bluuebunny/crossref_metadata_2025 huggingface dataset:
May the Systemic Immune-Inflammation Index be an Indicator of Premature Ovarian Insufficiency?
Authors: BAKİ ERİN Kübra
Published: February 2023

Objective: This study aimed to determine whether there was a correlation between the systemic im-mune-inflammation index and ovarian reserve markers such as follicle stimulant hormone, estradiol, and anti-mullerian hormone

Methods: The study comprised 65 people with premature ovarian insufficiency and 71 controls with sim-ilar demographics. The concentrations of hemoglobin, hematocrit, platelets, white blood cells, neutro-phils, and lymphocytes were evaluated. The neutrophil leukocyte ratio, platelet lymphocyte ratio, and systemic immune-inflammation index were calculated. The antral follicle count reserves of all patients were evaluated by transvaginal ultrasonography. An independent t-test was used for the comparison of the study and control groups. Correlations between variables were analyzed using Pearson's correlation test. A p value of 0.05 was considered significant.

Results: The results of the neutrophil-to-lymphocyte ratio and the platelet-lymphocyte ratio showed a significant difference between the groups (p = 0.043). The Systemic Immune Inflammation Index value was the statistically significant difference found between the groups. There was a significant positive correlation between the systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-lymphocyte ratio, and follicle stimulant hormone, while a significant negative correlation was found between the systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-lymphocyte ratio, antral follicle count, and anti-mullerian hormone. In ROC analysis for SII at a cut-off level of 441.35, the sensitivity was 72.1% and the specificity was 68.9.

Conclusion: Our study was the first in this field to reveal the relationship between premature ovarian failure and the systemic immune-inflammation index. According to our study results, the systemic im-mune-inflammation index, neutrophil-to-lymphocyte ratio, and platelet-lymphocyte ratio are significant-ly higher in individuals with ovarian failure.
Hypernatremia in Critically Ill COVID-19 Patients: Is it a manifestation of COVID-19 or acquired in the ICU?
Authors: KILIÇ Özgür , POLAT Mehmet , SANNAH Kamil , DİLEK Melda
Published: February 2023

Objective: It has been noted that COVID-19 patients experienced electrolyte problems more frequently, and these disturbances were linked to unfavorable results. The purpose of this study was to investigate the incidence and consequences of hypernatremia in severely ill COVID-19 patients receiving intensive care (ICU).

Methods: Retrospective data analysis was done on COVID-19 patients who were admitted to ICUs over a six-month period at two centers.

Results: Data from 270 patients were collected in total. 138 (51%) patients developed hypernatremia (Na >145 mmol/l) during ICU stay. Hypernatremia was observed to be more in older or ventilated patients, whereas less in patients with chronic kidney disease. However, in patients with and without hypernatremia, unfavorable outcomes like length of stay (LOS) or mortality were comparable. Frequency of hypertension, septic shock as well as SOFA score, and serum BUN levels were significantly higher in moderate to severe hypernatremic (Na ≥150 mmol/l) vs mild hypernatremic (Na=146-149 mmol/l) group. Moderate to severe hypernatremia had worse prognosis than the mild group: ICU LOS (12 vs 9-day, p=0.033), ICU mortality (86% vs 61%, p=0.001 and 28-day mortality (89% vs 68%, p=0.004). Elevated serum BUN levels and moderate to severe hypernatremia were independent predictors of both ICU and 28-day mortality.

Conclusion: Critically ill COVID-19 patients experienced hypernatremia more frequently than expected, suggesting that hypernatremia may be a manifestation of systemic involvement of COVID-19 rather than iatrogenic. Patients with and without hypernatremia were found to have similar outcomes.
Evaluation of Sleep Quality of Anesthesiologists Working in Turkey
Authors: CEBECİ Zübeyir , CANAKCİ Ebru , TAŞ Nilay , COŞKUN İlker
Published: February 2023

Objective: Sleep is one of the basic daily activities that are important for an individual with physical, mental, social, and intellectual needs to be in good physical and mental health. Although many definitions are made, sleep; is a complex and physiological event affected by pathophysiological, physical, psychological, and environmental factors. Anesthesiologists often work in closed environments and with long working hours, which can cause severe, chronic sleep loss and sleep disruption. Sleeplessness and low sleep quality can cause decreased attention during the day, impaired judgment, and delays in decision-making. This study, it is aimed to determine the sleep quality of Anesthesiology and Reanimation specialists working in Turkey.

Methods: The study included all anesthesiologists whose e-mail addresses were registered with the Turkish Society of Anesthesiology and Reanimation and who worked in Turkey. Survey questions, which the participants can answer electronically, were sent to the participant's e-mail addresses. To increase the number of participants, a reminder email was sent three weeks after the first email. The data were expressed as a number, percentage, mean, and standard deviation and the correlation between the parameters will be evaluated at a 95% confidence interval by performing Pearson correlation analysis; p< 0.05 was accepted as significant.

Results: Due to seven people with sleep disorders being excluded from the study, 210 out of 217 people who answered the questionnaires sent by email to the anesthetists who are members of the Turkish Society of Anesthesiology and Reanimation were included in the study. Of the respondents who worked in the following fields: 30% (n = 63) State Hospital, 33.3% (n = 70) University Hospital, 17.1% (n = 36) Ministry of Health Affiliate Hospital, 19.5% (n = 41) Private Hospital, and 73.3% (n = 154) at the Operating Room, 10% (n = 21) at the Intensive Care, 15.2% (n = 32) at the Operating Room + Intensive Care, and 1.4% (n = 3) at other departments, 48.4% (n = 105) were male, 51.6% (n = 112) were female, with a mean age of 41.5±7.6 years. The average hourly shift for the participants, 61% of whom were on the night shift, was 50 hours per month, and 25% were working more than 45 hours per week.

