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Legionnaires' disease
No full textLegionnaires disease is a severe from of pneumonia caused by Legionella species which arc ubiquitious in both natural and man-made environments. It has high morbidity and case fetality rates. The disease is acquired by aspiration of water or inhalation of aerosols containing the bactena from environmental sources. Early diagnosis and appropriate treatment are important factors in determining prognosis. Clinical and laboratory predictors will not reliably identify cases of legionnaires disease, therefore the diagnosis of Legionnaires' disease requires specific diagnostic tests. The diagnosis of Legionnaires' disease is made by culture, Legionella urinary antigenaria, polymeras ion, or serologic analyses. Isolation of Legionella from clinical samples is the gold standart for diagnosing Legioimaire's disease. Legionella urinary antigen tests are easy and useful for early diagnosis of Legionnaires' disease. Flouroquinolones, macrolides and doxycicline are drugs of choice. Legionnaires' disease is considered a preventable illness since it is possible to control and remove the bacteria in reserviors. In Turkey, travel-associated Legionnaires' disease has a specific surveillance programe since 1996. After the year of 2015, it became mandatory to take environmental cultures for Legionella from the hospital water systems. The aim of this review is to raise awereness for legionollosis and to summarize the current literature
Retrospective Analysis of Patients with Synchronous Primary Breast and Thyroid Carcinoma
No full textObjective: Breast and thyroid cancers are commonly encountered malignancies. Increased risk of breast cancer in follow-up period of thyroid cancer or vice versa has been reported. However, they have some associations, synchronous presentation of these tumors is rare. We presented 12 patients diagnosed as breast and thyroid cancer and treated at the same time.
Materials and Methods: Mastectomy and thyroidectomy were performed in 19 patients at the same time. 7 patients were excluded because of benign thyroid pathology. Therefore 12 patients who had diagnosis of synchronous breast and thyroid cancer were included. Data regarding clinical, pathological, treatment and prognostic factors was retrospectively analyzed.
Results: Total thyroidectomy was performed in all patients. The mean age of patients was 54 years (min. 44-max. 70). Only one patient was male. Thyroid pathology was detected preoperatively by FDG PET-CT scan in 11 patients. Breast reconstruction was performed in three patients. The most commonly seen thyroid malignancy was papillary thyroid carcinoma. Postoperative complication rate was 33.3%. Adjuvant chemotherapy was given in 11 patients whereas one patient received adjuvant radiotherapy.
Conclusion: Although synchronous presentation of breast and thyroid cancer is rare, surgical treatment of both of these tumors can be safely performed at the same time. Association of these tumors should be evaluated by large scaled studies
Consensus report for workshop on ⇜early diagnosis and intervention in cerebral Palsy” Turkey’s approach to babies at risk and suggestions 1. National congress on babies at risk (1-4 March 2018, the Ankara Hotel)
No full textThe workshop on “Early Diagnosis and Intervention in Cerebral Palsy” aimed to reflect the current situation of and the challenges encountered in the early diagnosis and intervention in cerebral palsy in babies at risk, in order to raise awareness in the corresponding community by putting forth suggestions for providing solutions to these problems, and also, to provide a model suggestion suitable for the whole country. In the direction of these purposes, problems encountered in the prenatal, natal, and postnatal periods, and the corresponding suggestions were discussed, and vital topics concerning numerous disciplines, especially for the postnatal period, were emphasized in the workshop. With the aim of providing a solution to the current problems in the country regarding the matter, by employing an interdisciplinary approach, the establishment of Monitoring Centers for the Babies at Risk was proposed, and a model for these centers was created. Implications derived from this workshop will establish a foundation for the creation of a special strategic plan for the early diagnosis and intervention in cerebral palsy for the babies at risk. Copyright © 2018 by Türkiye Klinikleri
Association Between Mitral Valve Prolapse, Migraine, and White Matter Hyperintensities on Magnetic Resonance Imaging
No full textObjective: Migraine is linked with an elevation in vascular risk factors, ischemic stroke, and a variety of constitutional brain lesions. However, the pathogenesis of this relationship is still inexplicit. The link between cardiac diseases and comorbid migraine-ischemic stroke might be a vascular disease involving both heart and brain. In this study, an association between mitral valve prolapse (MVP), migraine, and the presence of brain white matter hyperintensities (WMHs) were evaluated among adult subjects with migraine headache devoid of any traditional vascular risk factors.
