[A Case Report on Subarachnoid Hemorrhage Secondary to Neurobrucellosis in a Patient with Cerebral Aneurysm]. / Serebral Anevrizmali Hastada Nörobrusellozise Sekonder Subaraknoid Kanama: Olgu Sunumu.

Brucellosis is a multisystemic infection produced by a gram-negative bacillus that can develop a variety of clinical symptoms and complications. Involvement of the central nervous system is a challenging and dangerous consequence of systemic brucellosis. The neurobrucellosis clinical spectrum can be classified as central and peripheral. Meningitis, encephalitis, polyradiculoneuritis, cranial nerve involvement, depression, abscess and cerebrovascular events are some of the potential complications that may develop. The link between neurobrucellosis and cerebrovascular accident has been reported infrequently in the literature. In this report, a case of neurobrucellosis confirmed by cerebrospinal fluid agglutination test and who developed subarachnoid hemorrhage associated with cerebral aneurysm, which is a rare condition in its course was presented. Serum Rose Bengal test and serum Brucella standard tube agglutination (STA) tests were positive at a titer of 1/640 in a 38-year-old male patient who had complaints of fever, sweating, myalgia, arthralgia, weakness, head-neck-back pain and difficulty in walking for 14 days. On magnetic resonance imaging, Brucella sacroiliitis was identified. The patient's fever, head and neck pain continued and nuchal rigidity was found to be positive. Neurobrucellosis was diagnosed based on the cerebrospinal fluid (CSF) examination, which revealed a high white blood cell count, high protein, low glucose level, and STA in CSF at 1/640 titers. Imaging of the brain was conducted concurrently with cerebrospinal fluid analysis indicated subarachnoid hemorrhage caused by cerebral aneurysm rupture. In addition to the medical treatment, the aneurysm rupture was closed with surgical intervention. Three months of simultaneous triple antibiotic treatment were administered to the patient. In the third month of the treatment, the patient was completely cured and no longer had any problems. Although uncommon, subarachnoid hemorrhage due to aneurysm rupture is one of the cerebrovascular consequences of neurobrucellosis. In the process of differential diagnosis of cerebrovascular occurrences, particularly in areas where brucellosis is an endemic disease, it is important to keep in mind that neurobrucellosis can imitate a variety of diseases and cause cerebrovascular events.

Reconsidering the environmental Kuznets curve, pollution haven, and pollution halo hypotheses with carbon efficiency in China: A dynamic ARDL simulations approach.

Given a new perspective on the environmental hypothesis, this paper systematically investigates the validity of the environmental Kuznets curve (EKC), pollution haven, and pollution halo hypotheses using carbon efficiency as the dependent variable. Applying the dynamic autoregressive distributed lag simulations based on the annual time series data over the period 1990-2019, the study found that real GDP per capita has negative effects on China's environmental quality both in the short and long run, whereas the square of real GDP per capita has positive impacts. This validates the EKC hypothesis for China. Furthermore, foreign direct investment has negative effects on environmental quality in China, implying that the case of China exemplifies the pollution haven hypothesis and not the pollution halo hypothesis. The empirical results also demonstrate that energy efficiency and trade openness improve China's environmental quality both in the short run and long run. These findings, therefore, provide insights into achieving the ambitious climate goals in China by 2050.

Effectiveness of Derivo® Flow Diverter Device in the Endovascular Treatment of Cerebrovascular Aneurysms.

AIM: To report our experience with flow diverter devices in the treatment of intracranial aneurysms, and to share the efficacy and clinical results of the Derivo® flow diverter device in the endovascular treatment of cerebrovascular aneurysms. MATERIAL AND METHODS: This retrospective study was conducted at a regional training and research hospital between October 2015 and March 2020 after approval by the Clinical Research Ethics Committee. The radiology and file records of 21 patients with cerebrovascular aneurysms treated endovascularly using a Derivo® flow diverter device were examined. RESULTS: As per our findings, flow diverter devices were used to treat 27 aneurysms from 21 cases. Among the treated aneurysms, 3, 2, and 22 were in the middle cerebral artery, anterior communicating artery, and internal cerebral artery, respectively. Eight of the patients with a mean age of 56.9 years presented with subarachnoid hemorrhage. Derivo® flow diverters were used alone in 19 cases, whereas concurrent diverter device and coiling were used in only 3 patients. Complete closure of the aneurysms was observed in 3 (14.2%) cases; meanwhile, a 50% reduction in aneurysm size was observed in 2 (9.5%) cases. Complete aneurysm closure occurred in 20 cases (95%) at the 6-month follow-up. Mortality and morbidity each occurred in 1 (4.7%) case. CONCLUSION: Flow diverter devices provide an efficient and safe method of treatment, especially for fusiform, large, giant, widenecked intracranial aneurysms. Endovascular coil embolization treatment is deemed inappropriate for small aneurysms.

