlamlı bulunmamıştır (p>0.05).
Motosiklet kullanan bireylerde yapılan dinamik denge ölçümü skoru 1598.96 ±
533.66 olarak belirlenmiştir. Motosiklet kullanmayan bireylerde yapılan dinamik
denge ölçümü skoru 1595.00 ± 451.79 olarak belirlenmiştir. İki grup arasında elde
edilen sonuçlar istatistiksel olarak anlamlı bulunmamıştır (p>0.05). Her iki gruba da
yapılan pozisyonel testlerde herhangi bir patoloji (nistagmus, baş dönmesi)
saptanmamıştır. Motosiklet kullanan bireylerde sol kulak cVEMP n1 dalgası latansı
25.51±3.24 iken, motosiklet kullanmayan bireylerde latans 23.45±2.83 olarak
saptanmıştır (p<0.011). Ayrıca iki grup arasında yapılan sol kulak ölçümlerinde
oVEMP p1 dalgası latansında da istatistiksel olarak anlamlı fark vardır, motosiklet
kullanan bireylerin p1 latansları uzamıştır. Motosiklet kullanan bireylerde yapılan sol
kulak oVEMP p1 dalgası latansı 12.70±3.21 iken, motosiklet kullanmayan bireylerde 11.46±2.70 dir (p<0.041). Sağ kulak için cVEMP ve oVEMP latans değerleri iki
grup arasında istatistiksel farklılık göstermemiştir.
Elde edilen bulgular ışığında motosiklet kullanmanın vestibüler sistem
üzerinde belirgin etkisi olmadığı söylenebilir. Bu konuda farklı çalışmalara devam
edilmelidir.
The negative effects of motorcycle use on hearing have been shown in previous
studies. The purpose of this study is to investigate possible changes in the vestibular
system in motorcycle users.
Our study at BaĢkent University Ankara Hospital, at the department of
otolaryngology with 60 healthy individuals using motorcycles and not using them
were taken. All the study subjects participants were performed otolaryngologycal
assesment, positional tests, VEMP test, static and dynamic equilibrium tests.
The average age of participants using motorcycles was 39.76 ± 9.46, and the average
age of non-motorized participants was 31.96 ± 7.03. Individual motorcycle users
reported motorcycle 14.36 ± 8.12 years and 5.03 ± 1.90 days per week. The static
balance measurement score of the motorcycle users was 212.70 ± 188.80; the score
was 164.10 ± 81.57 in non-users. The results obtained between the two groups were
not statistically significant (p>0.05). The dynamic balance measurement score for
individuals using motorcycles was 1598.96 ± 533.66. The dynamic balance
measurement score for individuals without motorcycles was determined as 1595.00 ±
451.79. The results obtained between the two groups were not statistically significant
(p>0.05). No pathology (nystagmus, dizziness) was detected in the positional tests
performed on both groups. In motorcycle-using individuals, the left ear oVEMP n1
wave was 25.51 ± 3.24, while the non-motorized individuals were 23.45 ± 2.83 (p
<0.011). There was also statistically significant difference in oVEMP p1 wave in left
ear measurements between two groups. The left ear oVEMP p1 wave made by
motorcycle users was 12.70 ± 3.21, while those without motorcycle were 11.46 ±
2.70 (p<0,041). cVEMP and oVEMP latency values for right ear did not show
statistical difference between two groups.
