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.

Paediatric nurses' experiences of success and failure in first-time peripheral intravenous catheter insertion: A qualitative study.

PURPOSE: To explore in-depth the thoughts, anxiety factors, and experiences of paediatric nurses regarding the success and failure of first-time peripheral intravenous catheter insertion. DESIGN AND METHODS: The study employed a qualitative research method using the phenomenology design. Face-to-face semi-structured in-depth interviews were conducted with nurses (N = 12) working in the paediatric service and neonatal intensive care unit of a teaching and research hospital. The transcripts were analysed using a phenomenological approach and an inductive process. RESULTS: Four themes were identified: Peripheral Intravenous Catheter Insertion, Experience of Success on the First Attempt, Experience of Failure on the First Attempt, and Proposed Solutions. Nurses felt a sense of happiness when they successfully inserted a peripheral intravenous catheter on their first attempt in paediatric patients. Conversely, they experienced emotions such as sadness, worry, stress, and anxiety when they failed and had to make repeated attempts. CONCLUSION: Unsuccessful peripheral intravenous catheter insertions cause distress and anxiety for nurses, patients, and parents alike. Therefore, nurses' experiences of peripheral intravenous catheter insertions in healthcare settings should not be ignored and require improvement. IMPLICATIONS FOR CLINICAL PRACTICE: Unsuccessful peripheral intravenous catheter insertions affect children, parents, and nurses negatively, thus reducing the success rate of repeated peripheral intravenous catheter insertions. Therefore, it is advisable for nurses conducting paediatric peripheral intravenous catheterisations to undergo periodic training. A specialised intervention team should be established for cases of initial failure, and a mentoring system between seasoned and new nurses is recommended.

COMBINED HAMARTOMA OF THE RETINA AND RETINAL PIGMENT EPITHELIUM AT PEDIATRIC AGE: Surgical Versus Conservative Approach.

PURPOSE: To report outcomes of pediatric patients with combined hamartoma of the retina and the retina pigment epithelium followed up conservatively or after pars plana vitrectomy. METHODS: This retrospective multicenter study included 62 eyes of 59 pediatric patients with combined hamartoma of the retina and the retina pigment epithelium from 13 different international centers with an average age of 7.7 ± 4.7 (0.3-17) years at the time of the diagnosis and having undergone pars plana vitrectomy or followed conservatively. At baseline and each visit, visual acuity values, optical coherence tomography for features and central foveal thickness, and tumor location were noted. Lesions were called as Zone 1, if it involves the macular and peripapillary areas, and the others were called as Zone 2 lesions. RESULTS: Twenty-one eyes of 20 patients in the intervention group and 41 eyes of 39 patients in the conservative group were followed for a mean of 36.2 ± 40.4 (6-182) months. Best-corrected visual acuity improved in 11 (68.8%) of 16 eyes in the intervention group and 4 (12.9%) of 31 eyes in the conservative group ( P < 0.001). The mean central foveal thickness decreased from 602.0 ± 164.9 µ m to 451.2 ± 184.3 µ m in the intervention group, while it increased from 709.5 ± 344.2 µ m to 791.0 ± 452.1 µ m in Zone 1 eyes of the conservative group. Posterior location of tumor, irregular configuration of the foveal contour and ellipsoid Zone defect in optical coherence tomography, subretinal exudate and prominent vascular tortuosity were associated with poor visual acuity. CONCLUSION: Vitreoretinal surgery is safe and effective in improving vision and reducing retinal distortion in Zone 1 combined hamartoma of the retina and the retina pigment epithelium in children.

Choroidal vascularity index as an activity criterion and a treatment response measure in chronic central serous chorioretinopathy.

