Large vessel occlusion detection by non-contrast CT using artificial intelligence.

INTRODUCTION: Computer vision models have been used to diagnose some disorders using computer tomography (CT) and magnetic resonance (MR) images. In this work, our objective is to detect large and small brain vessel occlusion using a deep feature engineering model in acute of ischemic stroke. METHODS: We use our dataset. which contains 324 patient's CT images with two classes; these classes are large and small brain vessel occlusion. We divided the collected image into horizontal and vertical patches. Then, pretrained AlexNet was utilized to extract deep features. Here, fc6 and fc7 (sixth and seventh fully connected layers) layers have been used to extract deep features from the created patches. The generated features from patches have been concatenated/merged to generate the final feature vector. In order to select the best combination from the generated final feature vector, an iterative selector (iterative neighborhood component analysis-INCA) has been used, and this selector has chosen 43 features. These 43 features have been used for classification. In the last phase, we used a kNN classifier with tenfold cross-validation. RESULTS: By using 43 features and a kNN classifier, our AlexNet-based deep feature engineering model surprisingly attained 100% classification accuracy. CONCLUSION: The obtained perfect classification performance clearly demonstrated that our proposal could separate large and small brain vessel occlusion detection in non-contrast CT images. In this aspect, this model can assist neurology experts with the early recanalization chance.

Long-term clinical course and prognosis of hot water epilepsy: 15-Year follow-up.

OBJECTIVE: Hot water epilepsy (HWE) is a type of reflex epilepsy triggered by bathing with hot water. Hot water epilepsy is generally considered as a self-limiting benign disease although its long-term course and prognosis remains unknown. In this study, we aimed to determine the long-term clinical course and prognosis of hot water epilepsy and possible factors affecting them. METHODS: The diagnosis of HWE was made based on the clinical history obtained from patients and their first degree relatives witnessing to the seizures and video recordings of seizures if available; then, the type of seizure was identified. Good prognosis was defined as patients whose seizures were controlled with or without preventive measures and who did not require antiepileptic treatment. The poor prognosis was defined as patients whose seizures continued despite preventive measures and required antiepileptic treatment. RESULTS: The study included 50 (31 male and 19 female) patients with a mean follow-up of 17.63 ±â€¯10.46 (median, 15.0) years. The age at onset of seizure was 14.52 ±â€¯12.71 (median: 10.0) years. There were 38 (76%) patients in the good prognosis group. 18 (36%) of them achieved complete remission, who did not require preventive measures. In the remaining 20 (40%) patients, seizures could be controlled with only preventive measures. Seizures could be controlled with antiepileptic treatment in only 1 (2%) of 12 (24%) patients in the poor prognosis group. A significant relationship was found between the frequency of hot water seizures (HWSs) and poor prognosis (p = 0.019), as well as the presence of spontaneous seizures outside of bathing and poor prognosis (p = 0.000). SIGNIFICANCE: Hot water epilepsy, as previously known, is not a self-limiting benign disease. Approximately ¾ of the cases have a good prognosis, but the rest are in the case of chronic epilepsy. The low response rate to antiepileptics' treatment suggests that the pathogenesis of the HWE may differ from other epilepsies.

Restless legs syndrome affecting the head region: "restless head syndrome".

OBJECTIVE: Restless legs syndrome (RLS) is a well-established disease that has recently been shown to have variants affecting the arms, face, abdomen, and genital area. To our knowledge, there has been no study reporting on the RLS variant affecting the head region. METHODS: The retrospective study reviewed a total of 460 patients who presented to Firat University Medical School and were diagnosed as having RLS based on the International Restless Legs Syndrome Study Group (IRLSSG) criteria between June 2017 and January 2020. Of these, 18 patients that presented with head-related RLS symptoms (in addition to legs or arms) and four cases that presented with isolated head involvement were included in the study. RESULTS: In 15 out of 18 (81.8%) patients, the restless head syndrome was accompanied by restless arm syndrome (RAS). In the remaining four (18.2%) patients, the disease involved the head region alone. The disease initially emerged in a single region in the body and gradually spread to one or multiple other regions in most patients and the symptoms were relieved by head rubbing. Serum iron level was low in 8 (36.4%) patients and normal in 14 (63.6%) patients. All the patients had normal cranial imaging and the symptoms were eliminated after dopaminergic therapy. CONCLUSIONS: Although RLS typically involves the legs alone, it may also affect other body parts such as upper extremities, abdomen, face, and genital area. We propose that the novel RLS variant described in the present study could be termed "restless head syndrome."

