Evaluation of the Patients with the Diagnosis of Pontocerebellar Hypoplasia: A Multicenter National Study.

Pontocerebellar hypoplasia (PCH) is a heterogeneous group of neurodegenerative disorders characterized by hypoplasia and degeneration of the cerebellum and pons. We aimed to identify the clinical, laboratory, and imaging findings of the patients with diagnosed PCH with confirmed genetic analysis. We collected available clinical data, laboratory, and imaging findings in our retrospective multicenter national study of 64 patients with PCH in Turkey. The genetic analysis included the whole-exome sequencing (WES), targeted next-generation sequencing (NGS), or single gene analysis. Sixty-four patients with PCH were 28 female (43.8%) and 36 (56.3%) male. The patients revealed homozygous mutation in 89.1%, consanguinity in 79.7%, pregnancy at term in 85.2%, microcephaly in 91.3%, psychomotor retardation in 98.4%, abnormal neurological findings in 100%, seizure in 63.8%, normal biochemistry and metabolic investigations in 92.2%, and dysmorphic findings in 51.2%. The missense mutation was found to be the most common variant type in all patients with PCH. It was detected as CLP1 (n = 17) was the most common PCH related gene. The homozygous missense variant c.419G > A (p.Arg140His) was identified in all patients with CLP1. Moreover, all patients showed the same homozygous missense variant c.919G > T (p.A307S) in TSEN54 group (n = 6). In Turkey, CLP1 was identified as the most common causative gene with the identical variant c.419G > A; p.Arg140His. The current study supports that genotype data on PCH leads to phenotypic variability over a wide phenotypic spectrum.

Focality in childhood absence epilepsy.

BACKGROUND AND PURPOSE: Childhood absence epilepsy (CAE) has a typical electroencephalography (EEG) pattern of generalized 3 Hz spike and wave discharges (SWD). Focal interictal discharges were also documented in a small number of documents. The aim was to investigate the amplitudes of interictal 3 Hz SWD within the 1st second in drug-naïve CAE patients. In this way, areas with maximal electronegativity at the beginning of clinically generalized discharges will be documented. METHODS: The EEG records of children with drug-naïve CAE were evaluated retrospectively by two child neurologists first for 3 Hz SWD. Then, a machine-learning model evaluated the amplitudes of 3 Hz in the 1st second of SWD. Maximum electronegativity areas were documented and classified as focal, bilateral, and generalized. RESULTS: One hundred and twelve 3 Hz SWD were evaluated in 11 patients. Among discharges within the 1st second, maximum electronegativity areas were documented as focal for 44 (39.2%), bilateral for 8 (7.1%), generalized for 60 (53.5%). Among focal electronegativity areas, mostly right central, left occipital and midline parietal areas were documented in 12 (10.7%), 7 (6.2%), and 6 (5.3%), respectively. Eight (7.1%) of the maximum electronegativity areas were detected bilaterally, of which 7 (6.2%) originated from the frontopolar areas. CONCLUSIONS: Focal maximal electronegativity areas were frequently observed in drug-naïve CAE patients, comprising approximately half of non-generalized discharges. Focal discharges might be misleading in diagnosis. Focal areas within the brain may be responsible for and contribute to absence seizures that appear bilaterally symmetrical and generalized clinically. Although its clinical implication is unknown, this warrants further study.

Evaluation of retinal vascular and structural alterations in pediatric idiopathic intracranial hypertension patients without papilledema.

