Publications by authors named "H Ali Genç"

175 Publications

Psychological Hardiness and Spirituality in Patients with Primary Brain Tumors: A Comparative Study.

J Relig Health 2021 Apr 5. Epub 2021 Apr 5.

Department of Nursing, School of Health Dicle University, Diyarbakır, Turkey.

The purpose of this research was to compare healthy individuals with patients having primary brain tumors (PBTs) with respect to their psychological hardiness and spirituality. In this study, a comparative and descriptive research design was employed. The research sample included 122 individuals: 61 patients with PBTs and 61 healthy individuals. When healthy individuals were compared with patients with PBTs, it was found that the patients with PBTs had significantly lower mean scores for spirituality and psychological hardiness. The study revealed that spirituality (β = .661) and age (β = - .270) were statistically significant predictors of psychological hardiness (p < .001). These variables explained 53% of the total variance. To decrease the negative effects of PBTs on psychological hardiness, nurses and other health staffs should focus on strategies that strengthen patients' spirituality.
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http://dx.doi.org/10.1007/s10943-021-01238-1DOI Listing
April 2021

The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals.

Eur J Pediatr 2021 Apr 3. Epub 2021 Apr 3.

Kidz Health Castle, Paediatric Gastroenterology, Hepatology and Nutrition, Universitair Ziekenhuis Brussel, Brussel, Belgium.

This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1-12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had ≥1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and ≥2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged ≤6 months than in the non-FGID group (P = 0.039).Conclusion: FGIDs occur quite common in infants. Since early diversification was associated with the presence of FGIDs, nutritional guidance and intervention should be part of the first-line treatment. Only 31% of the infants diagnosed with a FGID were presented because of symptoms indicating a FGID. What is Known: • The functional gastrointestinal disorders (FGIDs) are a very common disorder and affect almost half of all infants. • In infants, the frequency of FGIDs increases with mistakes made in feeding. When FGIDs are diagnosed in infants, nutritional support should be the first-line treatment. What is New: • This study shows that only a third of children presented to hospital because of the symptoms of FGIDs, but pediatricians were able to make the diagnosis in suspected infants after appropriate evaluation. • The early starting of complementary feeding (<6 months) is a risk factor for the development of FGIDs.
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http://dx.doi.org/10.1007/s00431-021-04059-2DOI Listing
April 2021

Four ectopia cordis cases surgically managed with different strategies.

Turk Gogus Kalp Damar Cerrahisi Derg 2021 Jan 13;29(1):114-118. Epub 2021 Jan 13.

Department of Pediatric Cardiology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey.

Ectopia cordis is a rare congenital disorder in which the heart is partially or completely located outside the chest cavity. In this article, we present four cases of ectopia cordis accompanied by cardiac abnormalities with either thoracic and/or abdominal placed heart, managed with strategies ranging from follow-up without any intervention to complete surgical closure.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2021.19791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7970079PMC
January 2021

Evaluation of dysfunctional high-density lipoprotein levels with myeloperoxidase/paraoxonase-1 ratio in rheumatoid arthritis.

Int J Clin Pract 2021 Mar 23:e14172. Epub 2021 Mar 23.

Medical Biochemistry, Yildirim Beyazit University, Ankara, Turkey.

Background: The aim of this study is to evaluate dysfunctional high-density lipoprotein cholesterol (HDL) by measuring myeloperoxidase (MPO)/paraoxonase 1 (PON1) ratio in patients with rheumatoid arthritis (RA) and to investigate the relationship between dysfunctional HDL and cardiovascular disease (CVD) in RA patients.

Methods: Sixty-seven healthy individuals and 130 RA patients were included in the study. Routine lipid panels (triglyceride (TG), low-density lipoprotein cholesterol (LDL), HDL, total cholesterol (TC), PON1 and MPO levels were measured. Disease activity scores-28 (DAS28) of RA patients were calculated. Cardiological examination records of the patients were assessed to detect patients who also have CVD.

Results: There were no significant differences between RA and control groups in routine lipid profiles (P > .05 for all). MPO/PON1 ratios were significantly elevated in the RA group compared with the control group (P < .001). MPO/PON1 ratios were higher in RA patients with CVD history compared with those without CVD (P < .05). MPO/PON1 ratios were correlated with DAS28 scores (rho: 0.357, P < .001).

Conclusion: HDL dysfunction determined by the MPO/PON1 ratio may be associated with the pathophysiology of increased CVD in RA. Thus, evaluating dysfunctional HDL levels by measuring the MPO/PON1 ratio in RA patients may allow more detailed patient follow-up, as well as the reduction of CVD events in RA patients with therapeutic agents aiming to increase the functional properties of HDL by decreasing this ratio.
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http://dx.doi.org/10.1111/ijcp.14172DOI Listing
March 2021

Differential Responses to Bioink-Induced Oxidative Stress in Endothelial Cells and Fibroblasts.

Int J Mol Sci 2021 Feb 26;22(5). Epub 2021 Feb 26.

Section of Experimental Oncology and Nanomedicine (SEON), Else Kröner-Fresenius-Stiftung-Endowed Professorship for Nanomedicine, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany.