Conclusion: The sleep quality of anesthesiologists is poor, which causes daytime dysfunction. It is thought that the reason for poor sleep quality, in general, is the adverse effects of their duties and responsibilities, working environment, and operating conditions on sleep quality.
GCF Levels of Osteoclastogenesis-Related Cytokines in Periodontitis in Relation to Smoking During Non-Surgical Periodontal Therapy
Authors: ERENLER Nilüfer , PİRİM GÖRGÜN Emine
Published: February 2023

Objective: Interleukins (IL) -1β, -34, receptor activator of nuclear factor-kB ligand (RANKL), and osteoprotegerin (OPG) play a crucial role in osteoclastogenesis and bone resorption through modulating inflammatory processes and osteoclastogenesis. Smoking is the major risk factor in the initiation and progression of the periodontitis, and adversely affects the outcomes of non-surgical periodontal therapy. To date, there is no study investigating both gingival crevicular fluid (GCF) IL-1β, IL-34, RANKL, and OPG levels before and after non-surgical periodontal therapy in smoking and non-smoking patients with periodontitis stage 3, grade B and C. The aim of current research was to examine the GCF levels of some osteoclastogenesis-related cytokines in periodontitis in relation to smoking before and after periodontal therapy.

Methods: At baseline, full-mouth periodontal status together with GCF samples were collected from 116 individuals, including 60 periodontitis patients (30 smokers and 30 nonsmokers) and 56 periodontally healthy controls (28 smokers and 28 nonsmokers). Non-surgical periodontal therapy, consisting of instruction for daily plaque control and scaling and root planing (SRP), was performed. GCF sampling and full-mouth periodontal measurements were repeated 6 weeks after completion of SRP. The GCF levels of biomarkers were measured by enzyme-linked immunosorbent assay.

Results: The periodontitis groups exhibited significant improvement in clinical parameters. At baseline, the GCF IL-1β levels in periodontitis groups were significantly higher than periodontally healthy controls (p<0.05) and it was significantly decreased in periodontitis groups after non-surgical periodontal therapy. At baseline, the GCF IL-34 levels in periodontitis groups were significantly higher than periodontal healthy controls(p<0.05) and the GCF IL-34 level was significantly decreased in non-smoking periodontitis patients. At baseline and after periodontal therapy, the GCF RANKL levels were similar in all groups. The GCF OPG level was significantly lowest in non-smoking periodontitis patients at baseline and the GCF OPG level was significantly increased in smoking and non-smoking periodontitis patients after non-surgical periodontal therapy.

Conclusion: In the periodontal inflammation process, GCF IL-34 level followed a similar pathway to GCF IL-1β, suggesting that IL-34 may be a marker in the pathogenesis of periodontal disease. The significant decrease in GCF IL-34 and a significant increase in GCF OPG level in the non-smoker periodontitis group after periodontal therapy suggest the negative effect of smoking on the response to periodontal therapy. More comprehensive studies are needed by increasing the number of samples included in the study groups in order to better understand the pathogenesis of periodontitis.
Sosyal Bilgiler Öğretiminde Sosyal Bilgiler Laboratuvarlarının Kullanılmasının Öğretmen Görüşlerine Göre Değerlendirilmesi
Authors: KURU Esma
Published: February 2023

Sosyal bilgiler öğretiminde laboratuvarların kullanılmasının öğretmen görüşlerine göre değerlendirilmesinin amaçlandığı bu çalışma, nitel araştırma desenlerinden durum çalışması modelinde gerçekleştirilmiştir. Araştırmanın çalışma grubunu, 2021-2022 eğitim öğretim yılı Şanlıurfa merkez ilçeleri kamu okullarında görev yapan 13’ü kadın 17’si erkek 30 sosyal bilgiler öğretmeni oluşturmaktadır. Araştırmada amaçlı örneklem yöntemlerinden maksimum çeşitlilik örneklemesi tercih edilmiştir. Araştırma verileri yarı yapılandırılmış görüşme soruları ile elde edilmiş ve verilerin tamamı içerik analizine tabi tutularak çözümlenmiştir. Elde edilen bulgular ışığında; sosyal bilgiler öğretmenleri sosyal bilgiler laboratuvarlarını, kalıcı ve somut öğrenmelerin gerçekleşebileceği verimli ders çalışma ortamları olarak tanımlarken, laboratuvarların oturma düzeninin, tasarımının, teknolojiye ve kazanımlara uygunluğunun önemli olduğuna değinmişlerdir. Laboratuvarları materyal çeşitliliği sunması ve kullanımı açısından normal sınıf düzeninden farklı gören öğretmenler, okulların fiziki yapısının sosyal bilgiler laboratuvarı oluşturmak için uygun olmadığını ifade etmişlerdir. Öğretmenler imkan verilmesi halinde, içerisinde derse özgü her çeşit materyallerin olduğu, oturma düzeni ve öğrenci ihtiyaçlarının en üst düzeyde gözetildiği bir sosyal bilgiler laboratuvarı oluşturabileceklerini ifade ederken, okullarda böyle bir laboratuvarın olması halinde gerek öğretmenlerin gerekse öğrencilerin kendilerine ait ortamda ders işlemelerinin motivasyonu ve başarıyı da arttıracağı fikri öne çıkmıştır.
Sosyal Adaleti Anlamak: Eğitim Perspektifinden Akademik Bakış
Authors: KAHRAMAN Hilal , KARADAĞ Nazife , TÜZEL İŞERİ Emel
Published: February 2023

