Gait analysis in neurological populations: Progression in the use of wearables

Gait assessment is an essential tool for clinical applications not only to diagnose different neurological conditions but also to monitor disease progression as it contributes to the understanding of underlying deficits. There are established methods and models for data collection and interpretation of gait assessment within different pathologies. This narrative review aims to depict the evolution of gait assessment from observation and rating scales to wearable sensors and laboratory technologies and provide limitations and possible future directions in the field of gait assessment. In this context, we first present an extensive review of current clinical outcomes and gait models. Then, we demonstrate commercially available wearable technologies with their technical capabilities along with their use in gait assessment studies for various neurological conditions. In the next sections, a descriptive knowledge for existing inertial and EMG based algorithms and a sign based guide that shows the outcomes of previous neurological gait assessment studies are presented. Finally, we state a discussion for the use of wearables in gait assessment and speculate the possible research directions by revealing the limitations and knowledge gaps in the literature.

Susac Syndrome: Clinical characteristics, diagnostic findings and treatment in 19 cases

Susac's Syndrome (SS), which was first described in 1979, is a rare and presumably autoimmune disorder characterized by encephalopathy, hearing loss, and visual disturbance resulting from branch retinal artery occlusion (BRAO). This study reports 19 SS patients' clinical characteristics, MRI features, CSF analysis, treatment strategies and outcomes. At initial presentation, only three of 19 patients demonstrated the complete clinical triad. Clinic presentation varied from isolated hemiparesis to the full triad (encephalopathy, hearing loss and visual disturbances). Corpus callosum (CC) involvement was noted in the MRI of 18 patients (97%) and BRAO was detected in 17 (95%) patients. All patients were treated with intravenous methylprednisolone after the initial assessment. This case series is presented to emphasize the differences in clinical presentation of SS and the importance of MRI and FFA in diagnosis.

The efficacy of ozone therapy in neonatal rats with hypoxic ischemic brain injury

OBJECTIVES

This study is aimed to determine the effect of ozone therapy in neonatal rats with experimentally induced hypoxic ischemic brain injury (HIBI).

METHODS

The study included 7-d-old male Wistar rats that were randomized to the sham, control, ozone 1, and ozone 2 groups. All rats except those in the sham group were kept in a hypoxia chamber, and then the rats in the control group were given 0.5 mL of saline. Those in the ozone 1 group were given ozone 1 mg kg-1 intraperitoneally, and those in the ozone 2 group were given ozone 2 mg kg-1 intraperitoneally.

RESULTS

There were significantly fewer apoptotic neurons in the right hemispheres of the rats in the ozone 1 and ozone 2 groups than in the control group (p < 0.001 and p < 0.001, respectively). There were significantly fewer apoptotic neurons in the right hemispheres of the rats in the ozone 2 group than in the ozone 1 group (p < 0.001). Morris Water Maze (MWM) test results were similar in the ozone 2 and sham groups.

CONCLUSIONS

The present study's findings show that ozone therapy reduced neuronal apoptosis and improved cognitive function in neonatal rats with experimentally induced HIBI (Tab. 2, Ref. 30).

Therapeutic hypothermia and myocardium in perinatal asphyxia: a microvolt T-wave alternans and Doppler echocardiography study

OBJECTIVES

This is the first study evaluating the predictive value of myocardial performance on arrhythmia and mortality via tissue-Doppler and microvolt T-wave alternans in infants with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia-rewarming.

METHODS

The study included 23 term newborns having criteria for hypoxic-ischemic encephalopathy, and 12 controls. Tissue-Doppler imaging and T-wave alternans were performed in the first six hours after birth in patients from both groups and after hypothermia-rewarming treatment on the fifth day.

RESULTS

The basal T-wave alternans values were higher in patients in lead aVF(p < 0.001) which also correlated with existing acidemia (r = 0.517; p = 0.012). Basal T-wave alternans and post‑treatment values of patients were compared in leads V1 (p < 0.001) and aVF (p < 0.001); a significant decrease was found on the fifth day. Moreover, right ventricle diastolic diameter and estimated systolic pulmonary artery pressure of patients in the first 6 hours were higher (p = 0.03, p < 0.001, respectively). Although, the ejection fraction of patients did not decrease, basal values of left and right ventricular systolic and diastolic functions were lower initially, and increased significantly after treatment.

CONCLUSION

The global cardiac functions and myocardial performance of newborns with hypoxic-ischemia might be improved with therapeutic hypothermia which can be determined by using T-wave alternans and tissue-Doppler measurements. However, further studies are needed to assess whether these measurements are prognostic in determining the myocardial dysfunction and arrhythmias (Tab. 2, Fig. 3, Ref. 26).

Is levetiracetam neuroprotective in neonatal rats with hypoxic ischemic brain injury?

BACKGROUND

The aim of this study was to determine if levetiracetam (LEV) is neuroprotective in neonatal rats with hypoxic-ischemic brain injury (HIBI).

