Assessment of Cerebral Autoregulation Using Invasive and Noninvasive Methods of Intracranial Pressure Monitoring.

BACKGROUND: Pulse amplitude index (PAx), a descriptor of cerebrovascular reactivity, correlates the changes of the pulse amplitude of the intracranial pressure (ICP) waveform (AMP) with changes in mean arterial pressure (MAP). AMP relies on cerebrovascular compliance, which is modulated by the state of the cerebrovascular reactivity. PAx can aid in prognostication after acute brain injuries as a tool for the assessment of cerebral autoregulation and could potentially tailor individual management; however, invasive measurements are required for its calculation. Our aim was to evaluate the relationship between noninvasive PAx (nPAx) derived from a novel noninvasive device for ICP monitoring and PAx derived from gold standard invasive methods. METHODS: We retrospectively analyzed invasive ICP (external ventricular drain) and non-invasive ICP (nICP), via mechanical extensometer (Brain4Care Corp.). Invasive and non-invasive ICP waveform morphology data was collected in adult patients with brain injury with arterial blood pressure monitoring. The time series from all signals were first treated to remove movement artifacts. PAx and nPAx were calculated as the moving correlation coefficients of 10-s averages of AMP or non-invasive AMP (nAMP) and MAP. AMP/nAMP was determined by calculating the fundamental frequency amplitude of the ICP/nICP signal over a 10-s window, updated every 10-s. We then evaluated the relationship between invasive PAx and noninvasive nPAx using the methods of repeated-measures analysis to generate an estimate of the correlation coefficient and its 95% confidence interval (CI). The agreement between the two methods was assessed using the Bland-Altman test. RESULTS: Twenty-four patients were identified. The median age was 53.5 years (interquartile range 40-70), and intracranial hemorrhage (84%) was the most common etiology. Twenty-one (87.5%) patients underwent mechanical ventilation, and 60% were sedated with a median Glasgow Coma Scale score of 8 (7-15). Mean PAx was 0.0296 ± 0.331, and nPAx was 0.0171 ± 0.332. The correlation between PAx and nPAx was strong (R = 0.70, p < 0.0005, 95% CI 0.687-0.717). Bland-Altman analysis showed excellent agreement, with a bias of - 0.018 (95% CI - 0.026 to - 0.01) and a localized regression trend line that did not deviate from 0. CONCLUSIONS: PAx can be calculated by conventional and noninvasive ICP monitoring in a statistically significant evaluation with strong agreement. Further study of the applications of this clinical tool is warranted, with the goal of early therapeutic intervention to improve neurologic outcomes following acute brain injuries.

Aggressive squamous cell carcinoma of the renal pelvis.

Squamous cell carcinoma (SCC) of the renal pelvis is a particularly rare tumor that accounts for a minor portion of renal malignancies and is aggressive with an unfavorable prognosis. It is usually diagnosed after surgery and at advanced stages as it does not possess specific clinical and radiological properties. The pathological examination of a 38-year-old female patient who had undergone nephrectomy due to a nonfunctioning right kidney caused by long-standing staghorn calculus revealed moderately differentiated renal pelvis SCC invading the renal parenchyma. The patient who experienced severe lumbar pain in the second postoperative month presented lymphadenopathy, which could not be detected with ultrasonography but was diagnosed with 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG PET/CT). The patient received systemic treatment following the early diagnosis and survived past the average survival time. It was concluded that in cases where SCC was diagnosed after nephrectomy, investigating metastasis with 18FDG PET/CT and initiating early systemic treatment in the presence of metastasis could contribute to survival.

Primary molar pulpotomies with different hemorrhage control agents and base materials: A randomized clinical trial.

