Impaired theory of mind in adults with traumatic brain injury: A replication and extension of findings.

OBJECTIVE: To replicate a previous study of Theory of Mind (ToM) task performance in adults with traumatic brain injury (TBI) under different working memory (WM) demands, and determine if there are sex-based differences in effects of WM load on ToM task performance. METHOD: 58 adults with moderate-severe TBI (24 females) and 66 uninjured adults (34 females) matched group-wise for age, sex, and education viewed a series of video vignettes from the Video Social Inference Task (VSIT) (Turkstra, 2008) and answered ToM questions. Vignette presentation format required updating and maintenance of information, and WM load was manipulated by varying presence of distracters. RESULTS: There were main effects of group and WM load, no significant effect of sex, and a marginal interaction of group by WM load, with larger between-group differences in conditions with higher WM load. VSIT scores for the condition with the highest WM load were significantly correlated with scores on the first trial of the California Verbal Learning Test. CONCLUSIONS: We replicated findings of lower scores in adults with TBI on a video-based ToM task, and provided additional evidence of the effect of WM load on social cognition task performance. There were no significant accuracy differences between men and women, inconsistent with prior evidence - including our own data using the same test. There is strong evidence of a female advantage on other social cognition tasks, and the parameters of this advantage remain to be discovered.

Relationship between individual differences in functional connectivity and facial-emotion recognition abilities in adults with traumatic brain injury.

Although several studies have demonstrated that facial-affect recognition impairment is common following moderate-severe traumatic brain injury (TBI), and that there are diffuse alterations in large-scale functional brain networks in TBI populations, little is known about the relationship between the two. Here, in a sample of 26 participants with TBI and 20 healthy comparison participants (HC) we measured facial-affect recognition abilities and resting-state functional connectivity (rs-FC) using fMRI. We then used network-based statistics to examine (A) the presence of rs-FC differences between individuals with TBI and HC within the facial-affect processing network, and (B) the association between inter-individual differences in emotion recognition skills and rs-FC within the facial-affect processing network. We found that participants with TBI showed significantly lower rs-FC in a component comprising homotopic and within-hemisphere, anterior-posterior connections within the facial-affect processing network. In addition, within the TBI group, participants with higher emotion-labeling skills showed stronger rs-FC within a network comprised of intra- and inter-hemispheric bilateral connections. Findings indicate that the ability to successfully recognize facial-affect after TBI is related to rs-FC within components of facial-affective networks, and provide new evidence that further our understanding of the mechanisms underlying emotion recognition impairment in TBI.

Predictive value of plasma asymmetric dimethylarginine, homocysteine, and high-sensitive CRP levels in occult coronary artery disease: A multidetector-row computed tomography study.

BACKGROUND: Multidetector-row computed tomography (MDCT) is an attractive noninvasive imaging modality for detecting coronary atherosclerotic plaques, which may be underestimated by conventional angiography. The aim of our study was to determine the predictive value of plasma asymmetric dimethylarginine (ADMA), homocysteine, and high-sensitivity C-reactive protein (hsCRP) levels for occult coronary artery disease (CAD). PATIENTS AND METHODS: Thirty-five patients with angiographically normal coronary arteries (NCA) were consecutively included in our study. They underwent MDCT including indications and were divided into an NCA group (18 subjects, 8 male, 46 ± 8 years) and an occult CAD group (17 subjects, 11 male, 48 ± 9 years), with respect to the presence of coronary plaque. Plasma ADMA, homocysteine, and hsCRP levels were measured in blood samples. RESULTS: Plasma ADMA and homocysteine levels of the occult CAD group were significantly higher than those of the NCA group. A nonsignificant trend was observed for higher serum hsCRP levels in the occult CAD group. Receiver operating characteristics analysis revealed that an ADMA level of > 0.71 µmol/l could predict patients with occult CAD (sensitivity, 76 %; specificity, 67 %). The discriminative power of ADMA in distinguishing the occult CAD group from the NCA group was high (area under the curve, 0.80; CI, 0.66-0.95, p = 0.002), while it was not sufficiently high for homocysteine and hsCRP (p > 0.05). CONCLUSION: Plasma ADMA is a useful parameter for predicting subclinical atherosclerosis, whereas homocysteine and hsCRP are not, and it may be complementary to the conventional cardiovascular risk factors for the selection of individuals at high risk for CAD before undertaking MDCT procedures in clinical practice.

