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Background: We aimed to determine factors affecting mortality and survival after Percutaneous endoscopic gastrostomy (PEG) in patients who were hospitalized in the neurology intensive care unit during the coronavirus disease-2019 (COVID-19) pandemic Materials and Methods: The clinical and demographic data of 29 patients aged 18 years and older who received PEG tube insertion during hospitalization in the Neurology Intensive Care Unit of XXX Hospital, Turkey, between February 2020 and May 2021 were examined retrospectively. Patients’ demographics, clinical characteristics, and survival status were recorded. Results: We included 29 patients (16 females and 13 males) into our study. Median age was 71 (33–89) years among survivors and 75.5 (48–90) years among those who died. The groups were similar with respect to age (p = 0.119) and sex (p = 0.806). Mortality rate after PEG insertion was 66%. Mean overall survival after PEG tube insertion was 129.49 days (95% CI: 91.21–167.78). Cox regression revealed that having multiple comorbidities increased the likelihood of mortality by 2.822-fold (95% CI: 1.001–7.968, p = 0.049). Conclusions: These findings show that having multiple comorbidities was the most important factor associated with mortality among PEG recipients who were admitted to the Neurology Intensive Care Unit during the COVID-19 pandemic. Since multiple comorbidities cause shorter survival, it appears that the decision to insert PEG tubes must be made extremely cautiously among these patients. However, more comprehensive studies should be conducted to clarify the effect of COVID-19 on mortality rates and survival time after PEG.

Amaç: Bu çalışmanın amacı, acil servis hekimleri ve hemşirelerinin empati düzeyleri ile intravenöz trombolitik ve/veya endovasküler trombektomi tedavisi için hastaların sevk edilmesi arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntemler: Kesitsel tipteki bu çalışma Bursa'da inme kliniği olmayan hastanelerin acil servis hekimleri ve hemşireleri ile Temmuz 2019 tarihinde gerçekleştirilmiş ve çalışmaya toplam 198 acil servis personeli dahil edilmiştir. Katılımcıların sosyodemografik özellikleri, mesleki çalışma koşulları ve kendi yakın çevrelerindeki (aile ve arkadaşlar) inme öyküleri sorgulanarak kaydedildi ve empati düzeyleri ölçüldü. Acil servis hekimleri ve hemşirelerinin empati durumlarının değerlendirilmesinde Jefferson empati ölçeğinin sağlık çalışanları versiyonu kullanıldı.Bulgular: Çalışma grubunun Jefferson empati ölçeği ile elde edilen ortalama empati skoru 98,63±14,83 puan olarak bulundu. Bu çalışmada empati puanı ile sevklerin sayısı arasında herhangi bir anlamlı ilişki bulunmadı (p=0,962). Toplam empati puanı, katılımcıların hastanedeki rolüne (p=0,161) veya ailelerinde ya da arkadaşları arasında inme vakası görülmesine (p=0,694) göre de bir farklılık göstermedi. Acil eğitimi almış olan (p, Aim: The aim of this study was to investigate the relationship between the empathy level of emergency department physicians and nurses and the referral of patients for intravenous thrombolytic and/or endovascular thrombectomy treatment.Material and Methods: This cross-sectional study was carried out with the emergency department physicians and nurses of hospitals that did not have a stroke clinic in Bursa in July 2019, and included 198 emergency personnel. Participants’ sociodemographic characteristics, professional working conditions, and stroke history in their immediate environment (friends and family) were recorded and empathy level was measured. The health professions version of the Jefferson Scale of Empathy was used in the assessment of empathy status among emergency physicians and nurses.Results: The mean empathy score of the study group, by the Jefferson scale of empathy, was found 98.63±14.83 points. In this study, no significant relationship was found between the empathy score and the number of referrals (p=0.962). The total empathy score did not differ by the role of the participants in the hospital (p=0.161) or observation of stroke cases in their family or their friends (p=0.694). Healthcare professionals who had received emergency education (p