Bu çalışmanın amacı, sosyal adalet kavramına ilişkin öğretim elemanlarının görüşleri, önerileri ve algılarından yararlanılarak eğitimde sosyal adalet olgusunun incelenmesidir. Bu amaçla çalışmada, öğretim elemanlarının sosyal adalet ve toplumdaki sosyal adaletsizliğin giderilmesinde eğitimin rolüne ilişkin algıları, Türk eğitim sisteminin ve eğitim politikalarının sosyal adalet bağlamında değerlendirilmesine ilişkin görüşleri ve çözüm önerileri sosyal adalet olgusu temelinde değerlendirilmiştir. Nitel araştırma deseni ile yürütülen bu çalışmanın yöntemi olgubilimdir. Farklı üniversitelerin eğitim bilimleri bölümünde görev yapan 27 öğretim elemanından yarı yapılandırılmış görüşme formu aracılığıyla toplanan veriler, içerik analizi yöntemiyle analiz edilmiştir. Yapılan analizler sonucunda, öğretim elemanlarının sosyal adaleti en çok eşitliğe dayalı adalet şeklinde nitelendirdiği ve en sık toplumsal eşitliğe dayalı adalet olarak ifade ettikleri görülmektedir. Ayrıca öğretim elamanlarının büyük bir çoğunluğuna göre eğitim, bilinç oluşturarak, sosyal adaleti sağlayarak ve kaynak dağıtımını dengeleyerek toplumdaki sosyal adaletsizliğin giderilmesinde önemli rol oynamaktadır. Ancak öte yandan eğitimin sosyal adaletsizliği gidermenin tersine sosyal adaletsizliği tesis etmenin aracı olduğunu belirten öğretim elemanı görüşleri de bulunmaktadır. Bununla birlikte öğretim elemanlarının neredeyse tamamına yakını Türk eğitim sistemine dair sosyal adalet bağlamında olumsuz değerlendirmelerde bulunmuştur. Son olarak çözüm önerileri incelendiğinde ise, en yüksek oranda eğitime erişim, eşitlik, fırsat eşitliği, okul terki, çalışan çocuklar, eğitim hakkı, barınma problemi ve burslar gibi sosyal adaletin sağlanmasını destekleyen politikalar geliştirilmesi gerektiği görüşünü ortaya koydukları görülmektedir. Çalışma sonucunda, her vatandaşın özellikle toplumsal, hukuki, politik ve ekonomik olarak eşit haklara sahip olacağı, kaynakların eşit dağıtıldığı ve bütün bireylerin kendilerini güvende hissettiği bir toplum düzeninin sağlanması çözüm olarak görülmektedir. Bunun için de öncelikli olarak eğitimin, kamusal bir hizmet olarak devlet tarafından finanse edilmesi ve eğitime ayrılan kamu kaynaklarının artırılması yoluyla herkesin nitelikli eğitime eşit erişiminin sağlanmasının öncelikli politika olarak belirlenmesi önerilmektedir.
Siber Flört Şiddeti Mağdurları ve Faillerinde Şiddete Yönelik Tutum ve Sorumluluk Algısı
Authors: LADİKLİ Nefise , TARI CÖMERT Itır
Published: February 2023

Geleneksel flört şiddetinden farklı olarak, fiziksel ve zamansal sınırların ötesine geçen siber flört şiddeti yeni nesil bir toplumsal sorun olarak görülmektedir. Siber flört şiddeti sıkça geleneksel şiddet formuyla birlikte seyretmektedir. Bu araştırmada, siber flört şiddeti mağduru ve faili bireylerin şiddete yönelik kabul edici tutumları ve sorumluluk algıları arasındaki olası ilişkiler araştırılmıştır. Bulgular, şiddet uygulama ile şiddete yönelik kabul edici tutum ve sorumluluğu atfetme biçimleri arasında ilişki olduğunu; cinsiyet gruplarının şiddete yönelik tutum ve sorumluluk algılarında farklılık bulunduğunu; siber flört şiddeti mağduru ve faili olan kişilerin şiddete yönelik tutum ve sorumluluk algılarının farklılaştığını göstermektedir. Elde edilen sonuçların güncel literatür ekseninde tartışılarak sınırlı Türkçe literatüre katkıda bulunulması ve tespit edilen boşlukların paylaşılarak yeni araştırma konularına ışık tutulması hedeflenmektedir.
A Step Towards Precision Medicine
Authors:   Department of Neurology, University Hospital Centre Sestre milosrdnice, Zagreb, Croatia, Lovrenčić-Huzjan Arijana
Published: February 2023

Editorial
Transorbital Sonography in the Evaluation of the Optic Nerve and Optic Nerve Sheath Diameter Considering Specific Demographic Features
Authors: Vinski Ivana , Kobasić Galić Ivana , Pilepić Lara , Lisak Marijana , Martinić-Popović Irena , Lovrenčić-Huzjan Arijana
Published: February 2023

