The effect of sleep disorders on quality of life in patients with epilepsy: A multicenter study from Turkey.

OBJECTIVE: We aimed to investigate sleep disorders in patients with epilepsy (PWE) and to investigate the effects of sleep disorders on quality of life. METHODS: In our multicenter study conducted in Turkey, 1358 PWE were evaluated. The demographic and clinical data of the patients were recorded. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were administered. RESULTS: The mean age of 1358 patients was 35.92 ±â€¯14.11 (range, 18-89) years. Seven hundred fifty-one (55.30 %) were women. Some 12.7 % of the patients had insomnia (ISI > 14), 9.6 % had excessive daytime sleepiness (ESS > 10), 46.5 % had poor sleep quality (PSQI > 5), and 354 patients (26.1 %) had depressive symptoms (BDI > 16). The mean QOLIE-10 score was 22.82 ±â€¯8.14 (10-48). Resistant epilepsy was evaluated as the parameter with the highest risk affecting quality of life Adjusted odds ratio (AOR = 3.714; 95 % confidence interval (CI): [2.440-5.652] < 0.001)). ISI (AOR = 1.184; 95 % CI: [1.128-1.243]; p < 0.001), ESS (AOR = 1.081; 95 % CI: [1.034-1.130]; p < 0.001), PSQI (AOR = 0.928; 95 % CI: [0.867 - 0.994]; p = 0.034), BDI (AOR = 1.106; 95 % CI: [1.084-1.129]; p < 0.001), epilepsy duration (AOR = 1.023; 95 % CI: [1.004-1.041]; p = 0.014), were determined as factors affecting quality of life. SIGNIFICANCE: Sleep disorders are common in PWE and impair their quality of life. Quality of life can be improved by controlling the factors that may cause sleep disorders such as good seizure control, avoiding polypharmacy, and correcting the underlying mood disorders in patients with epilepsy.

Attitudes towards vaccination among parents of children aged 0-5 years: A scale development study.

BACKGROUND: Vaccination is the most important public health practice for preventing infectious diseases and maintaining health. However, some parents are hesitant to vaccinate their children. DESIGN: This study was designed as an instrument development study. METHODS: This study aimed to develop a scale to measure the attitudes of parents with children aged 0-5 years towards vaccination and to evaluate the validity and reliability of this scale. The data were collected from 691 participants between November 2020 and January 2021. During the development of the scale, experts provided feedback on its technical, content and language dimensions. The data were analysed using exploratory and confirmatory factor analyses for conceptual validity and Cronbach's α and item-level test-retest analyses for reliability. RESULTS: The developed scale is a reliable and valid tool for measuring attitudes towards vaccination among parents (Cronbach's α = 0.97, variance explained by these 28-item two factors = 62.47%). CONCLUSION: This scale can be used as a guide in measuring the attitudes of parents towards vaccination and determining the direction of primary health-care services based on the results of the measurement.

The relationship and affecting factors between oral health and frailty in the older people: A cross-sectional study.

OBJECTIVE: To investigate the connection between oral health and frailty in older people and to determine the affecting factors. DESIGN: The research was a community-based cross-sectional study. SAMPLE: A Family Health Center conducted a study on 321 older people. MEASUREMENTS: Data were collected face-to-face using the Personal Information Form, Geriatric Oral Health Assessment Index, and Edmonton Frailty Scale. Factors affecting oral health and frailty were examined using the MANOVA test and the relationship between them was examined using Pearson's correlation test. RESULTS: It was determined that 52.6% of the participants had poor oral health and 56.1% had different levels of frailty. Education was effective on the Geriatric Oral Health Assessment Index scale score. The presence of chronic disease, frequency of tooth/denture brushing, age, education, and sex were effective on the Edmonton Frailty Scale. When the partial eta square values were examined, it was determined that the variable that had the highest impact on the GOHAI and EFS scale scores was educational status. It was determined that there was a significant negative relationship between participants' oral health and frailty scores (r = -0.539, p < .001). CONCLUSIONS: It was determined that more than half of the older individuals included in the study had poor subjective oral health and varying levels of frailty. The influencing factors were determined through multivariate advanced analysis. This relationship and affecting factors are important in providing appropriate early detection and care to older people.