Association between left ventricular dysfunction, anemia, and chronic renal failure. Analysis of the Heart Failure Prevalence and Predictors in Turkey (HAPPY) cohort.

BACKGROUND: Anemia and chronic renal failure (CRF) are frequent comorbidities in patients with heart failure (HF), and they have been reported to be associated with increased mortality and hospitalization rates. HF, anemia, and CRF have been reported to interact with each other forming a vicious cycle termed cardio-renal-anemia syndrome. The aim of the present study was to evaluate the association of HF, anemia, and CRF using data from the large-scale"Heart Failure Prevalence and Predictors in Turkey (HAPPY)" study. PATIENTS AND METHODS: Among the HAPPY cohort, 3,369 subjects who had either left ventricular dysfunction (LVD) or normal left ventricular function on echocardiography or normal serum NT-proBNP levels were included in this analysis. RESULTS: The prevalence of anemia and CRF was significantly higher in patients with LVD compared with subjects with normal ventricular function (20.7 % vs. 4.0 % and 19.0 % vs. 3.7 %, respectively; p < 0.001 for each). Binary logistic regression analyses for the presence of LVD, anemia, and CRF demonstrated that each one was an independent predictor for the presence of the others. CONCLUSION: These findings point to the presence of cardio-renal-anemia syndrome and the necessity of treating these comorbidities in patients with HF.

The features of infectious diseases departments and anti-infective practices in France and Turkey: a cross-sectional study.

The aim of this study was to assess the infectious diseases (ID) wards of tertiary hospitals in France and Turkey for technical capacity, infection control, characteristics of patients, infections, infecting organisms, and therapeutic approaches. This cross-sectional study was carried out on a single day on one of the weekdays of June 17-21, 2013. Overall, 36 ID departments from Turkey (n = 21) and France (n = 15) were involved. On the study day, 273 patients were hospitalized in Turkish and 324 patients were followed in French ID departments. The numbers of patients and beds in the hospitals, and presence of an intensive care unit (ICU) room in the ID ward was not different in both France and Turkey. Bed occupancy in the ID ward, single rooms, and negative pressure rooms were significantly higher in France. The presence of a laboratory inside the ID ward was more common in Turkish ID wards. The configuration of infection control committees, and their qualifications and surveillance types were quite similar in both countries. Although differences existed based on epidemiology, the distribution of infections were uniform on both sides. In Turkey, anti-Gram-positive agents, carbapenems, and tigecycline, and in France, cephalosporins, penicillins, aminoglycosides, and metronidazole were more frequently preferred. Enteric Gram-negatives and hepatitis B and C were more frequent in Turkey, while human immunodeficiency virus (HIV) and streptococci were more common in France (p < 0.05 for all significances). Various differences and similarities existed in France and Turkey in the ID wards. However, the current scene is that ID are managed with high standards in both countries.

Right ventricular longitudinal deformation parameters and exercise capacity : prognosis of patients with chronic thromboembolic pulmonary hypertension.

OBJECTIVE: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease characterized by increased pulmonary vascular resistance resulting in pulmonary hypertension and right heart failure. The six-minute walk test (6MWT) distance is associated with the prognosis of CTEPH patients. Speckle tracking echocardiography (STE) is a reliable method for determining ventricular function. The aim of this study was to assess and compare the right ventricular (RV) function of CTEPH patients according to their 6MWT distances. METHODS: Forty-nine consecutive CTEPH patients (mean age, 50 ± 16 years; 22 male) who were referred to our center for pulmonary thromboendarterectomy (PTE) were included in the study. All patients underwent the 6MWT and right heart catheterization (RHC). Standard echocardiography and STE were performed on all patients before PTE. Patients were divided into two groups based on their 6MWT distance being less or more than 300 m. RESULTS: Patients with a shorter 6MWT distance had a significantly larger RV, while they had a significantly lower RV fractional area change and higher myocardial performance index suggesting impaired RV function. Both RV basal-lateral strain and strain rate measures were significantly lower in patients with shorter 6MWT distances than those with longer 6MWT distances. Similarly, they had lower RV basal-septal, mid-lateral, and global strain measures. 6MWT distances were correlated with RV basal-lateral and mid-lateral strain measures (r = 0.349, p = 0.025 and r = 0.415, p = 0.008, respectively). CONCLUSION: Our data suggest that RV myocardial deformation parameters are associated with 6MWT distances. Determination of RV dysfunction by STE may be helpful in identifying patients with a poor prognosis.

