A Comprehensive and Longitudinal View of Pregnancy from the Perspective of the Couple, Maternal Mental Health and Fetal Growth.

OBJECTIVE: This study investigates the impact of both maternal psychopathological factors and adaptive psychological changes within the couple on fetal growth, emphasizing the importance of evaluating pregnancy from the perspectives of the couple, the mother, and the fetus collectively. A "couple" in this context refers to heterosexual partners engaged in the pregnancy process together, whether married or in a stable relationship. METHODS: We included 189 pregnant women in their first trimester, tracking maternal depression, anxiety, body appreciation, prenatal attachment, and the couple's adjustment level across each trimester. Fetal growth parameters measured include biparietal diameter, femur length, humerus length, abdomen circumference, head circumference, ß-HCG, and amniotic fluid levels, with relationships between these variables being modeled accordingly. RESULTS: Our findings indicate stable levels of maternal depression, anxiety, body appreciation, and couple's adjustment throughout the pregnancy, with a significant increase in prenatal attachment levels in each subsequent trimester. Prenatal attachment in the first trimester and maternal depression levels in the second and third trimesters were found to directly influence fetal growth, while other variables exhibited indirect effects. CONCLUSIONS: Fetal growth is influenced by a myriad of biopsychosocial factors. Ensuring healthy pregnancy and fetal development necessitates close monitoring and support of the mother's adaptive psychological changes, early identification and treatment of potential psychopathologies, and maintenance of the psychosocial health of the couple.

Sexual Dysfunction in Women After Tibial Fracture: A Retrospective Comparative Study.

BACKGROUND Tibial fractures, common in adults, are often treated with external or internal fixation methods. While effective, external fixation (EF) can lead to sexual dysfunction (SD), especially in young patients. This study aimed to assess SD in women undergoing EF versus internal fixation for tibial fractures. MATERIAL AND METHODS Sexual function and frequency of monthly sexual intercourse (SI) were evaluated using the Female Sexual Function Index (FSFI) before surgery, with the fixator, after at least 6 months following fixator removal in EF group, and after achieving bone union for at least 3 months in the IF group. RESULTS The EF group consisted of 107 (mean age 28.5 years; 19-40 years) and IF group consisted of 106 patients (mean age 32.1 years; 18-40 years). The duration of EF was an average of 4.7 months (range, 2.5-13 months). FSFI scores were significantly lower in the EF group compared to the IF group (9.33 versus 27.3, P<0.001). Also, there was no significant difference between the FSFI scores before EF and after EF was removed (34.22 versus 33.8, P=0.413). FSFI sub-group scores such as desire, arousal, lubrication, and orgasm were significantly lower in the EF group (P<0.001). The monthly average frequency of SI before surgery and after the removal of EF was 10.2 and 9.1, respectively, while this frequency was 2.56 when EF was present (P<0.001). CONCLUSIONS The quality and frequency of SI in women significantly deteriorate and decrease during the period of extremity fixation following tibial diaphyseal fractures treated with EF, but return to normal after removal.

Comparison of Functional Outcomes and Complications of Inlay and Onlay Reverse Shoulder Arthroplasty in Neer Type 4 Proximal Humerus Fractures and Cuff Tear Arthropathy: A Multicentric Study.