PURPOSE: The aim of this study was to evaluate retinal structural and microvascular alterations using optical coherence tomography-angiography (OCTA) in pediatric idiopathic intracranial hypertension (IIH) patients with regressed papilledema. METHODS: This study included 40 eyes of 21 IIH patients and 69 eyes of 36 healthy controls. Radial peripapillary capillary (RPC) vessel density and peripapillary retinal nerve fiber layer (RNFL) thickness were evaluated by XR Avanti AngioVue OCTA (Optovue, Fremont, CA, USA). The data were obtained from measurement zones that are automatically divided into two equal hemispheres (superior and inferior) and eight quadrants (superior-temporal, superior-nasal, inferior-temporal, inferior-nasal, nasal-superior, nasal-inferior, temporal-superior, temporal-inferior). Initial cerebrospinal fluid (CSF) pressure, grade of papilledema, and duration of follow-up were recorded. RESULTS: There were significant differences in RPC vessel densities and RNFL thicknesses between the study groups (p Ëƒ 0.05). Significantly higher RPC vessel density measurements were observed in the patient group for the whole image, peripapillary, inferior-hemi, and whole nasal quadrants (p < 0.05). Except for the temporal-superior, temporal-inferior, inferior-temporal, and superior-temporal quadrants, the RNFL in all regions was significantly thicker in the IIH group than in the control group (p Ë‚ 0.001). CONCLUSIONS: RNFL thickness and RPC vessel density were significantly different between the IIH patient and control groups, suggesting that retinal microvascular and subclinical structural changes that were potentially secondary to CSF pressure can persist after the resolution of papilledema. However, our results should be confirmed by further longitudinal studies investigating the progress of these alterations to determine their effects on peripapillary tissues.

A Delayed Presentation of Arginase Deficiency Presenting with Status Epilepticus.

Arginase 1(ARG1) deficiency is a rare disorder of the urea cycle. The presentation is usually late, leading to loss of intellectual milestones, spasticity and liver involvement. Hyperammonemic crises are rarely encountered. We herein present a case of a 16-year immigrant girl of Syrian origin who was evaluated for acute onset of fever, vomiting, and seizures. Laboratory analyses showed slightly elevated lactate, creatine kinase, and coagulation parameters. Ammonium levels were also moderately increased. On 5th day of admission, she went into an encephalopathic state. Blood amino acid analysis showed highly elevated arginine levels. An increased level of orotic acid was found in urine organic acid analysis. Molecular genetic analysis of ARG1 gene showed a novel homozygous mutation. Although the presentation of ARG1 deficiency is usually chronic in the majority of patients, an acute crisis of encephalopathy due to hyperammonemia may occur and delayed diagnosis may lead to irreversible neurological damage. Key Words: Urea cycle disorder, Hyperammonemia, Argininemia, Encephalopathy.

Quantitative OCT angiography of the retinal and choroidal vascular circulation in pediatric patients with neurofibromatosis type 1.

PURPOSE: To investigate retinal and choroidal microvascular changes in neurofibromatosis type 1 (NF1) pediatric patients using optical coherence tomography angiography (OCTA). METHODS: This study was performed on 21 eyes of 21 NF1 patients and 30 eyes of 30 healthy subjects. Foveal avascular zone (FAZ) parameters, including area, perimeter, acircularity index, and foveal density, were measured using OCTA. Superficial (SCP) and deep (DCP) capillary plexus and radial peripapillary capillary (RPC) vessel densities and choriocapillaris flow were also evaluated. Choroidal nodules and thickness were detected using infrared reflectance and enhanced-depth imaging OCT. RESULTS: No significant differences were observed for FAZ parameters or SCP and RPC vessel densities between groups. DCP vessel densities in the perifovea were significantly lower in the NF1 group than in the control group (P = 0.001). A significantly lower choriocapillaris flow area (P < 0.001) and increased subfoveal and nasal perifoveal choroidal thickness (P < 0.001) were observed in the NF1 group. Choriocapillaris flow area tended to be inversely related to the number of choroidal nodules in the NF1 group. CONCLUSIONS: Perifoveal DCP vessel density and choriocapillaris flow significantly differed between NF1 patients and controls, suggesting that retinal and choroidal vascular microcirculation is affected in the former, potentially by choroidal nodules. Further longitudinal studies are required to determine the effects of these differences on circulation in the posterior segment of the eye.

A Near-Global Slowing of Background Activity and Epileptic Discharges in Children With Mild to Moderately Symptomatic COVID-19 Infection: An Electro-Neurophysiological Study.