Evaluation of treatment with hydrocortisone on oxidant/antioxidant system in preterm infants with BPD.

AIM: Evidence that oxidative stress plays a role in the development of bronchopulmonary dysplasia (BPD). There is a close relationship between oxidative stress and inflammation. In this study, it is aimed to investigate influences of hydrocortisone used in the treatment of BPD on anti-oxidant system in preterm infants with BPD. PATIENTS AND METHODS: The study enrolled 33 infants with severe BPD who were undergone inpatient treatment in neonatal intensive care unit (NICU) of our Hospital and received therapy with hydrocortisone. Total oxidant status (TOS) and total anti-oxidant capacity (TAC) levels of infants enrolled to the study before and one week after the hydrocortisone therapy were studies and oxidative stress index levels were calculated. Pre- and post-treatment TOS, TAC and OSI index levels were statistically compared. RESULTS: In preterm infants with BPD, who were enrolled into the study, TOS and OSI index were found high, whereas TAC values were low. Following the treatment with hydrocortisone, statistically significant decrease in TOS and OSI index and statistically significant elevation in TAC levels were found in comparison with pre-treatment levels. CONCLUSIONS: The treatment with hydrocortisone, which is used for BPD, improves anti-oxidant system and reduces oxidative stress in infants with BPD. There is need for further studies in order to clarify the physio-pathogenesis.

Endothelial dysfunction is an independent risk factor for stroke patients irrespective of the presence of patent foramen ovale.

BACKGROUND: Paradoxical embolization through the patent foramen ovale (PFO) is the major cause of most cryptogenic stroke cases. However, the presence of PFO may simply be an incidental finding in these patients, and endothelial dysfunction may be the underlying reason of ischemic stroke. The aim of this study was to compare the endothelial function of cryptogenic stroke patients according to the presence of PFO. METHODS: Sixty consecutive patients with cryptogenic stroke referred for transesophageal echocardiography (TEE) and 39 consecutive nonstroke patients referred for TEE examination because of suspected PFO were included in the study. Endothelial functions were assessed by brachial artery ultrasonography. PFO was diagnosed by the presence of right-to-left passage of contrast bubbles during TEE. Stroke and nonstroke patients were further subdivided into two groups according to the presence of PFO. RESULTS: Stroke patients had significantly lower flow-mediated dilation (FMD) values than nonstroke patients (8.36 ± 4.38 % vs. 12.57 ± 4.90 %, p < 0.001). The stroke patients with PFO had significantly lower FMD measures than nonstroke patients with PFO (6.60 ± 3.98 % vs. 10.84 ± 4.40 %, p = 0.001). Similarly, cryptogenic stroke patients without PFO had significantly lower FMD measures than nonstroke patients without PFO (9.90 ± 4.18 % vs. 14.22 ± 4.88, p = 0.002). Logistic regression analysis showed FMD as an independent predictor of cryptogenic stroke when adjusted by age, sex, and presence of PFO (odds ratio: 0.809, 95 % confidence interval: 0.719-0.911, p < 0.001). An FMD value of 11.30 % or lower predicted cryptogenic stroke with a sensitivity of 78.3 %, a specificity of 66.7 %, and positive and negative predictive values of 78.3 and 66.7 %, respectively. CONCLUSION: Endothelial dysfunction seems to play a more important role than PFO in the underlying mechanism of cryptogenic stroke.