Birth outcomes in pregnant women with epilepsy: A Nationwide multicenter study from Türkiye.

OBJECTIVE: The present study was aimed at investigating the effects of anti-seizure medications (ASMs), patient demographic characteristics, and the seizure type and frequency on the development of congenital malformations (CMs) in the infants of pregnant women with epilepsy (PWWE). METHODS: PWWE followed up at the neurology outpatient clinic of 21 centers between 2014 and 2019 were included in this prospective study. The follow-up of PWWE was conducted using structured, general pregnant follow-up forms prepared by the Pregnancy and Epilepsy Study Committee. The newborns were examined by a neonatologist after delivery and at 1 and 3 months postpartum. RESULTS: Of the infants of 759 PWWE, 7.2% had CMs, with 5.6% having major CMs. Polytherapy, monotherapy, and no medications were received by 168 (22.1%), 548 (72.2 %), and 43 (5.7 %) patients, respectively. CMs were detected at an incidence of 2.3% in infants of PWWE who did not receive medication, 5.7% in infants of PWWE who received monotherapy, and 13.7% in infants of PWWE who received polytherapy. The risk of malformation was 2.31-fold (95% confidence interval (CI): 1.48-4.61, p < .001) higher in infants of PWWE who received polytherapy. Levetiracetam was the most frequently used seizure medication as monotherapy, with the highest incidence of CMs occurring with valproic acid (VPA) use (8.5%) and the lowest with lamotrigine use (2.1%). The incidence of CMs was 5% at a carbamazepine dose <700 mg, 10% at a carbamazepine dose ≥700 mg, 5.5% at a VPA dose <750 mg, and 14.8% at a VPA dose ≥750 mg. Thus the risk of malformation increased 2.33 times (p = .041) in infants of PWWE receiving high-dose ASMs. SIGNIFICANCE: Birth outcomes of PWWE receiving and not receiving ASMs were evaluated. The risk of CMs occurrence was higher, particularly in infants of PWWE using VPA and receiving polytherapy. The incidence of CMs was found to be lower in infants of PWWE receiving lamotrigine.

Histopathological changes in tissues surrounding vagal nerve stimulation generators: A retrospective analysis of revision surgeries.

PURPOSE: Vagal nerve stimulation (VNS) is an effective treatment for patients with epilepsy, depression, and other neuropsychiatric conditions. Understanding the tissue changes associated with VNS devices is crucial for optimizing patient outcomes and device development. This study aimed to investigate the histopathological changes in the tissues surrounding the VNS generator and explore potential correlations with clinical factors and battery performance. METHODS: A total of 23 patients who underwent VNS generator revision surgery owing to battery depletion were included. Tissue samples from the areas surrounding the VNS generator were obtained and analyzed for histopathological changes. Demographic and device-related variables were also recorded. RESULTS: Capsule formation was observed in all patients. Acute inflammation were not detected in any case. Perivascular lymphocytic infiltration, foreign-body giant cell reaction (FBGCR), and calcification were observed in 8.7%, 26.1%, and 43.5% of patients, respectively. Crystalloid foreign body appearance was noted in 4 patients. The median output current of the generator was higher in patients with lymphocytic infiltration than in those without lymphocytic infiltration. The median off time was higher in patients with skin retraction than in those without skin retraction. Moreover, discomfort was associated with the presence of FBGCR. CONCLUSION: Our study provides insights into the tissue changes associated with the VNS generator, with capsule formation being a common response. Crystalloid foreign body appearance was not reported previously. Further research is needed to understand the relationship between these tissue changes and VNS device performance, including the potential impact on battery life. These findings may contribute to VNS therapy optimization and device development.

The effect of Otago exercises on fear of falling, balance, empowerment and functional mobility in the older people: Randomized controlled trial.