Background To examine the relationship between an institutionally prepared standardized patient evaluation form and the Edmonton Frail Scale (EFS) in patients receiving home health care. Material and Methods Our prospective, observational study included 200 patients over the age of 18 who requested home health care, regardless of gender. The EFS and institutional data collection forms were applied consecutively on the same day to all patients included in the study. Results Among the 200 individuals recruited for the study, 59% were female and 41% were male; the overall average age was 80 years. According to the EFS results, 4.5% of the patients were classified as non-frail, 6% were vulnerable, and 89.5% had varying degrees of frailty (mild, moderate and severe). There was a significant positive correlation between EFS score and age (p

OBJECTIVE To assess the stroke awareness levels of individuals whose first-degree relatives had a stroke and to compare the results with those of individuals whose first-degree relatives did not have a stroke. MATERIALS AND METHODS This cross-sectional study was conducted between March and May 2019, with first-degree relatives of patients who had a stroke (group 1) and a comparable set of individuals whose first-degree relatives did not have a stroke (group 2). Participants were asked to complete a questionnaire asking about signs and symptoms, risk factors, treatment options, information sources, responses after the development of stroke, and early treatment of stroke. RESULTS In response to the questions about the signs and symptoms of stroke, group 1 mentioned dizziness and comprehension disorder as a symptom of stroke more frequently than the other group. Stress was the second most frequently mentioned risk factor (by 81% of group 1 and 80.5% in group 2). When the participants were asked about the sources of information about stroke, family circle and friends were the most frequently mentioned sources for both groups. CONCLUSION The present study can serve as a guide in planning training to improve stroke awareness in the future, especially by including individuals whose first-degree relatives had a stroke.

Objectives: In our study, we investigated the effects of modafinil therapy on clinical and neurophysiological tests of multiple sclerosis (MS) patients with fatigue.Methods: The study was performed on 18 MS patients (16 females, 2 males) at Uludağ University School of Medicine, Department of Neurology, who are followed up according to Mc Donald’s criteria, who had 36 points or above based on the fatigue assesment scala (FAS), whose Beck depression inventory points were 16 and below, whose thyroid, liver and renal functions were evaluated as normal, and who had no systemic disorder. All patients had neurological examination and their expanded disability status scale (EDSS), fatigue impact scala (FIS) and multiple sclerosis quality of life (MSQoL-54) were evaluated. Somatosensory evoked potential (SEP), visual evoked potential (VEP), brainstem auditory evoked potential (BAEP), visual event related evoked potential (visual P300) were performed in our neurophysiology laboratory. After that the patients were given modafinil 100 mgr 1×1 (morning) for 1 week, the following weeks 2×1 (morning and noon). At the end of the 6 weeks of therapy the patients were called to the neurology polyclinic, and their neurological examinations, EDSS, FIS, MSQoL-54, SEP, VEP, BAEP and visual P300 were repeated.Results: When the patients’ previous and subsequent FIS and MSQoL-54 total scores were compared, a significant statistical difference was found. When all 3 subgroups of FIS (consciousness, physical and social) were evaluated after the modafinil therapy, a significant statistical decrease in previous and successive scores were found. It is found out that modafinil therapy improves life quality which is evaluated due to MSQoL-54 (p < 0.05). A significant statistical relation between the number of MS disease attacks and the three subgroups of MFIS was not figured out (p > 0.05). There were no statistically significant relation between the FAS, EDSS and Beck depression inventory scores before the modafinil therapy had been applied (p > 0.05). There was a statistically correlation between Beck depression inventory score and FIS’s social subgroup (p = 0.017). When the patient’s SEP, VEP, BAEP, visual P300 average test values before and after the modafinil therapy were compared, a statistically significant difference was not observed.Conclusions: In our study, it is found that modafinil therapy, which is used against fatigue, one of the MS disase’s most common symptom, has a positive impact on MS life quality and patients’ clinical symptoms of fatigue, although it has no effect on patients’ evoked potential methods (BAEP, SEP, VEP, visual P300) performed in neurophysiology laboratory.

