The purpose of the study was to evaluate the influences of cholinesterase inhibitors on sleep pattern and sleep disturbance. A total of 87 mild to moderate stage dementia patients who were not on cholinesterase enzyme inhibitor and memantine treatment were included in the study. The dementia patients were treated with donepezil, galantamine or rivastigmine, depending on the preference of the clinician. Fifty-five dementia patients (63.2 %) completed the study. Twenty-three elderly subjects, who had normal cognitive functions, were included in the study as the control group. The Pittsburgh Sleep Quality Index was used for evaluating the sleep quality at the beginning and at the final assessment. The improvement in sleep quality was better with regard to changes in Pittsburgh Sleep Quality Index scores with galantamine treatment compared to the donepezil and the control groups. A significant decrease in Pittsburgh Sleep Quality Index scores was detected in the galantamine group after treatment. Although statistically not significant, rivastigmine decreased and donepezil increased the Pittsburgh Sleep Quality Index scores after treatment. Dementia patients who had a poor sleep quality (n: 36), the rate of improvement in sleep disturbance was 81.8 % in the galantamine group, 75 % in the rivastigmine, and 50 % in the donepezil group. Galantamine may be the first choice of cholinesterase inhibitor in mild to moderate dementia patients in terms of improving sleep quality.

The UPSIT-T modification is an adequate olfactory test for clinical use in a Turkish population.

No abstract

Objective. Mean platelet volume (MPV) and platelet function analysis have been studied before in acromegaly, but the effect of treatment on both parameters has not been evaluated. We aimed to investigate MPV and platelet function analysis in acromegalic patients after sixmonths of treatment. Methods. Forty patients with active acromegaly and 36 healthy subjects were included in the study. Plasma glucose and lipids, fibrinogen, GH, IGF-1 levels, MPV and platelet function analysis were measured. All patients with acromegaly were re-evaluated six months after treatment. Results. Fasting blood glucose (FBG), GH, IGF-1, fibrinogen levels and MPV values were significantly higher in acromegalic group compared with the control. Platelet function was enhanced significantly (pcol-ADP: 0.002, pcolepinephrine: 0.002). After 6 months of treatment FBG, serum GH, IGF-1, fibrinogen and MPV decreased and collagen/ADP-and collagen/epinephrine-closure times (CT) were increased. Acromegalic patients that were in remission with long-acting SSA after surgery had significantly higher fibrinogen levels and MPV and decreased collagen/ epinephrine-CT with respect to the controls (pfibrinogen: 0.001, pMPV: 0.026, pcol-epinephrine: 0.037). Conclusion. Acromegaly was associated with increased MPV and enhanced platelet activity. Although growth hormone hypersecretion was controlled by surgery and medical treatment, these parameters did not improveindicating a still increased risk for cardiovascular events.

Frequency of anxiety and depression in epileptic patients Objectives: Depression and anxiety are commonly seen among epileptic patients. These comorbidities have a negative effect on achievement of effective treatment and improvement in the quality of life of epileptic patients. We aimed to determine the frequency of anxiety and depression in epilepsy and in subgroups of epileptic patients and their correlation with disease duration and seizure frequency. Methods: Forty-one young male patients (13 temporal lobe epilepsy and 28 extra-temporal lobe epilepsy) and 48 young males as a healthy control group were included in the study. Each study participants completed the Beck Depression Inventory and the Beck Anxiety Inventory. Results: There were high frequencies of anxiety (26.8%) and depression (34.14%) in the epileptic patients compared with control group (p=0.003, p=0.001, respectively). Although there was no statistical significance, the temporal lobe epilepsy group had higher anxiety and depression frequencies than the extra-temporal lobe epilepsy group (p=0.280, p=0.089, respectively). There was no significant correlations between disease duration and either anxiety inventory scores or depression inventory scores. However in the temporal lobe epilepsy group, we found a correlation with a medium level of significance between seizure frequency and Beck Anxiety Inventory scores as well as Beck Depression Inventory scores (r= 0.521, p= 0.068; r= 0.615, p= 0.025). Conclusion: There were high frequencies of anxiety and depression in epileptic patients. A multidisciplinary approach and inter-disciplinary help cooperation is needed in the treatment of epilepsy. There is a need for controlled studies with larger sample sizes.