A hydrogel system based on oxidized alginate covalently crosslinked with gelatin (ADA-GEL) has been utilized for different biofabrication approaches to design constructs, in which cell growth, proliferation and migration have been observed. However, cell-bioink interactions are not completely understood and the potential effects of free aldehyde groups on the living cells have not been investigated. In this study, alginate, ADA and ADA-GEL were characterized via FTIR and NMR, and their effect on cell viability was investigated. In the tested cell lines, there was a concentration-dependent effect of oxidation degree on cell viability, with the strongest cytotoxicity observed after 72 h of culture. Subsequently, primary human cells, namely fibroblasts and endothelial cells (ECs) were grown in ADA and ADA-GEL hydrogels to investigate the molecular effects of oxidized material. In ADA, an extremely strong ROS generation resulting in a rapid depletion of cellular thiols was observed in ECs, leading to rapid necrotic cell death. In contrast, less pronounced cytotoxic effects of ADA were noted on human fibroblasts. Human fibroblasts had higher cellular thiol content than primary ECs and entered apoptosis under strong oxidative stress. The presence of gelatin in the hydrogel improved the primary cell survival, likely by reducing the oxidative stress via binding to the CHO groups. Consequently, ADA-GEL was better tolerated than ADA alone. Fibroblasts were able to survive the oxidative stress in ADA-GEL and re-entered the proliferative phase. To the best of our knowledge, this is the first report that shows in detail the relationship between oxidative stress-induced intracellular processes and alginate di-aldehyde-based bioinks.
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http://dx.doi.org/10.3390/ijms22052358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956320PMC
February 2021

Hope, Sociodemographic and Clinical Characteristics as Predictors of Stigma-Related Negative Discrimination Experiences of Patients With Primary Malignant Brain Tumor.

J Neurosci Nurs 2021 Apr;53(2):81-86

Abstract: BACKGROUND: A brain tumor can cause specific dysfunctions including psychosocial problems, and neurological, cognitive, mental, personality, behavioral, body image, and self-concept changes. Hope is reported in previous studies as an important and protective factor during the difficult duration of the disease. The purpose of this study is to examine hope and related factors as predictors of the stigma-induced negative discrimination experience of patients with primary malignant brain tumor. METHODS: The relational research method was used. The study was conducted in neurosurgery and oncology clinics and outpatient clinics of a university hospital in Southeastern Turkey between July 2018 and March 2020. The research data were collected using an information form, the Discrimination and Stigma Scale, and the Dispositional Hope Scale. The research sample consisted of 124 patients with primary malignant brain tumor. The data were analyzed by stepwise multiple linear regression analysis. RESULTS: The average age of the patients with primary malignant brain tumor was 46.64 (±12.00) years. Of all the patients, 61.3% were male, and 25% received radiotherapy. When the negative discrimination experience of patients with primary malignant brain tumor was examined, age (β = -0.244, P = .004), total dispositional hope (β = -0.225, P = .009), and currently receiving radiotherapy (β = 0.169, P = .048) were determined to be significant predictors. CONCLUSION: This study demonstrates the importance of hope, age, and treatment type in the negative discrimination experience of patients with primary malignant brain tumor. Initiatives taking hope into account should be planned by nurses and healthcare professionals to reduce patients' experience of negative discrimination.
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http://dx.doi.org/10.1097/JNN.0000000000000579DOI Listing
April 2021

Microvesicular steatosis: a missed item in the management of nonalcoholic fatty liver disease?

Acta Gastroenterol Belg 2020 Oct-Dec;83(4):565-570

Department of Gastroenterology, Balikesir University Medical School, Cagis, Balikesir, 10145, Turkey.

Background: Nonalcoholic fatty liver disease (NAFLD) is among the most common causes of chronic liver disease and cirrhosis. In NAFLD, histological course of steatosis is usually macrovesicular (MacroS), but it may be accompanied by varying degrees of microvesicular steatosis (MicroS). Thus, in this study, we aimed to evaluate the prevalence and significance of MicroS in subjects with NAFLD.

Methods: A retrospective analysis of clinical and laboratory data of patients with histologically proven NAFLD was performed. The liver biopsy specimens which stained with hematoxylin eosin, reticulin, and Masson's Trichrome stains were evaluated by single expert liver pathologist. Scoring and semiquantitative assessment of steatosis and NAFLD severity was done according to Kleiner scale known as NAFLD activity score (NAS). Grading for steatosis, steatosis type, zonal distribution of steatosis and other histological findings were also determined.

Results: The prevalence of MicroS among the study population (n= 191) was 30.4%. There was no difference regarding the demographic and biochemical parameters between patients with or without MicroS. On the other hand, the prevalence of ballooning injury and megamitochondria were higher in patients with MicroS (p= 0.019 and p= 0.036, respectively). There was a significant association of MicroS with ballooning injury (OR 2.65, 95% CI= 1.26-5.55 ; p= 0.005) and the presence of megamitochondria (OR 3.72, 95% CI= 1.00-13.72 ; p= 0.037).

Conclusion: MicroS is common in patients with NAFLD and is associated with early histological findings in this clinically relevant condition. Further longitudinal studies are needed to characterize the role of MicroS in the natural history of NAFLD.
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December 2020

Cardiac Inflammatory Myofibroblastic Tumor Causing Pulmonary Artery Obstruction: A Rare Case Report.

J Pediatr Hematol Oncol 2020 Dec 2. Epub 2020 Dec 2.

Pathology.

Inflammatory myofibroblastic tumor (IMT) is a rare soft tissue tumor of the heart. In the literature, cardiac IMT is often described as an endocardial-based cavitary mass originating from the right side of the heart in infants and adolescents. In this article, we present a 5-year-old boy with a rare cardiac IMT who had no complaints and was diagnosed with murmur during his routine examination. Transthoracic echocardiography showed a homogeneous polypoid mass originating from the pulmonary valve, extending into the main pulmonary artery during systole and causing obstruction of the pulmonary artery and right ventricular outflow tract. Surgical resection of the tumor was performed successfully. There was no tumor recurrence in the control echocardiography at the postoperative first month.
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http://dx.doi.org/10.1097/MPH.0000000000002000DOI Listing
December 2020

The role of ultrasonography in follow-up of effectiveness of Complex Decongestive Therapy (CDT) in different subgroups of patients with breast cancer-related lymphoedema.

