Validity and Reliability of the Turkish Version of the Postextubation Dysphagia Screening Tool.

Background and Purpose: Patients who have been intubated ≥48 hours are at risk of dysphagia. Evaluation of swallowing before starting oral feeding after extubation is necessary to prevent aspiration and the problems caused by aspiration. The Postextubation Dysphagia Screening tool is a validated and reliable tool used to evaluate extubation-induced dysphagia. This study was conducted to evaluate the validity and reliability of the Postextubation Dysphagia Screening Tool for the Turkish population. Methods: The study had a methodological design and was carried out with 50 patients followed in the intensive care unit of a public hospital. The study was carried out in four stages: (1) language validity, (2) content validity, (3) establishing interrater reliability by agreement with two observers (intensive care nurse and intensivist), and (4) establishing sensitivity and specificity with the intensive care nurse and intensivist. Results: The overall content validity index was 0.91, indicating content validity. Interrater reliability was established (Cohen's g = 0.93). The prevalence of postextubation dysphagia was 42%, and the sensitivity of the Postextubation Dysphagia Screening Tool was 82% and the specificity was 64%. Implications for Practice: The Turkish version of the Postextubation Dysphagia Screening Tool exhibited good evidence of validity and reliability and was determined important as it can help nurses evaluate postextubation dysphagia in intensive care patients. The use of this tool by a nurse reduces the risk of unsafe oral intake among patients after prolonged intubation. This tool allows accurate assessment of dysphagia and initiation of early and safe oral feeding in critical care patients.

Evaluation of forward head posture and thoracic kyphosis in migraine.

BACKGROUND: The purpose of the current study was to investigate the forward head posture (FHP), thoracic kyphosis and their relationships between individuals with migraine and healthy controls using the DIERS Formetric 4D motion imaging system. METHODS: In this observational case-control study, a total of 39 migraine patients and 44 healthy subjects were enrolled. FHP and thoracic kyphosis were assessed by using the 4D Formetric DIERS system. The visual analogue scale (VAS) and Neck Disability Index (NDI) was used to evaluate neck pain and neck disability. Headache status were evaluated through Migraine Disability Assessment (MIDAS) and Numeric Pain Rating Scale (NPRS) questionnaires. RESULTS: The fleche cervicale (57.72 ± 13.72 mm vs. 40.00 ± 4.75 mm; p < 0.001) and kyphotic angle (57.39 ± 8.76° vs. 38.21 ± 5.67°; p < 0.001) were significantly higher in patients with migraine compared to control group. When NDI categories were compared, the migraine group showed significantly increase in the number of patients with moderate or severe disability (p < 0.001). A positive correlation was found between fleche cervicale and thoracic kyphosis (r = 0.71, p < 0.001). CONCLUSIONS: This study revealed that patients with migraine exhibited a greater FHP and thoracic kyphosis compared to the control group. A 3-dimensional objective measurement may be a reliable diagnostic tool to evaluate posture analysis in clinical practice in the future.

Silent Micro-Infarct in Carotid Artery Stenting: Who Has it and Why?

AIM: To compare the postprocedural cerebral diffusion-weighted imaging (DWI) findings in cases of carotid stenosis (CS)-related carotid plaques in terms of plaque morphology, degree of stenosis, and the use of a distal protection filter. Moreover, we used DWI to assess the asymptomatic cerebral embolism rates during carotid artery stending (CAS) operations performed for noncalcified versus calcified carotid plaques. MATERIAL AND METHODS: Our study included 99 patients admitted to the Ankara City Hospital Stroke Center in 2022. All of our patients have been evaluated and scheduled for CAS as a result of a decision made by the council. Cases of stenosis of > 50% in symptomatic patients and > 70% in asymptomatic patients were included. The patients were grouped according to their Doppler ultrasonography results. All of the patients underwent DWI within the first 24 hours after the procedure, and then two groups of patients were compared. RESULTS: A statistically significant difference was found between the distributions of the presence of silent micro-infarcts on DWI in terms of plaque characteristics (p < 0.001). In the patients with normal DWI findings, the percentage of calcified plaques was 38.7%, while the percentages of hypoechoic plaques, plaques with low echogenicity, and ulcerated plaques were 91.3%, 85.7%, and 78.8%, respectively. The rates of calcified plaques and ulcerated plaques differed in the group of patients with silent microinfarcts. The rate of silent micro-infarcts was 61.3% in the patients with calcified plaques, 8.7% in those with hypoechoic plaques, 14.3% in those with low-echogenicity plaques, and 21.2% in those with ulcerated plaques. CONCLUSION: The study found that carotid stents implanted in calcified and ulcerated plaques had a higher correlation with the presence of periprocedural asymptomatic ipsilateral DWI findings than those implanted in hypoechoic plaques and low-echogenicity plaques.

The relationship between temporal muscle thickness and triglyceride glucose index in sarcopenia with mortality and third-month functional outcomes in patients after acute stroke.

