Prevalence and Clinical Features of Idiopathic Parkinson's Disease in Western Turkey.

Introduction: We aimed to determine the prevalence and risk factors of idiopathic Parkinson's disease (IPD) in Western Turkey, which encompasses Edirne and its surrounding districts. Methods: In this study, 9887 individuals, able to communicate and agreed to participate in the study, were evaluated. The data was obtained by answering a face-to-face questionnaire consisting of 53 questions from volunteers living at 30 randomly selected family health centers in Edirne and its counties. The questionnaire included demographic information, questions to evaluate potential concomitant conditions, and questions regarding the symptomatology used in IPD diagnosis. Following the questionnaire, it was planned to determine the degree of IPD with the Unified Parkinson's Disease Rating Scale (UPDRS) and the Hoehn and Yahr scale (HY) clinical rating scale in patients diagnosed with IPD to assess disease severity in patients diagnosed with IPD. Results: Of the 9887 individuals, 118 were diagnosed with IPD according to the questionnaire results from Edirne and its districts, and the prevalence of IPD was 1.2%. Approximately, 58.4% of the patients with IPD were male and 41.6% were female, which was not significantly different (p=0.214). Non-motor symptoms such as difficulty urinating, anxiety, depression, fatigue, REM sleep behavior disorder, and difficulty falling asleep or staying asleep were also examined in patients diagnosed with IPD. Depression was identified in 45.7% of the cases, while the control group was 4.3% (p=0.001). Fatigue was identified in 46.8% of the cases and control group was 3.5% (p=0.002). Conclusions: IPD prevalence studies will increase the awareness in the community and provide early diagnosis and treatment as well as serve as a basis to increased life expectancy, reduce morbidity, and improve life quality.

The prevalence of essential tremor in Edirne and its counties accompanied comorbid conditions.

Objective: We aimed to determine the prevalence and risk factors of Essential Tremor (ET) in Edirne and its districts, located in Western Thrace, which is the most western part of Turkey. Methods: In this study, 3008 individuals who could communicate and agreed to participate in the study were evaluated. To obtain the data from the applicants in 30 Family Health Centres in Edirne and its districts, a face-to-face questionnaire that consisted of 37 questions was prepared by the researchers. The questionnaire included general information, questions to evaluate potential concomitant comorbid conditions and questions regarding the symptomatology used in ET diagnosis, as well as questions to evaluate ET severity, was examined with the spiral test. Patients were classified by using the Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) diagnostic and clinical evaluation scale. According to the diagnostic criteria for ET (used in participants who were examined and in those whose medical records were reviewed) were similar to those used in astudy conducted in Turkey. Results: Of 3008 individuals, 173 were diagnosed with ET according to the questionnaire results from Edirne and its districts, and the prevalence of ET was 5.8%. Approximately, 43.4% of the patients with ET were male, and 56.6% were female, which was not significantly different (p > 0.05). Participants with tremor related to alcohol withdrawal, hyperthyroidism, anxiety, depression other known causes of tremor were not considered to have ET. Thyroid disease was identified in 0.0% of the cases, and the control group was detected in 1.4%, which was not significantly different (p = 0.170). Psychiatric disease was identified in 0.0% of the cases, and the control group was detected in 1.3%, which was not significantly different (p = 0.271). Conclusions: ET prevalence studies will increase the awareness of the community and provide early diagnosis and treatment, as well as serve as a basis to reduce morbidity and improve the quality of life.

The prognostic value of cerebral oxygen saturation measurement for assessing prognosis after cardiopulmonary resuscitation / O valor da medida da saturação cerebral de oxigênio para avaliar o prognóstico após ressuscitação cardiopulmonar