Eur J Cancer Care (Engl) 2021 Mar 20;30(2):e13376. Epub 2020 Nov 20.

Ankara Training and Research Hospital, Physical Medicine and Rehabilitation Clinic, University of Health Science, Ankara, Turkey.

Objective: To determine the role of ultrasonography in the follow-up of effectiveness of complex decongestive therapy (CDT) in different subgroups of patients with breast cancer-related lymphoedema (BCRL).

Methods: Forty-seven patients with unilateral upper BCRL were enrolled in the study. The patient group was divided into two subgroups according to body mass index (BMI) as obese and non-obese and three subgroups according to International Society of Lymphology staging. All patients underwent CDT, the circumference measurements and ultrasonographic soft tissue thicknesses evaluations were performed at two anatomic sites, and upper extremity limb volumes were calculated using the truncated cone formula before and after CDT.

Results: There were significant decreases in both circumferential measurements and ultrasonographic soft tissue thicknesses in non-obese patients and stage 2 lymphoedema patients after 15 sessions of CDT. The ultrasonographic soft tissue thickness values were correlated with the upper arm and forearm circumference values before (r = 0.491, p < .001, r = 0.841, p < .001, respectively) and after (r = 0.535, p < .001, r = 0.714, p < .001, respectively) CDT.

Conclusions: Ultrasonography presents as a reliable method to measure the soft tissue thickness and treatment efficacy after CDT in only non-obese and stage 2 patients with BCRL.
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http://dx.doi.org/10.1111/ecc.13376DOI Listing
March 2021

Acute flaccid myelitis outbreak through 2016-2018: A multicenter experience from Turkey.

Eur J Paediatr Neurol 2021 Jan 4;30:113-120. Epub 2020 Nov 4.

Division of Pediatric Neurology, Department of Pediatrics, İstanbul University Faculty of Medicine, İstanbul, Turkey.

Aim: We aim to describe the demographic characteristics, etiology, neurophysiology, imaging findings, treatment, prognosis, and prognostic factors of acute flaccid myelitis.

Methods: The clinical data, laboratory test and, magnetic resonance imaging (MRI) results of pediatric patients diagnosed with acute flaccid myelitis according to the Centers for Disease Control criteria between August 1, 2016, and December 31, 2018, from 13 centers in Turkey were reviewed.

Results: Of the 34 cases identified, 31 were confirmed (91.2%). Eighteen patients (55.9%) were boys. The median patient age was 4 years (interquartile range 2.5-6.9 years). Most of the patients were admitted in 2018 (n = 27). A preceding history of a febrile illness was reported in all patients, with a median of 4 days (interquartile range 3-7 days) before symptom onset. Thirty-one patients had T2 hyperintensity on spinal MRI, and 18 patients had cerebrospinal fluid pleocytosis. The most common infectious agents were entero/rhinoviruses (n = 5) in respiratory specimens. All patients except one received immunotherapy either alone or in combination. Among 27 patients with follow-up data 24 had persistent weakness. Involvement of four limbs together with an abnormal brain MRI at onset were associated with a poor prognosis.

Conclusion: The number of patients with acute flaccid myelitis increased since 2012, spiking with every 2-year interval, largely in the pediatric population. The median age decreases with every outbreak. Clinicians should be aware of the clinical picture for early collection of specimens and early start of rehabilitation programs. Further studies are needed to better characterize the etiology, pathogenesis, risk factors, and treatment of this rare condition.
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http://dx.doi.org/10.1016/j.ejpn.2020.10.011DOI Listing
January 2021

Assessment of Patients with Intracerebral Hemorrhage or Hemorrhagic Transformation in the VENOST Study.

Eur Neurol 2020 30;83(6):615-621. Epub 2020 Oct 30.

Department of Neurology, Acibadem University, Istanbul, Istanbul, Turkey.

Introduction: Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increased intracranial pressure; besides, ischemic or hemorrhagic lesions may develop. Intracerebral hemorrhages occur in approximately one-third of CVST patients. We assessed and compared the findings of the cerebral hemorrhage (CH) group and the CVST group.

Materials And Methods: In the VENOST study, medical records of 1,193 patients with CVST, aged over 18 years, were obtained from 35 national stroke centers. Demographic characteristics, clinical symptoms, signs at the admission, radiological findings, etiologic factors, acute and maintenance treatment, and outcome results were reported. The number of involved sinuses or veins, localizations of thrombus, and lesions on CT and MRI scans were recorded.

Results: CH was detected in the brain imaging of 241 (21.1%) patients, as hemorrhagic infarction in 198 patients and intracerebral hemorrhage in 43 patients. Gynecologic causes comprised the largest percentage (41.7%) of etiology and risk factors in the CVST group. In the CH group, headache associated with other neurological symptoms was more frequent. These neurological symptoms were epileptic seizures (46.9%), nausea and/or vomiting (36.5%), altered consciousness (36.5%), and focal neurological deficits (33.6%). mRS was ≥3 in 23.1% of the patients in the CH group.

Discussion And Conclusion: CVST, an important cause of stroke in the young, should be monitored closely if the patients have additional symptoms of headache, multiple sinus involvement, and CH. Older age and parenchymal lesion, either hemorrhagic infarction or intracerebral hemorrhage, imply poor outcome.
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http://dx.doi.org/10.1159/000510627DOI Listing
October 2020

Repeat endoscopic third ventriculostomy success rate according to ventriculostoma closure patterns in children.

Childs Nerv Syst 2021 Mar 31;37(3):913-917. Epub 2020 Oct 31.

Department of Neurosurgery, Ankara University, Sihhiye, 06100, Ankara, Turkey.