OBJECTIVE: To evaluate the clinical and radiographical success of primary molar pulpotomies which used 15.5% ferric sulfate (FS) or 1.25% sodium hypochlorite (NaOCl) for hemostasis and zinc oxide-eugenol (ZOE) and calcium hydroxide (CH) pastes as base materials. METHODS: In 29 healthy children, 80 primary molars were randomly allocated to one of the study groups: Group 1: FS-ZOE, Group 2: FS-CH, Group 3: NaOCl-ZOE, and Group 4: NaOCl-CH. After hemostasis with the respective solutions, pulp stumps and floor of the pulp chambers were covered with either ZOE or CH pastes. All teeth were restored with stainless steel crowns. Follow-up examinations were carried out at 1, 3, 6, and 12 months. RESULTS: One tooth in Group 1 and two teeth in Group 4 were extracted because of pain and periapial pathosis at sixth month. After 12 months, clinical success rates of pulpotomies in Groups 1-4 were 95%, 100%, 100%, and 89.5%, respectively. The differences were not significant (P = 0.548). Radiographic success rates for Groups 1-4 were 80%, 88.9%, 78.9%, and 84.2%, respectively. No statistically significant difference was found (P = 0.968). Pain on percussion was the most observed clinical finding. However, internal root resorption was the most common radiological finding and it was observed significantly more in mandibular primary molars (P < 0.05). CONCLUSION: Both ZOE and CH can be preferred as base materials after hemostasis achieved by the use of 15.5% FS or 1.25% NaOCl in primary tooth pulpotomy.

The burden and epidemiology of community-acquired central nervous system infections: a multinational study.

Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.

eNOS and XRCC4 VNTR variants contribute to formation of nicotine dependence and/or schizophrenia.

BACKGROUND: This study aimed to evaluate whether VNTR variants in the Endothelial Nitric Oxide Synthase (eNOS) and the XRCC4 gene play any role in nicotine dependence (ND) and/or Schizophrenia+ND (Sch+ND) ethiopathogenesis. METHODS: Present study included 100 individuals with ND, 60 patients with Sch+ND, and 70 healthy controls. These variants were analyzed using PCR. RESULTS: The cases with ND had higher eNOS VNTR-BB genotype than the healthy control subjects (p = 0.001). eNOS-AA genotype was lower in cases with Sch+ND and ND groups compared to the controls (p = 0.001, p = 0.001, respectively). eNOS-B allele was found significantly more frequently in Sch+ND group compared to the controls (p = 0.001). eNOS-A allele was significantly lower in ND group than the controls (p = 0.001). XRCC4-ID genotype was more common in the ND group than the control group (p = 0.001) as heterozygosity disadvantage. XRCC4-DD genotype was more common in the Sch+ND group compared to the controls (p = 0.035). The frequency of XRCC4-I allele was lower in the Sch+ND group compared to the controls (p = 0.012). CONCLUSIONS: Our results showed that eNOS and XRCC4 VNTR variants might play a potential role in Sch+ND and/or ND pathophysiology (Tab. 2, Ref. 48).

Estimating causal effects for multivalued treatments: a comparison of approaches.

Interventions with multivalued treatments are common in medical and health research, such as when comparing the efficacy of competing drugs or interventions, or comparing between various doses of a particular drug. In recent years, there has been a growing interest in the development of multivalued treatment effect estimators using observational data. In this paper, we compare the performance of commonly used regression-based methods that estimate multivalued treatment effects based on the unconfoundedness assumption. These estimation methods fall into three general categories: (i) estimators based on a model for the outcome variable using conventional regression adjustment; (ii) weighted estimators based on a model for the treatment assignment; and (iii) 'doubly-robust' estimators that model both the treatment assignment and outcome variable within the same framework. We assess the performance of these models using Monte Carlo simulation and demonstrate their application with empirical data. Our results show that (i) when models estimating both the treatment and outcome are correctly specified, all adjustment methods provide similar unbiased estimates; (ii) when the outcome model is misspecified, regression adjustment performs poorly, while all the weighting methods provide unbiased estimates; (iii) when the treatment model is misspecified, methods based solely on modeling the treatment perform poorly, while regression adjustment and the doubly robust models provide unbiased estimates; and (iv) when both the treatment and outcome models are misspecified, all methods perform poorly. Given that researchers will rarely know which of the two models is misspecified, our results support the use of doubly robust estimation.