The economic evaluation of ALS care: quality and cost.

Objective: The study aims to analyze the quality of studies that make economic evaluations for amyotrophic lateral sclerosis (ALS). Assessing the quality of studies can guide policy-making and planning. Methods: One of the most recognized checklists "The Consensus on Health Economic Criteria" (CHEC)-list designed by Evers et al. in 2005 aims to answer two important questions: is the methodology of the study appropriate, and are the results of the study valid? We reviewed studies focusing on ALS and its economic costs, and evaluated the studies with (CHEC)-list. Results: We examined 25 articles in terms of their cost evaluation and quality. It is seen that they mainly focus on medical costs, ignoring social care costs. When the quality of the studies is examined, it is seen that the studies overall achieve high scores in terms of their purpose and research question, but some of the studies score low in terms of ethical dimension, comprehensiveness of expenditure items, their application of sensitivity analyses and their study design. Conclusions: The main recommendation of our study for future cost evaluation studies is that they should focus on the questions in the checklist that are scored low overall by the 25 articles, and consider the social care costs as well as medical costs. Our recommendations when designing cost studies can be applied to other chronic diseases with long-term economic costs like ALS.

Quantitative analysis of healthcare waste generation and composition in Antalya, Turkey.

Health-care waste (HCW) may pose a risk to human health and the environment because of its infectious and/or toxic properties. This study was conducted to evaluate the quantity and composition of all the HCW generated by different producers in Antalya, Turkey, using data obtained from two online systems. Accordingly, this study explored the trends in healthcare waste generation (HCWG) between 2010 and 2020 and the impact of COVID-19 on HCWG by comparing the post- and pre-COVID-19 patterns based on the data obtained from 2,029 different producers. The collected data were based on the waste codes reported by the European Commission, were characterised based on the definition of the World Health Organization, and were further analysed according to the healthcare types defined by the Turkish Ministry of Health to characterize HCW. The findings indicate that the main HCW contributor was infectious waste (94.62 %), most of which was generated by hospitals (80 %). This is due to the inclusion of only HCW fractions in this study and to the definition of infectious waste considered. This study indicates that the categorisation into the type of HCSs may be a good option to assess the increase of HCW quantities, in accordance with the service type, size, and the effects of COVID-19. The correlation results for hospitals offering primary HCS revealed a strong relationship between the HCWG rate and the population per year. This approach may help estimate future trends to promote better HCW management practices for the specific cases considered, and it can even be applied to other cities.

Determination of Workload, Work Stress and Related Factors in Nursing Home Workers during the COVID-19 Pandemic in Turkey.

COVID-19 has caused a major crisis all over the world. To manage this crisis, a fixed shift system was applied to nursing home staff in Turkey to protect nursing home residents from the COVID-19 pandemic. Staff were not allowed to leave the institution during fixed shifts. It is thought that this practice for the COVID-19 outbreak, while protecting nursing home residents on the one hand, increased the workload and related stress of nursing home staff on the other hand. To the best of our knowledge, there is no study examining the workload and stress caused by the COVID-19 pandemic for nursing home staff in Turkey. The aim of this study was to examine the level of workload and work stress experienced by staff working in nursing homes during the COVID-19 pandemic in Turkey. METHODS: A cross-sectional research design was used in the study. The sample of the study consisted of nursing home personnel working in nursing homes in the provinces of Istanbul, Ankara, Izmir and Antalya between October 2021 and January 2022. A personal information form and a workload and stress scale were used for collecting the data. Cluster analysis was performed with SPSS software. RESULTS: In total, 154 nursing home personnel participated in the study. A statistically significant difference was found between the mean age of the two clusters. The first cluster was described as "old" and the second as "young". Statistically significant and high values were found in the quantitative workload, qualitative workload, job organization, social work area and fatigue factors in the nursing home staff in the older participant cluster. CONCLUSION: The results of this study provide new information about the concepts of workload and work stress experienced during the COVID-19 pandemic in Turkey, which will serve as a guide for the management of future pandemics. Therefore, this study will contribute to the strategies to be followed in future pandemics in Turkey.