It can be said that the use of motorcycles in the finds obtained is not a significant
effect on the vestibular system. Different studies should be continued in this regard
Yüksek yağlı diyet ile beslenen sıçanlarda, probiyotik kullanımının karaciğer yağlanması ve metabolik endotoksemi üzerine etkisi
No full textNon alkolik yağlı karaciğer hastalığı (NAFLD), patogenezi tam olarak
anlaşılamayan, kompleks ve multifaktöriyel bir hastalıktır. Hastalığın patogenezi,
genetik polimorfizm, çevresel faktörler ve barsak mikrobiyotasının değişimini içeren
kompleks bir süreci içermektedir. Hastalığın tedavisinde, yaşam tarzı değişiklikleri
ve fiziksel aktivitenin artırılması birincil hedefler arasındadır. Bu çalışmada, yüksek
yağlı diyetle beslenen sıçanlarda probiyotik kullanımının karaciğer yağlanması ve
metabolik endotoksemi üzerine etkisi incelenmiştir. Çalışmada 24 adet Spraque
Dawley türü sıçan kullanılmış ve hayvanlar 3 gruba ayrılmıştır. Kontrol grubuna
standart purifiye yem, diğer iki gruba sırasıyla, yüksek yağlı yem + plasebo (NaCl
oral 1 damla) ve yüksek yağlı yem + probiyotik Lactobasillus rhamnasus GG (1x10⁹
cfu/1 damla) 16 hafta süresince verilmiştir. Bu süre sonunda sıçanların kan örnekleri
alınmış, mezenterik, perirenal ve gonadal yağ dokusu miktarları ölçülmüş ve
histopatoloji için karaciğer dokusu çıkartılmıştır. Grupların serum AST düzeyleri
karşılaştırıldığında istatistiksel farklılık önemli bulunmuş (p<0.05), en yüksek serum
AST düzeyi yüksek yağlı yem + plasebo alan grupta saptanmıştır. Grupların ortalama
serum ALT düzeyleri arasındaki fark anlamlı bulunmuş (p<0.05), en düşük ALT
düzeyi kontrol grubunda, en yüksek, yüksek yağlı yem + probiyotik alan grupta
bulunmuştur. Gruplar arasında, kolesterol, TNF-α, CRP ve LPS düzeyleri açısından
istatistiksel olarak önemli bir fark bulunmamıştır (p>0.05). Sıçanların AST, ALT,
kolesterol ve CRP değerleri ile LPS düzeyleri arasında bir ilişki bulunmamıştır.
Gruplar arasında karaciğer ağırlığı, perirenal ve mezenterik yağ miktarı ortalamaları
arasındaki fark önemli (p<0.05). Gruplar arasında histopatojik incelemede, kontrol
grubunda steatoz negatif, yüksek yağlı yem + plasebo alan grupta % 62,5 ve yüksek
yağlı yem + probiyotik alan grupta % 12.5 oranında hepatosteatoz+hepatosellüler
balonlaşma (1 hayvan) bulunmuştur.
Sonuç olarak, yüksek yağlı diyet ile oluşturulan karaciğer yağlanmasına
probiyotik desteğinin koruyucu etkisi histopatolojik olarak gösterilmiş ancak karaciğer enzimleri, inflamatuvar belirteçler ve metabolik endotoksin üzerindeki
etkisi tam olarak gözlenmemiştir.
Non alkolik yağlı karaciğer hastalığında probiyotik kullanımının
önerilebilmesi için hem doz hem de suş açısından daha fazla çalışmaya gereksinim
duyulmaktadır.
Non alcoholic fatty liver disease (NAFLD) is a complex and multifactorial disease,
it’s pathogenesis is not fully understood. The pathogenesis of disease is involves a
complex process, genetic polymorphism, enviromental factors and change of
intestinal microbiota. Lifestyle changes and physical activity are primary goals in the
treatment. In this study, the effect of probiotic use on the fatty liver and metabolic
endotoxemia in rats fed with high fat diet was invsetigated. Sprague Dawley rats
(n=24) were used in this study and animals were divided into 3 groups. The control
group received standard purified feed, the other two groups respectively, receieved
high fat feed+plasebo (1 drop of NaCl), high fat feed+probiotic Lactobasillus r. GG
(1x10¹⁰ cfu/ 1 drop) for 16 weeks. At the end of the period, blood samples were
taken from rats, mesenteric, perirenal, gonadal fat tissue levels were measured and
the liver was removed for the histopathology. When the serum AST levels of groups
were compared, statistical difference was found as significant, the highest level was
found in high fat feed+plasebo group. The difference between the mean serum ALT
levels of groups was found be significant and lowest ALT level was found in the
control, the highest level high fat feed+probiotic group. There was no statistical
difference between groups, cholesterol, TNF-α, CRP and LPS level (p>0.05). There
was no correlation between LPS with AST, ALT, cholesterol and CRP levels
(p>0.05). The difference between in gropups, mean of liver weight, perirenal and
mesenteric fat content was significant (p<0.05). At the histopathological examination
of the groups revealed steatosis negative in control group, 62.5 % of in high fat
feed+plasebo group and 12.5% hepatosteatosis + hepatocellular balloning in high fat
feed+probiotic group (1 animal). As a result, the protective effect of supplementation
with probiotics on high fat diet induced fatty liver was demonstrated as
histopathologically but its effects on liver enzymes, inflamatory markers and
metabolic endotoxemia has not been fully demonstrated. In order to recommend of
the use probiotics in NAFLD, more researches are needed in terms of both dose and
strain
Oxidant and Antioxidant Balance in Patients with Childhood Non-Cystic Fibrosis-Related Bronchiectasis
No full textObjective: To evaluate the role of the oxidant and antioxidant balance in the pathogenesis and prognosis of non-cystic fibrosis bronchiectasis (non-CF BE) in children.