PURPOSE: This study aimed to evaluate the choroidal vascularity index (CVI) as an activity criterion in chronic central serous chorioretinopathy (CSC) and as a measure of treatment response after full-dose-full-fluence photodynamic therapy (fd-ff-PDT). METHODS: This fellow-eye-controlled, retrospective cohort study included 23 patients with unilateral chronic CSC treated with fd-ff-PDT (6 mg/m2 ; 50 µcm2 ; 83 s). Subfoveal choroidal thickness (SFCT, µm) and CVI (%) of the affected and fellow eyes at baseline as well as at 1, 3 and 6 months after fd-ff-PDT were compared. RESULTS: The patients' mean age was 43.4 ± 7.3 years, and 18 (78.3%) were male. CVI was comparable between the affected and fellow eyes at baseline (66.09 ± 1.56 vs. 65.84 ± 1.57, p = 0.59). However, it became significantly lower in the affected eyes 1 (64.45 ± 1.68 vs. 65.87 ± 1.19, p = 0.002), 3 (64.21 ± 2.08 vs. 65.71 ± 1.59, p = 0.009) and 6 (64.47 ± 2.19 vs. 65.62 ± 1.52, p = 0.045) months after fd-ff-PDT. The mean SFCT and the mean CVI were significantly decreased in the affected eyes at all follow-up visits compared with baseline after fd-ff-PDT (p < 0.001). CONCLUSION: At baseline, CVI was comparable between affected and fellow eyes. Therefore, its use as an activity criterion in chronic CSC patients is questionable. However, it was significantly decreased in fd-ff-PDT-treated eyes, supporting its role as a measure of treatment response in chronic CSC.

Does Cerebral Oxygenation Change during Peripherally Inserted Central Catheterization in Preterm Infants?

OBJECTIVE: This study aimed to evaluate the effect of peripherally inserted central venous catheterization on cerebral oxygenation by near-infrared spectroscopy in very low birth weight preterm infants. STUDY DESIGN: Forty-one preterm infants (gestational age ≤32 weeks and birth weight ≤1,500 g) requiring peripherally inserted central venous catheter were included. Hemodynamic data and cerebral regional oxygen saturation values measured by near-infrared spectroscopy were prospectively collected before (T0) and every 5 minutes for 30 minutes following catheterization. When compared with baseline (T0) values, those values having relative maximum changes in the first 15 minutes and between 15 and 30 minutes were defined as T15 max and T30 max, respectively. Any change of more than a 10% decrease in baseline cerebral rSO2 was considered clinically significant. Additionally, any changes exceeding 20% in heart rate and mean arterial blood pressure values were considered significant. Following catheterization, the time interval to reach the baseline for cerebral regional oxygen saturation was noted. RESULTS: Cerebral regional oxygen saturation values at T15 max and T30 max were found to have decreased significantly in 46 and 22% of patients, respectively. A statistically significant difference was observed between these two time periods (p = 0.002); no significant differences in heart rate, mean arterial blood pressure, or cerebral fractional oxygen extraction values at T15 max and T30 max were observed. All patients reached their baseline cerebral regional oxygen saturation in a median of 25 (15-60) minutes. CONCLUSION: In very low birth weight preterm infants, monitoring cerebral regional oxygen saturation by near-infrared spectroscopy before and after peripherally inserted central venous catheterization may be useful in clinical practice. The assessment of factors affecting cerebral oxygenation and, in the case of low cerebral oxygenation, implementation of corrective actions before peripherally inserted central catheterization may offer a neuroprotective strategy. KEY POINTS: · Monitoring cerebral rSO2 by NIRS during PICC line procedure might be useful in preterm infants.. · In this study, a significant decrease in cerebral rSO2 level following catheterization was observed.. · Implementation of corrective actions before PICC line procedure may offer a neuroprotective strategy..

Point-of-Care Ultrasound for the Tip of the Endotracheal Tube: A Neonatologist Perspective.

OBJECTIVE: Point-of-care ultrasound (POCUS) has been reported to reduce radiation exposure and has been shown to be a reliable bedside technique to confirm endotracheal tube (ETT) placement, but evidence in neonates is still limited. The aim of this study was to compare the effectiveness and reliability of POCUS performed by a neonatologist, as an alternative to chest radiography (CXR) for the optimal position of ETT. STUDY DESIGN: Newborns who underwent intubation were included in this prospective observational study. The CXR was used to evaluate the position of the ETT tip and categorized into three groups: above the T1, between the T1 and T3, and below the T3 vertebra. An experienced neonatologist measured the distance between the ETT tip and the upper border of the aortic arch from the suprasternal notch with ultrasonography (US). A 5 to 10 mm measurement was considered as the optimal distance, and the position was classified into three categories: correct, high, and deep. RESULTS: Among 91 measurements performed on 63 intubated patients with US, 73 (80%) were within the 5 to 10 mm range (correct position). Of these, 61 (92.4%) were determined to be between T1 and 3 vertebrae in CXR. There was no significant difference between the two methods, and the US had an excellent ability to distinguish the correct position of the ETT. The distance measured by the US for the ETT tip to be located between the T1 and T3 vertebrae on CXR should range between 6.17 and 9.0 mm. CONCLUSION: This study showed that the US by an experienced neonatologist is an easy and feasible alternative to determine the position of the ETT in the neonatal intensive care unit. KEY POINTS: · POCUS has been reported to reduce radiation exposure, and it is areliable bedside technique.. · Evidence for confirmation of ETT placement in neonates is limited.. · POCUS can be used for determination of ETT position in NICU's by experienced neonatologists..