Materials and Methods: Four hundred subjects (200 subjects with migraine headache, 200 healthy controls; age range 18-50 years) were incorporated in the retrospective study. Existence of a headache compatible with migraine was diagnosed according to the International Headache Society-2 criteria. The participants were devoid of any known comorbid diseases, vascular risk factors or inflammatory diseases. All patients, both those with migraine and controls were screened with echocardiography to assess for MVP and with brain magnetic resonance imaging co evaluate the presence of any WMHs.
Results: The prevalence of MVP was found to be higher in the migraine group (p<0.011). The odds ratio (OR) for the presence of MVP in patients with migraine compared with controls was 2.44 [95% confidence interval (CI): 1.25-4.74; p=0.0086]. The OR for the presence of WMHs in patients with migraine compared with controls was 5.88 (95% CI: 3.42-10.10; p<0.0001). After modifying for confounding factors, multiple linear regression analyses revealed that migraine was independently and positively associated with MVP (p=0.044), tricuspid regurgitation (p=0.003), and WMHs (p<0.001), and mitral regurgitation and migraine was independently and positively connected with WMHs (p<0.005 and p<0.001, respectively).
Conclusion: MVP is found CO be independently associated with migraine when compared with controls. Therefore, we suggest that MVP might have an association with migraine. Nevertheless, we could not demonstrate any correlation between MVP and WMHs. Hence, we suggest that MVP might nor be involved in the evolution of WMHs in migrain
Post-traumatic Delayed Peripheral Facial Palsy
No full textPeripheral facial palsy in children is very rare in comparison to adults. The most common cause is idiopathic. Another rare cause of peripheral facial palsy in children is trauma. It occurs after head trauma, mostly due to temporal bone fracture as an early onset paralysis after trauma. Early onset facial palsy is usually due to direct damage to the facial nerve whereas there is some controversy about the etiology of late onset facial palsy. In this article, a child patient whose peripheral facial palsy developed six days after a head injury is presented, and the etiopathogenesis and the treatment of delayed traumatic facial palsy after temporal bone fracture is discussed
Prefrontal Brain Activation in Subtypes of Attention Deficit Hyperactivity Disorder: A Functional Near-Infrared Spectroscopy Study
No full textAccording to clinical symptoms, attention deficit and hyperactivity disorder (ADHD) is categorized into three groups: the predominantly inattentive subtype (ADHD-I),the predominantly hyperactive-impulsive subtype (ADHD-HI), and the combined subtype (ADHD-C). Recent advances in neuroimaging have demonstrated new approaches for assessing the ADHD subtypes with underlying pathophysiology.This study aims to examine the hemodynamic response and reaction time (RT) in healthy children and the ADHD subtypes as measured by functional near-infrared spectroscopy (fNIRS) during an auditory oddball attention task. The sample was made up of 40 children divided into four groups: control group (n=14), ADHD-I group (n=9), ADHD-HI group (n=6), and ADHD-C group (n=11). The target responses were identified and were grand-averaged for each participant. Right prefrontal cortex hemodynamic responses and groups performances on RT were compared between subtypes and between controls and subtypes. Functional near-infrared spectroscopy indicated that while control subjects exhibited higher activation than all ADHD subtypes, the ADHD subtypes did not differ from one another. Relative to control subjects, a longer RT was observed in all ADHD subtypes. The ADHD-I group showed significantly longer RTs compared to the ADHD-HI and ADHD-C groups.This study can bring a new perspective to the continuing controversy about ADHD subtypes, and the findings may help in the evaluation of fNIRS, RT, and RT variability studies in ADHD
Publication rates of dissertations written in medical faculties of Turkey in the field of urology between the years 2008, and 2011, and citation analysis: A cross-sectional study
No full textObjective: In our country, preparing dissertation is essential for the research assistants in order to complete their expertise in medicine. It is aimed to produce hypothesis for researchers via writing their dissertations, to collect data for the hypothesis established, to make the analysis and interpretation of these data, and to gain the ability for the comparison of the findings obtained with the literature. In this study, we want to investigate the publication rates and citations of urology dissertations that are written at the university hospitals in our country between 2008 and 2011.