Purpose: This study aimed to examine the success rate of repeat endoscopic third ventriculostomy (redo-ETV) according to pattern of ventriculostoma closure based on observations in 97 paediatric redo-ETV patients.

Methods: Clinical data and intraoperative video recordings of 97 paediatric hydrocephalus patients who underwent redo-ETV due to ventriculostoma closure at two institutions were retrospectively analysed. We excluded patients with a history of intraventricular haemorrhage, cerebrospinal fluid (CSF) infection or CSF shunt surgery and those with incompletely penetrated membranes during the initial ETV.

Results: Verification of ventriculostoma closure was confirmed with cine phase-contrast magnetic resonance imaging and classified into 3 types: type 1, total closure of the ventriculostoma by gliosis or scar tissue that results in a non-translucent/opaque third ventricle floor; type 2, narrowing/closure of the ventriculostoma by newly formed translucent/semi-transparent membranes; and type 3, presence of a patent ventriculostoma orifice with CSF flow blockage by newly formed reactive membranes or arachnoidal webs in the basal cisterns. The overall success rate of redo-ETV was 37.1%. The success rates of redo-ETV according to closure type were 25% for type 1, 43.6% for type 2 and 38.2% for type 3. The frequency of type 1 ventriculostoma closure was significantly higher in patients with myelomeningocele-related hydrocephalus.

Conclusion: For patients with ventriculostoma closure after ETV, reopening of the stoma can be performed. Our findings regarding the frequencies of ventriculostoma closure types and the success rate of redo-ETV in paediatric patients according to ventriculostoma closure type are preliminary and should be verified by future studies.
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http://dx.doi.org/10.1007/s00381-020-04949-0DOI Listing
March 2021

Why did we encounter gusher in a stapes surgery case? Was it enlarged medial aperture of the cochlear aqueduct?

Surg Radiol Anat 2021 Feb 27;43(2):225-229. Epub 2020 Oct 27.

Department of Otorhinolaryngology, Head and Neck Surgery, Gulhane Medical School, University of Health Sciences, 06018, Etlik, Ankara, Turkey.

Background And Purpose: Preoperative prediction of cerebrospinal fluid (CSF) gusher is important for stapes surgery. According to the current opinion settled among otologists and radiologists, the issues of whether enlarged cochlear aqueduct might be a cause of CSF gusher in stapes surgery and which segment of the aqueduct should be taken into account to diagnose enlarged cochlear aqueduct in computerized tomography (CT) are controversial. The case we encountered led us to hypothesize that enlarged cochlear aqueduct might cause CSF gusher in stapes surgery and that shape and diameter of medial aperture of the cochlear aqueduct are important in this prediction.

Methods And Results: Enlarged medial aperture of the cochlear aqueduct with a shape differed from that of the other side was retrospectively diagnosed in thin-slice CT in a patient who had been undergone middle ear and stapes surgery for conductive hearing loss. This finding went unnoticed in preoperative CT. In the small fenestra stapedotomy operation, CSF gusher occurred through opening in the ill-defined, fixed and thickened stapes footplate. A piece of temporalis fascia and reshaped incus were appropriately placed which stopped the gusher. Re-evaluation of preoperatively taken CT showed that anterior-posterior and superior-inferior diameters of the medial aperture were 11.7 mm and 2.87 mm in CSF gusher side versus 2.95 mm and 1.88 mm on the other side, respectively. Its shape in gusher side differed from that of the other side.

Conclusion: This report is the first to show video-documented CSF gusher in a patient with enlarged medial aperture of the cochlear aqueduct. It appears to be plausible to propose that these findings have to change the otologists' and radiologists' perspective to the cochlear aqueduct. It can be deduced that difference in shapes of the medial aperture in both sides might be an indicator of potential CSF gusher.
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http://dx.doi.org/10.1007/s00276-020-02602-8DOI Listing
February 2021

Pain relief in a patient with snapping scapula after 5% dextrose injection.

Turk J Phys Med Rehabil 2020 Sep 18;66(3):368-369. Epub 2020 Aug 18.

Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey.

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http://dx.doi.org/10.5606/tftrd.2020.4169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557628PMC
September 2020

Validity and reliability of the Turkish version of the adult ADHD Self-Report Screening Scale for DSM-5.

Balkan Med J 2021 Mar;38(2):111-115

Department of Child Psychiatry, Marmara University School of Medicine, İstanbul, Turkey;Child Study Center, Yale University School of Medicine, New Haven, CT, USA.

Background: Approximately half of the children with attention-deficit hyperactivity disorder continue to meet diagnostic criteria in adulthood. The prevalence of adult attention-deficit hyperactivity disorder is reported between 2.5% and 4.4% and is associated with significant impairment in quality of life and increased psychiatric comorbidity. Attention-deficit hyperactivity disorder in adults remains mostly undiagnosed and/or untreated despite the availability of effective treatments. The majority of people who do not receive necessary treatment are in the nonclinical or nonpsychiatric clinical population. Screening is an important step for diagnosing adults with attention-deficit hyperactivity disorder. Yet, there are no valid and reliable screening questionnaires calibrated for the Diagnostic and Statistical Manual for Mental Disorders-5 in Turkish.

Aims: We aimed to test the reliability and the validity of the Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 screening questionnaire designed according to DSM-5 in the Turkish population.

Study Design: Methodological and cross-sectional study.

Methods: The translation was carried out according to the World Health Organization Composite International Diagnostic Interview translation guide using a linguistic adaptation approach. We used a convenience sampling method to recruit an individual with adult attention-deficit hyperactivity disorder (n = 68) and a control group (n = 68). The participants completed a sociodemographic form, 6-items Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5, and the previous version 18-items Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 for the concurrent validity analysis. For the diagnostic validity, clinical diagnosis made by psychiatrists according to the Diagnostic and Statistical Manual for Mental Disorders-5 criteria was used. Internal consistency and item-total correlation coefficients, exploratory factor analyses, correlation with Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1, and receiver operating characteristic curve analysis were conducted.