Evaluation of Arterial Stiffness and Subfoveal Choroidal Thickness in Patients with Coronary Slow Flow.

Background: Coronary slow flow may not only affect the coronary arteries, but it may also be a vascular problem affecting the rest of the arterial system. Objective: The aim of this study was to determine peripheral arterial stiffness and the thickness of the choroid layer in patients with slow coronary flow. Methods: Fifty consecutive patients (age, 54.3 ± 11.4 years, 38 male) with coronary slow flow and 25 consecutive patients (age, 50.5 ± 9.9 years, 16 male) with normal coronary arteries both documented by coronary angiography were included. Arterial stiffness parameters were measured noninvasively using a Mobil-O-Graph arteriography system. The choroidal thickness was assessed using the enhanced depth imaging optical coherence tomography method. Results: The patients with coronary slow flow had significantly higher peripheral systolic blood pressure, peripheral pulse pressure, central pulse pressure, and pulse wave velocity (PWV) and significantly thinner choroidal thickness compared to the controls. Thrombolysis in myocardial infarction frame count was positively correlated with PWV (r: 0.237, p = 0.041) and negatively correlated with choroidal thickness (r: -0.249, p = 0.031). There was also a negative correlation between PWV and mean choroidal thickness (r: -0.565, p < 0.001). Linear regression analysis showed that coronary slow flow was an independent predictor of both PWV and choroidal thickness when adjusted by age and sex. Conclusions: The acceleration of average peripheral arterial PWV with a thinning of choroidal thickness in patients with coronary slow flow may support the idea that this phenomenon may be a coronary presentation of a systemic microvascular disorder.

Headache in idiopathic/genetic epilepsy: Cluster analysis in a large cohort.

OBJECTIVE: The link between headache and epilepsy is more prominent in patients with idiopathic/genetic epilepsy (I/GE). We aimed to investigate the prevalence of headache and to cluster patients with regard to their headache and epilepsy features. METHODS: Patients aged 6-40 years, with a definite diagnosis of I/GE, were consecutively enrolled. The patients were interviewed using standardized epilepsy and headache questionnaires, and their headache characteristics were investigated by experts in headache. Demographic and clinical variables were analyzed, and patients were clustered according to their epilepsy and headache characteristics using an unsupervised K-means algorithm. RESULTS: Among 809 patients, 508 (62.8%) reported having any type of headache; 87.4% had interictal headache, and 41.2% had migraine. Cluster analysis revealed two distinct groups for both adults and children/adolescents. In adults, subjects having a family history of headache, ≥5 headache attacks, duration of headache ≥ 24 months, headaches lasting ≥1 h, and visual analog scale scores > 5 were grouped in one cluster, and subjects with juvenile myoclonic epilepsy (JME), myoclonic seizures, and generalized tonic-clonic seizures (GTCS) were clustered in this group (Cluster 1). Self-limited epilepsy with centrotemporal spikes and epilepsy with GTCS alone were clustered in Cluster 2 with the opposite characteristics. For children/adolescents, the same features as in adult Cluster 1 were clustered in a separate group, except for the presence of JME syndrome and GTCS alone as a seizure type. Focal seizures were clustered in another group with the opposite characteristics. In the entire group, the model revealed an additional cluster, including patients with the syndrome of GTCS alone (50.51%), with ≥5 attacks, headache lasting >4 h, and throbbing headache; 65.66% of patients had a family history of headache in this third cluster (n = 99). SIGNIFICANCE: Patients with I/GE can be clustered into distinct groups according to headache features along with seizures. Our findings may help in management and planning for future studies.

TRANSCORNEAL ELECTRICAL STIMULATION THERAPY MAY HAVE A STABILIZATION EFFECT ON MULTIFOCAL ELECTRORETINOGRAPHY FOR PATIENTS WITH RETINITIS PIGMENTOSA.