AIM: This study aimed to test the effect of Otago exercises on fear of falling, balance, empowerment and functional mobility in older people living in nursing homes. METHODS: This study is a parallel-group randomized controlled trial. In total, 56 individuals were stratified randomized according to age-gender. Participants were recruited from September 2021 to August 2022. Data were collected at baseline, in the 8th and 12th weeks. The researcher gave Otago exercise training to the intervention group three times per week for the first 4 weeks and applied it to the individuals, and in the next 8 weeks, the researcher visited the institution to ensure the continuity of the exercises and contacted the individuals by phone. Friedman test and generalized linear model were used in the analysis of data. RESULTS: In the study, group and time interaction were found to be significant in terms of the Berg balance scale, 30-second sit-and-stand test, elderly empowerment scale and timed up-and-go test. It was determined that the intervention did not improve fear of falling, upper extremity strength and 6-min walk test results. CONCLUSION: Health personnel and administrators should have increased awareness about Otago exercises and can recommend implementation of the programme.

Use of a Hydrophobic Azo Dye for the Centrifuge-Less Cloud Point Extraction-Spectrophotometric Determination of Cobalt.

The hydrophobic azo dye 6-hexyl-4-(2-thiazolylazo)resorcinol (HTAR, H2L) was studied as part of a system for the centrifuge-less cloud point extraction (CL-CPE) and spectrophotometric determination of traces of cobalt. The extracted 1:2 (Co:HTAR) complex, [CoIII(HL-)(L2-)]0, shows an absorption maximum at 553 nm and contains HTAR in two different acid-base forms. Optimum conditions for its formation and CL-CPE were found as follows: 1 × 10-5 mol L-1 of HTAR, 1.64% of Triton X-114, pH of 7.8, incubation time of 20 min at ca. 50 °C, and cooling time of 30 min at ca. -20 °C. The linear range, limit of detection, and apparent molar absorptivity coefficient were 5.4-189 ng mL-1, 1.64 ng mL-1, and 2.63 × 105 L mol-1 cm-1, respectively. The developed procedure does not use any organic solvents and can be described as simple, cheap, sensitive, convenient, and environmentally friendly. It was successfully applied to the analysis of artificial mixtures and real samples, such as steel, dental alloy, rainwater, ampoules of vitamin B12, and saline solution for intravenous infusion.

The Effect of Aromatherapy on Sleep Quality and Fatigue Level of the Elderly: A Randomized Controlled Study.

This randomized controlled experimental study was conducted to determine the effect of inhaled aromatherapy on the sleep quality and fatigue level of the institutionalized elderly. The sample of the study consisted of a total of 59 elderly individuals (30 in the intervention group and 29 in the control group) who met the inclusion criteria and agreed to participate in the study. Aromatherapy (lavender oil) inhalation was administered to individuals in the intervention group half hour before their sleep every day for a month in accordance with aromatherapy protocol. No administration was applied to the control group. The data were collected using the Elderly Description Form, Pittsburgh Sleep Quality Index, and Fatigue Severity Scale. Forms were completed in the beginning of administration and in the follow-up at the end of 4 weeks (baseline and last follow-up). In the study, it was determined that aromatherapy administration improved sleep quality (P < .001) and decreased fatigue severity in the elderly (P < .05). The study should be replicated in a different group.

Methylation of cation-chloride cotransporters NKCC1 and KCC2 in patients with juvenile myoclonic epilepsy.

The etiology of juvenile myoclonic epilepsy (JME) is still unknown and the process of elaboration of multiple genetic mechanisms is ongoing. The aim of this study was to investigate the potential role of NKCC1 (SCL12A2) and KCC2 (SCL12A5) in JME by comparing their DNA methylation status in patients with JME versus healthy controls. Forty-nine patients with JME and 39 healthy individuals were compared for DNA methylation at the 5CpG islands. A total of 71 (81%) samples were found to have methylation in the NKCC1 gene, 36 (73%) from patients and 35 (90%) from healthy individuals. Out of the KCC2 samples, 50 (57%) were found to have methylation, 33 (67%) from patients and 17 (44%) from healthy individuals. In patients with JME, methylation of NKCC1 (73%) was lower than its methylation in the controls (90%) (p = 0.047). On the other hand, methylation of KCC2 in patients with JME (67%) was greater than the methylation in the controls (44%) (p = 0.022). Twenty-eight patients were treated with VPA and ongoing medications were not found to be associated with methylation (p > 0.05). In the present study, we determined significantly lower NKCC1 DNA methylation and significantly higher KCC2 DNA methylation levels in patients with JME compared with the healthy controls. This implies that NKCC1 expression can be higher and KCC2 expression can be reduced in affected people. Further studies that investigate the potential effect of DNA methylation mechanisms regulating gene expression on seizure activity and how they change JME network activity will be helpful.