N terminal-pro brain natriuretic peptide in fetal umbilical cord meconium-stained amniotic fluid: a prospective case control study.

PURPOSE OF INVESTIGATION: To evaluate the value of N terminal-pro brain natriuretic peptide (NTpBNP) levels in fetuses with meconiumtained amniotic fluid (MSAF). MATERIALS AND METHODS: In this case control study, of 36 fetuses, 19 had MSAF and 17 had normal, as controls. The blood samples were taken from the fetal umbilical cord just after birth to measure NTpBNP levels. RESULTS: Mean NTpBNP values were 1.01 ± 0.49 ng/ml in the patient group and 1.70 ± 0.93 ng/ml in the control group. The difference between the groups was statistically significant (p = 0.01) and power was 78% at 95% confidence interval. CONCLUSION: Serum NTpBNP levels were decreased in the study group. The result suggests that NTpBNP may be a valuable marker for fetuses with MSAF.

Clinical performance of aesthetic restorative materials in primary teeth according to the FDI criteria.

AIM: The purpose of this study is to evaluate the clinical performance of three different restorative materials in primary teeth according to the FDI criteria. MATERIALS AND METHODS: Resin-modified glass ionomer cement, compomer and composite resin restorations (n=93) were made in 31 patients. The restorations were clinically evaluated at baseline, 6th, 12th and 18th month with the FDI criteria. RESULTS: The cumulative survival rate after 18 months was found to be 90.3% for resin modified glass ionomer cement restorations, 100% for compomer restorations and 80.6% for composite resin restorations. Statistically significant increase in surface roughness, colour mismatch, anatomic form loss and marginal deterioration were detected in resin- modified glass ionomer group (p<0.05). The most frequent reason for restoration failure in composite resin group was restoration fractures. CONCLUSIONS: The resin-modified glass ionomer restorations necessitates close follow-up because of the risk of increase in surface roughness, changes in colour and loss in anatomic form and marginal adaptation. The clinical performance of compomer restorations is superior to resin-modified glass ionomer and composite resin restorations in primary teeth.

A RETT SYNDROME CASE WITH NOVEL NON-IDENTICAL MUTATION IN MECP2 GENE.

The Rett syndrome (RTT; OMIM #312750) is a rare genetic disease observed predominantly among girls that affects neurological development. The incidence of this disorder is approximately 1 in 10,000 female births. Diagnosis of the RTT is based on specific clinical criteria and the identification of a mutation in the methyl-CpG-binding protein (MECP), which mainly occurs on exons 3 and 4 of the gene. Mutations in the X-linked methyl-CpG binding protein 2 gene (MECP2) are observed in nearly 95% of RTT cases. RTT is associated with considerable genotypic and phenotypic heterogeneity. Recently, it has been observed that mutations in the genes Netrin G1 and cyclin-dependent kinase like 5 (CDKL5) also lead to clinical pictures resembling RTT. In this case report, we describe a 4-years-old female patient who met all the relevant criteria for the diagnosis of RTT. Sequence analyses performed on the patient identified a de novo, heterozygous c.489G>A mutation at exon 4 of the MECP2 gene.

Thrombin activatable fibrinolysis inhibitor : its role in slow coronary flow.