Results: The internal consistency measured by Cronbach alpha was 0.869. Item-total correlation coefficients were calculated to be between 0.602 and 0.717, and the correlations were statistically significant (P < 0.0001). The Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 showed to have a unidimensional factor structure explaining 60.54% of the variance. The correlation between Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 and Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 total score was calculated as 0.992 (P < 0.0001), and that between Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 and Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 attention-deficit subdimension was 0.868 (P < 0.0001). In the receiver operating characteristic analysis of Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5, the area under the curve was found to be 0.916. The cut-off score was calculated as 9 of 10 with a sensitivity of 85.2% and specificity of 89.7%.

Conclusion: Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 is a valid and reliable self-report measure to assess and screen attention-deficit hyperactivity disorder in the Turkish population. It may be useful for both clinical and population studies.
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http://dx.doi.org/10.4274/balkanmedj.galenos.2020.2020.5.119DOI Listing
March 2021

Cerebral Venous Sinus Thrombosis in Women: Subgroup Analysis of the VENOST Study.

Stroke Res Treat 2020 1;2020:8610903. Epub 2020 Sep 1.

Maltepe Government Hospital, Clinic of Neurology, Istanbul, Turkey.

Background: Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group.

Methods: Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF.

Results: The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34 ± 9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38 ± 9 years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%).

Conclusion: The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients.
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http://dx.doi.org/10.1155/2020/8610903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481993PMC
September 2020

Isokinetic evaluation of the trunk muscle strength in housewives with fibromyalgia: a cross-sectional study.

Adv Rheumatol 2020 08 14;60(1):40. Epub 2020 Aug 14.

Department of Physical Medicine and Rehabilitation, Health Sciences University, Ankara Training and Research Hospital, 06230, Ankara, Turkey.

Background: It is known that physical activity and muscular performance are reduced in fibromyalgia (FM) syndrome. This study aims to compare the performance of trunk muscles in women with FM and healthy controls and evaluate the correlation between trunk muscle strength and FM severity.

Methods: Forty-six patients with FM and 42 age- and body mass index-matched healthy housewives without FM were included in the FM and control groups, respectively. The Fibromyalgia Impact Questionnaire (FIQ) was used for the assessment of FM severity. The pain intensity was evaluated using the visual analogical scale (VAS). An isokinetic dynamometer was used to measure the isokinetic trunk muscle strength. The peak torque (PT) values were recorded. The psychological status of the patients was evaluated using the Beck Depression Inventory.

Results: There was no statistically significant difference in terms of age, BMI, and BDI scores in two groups (p > 0.05, for all). The isokinetic trunk extensor PT values were significantly lower in the FM group (p = 0.002 for 60°/s, and p < 0.001 for 90°/s and 120°/s) than control group. There was a statistically significant negative correlation between FIQ score and isokinetic extensor muscle parameters.

Conclusion: The results indicate that trunk extensor muscles were significantly weaker in FM patients. Trunk extensor muscle strength decreased as FM severity increased in FM patients.
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http://dx.doi.org/10.1186/s42358-020-00142-8DOI Listing
August 2020

Comparison of the effects of using non-steroidal anti-inflammatory drugs with or without kinesio taping on the radial nerve in lateral epicondylitis: A randomized-single blind study.

Explore (NY) 2020 Jul 30. Epub 2020 Jul 30.

Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey.

Background: There is no knowledge about the effects of kinesio taping (KT) on the radial nerve in lateral epicondylitis.

Objective: This study aimed to determine the effects of non-steroidal-anti-inflammatory drugs (NSAIDs) combined with KT on lateral epicondylitis using ultrasonographic findings.

Methods: NSAID therapy was administered to the control group for 10 days, and the KT group additionally received KT three times a week for two weeks. Clinical and ultrasonographic evaluations were performed before treatment and at post-treatment at second, sixth and fourteenth weeks. The radial nerve cross sectional area and common extensor tendon thicknesses were measured using ultrasonography.

Results: The study was completed with 40 patients in each group. Improvements in clinical parameters, common extensor tendon thickness, and cross sectional area values were significant in the KT group (p<0.01).

Conclusions: NSAID plus kinesio taping decrease pain intensity while improving functionality and ultrasonographic parameters, including common extensor tendon thickness and radial nerve cross sectional area; therefore, it may be an option treatment in lateral epicondylitis.
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http://dx.doi.org/10.1016/j.explore.2020.07.008DOI Listing
July 2020

Minimally invasive parathyroidectomy using intraoperative ultrasonographic localization for primary hyperparathyroidism in pregnancy: report of two cases.

Turk J Surg 2019 Sep 23;35(3):231-235. Epub 2019 Sep 23.

Clinic of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.

Primary hyperparathyroidism (pHPT) in pregnancy is a rare entity associated with increased maternal and fetal mortality and morbidity. Diagnosis of pHPT is challenging in pregnancy. Approximately 80% of the cases are asymptomatic, while the most common symptoms are nausea, vomiting, polyuria, polydypsia, and cloudy vision in symptomatic patients. Since the most common cause of pHPT in pregnancy is adenoma, such in the general population, focused anterior or lateral approach is recommended due to shorter operation time, less risk for the fetus, and lower complication risk. Performing intraoperative ultrasonography to do the incision just over the adenoma provides quicker access to the adenoma and intraoperative parathormone assay confirms the surgical cure. Laryngeal mask anesthesia causes lesser sore throat, laryngospasm, coughing, and rapid recovery as compared to endotracheal intubation anesthesia. This study aimed to present the management of two pregnant patients diagnosed with pHPT and who underwent minimally invasive parathyroidectomy under intraoperative ultrasonography and laryngeal mask anesthesia at the second trimester of gestation. To the best of our knowledge, parathyroidectomy under laryngeal mask anesthesia in pregnancy has never been described before.
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http://dx.doi.org/10.5578/turkjsurg.4330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795229PMC
September 2019

Voice outcomes for patients undergoing surgery for obstructive sleep apnea: a systematic review and meta-analysis.

