A retrospective cohort study: is COVID-19 BNT162b2 mRNA vaccination a trigger factor for cluster headache?

OBJECTiVE: Cluster headache (CH) is a coronavirus 2019 (COVID-19) vaccination-related adverse event. There are a few case reports of relapses or de novo cluster episodes following the vaccine. The disease's pathophysiology is still not clear. The most widely accepted mechanism is activation of the trigeminocervical complex (TCC). However, the correlation between vaccination and CH is unexplainable. Its goal is to compare the CH bouts of patients before and after the vaccine. METHODS: Patients with a history of CH and who had never experienced COVID-19 illness during the pandemic were included in this retrospective cohort analysis. The semi-structured survey was administered face to face to 24 CH patients (16 male). The headache features before and after vaccination were detailed in this survey. RESULTS: 18 patients got vaccinated twice, and 6 of them had no vaccination. After the first vaccination, 83.3% of them had CH bout; after the second vaccination, 72.2% of them had CH bout. We divided headache episodes into three groups: (1) before vaccination, (2) after the first vaccination, and (3) after the second vaccination. The third group had a higher pain intensity (9.30 ± 0.630, p = 0.047) and remitting longer (20.00 ± 5.40 days, p = 0.019) than the other groups. The management of the 53.3% bouts after vaccinations was less effective than the usual episodes. CONCLUSION: Most ECH patients experienced new bouts more intense and longer duration after vaccinations than their previous bouts, the mechanism, and pathogenesis of the bouts are the subject of future research. The new studies can be a light for understanding the CH pathophysiology more deeply.

Triglyceride-glucose index as a predictor of obstructive sleep apnoea severity in the absence of traditional risk factors.

OBJECTIVE: We evaluated the association between the triglyceride-glucose (TG) index, a marker of insulin resistance, and obstructive sleep apnoea (OSA) severity in patients without diabetes mellitus, obesity, and metabolic syndrome. METHODS: This retrospective cohort study included 1,527 patients. We used univariate and multivariate analyses to identify the independent predictors associated with OSA. RESULTS: Most patients were males (81.5%) with a mean age of 43.9 ± 11.1 (15-90) years. Based on the apnoea-hypopnea index (AHI), 353 (23.1%) patients were included in the control group, whereas 32.4%, 23.5%, and 21% had mild, moderate, and severe OSA, respectively. The TG index values demonstrated significant associations with OSA patients compared with the control group (p = 0.001). In addition, the mean values of the oxygen desaturation index (ODI), AHI, minimum oxygen saturation, and total sleep time percentage with saturation below 90% demonstrated statistically significant differences among the TG index groups (p: 0.001; p:0.001; p:0.001; p:0.003). The optimal TG index cutoff value to predict OSA was 8.615 (AUC = 0.638, 95% CI = 0.606-0.671, p = 0.001). In multivariate logistic regression analysis, after adjusting for age, sex, and body mass index, the TG index was independently associated with OSA patients. CONCLUSION: The TG index is independently associated with increased risk for OSA. This indicates that this index, a marker for disease severity, can be used to identify severe OSA patients on waiting lists for PSG.

OBJETIVO: Avaliamos a associação entre o índice triglicerídeos-glicose (TG), um marcador de resistência à insulina, e a gravidade da apneia obstrutiva do sono (AOS) em pacientes sem diabetes mellitus, obesidade e síndrome metabólica. MéTODOS: Este estudo de coorte retrospectivo incluiu 1.527 pacientes. Utilizamos análises univariadas e multivariadas para identificar os preditores independentes associados à AOS. RESULTADOS: A maioria dos pacientes era do sexo masculino (81,5%) com idade média de 43,9 ± 11,1 anos (15-90). Com base no índice apneia-hipopneia (IAH), 353 (23,1%) pacientes foram incluídos no grupo de controle, enquanto 32,4%, 23,5% e 21% tinham AOS leve, moderada e grave, respectivamente. Os valores do índice TG demonstraram associações significativas com pacientes com AOS em comparação com o grupo de controle (p = 0,001). Além disso, os valores médios do índice de dessaturação de oxigênio (IDO), IAH, saturação mínima de oxigênio e porcentagem de tempo total de sono com saturação abaixo de 90% demonstraram diferenças estatisticamente significativas entre os grupos de índice TG (p = 0,001; p = 0,001; p = 0,001; p = 0,003). O valor de corte ideal do índice TG para prever a AOS foi de 8,615 (AUC=0,638, IC de 95% = 0,606­0,671, p = 0,001). Na análise de regressão logística multivariada, após o ajuste para idade, sexo e índice de massa corporal, o índice TG foi independentemente associado a pacientes com AOS. CONCLUSãO: O índice TG está independentemente associado a um maior risco de AOS. Isso indica que este índice, um marcador de gravidade da doença, pode ser usado para identificar pacientes com AOS grave em listas de espera para polissonografia.

