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Patient Selection and Efficacy of Intradiscal Electrothermal Therapy with Respect to the Dallas Discogram Score
No full textAIM: Intervertebral disc degeneration can cause severe low back pain. Intradiscal electrothermal therapy (IDET) is a minimally invasive treatment option for patients with symptomatic internal disc disruption unresponsive to conservative medical care. We aimed to evaluate 12-month pain and functional outcomes and predictors of clinical success in patients with discogenic back pain treated with IDET with respect to the Dallas Discogram Scale (DDS).
MATERIAL and METHODS: This was a retrospective analysis of patients undergoing IDET for low back pain from 2009 through 2014 at Baskent University, Department of Neurosurgery. A total number of 120 consecutive patients data were collected retrospectively. The degree of disc degeneration was graded using the DDS during discography, and the presence of a high intensity zone (HIZ) on magnetic resonance (MR) imaging was noted. The primary outcome measure was assessment of back pain severity based on the Visual Analogue Scale (VAS); function was assessed by the Oswestry Disability Index (ODI). Follow-up examinations for ODI and VAS scores were assessed at 1, 6, and 12 months post-treatment. Outcomes were discussed with respect to morphological changes in intervertebral discs on discogram.
RESULTS: There was an average 57.39% and 47.16% improvement in VAS and ODI scores, respectively, between pretreatment and 12 months follow-up (p<0.0001 for both comparisons). Predictors of 12-month clinical success was depended on DDS (p< 0.0001), a HIZ on MR imaging (p<0.0001).
CONCLUSION: Durable clinical improvements can be realized after IDET in select surgical candidates with mild disc degeneration and HIZ, discography, and low-grade DDS, with more effective treatment results
Audio-Vestibular Findings in Increased Intracranial Hypertension Syndrome
No full textOBJECTIVE: Idiopathic intracranial hypertension (IIH) can be manifested by audiological and vestibular complaints. The aim of the present study is to determine the audio-vestibular pathologies and their pathophysiologies in this syndrome by performing current audio-vestibular tests.
MATERIALS and METHODS: The study was performed prospectively on 40 individuals (20 IIH patients, 20 healthy volunteers). Pure tone audiometry, tympanometry, vestibular evoked myogenic potentials, and electronystagmography tests were performed in both groups and the results were compared.
RESULTS: The mean age of both groups was found to be 30.2 +/- 18.7. There were 11 females and 9 males in each group. The study group patients had significantly worse hearing levels. Pure tone averages were significantly higher in both ears of the study group (p<0.05). Ten patients (50%) in the study group and one healthy volunteer (5%) had pathologic ENG, possibly related to central pathologies (p=0.008). Eight patients (40%) and one (5%) control had variable abnormal VEMP records (p=0008).
CONCLUSION: Many IIH patients initially visit otolaryngology clinics since cochlear and vestibular systems are frequently affected in this condition. Our test results suggest inner ear pathologies in these patients. Higher incidence of inferior vestibular nerve and/or saccule dysfunction is detected as a novelty. Increased intracranial pressure may affect the inner ear with similar mechanisms as in hydrops
Painful skin lesions and squamous cell carcinoma predict overall mortality risk in organ transplant recipients: a cohort study
No full textBackgroundOrgan transplant recipients (OTRs) have a highly increased risk of cutaneous squamous cell carcinomas (SCCs). Sensation of pain in cutaneous tumours is a powerful patient-reported warning signal for invasive SCCs in OTRs.
ObjectivesTo investigate the impact of painful vs. painless skin lesions and SCC vs. other skin lesions on the overall mortality risk in OTRs.
MethodsWe followed 410 OTRs from 10 different centres across Europe and North America between 2008 and 2015. These patients had been enrolled in an earlier study to define clinically meaningful patient-reported warning signals predicting the presence of SCC, and had been included if they had a lesion requiring histological diagnosis. Cumulative incidences of overall mortality were calculated using Kaplan-Meier survival analysis, and risk factors were analysed with Cox proportional hazard analysis.
ResultsThere was an increased overall mortality risk in OTRs who reported painful vs. painless skin lesions, with a hazard ratio (HR) of 16 [95% confidence interval (CI) 097-27], adjusted for age, sex and other relevant factors. There was also an increased overall mortality risk in OTRs diagnosed with SCC compared with other skin lesions, with an adjusted HR of 17 (95% CI 10-28). Mortality due to internal malignancies and systemic infections appeared to prevail in OTRs with SCC.