S100B and neuron-specific enolase levels in episodic and chronic migraine.

OBJECTIVES: In recent years, radiological and biochemical data have emerged regarding the development of cellular damage in the brain of patients with migraine, calling into question what has traditionally been accepted as a benign disorder. In order to investigate whether cellular damage develops in the brain of episodic migraine patient, serum levels of neuron-specific enolase (NSE) and S100B have been evaluated in recent studies. However, contradictory results were obtained in these studies. Moreover, there is no study on NSE and S100B in cases of chronic migraine. METHODS: Patients with episodic migraine with or without aura and chronic migraine were included. In addition, 27 healthy volunteers were included as a control group. Control group was selected from healthy volunteers of the same age and sex. We investigated serum NSE and S100B levels during the interictal period in 26 patients with episodic migraine and 27 patients with chronic migraine. RESULTS: The serum NSE and S100B levels were significantly higher in both patients with episodic and chronic migraine than controls. Although there were no significant differences in the serum NSE and S100B levels between the two patients' groups, these markers were found to be higher in cases of chronic migraine. CONCLUSION: These results suggest that there is both neuronal and glial involvement in the two migraine groups. Elevations in these markers in cases of episodic migraine suggest that cellular damage not only results from headache episodes, but that there may be also an ongoing pathological process during the interictal period.

Epileptic olfactory auras: a clinical spectrum.

OBJECTIVE: To investigate the relative frequency of olfactory aura in a large number of patients with focal epilepsy, and examine the full clinical spectrum of epileptic olfactory auras (OAs) and their relationship to hemispheric lateralization and localization of epileptogenic focus. METHODS: This retrospective study was based on the medical records of 1384 patients with focal epilepsy. Of these, 71 (5.1%) patients were present with OAs, comprising 25 (35.2%) men and 46 (64.8%) women with a mean age of 35.43 ± 12.89 years. These 71 patients were classified according to the clinical features of the OAs, and the electroencephalography and magnetic resonance imaging findings were examined. RESULTS: The relative frequency of OAs was 5.1% in the focal epileptic patients. The clinical spectrum of OAs in our cases was outlined as follows, complex OAs and elementary OAs. Elementary OAs were divided into three subgroups: elementary neutral OAs, elementary unpleasant OAs, and elementary pleasant OAs. In our cases, there was no difference between the right and left hemispheres in terms of lateralization of the epileptogenic focus. In all the 71 patients, the epileptogenic zone was most commonly localized in the temporal lobe (n = 58; 81.7%). CONCLUSIONS: The relative frequency of OAs in focal epilepsies is likely to be found higher than expected. Elementary OAs occur much more frequently than complex OAs. Among the elementary OAs, elementary unpleasant OAs and elementary neutral OAs are the most common types, whereas elementary pleasant OAs are extremely rare.

The relationship between saphenofemoral junction insufficiency and varicocele.

The aim of the study was to investigate whether or not there is a significant relationship between varicocele and SFJ insufficiency. This study included 200 men with (study group) and 200 men without (control group) primary varicocele which was initially diagnosed by observation during the Valsalva manoeuver. Subsequently, scrotal and lower extremity venous Doppler ultrasonography (USG) was performed by a senior radiologist, and participants with testicular veins >3.0 mm in diameter and reverse blood flow were determined to have varicocele. SFJ insufficiency was defined as retrograde flow in the SFJ of longer than 0.5 s. Retrograde venous flow in the pampiniform plexus was determined 3.5% (study) versus 0.0% (control) and 77.0% (study) versus 0.0% (control) in the right testis and left testis, respectively, and bilaterally at 11.5% (study) versus 0.0% (control). The presence of SFJ insufficiency was also found to be higher in the study group than in the control group (unilaterally: 26.0% versus 15.0%; bilaterally: 14.0% versus 5.0%). The current study demonstrates a statistically significant relationship between varicocele and SFJ insufficiency and supports the argument that varicocele is not a local disease and may be attributable to a systemic vascular insufficiency. Additional studies with larger series are needed to further elucidate this topic.