BACKGROUND: The slow coronary flow (SCF) phenomenon is characterized by slow progression of angiographic contrast medium in the coronary arteries in the absence of stenosis in the epicardial vessels. The pathophysiological mechanisms of SCF phenomenon remain uncertain. Several hypotheses, however, have been suggested for SCF phenomenon, including an early form of atherosclerosis, small vessel dysfunction, dilatation of coronary vessels, imbalance between vasoconstrictor and vasodilatory factors, platelet function disorder, and inflammation. Atherosclerosis and inflammation are the most accepted mechanisms for the pathogenesis of SCF. Thrombin activatable fibrinolysis inhibitor (TAFI) was described as a new inhibitor of fibrinolysis recently and plays an important role in coagulation and fibrinolysis. In previous studies, the role of TAFI was associated with inflammation and evolution of atherosclerosis in coronary artery disease. There are no data available about TAFI levels in patients with SCF phenomenon investigated by angiography. Our goal was to evaluate TAFI antigen (Ag) levels in patients with SCF and to determine the association of the TAFI Ag level with traditional cardiovascular risk factors in our study. METHODS: The study group constituted 41 patients with angiographically confirmed SCF and 46 patients with normal coronary flow as the control group. The TAFI Ag levels of each patient were determined. RESULTS: Between the control and study group, a statistical difference in the levels of TAFI Ag (p < 0.05) was observed. The TAFI Ag level was significantly higher in the SCF group than the control group (132.21 ± 21.14 versus 122.15 ± 21.59). CONCLUSION: We have demonstrated that TAFI might be a risk factor for the development of SCF independently of conventional cardiovascular risk factors. In addition, TAFI Ag levels were positively correlated with C-reactive protein (CRP) known as an acute phase reactant. Our findings support the reports of previous studies that increased TAFI levels may be associated with inflammation. Further large studies are required to evaluate the importance of TAFI antigen levels in relation to the development of SCF.

Evaluation of a stress model induced by dietary corticosterone supplementation in broiler breeders: effects on egg yolk corticosterone concentration and biochemical blood parameters.

1. This study aimed to evaluate a stress model induced by corticosterone (CORT) supplementation in the diet of broiler breeder hens. 2. A total of 60 Ross broiler breeder hens at 29 weeks of age were randomly divided into 4 groups with 15 hens each. The first group served as the control. The rest of the hens were given 1, 1.5 or 2 mg of CORT/hen/d (CORT1, CORT1.5 and CORT2, respectively) for 7 d. Concentrations of yolk CORT, plasma uric acid, glucose, cholesterol, creatine kinase, heterophil (H):lymphocyte (L) ratio and duration of tonic immobility (TI) were measured at d 3, 5 and 7 of CORT supplementation. The same measurements were repeated at 3, 5 and 7 d after CORT was withdrawn from the diet. 3. There were no significant CORT dose effect on yolk CORT and plasma glucose concentrations. Higher plasma uric acid and H:L ratio was obtained for CORT1.5 and CORT2 than for CORT1. From 3 to 7 d of dietary CORT supplementation, yolk CORT and plasma uric acid concentrations and H:L ratio increased whereas plasma glucose concentration decreased. After CORT was withdrawn from the diet, the H:L ratio remained elevated. The duration of TI and plasma creatine kinase concentration did not change during and after CORT supplementation. 4. Yolk CORT concentration was correlated with plasma uric acid concentration during CORT supplementation. 5. The results suggest that dietary CORT supplementation could be used as a stress model and to evaluate hormone-mediated maternal effects in broiler breeder hens.

Photoperiodic lighting (16 hours of light:8 hours of dark) programs during incubation: 1. Effects on growth and circadian physiological traits of embryos and early stress response of broiler chickens.