ConclusionsWe suggest that OTRs have an increased overall mortality risk if they develop painful skin lesions or are diagnosed with cutaneous SCC
Sensorineural Hearing Loss in Selective Immunglobulin A Deficiency
No full textObjective: To assess hearing functions in pediatric patients with selective immunoglobulin A (IgA) deficiency (SIGAD).
Methods: Pure-tone audiometry, acoustic impedance, otoacoustic emission, and brainstem audiometric measurements were taken during a non-infectious period in 28 patients with SIGAD and 28 healthy children with normal otoscopic examination. The results of the hearing tests were compared between the two groups.
Results: Two male patients and one female patient in the SIGAD group were found to have sensorineural hearing loss (SNHL). However, a comparison of the average pure tone cut-off values at 0.5, 1, 2, and 4 kHz did not reveal any statistically significant difference between the groups (p>0.05).
Conclusion: Pediatric patients with SIGAD may exhibit SNHL at certain frequencies and require follow-up for the potential development of hearing loss
The biochemical and histological analysis of subcutaneous calcitonin and intramedullary methylprednisolone on bone repair after bone marrow ablation: an experimental comparative study in rats
No full textBackground: Although, glucocorticoid (GC) and calcitonin-induced changes in bone repair have been studied previously, the exact effects of these on fracture healing remain controversial. Hence, the purpose of this experimental study is to determine biochemical and histological effects of locally administrated GC and systemically administrated calcitonin on the kinetics of healing response after bone marrow ablation in rats. Methods: After having undergone marrow ablation, a steroid-treated group of rats (n = 24) received a single dose of intramedullary methylprednisolone (2 mg/kg), a calcitonin-treated group (n = 24) received intermittently administrated subcutaneous salmon calcitonin (16 IU/kg), and a control group (n = 24) received intramedullary saline (25 μl). Results: Blood samples taken on days 1, 3, 7, 9, and 15 after ablation showed an increase in serum calcium, alkaline phosphatase (ALP), and phosphate levels in the Calcitonin and Control groups. Levels of calcium and ALP peaked on day 7 after ablation. However, an increase in phosphate levels indicated a biphasic reaction that peaked on the third and ninth day after ablation. Hypercalcemia was not observed in Steroid group because of the inhibition of osteoclastic bone resorption. In that group, the serum levels of ALP and phosphate were lower than baseline levels. The levels of urinary calcium excretion peaked 3 to 7 days after marrow ablation in the control group and 7 to 9 days after that procedure in the steroid group. Histologic evaluation showed that the rats in the control group demonstrated the expected healing period according to the histological grades and that a delay in healing occurred in the calcitonin group after day 9 because of the inhibition of osteoclastic bone resorption. All rats in the steroid group exhibited a decrease and delayed healing response. Conclusion: Total serum calcium, phosphate, and ALP levels increased after bilateral tibial bone marrow ablation and urine calcium and hydroxyproline excretion also increased as a factor of bone resorption. Subcutaneously administrated salmon calcitonin did not affect biochemical changes after marrow ablation. Single-dose intramedullary methylprednisolone inhibited extra-tibial bone resorption induced by cytokines after bone marrow ablation. © 2017, The Author(s)
Prolongation of Corrected QT Interval Is a Strong Predictor of Arterial Stiffness in Maintenance Hemodialysis Patients: A Prospective Observational Study
No full textBackground: Rate of mortality due to cardiovascular diseases is high in Maintenance Hemodialysis (MHD) patients. Additionally, prolonged QT interval is reportedly associated with high-risk ventricular arrhythmia and sudden death. Vascular calcification may be related to QT dispersion interval in MHD patients because the extensive nature of the calcification process may involve the conducting system and myocardium.
Objectives: This study aimed to evaluate the relationship between QT interval and Pulse Wave Velocity (PWV) as a sign of arterial stiffness associated with atherosclerosis in MHD patients.
Patients and Methods: This prospective, observational study was conducted on 149 eligible MHD patients for 12 months. Patients using drugs known to affect QT interval were excluded. The patients were divided into four groups as follows: normal corrected QT (QTc) interval at the beginning and end of the study (n = 44, 29.5%), normal QTc interval at the beginning but prolonged QTc interval at the end of the study (n = 30, 20.1%), prolonged QTc interval at the beginning but normal QTc interval at the end of the study (n = 24, 16.1%), and prolonged QTc interval at the beginning and end of the study (n = 51, 34.2%). Demographic parameters, laboratory parameters, and PWV were assessed at the beginning and the 12th month of the study. Then, the data were analyzed using ANOVA or Pearson 2 test and P < 0.05 was considered to be statistically significant.