Correlation between Pulmonary Embolism and Sleep Apnea.

Introduction: It has been shown that there is a correlation between Obstructive Sleep Apnea Syndrome (OSAS) and pulmonary thromboembolism (PTE); OSAS is a risk factor for PTE. We aimed to evaluate the frequency of OSAS in PTE patients, the correlation of OSAS with the severity of PTE, and its effect on 1-month mortality in PTE patients. Methods: This single-center, prospective, comparative case control study contains 198 patients diagnosed with non-massive PTE in our hospital between the dates of 01/07/2018-04/01/2020 who were confirmed by imaging methods. Daytime sleepiness was assessed with Epworth questionnaires, and OSAS risk was assessed with Berlin, STOP, STOP-BANG sleep questionnaires. Alongside demographic and clinical data, comorbidities, Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), WELLS scores, troponin, D-dimer values, echocardiyography (ECHO) findings were also examined. Epworth, Berlin, STOP, STOP-BANG sleep groups were compared in terms of PTE parameters. Results: A hundred and thirty-eight patients (69.6%) was assesed as high risk group according to Berlin, meanwhile STOP-BANG defined 174 patients (87.8%), furthermore STOP has considered 152 patients in the high risk group (76.7%) and Epworth questionnaire determined this number as 127 (64.1%). As a result of the logistic regression analysis, statistically significant correlation was found between Berlin score and heart failure, PESI, sPESI and troponin values; between Epworth score and WELLS score; between STOP-BANG score and PESI score (p<0.05). During the 1-month follow-up period, 9 of the patients were exitus and mortality was 4.5%. Conclusion: OSAS risk is more common in patients with PTE and it may be a risk factor for PTE. It has been shown that the risk of OSAS may aggravate PTE severity and prognosis.

Ultrasound-Guided Combined Greater Occipital Nerve Block at the C2 Level with Trapezius Trigger Point Injection and Supraorbital-Supratrochlear Nerve Block: More Effective on Allodynia and Disability in Chronic Migraine.

Background: Chronic migraine (CM) patients with cutaneous allodynia (CA) show a poor response to treatment. Long-term studies have yet to be conducted to demonstrate the efficacy of blocks on CA. This study evaluated the improvement in allodynia and disability in CM treated with ultrasound (US)-guided blocks. Methods: In this prospective, non-randomized comparative study, 60 CM patients with CA were evaluated for the clinical effectiveness of the therapy using the numeric rating scale (NRS), headache impact test-6 (HIT-6), brush allodynia test, and allodynia symptom checklist (ASC-12). At the first visit, tenderness in the nerve or trapezius muscle was confirmed in the intervention group. US-guided greater occipital nerve block (GONB), GONB, and trapezius muscle injection (TPI), or GONB, TPI, and peripheral trigeminal nerve block (PTNB), respectively, were performed four times once a week for a month. Initial and third-month assessments were performed. Results: The ASC-12 scores decreased in the GONB+TPI+PTNB and GONB groups more than the GONB+TPI group (mean rank, respectively, 26.86, 27.40, 38.39; P = 0.018). The decrease in HIT-6 scores was greater in the GONB+TPI+PTNB group than in the GONB group (mean rank, respectively, 21.98, 39.95, P < 0.017) in the first month. In the third month, the GONB+TPI+PTNB group scored HIT-6 significantly lower than GONB and GONB+TPI (mean rank: 18.84, 38.73, 35.61; P < 0.001). Conclusions: GONB+TPI+PTNB was more successful in alleviating allodynia and disability.