Abstract Background: Despite new improvements on cardiopulmonary resuscitation (CPR), brain damage is very often after resuscitation. Objective: To assess the prognostic value of cerebral oxygen saturation measurement (rSO2) for assessing prognosis on patients after cardiopulmonary resuscitation. Design: Retrospective analysis. Measurements and results: We analyzed 25 post-CPR patients (12 female and 13 male). All the patients were cooled to a target temperature of 33-34 °C. The Glascow Coma Scale (GCS), Corneal Reflexes (CR), Pupillary Reflexes (PR), arterial Base Excess (BE) and rSO2 measurements were taken on admission. The rewarming GCS, CR, PR, BE and rSO2 measurements were made after the patient's temperature reached 36 °C. Results: In survivors, the baseline rSO2 value was 67.5 (46-70) and the percent difference between baseline and rewarming rSO2 value was 0.03 (0.014-0.435). In non-survivors, the baseline rSO2 value was 30 (25-65) and the percent difference between baseline and rewarming rSO2 value was 0.031 (-0.08 to -20). No statistical difference was detected on percent changes between baseline and rewarming values of rSO2. Statistically significant difference was detected between baseline and rewarming GCS groups (p = 0.004). No statistical difference was detected between GCS, CR, PR, BE and rSO2 to determine the prognosis. Conclusion: Despite higher values of rSO2 on survivors than non-survivors, we found no statistically considerable difference between groups on baseline and the rewarming rSO2 values. Since the measurement is simple, and not affected by hypotension and hypothermia, the rSO2 may be a useful predictor for determining the prognosis after CPR.

Resumo Justificativa: Apesar dos novos avanços em reanimação cardiopulmonar (RCP), o dano cerebral muitas vezes ocorre após a reanimação. Objetivo: Avaliar o valor prognóstico de medir a saturação de oxigênio cerebral (rSO2) para estimar o prognóstico em pacientes após a reanimação cardiopulmonar. Projeto: Análise retrospectiva. Medidas e resultados: Foram avaliados após RCP 25 pacientes (12 do sexo feminino e 13 do masculino). Todos os pacientes foram submetidos à hipotermia (temperatura alvo de 33-34 °C). As mensurações da Escala de Coma de Glascow (GCS), dos reflexos corneanos (RC), dos reflexos pupilares (RP) e do excesso de base (EB) e rSO2 foram feitas na admissão. Na hipertermia, as mensurações de GCS, RC, RP, EB e rSO2 foram feitas depois que a temperatura atingiu 36 °C. Resultados: Em sobreviventes, o valor basal de rSO2 foi de 67,5 (46-70) e a diferença percentual entre o valor basal e a hipertermia de rSO2 foi de 0,03 (0,014-0,435). Em não sobreviventes, o valor basal de rSO2 foi de 30 (25-65) e a diferença percentual entre o valor basal de hipotermia de rSO2 foi de 0,031 (-0,08-20). Não houve diferença estatística nas variações percentuais entre os valores da rSO2 na fase basal e de reaquecimento. Uma diferença estatisticamente significativa foi observada entre os valores da GCS na fase basal e de reaquecimento dos grupos (p = 0,004). Não houve diferença estatisticamente significativa entre GCS, RC, RP, EB e rSO2 para determinar o prognóstico. Conclusão: Embora os valores da rSO2 tenham sido mais elevados em sobreviventes do que em não sobreviventes, não observamos uma diferença estatisticamente significativa dos valores da rSO2 entre os grupos na fase basal e de reaquecimento. Como a mensuração é simples, e não afetada por hipotensão e hipotermia, a rSO2 pode ser um indicador útil para determinar o prognóstico após a RCP.

Determining the Efficiency of Different Preoperative Difficult Intubation Tests on Patients Undergoing Caesarean Section.

