Optical coherence tomography findings in primary headache disorders: is pain duration a clinical correlate?

OBJECTIVE: Ganglion cell layer thickness (GCLT) may be used as a potential marker for central neural changes. We compared GCLT by using spectral domain optical coherence tomography (SD-OCT) in patients with primary headache disorders and healthy controls. We seek whether there was any difference between the headache groups and whether any clinical parameters correlated to GCLT. METHODS: Fifty-three primary headache patients, 11 age and sex-matched healthy subjects were included in this cross-sectional study after power analysis. All subjects underwent SD-OCT. The duration of disorder, headache frequency, severity, duration of pain, presence of ocular pain, and accompanying symptoms have been collected. RESULTS: Mean GCLT of the headache group was 15.7 ± 3.8 µm (mean ± standard deviation), and the control group was 17.5 ± 2.4. The difference was not statistically significant. When we compared the controls, migraine and tension-type headache patients' GCLT values, we found a significant difference (ANOVA, p = 0.001). Migraine patients had thinner GCLT compared to all non-migraine headache patients (p = 0.01). Intraocular pressure values of migraine patients and non-migraine patients were not statistically significantly different (p = 0.13). The only clinical parameter that correlated with GCLT was pain duration (r = -0.43 and p = 0.01). The patients with white matter lesions had thinner GCLT (p = 0.046). CONCLUSION: Our results suggest that not long-term suffering from pain but migraine pathophysiology itself seems to affect neuroretinal tissue. Pain duration was moderately and inversely correlated to GCLT, meaning that the longer the headache, the thinner the ganglion cell layer is.

Subacute neurological sequelae in mild COVID-19 outpatients.

Introduction: Neurological aspect of COVID-19 is less understood compared to its respiratory and systemic effects. We aimed to define subacute neurological sequelae in patients who recovered from mild COVID-19. Materials and Methods: This study enrolled long COVID patients who had mild infection, were non-hospitalized, and admitted to our hospital with neurological complaints occurring after COVID-19. The evaluation included detailed history of the symptoms, neurological examination, blood tests and necessary investigations relevant to their personal medical situation, and also a retrospective inquiry about their respiratory and neurological status during the acute phase of infection. Descriptive statistical measures, Chi-square and Student's t-test were utilized. Result: We identified 50 patients (29F/21M) with a mean age of 36.9 ± 1.6 (mean ± SEM). The average time from COVID-19 to admission was 99 days(min-max= 15-247). Most frequent neurological complaints were headache (42%) and cognitive dysfunction (42%). Sleep disturbance (36%), prolonged anosmia (30%), prolonged ageusia (22%), fatigue (22%), and dizziness (8%) followed. Most patients with headache experienced headache also as an acute manifestation of COVID-19 (p= 0.02). Acute-stage sleep disorders were found to be more associated with subacute cognitive symptoms than other central symptoms (p= 0.008). The most common neurological symptom in the acute phase was headache (74%). Six patients, despite the absence of any acute-stage neurological symptoms, presented with emergence of subacute neurological sequela. There were only five patients with pulmonary involvement during the acute stage, who were not different from the rest of the cohort in terms of neurological sequelae. There was no increase of inflammatory markers in the blood tests at the subacute stage, or no association of the symptoms to biochemical parameters. Conclusions: This study gives a description of neurological sequelae of mild COVID-19 at the subacute stage, in a relatively young group, and reveals that cognitive disturbances, as well as headache, are quite frequent.

Synergistic antimicrobial effects of activated lactoferrin and rosemary extract in vitro and potential application in meat storage.

This study aimed to explore the antimicrobial effects of activated lactoferrin (ALF) and rosemary extract (RE) on Escherichia coli O157:H7, Salmonella Enteritidis and Listeria monocytogenes, and to investigate their application potential in the meat storage. Minimum inhibitory concentrations (MICs) of ALF, RE and ALF-RE combinations were determined via microtiter plate assay. MICs of ALF were 1% for E. coli O157:H7; 0.5% for S. Enteritidis and 0.1% for L. monocytogenes. While 15% RE inhibited L. monocytogenes; 30% RE partially inhibited E. coli O157:H7 and S. Enteritidis growth. Synergistic effect of ALF and RE on the inhibition of E. coli O157:H7 increased the activity of ALF two to three folds. Food application of antimicrobials was performed by dipping of meat samples. Both ALF and RE were found effective in the prevention of L. monocytogenes growth about two logs. According to the data, choice of natural antimicrobials may be promising in food preservation.