Results: The study groups were similar with respect to age and comorbidities, including diabetes mellitus, hypertension, and dyslipidemia. In addition, there were no significant differences among the groups regarding the initial PWV (P = 0.412); however, the ending PWV showed significant differences (P = 0.029). The results of multivariate analysis showed that PWV was independently associated with change in the maximum QTc (confidence interval: 0.039 -1.787, P = 0.031, beta= 0.178).
Conclusions: The results suggested inclusion of QTc interval prolongation, as a predictor of cardiovascular disease, either alone or in combination with PWV in such high-risk patients
Differences in Physical Activity and Physical Fitness Level in Patients with Fibromyalgia Syndrome and Healthy Individuals
No full textObjective: The aim of this study was to investigate the physical activity and physical fitness levels in patients with fibromyalgia syndrome (FMS) and to compare the data with those in healthy individuals.
Methods: The study included 82 patients with FMS and 110 healthy individuals. In order to compare physical activity levels, all the subjects responded to the International Physical Activity Questionnaire, Long Form (IPAQ). The health-related physical fitness of the subjects was evaluated by body composition, muscle endurance, cardiorespiratory endurance, flexibility, and balance. Body mass index (BMI), sit-up test, 6-min walk test, sit and reach test, body lateral flexion, and Kinesthetic Ability Trainer 3000 (KAT 3000) were used to determine body composition, muscle endurance, cardiorespiratory endurance, flexibility, and balance, respectively.
Results: Of the patients with FMS, 36.6% were inactive, 45.1% were insufficiently active, and 18.3% were active. Of the healthy individuals, 40.9% were active, 36.4% were insufficiently active, and 22.7% were inactive. Significant differences were found (p<0.05) in IPAQ walking and total scores between the groups. The sit-up test scores (p<0.001) and right and left body lateral flexion scores (p<0.001) were significantly different between the FMS patient and control groups.
Conclusion: Our results showed that the physical activity and physical fitness levels of patients with FMS were lower than those of healthy individuals
Multimodality Imaging in Restrictive Cardiomyopathies: An EACVI expert consensus document In collaboration with the "Working Group on myocardial and pericardial diseases" of the European Society of Cardiology Endorsed by The Indian Academy of Echocardiography
No full textRestrictive cardiomyopathies (RCMs) are a diverse group of myocardial diseases with a wide range of aetiologies, including familial, genetic and acquired diseases and ranging from very rare to relatively frequent cardiac disorders. In all these diseases, imaging techniques play a central role. Advanced imaging techniques provide important novel data on the diagnostic and prognostic assessment of RCMs. This EACVI consensus document provides comprehensive information for the appropriateness of all non-invasive imaging techniques for the diagnosis, prognostic evaluation, and management of patients with RCM
New integer programming formulation for multiple traveling repairmen problem
No full textThe multiple traveling repairman problem (kTRP) is a generalization of the traveling repairman problem which is also known as the minimum latency problem and the deliveryman problem. In these problems, waiting time or latency of a customer is defined as the time passed from the beginning of the travel until this customer's service completed. The objective is to find a Hamiltonian Tour or a Hamiltonian Path that minimizes the total waiting time of customers so that each customer is visited by one of the repairmen. In this paper, we propose a new mixed integer linear programming formulation for the multiple traveling repairman problem where each repairman starts from the depot and finishes the journey at a given node. In order to see the performance of the proposed formulation against existing formulations, we conduct computational analysis by solving benchmark instances appeared in the literature. Computational results show that proposed model is extremely effective than the others in terms of CPU times. (C) 2016 The Authors. Published by Elsevie
Parathyroid Hormone Levels in the Prediction of Ischemic Stroke Risk
No full textObjective. It was examined whether PTH and 25-dihydroxyvitamin D(25(OH)D) levels, together or separately, are indicators of the risk of stroke. Materials and Methods. This prospective study was performed at two centers. In the study, 100 patients diagnosed with acute ischemic stroke and 100 control individuals in the same age range were examined. In addition to neurological examination, cranial imaging, extensive routine blood chemistry, PTH, and 25(OH) D levels were evaluated in all cases. Stroke risk factors were determined. Logistic regression was used for statistical analysis. Results. A total of 60 patients and 79 control individuals were included in the study. Different estimation models were designed in order to examine the relationship between PTH and 25(OH) D levels with stroke. According to modeling results, it was determined that the most effective predictor for risk of stroke was 25(OH) D levels, followed by hypertension and PTH levels, respectively. Conclusion. PTH and 25(OH) D levels together can make important contributions to determination of stroke risk, and further investigations are needed to understand this relationship more fully