METHODS

The study included 7-d-old male Wistar rats that were randomly divided into the LEV400, LEV800, control, and sham groups. All the rats, except those in the sham group, underwent ligation of the carotid artery and were then kept in a hypoxic chamber containing 8% oxygen for 2 h. At the end of the hypoxic period the rats in the control group were administered saline solution 0.5 mL, the rats in the LEV400 group were administered LEV 400 mg.kg-1, and rats in the LEV800 group were administered LEV 800 mg.kg-1 via the intraperitoneal route. The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL) method was used to evaluate neuronal apoptosis in the rats. The Morris Water Maze (MWM) test was performed at age 14 weeks in order to evaluate cognitive function.

RESULTS

The number of apoptotic neurons in the right hemispheres was significantly lower in the sham, LEV400, and LEV800 groups than in the control group (p < 0.001, p < 0.001, and p < 0.001, respectively). In addition, the number of apoptotic neurons in the right hemispheres was significantly lower in the LEV800 group than in the LEV400 group (p = 0.001). Platform finding time (PFT) during MWM testing was significantly shorter in the sham and LEV800 groups on d 4 than on d 1 (p = 0.001 and p = 0.006, respectively); however, PFT did not significantly change between d 1 and d 4 in the control or LEV400 groups (p = 0.91 and p = 0.096, respectively).

CONCLUSION

Based on the present findings, LEV exhibited a dose-dependent neuroprotective effect in neonatal rats with HIBI (Ref. 27).

Cost of Nosocomial Infection in Turkey: An Estimate Based on the University Hospital Data

Nosocomial infections significantly affect the resource needs of hospitalized patients. They increase the mortality and morbidity of affected individuals and expose hospital staff to increased risk of infection. To estimate the additional resources needed in the hospital sector to deal with such infections, a sample of infection cases was selected from the Hacettepe University Hospital in Ankara, Turkey. Each case of nosocomial infection was matched with a noninfected case after controlling for age, sex, clinical diagnosis etc. of the patients. The empirical results indicate that hospital infection increases the average hospital stay by about four days. Total cost of an infected case, on average, was found to be $442 higher than that for a matched noninfected case. Using this incremental cost estimate, projections for Turkey implies that the hospital sector had to spend an additional $48 million in 1995 for medical management of nosocomial infections. The benefit: cost ratio for a hospital-based infection control programme is found to be about 4.6. Clearly, a programme for preventing nosocomial infections will not only pay for itself but also will generate other direct and indirect benefits to patients and society as a whole.

Surgical outcome of bronchiectasis in children: long term results of 60 cases

BACKGROUND

Bronchiectasis is described as destruction and the irreversible dilatation of bronchial structure. We wanted to demonstrate our surgical practice and outcome of surgical treatment in bronchiectasis.

METHODS

We studied records of 60 pediatric patients who underwent surgical resection in our clinic between January 2000 and January 2013. The results were analyzed regarding factors influencing the outcome.

RESULTS

There were 32 boys and 28 girls with a mean age of 9.45 years (range 2-15). The most common cause was childhood infection in 25 (41.66%). The mean duration of the symptoms was 42.93 months. Patients underwent 64 operations including 2 staged thoracotomies and 2 re-thoracotomies. Atelectasis was the most frequent complication. Longer duration of symptoms related to postoperative complication. The morbidity and mortality rates were 20% and 3.33%, respectively. The outcome was optimal in 92%. Forced expiratory volume in 1 s less than 60% of the predicted value, hemoptysis and duration of symptoms were found prognostic variables for postoperative morbidity with high ratios of odds coefficients by using Binary Logistic Regression Method.

CONCLUSIONS

Complete and early resection of bronchiectasis provides a successful outcome. Duration of symptoms and timely intervention have a major impact on the management and prognosis.

Increased platelet count in severe peritoneal endometriosis

OBJECTIVE

Platelet count (PC) is higher in chronic inflammatory diseases. The aim of this study was to evaluate the PC in patients with severe pelvic endometriosis.

MATERIALS AND METHODS

Patients with advanced stage pelvic endometriosis were retrospectively evaluated in a tertiary center between January 2009 and December 2011. Patients with pelvic endometriosis were divided into two groups; advanced stage peritoneal endometriosis were classified as Group 1 (n = 28). Group 2 consisted of 29 patients which had ovarian endometrioma without clinically apparent peritoneal endometriosis foci. Group 3 included 51 women as control subjects. PC between the groups was tested by Student's t test. The mean values of three groups were analyzed by using one way ANOVA test followed post-hoc test Bonferroni.

RESULTS

PC in patients with pelvic endometriosis were found to be higher from the control group (290 +/- 67 10(9)/1; 264 +/- 63 10(9)/1, respectively; p = 0.038). Patients with peritoneal endometriosis (Group 1) had significantly higher PCs compared with the healthy controls (309 +/- 65 10(9)/1; 264 +/- 63 10(9)/1; respectively; p = 0.011).

CONCLUSION

Increased PC in advanced stage pelvic endometriosis may be a sign of increased systemic inflammation. The systemic inflammation may be more apparent in advanced stage peritoneal endometriosis.

The predictors of poor outcomes in patients with femoral artery injuries

PURPOSE

This study investigated the predictors of poor outcomes, including limb loss and death, in patients with femoral artery injuries.

PATIENTS AND METHODS

The study included 158 patients aged 2-82 (mean age 28.4 ± 16.5) with femoral arterial injury (common, deep, and superficial femoral artery) that were treated surgically between 2000 and 2010. Isolated venous injuries were excluded. Demographic and clinical data of the patients, including age, gender, admission time, pulse rate and blood pressure, hematocrit value, reason of injury, associated injury, and Mangled Extremity Severity Score (MESS) were recorded.