Effects of continuous theta burst transcranial magnetic stimulation on cortical excitability in patients with idiopathic generalized epilepsy.

INTRODUCTION: Transcranial magnetic stimulation (TMS) is a noninvasive technique for investigating cortical physiologic functions in the brain. In this study, the effects of continuous theta burst stimulation (cTBS) on motor evoked potential (MEP) parameters in patients with idiopathic generalized epilepsy (IGE) were investigated. MATERIALS AND METHODS: Fifteen patients with IGE were included. Motor threshold (MT) and cortical silent period (CSP) were determined before cTBS application. Next, cTBS was applied to the dominant (left) hemisphere M1 hand area as the first application. After 1 day, cTBS was applied first to the left M1 hand area and then to the right lateral cerebellar area as the second application. Parameters were again determined after the applications. RESULTS: There was no difference in resting MT values before and after cTBS application (p>0.05). Although CSP increased after stimulation (p<0.05), it was not significantly different between applications (p>0.05). CONCLUSION: For patients with epilepsy, cTBS is a safe technique when applied at a low intensity. The inhibitory effect of cTBS, a noninvasive technique, on cortical excitability in patients with IGE was determined using MEP parameters. The effect lasted at least 1 h. To our knowledge, this is the first study to assess the effect of cTBS on cortical excitability in patients with IGE. Our findings indicate that cTBS decreases cortical excitability in patients with IGE.

Distribution and pattern of implant therapy in a part of the Turkish population.

OBJECTIVE: To report the distribution and pattern of implant replacement of missing tooth/teeth. METHODS: This retrospective study was conducted at the Suleyman Demirel University, Isparta, Turkey, and used data of patients who had undergone implant replacement of missing teeth/tooth from May 2008 to May 2013. Data analysis included age, gender, number of implants placed, implant location distribution, additional surgery protocol, type of dentures and failure rate. SPSS 12 was used for data analysis. RESULTS: A total of 843 dental implants were performed on 280 patients, 143(51.1%) of whom were men and 137(48.9%) women. Besides, 89(31.8%) of all the participants were aged between 40-49 years. Moreover, 218(77.9%) patients received fixed dentures and 62(22.1%) received overdentures. The posterior region of mandible was the location in 281(33.3%) implants. Bone augmentation was performed in 152(54.3%) patients. Hard tissue grafting with sentetic bone grafts was used in 125(63.8%) patients. Failure was observed in 23(2.7%) implants. CONCLUSIONS: The relationships between denture type and age, and denture type and additional surgery were statistically significant.

18F-FDG PET/CT findings in a case of a semantic variant of primary progressive aphasia.

UNLABELLED: Progressive speech and language disorders are commonly referred to as primary progressive aphasia (PPA), which is a clinical syndrome eroding both speech and language. Functional imaging may reveal the cause of this disorder even if structural imaging is absent. Fluorine-18- fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) allows the assessment of neuronal activity by semi-quantitatively measuring glucose metabolism in the brain. In medical literature, (18)F-FDG PET/CT studies show hypometabolic areas in different regions of the brain which are special clues for differentiating the subgroups of PPA. CONCLUSION: This case was reported to demonstrate the characteristic (18)F-FDG PET CT findings for a semantic variant of PPA.

Methyl cellulose/okra mucilage composite films, functionalized with Hypericum perforatum oil and gentamicin, as a potential wound dressing.

There is a growing demand for the development of functional wound dressings enriched with bioactive natural compounds to improve the quality of life of the population by accelerating the healing process of chronic wounds. In this regard, a functional composite film of okra mucilage (OM) and methylcellulose (MC) incorporated with Hypericum perforatum oil (Hp) and gentamicin (G) was prepared and characterized as a wound dressing. Increasing Hp resulted in improved film properties with a more porous structure, higher WVTR, and lower surface hydrophobicity. Furthermore, incorporating Hp into OM:MC films led to increased elongation at the break while reducing the tensile strength of the films. The highest values of total antioxidant capacity (1.09-1.16 mM trolox equivalent) and total phenolic content (13.76-16.94 µg GA equivalent mL-1) were measured in the composite films containing the highest Hp concentration (1.5 %). In addition, OM:MC/HpG composite films exhibited significant antibacterial activity against both E. coli and S. aureus and prevented the transmission of these bacteria through the films. Hp incorporation reduced the cytotoxic effects of OM:MC films on BJ cells and increased the wound closure rate in vitro. In conclusion, the developed OM:MC/HpG composite film can be a promising candidate as a novel wound dressing with its superior properties.