BACKGROUND: Pregnancy-induced anatomical and physiological changes in the airway make airway management difficult in obstetric patients; thus, preoperative evaluation of the airway is important for obstetric patients. AIMS: To determine the effectiveness of the modified Mallampati test; the interincisor, sternomental and thyromental distances and the upper limb bite test. The second aim was to assess the effectiveness of the combination of the upper limb bite test with the other tests in obstetric patients. STUDY DESIGN: Cross-sectional study. METHODS: Pregnant women (n=250) scheduled for caesarean section were analysed. The patients' ages, heights and weights were collected. Preoperative airway evaluation was done by using a modified version of the Mallampati test. The interincisor, sternomental and thyromental distances were measured, and the upper limb bite test was performed. The laryngoscopy difficulty was evaluated by using Cormack-Lehane classification. RESULTS: No statistically significant differences were found between groups in age, height or weight (p>0.05). The modified Mallampati test and interincisor, sternomental and thyromental distances revealed a lower number of easy intubations than that determined by the Cormack-Lehane classification and a higher number of difficult intubations than the actual number of cases (p<0.05). The sensitivity and specificity of the modified Mallampati test, the upper limb bite test, the interincisor distance test and the sternomental and thyromental distance tests were found to be 73.08, 57.69, 84.62, 80.77 and 88.46 and 90.62, 99.11, 83.04, 84.37 and 87.05, respectively. When the combinations were examined, the sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test were found to be 57.69 and 100, respectively. When the upper limb bite test was combined with the interincisor distance, the sensitivity and specificity were 46.15 and 100, respectively. We found a sensitivity and specificity of 93.75 and 95.30, respectively, for the combination of the upper limb bite test with the thyromental distance test. The sensitivity and specificity of the combination of the upper limb bite test with the modified Mallampati test and interincisor distance test were found to be 46.15 and 100, respectively. For combination of all the tests, the sensitivity and specificity was 42.31 and 100, respectively. CONCLUSION: When all combinations are evaluated in the decision of difficult intubation, the combination of the upper limb bite test and thyromental distance test is superior to the use of other methods alone to predict difficult intubation in pregnant women.

[The prognostic value of cerebral oxygen saturation measurement for assessing prognosis after cardiopulmonary resuscitation]. / O valor da medida da saturação cerebral de oxigênio para avaliar o prognóstico após ressuscitação cardiopulmonar.

BACKGROUND: Despite new improvements on cardiopulmonary resuscitation (CPR), brain damage is very often after resuscitation. OBJECTIVE: To assess the prognostic value of cerebral oxygen saturation measurement (rSO2) for assessing prognosis on patients after cardiopulmonary resuscitation. DESIGN: Retrospective analysis. MEASUREMENTS AND RESULTS: We analyzed 25 post-CPR patients (12 female and 13 male). All the patients were cooled to a target temperature of 33-34°C. The Glascow Coma Scale (GCS), Corneal Reflexes (CR), Pupillary Reflexes (PR), arterial Base Excess (BE) and rSO2 measurements were taken on admission. The rewarming GCS, CR, PR, BE and rSO2 measurements were made after the patient's temperature reached 36°C. RESULTS: In survivors, the baseline rSO2 value was 67.5 (46-70) and the percent difference between baseline and rewarming rSO2 value was 0.03 (0.014-0.435). In non-survivors, the baseline rSO2 value was 30 (25-65) and the percent difference between baseline and rewarming rSO2 value was 0.031 (-0.08 to -20). No statistical difference was detected on percent changes between baseline and rewarming values of rSO2. Statistically significant difference was detected between baseline and rewarming GCS groups (p=0.004). No statistical difference was detected between GCS, CR, PR, BE and rSO2 to determine the prognosis. CONCLUSION: Despite higher values of rSO2 on survivors than non-survivors, we found no statistically considerable difference between groups on baseline and the rewarming rSO2 values. Since the measurement is simple, and not affected by hypotension and hypothermia, the rSO2 may be a useful predictor for determining the prognosis after CPR.

TURKISH VERSION QUALITY OF LIFE IN ESSENTIAL TREMOR QUESTIONNAIRE (QUEST): VALIDITY AND RELIABILITY STUDY.

BACKGROUND: Our aim was to translate the Quality of Life in Essential Tremor Questionnaire (QUEST) advanced by Troster (2005) and to analyse the validity and reliability of this questionnaire. METHODS: Two hundred twelve consecutive patients with essential tremor (ET) and forty-three control subjects were included in the study. Permission for the translation and validation of the QUEST scale was obtained. The translation was performed according to the guidelines provided by the publisher. After the translation, the final version of the scale was administered to both groups to determine its reliability and validity. RESULTS: The QUEST Physical, Psychosocial, communication, Hobbies/leisure and Work/finance scores were 0.967, 0.968, 0.933, 0.964 and 0.925, respectively. There were good correlations between each of the QUEST scores that were indicative of good internal consistency. Additionally, we observed that all of the QUEST scores were most strongly related to the right and left arms (p=0.0001). However, we observed that all of the QUEST scores were weakly related to the voice, head and right leg (p=0.0001). DISCUSSION: These findings support the notion that the Turkish version of the Quality of Life in Essential Tremor (QUEST) questionnaire is a valid and reliable tool for the assessment of the quality of life of patients with ET.