RESULTS

Of the 158 patients, the death and amputation rates were 5.7% (9) and 5.1% (8), respectively. In logistic regression analysis, four variables (pulse rate, MESS, hematocrit, and bone trauma) were found to be independent predictors for poor outcomes. The Odd's ratios and confidence interval values of these variables were as follows: 7.24 (1.94-26.92), 21.75 (5.41-87.48), 5.93 (3.04-11.54) and 7.46 (2.09-9.56), respectively.

CONCLUSIONS

The MESS value, presence of bone fracture, hematocrit, and pulse rate on admission are predictive risk factors for poor outcomes in patients with femoral artery injury. Therefore, in these patients, prompt intervention by experienced surgeons is crucial for limb salvage and decreased mortality.

Effects of treatment regimens on survival in patients with malignant pleural mesothelioma

BACKGROUND AND OBJECTIVE

In this study, we aimed to investigate the factors affecting the survival of patients with malignant pleural mesothelioma (MPM) according to their treatment regimens, including best supportive care (BSC), chemotherapy, surgical group and multimodality (MM) therapy.

PATIENTS

A retrospective analysis was performed on clinical data and treatment outcomes of 400 patients registered in our hospital with MPM between January 1989 and April 2010.

RESULTS

Mean age (p < 0.001), presence of asbestos exposure (p = 0.0014), presence of smoking history (p < 0.001), Karnofsky performance status (p < 0.001), histological subtype (p = 0.034) and stage (p < 0.001) variables were found to be significantly different among the four treatment regimens. Mean survival time of all patients was 12.32 months. Mean survival time 10.5 months for the BSC group, 15.7 for the surgical group, 16.02 for the chemotherapy group, and 26.55 for the MM group. There were significant differences in mean survival time among the four treatment regimens. In addition, a significant difference was found in survival time between the two chemotherapy groups (p = 0.032). Mean survival time for cisplatin + gemcitabine was found to be 14.49 months and for cisplatin + pemetrexed, 18.34 months.

CONCLUSIONS

The MM group had better survival rates than the other groups. The new chemotherapy combination, cisplatin + pemetrexed, can be helpful in improving survival time.      

Risk factors for maternal mortality in eclampsia: analysis of 167 eclamptic cases

BACKGROUND

The aim of this study was to evaluate risk factors associated with maternal mortality in patients with eclampsia.

METHODS

The probable risk factors of maternal mortality including maternal age, length of hospital stay, gestational age, systolic and diastolic blood pressures; hematocrit, hemoglobin, platelet count, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase were determined from patients' charts and Odds ratios (OR) of these factors were detected using by logistic regression analysis.

RESULTS

According to logistic regression model, AST [OR, (95% Confidence Interval, CI): 7.39 (2.71-20.13)]; ALT [6.45 (2.42-17.16)]; postpartum diastolic blood pressure [4.58 (1.80-11.62)]; hematocrit [3.52 (1.86-6.65)]; hemoglobin [2.67 (2.01-3.55)] were found to be significant risk factors for maternal mortality.

CONCLUSIONS

In eclamptic patients, close monitoring of particular laboratory values and blood pressure, and early intervention to alterations of certain variables will provide possibility for prevention against potential complications and subsequently decreasing mortality.

Clinico-epidemiological study of caustic substance ingestion accidents in children in Anatolia: the DROOL score as a new prognostic tool

BACKGROUND

To examine the clinico-epidemiological details of paediatric caustic substance ingestion (CSI) accidents in Turkey. To present the new DROOL Score (DS), which the authors developed based on the severity and duration of initial signs and symptoms (ISSs) to predict oesophageal stricture (OS) without endoscopy, and to present our management protocol based on immediate feeding, early detection, and oesophageal balloon dilatation (OBD) of OS with no barium study.

METHODS

We prospectively reviewed the records of 202 children admitted with a history of CSI within 48 hours. Patient, parent, caustic substance, and accident characteristics were noted in detail. Patients were fed as soon as they could swallow saliva. Diagnoses of OS were made earlier via timely endoscopy (mean, 10-14 days after CSI) for patients with persistent dysphagia and OBD was started earlier. ISSs and DSs were analyzed. OS treatment results were compared between early (10-14 days) and late (> or = 21 days) dilatation patients who were referred for OBD by other hospitals.

RESULTS

In total, 144 (71%) incidents occurred within the parents' home and 44 (22%) occurred at another individual's home. The caustic substances were frequently sold in non-original containers (68.8%). Most patients' parents had low incomes and were poorly educated. Ninety-six children had no ISSs, whereas 106 patients had ISSs. Seventeen symptomatic patients had persistent dysphagia after 10-14 days. Timely endoscopy was performed within 10-14 days for these patients only, and OS was diagnosed and successfully treated. DSs were significantly lower in patients with OS than those without (p < 0.001). A DS < or = 4 was a significant predictor of OS (100% sensitivity, 96% specificity, 85% positive and 100% negative predictive values). Results were significantly more satisfactory in early (n = 17) than in late (n = 6) dilatation patients.