A retroperitoneal myopericytoma: The first case located at the retroperitoneal area and not originate from the kidneys.

A 25-year-old woman had a mass of approximately 65 cm × 33 cm × 102 cm, located in the left paraaortic area on CT scan. It was diagnosed as retroperitoneal malignant neoplasm on imaging. Afterward, open retroperitoneal tumor excision was performed. At laparotomy, the mass was carefully dissected from the ureter, renal artery, and aorta and excised as en-bloc. The pathological result was "myopericytoma." Histologically, the pathological findings characterized a pericytic neoplasm characterized by a perivascular growth of myoid tumor cells. In addition, there were uniform, oval-shaped cells with eosinophilic cytoplasm arranged in short fascicles around blood vessels. The cytologic atypia and mitoses were absent. There are many different tumors in the retroperitoneal area. Most of these lesions are malign nature. Nevertheless, for each benign and malign neoplasm, the preoperative imaging method is generally similar. This present case showed the significant findings of myopericytoma, a benign pathology located in the retroperitoneal area.

Flow volume measurement of arterial venous and cerebrospinal fluid in patients with multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is usually described as an autoimmune disease, although the exact mechanism of the disease remains unknown. There have been studies reporting that venous flow abnormalities may be involved in the pathogenesis of MS or many of the associated clinical manifestations. OBJECTIVE: The aim of this study was to evaluate flow volumes of the middle cerebral artery (MCA), transverse sinus (TS), and cerebral aqueduct using phase contrast magnetic resonance imaging (PC-MRI) in relapsing-remitting MS patients and a control group. METHODS: We included 34 patients diagnosed by the McDonald criteria, revised in 2017, as well as 15 healthy controls matched by age and sex. The MRI scans were performed using a 1.5-T superconducting scanner. Axial T1-weighted, T2-weighted, and PC-MRI sequences were performed for the quantitative investigation of flow volume measurements. Quantitative analyses of flows were performed using flow analyses program PC-MRI angiography software. A circular region of interest was placed manually into the cerebral aqueduct, bilateral MCA, and TS. RESULTS: Flow volumes of the cerebral aqueduct and MCA were not statistically significant between the MS and control groups. The flow volumes of the TS for the patient group were lower than those of the control group, and this difference was statistically significant. CONCLUSIONS: A reduced TS flow volume in MS patients was noted in the present study when compared with the control group, suggesting a relation between venous pathologies and MS. Further studies are needed to understand whether this relation is causal or epiphenomenal.

ANTECEDENTES: A esclerose múltipla (EM) é comumente descrita como uma doença autoimune, embora seu mecanismo exato permaneça desconhecido. Há estudos que afirmam que anormalidades no fluxo venoso podem estar relacionadas à patogênese da EM ou a muitas das manifestações clínicas associadas. OBJETIVO: O objetivo deste estudo é avaliar os volumes de fluxo da artéria cerebral média (ACM), do seio transverso (ST) e do aqueduto cerebral usando ressonância magnética com contraste de fase (PC-MRI) em com EM recorrente-remitente. MéTODOS: Incluímos 34 pacientes diagnosticados pelos critérios de McDonald, revisados em 2017, além de 15 controles saudáveis pareados por idade e gênero. A ressonância magnética foi realizada usando um scanner supercondutor de 1,5 T. As sequências de PC-RM axiais, ponderadas em T1 e ponderadas em T2 foram realizadas para investigação quantitativa das medidas de volume de fluxo. As análises quantitativas de fluxo foram realizadas usando o software de angiografia PC-MRI do programa de análise de fluxo. Uma região circular de interesse foi localizada manualmente no aqueduto cerebral, ACM bilateral e ST. RESULTADOS: Os volumes de fluxo do aqueduto cerebral e da ACM não foram estatisticamente significantes entre o grupo de pacientes e os controles. Os volumes ST do grupo de pacientes foram menores que os do grupo controle, e essa diferença foi estatisticamente significante. CONCLUSõES: No presente estudo, um menor volume de fluxo ST foi registrado em pacientes com EM em comparação ao grupo controle, sugerindo uma relação entre patologias venosas e EM; Mais estudos são necessários para entender se essa relação é causal ou um fenômeno secundário.

Evaluation of neurological disorders that develop concurrently with COVID-19 pneumonia: a retrospective analysis.