Materials and Methods: Twenty-nine children with non-CF BE were enrolled between June 2009 and October 2010. Thirty healthy children were enrolled as controls. Paraoxonase 1 (PON1), total oxidant status (TOS), and total antioxidant status (TAS) serum levels were measured in controls and in patients when stable and at acute exacerbation.
Results: PON1 and TAS levels were lower in patients at acute exacerbation than in controls (P=0.05 and P=0.01, respectively). TOS levels indicative of oxidative stress were higher, and TAS/TOS levels were lower, in immune-deficient patients than control group (P=0.008 and P=0.01, respectively). TAS levels and PON1/TOS ratio were significantly lower in patients with moderate-severe bronchiectasis than in patients with mild bronchiectasis (P=0.043 and P=0.03, respectively).
Conclusion: Oxidative stress was increased and antioxidant capacity decreased in patients with non-CF BE during the exacerbation period. Antioxidant treatment in patients with non-CF BE, especially in patients with immunodeficiency and/or with moderate-severe bronchiectasis, could be helpful to reduce the frequency and severity of the attacks by reducing oxidative stress-induced damage, ultimately contributing to a better prognosis
Organ damage mitigation with the Baskent Sickle Cell Medical Care Development Program (BASCARE)
No full textThe Eastern Mediterranean is among the regions where sickle cell disease (SCD) is common. The morbidity and mortality of this disease can be postponed to adulthood through therapies implemented in childhood. The present study focuses on the organ damage-reducing effects of the Baskent Sickle Cell Medical Care Development Program (BASCARE), which was developed by a team who lives in this region and has approximately 25 years of experience. The deliverables of the program included the development of an electronic health recording system (PRANA) and electronic vaccination system; the use of low citrate infusion in routine prophylactic automatic erythrocyte exchange (ARCE) programs including pregnant women; the use of leukocyte-filtered and irradiated blood for transfusion; the use of magnetic resonance imaging methods (T2(*)) for the management of transfusion-related hemosiderosis; and the implementation of an allogeneic hematopoietic stem cell transplantation protocol for adult patients. The sample was composed of 376 study subjects and 249 control subjects. The hospital's Data Management System and the central population operating system were used for data collection. BASCARE enabled better analysis and interpretation of complication and mortality data. Vaccination rates against influenza and pneumococcal disease improved (21.5% vs 50.8% and 21.5% vs 49.2%, respectively). Effective and safe ARCE with low citrate infusion were maintained in 352 subjects (1003 procedures). Maternal and fetal mortality was prevented in 35 consecutive pregnant patients with ARCE. Chelating therapy rates reduced from 6.7% to 5%. Successful outcomes could be obtained in all 13 adult patients who underwent allogeneic peripheral stem cell transplantation from a fully matched, related donor. No patients died by day 100 or after the first year. Cure could be achieved without graft loss, grades III to IV acute graft versus host disease, extensive chronic graft versus host disease, or other major complications. The BASCARE program significantly improved patient care and thereby prolonged the life span of SCD patients (42 +/- 13 years vs 29 +/- 7 years, P < .001). We may recommend using such individualized programs in centers that provide health care for patients with SCD, in accordance with holistic approach due to the benign nature but malignant course of the disease
Saldırı tespit sistemlerinde genetik algoritma kullanarak nitelik seçimi ve çoklu sınıflandırıcı füzyonu
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. © 2018 Gazi Universitesi Muhendislik-Mimarlik. All rights reserved
The Evaluation of Clinical Signs in Patients with Suspected Renovascular Hypertension
No full textOBJECTIVE: Renovascular hypertension (RVH) is the most common yet correctable cause of secondary hypertension if diagnosed early. There are many clinical signs that can suggest RVH. The aim of this study was to find which clinical or laboratory signs are more indicative in diagnosing RVH and in determining which patients should go through renal angiography.
MATERIAL and METHODS: The study included 184 patients who presented to our clinic due to hypertension and were under risk of RVH. All patients underwent three-dimensional time-of-flight Magnetic Resonance Angiography with phase-contrast. The patients were divided into two groups as with and without renal artery stenosis, supported by MRA.