CONCLUSIONS

Paediatric CSI accidents might decrease if caustic substances were sold in the original child-proof containers. OS can be highly predicted by a simple DS instead of endoscopic grading, and can be diagnosed earlier (10-14 days) via endoscopy only in patients with persistent dysphagia, instead of a late barium study (> or = 21 days). OBD can then also be started earlier in these patients.

Outcomes of pregnancies in women with parity ten or more: a case control study

PURPOSE

To determine the outcomes of pregnancies in women with parity ten and more.

MATERIALS AND METHODS

We designed this study in a government hospital in rural Turkey. Pregnant women with parity of ten or more (n=126) were evaluated and compared with pregnant women with parity lower than ten (n=90). The risk factors recorded were maternal age, parity, gestational age (weeks), delivery mode, fetal birth weight and Apgar scores. Statistical analyses were carried out using the statistical packages for SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, U.S.A.).

RESULTS

During the study period, a total of 12,551 deliveries were delivered at the current clinic. One hundred and twenty-six mothers were delivered with parity ten or more with a ratio of 1.01%. There was a statistically significant difference between the study and control group by means of maternal age, parity, fetal birth weight and 1- and 5-min Apgar scores (p < 0.05). There was no difference in delivery mode between the groups.

CONCLUSION

According to this study, pregnant women with parity ten or more showed no adverse clinical characteristics when compared with pregnant women with parity lower than ten.

Management of non-traumatic acute limb ischemia and predictors of outcome in 270 thrombembolectomy cases

AIM

Acute limb ischemia (ALI) is one of the most potentially devastating but treatable diseases, resulting from a sudden obstruction in the arterial flow. The aim of this study was to examine the outcome of thromboembolectomy, and to determine the risk factors associated with limb loss and mortality in ALI.

METHODS

A retrospective chart review of 270 patients on whom thromboembolectomy was performed between September 2002 and December 2009 due to ALI. Of these, 146 (54.1%) were men and mean age was 64.3.

RESULTS

Etiology was embolic in 63.3% of cases. Late thromboembolectomy after 72 hours was performed in 57.8% of patients. On admission 38.9% of patients had grade IIb ischemia; grade III ischemia was present in 9.6% of patients. Failure of first thromboembolectomy developed in 21.1% of patients and bypass surgery was performed on 25.2% of patients. Amputation and mortality rates were 7.4% and 8.5% respectively. Binary logistic regression analysis revealed that risk factors of limb loss were thromboembolectomy failure, high ischemic stage, high level of plasma creatinine kinase and compartment syndrome on admission and predictors of mortality were congestive heart failure, ischemic heart disease, reperfusion injury and longer ischemic time.

CONCLUSION

In ALI, thromboembolectomy is highly protective against amputation, as well as mortality, even in delayed cases with more than one week in the clinical absence of tissue necrosis. At least, it provides partial limb salvage. In addition, patients must be given a chance for limb salvage in the case of stage 3 ischemia, too.

Comparison of responses to Ovsynch between Holstein-Friesian and Swedish Red cows

The Ovsynch protocol was designed to synchronize ovulation, thereby allowing timed artificial insemination (TAI) of all cows without detection of estrus. However, the effectiveness of Ovsynch in different breeds of dairy cows has not been previously compared. The aim of this study was to compare the response to Ovsynch in cycling lactating Holstein-Friesian (HF) and Swedish Red (SR) dairy cows. A total of 495 cyclic cows (n=347 HF, n=148 SR) were housed together and treated with Ovsynch (GnRH-7 d-PGF2α-56 h-GnRH-16 to 18 h-TAI). Ovulatory responses, synchronization rate, maximal follicle size at the time of AI, and percentage of pregnant cows per AI (P/AI at 31 and 62 d after AI) were compared between breeds. Ultrasonography was performed during Ovsynch at first GnRH, PGF2α, at time of AI, and 7 d after AI. Ovulatory response and synchronization rate were similar in HF versus SR cows (60.2 vs. 62.2%; 88.4 vs. 88.5%, respectively). Cows that ovulated to the first GnRH of Ovsynch had smaller follicle size at AI (15.9±0.1 vs. 16.4±0.2 mm). Maximal follicle size at AI was greater for HF (16.4±2.2 mm) than SR (15.5±2.3 mm) cows. The P/AI was greater for SR than HF cows at the 62-d pregnancy diagnosis (56.1 vs. 46.1%). In addition, pregnancy loss between 31 and 62 d of pregnancy was greater in HF (10.1%) than SR (3.5%) cows. Fertility was less in HF cows during the hot season (57.7 in cold vs. 38.1% in the hot season), whereas such a decrease was not observed in SR (60.0 in cold vs. 53.5% in the hot season) cows. Thus, although the GnRH treatments of Ovsynch were equally effective in SR and HF cows, pregnancy outcomes (P/AI at d 62 and pregnancy survival) were greater in SR than HF cows, and P/AI in SR cows was not compromised during the hot season as was found for HF cows.

Evaluation of adolescent pregnancies: 10-year experience of a hospital in rural Turkey

PURPOSE

To evaluate the characteristics of adolescent pregnancies admitted to our clinic.