Background: This multicenter retrospective study was conducted with the objective of comparing the outcomes and complications between inlay and onlay reverse shoulder arthroplasty (RSA) in patients presenting Neer Type 4 proximal humerus fractures and cuff tear arthropathy. The primary aim of this investigation was to assess and juxtapose the clinical as well as functional outcomes of individuals who underwent onlay reverse shoulder arthroplasty with those who underwent inlay reverse shoulder arthroplasty. Methods: A retrospective cohort study was conducted, involving patients who had undergone reverse shoulder arthroplasty between the period of 2016 and 2022. The study divided the population into two groups: Group A received inlay humeral components, while Group B received onlay humeral components. Functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) and Constant scores. Range of motion, infection, periprosthetic fractures, and nerve injuries were also assessed. Results: The study included 67 patients in Group A and 62 patients in Group B. Group A had significantly better functional outcomes, as indicated by higher ASES and Constant scores (p < 0.05). Group A also had greater shoulder joint motion (p < 0.05). Periprosthetic fractures were significantly more common in Group B (p < 0.05). However, complication rates, including infection and instability, did not significantly differ between the groups (p > 0.05). Nerve injuries occurred in both groups, with slightly higher occurrence in Group B. Conclusion: Inlay humeral components in reverse shoulder arthroplasty for Neer Type 4 fractures and cuff tear arthropathy resulted in better functional outcomes, increased range of motion, and lower incidence of periprosthetic fractures compared to onlay components. Onlay components showed potential advantages in reducing instability rates. Further studies with larger samples and standardized protocols are needed to confirm these findings.

Pectoralis major pedicle bone grafting vs. tricortical iliac grafting for Neer 4-part proximal humerus fractures: a randomized controlled trial.

BACKGROUND: The risk of avascular necrosis, nonunion, or malunion is high in osteoporosis-related 4-part fractures. We evaluated the results of patients who underwent plate osteosynthesis with a vascularized pectoralis major graft compared with tricortical iliac grafting to treat 4-part proximal humerus fractures. MATERIAL AND METHODS: Thirty-four patients aged 50-75 years with Neer 4-part proximal humerus fractures were studied. Group A (n = 17) underwent osteotomy of a 2.5 ± 1 cm pectoralis major pedicle bone graft and plate application, whereas group B (n = 17) underwent plate osteosynthesis using iliac autogenous grafts. Final follow-up assessments included evaluation using Constant and American Shoulder and Elbow Surgeons scoring systems, humeral neck-shaft angle (HNSA), humeral head height, and humeral head avascular necrosis. RESULTS: Reduction loss was observed in 3 patients (17.6%) in group A, whereas it was observed in 10 patients (58.8%) in group B (P = .013). Humeral head avascular necrosis was found in 1 patient (5.8%) in group A, whereas it was found in 5 patients (29.4%) in the other group (P = .071). The HNSA was normal in 12 (70.5%) of group A patients, whereas it was normal in 6 (35.2%) of group B patients. The HNSA was weak or bad (<1200) in 29.4% of group A patients, whereas this rate was 64.7% in group B patients. Humeral head height was 2.64 ± 1.45 mm in group A and 3.66 ± 1.65 mm in group B. There were no statistically significant differences between the 2 groups in terms of Constant and American Shoulder and Elbow Surgeons scoring systems. CONCLUSION: Pectoralis major bone pedicle graft in Neer 4-part proximal humerus fractures reduces the risk of avascular necrosis and nonunion rates. Our technique yielded excellent clinical and radiological results. We achieved recovery without creating additional donor site morbidity.

Quality of Life and Psychometric Characteristics of Syrian Refugee Physicians Who Migrated to Turkey: A Cross-Sectional Study.

Background: The concept of migration comes with various problems, affecting the quality of life and psychological state of immigrants. This study aimed to investigate the quality of life and depression and anxiety states of physicians who immigrated to Turkey after the civil war that started in Syria in 2011. Methods: In this cross-sectional study, a sociodemographic questionnaire form, the short version of the World Health Organization's quality of life assessment tool (WHOQOL-BREF), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were applied to Syrian doctors who received integration training to work in refugee health centers established for immigrants in Turkey. Results: A total of 570 participants were included in the study. The median scores of WHOQOL-BREF domains of the participants were 75 for DOM1 (min: 25, max: 100, IQR: 18), 69 for DOM2 (min: 6, max: 100, IQR: 25), 69 for DOM3 (min: 0, max: 100, IQR: 19), and 63 for DOM4 (min: 0, max: 94, IQR: 19). The median BDI score of the participants was 7 (min: 0, max: 41, IQR: 8), and the median BAI score was 5 (min: 0, max: 50, IQR: 8). Having primary care experience, having knowledge about the Turkish healthcare system, believing that they can adapt to work in refugee health centers, and not having a plan to return to their country were found to be associated with a higher score in at least one of the WHOQOL-BREF subdomains. Planning to turn back their country was significantly associated with higher BAI scores. Conclusions: The overall quality of life of most refugee physicians in Turkey was high, and the BDI and BAI scores were also below the threshold values. Further qualitative studies that allow in-depth analyses may reveal underlying factors for this situation.