PURPOSE: To assess the effects of transcorneal electrical stimulation (TES) on several measures of visual function in retinitis pigmentosa. METHODS: This prospective, randomized, fellow-eye-controlled study includes 30 eyes of 15 patients with retinitis pigmentosa. Each patient's eyes were randomly selected as treatment (TE) and control eye (CE), and 30 minutes/week TES was applied for 6 months. Patient evaluations were performed before and after TES, including comprehensive ophthalmological examination, visual fields, full-field and multifocal electroretinography, microperimetry, and optical coherence tomography. All parameters were compared before and after TES and between TE and CE. RESULTS: After TES, the mean signal amplitudes in multifocal electroretinography were stabilized in TE. The mean signal amplitudes in CE decreased in every ring, reaching significance in the fifth ring (847.15 ± 393.94 and 678.77 ± 282.66 nV, P = 0.039, before and after TES, respectively). The changes in the mean signal amplitudes of TE and CE were -0.38 ± 295.53 and -185.15 ± 332,62 nV in second (P = 0.046), 36.69 ± 326.4 and -143.38 ± 317,41 nV in fourth (P = 0.028), and -17.46 ± 333.07 and -168.38 ± 297,14 nV in fifth rings (P = 0.046), respectively. The decrease in the mean signal amplitudes between 2° and 20° midperipheral retina was significantly less in TE (-33.59 ± 225,1 nV) than CE (-205.56 ± 345.1 nV) (P = 0.011). There were no significant changes in other parameters. CONCLUSION: The progression in multifocal electroretinography might be stabilized with TES. Further studies with larger sample sizes and a longer follow-up are needed to conclude that TES reduces retinitis pigmentosa progression.

Choroidal vascularity index changes during the Valsalva manoeuvre in healthy volunteers.

PURPOSE: To evaluate the effects of the Valsalva manoeuvre (VM) on the choroidal vascularity index (CVI) in healthy volunteers. METHODS: This prospective, cross-sectional study included 60 eyes of 30 healthy volunteers. Enhanced depth imaging-optical coherence tomography scans of both eyes involving the fovea were taken, and a 1500 µm subfoveal choroidal area was selected for image binarization with open-access Fiji software. The binarized image was segmented into the stromal area (SA) and luminal area (LA), and CVI was calculated as the ratio (%) of LA to the total choroidal area (TCA). CVI, subfoveal choroidal thickness (SFCT), IOP, systolic and diastolic blood pressure were evaluated at rest and during the VM. RESULTS: During the VM, a mean ± standard deviation increase in LA (0.02 ± 0.05 mm2 , p < 0.001) and CVI (1.72 ± 2.83%, p < 0.001) was observed, whereas SA (-0.02 ± 0.05 mm2 , p < 0.001) decreased. There was no significant change in TCA (0.00 ± 0.03 mm2 , p = 0.55) or SFCT (1.05 ± 10.92 µm, p = 0.46). There was a moderate positive correlation between the spherical equivalent refractive error (SE) and SFCT both at rest and during VM (r58  = 0.49, p < 0.0005 and r58  = 0.49, p < 0.0005, respectively). However, there was no significant correlation between SE and CVI either at rest or during VM (p = 0.11 and 0.06, respectively). In a multiple linear regression analysis, CVI was only associated with SFCT; however, SFCT was also associated with SE, both at rest and during VM (p < 0.001). CONCLUSION: Valsalva manoeuvre increases CVI by choroidal vascular dilation as demonstrated by an increase in LA and a decrease in SA. Researchers should be careful about unintentional VM during examinations.

Evaluation of factors affecting body mass index of children with intellectual disability.

This study was conducted to evaluate the BMI of the children with intellectual disability and the factors affecting their BMI. This descriptive and cross-sectional study was carried out between March 2016 and April 2016 in Turkey and consisted of 135 children. Children's anthropometric measurements were and their BMI values were calculated. Categorization of children by BMI percentile according to AAP reference values was performed. There was a significant difference between the BMI categories of the children (p < 0.05) and the education level of children's father (x2 = 8.960; p = 0.028), the degree of intellectual disability (x2 = 16.113; p = 0.008), the presence of other disabilities (x2 = 22.013; p = 0.000), type of disability (x2 = 21.359; p = 0.001), the nutrient intake (x2 = 38.935; p = 0.000) and the presence of nutritional problems (x2 = 7.687; p = 0.042). Father's education level, children's degree of disability, child's having presence of other disabilities, child's being dependent in the view of nutrient intake, and child's having nutritional problems were determined as factors affecting BMI.