Background. To assess the functional involvement of the central nervous system (CNS) via quantitative electroencephalography (EEG) analysis in children with mild to moderate COVID-19 infection who were otherwise previously healthy children. Methods. This prospective, case-control study was conducted between June and September 2020. Sleep EEG records of at least 40 min were planned for children who tested positive for COVID-19 using real-time PCR analysis and within 4-6 months post-recovery. All of the EEG analyses in this study were performed on an Ubuntu 20.04.2 LTS Operating System with the developed software using Python 3.7.6. The quantitative analysis of the epileptic discharges within the EEG records was performed using random forest after elimination of the artifacts with a model training accuracy of 98% for each sample data point. The frequency analysis was performed using the Welch method. Results. Among the age and sex-matched groups, the global mean frequency was significantly lower among the COVID-19 patients, with a P-value of 0.004. The spike slow-wave and sharp slow-wave indices were significantly higher in the patients when compared to the controls. The mean frequency values were significantly lower in almost all of the electrodes recording the frontal, central, and occipital areas. For the temporal and parietal areas, those significantly low mean frequencies were limited to the right hemisphere. Conclusion. A near-global involvement of background activity with decreased frequency, in addition to epileptic discharges, was recorded in mild to moderately COVID-19 infected children post-infection.

Does aeroallergen sensitivity and allergic rhinitis in children cause milder COVID-19 infection?

Background: There are conflicting data with regard to the impact of respiratory and allergic comorbidities on the course of novel coronavirus disease 2019 (COVID-19) in children. Objective: This study aimed to investigate the relationship between allergic diseases and COVID-19 severity in pediatric patients. Methods: Seventy-five pediatric patients with COVID-19 were classified according to clinical severity and evaluated in the allergy/immunology and pulmonology departments 1 to 3 months after the infection resolved. Blood was collected from the patients for a complete blood cell count and assessment of immunoglobulin and total immunoglobulin E (IgE) levels, and skin-prick tests and spirometry tests were performed. Results: A total of 75 patients ages 5-18 years were evaluated. COVID-19 was asymptomatic/mild in 44 patients and moderate/severe/critical in 31 patients. Based on allergy evaluation, allergic rhinitis was diagnosed in 19 patients (25.3%), asthma in 10 patients (13%), and atopic dermatitis in 3 patients (4%). Aeroallergen sensitivity was detected in 26 patients (34.7%). COVID-19 infection was asymptomatic/mild in 15 patients with allergic rhinitis (78.9%) and in 21 with aeroallergen sensitivity (80.8%) (p = 0.038 and p = 0.005, respectively). There was no difference in severity between the patients with and without asthma (p = 0.550). The median (interquartile range) total IgE level was significantly higher in the asymptomatic/mild group (71.8 [30.7-211.2]) (p = 0.015). There were no differences in terms of spirometry parameters. Conclusion: Aeroallergen sensitization and allergic rhinitis in children may be associated with a milder course of COVID-19. The knowledge that atopy is associated with less-severe COVID-19 outcomes in children may guide clinical risk classification.

Midodrine treatment in children with recurrent vasovagal syncope.

BACKGROUND: Vasovagal syncope is the most common cause of syncope in childhood and its treatment is not at a satisfactory level yet. We aimed to investigate patients who were diagnosed with vasovagal syncope, did not benefit from conventional treatment, received midodrine treatment, and to evaluate their response to midodrine treatment. METHODS: Files of 24 patients who were diagnosed with recurrent vasovagal syncope, did not benefit from non-pharmacological treatments, and received midodrine treatment during June 2017-October 2019 were retrospectively analysed. RESULTS: In total, 24 patients received a treatment dose of midodrine at 5 mg/day (2.5 mg BID) included in the study. The mean number of syncope was 5.75 ± 2.67 prior to treatment. Following treatment, the mean number of syncope was 0.42 ± 0.89. It was observed that syncope episodes did not recur in 17 patients, but it recurred in 4 out of 7 patients in the first 3 months of the treatment and did not recur in the following months. The episodes improved in two patients with an increase in the treatment dose, but the syncope episodes continued in only one patient. CONCLUSION: It was concluded that midodrine treatment was effective and safe in adolescents with recurrent vasovagal syncope.

Diagnostic value of lung ultrasonography in children with COVID-19.