BACKGROUND: During the pandemic, many neurological symptoms have been evaluated as complications of COVID-19 pneumonia. OBJECTIVE: To investigate the frequency and characteristics of neurological findings, and their effects on the prognosis of patients with COVID-19 pneumonia who consulted with the Neurology department. METHODS: Data on 2329 patients who were hospitalized with the diagnosis of COVID-19 pneumonia in our hospital were scanned. The clinical, laboratory and radiological findings relating to treatment of 154 patients who required neurological consultation were retrospectively evaluated by reviewing the clinical notes. RESULTS: The number of COVID-19 pneumonia patients who required neurological consultations while hospitalized in the ICU was 94 (61.0%). The most common symptom among these patients was hyperactive delirium. Mean age, ferritin levels and CRP values ​​of those with delirium were higher, while the mean lymphocyte percentage were lower, than those of the patients without delirium. Epileptic seizures were observed in eight patients without an epilepsy diagnosis. Two patients were diagnosed with GBS and one patient with ICU neuropathy. The D-dimer levels of patients with acute hemorrhagic CVD and the thrombocyte levels of patients with acute ischemic CVD were found to be higher than in patients without acute ischemic CVD. CONCLUSION: The proportion of patients who required neurological consultations was higher in the ICUs. We observed neurological symptoms more frequently in the advanced age group. There were no significant increases in the incidence of other neurological conditions except delirium, in COVID-19 patients. We think that further studies are needed to support our data.

A case of syncopal convulsions triggered by glossopharyngeal neuralgia.

Syncopal convulsions and epileptic seizures are clinically hard to distinguish and differ in terms of treatment approaches. It is important to consider the cardiac arrhythmias that impair cerebral perfusion in the differential diagnosis of antiepileptic treatment-resistant convulsions. Here we offer a 72 year old male patient glossopharengial neuralgia after swallowing associated with recurrent episodes of syncopal convulsions. The patient was successfully treated with temporary pacemaker and carbamazepine. This phenomenon is noteworthy in terms of both asystole triggered by glossopharengial neuralgia and syncopal convulsions which are rare in the differential diagnosis of epileptic seizures.

Increased serum chemerin levels associated with carotid intima-media thickness.

BACKGROUND: Elevated levels of chemerin can predict future ischemic cerebrovascular disease. Although chemerin is thought to play a role in atherosclerotic inflammation, whether circulating chemerin levels are associated with the severity of atherosclerosis remains to be determined. OBJECTIVES: Through the use of carotid Doppler ultrasonography, our aim in this study was to investigate the relationships of serum chemerin levels with carotid intima-media thickness (CIMT) as an indicator of generalized atherosclerosis. METHODS: This study compared 40 patients with ischemic stroke and 40 healthy subjects. Measurements were made at end-diastole using color Doppler ultrasonography (CDUS) after a 5-min rest interval in a quiet and dark room. CIMT was defined as the distance between the innermost edge of the luminal echo to the innermost edge of the media/adventitia echo. CIMT was measured in the posterior wall of both common carotid arteries within 1 cm proximally to the bulbus. Three measurements were made on both sides and the average measurement was taken as the CIMT. Serum chemerin levels were determined in all patients and healthy subjects. RESULTS: Serum chemerin levels were significantly higher in the patient group than in the control group (p=0.004). Serum chemerin levels were positively correlated with CIMT (p<0.05). There was a significant difference between the groups with regard to CIMT (p<0.001). CONCLUSION: Elevated serum chemerin levels appear to be associated with CIMT, thus suggesting that a link exists between chemerin and atherosclerotic ischemic cerebrovascular disease.

Haemostatic role and histopathological effects of a new haemostatic agent in a rat bladder haemorrhage model: an experimental trial.