Effects of attachment styles, childhood traumas, and alexithymia in Turkish patients with epilepsy and functional seizures.

INTRODUCTION: In this cross-sectional study, we used self-report scales to compare childhood traumas, attachment styles, and alexithymia among patients with functional seizures (FS) to patients with epilepsy and healthy controls. We also investigated risk factors associated with FS. MATERIAL AND METHODS: A total of 44 patients with epilepsy, 14 patients with FS, and 25 healthy controls were included. All participants were over the age of 18 and were referred to the Baskent University Adana Epilepsy and Video-EEG Center. The patients underwent neurological examinations, brain MRIs, and video-EEG evaluations. Epileptic seizures were classified based on video EEG. The control group consisted of healthy individuals without neurological or psychiatric illness and a history of epileptic seizures or syncope. Beck Depression Inventory (BDI), Childhood Trauma Questionnaire (CTQ), Adult Attachment Scale (AAS), and Toronto Alexithymia Scale-20 (TAS-20) were applied to all participants. RESULTS: Patients with FS had lower educational levels, higher rates of unemployment and single-marital status. The FS group had higher depression, childhood trauma, and alexithymia scores than the other groups. Furthermore, FS patients had a higher prevalence of avoidant attachment. The alexithymia and childhood trauma scores were both correlated with depression. Through the logistic regression analysis, childhood trauma scores and alexithymia were significant risk factors for FS. CONCLUSION: The use of video-EEG for diagnosing FS can reduce the risk of misdiagnosis and inappropriate antiepileptic treatment. Psychiatric comorbidities, childhood traumas, and alexithymia are prevalent in patients with FS. Therefore, implementing a multidisciplinary treatment approach that addresses the psychological, medical, and social aspects of FS can significantly improve outcomes.

Arthroscopic Biological Augmentation With Subacromial Bursa for Bursal-Sided Partial-Thickness Rotator Cuff Tears.

Background: Augmentation with subacromial bursa has not been fully established in bursal-sided partial-thickness rotator cuff tears (PT-RCTs). Purpose: To compare the results of acromioplasty + arthroscopic debridement versus acromioplasty + augmentation with subacromial bursa for Ellman type 2 PT-RCTs involving 25% to 50% of the tendon surface area. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 40 patients (mean age, 47.8 years) with Ellman type 2 PT-RCTs whose symptoms did not regress despite 3 months of nonoperative treatment. The patients underwent either acromioplasty + debridement (group A; n = 18) or acromioplasty + augmentation (group B; n = 22). Outcome scores (visual analog scale [VAS] pain score, Constant-Murley score [CMS], and American Shoulder and Elbow Surgeons [ASES] score) were obtained preoperatively and at 6, 12, and 18 months postoperatively. Magnetic resonance imaging (MRI) scans performed at 6 months postoperatively were used to determine the integrity and state of healing. Results: There were no significant differences between groups A and B in preoperative VAS, CMS, or ASES scores, and patients in both groups saw significant improvement at each follow-up time point on all 3 outcome scores (P = .001 for all). Scores on all 3 outcome measures were significantly better in group B than group A at each postoperative time point (P < .05 for all). Postoperative MRI scans revealed persistent partial tears in 5 of 18 patients in group A compared with 2 of 22 patients in group B (P < .05). Conversion to full-thickness tear (3/18 patients) was seen only in group A. Conclusion: Patients who underwent biological augmentation of their PT-RCTs had improved outcome scores compared with those treated with acromioplasty and debridement alone.

Acute polyneuropathies after bariatric surgery: does immunity play a role? Case series and literature review.