BACKGROUND: Lung ultrasound (LUS) has been successfully used in the diagnosis of different pulmonary diseases. Present study design to determine the diagnostic value of LUS in the evaluation of children with novel coronavirus disease 2019 (COVID-19). METHODS AND OBJECTIVES: Prospective multicenter study, 40 children with confirmed COVID-19 were included. LUS was performed to all patients at admission. The chest X-ray and computed tomography (CT) were performed according to the decision of the primary physicians. LUS results were compared with chest X-ray and CT findings and diagnostic performance was determined. RESULTS: Of the 40 children median (range) was 10.5 (0.4-17.8) years. Chest X-ray and LUS were performed on all and chest CT was performed on 28 (70%) patients at the time of diagnosis. Sixteen (40%) patients had no apparent chest CT abnormalities suggestive of COVID-19, whereas 12 (30%) had abnormalities. LUS confirmed the diagnosis of pulmonary involvement in 10 of 12 patients with positive CT findings. LUS demonstrated normal lung patterns among 15 of 16 patients who had normal CT features. The sensitivity and the area under the receiver operating characteristics (ROC) curve (area under the ROC curve) identified by the chest X-ray and LUS tests were compared and statistically significantly different (McNemar's test: p = .016 and p = .001 respectively) detected. Chest X-ray displayed false-negative results for pulmonary involvement in 75% whereas for LUS it was 16.7%. CONCLUSIONS: LUS might be a useful tool in the diagnostic steps of children with COVID-19. A reduction in chest CT assessments may be possible when LUS is used in the initial diagnostic steps for these children.

Clinical and demographic characteristics of children and adolescents with acute vertigo symptoms: A cross-sectional study

Background/aim: Vertigo is one of the rarely diagnosed disorders during childhood due to insufficient description of the children regarding their experiences to the physicians. The clinical features of children and adolescents admitted by acute vertigo symptoms were investigated to elaborate the subject retrospectively. Materials and methods: BetweenJanuary 2017­July 2019, records of cases admitted with acute vertigo complaints to pediatric neurology were retrospectively examined. Results: Of 761 patients, mean age was 13.8 years, 64% (n = 487) were women, 22.6% (n = 172) of which were children (1­11 years). A total of 37.3% of the cases (n = 284) had unknown etiology of acute vertigo symptoms, 39.6% (n = 301) had acute vertigo, and 23.1% (n = 176) were considered with no organicity problems but a group of the families stopped cooperating to the full extent in the study. Among all the patients, 25.6% (195/761) had paroxymal vertigo, 6.8% (52/761) had migraine-associated vertigo, 4.5% (34/761) had psychogenic vertigo, and 2.6% (20/761) had epileptic vertigo. Epileptic vertigo was significantly higher in younger children (mean age = 10.6, F(3) = 8874, P < .001), and the ratio of its occurence was also higher among children (60%, χ2 (3) = 20.347, P < .001). Conclusion: Vertigo complaints are 1.7 times more common among the girls. Epileptic vertigo is significantly higher among the children. Among younger children, it seems important to consider epilepsy when vertigo emerged.

The Association of Autoimmune Diseases with Type 1 Diabetes Mellitus in Children Depends Also by the Length of Partial Clinical Remission Phase (Honeymoon).

Type 1 diabetes mellitus (DM) is characterized by irreversible, autoimmune, pancreatic ß-cell destruction. During the disease, some patients experience a phase of Partial Clinical Remission (PCR) known as "honeymoon." This is a transitory period that is characterized by insulin production by residual ß cells following DM diagnosis and initiating the insulin therapy. In this study, we aimed to evaluate the influence of insulin production on immune system after the onset of diabetes, and we showed that the duration of honeymoon period could be related to the onset of other autoimmune conditions. For this retrospective study, 159 children aged between 11 and 18 years with type 1 DM were eligible. They have been diagnosed diabetes at least 10 years ago and use exogenous insulin. Our results showed that younger age at the onset of Type 1 DM in children, predicts Celiac Disease. Female sex and low HCO3 levels at the onset of DM had a high predictive value on patients who did not experience longer Partial Clinical Remission phase. Patients with higher BMI at the diagnosis of DM experienced shorter honeymoon period than the average. Smaller of our patients who diagnosed just DM have more than 297 days honeymoon period with respect to patients with one associated autoimmune disease. This may be due to a continuous and prolonged stimulation of immune system during the period of honeymoon that predispose the patient to develop other TH1 diseases. The patients who experienced more than 297 days Partial Clinical Remission seem under risk of developing one other autoimmune disease more than the patients who experienced less than 297 days Partial Clinical Remission. We have to consider that this observation is very intriguing because many protocols spring-up to try prolonging the honeymoon period in patients with autoimmune DM. If this aim is important from a metabolic point of view, long follow-ups are needed to be sure that the risk of other autoimmune diseases does not increase.