This study was conducted to evaluate the effect of a 16L:8D photoperiod during incubation, either during the whole incubation period (Inc(0-21d)) or the last week of incubation (Inc(14-21d)), on embryo growth, incubation performance, and light:dark rhythm of plasma melatonin and corticosterone in relation to early stress responses of newly hatched chicks to the posthatching environment. A dark incubation condition (Inc(Dark)) served as control. Three batches of eggs (n = 1,080, 1,320, 720) from Ross 308 broiler breeders were used in the experiment. Embryos from Inc(0-21d) presented a daily rhythm of melatonin at internal pipping and hatching, but Inc(Dark) embryos did not. The Inc(14-21d) group had rhythmic plasma melatonin at hatching only. A L:D rhythm of corticosterone was apparent at hatching. A significant incubation × sampling time interaction suggested that a lower increment in blood corticosterone level in Inc(0-21d) at 8 h posthatching (light period), as compared with hatching (dark period) values, might be associated with probable changes in the hypothalamic-pituitary-adrenal axis in Inc(0-21d) through incubation lighting. This finding may also suggest improved adaptation to the posthatching environment. Incubation lighting did not consistently affect brain malondialdehyde concentration; the only difference between groups was higher concentrations at hatching in Inc(14-21d), whereas incubation groups at the internal pipping stage had similar values. Mean relative asymmetry (RA) did not differ with incubation lighting. The malondialdehyde and RA results indicate that neither lighting nor darkness during the overall incubation exacerbated embryo oxidative and developmental stress. An increased breast muscle weight was observed at hatching only in Inc(14-21d). The Inc(0-21d) group had increased embryo weights relative to egg weight and decreased residual yolk but had no effect on chick weight, relative heart and liver (% of embryo weight), hatchability, embryo mortality, incubation time, oxidative stress, or mean RA. In conclusion, these results provide further evidence that photoperiodic lighting during incubation (Inc(0-21d)) may improve adaptation of chicks to a novel environment at hatching, possibly giving birds a better start for early posthatching development.

Photoperiodic lighting (16 hours of light:8 hours of dark) programs during incubation: 2. Effects on early posthatching growth, blood physiology, and production performance in broiler chickens in relation to posthatching lighting programs.

Photoperiodic incubation lighting might improve bird adaptation to a novel environment at hatching for a better start in early posthatching development. We evaluated the effect of 16L:8D lighting for either the whole incubation period (Inc(0-21d)) or the last week of incubation (Inc(14-21d)) on early posthatching growth, blood melatonin, and corticosterone at 6 d as well as malondialdehyde levels in brain tissue, relative asymmetry, and overall broiler performance as an interaction with the posthatching lighting programs. Dark incubation conditions (Inc(Dark)) served as control. There were 3 incubation batches in the experiment. Chicks from 2 of 3 batches were reared either at 16L:8D or under continuous lighting (24 h) through 6 d posthatching. Batch 3 chicks were reared to 35 d under either 16L:8D or 23L:1D. The main finding was a significant incubation × posthatching lighting interaction for 35-d BW in broilers. Although groups had similar BW under continuous lighting, Inc(0-21d) and Inc(14-21d) broilers were respectively 94 and 78 g heavier than Inc(Dark) birds under 16L:8D at 35 d. Lighted incubation groups increased 0 to 6 d of gain and had higher d-6 breast muscle weights with no effect on other traits measured. Posthatching 16L:8D reduced the gain and d-6 breast muscle. Significant incubation × posthatching lighting and posthatching lighting × sampling time interactions for blood melatonin may indicate that Inc(0-21d) affects melatonin diurnal rhythms even at 6 d under continuous light. Lower blood corticosterone levels on d 6 in Inc(0-21d) chicks reared under 16L:8D posthatching may support our hypothesis that incubation lighting can modify the bird stress response, probably affecting the hypothalamic-pituitary-adrenal axis during ontogeny, and may improve adaptation to a similar environment posthatching. The lower malondialdehyde concentration in brain tissue of Inc(0-21d) birds on d 6 may indicate lower lipid peroxidation and thus lower oxidative stress compared with Inc(Dark). These results provide further evidence that Inc(0-21d) may improve both bird adaptation to a similar photoperiodic environment and growth, probably through early entrainment of circadian physiology.

Validity, reliability and test-retest study of Grip strength measurement in two positions with two dynamometers: Jamar® Plus and K-Force® Grip.