BackgroundThe incidence of bariatric surgery (BS) is on the rise, and the prevalence of complications associated with this procedure has also increased. The most common neurologic complications of BS are peripheral neuropathy and encephalopathy. In this study, we presented the clinical and electrophysiological courses of five patients with acute-subacute axonal polyneuropathy after BS.MethodWe evaluated neurological examinations, micronutrient deficiencies (B12, folic acid, thiamine, and vitamin D), nerve conduction studies (NCS), and Guillain-Barré syndrome (GBS) disability scores.Cases All patients were female; the average weight loss was 35.2 ± 7.52 kg, and the CSF protein level was 40.98 ± 6.99 mg/d. All patients underwent vitamin supplementation and physical therapies. The presence of more pronounced axonal involvement in NCS and the higher likelihood of normal CSF protein levels in BS-related acute polyneuropathy patients suggest that the underlying pathogenesis may differ from classical GBS. In the presented studies in the literature, inflammation is frequently observed in nerve biopsies of BS patients, suggesting that both micronutrient deficiencies and immune mechanisms play a role in the pathogenesis. Intravenous immunoglobulin (IVIG) treatment may improve neurologic deficits in patients with GBS-like clinical presentations. In the presented study, three patients were treated with IVIG, while two patients were treated with plasma exchange therapy followed by IVIG. Three cases improved significantly and were able to walk without assistance at one year visit.ConclusionIn patients with bariatric surgery (BS)-associated polyneuropathy, immunotherapy, and intensive pre- and post-operative nutritional management may improve patients' morbidity. Therefore, we suggest close monitoring by a multidisciplinary team for PBS patients.

Feasibility of diagnosing osteoporosis using routine computed tomography scans for hip fractures: Correlation with histopathological diagnosis of head and neck regions.

OBJECTIVE: The aim of this study was to demonstrate the feasibility of diagnosing osteoporosis through routine computed tomography (CT) by assessing the association between the histopathological assessment of femoral head specimens extracted from patients who underwent surgery for intertrochanteric fractures and the Hounsfield unit (HU) measurements derived from preoperative CT scans. METHODS: Forty-eight patients who presented to our clinic between November 2019 and May 2020 with hip fractures and underwent partial prosthesis fixation were included in this retrospective study. Hounsfield unit measurements were performed on the head and neck regions using dual-energy x-ray absorptiometry (DEXA) and CT scans, respectively. The trabecular ratio per unit area was calculated using the Nikon Imaging Software (NIS-Elements ) program in the pathology laboratory from digitally captured images of the removed head and neck specimens. RESULTS: The mean HU receiver operating characteristic analysis had a sensitivity of 77% and a specificity of 87%, with a cutoff value of 77.68. There was a moderate correlation between the mean trabecular density and the mean HU of the femoral head (P=0.013, r=0.340). Additionally, there was a significant correlation between the mean HU and the T-score of the head, although this correlation was not found with the maximum-minimum HU. Although there was a significant correlation between trabecular density and mean HU, the correlation coefficient indicated a moderate relationship. This relationship was also observed between the inferior sections of the head and the trabecular density and HU (P=.018). However, no significant correlation was found between the T-score and the trabecular structure of the head (P=.977). CONCLUSION: The results of the present study suggest that conventional CT has the potential to serve as a diagnostic tool for osteoporosis and may offer a more precise and accurate method for evaluating the success of intraosseous implants when compared to T-scores without the need for additional tests or procedures.

Shoulder Proprioception Following Reverse Total Shoulder Arthroplasty for Unreconstructable Upper Third Fractures of the Humerus: 2-Year Outcomes.