Torsade de pointes. A rare cause of syncope in severe aortic stenosis.

The evaluation of syncope in severe aortic stenosis usually requires intense work-up. Mechanical obstruction should not always be implicated as the underlying cause of syncope. Syncope at rest may be rarely associated with ventricular arrhythmias. We present a patient with severe aortic stenosis who experienced syncopal events due to torsade de pointes.

Left ventricular strain and strain rate by two-dimensional speckle tracking echocardiography in patients with subclinical hypothyroidism.

AIM: Subclinical hypothyroidism (SH) is an asymptomatic condition defined by increased serum thyroid-stimulating hormone (TSH) with normal free thyroid hormone levels. Heart is a major target organ for thyroid hormone action. The aim of this study was to evaluate cardiac functions in patients with SH by speckle tracking imaging. PATIENTS AND METHODS: We included 23 consecutive patients with untreated SH (Group A; 7 male, mean age: 40.9±1.6 years) and 21 patients with treated SH (Group B; 6 male, mean age: 40.2±2.1 years). The control group included 25 healthy volunteers (8 male, mean age: 39.9±2.8 years). Left ventricular (LV) functions were assessed with speckle tracking imaging. RESULTS: Age and sex distributions were similar among the groups. Mean serum TSH and free T4 levels were 11.7±2.9 µIU/mL, 1.16±0.06 ng/dL for group A; 2.6±0.3 µIU/mL, 1.35±0.09 ng/dL for group B; 1.4±0.3 µIU/mL, 1.31±0.09 ng/dL for controls, respectively (p = 0.001, p = 0.122). The untreated SH patients had significantly lower LV strain and strain rate values compared to controls. The treated SH patients had higher LV strain and strain rate values compared to untreated SH patients although the difference was not statistically significant. The treated SH patients had lower LV strain and strain rate values compared to controls but the difference was not statistically significant. CONCLUSIONS: Untreated SH is associated with impairment in LV longitudinal myocardial function. Speckle tracking echocardiography appears to be useful both for early detection of LV impairment in patients with SH and documentation of improvement in myocardial deformation parameters with treatment.

Efficacy of supervised exercise combined with transcutaneous electrical nerve stimulation in women with fibromyalgia: a prospective controlled study.

The aim of this study was to investigate the results of a supervised exercise with transcutaneous electrical nerve stimulation (TENS) in an exercise controlled study in women with fibromyalgia. Sixty-six women with fibromyalgia who admitted to the outpatient clinic of our hospital were randomized into two treatment groups. The patients in both groups participated in a supervised combined exercise program for 12 weeks. The women in first group had additional TENS in the first 3 weeks of the study. All subjects were analyzed at the baseline, at the end of the 3rd and 12th weeks. Outcome measures were tender point count (TPC), myalgic pain score (MPS), Fibromyalgia Impact Questionnaire (FIQ) and Short Form-36 (SF-36) Health Survey. Sixty women with fibromyalgia completed the study. The patients in both groups showed improvement in terms of TPC, MPS, FIQ, physical and mental summary scores and total scores of SF-36 at the end of the 3rd and 12th weeks. The improvement in MPS at the third week was higher in the first group (p = 0.01). But there was no difference in terms of the improvement in MPS between the groups at the end of the 12th week control (p = 0.87). There was no significant difference between the improvement in the other outcome parameters of the two groups. As a result, supervised exercise program was successful to improve the myalgic pain, functional status and quality of life in women with fibromyalgia. Exercises combined with TENS might be useful due to quick myalgic pain relief in the treatment of fibromyalgia in everyday practice.

Two different cardiomyopathies in a single patient : hypertrophic cardiomyopathy and left ventricular noncompaction.

Hypertrophic cardiomyopathy is a complex and relatively common genetic disorder characterized by left ventricular (LV) hypertrophy, usually associated with a nondilated and hyperdynamic chamber with heterogeneous phenotypic expression and clinical course. On the other hand, LV noncompaction is an uncommon cardiomyopathy characterized by the persistence of fetal myocardium with a pattern of prominent trabecular meshwork and deep intertrabecular recesses, systolic dysfunction, and LV dilatation. We report a 29-year-old man with these two different inherent conditions. Our case raises the possibility of a genetic mutation common to these two clinical entities or different gene mutations existing in the same individual.