The methylation status of NKCC1 and KCC2 in the patients with refractory temporal lobe epilepsy.

BACKGROUND AND PURPOSE: Methylation is a key epigenetic modification of DNA and regarding its impact on epilepsy, it is argued that "DNA methylation may play an important role in seizure susceptibility and maintenance of the disorder". DNA methylation status of KCC2 (SCL12A5) and NKCC1 (SCL12A2) associated with refractory temporal lobe epilepsy was investigated in our study. METHODS: Thirty-eight patients with temporal lobe epilepsy (TLE) who were diagnosed by video EEG monitoring and 32 healthy control subjects were included in the study. Twenty-three patients in TLE group were men and the remaining 15 were women. Among them, 27 had unilateral temporal focus (9 with right; 18 with left) and 11 patients had bilateral TLE. We analyzed promoter region methylation status of the KCC2 (SCL12A5) and NKCC1 (SCL12A2) genes in the case and control groups. Gene regions of interest were amplified through PCR and sequencing was accomplished with pyro-sequencing. RESULTS: We found a significant relationship between TLE and methylation on the NKCC1. However, there was no association between TLE and methylation on the KCC2 gene. Also, we found no association between right or left and unilateral or bilateral foci of TLE. There was no relationship between TLE and methylation on the NKCC1and KCC2 genes in terms of mesial temporal sclerosis in cranial MRI, head trauma or febrile convulsions. CONCLUSION: The methylation of NKCC1 can be a mecha-nism of refractory temporal lobe epilepsy. There are limited findings about DNA methylation in TLE. Therefore, further studies with large sample sizes are necessary.

Relationship between Status Epilepticus Severity Score and etiology in adult NCSE patients.

BACKGROUND AND PURPOSE: Nonconvulsive status epilepticus (NCSE) is a heterogeneous, severe neurological disorder of different etiologies. In this study, the outcomes of NCSE episodes was assessed in a large series of adult patients. Our objective was to evaluate relationship between Status Epilepticus Severity Score (STESS) and etiology and the role of etiological factors on predicting the outcomes. METHODS: In this retrospective study, the medical records of 95 patients over 18 years of age who were diagnosed with NCSE between June 2011 and December 2015 were reviewed. Their treatment and follow-up for NCSE was performed at the Epilepsy Unit in Department of Neurology, Antalya Research and Training Hospital. Etiological factors thought to be responsible for NCSE episodes as well as the prognostic data were retrieved. The etiological factors were classified into three groups as those with a known history of epilepsy (Group 1), primary neurological disorder (Group 2), or systemic/unknown etiology (Group 3). STESS was retrospectively applied to patients. RESULTS: There were 95 participants, 59 of whom were female. Group 1, Group 2, and Group 3 consisted of 11 (7 female), 54 (33 female), and 30 (19 female) patients, respectively. Of the 18 total deaths, 12 occurred in Group 2, and 6 in Group 3. The negative predictive value for a STESS score of ≤ 2 was 93.88% (+LR 2.05 95% CI: 1.44-2.9 and -LR 0.3 95% CI 0.10-0.84 ) in the overall study group. While the corresponding values for Group 1 (patients with epilepsy), Group 2 (patients with primary neurological disorder), and group 3 (patients with systemic or unknown etiology) were 100%, 92.59% (+LR 2.06 95%CI: 1.32-3.21 and -LR 0.28 95% CI 0.08-1.02 ) 83.33% (+LR 1.14 95%CI: 0.59-2.9 and -LR 0.80 95% CI 0.23-2.73). CONCLUSION: This study included the one of the largest patients series ever reported in whom STESS, a clinical scoring system proposed for use in patients with status epilepticus, has been implemented. Although STESS appeared to be quite useful for predicting a favorable outcome in NCSE patients with epilepsy and primary neurological disorders, its predictive value in patients with systemic or unknown etiology was lower. Further prospective studies including larger NCSE samples are warranted.