Background: Proximal humerus fractures may be comminuted in the elderly or after injury with high-energy mechanisms. Reverse total shoulder arthroplasty that may affect shoulder proprioception (rTSA) has also begun to play a part in treating acute proximal humeral fractures. In this study, the authors aimed to evaluate joint position sense (JPS) after rTSA. Methods: Humac Norm II isokinetic device was used to evaluate the joint position sense. A joint angle was determined and the ability of the patient to create the same value of the angle by the active movement was evaluated. The difference between the pre-determined angle and the patient's measured angle was recorded. For proprioceptive sense, the initial position was 0° and the determination position was 30°, 60°, and 90° for flexion and abduction, and 15° and 30° for internal rotation and external rotation. Results: While both the mean Constant and ADLEIR scores did not differ between non-operated and operated sides, the mean proprioception differences in all flexion (30°, 60°, and 90°), abduction (30°, 60°, and 90°), internal rotation (15° and 30°), and external rotation (15° and 30°) were significantly higher in the operated side than that in non-operated side (p < 0.01 for each pairwise comparison). Conclusion: Reverse total shoulder arthroplasty (rTSA) treatment, which has increasingly become a surgical option in un-reconstructable proximal humeral fractures has significant adverse effects on proprioception on the operated side and may pose a risk for long-term instability, premature loosening, and prosthesis mechanical complications, in this context, well-designed prospective controlled studies are required.

Kinesiotaping therapy for midshaft clavicular fractures: a randomised trial study.

Midshaft clavicle fractures with shortening by less than 2 cm or minimal displacement without neurovascular injury can be treated conservatively. We hypothesized that kinesiotaping reduces the disadvantages of conservative treatment, such as early-phase pain, high nonunion rates, and a prolonged time to return to work, and yields better clinical and functional outcomes. Forty patients were randomly divided into the arm slings only (group S) or arm sling with kinesiotaping therapy group (group K). The outcome measures included the visual analog scale (VAS) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, union time, magnitude of shortening, and time to return to work. The mean follow-up period of the study was 8.5 (6- 10) months. The ASES and Constant scores were significantly better in group K than in group S in the 3rd month. The mean union time was 8.60 (8-12) weeks in group S and 8.25 (6-12) weeks in group K. The mean time to return to work was 7.23 (4-12) weeks in group S and 5.37 (2-10) weeks in group K, and the difference was statistically significant (p <0.05). There was no significant difference in terms of shortening between the two groups. Compared with an arm sling only, an arm sling with kinesiotaping can yield better clinical functional results, higher union rates, and a shorter the time to return to work due to the early control of pain and edema.

Clinical-epidemiological and radiological characteristics of stroke patients: A multicentre study.

INTRODUCTION AND AIM: Stroke is the leading cause of disability in adults and the second most common cause of death, at a rate of 11.8% worldwide. The purpose of this study was to examine the aetiological, demographic, and clinical characteristics of patients admitted to hospital because of acute strokes. MATERIALS AND METHODS: This multicentre study retrieved information for all patients admitted to hospital because of an acute cerebrovascular event over a six-month period, and sociodemographic, aetiological, and clinical characteristics were recorded. RESULTS: A total of 1136 patients, 520 of whom were women (45.7%), with a mean age of 70.3 ± 12.8 years, were included in the study. Of these, 967 were diagnosed with ischaemic stroke (IS) (85.1%), 99 with haemorrhagic stroke (HS) (8.7%), and 70 with transient ischaemic attack (6.1%). The most common risk factor for stroke was hypertension (73%). Carotid disease and hyperlipidaemia rates were higher in patients with HS. Numbers of functionally dependent patients with severe neurological status according to the National Institutes of Health Stroke Scale and modified Rankin scale were significantly higher in the HS group (P < .001). When IS was classified according to the Trial of Org 10172 in Acute Stroke Treatment, small vessel disease emerged as the most common cause (41%). The most common lesion localisations were the parietal lobe (23%) in the IS group and the thalamus (35.3%) in the HS group. Eighty-eight patients (7.7%), 62 (6.4%) in the ischaemic subgroup, and 26 (26.3%) in the haemorrhagic subgroup, died within the first month. CONCLUSION: Current and accurate evaluations of stroke aetiology are essential for stroke prevention and treatment planning. This study, shows that no change occurred in the aetiology of stroke and epidemiological characteristics and that accurate identification of modifiable stroke risk factors is still a major goal.