Especially in recent years, temporal muscle thickness has been used as an important parameter for sarcopenia in neurological disorders. In addition, triglyceride glucose index was evaluated separately in studies conducted in terms of coronary diseases, diabetes, high blood pressure, body mass index and acute stroke. In this clinical study, unlike the others, both temporal muscle thickness and triglyceride glucose index were evaluated together in acute stroke patients in terms of sarcopenia. We aimed to investigate the relationship between temporal muscle thickness and triglyceride glucose index, which is atherosclerotic index, with mortality and 3rd month functional outcomes in acute stroke patients. In this retrospective study, 147 patients admitted to Ankara City Hospital with the diagnosis of acute ischemic stroke between January 2021 and September 2022 were evaluated. Fasting triglyceride glucose indexes of the patients were calculated. The temporal muscle thickness measurement of the patients was performed by the radiologist using computed tomography images. Those who scored 3 or higher on the modified Rankin Scale (mRS) at the third month were considered to have poor functional outcome. A significant cutoff point was found for estimating mortality for the temporal muscle thickness parameter [area under the curve for a receiver operating characteristic curve (AUC) = 0.636; P = .012]. The cutoff point was obtained as ≤ 5.2. Sensitivity value was 65%, specificity value was 65%, the positive predictive value (PPV) value was 42.62% and the negative predictive value (NPV) value was 82.28%. Similarly, for the triglyceride glucose index parameter, there was a significant cutoff point in estimating mortality (AUC = 0.673; P = .003). The cutoff point was obtained as ≥ 8.23. Sensitivity value was 91.18%, specificity value was 13%, PPV value was 26.96% and NPV value was 81%. Temporal muscle thickness and triglyceride glucose index parameters were found to be statistically important parameters of sarcopenia. It was concluded that the evaluation of these 2 parameters in terms of both mortality and sarcopenia in acute stroke patients is important in the evaluation of neurological and cardiac disorders.

Peripheral nerve conductions in relapsing remitting multiple sclerosis (RRMS) patients.

PURPOSE: The purpose of this study was to investigate with Elektromioneurografija (EMNG) whether there is any affection on peripheral nerves in (RRMS) patients. MATERIAL AND METHOD: Motor and sensory nerve conductions were studied in the control group including 33 RRMS patients and 25 healthy individuals. Expanded Disability Status Scale (EDSS) scores, mean annual attack frequency, duration of disease and treatments of RRMS patients were recorded. RESULTS: There was a statistically significant (p < 0.05) elongation in motor distal latency of the right peroneal nerve, slowing in the left peroneal nerve conduction velocity, and an elongation in the F-wave response in the RRMS group compared to the control group. It was observed that motor nerve conduction velocities were slower, albeit not statistically significant, and F wave latencies were longer than control group. CONCLUSION: There are studies in the literature related to the association between MS and peripheral neuropathy. In this study, we found demyelinating type changes, differing significantly from the control group, in motor nerve conductions in RRMS patients. There may be demyelinating type affection in peripheral nervous system with common autoimmune mechanism in MS, a demyelinating disease of the central nervous system.

Relationship among health-related quality of life, depression and awareness of home care services in elderly patients.

AIMS: The present descriptive study was carried out to determine the relationship between health-related quality of life, depression and awareness of home care services among elderly patients. METHODS: Patients aged 65 years or older staying at the surgery and internal medicine clinics were included in the study. The "Patient Introduction Form," "Short Form-36 Quality of Life Questionnaire" and "Geriatric Depression Scale" were utilized in the collection of data. RESULTS: In the present study, it was determined that only approximately half of elderly patients (54.9%) knew the concept of home care, most of them had not previously received home care and requested home care related to medical care. The mean scores were lower in some areas of the quality of life questionnaire in some factors that could influence home care awareness. These factors were determined as: female sex, history of falling, chronic illness, functionally, moderately or severely dependent, no previous receipt of home care and wishing to receive home care. CONCLUSIONS: The home care requirement of elderly patients can be influenced by many physiological, psychological and social factors that can affect their quality of life. Thus, it is of utmost importance that medical professionals evaluate the quality of life of elderly individuals and its influencing factors. Geriatr Gerontol Int 2016; 16: 1211-1219.

Serotonin syndrome due to duloxetine.

Serotonin syndrome is a toxic condition due to serotoninergic hyperstimulation, which is caused mostly by serotonergic agents either in overdose or in combination. The diagnosis is purely clinical and poorly validated. We described a patient with tremor, mydriatic pupils, clonus, and ataxia after a single dose of duloxetine; on the dosage of admission. Duloxetine belongs to a large class of antidepressants called reuptake inhibitors. The case is presented to emphasize this possible toxicity due to increasing availability of serotonergic agents. It is a complex but easily preventable and recognizable condition. We believe this to be one of the rare reports of serotonin syndrome associated with duloxetine.