Transorbital sonography is a reliable method for non-invasive assessment of optic nerve diameter (OND) and optic nerve sheath diameter (ONSD) in patients with increased intracranial pressure. A wide range of regular ONSD values has been reported in the literature. The aim of this study was to determine normal values for OND and ONSD, to determine differences between OND and ONSD considering sex, age, and body mass index (BMI), and to evaluate inter - and intra - examiner variability. The study included 100 healthy subjects, aged 22 - 87 years, who underwent transbulbar sonography by the two examiners, each examiner measuring OND and ONSD twice on both eyes at a depth of 3 mm behind the optic nerve papilla. Measurement and analysis of OND and ONSD was possible in all subjects. Mean OND was 2.39 +/- 0.28 mm and mean ONSD was 4.48 +/- 0.76 mm. In males, mean OND was 2.47 +/- 0.28 mm and in females 2.35 +/- 0.27 mm (p = 0.042). There was no statistically significant difference between mean ONSD values between sexes (p > 0.001). Correlation between age and mean OND and ONSD wasn`t observed. Positive correlation between mean OND and BMI (p = 0.001) was observed. Positive correlation within and between investigator measurements (p < 0.01) was shown. Men have a wider OND compared to women, but no difference in ONSD was observed. Age doesn`t effect on the width of OND and ONSD. BMI correlates positively with OND, but not with ONSD. Positive correlation within and between investigator measurements was shown.
Why She? A Retrospective Study on Sex Inequality Related to Subarachnoid Haemorrhage
Authors: Silconi Frederic-Ivan , Radić Marijana , Bralić Marina , Besser Silconi Žana
Published: February 2023

Subarachnoid haemorrhage (SAH) is the only type of stroke with female predominance. We conducted a retrospective analysis of SAH patients throughout a decade and tried to establish any reason for such remarkable sex difference. We conducted a retrospective analysis of subarachnoid haemorrhages treated in Istria County between 2010 and 2021. Some of those patients were referred to a comprehensive stroke centre and we collected those data too. We also collected data regarding the outcome recorded at follow up exams of patients treated for SAH in that period. A total of 193 patients with subarachnoid haemorrhage were found in observed period. We found a lower incidence regarding general population but with a tendency to increase, compared with data from other studies. Among all SAH, 113 were female, which makes a Risk Ratio (RR) of 1.44. The highest RR in females was in aneurysmal subarachnoid haemorrhages, 2.06. We obtained a similar high RR of 2.03 in the case of female ruptured multiple intracranial aneurysms (IA), clearly with a worse outcome. Conversely, the RR in non-aneurysmal subarachnoid haemorrhages and perimesencephalic subarachnoid haemorrhages was lower in the case of female sex and amounted 0.67. We noticed similar sex inequality as shown in other studies, so we can also state that women are at higher risk of IA rupture than men. The reason has to be multifactorial. As found in this study, women have different predilection sites of IA rupture compared with men so we strongly believe that certain hemodynamic forces may lead to aneurysm growth and rupture. As we also confirmed IA rupture is age dependent more in women than in men. As shown in other studies, oestrogen level might be the reason for that. Future studies should further establish and prove these risk factors for IA aneurysm rupture and improve preventive measures.
Psychiatric Symptoms in Women with Focal Cervical Dystonia - Exploring New Pathophysiological Pathways
Authors: Gilman Kurić Tihana , Popović Zvonimir , Tomić Svetlana , Kragujević Jagoda , Mirošević Zubonja Tea , Pučić Tomislav , Petek Erić Anamarija , Kurić Igor
Published: February 2023

So far there is not much research considering female sex as a risk factor for developing focal cervical dystonia and concomitant psychiatric symptoms such as anxiety. New research proposes ideas of CD baseline pathophysiology targeting neurobiological mechanisms of gamma aminobutyric acid GABAergic function underlying sexual dimorphism and psychiatric symptoms as an intrinsic factor of the disease itself. Our research examines the connection between motor and non-motor symptoms in female patients suffering from focal cervical dystonia and their response to treatment, cit- ing the available literature and hypothesising whether it can be linked to previously described alterations in GABA levels.
Clinical and Demographic Determinants of Cognitive Disorders in Multiple Sclerosis Patients
Authors: Šehanović Aida , Kunić Suljo , Smajlović Dževdet
Published: February 2023

Multiple sclerosis (MS) is a chronic, inflammatory, (auto) immune disease of the central nervous system (CNS). The aim of the study was to determine the distribution of cognitive disorders in MS in relation to demographic parameters, degree of clinical disability and depression. The prospective study included 135 subjects with MS in the Clinic of Neurology of the University Clinical Center in Tuzla. The first group consisted of women (101 respondents) and the second of men (34 respondents). Clinical assessment instruments were: Expanded Disability Status Scale Score, Mini Mental Status, Beck Depression Scale, Battery of Cognitive Function Assessment Tests: Wechsler Intelligence Scale, Revised Beta Test, Raven Coloured Progressive Matrix, Wechsler Memory Verification Scale, Audio Memory Test learning, Rey-Osterriecht complex character test, verbal fluency test. There were no significant differences between the mentioned groups in age, level of education, duration of the disease, severity of disease symptoms or in the prevalence of certain forms of MS. Cognitive disorders are present in 40-60 % of subjects with MS. Visuospatial, visuoconstructive, visuoperceptive functions, mnestic functions were most affected in both groups of respondents. There was no difference in the level of depression in relation to sex. Poor results of cognitive parameters in 32.7 % can be considered the cause of high scores of EDSS in female patients and in 29.2 % in patients, which is not statistically significant. The correlation between depression and EDSS is positive but not statistically significant in both sexes. Cognitive disorders are heterogeneous regardless of sex. Cognitive impairment in MS patients is related to impairment of working ability and memory, executive functions and attention. Subjects with a more severe degree of clinical disability had poorer cognitive functions.
Specificity of Migraine Treatment in Women
Authors: Bačić Baronica Koraljka , Tomasović Sanja , Košćak Lukač Jelena , Sremec Josip , Baronica Robert
Published: February 2023