Individualised prediction of drug resistance and seizure recurrence after medication withdrawal in people with juvenile myoclonic epilepsy: A systematic review and individual participant data meta-analysis.

Background: A third of people with juvenile myoclonic epilepsy (JME) are drug-resistant. Three-quarters have a seizure relapse when attempting to withdraw anti-seizure medication (ASM) after achieving seizure-freedom. It is currently impossible to predict who is likely to become drug-resistant and safely withdraw treatment. We aimed to identify predictors of drug resistance and seizure recurrence to allow for individualised prediction of treatment outcomes in people with JME. Methods: We performed an individual participant data (IPD) meta-analysis based on a systematic search in EMBASE and PubMed - last updated on March 11, 2021 - including prospective and retrospective observational studies reporting on treatment outcomes of people diagnosed with JME and available seizure outcome data after a minimum one-year follow-up. We invited authors to share standardised IPD to identify predictors of drug resistance using multivariable logistic regression. We excluded pseudo-resistant individuals. A subset who attempted to withdraw ASM was included in a multivariable proportional hazards analysis on seizure recurrence after ASM withdrawal. The study was registered at the Open Science Framework (OSF; https://osf.io/b9zjc/). Findings: Our search yielded 1641 articles; 53 were eligible, of which the authors of 24 studies agreed to collaborate by sharing IPD. Using data from 2518 people with JME, we found nine independent predictors of drug resistance: three seizure types, psychiatric comorbidities, catamenial epilepsy, epileptiform focality, ethnicity, history of CAE, family history of epilepsy, status epilepticus, and febrile seizures. Internal-external cross-validation of our multivariable model showed an area under the receiver operating characteristic curve of 0·70 (95%CI 0·68-0·72). Recurrence of seizures after ASM withdrawal (n = 368) was predicted by an earlier age at the start of withdrawal, shorter seizure-free interval and more currently used ASMs, resulting in an average internal-external cross-validation concordance-statistic of 0·70 (95%CI 0·68-0·73). Interpretation: We were able to predict and validate clinically relevant personalised treatment outcomes for people with JME. Individualised predictions are accessible as nomograms and web-based tools. Funding: MING fonds.

Does smoking impair sleep hygiene?

BACKGROUND: Sleep architecture and sleep hygiene might be disrupted by several pathogenetic mechanisms, and the effect of smoking has not been evaluated. OBJECTIVE: To investigate the effect of smoking on sleep hygiene behaviors that might be associated with the deterioration of quality-of-life (QoL) parameters. METHODS: In a prospective cross-sectional study, smokers (n=114) and nonsmokers (n=119) were included. The Pittsburgh Sleep Quality Index (PSQI), the Epworth Daytime Sleepiness Scale (ESS), the Sleep Hygiene Index (SHI), and the Short Form-36 quality of life scale (SF-36) were applied. RESULTS: We found that none of the components, as well as the PSQI total score were affected in smokers compared with the nonsmoker controls (65.5% of smokers had poor sleep compared to 62.5% of nonsmokers). Although smokers tend to get out of bed at different times from day to day and do important work before bedtime (components of the SHI) more often than non-smokers, no significant differences were detected between groups in any component and SHI total score (27.91±6.72 for smokers and 29.23±8.0 for non-smokers). ESS, depression and anxiety symptoms, and SHI scores in smokers with poor sleep quality were significantly different compared with smokers that had normal sleep quality. Both PSQI and SHI scores were inversely associated with QoL parameters. CONCLUSIONS: Our results suggest that smoking by itself is not associated with poor sleep hygiene or sleep quality. It can be concluded that worse SHI and quality of sleep negatively affect QoL, depression, and anxiety in smokers.

Does smoking impair sleep hygiene? / O tabagismo prejudica a higiene do sono?