OBJECTIVE: To investigate the haemostatic efficacy and histopathological effects of a new haemostatic agent, Ankaferd BloodStopper (ABS; Ankaferd Drug Cosmetic Co., Istanbul, Turkey) in a rat bladder haemorrhage model. ABS is a unique combination of five plant extracts that has been used in Turkish traditional medicine as a haemostatic agent for external traumatic bleeds. MATERIALS AND METHODS: In all, 20 male Sprague-Dawley rats were divided into two equal groups. In both groups, the mucosa was damaged on the posterior wall (PW) of the bladder. The liquid form of ABS was applied to the bleeding area of one group (group 1) and 0.9% NaCl to the bleeding area of the other group (group 2, controls). The solutions were applied drop by drop with a 2 mL injector until the bleeding stopped and the bleeding times recorded. For histopathological examination, two tissue samples were taken from all rats in each group; one from the damaged mucosa in the PW and one from undamaged mucosa in the lateral wall (LW). Two sections were prepared from all samples. One section was stained with haematoxylin and eosin (H&E), and the rest was used for immunohistochemical staining for fibronectin. RESULTS: The mean bleeding times were 65 s and 147 s for groups 1 and 2, respectively (P < 0.001). In the pathological specimens stained with H&E, fibrosis and other studied pathological features were similar in the LW samples in groups 1 and 2. Similarly, there were no differences between the PW samples of groups 1 and 2. In the pathological specimens stained for fibronectin, the number of attenuated cells was similar in the LWs of group 1 and 2 (P = 0.21) as well as in the PWs of each group (P = 0.066). CONCLUSIONS: ABS decreased bleeding time and did not increase fibrotic reactions in rat bladder tissue.

Analysis of Childhood Traumas and Defense Styles in Patients With Tension Headache.

OBJECTIVE: Studies indicate that patients tend to develop chronic tension headache as a response to stress. The present study investigated the relationship between headache and the events that caused childhood traumas and defense styles, which could be considered as a significant source of stress in individuals with tension headache. METHODS: Fifty patients between the ages of 18 and 65 years diagnosed with tension headache were included in the present study. The control group included 50 healthy participants. All study participants completed a sociodemographic data form prepared by the researchers and the Childhood Trauma Questionnaire and Defense Style Questionnaire. RESULTS: Traumatic experiences (emotional abuse, physical abuse, emotional neglect, physical neglect, and sexual abuse) were significantly higher in the patient group compared to the control group. The total score of immature and neurotic defense styles was higher in the patient group than in the control group (P < .001, P < .001). The mature defense styles total score was significantly higher in the control group than in the patient group (P = .006). A positive correlation was found between the childhood trauma scores and immature and neurotic defense style scores. CONCLUSION: The findings indicate that traumatic experiences during childhood were more frequent in patients with tension headache compared to healthy individuals. Furthermore, these individuals had difficulty coping with stress, and inappropriate defense styles were employed as a response to stress.

Evaluation of ubiquitin C-terminal hydrolase-L1 enzyme levels in patients with epilepsy.

OBJECTIVE: Ubiquitin C-terminal Hydrolase-L1 (UCH-L1) enzyme levels were investigated in patients with epilepsy, epileptic seizure, remission period, and healthy individuals. METHODS: Three main groups were evaluated, including epileptic seizure, patients with epilepsy in the non-seizure period, and healthy volunteers. The patients having a seizure in the Emergency department or brought by a postictal confusion were included in the epileptic attack group. The patients having a seizure attack or presenting to the Neurology outpatient department for follow up were included in the non-seizure (remission period) group. RESULTS: The UCH-L1 enzyme levels of 160 patients with epilepsy (80 patients with epileptic attack and 80 patients with epilepsy in the non-seizure period) and 100 healthy volunteers were compared. Whereas the UCH-L1 enzyme levels were 8.30 (IQR=6.57‒11.40) ng/mL in all patients with epilepsy, they were detected as 3.90 (IQR=3.31‒7.22) ng/mL in healthy volunteers, and significantly increased in numbers for those with epilepsy (p<0.001). However, whereas the UCH-L1 levels were 8.50 (IQR=6.93‒11.16) ng/mL in the patients with epileptic seizures, they were 8.10 (IQR=6.22‒11.93) ng/mL in the non-seizure period, and no significant difference was detected (p=0.6123). When the UCH-L1 cut-off value was taken as 4.34 mg/mL in Receiver Operating Characteristic (ROC) Curve analysis, the sensitivity and specificity detected were 93.75 and 66.00%, respectively (AUG=0.801; p<0.0001; 95%CI 0.747‒0.848) for patients with epilepsy. CONCLUSION: Even though UCH-L1 levels significantly increased more in patients with epilepsy than in healthy individuals, there was no difference between epileptic seizure and non-seizure periods.