MATERIALS AND METHODS

This retrospective and descriptive study was performed at Ergani State Hospital from January 2000 to December 2010. This is an outpatient gynecology and obstetrics at government hospital in Southern Eastern Region of Turkey. A total of 15,210 pregnancies were delivered during the study period, of whom 711 of them were adolescent pregnancies. Statistical analyses were carried out using the statistical packages for SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA).

RESULTS

During the study period, of the total of 15,210 deliveries 711 (4.6%) were adolescent pregnancies (age range 14-19 years). The mean age (95% CI) of the patients was 17.90 +/-1.12 (17.82-17.98) years old. Most of the patients were nulliparous (n = 559, 78.60%). Mean gestational weeks, fetal birth weight and fetal birth length and 95% CI values were as follows: 37.11 +/- 2.53 (36.93-37.30), 3045.73 +/- 51.70 (3007.65-3083.79) and 48.68 +/- 2.31 (48.51-48.85), respectively. Six hundred and twenty (87.20%) of the patients delivered spontaneously by the vaginal route, while 91 (12.80%) were delivered by cesarean section. Although the age range of the patients was not wide, there was a significant correlation between maternal age, gestational age, fetal birth weight and fetal birth length (p < .01).

CONCLUSION

According to this study, the ratio of adolescent pregnancies was found to be 4.6% which was lower than other regions of Turkey. The majority of the patients were nulliparous and most delivered spontaneously by the vaginal route. There was a significant correlation between maternal age, gestational age, fetal birth weight and fetal birth length.

Clinical significance of procalcitonin in cervico-vaginal secretions of women with preterm rupture of membranes

PURPOSE

To compare vaginal fluid procalcitonin (PCT) concentrations in cases of preterm premature rupture of membranes (PPROM) and healthy pregnant women, and to determine whether the PCT concentrations are of value in the diagnosis of PPROM cases and clinical amnionitis.

METHODS

50 cases with PPROM and 50 healthy pregnant women were enrolled in the study. In the PPROM group, analysis was conducted on PCT concentrations with reference to serum leucocytosis, serum C-reactive protein level and urine analysis, as well as to presence/absence of clinical amnionitis. Statistical analyses were carried out by using the statistical packages for SPSS 12.0 for Windows (SPSS Inc., Chicago, IL, USA).

RESULTS

Procalcitonin levels in the PPROM group were significantly higher than in cases of healthy pregnant women (1.17 vs 0.05 ng/ml; p < 0.001). In the PPROM group PCT concentrations between the patients with and without clinical amnionitis were comparable. Also, a significant correlation was observed between PCT and leucocytosis (r = 0.64; p < 0.001) and C-reactive protein (r = 0.90; p < 0.001).

CONCLUSION

These findings suggest that the value of vaginal fluid PCT determinations can be useful for diagnostics of PPROM cases suspected of intrauterine infection.

The association of preoperative thrombocytosis with prognostic factors in malign ovarian tumor

PURPOSE

We assessed the association of preoperative thrombocytosis with prognostic factors in malign ovarian tumor.

METHODS

Over a five-year period, cases treated for ovarian cancer were randomly assigned. The data were collected from gynecological oncology, radiation oncology, medical oncology and pathology departments. Statistical analyses were carried out by using the statistical packages for SPSS 12.0 for Windows (Chicago, IL, USA). Survival was analyzed by the method of Kaplan and Meier, using log-rank (Mantel-Cox) analysis.

RESULTS

51 cases with ovarian cancer were evaluated. Cases with thrombocytosis were found to have greater CA-125 levels, more advanced stage disease, more ascites and shorter periods of survival.

CONCLUSION

Thrombocytosis is a poor prognostic factor in ovarian cancer. As reported previously, it is associated with aggressive tumor biology. Thus, preoperative thrombocytosis can be a used as a marker of poor outcomes.

The clinical significance of HPV screening in premalignant cervical lesions

PURPOSE

We evaluated the clinical significance of human papilloma virus (HPV) screening in premalignant cervical lesions.

METHODS

This prospective study was performed at Dicle University, School of Medicine, Department of Obstetrics and Gynecology, from January 2009 to June 2009. A total of 60 cases were evaluated. Thirty cases had premalignant cervical lesions. The prevalence of HPV was analyzed by polymerase chain reaction and types determined by Hybrid Capture II. The cases that had premalignant cervical lesions were evaluated with colposcopy. Statistical analyses were carried out by using the statistical packages for SPSS version 12.0 for Windows (Chicago, IL, USA).

RESULTS

Of all the cases, those with premalignant cervical lesions had higher prevalence of HPV DNA. The cases that had high oncogenic HPV type had more abnormal colposcopic findings.

CONCLUSION

Premalignant cervical lesions should be evaluated by cervical cytology, colposcopy, HPV DNA screening and cervical tissue sampling. In this way, development of cervical cancer can be prevented.

Changing cerebral blood flow velocity detected by transcranial Doppler ultrasound during head up tilt in patients with multiple sclerosis

BACKGROUND AND PURPOSE

Multiple sclerosis (MS) is a chronic inflammatory disease of central nervous system. We aimed to investigate the cerebral blood flow velocity (CBFV) changes in MS by transcranial Doppler.