The effect of acupressure application on chemotherapy-induced nausea, vomiting, and anxiety in patients with breast cancer.

OBJECTIVE: The purpose of this study was to determine the effect of acupressure applied to the pericardium 6 (P6 or neiguan) acupuncture point on chemotherapy-induced nausea, vomiting, and anxiety in patients with breast cancer. METHOD: The study was conducted using a quasi-experimental model with a control group. It included a total of 64 patients with stages 1-3 breast cancer who received cycle two and more advanced chemotherapy in an ambulatory chemotherapy unit. There were 32 patients in the experimental group and 32 patients in the control group. Acupressure was applied to the P6 acupuncture point of patients in the experimental group with the help of a wristband. A Patient Information Form, the Beck Anxiety Inventory, and the Index of Nausea, Vomiting and Retching were employed to collect the data. RESULTS: It was determined that the mean nausea, vomiting, and retching scores, the total (experience, occurrence, and distress) scores, and the mean anxiety scores for patients to whom acupressure was applied at the P6 acupuncture point were statistically significantly lower compared with the scores of patients in the control group. SIGNIFICANCE OF RESULTS: The efficacy of applying acupressure was demonstrated. We determined that applying acupressure at the P6 point is effective in decreasing chemotherapy-induced nausea, vomiting, and anxiety in patients with breast cancer. Further research with more subjects is needed.

Turkish Adaptation of the Frailty Index for Elders: A Methodologic Study.

Background and Purpose: Frailty is an important problem in the aging process and can be prevented or delayed when detected at an early stage. Therefore, appropriate measurement tools are needed to determine frailty. The study aimed to adapt the Frailty Index for Elders (FIFE) into Turkish.Methods: Data were collected from 300 older individuals between January and April 2023. Rasch analysis was used to evaluate the construct validity. The KR-20 reliability coefficient of the factor items was evaluated and interpreted for internal consistency.Results: The reliability coefficient of the scale was .98, item separation (item separation index) was 7.62, and item reliability was .98. The content validity, based on the opinions of seven experts, was found as .85. In general, the relationship between the total scores of the individuals in the first application and the scores of the individuals in the second application was .92.Conclusions: It was concluded that the seven-item single-factor FIFE was a valid and reliable tool to measure the frailty of older individuals living in Turkey.

A theoretical study on 1H-indole-2,3-dione complexes with lithium, sodium, and potassium cations.

CONTEXT: A comparative study of the change in different properties of electronic and structural of the free 1H-indole-2,3-dione molecule and its complexes has been obtained. HOMA analysis was performed to investigate the effects of lithium sodium and potassium cations on the aromaticity of lithium sodium and potassium complexes of 1H-indole-2,3-dione. METHODS: Several 1H-indole-2,3-dione complexes with lithium, sodium, and potassium cations were optimized at the B3LYP/6-311G(d,p) level. The cation and π interaction has been investigated from different aspects, including interaction energy calculations, charge transfer values, and changes in the aromaticity of the ring upon complexation. The charge transfer and natural population analysis for the complexes were performed with the natural bond orbital (NBO) analysis. The properties of bond critical points in complexes were studied by applying the quantum theory of atoms in molecules (QTAIM). Finally, the aromaticity change of phenyl induced upon complex formation was evaluated by applying the harmonic oscillator model of aromaticity (HOMA). [Li-INa]+ and [[Li-INb]+ were optimized with the wB97XD function using a version of Grimme's D2 dispersion model, and the absorption energy was compared with the calculation made with the B3LYP functional.