ABSTRACT Background: Sleep architecture and sleep hygiene might be disrupted by several pathogenetic mechanisms, and the effect of smoking has not been evaluated. Objective: To investigate the effect of smoking on sleep hygiene behaviors that might be associated with the deterioration of quality-of-life (QoL) parameters. Methods: In a prospective cross-sectional study, smokers (n=114) and nonsmokers (n=119) were included. The Pittsburgh Sleep Quality İndex (PSQI), the Epworth Daytime Sleepiness Scale (ESS), the Sleep Hygiene Index (SHI), and the Short Form-36 quality of life scale (SF-36) were applied. Results: We found that none of the components, as well as the PSQI total score were affected in smokers compared with the nonsmoker controls (65.5% of smokers had poor sleep compared to 62.5% of nonsmokers). Although smokers tend to get out of bed at different times from day to day and do important work before bedtime (components of the SHI) more often than non-smokers, no significant differences were detected between groups in any component and SHI total score (27.91±6.72 for smokers and 29.23±8.0 for non-smokers). ESS, depression and anxiety symptoms, and SHI scores in smokers with poor sleep quality were significantly different compared with smokers that had normal sleep quality. Both PSQI and SHI scores were inversely associated with QoL parameters. Conclusions: Our results suggest that smoking by itself is not associated with poor sleep hygiene or sleep quality. It can be concluded that worse SHI and quality of sleep negatively affect QoL, depression, and anxiety in smokers.

RESUMO Antecedentes: A arquitetura e a higiene do sono podem ser interrompidas por vários mecanismos patogenéticos, e o efeito do tabagismo ainda não foi avaliado. Objetivo: Investigar o efeito do tabagismo nos comportamentos de higiene do sono que podem estar associados à deterioração dos parâmetros de qualidade de vida (QV). Métodos: Em um estudo transversal prospectivo, foram incluídos fumantes (n=114) e não fumantes (n=119). Foram aplicados o índice de qualidade do sono de Pittsburgh (Pittsburgh Sleep Quality İndex - PSQI), a escala de sonolência diurna de Epworth (ESS), o índice de higiene do sono (Sleep Hygiene Index - SHI) e a escala de qualidade de vida Short Form-36 (SF-36). Resultados: Descobrimos que nenhum dos componentes, assim como o escore total do PSQI, foram afetados em fumantes em comparação com os controles não fumantes (65,5% dos fumantes dormiam mal em comparação com 62,5% dos não fumantes). Embora os fumantes tendam a sair da cama em horários diferentes do dia a dia e fazer trabalhos importantes antes de dormir (componentes do SHI) com mais frequência do que os não fumantes, não foram detectadas diferenças significativas entre os grupos em qualquer componente e pontuação total do SHI (27,91±6,72 para fumantes e 29,23±8,0 para não fumantes). A ESS, os sintomas de depressão e ansiedade e os escores SHI em fumantes com má qualidade de sono foram significativamente diferentes em comparação com fumantes com qualidade de sono normal. Os escores do PSQI e SHI foram inversamente associados aos parâmetros de QV. Conclusões: Nossos resultados sugerem que o tabagismo por si só não está associado à má higiene ou qualidade do sono. Pode-se concluir que o pior SHI e a qualidade do sono afetam negativamente a QV, a depressão e a ansiedade em fumantes.

The Effect of Sleep Hygiene and Sleep Deterioration on Quality of Life in Shiftworking Healthcare Professionals.

INTRODUCTION: Deterioration in sleep quality and sleep hygiene may result in impairments on mental and physical health leading to deterioration of quality of life (QoL) in healthcare shift workers. We aimed to determine the presence of sleep deterioration as well as poor sleep hygiene, and if any, the effects of these on health-related outcomes. METHODS: This study prospectively included healthcare professionals who did and did not work shifts (n=90 and n=66, respectively). The participants completed the Pittsburgh Sleep Quality Index (PSQI), Sleep Hygiene Index (SHI), Epworth Daytime Sleepiness Scale (EDSS), Short Form-36 quality of life scale (SF-36), and the Beck depression (BD) and Beck anxiety (BA) scales. RESULTS: Although the total PSQI scores showed a tendency to increase in shift workers, no significant differences were observed in total scores as well as subdivisions, except for an increase in sleep latency. Increased SHI total score in shift workers were represent more deteriorated sleep hygiene behavior (p=0.002). Increased needs of daytime nap, variability of both go and get out of bed and stay in bed longer than usual were recorded respectively (p: 0.001, p: 0.001, p: 0.001, p: 0.001, p: 0.001). SHI had prominent effects on QoL parameters such as vitality (r=-0.284, p=0.007), social function (r=-0.323, p=0.002), mental health (r=-0.274, p=0.009), and calculated mental component total score (r=-0.302, p=0.004). CONCLUSION: In our study, we clearly detected prolonged sleep latency and poor sleep hygiene in shift workers which should be responsible for the deterioration of QoL.