The Effect of Distance Education Conducted during the COVID-19 Pandemic Period on the Psychomotor Skill Development of a Dental School Students.

Purpose: This study compared the development of face-to-face (F2F) psychomotor skills vs. a modified online dental anatomy course during the COVID-19 pandemic. Methods: The 9-HPT is regularly applied for the students' psychomotor skill assessment in the Faculty of Dentistry of Süleyman Demirel University. In the 2020-21 academic year, 92.2% of students who took the dental anatomy course in distance education voluntarily participated in this study (observation group). These data were compared with 34.6% of students who applied for 9-HPT in 2019-2020 in F2F education (control group). The Mann-Whitney U test and t-test were used for comparison. The significance level was taken as p < 0.05. Results: Based on the dominant hand 9-HPT score, a positive change occurred in 81.8% of the F2F and 61.6% of the online education students. Based on both dominant and nondominant hand 9-HPT scores, a statistically significant difference between the change in scores according to the fall/spring term measurements was observed in both F2F and distance education (p < 0.001). However, the F2F-educated group students showed better psychomotor skill development than those exposed to the online-educated group in 9-HPT. The results showed statistical significance for both dominant and nondominant hands (p < 0.001). Conclusion: The F2F education is the gold standard in psychomotor skill training; however, in cases where this approach cannot be realized, practical training protocols modified for online training may contribute to the motor development of students.

Headache and cognitive disturbance correlate with ganglion cell layer thickness in patients who recovered from COVID-19.

BACKGROUND: Retinal abnormalities are being increasingly reported in COVID-19, in addition to the well-known symptoms of this disease accounting for the neurological involvement. In this study, we aimed to investigate whether ganglion cell layer thickness (GCLT) was different in recovered COVID-19 patients compared to controls in the subacute stage and to determine whether it correlated with COVID-19-related neurological symptoms or pneumonia. METHODS: This study involved 40 patients who had recovered from COVID-19 and 40 age- and sex-matched healthy controls. All the participants underwent ophthalmological examination, spectral domain optical coherence tomography and neurological examination. The clinical and biochemical properties of the patients were noted and their correlations with GCLT were sought. RESULTS: The duration after COVID-19 infection was 113 ± 62 (mean ± SD) days. At this subacute stage, there was no significant difference between the GCLT measurements of the COVID-19 patients and the controls (14 ± 4.0 µm [median ± IQR] vs 16 ± 4.8 µm, respectively). When we analyzed the relationships with neurological symptoms in the patient group, we found that patients with cognitive symptoms had lower GCLT values compared to those without (13 ± 3 µm vs. 16 ± 4 µm, respectively; p = 0.002). Patients who suffered headache during the acute infection also had lower GCLT values compared to those without (14 ± 4 µm vs. 18 ± 5 µm, respectively; p = 0.015). The GCLT values did not differ significantly with respect to anosmia, ageusia, sleep disturbances, having had COVID-19 pneumonia, or smoking status. Age, duration after COVID-19, and blood levels of thyroid stimulating hormone, glucose, vitamin D and vitamin B12 were not in correlation with GCLT in our study. CONCLUSION: Our findings highlight an association between GCLT values and neurological symptoms such as cognitive disturbance (brain fog) and headache in patients who had recovered after non-severe COVID-19 infection. Neuroretinal involvement by SARS-CoV2 might be linked to central neurological symptoms. The patients with lower GCLT values may benefit from close monitoring for neurological problems.

Normal Pressure Hydrocephalus Overshadowed by Traumatic and Degenerative Spinal Diseases: A New Assessment Proposal.