Objective: It is known that intravenous thrombolytic therapy in ischemic stroke is beneficial in selected patients who arrived within the first 4.5 hours after the onset of the symptoms and the effectiveness of the treatment depends on early arrival to the hospital. The more patients arrival to the hospital within this time zone, the more they will have the chance to receive thrombolytic therapy. This study aims to investigate the factors that cause delay in the arrival of patients with ischemic stroke to the hospital. Methods: Patients diagnosed with acute ischemic stroke who applied to the neurology outpatient clinic and emergency room between February and May 2019 were included in the study. A direct interview survey was conducted to investigate the factors that delay the arrival to patients or relatives of the patients arrival to Bursa Yuksek Ihtisas Training and Research Hospital due to acute stroke. According to the time of arrival to the hospital after the onset of stroke symptoms, patients were classified as early (≤ 4.5 hours) and late arrival (> 4.5 hours). Based on this grouping, factors causing delay in patients' access to hospital were compared statistically. Results: A total of 251 patients and / or patient relatives who arrived to the emergency and neurology outpatient clinic were interviewed. Of the 251 patients included in the study, 119 (47.4%) were female and the mean age was 70 (34-94) years. Approximately 72.5% of the patients were arrived in the first 4.5-hour slice after the onset of stroke symptoms. Factors causing late arrival were determined as being female, having low NIHSS score and not using ambulance in transportation. Conclusion: Due to the delay in arrival of 27.5% of the patients, there is no chance to apply thrombolytic therapy to eligible ones. The factors resulting in the delay were discovered as female gender, low severity of the stroke and transportation without ambulance. In this respect, community-oriented trainings are required.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease that affects many organs, especially the lung, and may lead to multiorgan failure. Studies describing neurological dysfunctions involving the central and peripheral nervous systems have emerged. In our study, we aimed to evaluate the neurological signs and symptoms in hospitalized patients with COVID-19. METHODS: The data of 290 patients admitted to our center (ward and intensive care unit) who received a diagnosis of COVID-19 were analyzed retrospectively. Patients' demographic, clinical and laboratory data, and their neurological diseases, symptoms, and complications were compared. RESULTS: Male sex, heart disease, chronic obstructive pulmonary disease and having a history of neurological disease were associated with increased mortality in patients with COVID-19. Seizures and altered consciousness were also found to be more common in patients who died. In addition, lower platelet counts (P=0.001), higher C-reactive protein levels (P

Pandemi Sırasında İnme Merkezi Kurmak: İlk Yıl DeneyimleriÖzet Amaç: Pandemi döneminde ülkemizde yeni açılan bir hastanenin Nöroloji Yoğun Bakım Ünitesi’ne, acil servise başvurarak yatırılan intravenöz trombolitik tedavi ve/veya mekanik trombektomi uygulanan iskemik inmeli hastaların verilerinin incelenmesi amaçlandı.Yöntemler: Ocak 2020-Aralık 2020 tarihleri arasında XXXXXX İnme Merkezi’nde akut iskemik inme tanısı ile yatırılan ve intravenöz trombolitik tedavi ve/veya mekanik trombektomi uygulanan ardışık 85 hastanın dosyaları retrospektif olarak incelendi.Bulgular: Hastaların ilk semptomdan kapıya kadar geçen süre (p, Establishing a Stroke Center During the COVID-19 Pandemic: First-year ExperiencesAbstractObjective: This study examines the data of patients of ischemic stroke who underwent intravenous thrombolytic therapy and/or mechanical thrombectomy after applying to the emergency department of a newly opened hospital in our country during the COVID-19 pandemic. Methods: The files of 85 consecutive patients who were hospitalized in the Stroke Centre of XXXXXX with a diagnosis of acute ischemic stroke between January and December 2020 who underwent intravenous thrombolytic therapy and/or mechanical thrombectomy were retrospectively reviewed. Results: Symptom-to-door times (p