Thiol levels in mild or moderate COVID-19 patients: A comparison of variant and classic COVID-19 cases.

BACKGROUND: Various variants of the COVID-19 have started to attract attention recently. The clinical course of these variants and possible predictive parameters are being investigated. This study aimed to examine the relationship between thiol levels, which are indicators of oxidative stress, and variant COVID-19 types. METHODS: In this cross-sectional study, patients with a diagnosis of classic COVID-19 and patients with a diagnosis of variant COVID-19 with mild and moderate symptoms followed in the clinical observatory of Ankara city hospital were included in the study group. The patients were divided into two groups according to the COVID-19 type as a variant and classic COVID-19, and a healthy control group was added for comparison. A complete blood count and thiol analysis were performed from the venous blood samples. Obtained results were compared between groups, and the ROC analysis was performed. RESULTS: Thiol levels were significantly lower in patients with a diagnosis of COVID-19 compared with the control group. In terms of WBC, lymphocyte, neutrophil, NLR, ferritin and thiol parameters, patients with variant COVID-19 differed significantly from patients with a classic COVID-19 diagnosis. Thiol levels' cut-off values to distinguish between variant COVID-19 patients and control group from classical COVID-19 patients were almost identical (423 and 422 µmol/L, respectively). CONCLUSIONS: It seems possible to use thiol as a sensitive, specific and cost-effective marker to suspect variant COVID-19 cases. Since this study is probably the first example in this subject, it would form a basis for further studies.

Assessment of the relation between the neutrophil to lymphocyte ratio and severity of ischemic stroke in a large cohort.

AIM OF STUDY: The NLR is a simple and inexpensive parameter that is useful as a marker of subclinical inflammation. The purpose of this study was to investigate the clinical characteristics of patients diagnosed with acute cerebral ischemia at the time of initial evaluation in the emergency department. PATIENTS AND METHODS: The study was designed as a multicentre cross-sectional study of acute ischemic stroke patients. Neurological evaluations were assessed using the NIHSS and mRS. Evaluations included the results of patients' laboratory tests performed at the time of presentation to the emergency department. RESULTS: Seven hundred and thirty-five ischemic stroke patients were included in the study. Stroke cases assessed by the mRS as mild or severe showed significant differences with respect to age, leukocyte counts, neutrophil counts, NLR, LDL cholesterol values, and serum glucose values (P = .001). When analysed using NIHSS, lymphocyte levels were significantly higher in very severe stroke cases compared with mild, moderate, and severe cases. NLR was also significantly higher in very severe stroke cases and severe stroke cases as compared with the mild and moderate stroke groups. Neurological evaluations assessed using the mRS showed a mild positive correlation with neutrophil and leukocyte count and a weak correlation with the NLR. CONCLUSION: The NLR exhibited a significant correlation with the results of the mRS and NIHSS. The NLR measured in the very early period was also significantly associated with clinical condition. These results suggest that high NLR values may be a marker of stroke' severity.What's known Stroke is an important disease that has a significant impact on mortality and morbidity and is closely related to the aging world population. In recent years, highly innovative approaches have been developed in the treatment of stroke. Although a long distance has been covered in the early diagnosis of stroke, the ability to predict the severity of the disease with many parameters is still up to date. What's new At the time of admission, in the absence of infection, parameters such as leukocytelymphocyte count and NLR may be telling about stroke severity. Demonstrating the utility of these simple, practical, inexpensive and naninvasive parameters to predict stroke severity can contribute to the scoring to be established at the time of initial diagnosis.

Social adaptation status of Syrian refugee physicians living in Turkey.