Angiographic findings in cases with a history of severe retinopathy of prematurity treated with anti-VEGFs: Follow-up to age 6 years.

PURPOSE: To report the effects of anti-vascular endothelial growth factor (VEGF) treatment in vascular development for cases of acute retinopathy of prematurity (ROP) using fluorescent angiography (FA) and to present the results of our observational approach to retinal sequelae. METHODS: A total of 31 eyes in 19 patients with a history of treatment with anti-VEGF agents for classic type 1 ROP and aggressive posterior ROP who underwent FA between March 2014 to February 2020 were reviewed. Angiograms of retinal developmental features of patients aged 4 months to 6 years were examined. RESULTS: The patients mean gestational age were 26.06 ± 1.90 weeks and the mean birth weight were 837.68 ± 236.79 g. All cases showed various abnormalities at the vascular and avascular retina, and the posterior pole. All but one case showed a peripheral avascular area on FA evaluation during the follow-up period. We did not apply prophylactic laser treatment to these avascular retina. On the final examination, except one case, we did not observe any late reactivation in any patients. CONCLUSION: FA is an important tool for assessing vascular maturation in infants. Every leakage should not be assumed to be evidence of late activation, as some leaks may be related to vascular immaturity. Retinal vascularization may not be completed in all patients, however this does not mean that all these patients need prophylactic laser application. Our observational approach may be more daring than the reports frequently encountered in the literature, but it should be noted that unnecessary laser treatment will also eliminate all the advantages of anti-VEGF treatment.

The effect of COVID-19 pandemic restrictions on neovascular AMD patients treated with treat-and-extend protocol.

PURPOSE: To investigate the adherence rate of neovascular age-related macular degeneration (nAMD) patients in treat-and-extend (TAE) protocol to their anti-vascular endothelial growth factor (anti-VEGF) intravitreal injection (IVI) appointments and to evaluate the functional and anatomical outcomes of the patients who attended and did not attend their IVI appointments during the coronavirus disease 2019 (COVID-19) restriction period (RP). METHODS: The patients with nAMD having IVI appointments between March 16 and June 1, 2020 (RP in Turkey) were included in this retrospective study. For adherence analysis, the patients who attended (Group 1, n = 44) and who did not attend (Group 2, n = 60) their IVI appointment visits during the RP (VRP) were evaluated according to their last visit before the RP (V0). For outcome analysis, the patients who attend VRP and have follow-up (Group 1a, 46 eyes) and who did not attend VRP but later attended for follow-up (Group 2a, 33 eyes) were evaluated for functional (best-corrected visual acuity, BCVA [logMAR]) and anatomical (optical coherence tomography [OCT] disease activity) outcomes at the first visit after RP (V1) and last visit within six months after RP (V2). Patients received a complete ophthalmologic evaluation with anti-VEGF (Aflibercept) IVI administration at all visits. RESULTS: The adherence rate of the patients to VRP was 42.3% (44/104). The patients in Group 1 were significantly younger (mean ± SD years, 71.0 ± 8.1 vs. 74.7 ± 8.0, p = 0.024), had better median [IQR] BCVA at their first presentation (0.30 [0.54] vs. 0.61 [1.08], p = 0.023) and V0 (0.40 [0.48] vs. 0.52 [0.70], p = 0.031), and had less hypertension (36.4% vs. 58.3%, p = 0.044) than Group 2. The mean ± SD delay of planned IVI at VRP in Group 2a was 13.9 ± 6.2 weeks. Disease activity in OCT was significantly higher in Group 2a than Group 1a at V1 (60.6% vs. 32.6%, p = 0.025). In Group 2a, the median (IQR) BCVA was significantly worse at V1 (0.70 [0.58]) and V2 (0.70 [0.59]) than V0 (0.52 [0.40], p = 0.047 and p = 0.035, respectively). CONCLUSIONS: More than half of the scheduled nAMD patients in TAE protocol missed their IVI visits during the RP, which resulted in a delay of their treatments. The delay of IVI treatment in those patients resulted in an increase in OCT disease activity and a decrease in BCVA.

Compound muscle action potential scan and MScanFit motor unit number estimation during Wallerian degeneration after nerve transections.