AIM: Normal pressure hydrocephalus (NPH) is a rare disorder among the elderly, characterized by gait disorder, dementia, and urinary incontinence. Considering the rareness of NPH and a lot of other pathologies, such as Parkinson's disease, lumbar spinal stenosis, and even aging cause similar symptoms, NPH is an underdiagnosed entity. However, the percentage of misdiagnosis is not given in the literature. MATERIAL AND METHODS: In this study, patients diagnosed with NPH were retrospectively screened between 2015 and May 2019 in our clinical database and Ste-P formula was applied. Example cases showed that some of the patients receive inaccurate medical and surgical treatments before being diagnosed with NPH. RESULTS: As a result of the study was seen that a few out of 29 patients confused dizziness with trunkal ataxia or imbalance due to gait abnormality. As the time between onset of complaints and diagnosis increased, the value approached "zero", and diagnosis became difficult. CONCLUSION: Every unnecessary operation carries serious risks that may threaten the life of the patient and decrease the quality of life. These surgeries and instrumentation materials used may also result to additional financial cost. Similarly, long-term use of Parkinson's and dementia medications has a serious economical burden on the insurance systems and is detrimental to the patient's health. Considering all these diagnoses and physiological conditions that can be easily confused with each other, we recommend in this article a new formula to reduce the possibility of misdiagnosis and treatment in patients with walking disorder.

A Resveratrol-Loaded Poly(2-hydroxyethyl methacrylate)-Chitosan Based Nanotherapeutic: Characterization and In Vitro Cytotoxicity Against Prostate Cancer.

The delivery of therapeutic molecules such as drugs, nucleic acids, or other active molecules into the target tissue and cells is limited because of biological and cellular barriers. Recently, many efforts are being made to bypass these barriers using nanosized drug delivery vehicles. For the targeted transfer of anticancer agents into the cancer tissue with higher efficiency and lower cellular toxicity, synthesis of nano-scale smart materials hold great promise due to the enhanced permeability and retention capability. Encapsulation of natural anticancer compounds such as resveratrol displaying low water-solubility and poor chemical stability into nanomaterials are intensely being studied to achieve the enhanced anticancer activity. The aim of this study is to investigate the drug delivery efficiency of the poly(2-hydroxyethyl methacrylate) (pHEMA)-chitosan nanoparticles (PCNPs) against PC-3 human prostate cancer cells In Vitro. To achieve this aim, resveratrol (RES), one of the widely known natural anticancer agent, is encapsulated into pHEMA core and pHEMARES nanospheres were coated with a cationic polymer, chitosan. Then, developed PCNPs-RES complexes were characterized using fourier transformed infrared (FTIR) spectroscopy, ultraviolet (UV) visible spectroscopy, scanning electron microscopy (SEM), dynamic light scattering (DLS), zeta potential and atomic force microscopy (AFM) analyses. The characterization studies revealed the synthesis of PCNPs nanoparticles and the entrapment of RES into PCNPs. Also, the cytotoxicity and drug delivery efficiency of PCNPs-RES complexes were tested in human prostate cancer cells, PC-3, In Vitro. As a consequence, PCNPs was shown to be a promising candidate as a new generation nanotherapeutic against prostate cancer In Vitro.

Superficial radial neuropathy and brachioradial motor nerve palsy associated with proximal radius osteochondroma.

The cutaneous branch of the radial nerve (superficial radial nerve, SRN) might be compressed or injured at various anatomical sites along its course in the forearm. Compression of the SRN occurring at the proximal third of the forearm is unusual. A 22-year-old man was admitted with pain and paraesthesia over the lateral aspect of his right wrist and thumb and pain at the elbow for six months. In electrodiagnostic testing, a sensory nerve action potential from the right SRN could not be recorded, while it was normal on the left. In a needle electromyography study, denervation potentials have been seen in the right brachioradial muscle and a decrease in interference pattern signals was also found. An exophytic lesion of the proximal radius was observed in radiographs. Computed tomography evaluation revealed an osteochondroma of the proximal radius. Neuropathies of the SRN and the brachioradial motor branch of the radial nerve are thought to be associated with proximal radial osteochondroma.

Evoked potential studies can only be interpreted as a neurophysiologic measure if applied accurately.

Evoked potentials are commonly used in neurology but standardized protocols have to be carried out during both application and evaluation. Otherwise adequacy and reliability might be questioned, which is unacceptable in evidence-based modern science. Both motor and somatosensory evoked potential studies can only be interpreted as a neurophysiologic measure in cord lesions if applied irreproachably.