RESULTS: Advanced age, low body mass index, high serum creatinine level, presence of proteinuria, and patients with diabetes mellitus and coronary artery disease were found to be significant risk factors for RVH. Only the presence of renal asymmetry and the history of coronary artery disease were found to be independent risk factors.
CONCLUSION: In conclusion, detailed patient history and the evaluation of renal size are very important for patients with hypertension. Coronary artery disease and a difference in renal size of more than 1.5 cm could be strong indicators of RVH
Bilateral synchronous ovarian tumours: an uncommon case and review of the literature
No full textSynchronous ovarian tumours are rare. Management of these patients can differ from that of patients with uniform tumours. We present a case of synchronous epithelial ovarian cancer and malignant mixed Mullerian tumour in different ovaries, its follow-up and management until death. To our knowledge this is the second case in the English literature to date.
A 61-year-old woman with bilateral adnexal masses underwent complete debulking surgery for ovarian cancer. The final pathology was reported as malignant mixed Mullerian tumour in the right ovary with intact borders and stage 2 grade 3 serous carcinoma in the left ovary. She had a 17-month disease-free interval after 6 cycles of paclitaxel and carboplatin. Recurrence of malignant mixed Mullerian tumour was reported in the pathology after secondary debulking including a partial ileal resection. After 6 cycles of gemcitabine and cisplatin she had a widespread recurrence in the thorax and abdomen. The patient died of disease recurrence at the 25th month after diagnosis.
Coexistence of serous and malignant mixed Mullerian tumour in different ovaries is very rare. The main treatment is complete cytoreduction followed with chemotherapy. Platinum-taxane based chemotherapy resulted in an acceptable disease-free interval in our case, but it is not standard yet. A management protocol may be developed with the increasing number of similar cases in the literature
Sacral Spine Eosinophilic Granuloma in an Adult Patient: A Case Report of Unusual Age and Location
No full textEosinophilic granuloma one of a triad of diseases under Langerhans' cell histiocytosis as known as Histiocytosis X, is a rare disorder characterized with uncontrolled proliferation of histiocytes, mostly seen among children and adolescents instead of adults. Although the clinical picture is well defined, there are still unclear aspects on etiology, histology and prognosis. Here we are presenting our experiences on a case of eosinophilic granuloma interestingly in an adult patient. She was admitted with back and hip pain. After her diagnosis of sacral spine osteolytic tumor, the biopsy was performed in our clinic and her histopathology was resulted as eosinophilic granuloma. In this paper we are presenting the clinical and hystopathological features of esonophilic granuloma. We aimed to contribute an additional data to the literature on eosinophilic granuloma presented with an atypical localization and age. According to current literature, there are only few reports on both adults and sacrum affected with eosinophilic granuloma
Approach to hypoglycemia in the newborn: Turkish neonatal and pediatric endocrinology and diabetes societies consensus report
No full textHypoglycemia is one of the most important and most common metabolic problems of the newborn because it poses a risk of neurological injury, if it is prolonged and recurs. Therefore, newborns who carry a risk of hypoglycemia should be fed immediately after delivery and the blood glucose level should be measured with intervals of 2-3 hours from the 30th minute after feeding. The threshold value for hypoglycemia is 40 mg/dL for the first 24 hours in symptomatic babies. In asymptomatic babies, this value is considered 25 mg/dL for 0-4 hours, 35 mg/dl for 4-24 hours, 50 mg/dL after 24 hours and 60 mg/dL after 48 hours. Screening should be performed with bed-side test sticks. When values near the limit value are obtained, confirmation with laboratory method should be done and treatment should be initiated, if necessary. The level targeted with treatment is considered 50 mg/dL in the postnatal first 48 hours before feeding, 60 mg/dL after 48 hours in babies with high risk and above 70 mg/dL in babies with permanent hypoglycemia. In cases in which the blood glucose level is below the threshold value and can not be increased by feeding, a glucose infusion of 6-8 mg/kg/min should be initiated. If symptoms accompany, a mini bolus of 10% dextrose (2 ml/kg/min) should accompany. Incements (2 mg/kg/min) should be performed, if the target level can not be achieved and decrements (2 ml/kg/ min) should be performed, if nutrition and stabilization is provided. The infusion should be discontinued, if the infusion rate decreases to 3-5 mg/ kg/min. If necessary, blood samples should be obtained during hypoglycemia in terms of differential diagnosis and the investigation should be performed following a 6-hour fasting period in babies fed enterally and at any time when the plasma glucose is 60 mg/dL following a 6-hour fast. © 2018 by Turkish Pediatric Association