BACKGROUND: Compound muscle action potential (CMAP) scan and MScanFit have been used to understand the consequences of denervation and reinnervation. This study aimed to monitor these parameters during Wallerian degeneration (WD) after acute nerve transections (ANT). METHODS: Beginning after urgent surgery, CMAP scans were recorded at 1-2 day intervals in 12 patients with ANT of the ulnar or median nerves, by stimulating the distal stump (DS). Stimulus intensities (SI), steps, returners, and MScanFit were calculated. Studies were grouped according to the examination time after ANT. Results were compared with those of 27 controls. RESULTS: CMAP amplitudes and MScanFit progressively declined, revealing a positive correlation with one another. SIs were higher in WD groups than controls. Steps appeared or disappeared in follow-up scans. The late WD group had higher returner% than the early WD and control groups. CONCLUSIONS: MScanFit can monitor neuromuscular dysfunction during WD. SIs revealed excitability changes in DS.

Immediate changes in blood pressure during intravitreal anti-VEGF agents' applications in exudative age-related macular degeneration patients.

PURPOSE: To determine the short-term changes in systemic arterial blood pressure (SABP) during intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection in patients with exudative age-related macular degeneration (ARMD). MATERIALS AND METHODS: This study retrospectively reviewed the data of 550 patients with exudative ARMD, who received intravitreal anti-VEGF (bevacizumab or ranibizumab; selected randomly) injections. Patients with hypertension on medication with antihypertensive drugs were assigned to the hypertension group (HTG; n = 278); those with normal blood pressure and not on antihypertensive drugs were assigned to the normotensive group (NTG; n = 272). The SABP levels were measured 30 min before anti-VEGF injection (baseline = B), during anti-VEGF injection (DI), as well as 30th (I30) and 60th (I60) min after anti-VEGF injection. RESULTS: Both groups had significantly higher systolic blood pressure (SBP) at DI than that of the baseline values (p < 0.001), whereas the diastolic blood pressures (DBP) increased significantly at DI, I30, and I60 compared with baseline (p < 0.001). In NTG, SBP was significantly higher in patients at I30 (p = 0.019), whereas that in HTG was significantly higher at all measurements (p < 0.05) only in patients who received intravitreal bevacizumab injection. CONCLUSION: Our study results show that intravitreal anti-VEGF injection is associated with a short-term increase in SABP. To prevent potential systemic complications during anti-VEGF administration, the systemic status of patients with ARMD should be evaluated before the injection and those with a risk of high SABP during injection should be closely monitored.

Early Retinal Findings Following Cooling in Neonatal Encephalopathy.

BACKGROUND AND AIM: Perinatal HI (hypoxia-ischemia)-related visual defects including blindness are known to be associated with ischemic lesions in intracerebral visual pathways and ischemic retinal damage (IRD). Intraocular hemorrhages (IOH) such as retinal hemorrhage (RH), which may result from perinatal HI, can cause IRD by various mechanisms. We aimed to evaluate the early retinal findings in neonates with moderate-to-severe neonatal encephalopathy (NE) who underwent TH and its relationship between coagulation status, amplitude-integrated electroencephalography (aEEG) patterns, and magnetic resonance imaging-magnetic resonance spectroscopy (MRI-MRS) findings. METHOD AND PATIENTS: A total of 31 newborn infants who underwent moderate-to-severe NE and TH included in the study. Coagulation parameters were taken immediately before starting TH, and daily during TH period. aEEG records were obtained during TH and rewarming period.Binocular indirect ophthalmoscopic examination (BIOE) and MRI-MRS scanning were performed when TH protocol completed. RESULTS: Total 13 (41.9%) patients had abnormal BIOE findings. Ten of them were (77%) IOH, other findings are as follows: RH (n = 7), optic disc hemorrhage (n = 2), and vitreous hemorrhage (n = 1). Initial coagulation status was not related to IOH. Worsened aEEG and MRI-MRS results were not related to BIOE findings. CONCLUSION: Frequency of IOH is high in newborns with NE who underwent TH being independent from severity of MRS-MRI findings, aEEG pattern, and disturbed coagulation status.

Evaluation of efficiency of puppet show in decreasing fears of school-age children against medical procedures in Zonguldak (Turkey).