[The effect of steroid injection treatment with carpal tunnel syndrome on sleep hygiene]. / Karpal tünel sendromu tedavisinde steroid enjeksiyonun uyku hijyeni üzerindeki etkisi.

OBJECTIVES: Carpal tunnel syndrome (CTS) is the most seen entrapment neuropathy. CTS is a complex syndrome arisen with entrapment of median nerve at wrist. Pain worst at night, paresthesia, hypoesthesia, paralysis, and muscle atrophy can be seen through nerve entrapment level. Besides, we see negative symptoms for sleep in our practice. It is known the effect of invasive and non-invasive treatments on the sleep. We aimed to search the effect of treatment of CTS on the sleep modalities. METHODS: In our study, the effect of injection treatment of CTS patients diagnosed clinically with electrophysiological methods in neurology clinic, on sleep modalities. After excluding the secondary reasons of CTS; patients responded to visual analog scale (VAS), symptom, and functional scales of Boston questionnaire (BQ-FS), Leeds Assessment of Neuropathic Symptoms and Signs, Pittsburg sleep quality index (PSQI), insomnia severity index (ISI), sleep hygiene index (SHI), Epworth sleepiness scale, Beck depression scale, and Beck anxiety scale. RESULTS: Twenty-nine patients (2 males and 27 females) were enrolled. After treatment, VAS, BQ-FS, LANNS, PSQI, ISI, and SHI both resulted in a significant reduction. CONCLUSION: Sleep hygiene is affected negatively in CTS patients. A healing effect is observed on the quality of sleep impaired by the injection treatment of CTS.

Modulation of the excitatory phase following the cutaneous silent period by vibration.

INTRODUCTION: The post-inhibition excitatory phase (E3) of the cutaneous silent period (CSP) is attributed to the resynchronization of motoneuron activity following the inhibitory period but there is also evidence that a somatosensory startle reflex may contribute to this phase. We hypothesized that the startle reflex component contained in E3 will decrease during vibration. METHODS: Sixteen healthy individuals were included in the study. CSP was recorded from slightly contracted right thenar muscles after painful index finger stimulation, before, during, and immediately after vibration. The values of the percentage change of E3 relative to pre-stimulus baseline (E3%) were compared before, during, and after vibration for each individual. RESULTS: There was a reduction in E3% during vibration and the values returned to normal immediately after vibration (153.1 ± 43.5%, 115.2 ± 30.2%, 154.9 ± 68.2%, respectively; p = 0.030). DISCUSSION: E3 is reduced during vibration in healthy individuals, presumably due to suppression of a reflex component, which is superimposed upon the known resynchronization of motoneurons.

Uric acid as a marker of severity of obstructive sleep apnoea syndrome in older patients.

OBJECTIVE: Uric acid has been shown to be related to the severity of obstructive sleep apnoea syndrome (OSAS) in adults. We assessed the role of uric acid in OSAS in a cohort of older patients. METHODS: A total of 164 patients aged >65 years, admitted to our sleep laboratory between January 1st, 2016 and July 1st, 2018 with a complaint of snoring, underwent overnight polysomnography and were retrospectively evaluated. RESULTS: A total of 126 patients who fulfilled the inclusion criteria (mean age 69.16±3.68 years, 56% men) were included. The control group was comprised of 14 patients, while the OSAS group consisted of 112 patients (31 mild, 44 moderate and 37 severe cases). No differences were observed in age, sex, hip circumference, waist/hip ratio or comorbidities between the groups. The Epworth Sleepiness Scale score, body mass index (BMI), and waist circumference were significantly higher in OSAS patients than in controls (p=0.001, p=0.02, and p=0.36, respectively). Uric acid was not correlated with any of the sleep parameters, and no significant differences were detected between the groups. Hyperuricemic patients were similar in terms of sleep parameters and comorbidities in comparison with the other patients. CONCLUSIONS: No relationship was observed between uric acid level and OSAS severity, as defined by the apnoea-hypopnea index. Further studies are needed to determine the value of uric acid as a marker of OSAS, after controlling for cardiovascular comorbidities, in older patients with this syndrome.