Reversible cerebral vasoconstriction syndrome: case report.

A 28-year-old woman had thunderclap headache (TCH), after 7 days she had left hemiparesis. She had a history of oral contraceptive and citalopram medications. Brain magnetic resonance (MR) angiography demonstrated multiple stenotic segments. Digital subtraction angiography (DSA) showed multiple segments of narrowing in vessel calibre. Two probable diagnoses performed; primary angiitis of the central nervous system and reversible cerebral vasoconstriction syndrome (RCVS). Because of clinical characteristics and normal cerebrospinal fluid findings she was set on medication for probable RCVS. Follow-up MR angiography after 4 weeks and DSA after 7 weeks demonstrated improvement in vessel calibre. Thus, diagnosis RCVS was established. Diagnosis and management of TCH contain many potential difficulties. Clinicians should consider the imaging of cerebral arteries, even if computed tomography scan and lumbar puncture are normal in TCH. Potential precipitating factors and triggers should also be known and avoided.

Long-term follow-up of patients with adult-onset subacute sclerosing panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is a rare infectious central nervous system disease with a poor prognosis. Nineteen patients, 18 males and one female, ranging in age from 18 to 22, mean 19.6+/-1.5 years with SSPE were evaluated. We treated 9 patients with oral isoprinosine and 10 patients with alpha-interferon plus oral isoprinosine and followed up for 16 to 160 months. Of the 9 patients treated with oral isoprinosine, 7 (77.7%) died, one stabilized, and one showed progression. Seven (70%) of 10 patients treated with alpha-interferon plus oral isoprinosine died, one showed progression, and stabilization was observed in two patients. Thus, we suggest that isoprinosine alone or in combination with intraventricular interferon did not change the prognosis in long-term follow-up periods.

Change of shade by light polymerization in a resin cement polymerized beneath a ceramic restoration.

OBJECTIVES: The aim of this in vitro study was to examine the effect of the color changes of a resin cement material (Variolink II) polymerized beneath a simulated ceramic restoration (IPS Empress II) by two different light polymerizing units. METHODS: A conventional halogen light and a light emitting diode unit were used to polymerize resin cement with catalyst. A pressable ceramic block (10mm in diameter, 2 or 1mm in height) was used as an interface between the polymerizing light tip and resin cement. Colorimetric values of the specimens before and after polymerization were measured using a spectrophotometer (Easy Shade). The CIE L*a*b color system was used for the determination of the color difference. Differences between measurements were calculated as delta E*(ab). Repeated measurements analysis of variance (ANOVA) was used to analyze the data (polymerization of resin cement, polymerizing unit and ceramic thickness) for significant differences. The Tukey HSD test and paired two-tailed tests were used to perform multiple comparisons (alpha=.05). RESULTS: L*a*b values of ceramic system were affected by the polymerization of resin cement (before and after) (P<.01). The a* value was affected by polymerization unit (P<.05), however L* and b* values were not affected by the light polymerization unit (P>.05). The b* value was affected by ceramic thickness (1 or 2mm) (P<.05), but L* and a* values were not affected by ceramic thickness (P>.05). The specimens polymerized beneath 1mm ceramic thickness with conventional halogen light induced a significantly higher color changes than any other specimen (P<.05). CONCLUSIONS: The results of this in vitro study suggest that light polymerization of the resin cement (Variolink II) used in this study is an important factor for the color of the definitive restoration and should be considered during shade selection and fabrication.

Visual and brainstem auditory evoked potentials in children with headache.

BACKGROUND: Headache is a common problem in the pediatric population. The purpose of the present study was to evaluate visual evoked potentials (VEP) and brainstem auditory evoked potentials (BAEP) in children with headache. METHODS: Thirty-seven children fulfilling the International Headache Society Criteria for a diagnosis of migraine, 35 children with tension-type headache and 40 healthy children (control group) were enrolled in the study. RESULTS: The mean age of patients and controls was 10.4 years. P100 latency and amplitudes of migraine patients were significantly higher than children with tension-type headache and control subjects. Children with tension-type headache also had higher P100 latency and amplitude values than control subjects but there was no statistical difference. BAEP responses were similar between all groups. CONCLUSION: Measurement of VEP latency and amplitude is a valuable and reliable test for the diagnosis of migraine and can be used safely in childhood.