Marriage and childbearing in patients with epilepsy in Turkey.

Introduction: For epilepsy, a common neurological disorder, brings psychosocial challenges like stigma, employment difficulties, and barriers to marriage and childbearing. Stigma often stems from misconceptions and societal beliefs, particularly in less developed regions like Turkey. However, research on the marital and childbearing experiences of epilepsy patients in such settings is limited. We aimed to research the marriage and childbearing behaviors of men and women with epilepsy. Methods: We conducted a cross-sectional study involving 215 adult epilepsy patients at Antalya Training and Research Hospital between 2019 and 2022. Patients were asked questions about marriage and having children on prepared questionnaires. Result: The gender distribution of the 215 patients included in the study was revealed to be 62.3% (134) females and 37.7% (81) males. 71.6% of patients were married, and 12.7% had no children. 33.3% of these patients stated that they did not desire children because of the disease. A statistically significant correlation was observed between the duration of the disease and being unmarried. A significant correlation was observed between age at disease onset and number of children. Conclusion: Our study revealed the effects of individuals with epilepsy on marriage and childbearing, and as we know, it is the first study conducted in Turkey on childbearing attitudes in individuals with epilepsy. Despite medical and social developments, epilepsy is still one of the most stigmatized diseases, and the disease has considerable negative effects on marriage and fertility. Our study supported the findings of a small number of previous similar studies on this subject and additionally showed that the likelihood of having children decreased in patients using multiple ASM, and on the other hand, it showed that marriage positively affected patients in terms of social support.

Development of the Turkish version of the oral health assessment tool: Methodological study.

AIM: This research aimed to assess the validity and reliability of the "Oral Health Assessment Tool for the Elderly" Turkish form. METHODS: A total of 262 elderly individuals > 65 years of age were included in the study. These individuals were selected from community-dwelling elderly and nursing home residents in the Konya province of Turkey. A data form containing sociodemographic information and oral health behavior was used to collect the data. In addition, the Geriatric Oral Health Assessment Index and the Oral Health Assessment Tool for the Elderly were used. To create the Turkish version of the tool, the form was translated and back-translated for content validity. Expert opinion was obtained for criterion validity. Last, confirmatory factor analysis and exploratory factor analysis were performed to evaluate construct validity. Test-retest reliability, interobserver reliability, and Cronbach's alpha reliability coefficients were calculated. RESULTS: The Tool Turkish form consisted of 10 items and two factors. The Cronbach's alpha reliability coefficient was 0.86. The total variance explained by the items was 60.19%, and the test-retest reliability coefficient was 0.95. The content validity index was 0.90, and Kendall's coefficient of concordance was 0.97. The correlation coefficient between the scales is 0.719. The mean Oral Health Assessment Tool for the Elderly score obtained by the participants was 5.4 ± 4.32 (median 5, min-max: 0-17). CONCLUSION: The Turkish version of the tool is a valid and reliable tool to assess oral health in community-dwelling elderly individuals and those living in nursing homes.

Unfavorable Effects of Low-carbonhydrate Diet in a Pediatric Patient with Type 1 Diabetes Mellitus

A balanced and healthy diet is very important in type 1 diabetes mellitus (T1DM) in childhood. In addition to regulating blood glucose with diet, diet should also support optimal growth. Low-carbohydrate diet aims to provide daily energy from fats and was originally used for childhood epilepsy. We present a patient with T1DM who experienced unfavorable effects when on a low-carbohydrate diet.

Theoretical B3LYP Study on Electronic Structure of Contrast Agent Iopamidol.