METHODS

Twenty patients with MS, 20 age-matched healthy controls were included in the study. In both groups, blood flow velocities (BFVs) of middle cerebral arteries (MCAs) were evaluated. The changes of blood pressure, heart rate along with the changes in BFV of MCA were recorded after the patients were raised to upright position.

RESULTS

In both groups, upon raising the tilt table to the upright position, the mean CBFV values were found to be lower in comparison with the recorded baseline values (P values <0.05). The decline in the mean CBFV values was more significant in patients with MS (P = 0.01).

CONCLUSION

Our study showed upon raise of the tilt table, the mean BFVs decreased more in MS patients than control group with a more prominent change in the subgroup of MS patients with expanded disability scale scores > or =2. By use of transcranial Doppler ultrasound, it may be possible to evaluate BFV changes in patients with MS.

The Role of Asymmetric Dimethylarginine (ADMA) and Leptin in Hypertensive Patients

We investigated the role of leptin and asymmetric dimethylarginine (ADMA) in uncomplicated hypertension. We also investigated their relationship with insulin resistance and serum levels of several metabolic parameters, including homocysteine, lipoprotein(a) and malondialdehyde (MDA). A total of 34 untreated newly-diagnosed hypertensive patients (seven men and 27 women; mean age, 57.4 ± 10.1 years) and 38 normotensive healthy subjects (20 men and 18 women; mean age, 55.9 ± 8.7 years) were studied prospectively. Serum leptin, homocysteine, lipoprotein(a), MDA and insulin resistance (HOMA-IR) were significantly higher in hypertensive patients compared with normotensive subjects. There were no significant differences in ADMA, insulin-like growth factor-1 and insulin-like growth factor binding protein-3 between the two groups. No correlation was found between serum ADMA and leptin levels. Our findings suggest that high serum leptin and homocysteine levels, oxidative stress and insulin resistance may be important risk factors for atherosclerosis among patients with uncomplicated hypertension.

Comparison of tuberculin skin test and a specific T-cell-based test, T-Spot.TB, for the diagnosis of latent tuberculosis infection

There is substantial evidence that the detection of T cells specific for the proteins ESAT-6 and CFP-10 using the ex vivo enzyme-linked immunospot technique is a marked improvement on the existing tuberculin skin test (TST). This new technique, which detects gamma-interferon-producing T cells, is now available as the commercial assay, T-Spot.TB. We compared the T-Spot.TB test with the TST for the diagnosis of latent tuberculosis infection (LTBI) in different groups of subjects. Significant accordance (85.7%) between the tests was found in subjects with active lung tuberculosis and in tuberculosis clinic and laboratory personnel (63.6%) but accordance was lowest and not significant amongst house contacts of tuberculosis patients (53.6%). We conclude that, in countries where vaccination is routinely performed, the T-Spot.TB test is a useful diagnostic test for LTBI in high-risk groups when carried out either together with the TST and/or to confirm the TST result.

Brain SPECT findings in Wernicke?s encephalopathy

Wernicke's encephalopathy, a neurologic disease caused by thiamine deficiency, is observed chiefly in chronic alcoholics. We performed magnetic resonance imaging and single-photon emission computed tomography (SPECT) in an alcoholic patient who had developed Wernicke's encephalopathy. Although cranial MRI detected no pathology, brain SPECT revealed bilateral frontal and frontoparietal hypoperfusion as well as right basal ganglia hypoperfusion.

Electrocardiographic findings and prognosis in ischemic stroke

INTRODUCTION

Electrocardiographic (ECG) changes are observed in patients with acute stroke and are related with the prognosis.

AIMS

To determine the frequency and significance of ECG changes in patients with acute ischemic stroke.

MATERIAL AND METHODS

In a prospective hospital-based study 87 patients with cerebral infarction were observed for ECG changes during their stay in the hospital. All the patients had ischemic stroke for the first time. The ECG changes observed were compared with those of the control group consisting of 87 patients.

RESULTS

Of the 87 patients of the study group, 47.1% were females and 52.9% males. The mean age was 65.5 +/- 11.9 (range 31-91 yrs). The control group consisted of 50.6% females and 49.4% males. The mean age was 64.5 +/- 11.9 (range 31-87 yrs). The frequency of the ECG changes observed in patients with cerebral infarct was 62.1% while it was 29.9% in the control group (P<0.0001). ECG changes observed were mostly related to myocardial ischemia. The six-month mortality rate in the patients with ECG changes was 38.9% whereas it was 15.2% in those with normal ECG (P<0.05).

CONCLUSIONS

The observations of this study suggest that cardiac evaluation in patients with acute ischemic stroke is of prognostic importance.

Mitral valve vegetation and cerebral emboli in a primary antiphospholipid syndrome patient who had hepatitis C virus infection: report of a case and review of the literature

We report the case of 36-year-old woman who came to us with a history of recurrent miscarriages and who was later diagnosed as having primary antiphospholipid syndrome (PAPS) and chronic hepatitis C virus (HCV) infection. The patient was referred to us with generalised seizures; cranial MRI revealed multiple embolic infarcts in both frontal lobes and a focal cortical infarct in the left frontoparietal lobe. Her echocardiography showed mitral valve vegetation and insufficiency. The patient was put on oral anticoagulant therapy and during her 8-month follow-up period no thrombotic events occurred. We report this case because it was the first in which PAPS, valvular disease, a cerebral embolic event and HCV infection were coexistent in the same patient. We also review other cases in which there was valvular vegetation and a cerebral ischaemic event associated with PAPS.