OBJECTIVE: To determine children's medical fears and to evaluate the effectiveness of puppet show to decrease such fears. METHODS: The quasi-experimental study was conducted from February 1 to May 31, 2016, in Zonguldak, Turkey, and comprised primary school students. Descriptive Information Form and Medical Operations Fear Scale were used to collect data. Those found to be 'very afraid' subsequently underwent a puppet show. The Scale was applied postintervention o track changes. SPSS 18 was used for data analysis. RESULTS: There were 617 children with a mean age of 8.86}0.96 years and studying in second third and fourth grades. Of them, 316(51.2%) were boys. The mean score on the fear scale was 43.9}1.03 (range: 29-87); 58(9.4%) were terrified of medical procedures. There was a significant difference between the scores of children with respect to the year of education (p=0.001), age (p=0.0001), previous hospitalisations (p=0.0001), previous fears related to hospitalisations (p=0.0021) and fear of being sick (p=0.0001). Two sessions of puppet shows were performed for 44(76%) of the terrified students. There was a significant difference between baseline and post-intervention scores (p=0.0001).. CONCLUSIONS: Age, previous negative experiences of hospitalisations and the fear of being sick were factors that shaped children's medical fears. Puppet show effectively decreased such fears.

Investigation of the Fear of 7-18-Year-Old Hospitalized Children for Illness and Hospital.

Illness and hospitalization are conditions leading to negative effects in children's lives regardless of their age. This study was performed descriptively in order to examine the fears of hospitalized children for illness and hospital. The study was descriptive and sectional and performed in Karabük University (Turkey) Training and Research Hospital between February 1 and May 1, 2015. Sample of the study was composed of 144 children who were hospitalized due to an acute illness and their parents who approved to participate in the study. Participant information form and an information form that was prepared to evaluate the fears of children for illness and hospital were used as data collection tools. Data were collected by face-to-face interview technique. Statistical analyses were used to assess data. It was found that 56.2% of children in the study were males and were between 7 and 10 years of age; 42.4% were scared of getting illness. 39.5% of 86 children who were previously hospitalized have stated that they experienced fear due to hospitalization; injections were in the first place among causes of fear by 64.7%. When the causes of children's fear for illness and hospital were examined, it was determined that "undergoing an operation (3.21 ± 1.13)," "staying away from the family during hospitalization (3.11 ± 0.96)" and "worrying the family when he/she gets an illness (3.02 ± 1.05)" were in the first three ones. When the relationship between some characteristics of the children and their parents and children's status of fear for illness was investigated, it was detected that there was a significant difference between their previous fear of hospitalization and their current status of fear for getting illness (p = 0.003). It was observed that children in the study experienced fear for illness and hospitalization and the percentage of children with fears was found to be high. It was also determined that undergoing an operation, staying away from the family during hospitalization and worrying the family when he/she gets an illness were among the first causes of their fears.

Erdheim-Chester disease diagnosed by 99mTc-MDP bone scintigraphy and brief literature review.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis with lipid-laden macrophages and fibrosis. Although ECD is a multisystemic disease, the most common finding is sclerotic bone involvement in the diametaphyseal regions of bilateral distal femur and in proximal and distal tibia. We present a 40 years old woman who for the last two years had various systemic symptoms, especially knee pain, polyuria and polydipsia. Although a "hot knee" pattern was seen in bone scintigraphy (BS), a femur biopsy was performed, due to the preliminary diagnosis of haematologic malignancy. The biopsy specimen showed only intense fibrosis. One year later while the patient was in our clinic, BS showed characteristic for ECD bone involvement. Bone biopsy specimens stained in hematoxylin and eosin showed dense fibrosis but not histiocytosis. However, after immunohistochemical staining with CD-68, histiocytes were discerned. In conclusion, the authors underline that ECD was diagnosed at a second diagnostic attempt both clinically and by specific staining pathology specimens.

A further family of Stromme syndrome carrying CENPF mutation.

Stromme syndrome is a rare genetic disorder characterized by microcephaly, anterior ocular chamber anomalies, and "apple peel" type jejunal atresia. Here, we report a Stromme syndrome family with two affected siblings with a homozygous truncating frameshift mutation in CENPF. A 3-month-old girl was hospitalized due to prenatally diagnosed microcephaly, microphthalmia, and dysmorphological features. The history of a previous child with the same findings in addition to "apple peel" intestinal atresia had been noted. Regarding the clinical features of both affected siblings, a diagnosis of Stromme syndrome was established. Exome-sequencing of these two cases showed the homozygous mutation (c.5912_5913insA)/(p.T1974Nfs*9) in CENPF. While confirmation of this gene being responsible for Stromme syndrome was pending our results, Filges et al. reported that CENPF was indeed underlying the reason for Stromme syndrome. This is the second case report identifying CENPF mutation as the cause of Stromme syndrome.