Objectives The outbreak of coronavirus disease 2019, known as COVID-19, has rapidly evolved to a global pandemic. This pandemic represents an unprece - dented public health issue not only for the general population but also for patients on the transplant wait list. Multiple organizations around the world have published recommendations for the proper conduct of transplant procedures, including donor and recipient screening and perioperative management. We investigated the efficacy of these new recommendations and the effects of SARS-CoV-2 infection on the deceased donation rate, donor organ management, and the time from family consent to procurement. Materials and methods The characteristics of potential donors diagnosed with brain death between July 15, 2019, and November 18, 2020, were evaluated retrospectively. Demographic and clinical features, the time elapsed from the clinical diagnosis until confirmation, and rates of acceptance were recorded. Potential donors diagnosed with brain death before the pandemic and during the pandemic were compared according to these variables. Results Within the study period, 40 patients were diagnosed with brain death: 13 before the pandemic and 27 during the pandemic. The organs from 2 donors were procured before the pandemic. Organs from 3 of 8 donors were procured during the pandemic (the organs from 5 of these 8 patients were not donated). The organ donation time was 8.5 ± 2.12 hours (minimum-maximum, 7-10 hours) in the period before the pandemic and 54 ± 11.53 hours (minimummaximum, 45-67 hours) during the pandemic. Conclusions The number of donors decreased significantly in our hospital during the pandemic and was similar to the overall rate in Turkey. The duration of the donation process has been prolonged, and strategies to improve rates of organ donation, including infection control, have become a focus of concern.

Stroke is one of the most common causes of morbidity and mortality. The need for additional objective parameters as well as the existing criteria continues for eligible patients. The objective of this study is to determine whether the baseline neutrophil/lymphocyte ratio (NLR) predicts symptomatic intracranial hemorrhage (SICH) due to intravenous thrombolytic therapy. One hundred thirty-three consecutive patients aged 18 years and over who were admitted to the emergency department of a training and research hospital for acute ischemic stroke and underwent intravenous thrombolytic therapy were retrospectively analyzed. For the definition of SICH, European Cooperative Acute Stroke Study III (ECASS III) classification was accepted. When the groups with and without intracranial hemorrhage were compared, there was a significant difference in terms of the initial National Institutes of Health Stroke Scale (NIHSS) score (p < 0.006), glucose level (p < 0.018), and systolic blood pressure (SBP) (p < 0.050). The NLR value of the patients ranged from 0.47 to 13.74. In the group with SICH, NLR was found to be higher but not statistically significant. (p = 0.125). For predicting SICH, NLR did not provide strong specificity and sensitivity. A precise cut-off value could not be found to predict the hemorrhagic transformation.

Degerli meslektaslarimiz dunyayi etkileyen pandemi surecinde, onun kiskacinda olaganustu gunler geciriyoruz. Bu surecte saglik calisanlarinin fedakarligi yadsinamaz. Degerlerin yitirildigi bir donemde meslegini hayati ile ozdeslestiren, gecesi gunduzu olmayan, fedakarligin ust seviyede oldugu, kimi zaman kuru bir tesekkurun cok goruldugu arkadaslarimiza bizlerde bir katkida bulunmak istedik.Olaganustu, farkli bir sey mi yaptik. Tabiiki hayir. Amacimiz meslege yeni baslayan arkadaslarimizin kolay okuyabilecegi, cok sikmadan ozet bulabilecekleri bilgileri paylasmakti. Bu surecte hayatini kaybeden meslektaslarimizi ve hastalarimizi rahmet ve minnetle aniyorum.

Introduction This study aimed to investigate the impact of home quarantine in older patients without COVID-19 hospitalized due to neurological disorders. Methods We consecutively enrolled 255 elderly patients(median age: 75 years, female: 54%), including 180 (70%) in the pre-home quarantine period and 75 (30%) home quarantine period from January to May 2020 (ten weeks before and ten weeks after the March 21, 2020, lockdown for older patients in Turkey) in a tertiary referral neurological center. Results In the home quarantine period, we documented a fall in the number of neurological admissions by 58.3%, but an increased need for intensive care in older patients. Patients in the home quarantine period were younger [73 (65−91) vs 76 (65−95), p = 0.005], had worse Glasgow Coma Scores (12.3 ± 3.6 vs 13.7 ± 2.5, p = 0.007), higher in-hospital mortality rate (21.3% vs. 6.7%, p = 0.001), had a lower prevalence of comorbidities such as diabetes mellitus, hypertension, and cardiovascular disease, and chronic neurologic disease, albeit had a higher prevalence of the acute cerebrovascular disease (hemorrhagic/ ischemic stroke)(90.7% vs 78.9, p = 0.025). In this period, even there was an increase in the proportion of the patients undergoing reperfusion therapy, it wasn’t statistically significant (20.3% vs. 10.1%, p: 0.054). Multivariate analysis revealed that high NIHSS (The National Institutes of Health Stroke Scale) score (OR=1.25; p