CADASIL syndrome in a large Turkish kindred caused by the R90C mutation in the Notch3 receptor

Mutations in the Notch3 gene are the cause of the autosomal dominant disorder CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). The CADASIL is an adult-onset neurologic disorder (average age of onset is 45 years) characterized by recurrent strokes and dementia. Clinical features combined with cerebral magnetic resonance imaging (MRI), showing a diffuse leukoencephalopathy with subcortical infarcts in the basal ganglia and white matter, are highly contributive to the diagnosis. We present a Turkish family with CADASIL, in which 12 individuals in four generations were affected showing the typical clinical features of recurrent strokes. Mutation analysis of the Notch3 receptor gene identified the recently described R90C mutation in the N-terminal part of the gene in affected individuals. Interestingly, migraine without aura was found as an initial symptom of the disease in two young mutation carriers (22 and 25 years, respectively), who did not show any additional clinical features or any MRI abnormalities. This indicates that migraine without aura in the absence of MRI abnormalities may represent an early initial symptom of CADASIL, which is difficult to diagnose in the absence of molecular diagnosis. Therefore, the used molecular screening method for Notch3 mutations provides a rapid and accurate diagnostic tool in addition to the standard diagnostic procedures.

Bilaterally persistent horizontal gaze palsy and facial palsy caused by pontine infarction

Tegmental pontine infarctions make up only a small portion of all isolated pontine infarcts. These lesions cause isolated cranial nerve palsies, neuro-ophthalmologic signs, and sensory deficits. Clinical and anatomic correlation of these lesions has been made simple with the use of cranial magnetic resonance imaging (MRI). In this article, we report on a 43-year-old hypertensive woman with bilateral horizontal gaze palsy and peripheral facial paralysis but no limb weakness. Pontine paramedian tegmental infarct was visible on cranial MRI.

Cost of nosocomial infection in Turkey: an estimate based on the university hospital data

Nosocomial infections significantly affect the resource needs of hospitalized patients. They increase the mortality and morbidity of affected individuals and expose hospital staff to increased risk of infection. To estimate the additional resources needed in the hospital sector to deal with such infections, a sample of infection cases was selected from the Hacettepe University Hospital in Ankara, Turkey. Each case of nosocomial infection was matched with a noninfected case after controlling for age, sex, clinical diagnosis etc. of the patients. The empirical results indicate that hospital infection increases the average hospital stay by about four days. Total cost of an infected case, on average, was found to be $442 higher than that for a matched noninfected case. Using this incremental cost estimate, projections for Turkey implies that the hospital sector had to spend an additional $48 million in 1995 for medical management of nosocomial infections. The benefit: cost ratio for a hospital-based infection control programme is found to be about 4.6. Clearly, a programme for preventing nosocomial infections will not only pay for itself but also will generate other direct and indirect benefits to patients and society as a whole.

Inappropriate use of hospital beds: a case study of university hospitals in Turkey

The purpose of this study is to estimate the degree of Inappropriate Patient Days (IPDs) in a teaching hospital in Turkey using the Appropriateness Evaluation Protocol (AEP) criteria. One day was randomly chosen in 1995 for review and a second day was chosen close to the randomly selected day to indicate possible differences between a weekday and a weekend. Total hospital days reviewed were 221 with 114 days on Sunday and the remaining 107 days on a Tuesday. The evaluation indicates that more than 22 percent of patient days were inappropriate in the university hospital in Turkey. Multiple logistic regression equations were estimated to identify the determinants of IPDs. The results imply that age and sex of patient, clinical diagnosis at admission and type of health insurance coverage affect IPDs significantly. However, most of the IPDs occurred during the initial few days of hospital stay. Therefore, to improve the productivity of hospital resources, the gap between the admission date and the date of medical or surgical interventions should be reduced.

The socio-economic determinants of alternative sources of antenatal care in Turkey

This paper tries to ascertain the factors affecting the choice of alternative sources for antenatal care. The analysis is based on data collected from ever-married women in the 1998 Turkey Demographic and Health Survey (TDHS). The developing country setting provides substantial variation in the type of facility chosen, ranging from no antenatal care, to formal health care personnel, to modern private hospitals. The alternatives vary greatly in quality and price, making this an ideal context for examining the role of these variables in choosing a facility. The logit model specifications estimated individual, household-level and community-level characteristics of the women in the urban and rural sample as well as in the total sample in this study. The estimation results indicate that individual characteristics such as educational attainment and birth order are significant determinants of choosing alternative sources for antenatal care. The results also indicate that household-level characteristics such as health insurance coverage, car ownership, household assets and community-level characteristics are the other significant determinants of using alternative sources for antenatal care.