The prevalence of migraine is higher in women than in men, with female to male ratio 3:1 in reproductive age. It is believed that sex hormones play significant role in migraine pathogenesis. Therefore, treatment of migraine in women has some specificities due to hormonal differences between sexes and due to hormonal fluctuations during menstrual cycle, pregnancy, lactation and perimenopause. Treatment of migraine during pregnancy depends on safety profile of the therapy. NSAID-s like naproxen and ibuprofen are being considered safe during the second trimester, but during the first and third trimester they may have adverse effects on pregnancy and foetus. CGRP antagonists should be avoided during pregnancy. Acetaminophen, ibuprofen, and diclofenac are considered to be safe acute therapy during breastfeeding and for preventive treatment propranolol should be used as first line therapy. Women with severe menstrual and menstrual related migraine without aura may be treated with hormonal therapy, whereas it should be avoided among patients with aura due to increased risk of stroke.
Cardiovascular Disease and Sex
Authors: Delić-Brkljačić Diana , Golubić Karlo
Published: February 2023

One of the primary causes of death worldwide is cardiovascular disease (CVD). Women typically have a lower incidence of CVD than men, however after acute cardiovascular events, women have a higher mortality and worse prognosis. Different CVDs, such as coronary heart disease, stroke, heart failure, and aortic diseases, exhibit these sex variances. These differences have raised serious concerns so sex consideration is significant for the prevention, diagnosis, treatment, and management of CVD. In order to highlight the need of taking sex differences into account when determining cardiovascular risk, this study seeks to offer an overview of sex-related differences in numerous common CVDs as well as an analysis of potential factors linked with the disparities. Future studies should focus on how to define and include sex-related indicators into the methods currently used for cardiovascular risk assessment and management.
Fibromuscular Dysplasia – Underrecognized Vasculopathy with Female Preponderance
Authors: Lovrenčić-Huzjan Arijana
Published: February 2023

Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory vascular disease with strong female preponderance. However the diagnosis of the disease is low. FMD affects medium-sized muscular arteries, predominantly renal arteries, but equally carotid and vertebral arteries. It leads to artery stenosis, occlusion, aneurysm or dissection. The clinical picture depends on the affected blood vessels. It is most commonly recognized as a cause of hypertension in young female patients. In the case of involvement of cranial and cervical arteries, the clinical picture is mostly nonspecific, with headache, migraine and tinnitus. In registries, females had more frequent classical symptoms of cerebrovascular FMD like pulsatile tinnitus, cervical bruit and neck pain, and males have more frequently visceral affection (abdominal pain, renal impairment and renal infarction). Also, man had more frequently more sever clinical presentation like arterial dissection or arterial aneurysm. At the age of diagnosis males are younger compared to females. Large cohort studies showed the association of FMD with female sex, migraine, and intracranial aneurysm. FMD is an under-recognized vascular disease, more prevalent in females, but exhibiting more sever clinical presentation in males.
Dementia and Palliative Care: Sex Differences
Authors: Kunkera Lea , Sjaus Regina , Klepac Nataša
Published: February 2023

Patients who need palliative care have complex physical and psychosocial needs during their illness. The results of previous studies show clear sex inequalities in the occurrence of various symptoms and the need for palliative care. Despite the undoubted sex differences in the creation of palliative care, sex is not a key determinant and is regularly neglected. According to the results of previous studies, women live longer than men, but they live more years with dis- abilities, especially with cognitive impairment. They end up in hospices much more often than men and die more often in institutions (21 % vs. 10 %). The biggest sex differences are present in the domain of caregivers. Most caregivers are women and according to the results of studies it is evident that more than 75 % of all caregivers are women and that women spend 50 % more time providing care than men. The time and effort that women put into caregiving is largely unrecognised and assumed to be a ‘natural’ role for women. In contrast, male caregivers are seen as heroes and numerous studies show that male caregivers receive more support than female caregivers. This is thought to be the reason why female carers have more physical and mental health problems, including anxiety and depression. Health professionals also play a role in the creation of this stereotype. A recent study showed that nurses felt that wives and daughters of patients needed less help than husbands and sons. Overall, all studies show that although women provide most of the care during life, they often lack a reciprocal level of care at the end of their lives. The policy of palliative care is focused on the approach that care at the end of life ‘in the community’ is desirable and achievable for everyone. Unfortunately, the fact that in this context care falls disproportionately on one person - who is most likely a woman - is ignored.
Autoimmune Encephalitis
Authors: Lisak Marijana , Špiljak Bruno , Pašić Hanna
Published: February 2023