OBJECTIVES: Since the beginning of the civil war in Syria, over 3.5 million Syrians have fled to Turkey. Considering the massive burden of healthcare service needs of this population, the Turkish government has launched an initiative as employing Syrian doctors to provide health services to their citizens in Refugee Health Centres. In this study, we aimed to explore the social adaptation status of Syrian physicians living in Turkey using a structured questionnaire and the Social Adaptation Self Evaluation Scale (SASS). METHODS: Between November 2016 and April 2018, 799 physicians who participated in "Syrian Physicians' Adaptation Training" were enrolled in the study and underwent a structured questionnaire that questioned socio-demographic data and the SASS. The participants were divided into two groups as having poor and normal/high SASS scores. The binary SASS groups were compared with some demographic data. RESULTS: The median SASS score of the respondents was found as 43 (min. 10, max. 60, IQR 10) which can be accepted as normal. In the binary grouping, it was seen that 107 (13.39%) participants had poor social adaptation, whereas 692 (86.61%) participants had normal or high social adaptation scores. The physicians who were certain about not going back to Syria had significantly higher SASS scores. CONCLUSION: The social adaptation scores of the Syrian physicians were considerably high. The adaptation status was found to be associated with some characteristics like living in Turkey for a long time and having pre-knowledge about the Turkish healthcare system.

Idiopathic Intracranial Hypertension: Etiological factors, Clinical Features, and Prognosis.

INTRODUCTION: Idiopathic intracranial hypertension (IIH) occurs due to increased intracranial pressure (ICP), is most commonly encountered in obese women, and may lead to loss of vision. This study aimed to determine the demographic features, clinical signs and symptoms, and radiological findings of patients with IIH, and to investigate the factors associated with the prognosis. METHODS: Patients with IIH who were examined and followed-up between January 1992-January 2012 in the Neuro-ophthalmology Unit were retrospectively evaluated. Patients were diagnosed based on the modified Dandy criteria. RESULTS: The mean age of 59 patients included in the study (female, 88.1%) was 30.25±13.12 years. Reported complaints were headache (78.0%), transient visual obscuration (45.8%), nausea (32.2%), dizziness (16.9%), and diplopia (13.6%). Of the patients 69.4% had visual field deficits, and 71% had papilledema (66.1% were bilateral). The rate of obesity was 20.3%. The prognosis was good in 64.7% of the patients, and 35.3% of the patients clinically worsened. Recurrence of symptoms was observed in 33% of the patients and 4 patients had severe permanent vision loss. Demographic features, initial complaints, mean ICP, and pathological magnetic resonance imaging findings were not associated with the prognosis. Delay in treatment and generalized constriction in the visual field were associated with the poor prognosis. CONCLUSION: Compared to patients with IIH in the western population, obesity was less frequent in the present study. Initial visual field defects, especially the generalized constriction and delay to treatment were related to poor prognosis. Cessation of medical treatment was a factor for recurrence. Early diagnosis and appropriate treatment may subside the severity of permanent vision loss in fulminant IIH.

Anti-N-methyl-d-aspartate receptor encephalitis during pregnancy: A case report.

Following a generalized tonic-clonic seizure, a previously healthy 27-year-old pregnant woman (18-week pregnancy) was admitted to our emergency department. She experienced lethargy, forgetfulness and persecutory hallucinations the day before hospitalization. Cerebrospinal fluid examination revealed moderate pleocytosis, and abdominal ultrasonography did not detect neoplasia. Orofacial dyskinesia, catatonia and central hypoventilation gradually developed despite medical intervention to ameliorate the symptoms. At 32 weeks of pregnancy, vaginal bleeding and hypotension occurred. Further, owing to septic shock due to fetal demise, the patient died. N-methyl-d-aspartate antibody test results obtained after the patient's death were positive (2++). Currently, no consensus exists on the appropriate treatment and follow-up for pregnant women with anti-N-methyl-d-aspartate receptor encephalitis; however, immunomodulators and teratoma resection may be helpful. Second line immunotherapy (rituximab, cyclophosphamide) and teratoma resection may be necessary in pregnant patients with high N-methyl-d-aspartate receptor antibody titers and inadequate response to first-line treatment.

Evaluation of the effects of different sand particles that used in dental implant roughened for osseointegration.