Tubeless and stentless percutaneous nephrolithotomy in patients requiring supracostal access.

PURPOSE: To evaluate the feasibility and safety of supracostal access in tubeless and stentless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: From March 2005 to June 2007, 10 patients underwent tubeless and stentless PCNL via supracostal access. Patients requiring more than 2 percutaneous tracts, or those with significant intraoperative bleeding were excluded from the study. Perioperative and postoperative outcomes for these patients (the study group) were compared with those of a similar number of patients who underwent unilateral PCNL via an intercostal approach with routine placement of a nephrostomy tube before March 2005 (the control group). The 2 groups had a comparable demographic data. RESULTS: Patients undergoing tubeless and stentless PCNL required less analgesia (p = 0.001) and were discharged earlier (p = 0.000) than were those in the control group. The difference in the mean decrease in hemoglobin concentration was not statistically significant. CONCLUSIONS: Supracostal access in tubeless and stentless PCNL appears to be safe and feasible, offering the advantages of a lower need for analgesia and a shorter hospital stay without increasing thoracic complications.

Outcome of percutaneous nephrolithotomy in children having complex stones.

OBJECTIVES: To review our experiences with percutaneous nephrolithotomy in children with complex renal calculi. PATIENTS AND METHODS: We retrospectively analyzed the records of 31 children with complex renal calculi who were treated by percutaneous nephrolithotomy at 2 hospitals of our university between June 2003 and June 2008. The mean age of the patients was 10.4 years (range 22 months to 15 years). Three patients were aged < or =5 years. Stone clearance and complications were recorded. RESULTS: The mean operating time (time from insertion of the ureteral catheter to placement of a nephrostomy tube) was 87.4 (range 50-180) min. In 2 patients the procedures were staged because of a large residual stone load. The extent of percutaneous tract dilation was undertaken taking patient age and the presence of hydronephrosis into consideration. Complete stone clearance with percutaneous nephrolithotomy was achieved in 21 (67.7%) of 31 patients. Adding extracorporeal lithotripsy increased total clearance to 24/31 (77.4%). The most common complication was bleeding that necessitated blood transfusion (7/31, 22.5%). CONCLUSION: Percutaneous nephrolithotomy is as safe and effective in children as it is in adults. The clearance rate can be increased with dual therapy. Tract dilation should be tailored according to patient age and the extent of hydronephrosis.

Acute Rhinosinusitis as an Infrequent Cause of Symptomatic Cluster Headache: Report of Seven Cases.

Cluster headache (CH) is a primary headache disorder characterized by unilateral headache attacks lasting 15 to 180 minutes, occurring between two and eight times a day, and accompanied by autonomic symptoms ipsilateral to the pain. However, cases of symptomatic CH that occur secondary to an underlying structural pathology have also been reported in the literature. In this report, seven patients are presented who were admitted with signs of CH and diagnosed with acute rhinosinusitis depending on extensive clinical and radiologic examinations. Symptomatic CH, though rarely reported in the literature compared to CH, should be kept in mind in patients presenting with the first attack of CH. Moreover, in such patients, whether the pain becomes worse when bending forward and becomes sensitive on palpation should be questioned, and a radiologic work-up should be performed to rule out secondary causes such as rhinosinusitis. In the present cases, the resolution of CH attacks with acute sinusitis therapy confirmed the diagnosis.

Serum and urinary levels of brain-derived neurotrophic factor (BDNF) in enuresis. / Niveles séricos de factor neurotrófico derivado de cerebro en la enuresis.

OBJECTIVES: Enuresis is one of the most frequently seen psycho-social problems in childhood, which causes anxiety and stress in the child, thus affecting his/her self-respect and quality of life. The aim of the study was to determine the role of bladder function or psychologic factors or both as factors causing enuresis. METHODS: This study on pediatric patients with primary enuresis included 30 patients with monosymptomatic nocturnal enuresis (MonoNE), 30 patients with polysymptomatic nocturnal enuresis (PolyNE), and 30 healthy controls, making a total of 90 subjects with an age range of 8-18. In all subjects, the levels of serum and urinary Brain-Derived Neurotrophic Factor (BDNF) were measured, in addition to urinary creatinine levels and calculated as BDNF/Cr ng/mg creatinine (BDNF/ Cr). RESULTS: The serum BDNF results of the PolyNE group (0.949±0.587) were significantly lower than those of the control group (1.158±0.587) (p=0.014). The urinary BDNF results of the PolyNE group (1.107±0.360) were significantly higher than those of both the MonoNE (0.657±0.272) and the control (0.670±0.271) groups (p<0.0001). The BDNF/Cr results of the PolyNE group (1.472±0.714) were significantly higher than those of the MonoNE group (0.956±1.017) and the control group (0.931±0.618) (p=0.044 and p=0.032, respectively). CONCLUSIONS: In addition to bladder-specific problems, it is possible for anxiety and psychological stress-induced problems to occur in PolyNE. Therefore, in addition to the increasing number of studies on the bladder in enuresis, further studies on the neurogenic and psychogenic aspects of enuresis should be carried out.