Comparison of autogenous bone graft donor site haemostatic agents used in spinal surgery.

OBJECTIVE: The aim of our study was to investigate the effects of haemostatic agents used at the autograft donor sites in spinal fusion. METHODS: The study included 66 patients (26 men, 40 women; mean age: 42.9 years) who underwent spinal fusion surgery between March 1999 and October 2002. Patients were randomly assigned to 4 different groups according to the haemostatic agents used during surgery. In Group 1, bone wax was used on the graft donor site. In Group 2, spongostan was used. In Group 3, spongostan was applied to the donor site and removed after 10 minutes. Group 4 was the control group and no haemostatic agent was applied. Age, sex, diagnosis and incision shape were not taken into consideration during the selection of patient groups. Closed suction drainage systems were used for the evaluation of drainage amount. The drainage system was removed after 48 hours in patients with a daily drainage of less than 30 cc. RESULTS: In Group 1, there was significantly less drainage than the other groups. Group 2 and Group 3 had less drainage than the control group. When a separate incision was used for graft harvesting, keeping the spongostan at the application site (Group 2) was more effective than its removal (Group 3). CONCLUSION: The application of bone wax and spongostan to bleeding cancellous bone surfaces at the donor site is a safe and effective method to reduce bleeding and hematoma. Bone wax is more effective than spongostan for haemostasis.

Effects of bupivacaine versus levobupivacaine on pulmonary function in patients with chronic obstructive pulmonary disease undergoing urologic surgery: a randomized, double-blind, controlled trial.

BACKGROUND: There are limited data to determine the impact of subarachnoid blockade with local anesthetics on perioperative pulmonary function. The effects of local anesthetics used in spinal anesthesia are very important in terms of respiratory function in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: The aim of this study was to evaluate the effects of bupivacaine versus levobupivacaine on pulmonary function in patients with COPD undergoing urologic surgery. METHODS: Patients were randomized into 2 groups: group B (n = 25) received 3 mL of hyperbaric 0.5% bupivacaine; group L (n = 25) received 3 mL of isobaric 0.5% levobupivacaine. Both agents were administered intrathecally. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow rate (PEFR), vital capacity (VC), and FEV1/FVC ratio were measured using spirometry 10 and 30 minutes after spinal anesthesia and 30 minutes after completion of the operation. An arterial blood gas test was performed before and after spinal anesthesia. RESULTS: Fifty male patients aged 40 to 80 years completed the study. There were no differences in the results of preoperative and postoperative FVC, FEV1, PEFR, VC, FEV1/FVC ratio, and arterial blood gas between the bupivacaine (n = 25) and levobupivacaine (n = 25) groups. However, patients who took bupivacaine showed a significant decrease in intraoperative PEFR at 30 minutes compared with baseline, a result not seen in patients who took levobupivacaine (P = 0.036 and P = 0.282, respectively). CONCLUSIONS: In 50 patients with moderate COPD undergoing urologic surgery, hyperbaric bupivacaine caused a decrease in intraoperative PEFR compared with baseline because of higher level block; however, the effects of hyperbaric bupivacaine and isobaric levobupivacaine on pulmonary function in these patients showed equally effective potencies for spinal anesthesia.

How do marginal osteophytes, joint space narrowing and range of motion affect each other in patients with knee osteoarthritis.