Elderly trauma: the two years experience of a university-affiliated emergency department.

OBJECTIVE: The elderly population is steadily increasing in the modern world. The aging of the population has led to an increase in geriatric trauma. Elderly trauma patients present unique challenges and face more significant obstacles in recovery compared to younger patients. This study is designed to determine the epidemiologic data of trauma in elderly patients and to contribute to the national trauma database. MATERIALS AND METHODS: We prospectively collected the data of trauma patients, aged 65 and older, presenting to our Emergency Department. Patients' data, including demographic data, diagnosis, prognosis, trauma scores [Glasgow coma scale (GCS), injury severity score (ISS)], mortality, body regions of injury and outcomes were analyzed. RESULTS: During the study period, 407 patients, of whom 63.9% were males and 36.1% females, were admitted to our Emergency Department. The mean age of, the patients was 73.14 +/- 7.14 years. Falls (59%) accounted for the most common cause of injury. The mean GCS and mean ISS were 14.39 and 10.69, respectively. Trauma to extremities was the most frequent body region of injury (56.3%). A total of 149 patients were hospitalized. The mean hospital length of stay was 11.07 +/- 14 days. The mortality rate was found to be 6.4%. Head trauma was the most common cause in mortality. CONCLUSIONS: The risk of trauma in the elderly population is higher. As a result of the decrease in physiological reserve and lack of adaptation to trauma, elderly trauma patients require more aggressive management and a multidisciplinary approach. Further studies are needed for data of elderly trauma patients.

Cognitive and learning styles as predictors of success on the National Board Dental Examination.

Using a deidentified retrospective dataset of three cohorts of matriculated dental students, we measured the degree to which selected student attributes, the Learning Type Measure, the Myers-Briggs Type Indicator, and Dental Admission Test subtests scores predicted passage on the National Board Dental Examination (NBDE), Parts I and II. Gender, Myers-Briggs Type Indicators, and the Dental Admission Test subtests for academic average and biology were found to be predictive of passing the NBDE Part I. Gender, a Myers-Briggs Type Indicator (thinking over feeling), and the Dental Admission Test subtests on reading and biology were found to be predictive of passing the NBDE Part II. The Learning Type Measure was not found to be predictive of passing the NBDE Part I or Part II. This study holds implications for heightening faculty members' awareness of students' aptitude and cognitive attributes, for teaching, and for the admissions process.

Development and in vitro evaluation of topically applied cinnamic acid formulations.

The aim of this study was to formulate microcapsulated cinnamic acid (CN) formulations in w/o and o/w emulsions and to compare their release profiles with w/o, o/w and w/o/w emulsions without microcapsules through cellulose acetate, cellulose nitrate membranes and excised rat skin. The experimental design approach was used for understanding the influence of different formulation factors on release characteristics and to optimise most accurate formulating parameters. The data obtained in this study were subjected to statistical analysis by a repeated measures ANOVA, following Bonferroni multiple comparisons test. A significantly different release was observed due to the core:wall ratio of microcapsules. Emulsions containing microcapsules with 2:1 core:wall ratio were found to be ideal according to the factorial design, dissolution and diffusion studies. The type of emulsion was found to be a very important factor affecting the release profile of CN. The results described in this study indicate that microencapsulation of CN in w/o emulsion could be suggested as an effective carrier for CN to achieve sustained release and to protect the drug. Moreover, w/o/w emulsions were also useful carriers for prolonged release by encapsulating the substances in their internal aqueous phase and they also protect drugs and their preparation and application are easy. By the way, in the case of o/w emulsion any significant difference was observed. The type of the membrane also affected release. According to the release results, rat skin was found to be significantly different from the synthetic membranes.

Predictors and prognostic significance of troponin-I release following elective coronary angioplasty.