Seizures in children with epilepsy and attention-deficit/hyperactivity disorder.

BACKGROUND: Epilepsy is an important disorder that is sometimes accompanied by inattention problems. This study explored the features of seizures in children with epilepsy, with or without attention-deficit/hyperactivity disorder (ADHD). METHODS: Between January 2017 and January 2018, data records of children with epilepsy aged 5-18 years admitted to hospital were retrospectively collected. SPSS 17.0 was used for analyses and P < 0.05 was accepted as significant. RESULTS: Of 301 patients with epilepsy, 32 of them had ADHD. Median age at diagnosis of epilepsy in the epilepsy + ADHD group was lower than in the epilepsy alone group (6 vs 8 years; z = -2.989, P = 0.003). The two groups were similar in terms of duration of epilepsy, seizure types and features of complicated versus non-complicated epilepsy, number of anti-epileptic drugs (AED) used (for all, P > 0.05). The epilepsy + ADHD group had a significantly higher prevalence of intellectual disability (31.3% vs 12.6%; χ2 (1) = 7.9, P = 0.014) and specific learning disorder (12.5% vs 1.9%; χ2 (1) = 11.1, P = 0.009) than the epilepsy alone group (χ2 (1) = 11.1, P = 0.009). ADHD medication use was identified in 68.8% of children in the epilepsy + ADHD group. CONCLUSION: Attention-deficit-hyperactivity disorder was identified in 11.8% of 5-18-year-old children (32/301) with epilepsy in a 1 year period. ADHD is more frequent in children with epilepsy in childhood (5-11 years of age). Epilepsy diagnosis is more frequent in younger children with ADHD. Children with epilepsy and ADHD, also have a significantly higher prevalence of intellectual disability and specific learning disorder. Younger children diagnosed with epilepsy should be carefully monitored for ADHD.

Male Nursing Students' Social Appearance Anxiety and Their Coping Attitudes.

This study aimed at examining social appearance anxiety levels of male nursing students and their coping attitudes and identifying the relationship between them. A cross-sectional research approach was adopted in a study population of 180; the sample comprised 129 students. Data were collected using a socio-demographic information form, the Social Appearance Anxiety Scale (SAAS), and the Assessment of Coping Attitudes Inventory (COPE). The average age of students was 20.54 ± 1.49 years. The male students' average score obtained from the SAAS measure was 32.64 ± 13.07, while that of the COPE Inventory was 138.11 ± 14.47. Significant correlations were detected between students' SAAS scores and COPE scale scores. There were negative relationships between social anxiety scores and COPE subscales of positive reinterpretation and growth ( p < .05), use of instrumental social support ( p < .05), active coping ( p ≤ .01), and planning ( p ≤ .01). In contrast, there were positive relationships between social anxiety scores and COPE subscales of mental disengagement ( p ≤ .01), denial ( p ≤ .01), behavioral disengagement ( p ≤ .01), restraint ( p ≤ .01), use of emotional social support ( p < .05), substance use ( p ≤ .01), and acceptance ( p < .05). The conclusion was that male students who do not perceive themselves as having an ideal body image face high social appearance anxiety. There is a prejudice that social appearance anxiety has negative effects on these students' self-confidence. In this context, this research revealed concrete results about how male nursing students have battled the prejudices that they have faced throughout their student life.

Pictures portrayed by children with migraine with aura: a Turkish case series.