Our objective was to compare grip strength measurement in two body positions (sitting and standing) with the K-Force® Grip dynamometer and the Jamar® Plus Digital hand dynamometer, and to conduct a test-retest study of the K-Force Grip device. The study was conducted on 50 healthy young adults aged 18-25 years. Maximal grip strength was tested in sitting and standing positions with both devices. After 2 days, a re-test was conducted with the K-Force Grip. The correlation coefficient was high for grip strength measurements in sitting and standing positions with the K-Force Grip and Jamar Plus dynamometers (r > 0.9 for all). K-Force Grip values were similar in sitting and standing positions (p > 0.05). Despite this similarity, K-Force Grip measured significantly lower values than Jamar Plus (p < 0.05). Thus, the K-Force Grip device can be used as an alternative to the Jamar Plus dynamometer, regarded as the gold standard in evaluating grip strength. We believe that the same devices should be used in clinical studies, research, and patient follow-up.

Daptomycin versus teicoplanin in the treatment of osteomyelitis: Results of the Göztepe retrospective cohort study.

OBJECTIVES: Daptomycin is highly effective against Gram-positive multidrug-resistant bacteria. Publications on daptomycin in osteomyelitis treatment are limited. PATIENTS AND METHODS: In this multicenter retrospective cohort study, the aim was to evaluate the outcomes of osteomyelitis cases having received daptomycin or teicoplanin. This multicenter retrospective cohort study gathered data from seven centers located in five cities of Turkey. Study inclusion criteria were as follows: (a) magnetic resonance imaging and/or direct X-ray revealed osteomyelitis or biopsy pathologic examination results concomitant with osteomyelitis. Chi-squareand Student t-tests were used for statistical comparison. RESULTS: A total of 72 patients, 38 cases in the daptomycin group and 34 cases in the teicoplanin group diagnosed with osteomyelitis fulfilling the study inclusion criteria, were included in the study. Clinical success at the end of induction therapy was achieved in 32/38 cases in the daptomycin cohort vs. 30/34 cases in the teicoplanin cohort (p: 0.73). CONCLUSION: Although this is a limited experience in a small but well-defined cohort, our data suggest that daptomycin may be a safe alternative to glycopeptides in osteomyelitis treatment. A randomized controlled clinical study involving larger cohorts may increase the available evidence.

Boy with seizures (West syndrome) and distal 7q duplication syndrome due to an unbalanced 7q;9p translocation.

We report a 15 month old boy with prominent metopic suture, epicanthal folds, strabismus, low-set ears, microretrognathia, large anterior fontanel, bilateral simian creases, muscular hypotonia, and severe psychomotor retardation. He also had West syndrome. An electroencephalogram showed hypsarrythmia, and cranial MR indicated a myelinisation delay. Standard karyotyping showed additional material on one chromosome 9p. Using FISH, a terminal 7q duplication spanning 26 Mb in size and a terminal 9p deletion sized (at least) 9.1 Mb were identified. The father had a karyotype of t(7;9)(q33;p23) and the mother's karyotype was normal. The boy presented typical facial features of the distal 7q duplication syndrome but no genital anomalies attributable to his distal 9p deletion. We assume that the severe epilepsy is likely due to the trisomy 7q.

Effect of turban use on temporomandibular joint problems.

The aim of this study was to evaluate the effects of daily turban wear on temporomandibular joint (TMJ) problems. This cross-sectional study was carried out on 249 female patients. Of these, 119 patients were using turban daily, while 130 patients did not use. Patients were asked questions to ascertain the signs of TMJ problems. Thereafter, the TMJ region was examined clinically. Cross-tabulations and Chi-square statistics were computed in accordance with Bonferroni correction for multiple comparisons. To investigate the association between continuous turban wear and temporomandibular disorder symptoms, logistic regression analysis was performed. Limited mouth opening, deviation, pain on TMJ palpation and mouth opening were not affected with turban usage. However, turban users more frequently demonstrated pain during palpation of the masticatory muscles than non-users (P = 0.001). Duration of the turban usage did not affect clinical examination findings except pain on masticatory muscles during palpation (P = 0.001). Complaint of pain on masticatory muscles are more frequently seen among the turban users.

The combined use of brachial artery flow-mediated dilatation and carotid artery intima-media thickness measurements may be a method to determine vasculogenic erectile dysfunction.