Seizures in patients with respiratory disease - a retrospective single center study.

OBJECTIVE: Seizures are a neurological condition commonly experienced during the follow-up period after systemic or metabolic disorders. The aim of the present study was to determine the etiological factors of seizures in patients at a tertiary care chest clinic. METHODS: We reviewed all neurology consultations that were requested due to seizures in inpatient clinics in a tertiary care hospital specializing in respiratory disorders between January 2011 and January 2018 were retrospectively reviewed. RESULTS: The present study included 705 of 2793 (25.2%) patients who requested consultations for seizures during the study period. The mean age of the sample was 64.05±17.19 years. Of the 705 patients, 307 (43.5%) had a previous history of epilepsy (Group I) and 398 (56.5%) had a first-time seizure and were considered to have symptomatic seizures (Group II). Multiple factors played roles in the development of seizures in 54.8% of the patients. In most patients, metabolic causes, systemic infections, and drug use were identified and an intracranial metastatic mass lesion was the major cause in patients with lung cancer. Rates of hypoxemia and respiratory acidosis were significantly higher in patients with symptomatic seizures (Group II) than in patients with primary epilepsy (Group I). CONCLUSIONS: Blood gas changes such as hypoxemia and respiratory acidosis were among the factors statistically associated with the development of symptomatic seizures in patients with respiratory diseases. Additionally, hypoxemia, hypercapnia, and respiratory acidosis were correlated with mortality in patients hospitalized for respiratory system diseases who requested consultations for seizures.

A new electrocardiographic parameter associated with sudden cardiac death in pulmonary sarcoidosis.

INTRODUCTION: The interval from the peak to the end of the electrocardiographic T wave (Tp-Te) may correspond to malignant ventricular arrhythmias. In this study we aimed to assess Tp-Te variability and investigate the transmural dispersion of repolarisation in pulmonary sarcoidosis disease without proofed cardiac involvement. MATERIAL AND METHODS: This was a retrospective case-control study that included patients who had a pathologic and radiologic diagnosis of sarcoidosis. All data of the patients' demographic features and electrocardiographs were analysed. RESULTS: We enrolled 78 patients with sarcoidosis and 54 healthy volunteers as controls in our study. Men comprised 36% of the sarcoidosis group and 27% of controls. The mean age in the sarcoidosis and control group was 45.4 ±8.7 years (range: 23-58 years) and 44.6 ±11.9 years (range: 21-73 years), respectively. There was no significant difference between the groups for age or sex (p = 0.654, p = 0.246, respectively). There was a significant increase in Tp-Te results in all precordial leads in the sarcoidosis group compared with the control group (p < 0.05). CONCLUSIONS: Pulmonary sarcoidosis is suspected to have cardiac involvement; therefore, we need to develop new approaches. We present strong evidence that Tp-Te intervals were increased in patients with pulmonary sarcoidosis, which suggests that there may be a link between sarcoidosis and ventricular arrhythmias without proofed cardiac involvement.

Seizures in patients with respiratory disease - a retrospective single center study / Convulsões em pacientes com doença respiratória - estudo retrospectivo de centro único

ABSTRACT Objective: Seizures are a neurological condition commonly experienced during the follow-up period after systemic or metabolic disorders. The aim of the present study was to determine the etiological factors of seizures in patients at a tertiary care chest clinic. Methods: We reviewed all neurology consultations that were requested due to seizures in inpatient clinics in a tertiary care hospital specializing in respiratory disorders between January 2011 and January 2018 were retrospectively reviewed. Results: The present study included 705 of 2793 (25.2%) patients who requested consultations for seizures during the study period. The mean age of the sample was 64.05±17.19 years. Of the 705 patients, 307 (43.5%) had a previous history of epilepsy (Group I) and 398 (56.5%) had a first-time seizure and were considered to have symptomatic seizures (Group II). Multiple factors played roles in the development of seizures in 54.8% of the patients. In most patients, metabolic causes, systemic infections, and drug use were identified and an intracranial metastatic mass lesion was the major cause in patients with lung cancer. Rates of hypoxemia and respiratory acidosis were significantly higher in patients with symptomatic seizures (Group II) than in patients with primary epilepsy (Group I). Conclusions: Blood gas changes such as hypoxemia and respiratory acidosis were among the factors statistically associated with the development of symptomatic seizures in patients with respiratory diseases. Additionally, hypoxemia, hypercapnia, and respiratory acidosis were correlated with mortality in patients hospitalized for respiratory system diseases who requested consultations for seizures.