The purpose of this paper is to provide a comprehensive review of recent literature data for autoimmune encephalitis (AIE). AIE refers to inflammatory, non-infectious, immune-mediated encephalitis characterised by neuroinflammation, synthesis of neuronal autoantibodies (NAAs), directed against surface, synaptic and intracellular antigens, with subsequent neuronal dysfunction. It is characterised by heterogeneous anatomic-clinical syndromes and prominent neuropsychiatric symptoms. Due to overlapping of different clinical and diagnostic biomarkers, AIE is often considered diagnosis of exclusion and requires an extensive work-up. Systematic search of the term «autoimmune encephalitis» in the PubMed database was performed, with limitation set for systematic review in papers English, published from 2004- 2022. Further analysis was performed by the search of the author’s reference list and Autoimmune Encephalitis Alliance (AEA) website. The analysis was conducted according to PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Outcomes that were sought included: AIE classification and presentation; diagnostic processing; treatment. Preset search of published systematic reviews in PubMed database, derived eighty six papers. Further screening of derived data, author’s reference list and AEA website was performed, according to previously defined out- comes. Finally, sixteen papers were independently selected and thoroughly analysed, with relevant conclusions present- ed in this paper. AIE is a severe inflammatory central nervous system (CNS) disorder with a complex differential diagnosis that often remains unrecognised. AIE research has established a wide range of new autoimmune antibodies syndromes, clinical and diagnostic biomarkers, which have improved diagnostic approach and treatment. Initial application of immunotherapy improves the outcome of disease.
Cluster Headache: Literature Review with Reference to Sex Differences
Authors: Mahović Darija , Bračić Matea
Published: February 2023

Cluster headache is a pain syndrome characterised by severe, unilateral and predominantly orbital pain which lasts 15 - 180 minutes. It is accompanied by a range of ipsilateral autonomic symptoms, such as lacrimation, rhinorrhoea and myosis. Cluster headaches can be episodic with periods of remission or chronic. Even though it is a relatively rare condition, the excruciating pain causes significant disruption of patients’ daily life. The pathophysiology behind cluster headaches is complex and despite making significant progress, the pathogenetic cascade of events hasn’t been entirely elucidated yet. However, research into this subject has discovered brain structures, peripheral pathways and neuropeptides which have key roles in pathogenesis. The basis of diagnosing cluster headaches is a detailed patient history and the exclusion of other primary headaches and potential secondary causes. Sex differences in clinical presentation need to be taken into consideration in order to avoid misdiagnosis. Treatment options are divided into three categories: acute, transitional and prophylactic treatment. Although there are a lot of treatment modalities available, further research is necessary in order to find new therapeutic targets and more effective prophylaxis, especially for chronic cluster headache.
Stroke in Pregnancy and Puerperium - Current Knowledge, Questions and Controversies
Authors: Pavlović Aleksandra
Published: February 2023

Stroke associated with pregnancy and the postpartum period (SiPP) is not common but its consequences can be devastating both for the mother and the child. Pregnancy confers a substantially increased risk of stroke, especially during the third trimester and until 6 weeks postpartum. SiPP is heterogeneous both in aetiology and presentation as it includes both ischemic and haemorrhagic events as well as cerebral venous thrombosis. Specific risk factors for SiPP have been identified and well described, such as hypertensive disorders of pregnancy and a prothrombotic state. However, it is still a controversial issue if pregnancy should be considered a risk factor for stroke, although pregnancy and postpartum period clearly increase the stroke risk compared to non-pregnant time. Recent European Stroke Organization [ESO] guidelines addressed the management of acute SiPP while other issues, particularly primary and secondary prevention are still under investigated. There is also a lack of research and knowledge regarding long-term mother and foetus/child outcomes post-SiPP. This paper addresses current knowledge on SiPP management and prognosis and discusses new challenging clinical scenarios including the relationship between COVID-19 infection and SiPP.
A Review of Awareness of Pregnancy-Related Issues Among Reproductive-Aged Croatian Women with Epilepsy
Authors: Sruk Ana , Raifi Zurap , Đumbir Fabijan , Friedrich Latica
Published: February 2023

Pregnancy-related epilepsy issues (PREIs) are crucial in managing women with epilepsy (WWE). The main PREIs are reduced compliance and self-discontinuation of antiseizure medications (ASMs), pharmacokinetic alterations during pregnancy, and the teratogenic potential of particular ASMs. According to a recent study, knowledge of PREIs among reproductive-aged WWE in Croatia is unsatisfactory, as are neurologist consultations about PREIs. Two hundred WWE were polled on their knowledge, sources, and needs for information about PREIs and their current ASMs usage. Prior consultation with a neurologist and increased use of books/brochures were the main predictors of knowledge. Forty-five percent of participants had a prior neurologist consultation on PREIs. Most women (61 %) chose their neurologist as their favourite future source of information, and 13 % favoured Internet. The most usually prescribed ASM was levetiracetam (34.5 %). Valproate was utilized by 26 % of respondents, among which 59 % claimed no prior PREIs consultation with a neurologist. A new campaign called Epilepsy and Pregnancy was launched by the International Bureau for Epilepsy in 2021. In February 2021, a poll of nearly 900 women was conducted across Europe as the first stage in this significant project, including 94 respondents from Croatia. Forty-two percent of Croatian WWE were given no information on pregnancy-related risks. In contrast with the aforementioned study, neurologists provided 82 percent of information about the risks of ASMs. Seventy percent reported they were not given contraception information. Providing clear, accurate and timely information on PREIs should become the norm for all neurologists caring for WWE.
Less Help-Seeking Behaviour in Female Patients Exhibiting Stroke or TIA - Related Symptoms
Authors: Mikula Tea , Lovrenčić-Huzjan Arijana
Published: February 2023