Endoscopic Untethering of Tight Filum Terminale: An Operative Technique.

AIM: To demonstrate the various technical advantages of minimally invasive endoscopic untethering of tight filum terminale for the treatment of tethered cord syndrome (TCS). MATERIAL AND METHODS: In five pediatric cases of TCS, we performed untethering by using the endoscopic technique. The age of the patients were 6, 7, 8, 9, and 12 years old. We used a nasal speculum of the transsphenoidal approach during the endoscopic surgical procedure. RESULTS: All the procedures were performed uneventfully, except for one case with a split cord malformation that showed neurologic deterioration caused by excision of the diastematomyelic fibrous septum at the thoracic level (unrelated to the endoscopic procedure at the L5-S1 level). This patient was referred to a rehabilitation clinic 5 days after surgery and showed significant improvement by the third postoperative month. The other four patients were discharged 1 day after the operation. CONCLUSION: Endoscopic release of filum terminale is a safe technique especially if it is performed with neuromonitoring. This technique may shorten the length of hospital stay and reduce perioperative blood loss. However, futher studies with a larger number of patients and long-term follow-up are needed.

Excitatory rubral cells encode the acquisition of novel complex motor tasks.

The red nucleus (RN) is required for limb control, specifically fine motor coordination. There is some evidence for a role of the RN in reaching and grasping, mainly from lesion studies, but results so far have been inconsistent. In addition, the role of RN neurons in such learned motor functions at the level of synaptic transmission has been largely neglected. Here, we show that Vglut2-expressing RN neurons undergo plastic events and encode the optimization of fine movements. RN light-ablation severely impairs reaching and grasping functions while sparing general locomotion. We identify a neuronal population co-expressing Vglut2, PV and C1QL2, which specifically undergoes training-dependent plasticity. Selective chemo-genetic inhibition of these neurons perturbs reaching and grasping skills. Our study highlights the role of the Vglut2-positive rubral population in complex fine motor tasks, with its related plasticity representing an important starting point for the investigation of mechanistic substrates of fine motor coordination training.

A New Less Invasive Technique for Multiple-Level Spontaneous Spinal Epidural Hematomas: Wash-and-Go Technique.

Aim Spinal epidural hematomas are rare entity in neurosurgery practice. Most of them are spontaneous due to anticoagulant therapy and called spontaneous spinal epidural hematomas (SSEHs). Laminectomy or hemilaminectomy for affected levels is still the first choice in the operative treatment of an SSEH. We describe a new less invasive surgical technique, performing single-level laminectomy and washing with 0.9% sodium chloride through a thin soft catheter for a 12-level thoracic-cervical SSEH in a patient under anticoagulant therapy. Patient and Operative Technique A 55-year-old woman was brought to the emergency department with a rapid onset of pain in her upper back and both legs with weakness of her lower extremities. An urgent magnetic resonance imaging (MRI) of the whole spine showed a SEH. During the operation, after T2 laminectomy, a thin soft catheter was epidurally placed under the T1 lamina and gently pushed forward rostrally. Then continuous saline irrigation was utilized and aspiration made via the catheter to wash out the hematoma. Drainage of blood was observed. The procedure was performed for 15 minutes. Then the catheter was epidurally placed under the T3 lamina, and the procedure for the hematoma in the lower segment was repeated. Decompression of spinal cord and nerve roots was observed. Result Postoperative early MRI of the thoracic-cervical spine showed gross total evacuation of the SEH. Accordingly, the patient's muscle strength improved. Conclusion Although multiple laminectomy or hemilaminectomy for affected levels to evacuate the hematoma and decompress the spinal cord is the main choice of surgical treatment, single-level laminectomy and irrigation plus aspiration via a thin soft catheter can be performed successfully with good results in SSEH.