RESUMO Objetivo: Convulsões são uma condição neurológica comumente vivenciada durante o período de acompanhamento após distúrbios sistêmicos ou metabólicos. O objetivo do presente estudo foi determinar os fatores etiológicos das convulsões em pacientes de uma clínica torácica de atendimento terciário. Métodos: Foram revisadas retrospectivamente todas as consultas neurológicas solicitadas devido a convulsões em clínicas de internação em um hospital terciário especializado em distúrbios respiratórios entre janeiro de 2011 e janeiro de 2018. Resultados: O presente estudo incluiu 705 dos 2.793 (25,2%) pacientes que solicitaram consultas para convulsões durante o período do estudo. A idade média da amostra foi de 64,05±17,19 anos. Dos 705 pacientes, 307 (43,5%) tinham história prévia de epilepsia (Grupo I) e 398 (56,5%) tiveram uma convulsão inicial e foram considerados como tendo crises sintomáticas (Grupo II). Vários fatores desempenharam papel no desenvolvimento de convulsões em 54,8% dos pacientes. Na maioria dos pacientes, causas metabólicas, infecções sistêmicas e uso de drogas foram identificadas e uma lesão em massa metastática intracraniana foi a principal causa em pacientes com câncer de pulmão. As taxas de hipoxemia e acidose respiratória foram significativamente maiores em pacientes com crises sintomáticas (Grupo II) do que em pacientes com epilepsia primária (Grupo I). Conclusões: Alterações dos gases sanguíneos, como hipoxemia e acidose respiratória, foram alguns dos fatores estatisticamente associados ao desenvolvimento de convulsões sintomáticas em pacientes com doenças respiratórias. Além disso, hipoxemia, hipercapnia e acidose respiratória foram correlacionadas com a mortalidade em pacientes hospitalizados por doenças do sistema respiratório que solicitaram consultas para convulsões.

Response of Blood Parameters to CPAP Treatment in Patients with Obstructive Sleep Apnea.

INTRODUCTION: Many studies have evaluated the relationship between the NLR and PLR in patients with obstructive sleep apnea (OSA), and have shown that they are related to inflammation. We evaluated whether 3 months of continuous positive airway pressure (CPAP) treatment in patients with moderate to severe OSA without any comorbidities would affect the NLR and PLR values. METHODS: Full blood count parameters were evaluated before and after 3 months of CPAP treatment in patients with a diagnosis of moderate to severe OSA without any comorbidities. RESULTS: Twenty-nine patients (18 [62.1%] males) were enrolled. The mean body mass index (BMI) was 34.85±5.75 kg/m2, the apnea-hypopnea index score was 49.85±27.42, and CPAP was 9.34±1.77. No significant change in BMI was observed after the third month of treatment. Although the Epworth Sleepiness Scale (ESS) score decreased significantly (p=0.000), no changes were observed in the NLR, PLR, or C-reactive protein level (p>0.05). Mean platelet volume and red blood cell distribution width changed significantly after treatment (p=0.01; p<0.001). CONCLUSIONS: The NLR and PLR did not change after CPAP treatment in patients with moderate to severe OSA without any comorbidities.

Outcomes of low-dose valproic acid treatment in patients with juvenile myoclonic epilepsy.