Several studies have shown sex differences regarding help-seeking behaviour in stroke and transient ischemic attack [TIA] patients. Women are less likely to perceive their symptoms as requiring immediate hospital care. They are also more inclined to involve friends and family in decision-making and help-seeking. Delaying transport to the hospital is partly due to behavioural and socio-demographic factors of female patients. These impact help-seeking behaviour and prolong prehospital delay, which may affect patient outcomes. We present a 69-year-old woman exhibiting neurological symptoms indicative of a cerebrovascular event, refusing to go to the hospital. The Emergency medical service [EMS] team made the initial medical assessment, outlining the need for immediate transport. Our patient did not view her symptoms as worrying but finally agreed to go to the hospital. She was persuaded by her children, who had an active role in the patient’s decision-making process. Factors that affected help-seeking behaviour and prehospital delay were analysed, accompanied by a review of literature related to the subject.
Young Female with Recurrent Spontaneous Cervical Artery Dissection
Authors: Pintarić Melanija , Vukasović Rafaela , Lovrenčić-Huzjan Arijana
Published: February 2023

Previous neurosonological study demonstrated the value of neurosonology in daily monitoring of the cervical artery dissection. This study showed rate of recurrence of 27 % in unaffected arteries. There are two group of recurrences, early and late. Early spontaneous cervical artery dissection (sCAD) recurrences are not uncommon and usually involve arteries previously unaffected by dissection. They are oligosymptomatic (headache or neck pain) or asymptomatic and might be correlated with a transient arterial disorder. Late sCAD recurrences are rare and can occur at site of previous sCAD and might be indicative of an underlying persistent connective tissue weakness. In this case report we present a 31- year old female patient who presented to emergency room because of headache and pain in the neck which started 3 days before. Initial brain CT scan and CT-angiography were normal. Next day she became disoriented and complained of headache, vertigo, nausea. Magnetic resonance of the brain showed little hematoma in quadrigeminal cistern and left vertebral artery dissection in V2 segment. Initial neurovascular ultrasound (nUS) showed dissection in V2 segment left vertebral artery. Next nUS after five days showed new dissection in V1 and V2 segment in right vertebral artery. Following nUS showed initial regression hematoma in both vertebral arteries. To conclude, early sCAD recurrences are not uncommon and usually involve arteries previously unaffected by dissection. Because of that it is important to daily neurosonology monitoring of the dissection.
Headache as a Symptom of Carotid Web
Authors: Vukasović Rafaela , Pintarić Melanija , Lovrenčić-Huzjan Arijana
Published: February 2023

Headache is a frequent symptom in emergency department, especially in patients with hypertension. Carotid web, also known as the variant of fibromuscular dysplasia (FMD), is a rare disorder, found in only 1- 1.2 % of patients undergoing angiography, and it should be searched for in patients with cryptogenic stroke. We present a female hyper- tensive patient presented to emergency department with headache and visual symptoms, in whom further work-up revealed carotid web. A 46 years old female patient presented to the ED with headache occurring few days before the examination. It was a constant left temporal headache accompanied with flashes in the right half of the visual field. History taking revealed well-controlled hypertension with calcium channel antagonists. The first manifestation of hypertension was eclampsia during pregnancy. In emergency department normal neurologic status was obtained, brain CT scan was normal. Neurosonological examination revealed right carotid web, confirmed by MSCT angiography.
Intracranial Fibromuscular Dysplasia in a Male Child Presented by Middle Cerebral Artery Dissection and Stroke
Authors: Vukasović Rafaela , Pintarić Melanija , Đuranović Vlasta , Lovrenčić-Huzjan Arijana
Published: February 2023

Fibromuscular dysplasia (FMD) is a group of nonatherosclerotic, noninflammatory arterial diseases that most commonly involve the renal and carotid arteries it typically occurs in women aged between 30 and 50 years. FMD in children is rare and its most common site of involvement are renal arteries. Stroke in children is generally uncommon and due to FMD is even rarer, which is why it is often unrecognized. We present a case of a boy, with an inconspicuous previous anamnesis and orderly development, who woke up at the age of 9 with weakness of the left side of the body and speech disorders. MR showed an ischemic lesion in the irrigation area of the right middle cerebral artery (arteria cerebri media- ACM). In neurological status mild dysarthria with left central facial nerve lesion was noted as well as mild paresis of the left extremities. Neurosonological testing showed segmental extensions and narrowing of the right ACM with underlying dissection, which speaks in favour of fibromuscular dysplasia. Therapy with acetylsalicylic acid 50 mg was initiated, and with further follow-up of the patient, complete regression of symptoms and normal neurological status were recorded.
Venous Sinus Thrombosis – Women’s Disease?
Authors: Frol Senta
Published: February 2023

Letter to the Editor
Sex Differences of Oral Anticoagulant Therapy in Atrial Fibrillation
Authors: Pretnar Oblak Janja
Published: February 2023

Letter to the Editor
Sex Differences in Periodontology as a Risk Factor for Cerebrovascular Diseases
Authors: Puhar Ivan
Published: February 2023

Letter to the Editor
Epidemiology of Parkinson’s Disease
Authors: Telarović Srđana
Published: February 2023

Letter to the Editor
Tension - Type Headache in Clinical Practice
Authors: Titlić Marina
Published: February 2023

Letter to the Editor
Intersex Differences in Functional Neurological Disorders
Authors: Tomasović Sanja , Meštrović Andrija , Sičaja Gordana , Tomasović Hrvoje , Košćak Lukač Jelena , Sremec Josip , Bačić Baronica Koraljka
Published: February 2023