Eur Arch Otorhinolaryngol 2020 Dec 2;277(12):3261-3281. Epub 2020 Jun 2.

Department of Otolaryngology, Head and Neck Surgery, Gulhane Medical School, Ankara, Turkey.

Purpose: To evaluate the effect of the different surgical techniques used in the treatment of obstructive sleep apnea (OSA) on the postoperative voice and nasalance, and to conduct a meta-analysis through the assessment of postoperative changes.

Methods: Systematic literature review and meta-analysis of published data using the data sources, MEDLINE, Google Scholar, Cochrane, and SAGE. All studies published in English specifying any upper airway surgery for treatment of snoring and/or OSA were included, provided they indicated the pre- and postoperative mean ± standard deviation (SD) values for voice parameters and nasality. The primary outcomes were the changes in preoperative-postoperative mean values of fundamental frequency (mF0), jitter, shimmer, and nasalance scores.

Results: After removal of duplications, 214 studies were potentially relevant, and 25 studies ultimately met the criteria for inclusion in the present review. Of the 25 studies evaluated in this review, 12 studies with 379 patients were available for the meta-analysis calculations. In general, a fixed-effects model was used to analyze the data in the subgroups. The meta-analysis results showed no significant differences in either subgroup analysis between the preoperative and postoperative assessments of mF0, jitter, shimmer, oral nasalance, nasal nasalance, and oronasal nasalance (All had values of p > 0.05).

Conclusion: The results of this meta-analysis indicated no significant effect of surgical treatments for snoring or OSA on glottic functioning and nasalance parameters, regardless of surgery type. Further prospective studies are needed to assess more parameters for detailed acoustic analyses.
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http://dx.doi.org/10.1007/s00405-020-06101-9DOI Listing
December 2020

The Effects of Operation Technique on Recurrence of Incisional Hernia Repair.

Sisli Etfal Hastan Tip Bul 2020 24;54(1):23-28. Epub 2020 Mar 24.

Department of General Surgery, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.

Objectives: The selection of incision type, closure type of incision and the suture material are some of the important factors to prevent hernia development. We should aim to perform the best procedure with the best technique to reduce the risk of recurrence. Surgical options include primary repair and open or laparoscopic repair with mesh. Mesh repairs can be performed as onlay, sublay or inlay according to the area where the mesh is to be laid. In this retrospective study, our main goal was to compare the recurrence rates in patients who underwent incisional hernia repair with onlay and inlay mesh techniques.

Methods: This retrospective study included 185 patients who underwent surgery due to incisional hernia in our clinic between January 2012 and October 2017. Patients were divided into two groups according to the technique as Group 1 with onlay mesh repair and Group 2 with inlay mesh repair. The same type of mesh (prolen) was applied to all patients.

Results: There were 121 patients in Group 1 and 64 patients in Group 2. According to data we obtained, 64.3% of the patients were women and the mean age of all patients was 58.4±16.4 years. Postoperative complications (such as seroma-hematoma, surgical site infection, mesh rejection, postoperative ileus) developed in 29.2% (n=54) of the patients. The length of hospital stay was 4.2±3 days in Group 1 and 5.6±5 days in Group 2. The mean follow-up period was 48.6 months (24-93 months), with the recurrence rates of 5.8% (n=7) in Group 1 and 10.9% (n=7) in Group 2, respectively. There was a statistically significant difference between the groups concerning comorbidity, postoperative complications, the length of hospitalization stay and recurrence.

Conclusion: We believe that the onlay technique will be more appropriate than the inlay technique when only prolen mesh is preferred because the recurrence rates are higher in the inlay technique.
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http://dx.doi.org/10.14744/SEMB.2019.23334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192261PMC
March 2020

Epileptic seizures in cerebral venous sinus thrombosis: Subgroup analysis of VENOST study.

Seizure 2020 May 3;78:113-117. Epub 2020 Mar 3.

Clinic of Neurology, Saglik Bilimleri University, Istanbul Research and Training Hospital, Istanbul, Turkey.

Purpose: The aim of this study is to evaluate the presence and prognostic impact of early seizures in cerebral venous sinus thrombosis patients (CVST).

Method: VENOST is a retrospective and prospective national multicenter observational study. CVST patients with or without epileptic seizures (ES) were analyzed and compared in terms of demographic and imaging data, causative factors, clinical variables, and prognosis in a total of 1126 patients.

Results: The mean age of the patients in the ES group was 39.73 ± 12.64 and 40.17 ± 14.02 years in the non-ES group (p > 0.05). Epileptic seizures were more common (76.6 %) in females (p < 0.001). Early ES occurred in 269 of 1126 patients (23.9 %). Epileptic seizures mainly presented in the acute phase (71.4 %) of the disease (p < 0.001). Majority of these (60.5 %) were in the first 24 h of the CVST. The most common neurological signs were focal neurologic deficits (29.9 %) and altered consciousness (31.4 %) in the ES group. Superior sagittal sinus (SSS) and cortical veins (CV) involvement were the most common sites of thrombosis and the mostly related etiology were found puerperium in seizure group (30.3 % vs 13.9 %). Patients with seizures had worse outcome in the first month of the disease (p < 0.001) but these did not have any influence thereafter.