The aim of this study was to investigate the relationship between penile color Doppler sonography (CDS) findings and sonographic endothelial parameters in patients with erectile dysfunction (ED), including intima-media thickness (IMT) of common carotid arteries (CCA) and flow-mediated dilatation (FMD) of brachial artery. Fifty-six ED patients were included in the study. Penile CDS, IMT of CCA and FMD of brachial artery were performed in all patients. According to penile CDS findings, 27 (48%) patients had non-vasculogenic and 29 (52%) patients had vasculogenic ED. Among 29 patients, 17 (30%) patients had cavernous veno-occlusive disease (CVOD) and 12 (22%) patients had arterial/combined insufficiency (AI). Median (interquartile range) FMD values of non-vasculogenic ED, CVOD and AI were 12.50 (6.54)%, 12.82 (7.41)% and 6.25 (7.17)%, respectively. FMD was found to be impaired significantly in AI group when compared to the other groups. FMD values of CVOD group were lower when compared to non-vasculogenic group, but the difference was not statistically significant. IMT values of vasculogenic ED patients were higher than non-vasculogenic ED patients (P<0.05). Although IMT values were higher in AI group when compared to CVOD, the difference was not statistically significant. The combined use of IMT and FMD established the diagnosis of vasculogenic ED with 100% sensitivity and 59.2% specificity. The positive predictive value was 72%, negative predictive value 100% and accuracy 80%. The combined use of brachial artery FMD and carotid arteries IMT measurements may be suggested as an alternative method to evaluate vasculogenic ED.

Seizures during treatment of Vitamin B12 deficiency.

Epileptic seizures during infancy have a wide variety of clinical presentations and the outcome differs according to the etiology. Among the benign and rare causes of infantile seizures, Vitamin B12 deficiency has been encountered. Common symptoms of Vitamin B12 deficiency in infants include megaloblastic anemia, feeding difficulties, developmental delay, microcephaly, failure to thrive, hypotonia, lethargy, irritability, involuntary movements, seizures and cerebral atrophy. Involuntary movements and seizures may rarely be the initial symptoms of Vitamin B12 deficiency. Involuntary movements have also been reported to appear after initiation of Vitamin B12 supplementation in isolated cases, whereas, no such information exits for seizures. In this paper, three infants with Vitamin B12 deficiency associated with motor and mental retardation are reported because of long-lasting focal/multifocal epileptic seizures following the initiation of intramuscular Vitamin B12 treatment. Antiepileptics were introduced in addition to Vitamin B12. Seizures disappeared within a few days or weeks; electroencephalographic findings were normalized in a few months. No relapses occurred during the follow-up period.

Evaluation of antioxidant potential, enzyme inhibition activity and phenolic profile of Lathyrus cicera and Lathyrus digitatus: Potential sources of bioactive compounds for the food industry.

The genus Lathyrus has great importance in terms of food and agricultural areas. In this study, the in vitro antioxidant activity (phosphomolybdenum, DPPH, ABTS, FRAP, CUPRAC and metal chelating) and enzyme inhibitory activity evaluation (acetylcholinesterase, butyrylcholinesterase, α-amylase and α-glucosidase) of L. cicera and L. digitatus were investigated, as well as their phytochemical profiles. The screening of the main phytochemical compounds in aerial parts of L. cicera and L. digitatus was carried out by high-performance liquid chromatography with electrospray ionization mass spectrometric detection (HPLC-ESI-MSn), observing that flavonoids represent the highest percentage of identified compounds, with abundance of tri- and tetra-glycosilated flavonoids, including acylated ones, especially in L. cicera. Generally, L. digitatus exhibited stronger antioxidant and enzyme inhibitory activities in correlation with its higher level of phenolics. The high number of phenolic compounds and the results of the antioxidant and enzyme assays suggest that these plants may be further used as sources of bioactive compounds, and for the preparation of new nutraceuticals.