INTRODUCTION: In this study, we aimed to discuss the data of patients with acute ischemic stroke with intravenous thrombolytic therapy (IV-tPA) in our clinic in the light of the literature. METHODS: Seventy patients with acute ischemic stroke diagnosed between April 2016 and 2017 who received IV-tPA were included in the study. Demographic, radiological and clinical data of the patients were recorded. The intracranial hemorrhages and neurological status at the end of the third month were evaluated with the modified MRS score and the National Stroke Health Scale (NIHSS) scores within 3 months after discharge. The values of the symptom-needle time, the Alberta stroke program, the early computerized tomography score (ASPECT) and the NIHSS scores at the first application and follow-up were analyzed. RESULTS: 28 of the patients were female and 42 were male and the mean age was 66.44 ± 13.47. Thirty-nine (55.7%) of the patients were referred to emergency services and 31 (44.3%) were directed to thrombolytic therapy from the emergency department of other hospitals. The initial NIHSS scores at the time of admission were 14.27 ± 4.26, while the NIHSS scores at the 24th hour were 11.47 ± 5.85. The ASPECT score at the time of admission was 9.61 ± 0.81. The median symptom-to-needle time was 89.5 minutes (0-245). The median door-to-needle time was 77 minutes (20-187). During thrombolytic application, edema occurred in 4 patients and intrahepatic hemorrhage occurred in 1 patient. At the end of the third month, 20 patients (28.5%) had complete recovery of neurological disability and 9 (12.9%) were exiting. DISCUSSION AND CONCLUSION: The results of this study show that IV-tPA treatment is a safe and effective treatment for acute ischemic stroke, similar to past studies, and that this treatment reduces the disability at the end of the third month.

Purpose: To investigate neuronal dysfunction in the thalami of juvenile myoclonic epilepsy (JME) by using proton magnetic resonance spectroscopy (MRS). Methods: We performed single-voxel proton MRS over the right and the left thalami of 15 consecutive patients (10 women, 5 men) with JME (mean age 20.3 years) and 16 healthy volunteers (10 women, 6 men) (mean age 24.5 years). All patients had seizure onset in late childhood-teenage, normal neurologic examination, typical electroencephalogram (EEG) of JME and normal magnetic resonance imaging (MRI). We determined N-acetylaspartate (NAA) values and NAA over creatine-phosphocreatine (Cr) values. Mann-Whitney U-test was used to evaluate group differences. Results: Group analysis showed that echo time (TE) 270 integral value of NAA over left thalamus were significantly decreased in JME patients as compared with controls (34.6033 +/- 15.8386; 48.0362 +/- 22.2407, respectively, P = 0.019). Also group analysis showed that thalami NAA/Cr ratios were significantly decreased in JME patients (right side, 2.21 +/- 1.07; left side 2.00 +/- 0.72) as compared with controls (right side, 3.45 +/- 1.50; left side, 3.08. +/- 1.60; P = 0.011 and P = 0.030, respectively). Conclusion: In the previous studies, NAA values inpatients with JME found that they were not statistically lower in thalami than control group. But, in our study, NAA value was found tow as well. It has been known that NAA is a neuronal marker and hence it is a valuable metabolite in the neuron physiopathology. As a result, in the patients with JME we tried to support the theory that the underlying mechanism of the generalized seizures was the abnormal thalamocortical circuity, determining the thalamic neuronal dysfunction in MRS statistically.