Material and methods: Urology dissertations that are written at the university hospitals between 2008 and 2011 were reviewed by entering the website of Board of Higher Education Dissertation between 23-27 March 2017 and 229 dissertations were reported. The publication rates of these dissertations were analysed.
Results: Hundred and fourteen of 229 dissertations (49.7%) analysed were published. Of these publications, 75 (32.7%) in Science Citation Index Expanded, 24 (10.4%) in international, 15 (6.5%) are published in national indexed peer-reviewed journals. While the publication rate of 81 dissertations written in universities located in 3 metropolitan cities (Istanbul, Ankara, and Izmir) of Turkey was 50.6%, the publication rate of 148 dissertations written in remaining universities was 49.3%; and no statistically significant difference was found between the two groups (p=0.96).
Conclusion: Preparing dissertation is a challenging process that requires considerable effort and time. At the end of this process, it is necessary to publish the dissertation in order to have it reach more people and to contribute to the literature. Even though publication rate of dissertations written in urology at university hospitals in Turkey was at acceptable level, there have still been problems required to solve
Complete resection in old age bladder cancers filling bladder cavity
No full textRadical cystectomy is often the treatment of choice in widespread bladder tumors that may not be possible to be resected. However, it is extremely important to perform a complete resection prior to surgery, to perform healthy staging, to remove complaints related to the tumor, and to offer alternative treatment options for patients who do not accept surgery or who are at risk for surgery. In this study, the results of complete resection of two old age patients with bladder cancer tumors filling all the bladder cavity were reported
Abnormal subcortical activity in congenital mirror movement disorder with RAD51 mutation
No full textPURPOSE
Congenital mirror movement disorder (CMMD) is characterized by unintended, nonsuppressible, homologous mirroring activity contralateral to the movement on the intended side of the body. healthy controls, unilateral movements are accompanied with predominantly contralateral cortical activity, whereas in CMMD, in line with the abnormal behavior, bilateral cortical activity is observed for unilateral motor tasks. However, task-related activities in subcortical structures, which are known to play critical roles in motor actions, have not been investigated in CMMD previously.
METHODS
We investigated the functional activation patterns of the motor components in CMMD patients. By using linkage analysis and exome sequencing, common mutations were revealed in seven affected individuals from the same family. Next, using functional magnetic resonance imaging (fMRl) we investigated cortical and subcortical activity during manual motor actions in two right-handed affected brothers and sex, age, education, and socioeconomically matched healthy individuals.
RESULTS
Genetic analyses revealed heterozygous RAD51 c.401C>T mutation which cosegregated with the phenotype in two affected members of the family. Consistent with previous literature, our fMRI results on these two affected individuals showed that mirror movements were closely related to abnormal cortical activity in M1 and SMA during unimanual movements. Furthermore, we have found previously unknown abnormal task-related activity in subcortical structures. Specifically, we have found increased and bilateral activity during unimanual movements in thalamus, striatum, and globus pallidus in CMMD patients.
CONCLUSION
These findings reveal further neural correlates of CMMD, and may guide our understanding of the critical roles of subcortical structures for unimanual movements in healthy individuals
Modeling the burden of cardiovascular disease in Turkey
No full textObjective: This study aims to estimate the current and future burden of cardiovascular diseases (CVD) in Turkey.
Methods: A burden-of-disease model was developed that included inputs on population growth, prevalence, and incidence of ischemic disease (IHD) and cerebrovascular disease (CeVD), prevalence of modifiable risk factors, mortality rates, and relationship between risk factors and IHD/ CeVD. Direct costs to the public health-care system and indirect costs from lost production due to premature mortality, hospitalizations, disability, and absenteeism were considered.
Results: We estimated that in 2016, 3.4 million Turkish adults were living with CVD, including 2.5 million affected by IHD, and 0.9 million by CeVD. This prevalence is projected to increase to 5.4 million by 2035. The economic burden of CVD was estimated at US19.4 billion by 2035.
Conclusion: Our study confirms that the current burden of CVD is significant, and that it is projected to increase at a steep rate over the next two decades. This growing burden of disease will likely create significant pressure on the public health-care system in the form of direct health-care costs, as well as on society in the form of lost productivity. (Anatol J Cardiol 2018; 20: 235-40