BACKGROUND: Successful dental implant treatment is directly related to osseointegration. In achieving osseointegration, the surface property of the implant is of great importance. Sandblasting is the most commonly used basic method for modifying the surface. Many companies use different sand particles for surface roughening and claim their sand is the best. This leads clinicians to mix their minds in product selection. In this study, we tried to find the appropriate sand material by working objectively without praising any brand. We believe that the results of the study will help clinicians choose the right dental implant. In this study, machined-surfaced implants and implants sandblasted with Aluminum oxide (Al2O3), Titanium dioxide (TiO2) and Silicon dioxide (SiO2) were compared via biomechanical testing. METHODS: For the study, four 2 year-old sheep, weighing 45 kilograms (kg), were used. Eight implants (Al2O3, TiO2, and SiO2 sandblasted implants and machined-surfaced implants), each with different surface characteristics, were inserted into the bilateral tibia of each sheep under general anesthesia. Results of the initial Resonance Frequency Analysis (RFA) were recorded just after implant insertion. The sheep were then randomly divided into two groups, each with 2 sheep, to undergo either a 1-month or a 3-month assessment. At the end of the designated evaluation period, RFA and removal torque tests were performed. RESULTS: Although there were no statistically significant differences between the groups, the implants sandblasted with Al2O3 showed a higher Implant Stability Quotient (ISQ) and removal torque value at the end of the 1st and 3rd month. CONCLUSIONS: In short, the results of the study demonstrate that Aluminum oxide is superior to other sand particles.

Copeptin levels in carbon monoxide poisoning.

BACKGROUND/AIM: The aim of this study is to identify the copeptin levels in patients presenting with carbon monoxide (CO) poisoning to the emergency department and to investigate its correlation with the neurological effects. MATERIALS AND METHODS: The study group consisted of patients presenting with CO poisoning and carboxyhemoglobin levels >10%. Blood samples for copeptin levels were obtained twice, first at presentation then at the fourth hour of observation. The data were analyzed using SPSS 16 for Windows. RESULTS: The median copeptin levels of the patient group were identified as 0.63 (0.39-1.06) ng/mL at hour 0 and 0.41 (0.31-0.49) at hour 4. The copeptin levels of the control group were 0.34 (0.25-0.42) ng/mL and were significantly lower than those of the patient group (P < 0.000). According to our results, 0.345 ng/mL for plasma copeptin level as the best cut-off level may be used with sensitivity of 94.0% and specificity of 60%. The copeptin levels at hour 0 were statistically significantly higher in the neurologically affected patients than those not affected (P < 0.001). CONCLUSION: In this study it was shown that blood copeptin levels increase in patients presenting to the emergency department with CO poisoning.

Biomechanical evaluation of oversized drilling on implant stability - an experimental study in sheep.

OBJECTIVE: To evaluate the effect of oversized drilling on implant success and secondary stability. METHODS: The experimental study was conducted in Turkey from January to July 2013, after approval by the ethics committee of the University of Ankara, and comprised 2 female sheep. Alumina blasted implants 4mm in diameter and 10mm in length were employed; 16 implant sites were prepared on the proximal tibias of the 2 sheep. In the right tibia, a standard preparation with 3.5mm diameter was performed in the control group, while in the left tibia, an over-preparation with 4.2mm diameter was performed at the experimental group. The implants of the control group were non-mobile, while the experimental group had rotational and vertical movements. The initial implant stability was measured using the resonance frequence analysis. Animals were sacrificed after 12 weeks, and resonance frequence analysis and reverse torque values were measured. RESULTS: In the experimental group, the mean resonance frequence analysis value was 60.25±7.46 (range: 49-74) at the end of the 12-week healing period. There was no statistically significant difference between the two groups (p=0.926). In the removing stage, the mean reverse torque values was 97.75±22.23N/cm (range: 68.63-138.83) for control group and 96.25±21.93N/cm (range: 63.34-126.9) for the experimental group (p=0.84). CONCLUSIONS: Osseointegration can be achieved in the absence of primer stability in the 12-week period of healing time even for alumina-blasted implants.