No abstract

The aim of this study was to evaluate the effect of olfactory dysfunction on quality of life (QOL), and to investigate olfactory dysfunction related self-reported clinical features in Turkish population. The participants were questioned about the presence of any olfactory dysfunction. Participants with a complaint of olfactory dysfunction were asked to fill out a survey and then a validated olfactory test was performed. We asked 2,824 volunteers whether they had olfactory dysfunctions or not. A total of 199 (6.7 %) people mentioned that they had, and filled out the questions in our survey. The mean age of the surveyed population was 44 ± 15 years. The current investigation produced four major findings (1) the feeling of inadequacy due to olfactory dysfunction was more common among females than males (2) there was a significant correlation between subjective olfactory complaints and objective olfactory testing (3) problems in QOL issues are typically reported primarily in the areas of safety and nutrition (4) the possible reasons for the olfactory dysfunction according to the volunteers were upper respiratory infections including rhinosinusitis (46 %), allergic rhinitis (27 %), severe face and head trauma (6.5 %). The effect of subjective olfactory dysfunctions on QOL among the Turkish population was investigated for the first time. Problems in daily life issues are typically reported primarily in the areas of safety and nutrition.

Sayın Editör, Barut ve ark.nın [1] göndermiş olduğu 'Karbamazepin Doz Aşımına Bağlı Sıklaşan Epileptik Nöbetler' adlı olgu sunumunu ilgi ile okuduk. Bu olgu yüksek kan karbamazepin (KZP) düzeylerine bağlı nöbetlerin sıklaşabileceğini göstermesi bakımından öğreticidir. Bununla birlikte yazarların olgu ile ilgili bazı noktaları açıklığa kavuşturması ve dikkate alınması gereken bazı önerilerimizi sunmak istiyoruz.Ayda birden az nöbet geçirdiği belirtilen olgunun, bu durumdan önceki kan KZP düzeyleri belirtilmemiştir. İlacın son kullanım dozu, hastanın nöbetlerinin sıklaşmasından iki gün önce ve kanımızca gerekli olmayan bir şekilde 200 mg artırılmıştır. Hastanın laboratuvar test sonuçlarını incelediği-mizde; kan KZP düzeyi acil servis şartlarında ölçülmüştür. Bu durumda ölçülen kan KZP düzeylerinin doğru değerlendiri-lebilmesi için bazı önemli noktaların göz önünde bulundurulması gerekmektedir. Öncelikle, kan KZP ölçümü için en iyi örnek alma zamanı, bir sonraki ilaç dozajının alınmasından hemen öncedir. Hasta acil servis şartlarında kan verdiği için bu noktanın gözden kaçmış olabileceğini düşünmekteyiz. Karbamazepin ölçüm yöntemlerinin başta gelenleri kromatografik yöntemler (gaz ve sıvı kromatografileri) ve immüno-lojik temelli yöntemlerdir. İmmün bağlanma esasına dayalı ölçüm yöntemlerinde KZP ile trisiklik antidepresan ilaçlar başta olmak üzere bazı ilaçların çapraz reaksiyonlara bağlı olarak interferansı oluşabilmekte ve yanlış yüksek sonuçlar rapor edilebilmektedir.[2] Bu nedenle bu tür hastalarda serum karbamazepin düzeyleri yüksek bulunmuşsa, farklı bir yöntemle, özellikle interferansın çok daha az olduğu kromatografik yöntemlerle testin tekrar edilmesi, doğru yaklaşım tarzı olacaktır. Bununla birlikte, serum KZP düzeylerini ölçen çoğu test, serumdaki toplam KZP değerlerini ölçmektedir.Toksikasyon varlığından şüphelenildiği durumda, yazarların bir kısmı total KZP değerleri ile değerlendirmeyi doğru bulmakla beraber, tüm yazarlar bu fikre katılmamakta, serbest KZP ölçümünü daha doğru bulmaktadır.[3] Bu tür olgularda serum serbest KZP testinin de istenmesi, daha aydınlatıcı fikirler verebilir. Hastanın serum albumin, total protein, elektrolitler ve tam kan değerleri incelendiğinde; KZP'nin doz aşımında ortaya çıkan etkiler bakımından, hastanın kan KZP testi sonuçlarına şüphe ile yaklaşılmasını ve testin mümkün-se başka bir yöntem ile tekrar edilmesini önermekteyiz. Ayrıca, 24 μg/ml serum KZP düzeyleri olan ve nöbetlerin sık-laştığı belirtilen bir olguda, karaciğer ve böbrek fonksiyon testlerinin normal olması, [3] tabloya yalnızca çok iyi tarif edilmemiş ve bazı belirsizlikleri de içeren bir çift görme şikayeti-nin eşlik etmesi, ayrıca klasik kitaplarda günlük dozajın 1600 miligrama kadar yükseltilebileceği tarif edilen bir ilaçla [3] 1000 mg/gün dozaj ile kan düzeylerinin normalin üst sını-rından daha fazla yükselmesi tanıda şüphe uyandırmaktadır. 2. Dasgupta A, McNeese C, Wells A. Interference of carbamazepine and carbamazepine 10,11-epoxide in the fluorescence polarization immunoassay for tricyclic antidep...