The socio-economic determinants of maternal health care utilization in Turkey

The purpose of this study is to investigate the individual-, household- and community-level factors that affect women's use of maternal health care services in Turkey. The data used for the study come from the 1993 Turkey Demographic and Health Survey (TDHS), a nationally representative survey of ever married women 15 to 49 years of age. In order to assess the impact of socio-economic factors on maternal health care utilization, we use logistical regression techniques to estimate models of the prenatal care use and birth delivery assistance among women who have had at least one birth in the three years prior to the survey. Separate models are also estimated for urban and rural women. The results indicate that educational attainment, parity level, health insurance coverage, ethnicity, household wealth and geographic region are statistically significant factors that affect the use of health care services thought essential to reduce infant and child mortality rates. The results of the model are used to provide insights for both micro- and macro-level planning of maternal health service delivery.

Turkish hospital management at a crossroads: prospects for the year 2000

The Turkish health system has been undergoing a radical reform process since the early 1990s. Reform proposals, based on purchaser/provider split, self-governing hospitals (ultimately leading to full privatization), compulsory health insurance etc., are expected to have a profound effect on hospital management. In such an environment, hospital administrators' views on the domains and issues that will come to the fore in the year 2000 gain importance. In this paper, results of a study undertaken among hospital administrators are presented. The study aimed to find the views of hospital administrators on issues likely to gain prominence in the year 2000 and the skills, knowledge, and abilities required to tackle these issues. It was concluded the autonomous status of hospitals, privatization, competition, and health trusts will become the central domains in the year 2000 in hospital administration. Innovation and following technological developments were considered most critical.

Amebic liver abscess: changing trends over 20 years

Amebiasis and amebic liver abscess (ALA) continue to be a major fatal disease in developing countries where unhygienic environmental conditions prevail. Between January 1975 and December 1984 there were 60 patients and from January 1985 to December 1994 there were 44 patients with ALA who were diagnosed and treated. In the first group, all patients were operated on, and drainage was performed. The morbidity and mortality rates were 53.3% and 23.3%, respectively. Metronidazole was given to all patients in the second group, and in those who did not respond to the metronidazole percutaneous needle aspiration was applied. Surgical treatment was performed in seven patients because four did not respond to metronidazole therapy and percutaneous needle aspiration, and in three the abscess ruptured into the peritoneal cavity. The lesion disappeared ultrasonographically after 4 months in all patients. The morbidity and mortality rates were 4.5% and 2.2%, respectively. The result of this study suggests that uncomplicated ALA can be managed conservatively with metronidazole and needle aspiration of the abscess. Operative therapy should be performed for complications of the abscess and when conservative therapy fails.

Use of the label "litigation neurosis" in patients with somatoform pain disorder

The use of the term "litigation neurosis"--a condition with controversial clinical significance--might correspond to the expression for a difficult physician-patient relationship. The characteristics of patients with a DSM-III-R diagnosis of somatoform pain disorder who had been labeled "litigation neurosis" by their physicians were explored. Among 74 patients referred to a pain clinic, 30% had been labeled litigation neurosis, and among 81 patients referred while claiming disability benefits, 19% had been thus categorized. The attribution of this label was neither correlated to actually being involved in a claim for disability benefits nor to involvement in legal action. Patients who had been designated with litigation neurosis were characterized by a lower educational level, a higher rate of DSM-III-R major depression, and a much higher frequency of personality disorders than patients who were not thus labeled. We postulate that the communication style of patients with this constellation of characteristics, in particular the presence of psychiatric comorbidity, may have engendered a difficult doctor-patient relationship, leading physicians to use the label in the absence of objective evidence of litigation or involvement in legal action. We agree that the inappropriate use of labels such as "litigation neurosis" should be questioned.

Comparison of microsuturing to the use of tissue adhesives in anastomosing sciatic nerve cuts in rats

The purpose of this study was to investigate and to compare the effects of microsuturing to that of tissue adhesives (Tisseel) on the healing of anastomosing peripheral nerve incisions. Forty-five Wistar-Albino rats were placed in special cages and separated into three groups (n = 15). In the control group, biliteral sciatic nerves were explored but no incision was made. In the first experimental group, bilateral sciatic nerves were incised and end-to-end anastomosing was performed by microsuturing the epineurium. In the second experimental group, tissue adhesive (Tisseel) was used alone in anastomosing the sciatic nerve cuts. Assessments of the healing processes were demonstrated by 1.electromyography (EMG), 2. measuring the electrical responses of the anastomosed nerves after electrical stimuli, 3. histopathological examination. Statistical analysis of the EMG findings showed that the Tisseel group was the closest in the healing process to the control group. After applying electrical stimuli to the dissected nerves, the resistance value of the Tisseel group was nearest to those of the control group. The histopathological examinations showed highly degenerative nerve bundles and prominent foreign body granuloma at the anastomosed sites of the microsutured group. The granulomatous inflammation was observed to be much less in the Tisseel group. We conclude that the healing effect of Tisseel was found to be superior to that of microsuturing as demonstrated by the findings of EMG, electrical responses of the anastomosed nerves, and histopathological examination.

Impression cytology, tear film break up, and Schirmer test in patients with inactive trachoma

Schirmer I and tear film break up time (BUT) test were used to determine cytological changes and conjunctival surface epithelial morphology was investigated using impression cytology in patients with inactive trachoma; patients with mild and severe scarring, and control subjects, were compared. Schirmer I, BUT, and goblet cell populations were significantly lower whereas the grade of squamous metaplasia was significantly higher in patients with inactive trachoma. There was a close correlation between our findings and the clinical severity of trachoma.