Cervical disc hernia operations through posterior laminoforaminotomy.

OBJECTIVE: The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. MATERIALS AND METHODS: We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015. RESULTS: The file records and the radiographic images of the 35 patients were assessed retrospectively. The mean age was 46.4 years (range: 34-66 years). Of the patients, 19 were males and 16 were females. In all of the patients, the neurologic deficit observed was radiculopathy. The posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. In 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. In 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%). On control examinations, there was no finding of instability or cervical kyphosis. CONCLUSION: Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis.

A Tumor Suppressor Function for Notch Signaling in Forebrain Tumor Subtypes.

In the brain, Notch signaling maintains normal neural stem cells, but also brain cancer stem cells, indicating an oncogenic role. Here, we identify an unexpected tumor suppressor function for Notch in forebrain tumor subtypes. Genetic inactivation of RBP-Jκ, a key Notch mediator, or Notch1 and Notch2 receptors accelerates PDGF-driven glioma growth in mice. Conversely, genetic activation of the Notch pathway reduces glioma growth and increases survival. In humans, high Notch activity strongly correlates with distinct glioma subtypes, increased patient survival, and lower tumor grade. Additionally, simultaneous inactivation of RBP-Jκ and p53 induces primitive neuroectodermal-like tumors in mice. Hence, Notch signaling cooperates with p53 to restrict cell proliferation and tumor growth in mouse models of human brain tumors.

Neuroprotective effects of agmatine in experimental peripheral nerve injury in rats: a prospective randomized and placebo-controlled trial.

AIM: The purpose of this study was to demonstrate the activity of agmatine, an inducible nitric oxide synthase (iNOS) inhibitor and selective N-methyl-D-aspartate receptor (NMDAR) antagonist, on reducing tissue damage in distal part of traumatic nerve in an experimental rat peripheral nerve injury model. MATERIAL AND METHODS: Sciatic nerves of 30 Sprague Dawley male rats were used. Rats were divided into 5 groups; group 1 (n=6), control group; group 2 (n=6), axonotmesis + placebo group; group 3 (n=6), axonotmesis + 50 mg/kg agmatine treatment group; group 4 (n=6), neurotmesis + placebo group; group 5 (n=6), neurotmesis + 50 mg/kg agmatine treatment group. Axonolysis, axon degeneration, edema, hemorrhage, and inflammation were evaluated in histopathologic examinations of all the groups. RESULTS: When group 2 was compared with group 3 in histopathologic sections, axonolysis was less in group 3 (p=0.007), as was axon degeneration (p=0.022) and edema (p=0.018). When group 4 was compared with group 5, axonolysis was less in group 5 (p=0.009), as was axon degeneration (p=0.006) and edema (p=0.021). CONCLUSION: This study demonstrated agmatine to have antioxidant and antineurotoxic effects in an experimental rat peripheral nerve injury model.

The socio-cultural perception of death in Turkish society recorded in lament epics (1955-1975).

This study explores the socio-cultural perception of death among Turkish people. For this reason, 210 published lament epics written by Turkish folk singers across all of Turkey concerning deaths between 1955 and 1975 were selected for analysis. These epics were published on single pages and were sold. The statistical analysis based on detailed content analysis was done at the univariate, bivariate, and multivariate levels. The results of the study provide a full picture of perception of cases of death in Turkish society. These results show Turkish society is especially sensitive to cases of death at young age and to the murdered. Further, a clear perception of the working of fate is encountered in deaths resulting from disaster and accidents; but the desire for vengeance is recorded in those laments concerning martyrs and the murdered. The statistical data show that most commonly cited reasons for death after road accidents, were a consequence of relationships with the opposite sex and from a sense of honor.

Neuroprotective effect of acute interferon-beta 1B treatment after spinal cord injury.