To assess the number, location, direction and size of osteophytes and the change of the joint space width (JSW) in radiographs of the tibiofemoral (TF) joint in middle-aged people with longstanding knee pain with radiographic osteoarthritis (OA), and to correlate between the range of motion (ROM). In the format of a retrospective study, the OA of both knee in 84 people, 8 men and 76 women (aged 42-77 years), with chronic knee pain at inclusion were examined. The JSW of the TF joint and the number, location, direction and size of osteophyte were evaluated using a PA view in weightbearing. The location and direction of osteophytes showed some variation at each site, particularly at the lateral tibial plateau and medial femoral trochlea. Significant correlations were found between ROM of the right and left knee and the size, location and direction of the most osteophytes. In both knees, the JSW medially was lower when compared with the lateral compartment. The mean JSW in the lateral tibiofemoral compartment of the right knee was associated with active and passive flexion degree of the patients. The mean JSW in the medial and lateral tibiofemoral compartment of the left knee correlated with BMI, and changes in the Kellgren and Lawrence grade of the patients. There was found statistically significant correlation between mechanical medial proximal tibial angle and the osteophyte size of the right and left knee. We think that definitions which incorporate both osteophytes and joint space narrowing offer the association with worsening of active and passive ROM.

Gastroprotective effect of L-carnitine on indomethacin-induced gastric mucosal injury in rats: a preliminary study.

BACKGROUND: Numerous studies have shown that use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with various gastric mucosal lesions, collectively referred to as NSAID gastropathy, but the detailed mechanism is still not properly understood. L-carnitine, a vitamin-like substance, is a naturally occurring enzymatic antioxidant with a potent free oxygen radical quencher and scavenger capacity; it protects the biological membranes against lipid peroxidation. It has recently been shown that L-carnitine has a gastroprotective effect on gastric mucosa. To our knowledge, the role of L-carnitine on NSAIDs-induced gastric mucosal injury is undefined. AIM: The aim of the present study was to determine the gastroprotective effect of L-carnitine on indomethacin-induced gastric mucosal lesions in the rat stomachs. MATERIAL AND METHODS: In our study, gastric mucosal injury was induced by the intragastric administration of indomethacin (30 mg/kg). L-carnitine (10, 50, 100 mg/kg) was given to rats by gavage 30 min before the indomethacin administration. The animals were killed 3 h after administration of indomethacin. The stomach of each animal was removed. Mucosal damage was evaluated with macroscopic study and histopathologically. RESULTS: The intragastric administration of indomethacin induced hyperemia and hemorrhagic erosions in the rat stomachs. L-carnitine significantly prevented gastric ulcerogenesis induced by indomethacin and decreased the ulcer index macroscopically and histopathologically. CONCLUSION: L-carnitine decreases indomethacin-induced gastric mucosal injury and this gastroprotective effect may be attributed to its well-known antioxidant effect.

L-carnitine inhibits ethanol-induced gastric mucosal injury in rats.

L-carnitine is a quaternary amine that is essential for the normal oxidation of long-chain fatty acids by mitochondria. It is known that L-carnitine and its derivatives prevent the formation of reactive oxygen species, scavenge free radicals and protect cells from peroxidative stress. Oxygen-derived free radicals and lipid peroxidation products play a critical role in the pathogenesis of ethanol-induced gastric mucosal injury. The aim of the present study was to determine the effect of L-carnitine on lipid peroxidation induced by ethanol in the rat stomach. In our study, gastric mucosal injury was induced by the intragastric administration of 1 ml of absolute ethanol. Test compounds were given to rats by gavage 30 min before the ethanol administration. The animals were killed 60 min after the administration of ethanol. The stomach of each animal was removed. Mucosal damage was evaluated by macroscopic examination, histological analysis and by measurement of lipid peroxidation and glutathione activity. The intragastric administration of ethanol induced hyperemia and hemorrhagic erosions in the rat stomachs. L-carnitine significantly prevented gastric ulcerogenesis induced by ethanol and decreased the ulcer index. Plasma and gastric lipid peroxidation that was increased significantly by ethanol was decreased after treatment with L-carnitine. Ethanol treatment decreased significantly the gastric glutathione levels, and pretreatment with L-carnitine increased them significantly. Based on these data, the beneficial effects of L-carnitine on ethanol-induced gastric mucosal injury may be attributed to its antiperoxidative effects.