Conclusions: In this largest CVST cohort (VENOST) reported female sex, presence of focal neurological deficits and altered consciousness, thrombosis of the SSS and CVs, hemorrhagic infarction were risk factors for ES occurrence in patients with CVST.
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http://dx.doi.org/10.1016/j.seizure.2020.02.017DOI Listing
May 2020

Attention-Deficit Hyperactivity Disorder Symptoms in A Group of Children Receiving Orthodontic Treatment in Turkey.

Turk J Orthod 2020 Mar 1;33(1):31-36. Epub 2020 Mar 1.

Department of Child and Adolescent Psychiatry, Marmara University School of Medicine, İstanbul, Turkey.

Objective: Children with attention-deficit hyperactivity disorder (ADHD) are known to have several oral health problems, particularly traumatic dental injuries, decayed or filled teeth, and poor oral hygiene. The objective of the present study was to determine the ADHD symptoms in a group of patients with malocclusion and receiving orthodontic treatment.

Methods: A total of 88 subjects with a diagnosis of malocclusion between aged 8 and 17 years were included in the study. Socio-demographic characteristics, breastfeeding history, oral habits, and dental trauma history of the subjects were acquired by a detailed questionnaire. Subjects and their parents completed questionnaires addressing ADHD, other psychiatric problems, and dental health impact on the quality of life. During the orthodontic examination, the Index of Complexity, Outcome, and Need was applied to confirm the diagnosis of malocclusion.

Results: Parent-reported psychiatric complaint occurred in almost half of the patients (n=38, 43.2%); the most frequent psychiatric complaints were inattention (n=22, 25%), opposition (n=13, 14.8%), and hyperactivity (n=11, 12.5%). The estimated ADHD prevalence according to parent measure was 15.9% (n=14). Self-report measures revealed that 18.4% (n=16) had behavioral symptoms. The most affected quality of life domain was psychological discomfort.

Conclusion: The findings indicate that ADHD prevalence in children with malocclusion is high. The orthodontists should have a keen eye on behavioral problems.
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http://dx.doi.org/10.5152/TurkJOrthod.2020.19020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138232PMC
March 2020

The effects of watching comedy videos on anxiety and vital signs in surgical oncology patients.

Explore (NY) 2020 Nov - Dec;16(6):401-406. Epub 2020 Mar 6.

Department of Surgical Nursing, Inonu University, Fac.of Nursing Malatya, Malatya, Turkey,. Electronic address:

Background: Cancer, a disease as old as recorded human history, causes patients pain and psychological problems. Watching comedy videos can distract these patients, relieving psychological issues without causing any further harm.

Methods: This randomized clinical trial was conducted on patients who were candidates for oncologic surgery at a university hospital in Turkey. The sample of the study consisted of 88 patients. Before surgery, patients in the experimental group (n = 44) watched comedy videos while those in the control group (n = 44) received no intervention. The Patient Introduction and Registration Form and the State and Trait Anxiety Inventory (STAI) were used as data collection tools. Anxiety, measured by the STAI, and vital signs (blood pressure, pulse, respiration, and oxygen saturation) were measured before and after the experimental protocol. Descriptive statistics, chi-square and t-test were used in the analysis of the data.

Results: The pretest of STAI scores and vital signs were similar in both groups (p  >  0.05). After video watching, the mean state anxiety score of the patients was 43.36 ± 9.76 in the experimental group and 47.13 ± 5.76 in the control group. The difference between the mean anxiety scores of the two groups was statistically significant (p < 0.05). However, there were no significant differences in vital signs across groups (p > 0.05). Within group pre- versus post-treatment comparisons showed significant reduction in anxiety, diastolic and systolic blood pressures in the video group (p<0.05), while in controls, there was no significant improvement in anxiety and physiologic values.

Conclusions: The results suggest that watching comedy videos has a beneficial effect on pre-operative anxiety and blood pressure in surgical oncology patients.
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http://dx.doi.org/10.1016/j.explore.2020.02.009DOI Listing
March 2020

Comparative efficacy of medical treatment versus surgical sphincterotomy in the treatment of chronic anal fissure.

Niger J Clin Pract 2020 Apr;23(4):539-544

Department of General Surgery, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, Çigli, İzmir, Turkey.

Background: Anal fissure which is defined as a longitudinal tear in anoderm below the dentate line is one of the most common benign diseases of anorectal area. Severe pain during the defecation and emotional stress that it causes may reduce people's quality of life.

Aims: In this randomized clinical trial, we aimed to compare the efficiency of the topical ointment with medical treatment and surgical lateral internal sphincterotomy.

Method: This is a randomized clinical trial of 550 patients who were treated for chronic anal fissure. Patients were randomly divided into 4 groups according to the treatment type they received.

Results: In a vast majority of the patients, the primary complaint was pain (92.3%) and bleeding during defecation (62%). Both pain relief and healing of the fissure, which are the components of response to treatment, had not been observed in 56 (37.3%) patients of topical nitroglycerin ointment group until the second month. Among the recalcitrant patients in both topical nitroglycerin (56) and topical diltiazem ointment (47) groups, 27 (48.2%), and 36 (76.5%) patients underwent surgery, respectively. The best response to treatment was also obtained in lateral internal sphincterotomy group.

Conclusion: LIS is still the gold standard for the treatment of chronic anal fissure when the physicians would like to avoid recurrence and obtain the best pain relief.
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http://dx.doi.org/10.4103/njcp.njcp_383_19DOI Listing
April 2020

Acute ophthalmoparesis and persistent mydriasis: expanding the clinical spectrum of anti-GQ1b positive cranial neuropathy in a 5.5-year-old girl.

Turk J Pediatr 2019 ;61(5):794-797

Division of Child Neurology, Department of Pediatrics, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.