BACKGROUND: Migraine is one of the most debilitating disorders with its chronic nature seen in childhood characterized by episodic bilateral or unilateral throbbing pain on the head that strikes at any time. It is divided into two categories as with or without aura and is diagnosed according to the 2013 International Headache Society criteria. AIM AND METHOD: This study aims to present the pictures depicted by adolescents aged 14-18 who were diagnosed with migraine with visual aura by Ankara Training and Research Hospital Child Neurology Department. RESULTS: They were told to draw their visual auras as a picture that they depict or as a draft via changing another picture. In this article, five adolescents with migraine and their pictures related to their visual aura were presented. CONCLUSION: The diagnosis of migraine with visual aura in patients under 18 years of age would be supported by picturing of their visual images. Thus, pediatric patients could better express themselves and the clinician would better manage the process both in diagnosis and follow-up of the migraine with aura.

Retrospective analysis of children with myelin oligodendrocyte glycoprotein antibody-related disorders.

BACKGROUND: Knowledge has been expanding on myelin oligodendrocyte glycoprotein (MOG) antibody-associated central nervous system disorders. We delineate the clinical and paraclinical findings and outcome of our pediatric patients with MOG antibody seropositive disease. METHODS: We retrospectively analyzed the clinical presentation, cerebrospinal fluid findings, magnetic resonance imaging (MRI) studies, course and outcome of children seropositive for anti-MOG IgG. RESULTS: Total 20 children with neurological symptoms and serum anti-MOG IgG were identified from six centers in Turkey. Median age at onset was 9 years (mean 8.8 ±â€¯5.0 years, range: 1.5-16.5 years). Final diagnoses were acute disseminated encephalomyelitis (ADEM) (n = 5), ADEM + optic neuritis (n = 4), neuromyelitis optica spectrum disorder (NMOSD) (n = 3), myelitis (n = 2), relapsing optic neuritis (n = 2), multiphasic DEM (n = 3), and unclassified relapsing demyelinating disease (n = 1). Seven/20 (35%) children experienced a single episode while 13/20 (65%) had a least one relapse during follow-up. On MRI, subcortical white matter, brainstem, and corpus callosum were preferentially involved regions. Full recovery was observed in 15/20 (75%) children. CONCLUSION: MOG autoimmunity in children has a wide clinical spectrum, tendency to relapse, and a favourable outcome compared with other relapsing demyelinating diseases.

Phagophobia Successfully Treated With Low-Dose Aripiprazole in an Adolescent: A Case Report.

Phagophobia is a condition characterized by an avoidance of swallowing foods and an intense fear of choking while eating solid foods in the absence of physiological and anatomical abnormalities. Phagophobia is mentioned in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Classification of Diseases, 11th Edition in the new diagnostic category of avoidant/restrictive food intake disorder. The literature concerning phagophobia is sparse, and there is no specific treatment modality for this life-threatening condition. We describe a case of phagophobia in a 15-year-old girl who was treated successfully with low-dose aripiprazole as an augmentation therapy after she witnessed her father choking while eating chicken. To our knowledge, this is the first report showing that phagophobia was successfully treated with aripiprazole.

Self-efficacy, depression and self-care activities of people with type 2 diabetes in Turkey.

Background: Self-efficacy related to self-care behaviors in people with type 2 diabetes has been well reported. However no work has been reported in Turkey that uses reliable instruments to examine the relationships among self-care activities, depression and self-efficacy. Aim: This study aims to investigate self-care activities, depression and self-efficacy among people with type 2 diabetes in Turkey. Methods: The sample included 200 patients with type 2 diabetes from an endocrinology outpatient clinic at a university hospital. Self-care activities, self-efficacy, and symptoms of depression were measured using established instruments: The Summary for Diabetes Self-Care Activities, the Self-Efficacy Scale, and the Beck Depression Inventory. Descriptive and correlational statistics were used in data analysis. Findings: One in three (37.5%) of participants had depression symptoms. Beck Depression Inventory scores were higher in women and in those with a lower education level, had diabetic complications and difficulty in meeting health care costs. The mean self-efficacy score was 66.5 ±â€…14.0; those who lived alone, were unemployed and knew their HbA1c level had significantly higher scores (p < .05). Demographic and diabetes characteristics including age, education, social support, diabetes complications, HbA1c level, and having diabetes education were found to be significantly associated with all self-care activities except smoking. Conclusion: The association between self-efficacy and self-care activities was positive. Interventions to improve patients' self-efficacy and self-care are needed in order to maximize diabetes self-management.