OBJETIVOS: La enuresis es uno de los problemas psicosociales más frecuentes en la infancia, que causa ansiedad y estrés a los niños, afectando a su autoestima y calidad de vida. El objetivo de este estudio es la determinación del papel de la función vesical, los factores psicológicos o ambos como factores causales de la enuresis.MÉTODOS: Este estudio en pacientes pediátricos con enuresis incluyó 30 pacientes con enuresis nocturna monosintomática (ENmono), 30 pacientes con enuresis nocturna polisintomática (ENpoli) y 30 controles sanos, sumando un total de 90 individuos con un rango de edad entre 8-18 años. En todos los casos se midieron los niveles séricos y urinarios de factor neurotrófico derivado del cerebro (FNDC), además de los niveles de creatinina urinaria y se hizo el cálculo de FNDC/Cr ng/mg creatinina. RESULTADOS: Los resultados de FNDC sérico en el grupo ENpoli (0,949±0,587) fueron significativamente menores que los del grupo control (1,158±0,587) (p=0,014). Los resultados de FNDC urinario en el grupo de ENpoli (1,107±0,360) fueron significativamente mayores que los de los grupos ENmono (0,657±0,272) y control (0,670±0,271) (p<0,0001). Los resultados de FNDC/Cr el grupo ENpoli (1,472±0,714) eran significativamente mayores que los de los grupos ENMono (0,956±1,017) y control (0,931±0,618) (p=0,044 y p=0,032, respectivamente). CONCLUSIONES: Además de problemas específicos vesicales, es posible que los problemas de ansiedad e inducidos por estrés psicológico ocurran en la ENPoli. Por lo tanto, además del creciente número de estudios sobre la vejiga en enuresis, es necesario desarrollar más estudios sobre los aspectos neurogénicos y psicogénicos de la enuresis.

Suboccipital steroid injection alone as a preventive treatment for cluster headache.

BACKGROUND: Suboccipital steroid injection can be used as a preventive treatment for episodic and chronic cluster headache (CH). In recent studies, prophylactic treatment has been used in addition to suboccipital steroid injection. In this study, we aimed to investigate the effectivity of the sole use of rapid- and long-acting steroid injections without prophylactic treatment in patients with episodic and chronic CH. METHODS: The retrospective study included 51 patients with episodic and chronic CH that underwent greater occipital nerve (GON) blockade with a single dose of rapid- and long-acting steroid injection without additional prophylactic treatment. The frequency, severity, and duration of attacks after GON blockade as well as the side effects and long-term outcomes were reviewed. RESULTS: In 28 (54.9%) patients, no attack occurred after GON blockade and cluster bouts were aborted. Mean duration of attacks was 86.67 ±â€¯37.45 min before the treatment. However, in the 23 patients that had at least one attack after GON blockade, the mean duration of attacks was 31.73 ±â€¯36.10 min between post-treatment days 0-3, 29.35 ±â€¯40.49 min between post-treatment days 4-10, 28.48 ±â€¯42.17 min between post-treatment days 11-28, and 35.65 ±â€¯46.55 min after the post-treatment day 28 (p < 0.001). Moreover, 10 (37.04%) out of 27 patients with episodic CH who periodically had one or two cluster bouts in a year had no CH attack at the time of the expected subsequent cluster bout. CONCLUSION: GON blockade is a practical, reliable, and cost-effective treatment option for patients with episodic and chronic CH. Moreover, GON blockade is highly effective in reducing headache attacks and even aborting cluster bouts in CH patients without requiring additional prophylactic treatment.