Sakarya Güneş A, Maraş Genç H, Uyur Yalçın E, Yılmaz V, Saruhan Direskeneli G, Kara B. Acute ophthalmoparesis and persistent mydriasis: expanding the clinical spectrum of anti-GQ1b positive cranial neuropathy in a 5.5-year-old girl. Turk J Pediatr 2019; 61: 794-797. Acute ophthalmoparesis without ataxia (AO) is an atypical form of Miller- Fisher syndrome (MFS) and is rare in children. Anti-GQ1b antibodies can be detected in patients with AO, as in MFS. A 5.5-year-old girl had total ophthalmoparesis, blurred vision, ptosis, diplopia and mydriasis non-reactive to light or near stimuli with preserved consciousness and deep tendon reflexes. She had no ataxia. Cerebrospinal fluid (CSF) examination and cranial MRI were normal. Serum antiGQ1b antibodies were positive. She was diagnosed with AO and intravenous Immunoglobulin (IVIG) was ordered, 400 mg/ kg/day, for 5 days. Ophthalmoparesis and blurred vision improved in a few weeks. At the end of the first year, mydriasis still persisted, but improved and became responsive to near stimuli. Pupillary involvement may be seen in approximately 50% of MFS patients, and improvement in a few weeks or months has been reported in adults. Our case shows the expanding clinical spectrum of anti-GQ1b positive cranial neuropathy as early-onset AO and prolonged mydriasis more than one year.
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http://dx.doi.org/10.24953/turkjped.2019.05.023DOI Listing
August 2020

A Rare Presentation of Gout: Achilles Tendinopathy, Ultrasonographic Assessment.

Am J Med Sci 2020 04 23;359(4):245-246. Epub 2020 Jan 23.

Department of Physical Medicine and Rehabilitation Health Sciences University, Ankara Training and Research Hospital Ankara, Turkey.

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http://dx.doi.org/10.1016/j.amjms.2020.01.016DOI Listing
April 2020

Acute compressive radial neuropathy and wrist drop due to the repetitive overuse of the arm.

Neurol Sci 2020 Apr 9;41(4):989-991. Epub 2019 Dec 9.

Department of Physical Therapy and Rehabilitation, Health Sciences University Ankara Training and Research Hospital, Ulucanlar Street Altındağ, 06230, Ankara, Turkey.

Objection: Entrapment neuropathies are common in clinical practice. Early diagnosis and management of nerve compression is necessary to maintain limb function and to improve the patient's quality of life.

Case Report: In this article, we reported a woman presenting with wrist drop as a result of acute radial nerve compression following strenuous activity involving the arms. The diagnosis was based on clinical and ultrasonographic findings. Once the diagnosis was made, activity modifications and systemic steroid were prescribed, and the patient made a near-complete recovery.

Conclusion: Patients with acute wrist drop and sensorial loss should be examined in terms of arm overuse, and radial nerve compression should be confirmed by peripheral nerve ultrasound.
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http://dx.doi.org/10.1007/s10072-019-04100-1DOI Listing
April 2020

Effect of Dextrose Prolotherapy on Pain Intensity, Disability, and Plantar Fascia Thickness in Unilateral Plantar Fasciitis: A Randomized, Controlled, Double-Blind Study.

Am J Phys Med Rehabil 2020 04;99(4):318-324

From the Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey.

Objective: The aim of the study was to evaluate the efficacy of dextrose prolotherapy in the treatment of chronic resistant plantar fasciitis through comparison with a control group.

Design: In this double-blind, randomized, controlled study, the patients were divided into two groups. The prolotherapy group (n = 30) was administered 5 ml of 30% dextrose, 4 ml of saline, and 1 ml of 2% lidocaine mixture (15% dextrose solution) and the control group was given 9 ml of saline and 1 ml of 2% lidocaine mixture twice at a 3-wk interval. During the 15-wk follow-up period, pain intensity was measured using the visual analog scale during activity and at rest. The foot function index was used to measure pain and disability. The plantar fascia thickness was measured by ultrasonography. The measurements were undertaken before treatment and at posttreatment weeks 7 and 15.

Results: Improvements in visual analog scale during activity, at rest, foot function index (all subgroups), and plantar fascia thickness measured at the 7th and 15th weeks were significantly higher in the prolotherapy group compared with the control group (P < 0.001).

Conclusions: Dextrose prolotherapy has efficacy up to 15 wks and can be used as an alternative method in the treatment of chronic resistant plantar fasciitis.
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http://dx.doi.org/10.1097/PHM.0000000000001330DOI Listing
April 2020

Canalicular laceration (cheese wiring) with a silicone tube after endoscopic dacryocystorhinostomy: when to remove the tube?

GMS Ophthalmol Cases 2019 30;9:Doc35. Epub 2019 Oct 30.

Isparta Suleyman Demirel University, Faculty of Medicine, Department of Ophthalmology, Isparta, Turkey.

To discuss the removal time of a nasolacrimal silicone tube stent by reporting three cases with canalicular laceration due to prolonged indwelling of the stent. This study involved three cases of nasolacrimal duct obstruction treated by endoscopic dacryocystorhinostomy with silicone tube insertion. The mean indwelling time of the silicone tube was 9.3 months and all of the patients had lower canalicular laceration near the common canaliculus. One patient presented with a complaint of canthal pain, blurred vision, and epiphora while the other two patients reported no complaint. The nasal endoscopic examination revealed a narrow fibrotic ostium below the medial concha. The silicone tubes were removed. To increase the success rate of the operation, the removal time for nasolacrimal silicone tubes after dacryocystorhinostomy is also important. Our findings indicate that physicians should be aware of the potential problems related to prolonged intubation.
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http://dx.doi.org/10.3205/oc000124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848888PMC
October 2019