Pregnancy and teratogenicity of antiepileptic drugs.

Maternal use of antiepileptic drugs (AEDs) during pregnancy has been associated with an increased risk of congenital abnormalities in the fetus. This is partly attributable to AEDs. We aimed to analyse seizure frequency and the rate and type of any congenital malformation related to pregnancies in women with epilepsy in this prospective study. Eighty four pregnant women with epilepsy on AEDs were followed for congenital malformations. Z test was used for statistical analysis. Pregnancy did not influence the seizure frequency in 64 (76.2%) pregnancies. The seizure frequency increased in 16 (19.04%) pregnancies. In 4 (4.76%) pregnancies the number of seizures decreased during pregnancy. Overall percentage of congenital malformations in infants of mothers with epilepsy treated with AEDs was 10%, versus 3.65% in the general Turkish population. Percentages of malformations in children of pregnancies in women with epilepsy on antiepileptic drugs (AEDs) were; 6.52% (3/46) for carbamazepine (CBZ), 14.28% (2/14) for phenytoin (PHT), 13.33% (2/15)for valproic acid (VPA) and 20% (1/5) for phenobarbital (PB). This comfirms previous reports that all four AEDs (CBZ, PHT VPA, PB) are associated with an increased risk of congenital malformations, although CBZ seems to be the the safest agent in monotherapy.

Resveratrol induces mitochondria-mediated, caspase-independent apoptosis in murine prostate cancer cells.

Found in the skins of red fruits, including grapes, resveratrol (RES) is a polyphenolic compound with cancer chemopreventive activity. Because of this activity, it has gained interest for scientific investigations. RES inhibits tumor growth and progression by targeting mitochondria-dependent or -independent pathways. However, further investigations are needed to explore the underlying mechanisms.The present study is focused on examining the role of RES-induced, mitochondria-mediated, caspase-independent apoptosis of prostate cancer cells, namely transgenic adenocarcinoma of mouse prostate (TRAMP) cells. These cells were exposed to RES for various times, and cell killing, cell morphology, mitochondrial membrane potential (Δψm), expression of Bax and Bcl2 proteins, the role of caspase-3, and DNA fragmentation were analyzed.TRAMP cells exposed to RES showed decreased cell viability, altered cell morphology, and disrupted Δψm, which led to aberrant expression of Bax and Bcl2 proteins. Furthermore, since the caspase-3 inhibitor, z-VAD-fmk (benzyloxycarbonyl-valine-alanine-aspartic acid-fluoromethyl ketone), had no appreciable impact on RES-induced cell killing, the killing was evidently caspase-independent. In addition, RES treatment of TRAMP-C1, TRAMP-C2, and TRAMP-C3 cells caused an appreciable breakage of genomic DNA into low-molecular-weight fragments.These findings show that, in inhibition of proliferation of TRAMP cells, RES induces mitochondria-mediated, caspase-independent apoptosis. Therefore, RES may be utilized as a therapeutic agent to control the proliferation and growth of cancer cells.

Immunogenicity of RSV F DNA Vaccine in BALB/c Mice.

Respiratory syncytial virus (RSV) causes severe acute lower respiratory tract disease leading to numerous hospitalizations and deaths among the infant and elderly populations worldwide. There is no vaccine or a less effective drug available against RSV infections. Natural RSV infection stimulates the Th1 immune response and activates the production of neutralizing antibodies, while earlier vaccine trials that used UV-inactivated RSV exacerbated the disease due to the activation of the allergic Th2 response. With a focus on Th1 immunity, we developed a DNA vaccine containing the native RSV fusion (RSV F) protein and studied its immune response in BALB/c mice. High levels of RSV specific antibodies were induced during subsequent immunizations. The serum antibodies were able to neutralize RSV in vitro. The RSV inhibition by sera was also shown by immunofluorescence analyses. Antibody response of the RSV F DNA vaccine showed a strong Th1 response. Also, sera from RSV F immunized and RSV infected mice reduced the RSV infection by 50% and 80%, respectively. Our data evidently showed that the RSV F DNA vaccine activated the Th1 biased immune response and led to the production of neutralizing antibodies, which is the desired immune response required for protection from RSV infections.