Evaluation of the neuropathic pain in the smokers.

OBJECTIVES: Nicotine addiction is one of the most important causes of the general failure of treatment and keeping the habit of smoking. Peripheral neuropathy is a leading factor of smoking. This study aimed to analyze the association of neuropathic pain and addiction levels of individuals. METHODS: The study was performed on the day on which the smokers visited the hospital for any reason. The Douleur Neuropathique 4 (DN-4) Scale and Fagerström Addiction Survey were administered to the individuals after obtaining their consent. RESULTS: In total, 444 individuals were included in the study, and 57.2% of them were males (n = 254). The age average of the individuals with neuropathic pain (46.4±12.3 years) was significantly higher than that of those without pain. The individuals with pain smoked approximately 31.8±18.3 packet/year cigarettes, whereas those without pain smoked approximately 22.4 ± 15.5 packet/year cigarettes; the difference was significant statistically (p<0.05). According to multivariate logistic regression analysis with the backward elimination method, the existence of pain was found to be PR = 2.22 (95% GA, 1.26-3.91) in terms of sex, DM existence was found to be PR = 1.97 (95% GA, 1.02-3.81), and for each standard deviation increase (2.7) in Fagerström scale, PR was 1.29 (95% GA, 1.14-1.46). CONCLUSION: Smoking is a risk factor for neuropathic pain. In our study, the possibility of neuropathic pain increases as the duration of smoking and addiction level increase, and with diabetes, this rate increases even more. It is extremely important that the smokers should be informed regarding these facts and possibilities.

Development and Implementation of the Clinical Decision Support System for Patients With Cancer and Nurses' Experiences Regarding the System.

PURPOSE: The purpose of this study was to develop and implement the clinical decision support system (CDSS) for oncology nurses in the care of patients with cancer and to explore the nurses' experiences about the system. METHODS: The study was conducted using a mixed-methods research design with 14 nurses working at a gynecological oncology clinic at a university hospital in Turkey. FINDINGS: The nurses stated that they did not experience any problems during the implementation of the CDSS, and its usage facilitated the assessment of patients' needs and care management. CONCLUSIONS: The results indicated that the CDSS supported the nurses' decision-making process about patients' needs and preparation of individual care plans. PRACTICE IMPLICATIONS: The CDSS should be developed and implemented by the nurses working with patients with cancer. AMAÇ: Amaç kanser hastalarinin bakimina yönelik klinik karar destek sistemi olusturmak, uygulamak (KKDS) ve sistemi kullanan hemsirelerin deneyimlerini incelemektir. YÖNTEM: Çalisma kalitatif ve kantitatif arastirma yöntemleri kullanilarak Türkiyede'ki bir üniversite hastanesinin jinekolojik onkoloji servisinde çalisan 14 hemsire ile yürütülmüstür. BULGULAR: Hemsireler KKDS'ni kullanirken herhangi bir sorun yasamadiklarini ve sistemin hasta gereksinimlerini degerlendirmeyi ve bakim yönetimini kolaylastirdigini belirtmislerdir. SONUÇ: Bulgular hastanin gereksinimlerine karar verme sürecinde ve bireysel bakim planlari hazirlamada KKDS'nin hemsireleri destekledigini göstermektedir. HEMSIRELIK UYGULAMALARI IÇIN ÖNERILER: Kanserli hastalarin bakimina yönelik KKDS gelistirilebilir ve hemsireler tarafindan klinikte kullanilabilir.

Late Presentation of Ataxia, Areflexia, and Electrophysiological Abnormalities as Part of Miller Fisher Syndrome: Case Report.

Miller Fisher syndrome (MFS) is characterised by the triad of ophthalmoplegia, ataxia, and areflexia. A case with external ophthalmoplegia and absence of ataxia and areflexia until the end of second week is presented. Electrophysiological findings became apparent after the third week and showed reduced amplitudes of sensory nerve action potentials and prolonged latencies of F with no evidence of conduction blocks. There was no response to intravenous immunoglobulin, but there was response to corticosteroids. This case may represent an atypical MFS with late presenting electrophysiological abnormalities. Corticosteroids can be a therapeutic option when intravenous immunoglobulin fails to control clinical symptoms.