Nonionic low-osmolar contrast agents are thought about safe for intravenous or intra-arterial administration. Iopamidol is one of the contrast agents used for diagnostic clinical computed tomography (CT) protocols last four decades years.The molecular structure of Iopamidol was calculated by the B3LYP density functional model with the LANL2DZ basis set by the Gaussian program. The natural bond orbital analysis in terms of the hybridization of atoms and the electronic structure of the title molecule have been analyzed by using the data obtained from the quantum chemical results. First-order hyperpolarizability (ßtot), the dipole moment (µ) and polarizability (α) and anisotropic polarizability (∆α) of the molecule have been reported. HOMO and LUMO energies and parameters related to energies, and dipole moment, polarizability and hyperpolarizability show minor dependences on the solvent polarity. The hardness of Iopamidol decreases with increasing solvent polarity. The stability of the Iopamidol contrast agent with the hyper conjugative interactions, charge delocalization has been analyzed using natural bond orbital analysis. In addition, thermodynamic properties were obtained in the range of 200-1000 K.

Does Short-Term and Low-Dose N-Acetylcysteine Affect Oxidative Stress and Inflammation in The Liver Tissues of Diabetic Rats?

Diabetes mellitus is a serious chronic disease in which the oxidant-antioxidant balance is impaired, causing many complications, including hepatopathy. In this study, the effects of short-term and low-dose N-acetylcysteine (NAC) administration on the biochemical, proinflammatory, and oxidative stress parameters in the liver tissue of diabetic rats were investigated. Twenty-four adult male Wistar albino rats weighing approximately 250-300 g were divided into 4 groups (n = 6): Control, Streptozotosin (STZ)-induced diabetes (DM), NAC treatment (60 mg/kg), and STZ-induced diabetes treated with NAC (DM+NAC; 60 mg/kg). NAC treatment was administered intraperitoneally as a single daily dose for 7 days. At the end of the experiment (3 weeks), blood and liver samples were collected for biochemical parameter analysis. Lipid peroxidation, antioxidant parameters, and nitric oxide (NOx) levels were determined by spectrophotometric method. Tissue inflammation parameters were evaluated by ELISA. Lipid peroxidation, proinflammatory cytokines, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) values increased significantly with diabetes. NAC treatment significantly decreased serum ALT and AST levels and proinflammatory cytokines in the diabetic group. Liver glutathione (GSH) and NOx levels increased significantly in the DM+NAC group (p < 0.05). While NAC treatment reduced lipid peroxidation in the liver, it improved the inflammatory response and antioxidant status. The beneficial effect of NAC treatment may be due to its antioxidant activity and the resulting increased level of GSH. The results show that low-dose and short-term NAC treatment had a positive effect on oxidative damage and inflammation in liver tissue. NAC can be used as a potential antioxidant in diabetes to prevent hepatopathy.

Early and late-onset nonconvulsive status epilepticus after stroke.

BACKGROUND: Nonconvulsive status epilepticus (NCSE) is a condition that needs timely diagnosis and treatment. It has insignificant clinical features and presents high risk of misdiagnosis. OBJECTIVE: To investigate NCSE among patients with stroke, given that stroke plays an important role in the etiology of NCSE. METHODS: In this retrospective study, acute stroke patients who were admitted and followed up at a stroke outpatient clinic between January 2013 and March 2016 were included. Patients with previous histories of epilepsy, brain tumor, head trauma, hypertensive encephalopathy, arteriovenous malformation, subarachnoid hemorrhage or cerebral venous thrombosis were excluded. Demographic properties, stroke etiology, imaging method, EEG findings, stroke severity according to the NIHSS score, functional disability and modified Rankin Scale were recorded for all patients. RESULTS: Thirty-nine out of 792 stoke patients experienced NCSE. The mean age of the study population was 70±1.2 years (min-max: 46‒90). The study population was composed of 28 females (71.8%) and 11 males (28.2%). NCSE had early onset in 23 patients (59%) and late onset in 16 (41%). The early-onset NCSE patients were older and this was statistically significant between the groups (early onset: 73.5±11.5; late onset: 65.9±12.1; p=0.04). A history of previous stroke was more frequent in the late-onset NCSE group (14; 87,5%) than in the early-onset group (11; 47.8%) (p=0.01). The prognosis was worse in the early-onset group, but without statistical significance. CONCLUSION: Changes in mental status in the early stages of stroke are mostly attributed to stroke itself, but NCSE should be suspected in the right clinical setting, such as in older patients with suspicious anatomical and clinical associations.