PURPOSE: There are conflicting data regarding the drug dose that is sufficient to achieve seizure control as well as the parameters of seizure remission in juvenile myoclonic epilepsy (JME). The present study aimed to identify factors that contribute to seizure control in JME and to evaluate factors associated with JME remission and the efficacy of low-dose valproic acid (VPA) therapy. METHODS: This retrospective, cross-sectional study included a total of 215 patients (121 female and 94 male; mean age: 28.03 ±â€¯8.43 [14-59] years) diagnosed with JME. The patients were divided into remission and refractory groups. Remission was defined as a seizure-free (myoclonic, absence, and/or generalized tonic-clonic) period of at least 2 years. Patients in whom remission was achieved with VPA monotherapy were further divided into two groups according to the use of low-dose VPA therapy (VPA ≤ 750 mg/day and >750 mg/day). Potential contributing factors were evaluated in terms of the relationship between the dose and the remission parameters. RESULTS: Remission was achieved with VPA monotherapy in 116 patients (87.9%) in the remission group; the VPA dose was ≤750 mg in 77.6% of the patients. The dose of VPA was higher in patients with absence seizure who achieved remission (p = 0.026). Remission was achieved with a lower dose of VPA in females than in males (p = 0.004). CONCLUSIONS: Low-dose VPA can be used to achieve remission in JME. However, identification at follow-up visits of the factors that may affect remission may change the planned effective dose of VPA.

Association Between Titration Method and Outcomes of First Night Satisfaction and CPAP Compliance.

INTRODUCTION: The gold standard therapy for obstructive sleep apnoea syndrome (OSAS) is continuous positive airway pressure (CPAP). Our study evaluated the relationship between first night satisfaction and CPAP compliance, and the effect of using the titration method in this relationship. METHODS: Between January 2012 and December 2012, 40 patients with the diagnosis of OSAS and without comorbidities, who had undergone CPAP titration, were included. Of these, 20 patients had undergone manual titration (MT) with polysomnography, whereas 20 patients had undergone auto-adjusted CPAP (APAP) titration. Questionnaires were administered during the morning of the titration night. The first-year adherence to treatment and patient compliance were evaluated. RESULTS: Forty patients were randomised in two groups; 35 patients who could procure the CPAP and were available at the end of the first year completed the study. From the 35 patients, 20 (6 males; 40%) were in the MT group while 15 (6 males; 30%) were in the APAP group. No significant difference was detected between the mean titration pressure levels obtained with the MT or APAP group. There was no difference in terms of responses to the questions on the questionnaire between the two groups. At the first-year evaluation, no significant difference was detected between the groups. CONCLUSIONS: The titration method used to detect CPAP pressure, MT, or APAP does not affect patient satisfaction on the day following the titration night, and does not affect first-year compliance.

A Case Report of A Drop Foot Developed After Common Femoral Artery Cannulation for Venoarterial Extracorporeal Membrane Oxygenation.

The drop foot cases that are associated with developing neuropathies as a result of acute compartment syndrome or femoral artery ischemia after having cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO) have been reported rarely in literature. In this case report, female patients who are 21 years old and developed drop foot depending on ECMO during the process of lung transplantation will be presented as both to be one of the rare neurological complications connected to ECMO and its possible causes will be analyzed.

Effects of vibration on cutaneous silent period.

Suppression of an ongoing muscle contraction following noxious digital stimulation is called cutaneous silent period (CSP) which is under the influence of several physiological factors. In this study, we aimed to evaluate the influence of group Ia afferents on the cutaneous silent period (CSP) by applying 2-min vibration. CSP was obtained from abductor pollicis brevis muscle after stimulating index finger. The recordings were repeated three times-before, during and after vibration-which was applied over the tendon of flexor carpi radialis muscle. Onset latency, duration and magnitude of total CSP, inhibitory phases I1 and I2, and of the long-loop reflex were measured and compared. Suppression indices of CSP, I1 and I2 increased significantly during and after vibration, indicating significantly less exteroceptive EMG suppression outlasting the time of vibration. Vibration also caused mild shortening of I2 end latency (p = 0.048) and I2 duration (p = 0.019). Our findings indicate that vibration exerts a powerful influence on CSPs and causes reduction in the magnitude of exteroceptive EMG suppression during and after vibration. Although vibration is known to activate Ia afferents, we cannot exclude contribution of other afferents, e.g. mechanoreceptors, as well as pre- or postsynaptic inhibitory effects on ensuing interneurons, or enhanced vibration-related excitatory influence.