AIM: The purpose of this trial was to investigate the effect of a well known immunomodulator -interferon beta- on traumatized spinal cord in terms of biochemical and histopathological features. MATERIAL AND METHODS: Twenty-four rats were used in this trial. The rats were divided into 3 groups. In the first group of rats, spinal cord injury was created by the weight drop method and interferon beta was administered. In the second group, physiological saline was administered. Third group was used as control. Rats were sacrificed 24 hours following trauma. Heat shock protein 70 levels were measured in the spinal cord samples and the samples were examined histopathologically. RESULTS: When the rats in the physiological saline and control groups were compared to rats treated with interferon beta 1b, those treated with interferon beta 1b revealed significant increases in the heat shock protein 70 levels in tissues, and histopathological examination revealed decreases in polymorphonuclear leucocyte infiltration, haemorrhage, oedema and necrosis. CONCLUSION: Although, the results of the study indicated that interferon beta might have some healing effects via increasing the cellular heat shock protein 70 on spinal cord injuries, more studies are needed.

Are all deaths the same for physicians and nurses?: stereotype questions physicians and nurses utilize to characterize a person who has died.

How do healthcare professionals classify or characterize human beings: how do they identify and define a patient or in the case of this study a dead person? Healthcare professionals are fairly regularly exposed to human beings dying. Part of their duty is to postpone death but, death being inevitable, they regularly lose the fight. This study aims to determine how healthcare professionals classify human beings by asking only 1 question, and allowing respondents to provide 5 answers of their own making ("You are exposed to a dead person, victim of a car accident. Apart from name and surname, what are the 5 questions you would ask?"). Thereby, it is hoped to avoid both conflicts with responsibilities of healthcare professionals and predetermining the answers. As described above, one self-administered open question related to a very short story had to be answered anonymously and was asked by e-mail. As a result of the analysis, a number of stereotype question sets were obtained through the answers of the respondents. The stereotype questions and derived thought concepts provide an insight into the awareness and (prioritized) values of healthcare professionals in Turkey. In the replies, questions related to the personal background of the dead (such as age, marital status, and parenthood) had the highest frequency, while questions of professional relevance followed with medium frequency. A question relating to the consent of the deceased to organ donation was almost never asked. It is suggested that any potential educational material for healthcare personnel should be reviewed in order to increase awareness of relevant issues.

What do we know about the medical biography of Kemal Atatürk (1881-1938)? A summary of the state of knowledge and outlook on relevant issues for further research.

Mustafa Kemal Atatürk, the founder and first President of the Turkish republic, is the subject of many more or less 'heroic' biographies and few critical ones. His anamnesis, however, is only available in fragments. Many books omit details of Atatürk's health and life, for example his bloodline, his illness and eventually his death, his funeral prayer and ceremony and his burial. His liver problem, diagnosed as cirrhosis and said to be the cause of his death, is well described but his general health and other sicknesses are scarcely recorded. This paper provides an overview of his anamnesis as far as it is known, the literature describing it and the level of knowledge generally published, and it also indicates where original research in the archives is needed to complete the picture.

Neuroprotective effect of ACE inhibitors in glutamate - induced neurotoxicity: rat neuron culture study.

AIM: Glutamate is known to be neurotoxic at concentrations of 10-6M and 10-7M. Angiotensin converting enzyme (ACE) inhibitors can be assumed to be neuroprotective as they open the mitochondrial adenosine triphosphate-sensitive potassium channels by inhibiting the degradation of bradykinin. In this study, we investigated whether the ACE inhibitors captopril, ramipril and perindopril have protective effects in glutamate-induced neurotoxicity in newborn rat cerebral cortex cell cultures. MATERIAL AND METHODS: Viability tests were performed among ACE inhibitors by constituting groups of control and 10-7M and 10-6M glutamate doses in newborn rat cortex cultures. RESULTS: While the mean viable cell number was 0.47±0.06 in the control group, it was 0.37±0.03 in the group exposed to 10-7M glutamate (p < 0.05) and 0.37±0.01 in the group exposed to 10-6M glutamate (p < 0.05). Captopril was used at a dose of 10 µM, perindopril was used at a dose of 1 µM, and ramipril was used at a dose of 30 µM against 10-7M and 10-6M glutamate. Ramipril and perindopril reversed the toxicity against 10-6M glutamate (p < 0.05). The neuroprotective properties of captopril, perindopril and ramipril were not found to be statistically significant against 10-7M glutamate at the doses mentioned above. CONCLUSION: Data obtained from this study indicate that ramipril and perindopril can prevent 10-6M glutamate-induced neurotoxicity.