The objective of this study was to investigate the predictors and prognostic significance of post-procedural cardiac troponin (cTn)-I elevations in a consecutive series of patients who underwent elective percutaneous coronary intervention (PCI). cTn-I was measured in 100 patients immediately before and within 24 h after the elective PCI. Post-procedural cTn-I elevation was observed in 27 of the 100 patients. In multivariate analysis, basal haemoglobin values and the number of repeated balloon dilatations were found to be independent predictors of cTn-I elevation. During the follow-up period of 12 +/- 1.2 months, the cTn-I-positive group had more major adverse cardiovascular events than the cTn-I-negative group (33.3% versus 16.4%, respectively), but the difference was not significant. An increase in cTn-I levels following elective PCI procedures was frequent but did not predict a poor long-term outcome.

Case report: peritonitis by Penicillium spp. in a patient undergoing continuous ambulatory peritoneal dialysis.

Even though prominent technical improvements in continuous ambulatory peritoneal dialysis (CAPD) treatments during the last decade, peritonitis keeps its place as an important cause of morbidity and mortality in these patients. Among them fungal peritonitis is happened to be the most difficult one to deal with and comes out serious clinical presentation. It is presented here a case of CAPD related fungal peritonitis caused by Penicillium spp. This case experienced recently relapsing bacterial episodes of peritonitis and received long term antibiotics intraperitoneally and systemically. Eventually, Penicillium spp. was detected in several cultures of peritoneal effluent and also tip of Tenckhoff catheter, therefore it was considered as a causative agent. Then, the catheter was removed and amphotericin B therapy was performed. But the general condition of the patient did not improve till surgically drainage of peritoneal collection which was determined by MR (Magnetic Resonance) examination of abdomen after antifungal treatment was completed and Penicillium spp. in the drainage samples was not determined anymore.

Prosthesis culture 6 months after implantation and the effect of haematogenous seeding in a rat model.

The aim of this study was to investigate the role of haematogenous seeding in late prosthesis infection. In all, 45 male Wistar albino rats were divided into three equal groups. A small piece of silicone prosthesis was implanted into the scrotum of all rats under sterile condition and antibiotic prophylaxis. In the first group, all silicones were removed after 6 months without any complication and were cultured for bacterial growth. In the second group, a disc, which was saturated with Staphylococcus epidermidis, was inoculated subcutaneously in the legs of the rats in the 6th month, revealing a nodule formation 4-5 days after the inoculation and treated with an appropriate antibiotic after the nodule formation. In the third group, the same disc was inoculated, but all rats were treated immediately from the inoculation time onwards. The silicones of the second and third group were also removed at the end of the 6th month and were cultured to observe the bacterial growth. There was no evidence of prosthesis infection in any of the three groups. In the first group, three cultures were positive and revealed approximately 10 000 colonies of S. epidermidis in two and Proteus mirabilis in the remaining. Three and four cultures were positive in the second and third group, respectively. Low colonies of four different organisms (Escherichia coli, S. aureus, S. epidermidis, Pseudomonas aeruginosa) were identified in these cultures. There was no statistical significance of positive cultures in the three groups. Based on our results, there does not appear to be a true significance of haematogenous seeding on late prosthesis infection.

A methicillin-resistant Staphylococcus aureus outbreak in a new University hospital due to a strain transferred with an infected patient from another city six months previously.

Kocaeli University Medical School was established in 1995. The first methicillin resistant Staphylococcus aureus isolate was detected two years later in a patient transferred from a different city. Six months after this, we detected a small MRSA outbreak in the intensive care unit involving four patients, two of whom had bacteremia, and a staff nasal carrier. All isolates, including the first, appeared to be a single outbreak strain, demonstrated by pulsed field gel electrophoresis profiles which different by at most two bands, identical randomly amplified polymorphic DNA profiles, and identical coagulase gene types by PCR. Antibiogram were identical except that one isolate was additionally resistant to cotrimoxazole. These results show that MRSA isolates can spread between hospitals with infected or colonized patients and can apparently persist in the hospital for six months without causing infection. Screening of asymptomatic patients on wards affected by MRSA or transferred from other hospitals may be helpful in controlling these infections.