Letter to the Editor
Elderly and their barriers to accepting and learning to use technology: A scoping review
Authors: Mohd Zaid Najmi Najiha , Ahmad Nahdatul Akma , Abd Rauf Muhammad Fairuz , Zainal Azaliza , Abdul Razak Fariza Hanis , Tengku Shahdan Tengku Shahrom , Pek Lim Seong
Published: February 2023

As the rate of technology development is concurrently increasing with the number of elderly people, it is necessary for people to be digitally literate and be able to use technology to its full capacity. However, research has found that the digital divide is still happening within the community, as not everyone has fully accepted technology in their daily life routines. With the aim of identifying barriers and challenges of elderly learning technology, and mitigating efforts used by past researchers to cater to the barriers, a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guideline was conducted, and 19 eligible articles have identified having low self-confidence, lack of knowledge, cognitive and physical limitations, as well as psychological and socioeconomic challenges as the common barriers associated with elderly learning. Recognizing what the elders can and cannot do, alongside having intervention programs that promote digital inclusion, could be taken as measures to mitigate the barriers faced by the elders in learning to use technology.
Rethinking Nigeria’s soft power capability as a regional leader in Africa
Authors: Eshiett Imo Akanimo , Dayıoğlu Ali
Published: February 2023

Nigeria has always been seen as a significant regional player in Africa, and the country has not hidden its aspiration to be its leader. However, recent events, particularly in the fourth republic between 1999 and to date, have seen this ambition decline significantly. The study interrogates Nigeria’s soft power leadership capability as contemporary power diffusion theory and its ambition to be a regional leader in Africa. It examines various ways Nigeria can rethink its soft power strategies to achieve its age-long regional aspiration. The qualitative research method was adopted for the study, while primary and secondary sources were used in collecting data for the research. Findings reveal that Nigeria’s neglect and underutilisation of its strategic soft power tools in gaining regional influence continue to inhibit its African leadership ambitions. The study recommends a dynamic policy of developing and deploying significant soft power resources to boost Nigeria’s leadership in Africa.
Afrocentric beauty: The proliferation of ‘Texturist’ and ‘Colorist’ beliefs among young women in Kenya
Authors: Kinuthia Karen Mwende , Susanti Emy , Kokonya Stacy Pamba
Published: February 2023

The beauty ideals of a Eurocentric nature have been promulgated among African communities for decades dating back to the colonial era. The beauty ideal posits lighter or brown skin tone as prettier and straight hair as attractive. The study aimed to identify ways in which families and peers have perpetuated this common beauty ideal within the home and school settings and how these have influenced how young women view themselves. There were 20 young women of different skin tones ranging from light, medium (brown) to dark participated in two focus group discussions. Thematic analysis was used whereby three main themes (familial influence, peer socialization and self-perceptions) and four sub-themes were identified (general opinion, teasing, family disassociation and preferential vs. unfair treatment). Findings revealed that family member and peers knowingly and unknowingly augmented ‘colorist’ and ‘texturist’ beliefs by ridiculing both dark-skinned and light-skinned women. Most of them treated dark skinned people unfairly. The research findings suggested that future research should investigate how body features represent attractiveness within the African communities.
Epistocracy vs constitutional democracy: A Hayekian response to Jason Brannan
Authors: Kalkan Buğra , Ebe Güzgü Pınar
Published: February 2023

Jason Brennan, who proposes assessing democratic decisions based on non-procedural expert knowledge from a pure utilitarian standpoint, holds a prominent position among libertarian critiques of democracy. Brennan contends that epistocratic regimes can outperform democracies since democracies perform badly due to the phenomena of rational ignorance and deliberative democratic methods cannot solve this problem. Brennan, who compares epistocratic institutions to constitutional institutions, wants to tame democracies using negative externality arguments. In this study, we demonstrate that constitutional democracies cannot be assessed by the Brennanian metrics and that epistocracy will erode the libertarian political successes of constitutional democracy. Two important arguments back up this conclusion. First, transforming libertarian ideals beyond constitutional rules into the standard for daily politics allows experts tremendous discretion. Even with good intentions, the unchecked discretion of experts would most likely undermine the general, abstract, and egalitarian rules required by a complex society. Second, taking the concept of rational choice out of its original context will make the distinction between constitutional and unconstitutional governments unclear. Therefore, the libertarian ideal of the limited government established by the separation of powers and the procedures of checks and balances would lose its significance, giving place to the unchecked discretion of expert rule.
Implementation of Civil Rights against Vulnerable Groups in the Legal and Constitutional System in Indonesia
Authors: Rudy Rudy , Natamiharja Rudi , Serna Jalil Alejandro Magaldi , Syofyan Ahmad
Published: February 2023

Constitutional Court is established as an effort to uphold the rule of law and provide maximum protection for democracy as well as human rights, particularly civil rights. The main purpose of the rule of law is to protect citizens' freedom from state power. Therefore, this study aims to examine the implementation of civil rights against vulnerable groups in the Indonesian legal and constitutional system. Data were analyzed using a normative juridical approach by examining theories, concepts, legal principles, and statutory regulations obtained from legal sources such as books, articles/writings, and other documents. The government issued various laws and regulations with multiple conventions such as the rights of the child and the elimination of all forms of discrimination but this effort has not been supported by a strong shared commitment. Based on these circumstances, it is necessary to develop an effective law enforcement mechanism to protect citizens' rights, particularly vulnerable groups.