An anatomical analysis of the occipital nerve complex: an essential tool for the application of occipital nerve blocks.

BACKGROUND: Occipital nerve blocks are essential in diagnosing and treating headache disorders such as migraine, cervicogenic headache, occipital neuralgia, and cluster headache. In this study, we aimed to investigate the potential compression points of the greater occipital nerve (GON), third occipital nerve (TON), and lesser occipital nerve (LON) which are targeted to block in occipital nerve blocks and to develop a method to detect these points easily. METHODS: To identify potential compression points of the GON, TON, and LON, we dissected 43, 41, and 26 cadavers, respectively. A rigid, transparent tool divided into 1 × 1 cm sections was placed on the external occipital protuberance to measure the determined points. The cadaveric head was viewed from above, vertically, and the coordinates corresponding to each point were noted separately. RESULTS: Six, four, and one potential entrapment points were detected for the GON, TON, and LON, respectively. The distances of the point where the GON arose from the lower border of the obliquus capitis inferior muscle and the emerging point of the TON from the C2-C3 vertebrae to the posterior midline were statistically significant in terms of the sides (p = 0.040). Similarly, there was a statistical significance between genders for the distance of the point where the LON arose from the posterior edge of the sternocleidomastoid muscle to the posterior midline (p = 0.002). CONCLUSIONS: We believe that with the method developed, the GON, TON, and LON compression points can be easily localized and blocked in diagnosing and treating patients experiencing headaches such as migraines, cervicogenic headaches, occipital neuralgia, and cluster headache.

Quality and Reliability of YouTube Video Contents About Sports Mouthguards: A Cross-Sectional Study.

BACKGROUND: Sports dentistry aims to prevent and manage orofacial injuries, tooth fractures, tooth loss, and soft tissue trauma during sport activities. Mouthguards are appliances that protect athletes from dental trauma during contact sports. The video-sharing platform YouTube has a large number of informative videos about mouthguards. This study aimed to analyze the quality, accuracy, and reliability of YouTube videos about mouthguards, investigate the relationship between the features and the quality of mouthguard videos on YouTube, and provide suggestions for future informative content about mouthguards and sports dentistry. MATERIALS AND METHODS: The first 100 videos for each keyword from YouTube were collected using the keywords "mouthguard," "sports mouthguard," and "mouthguard and dental trauma." Videos meeting the inclusion criteria were categorized based on publisher (dental professionals and nonprofessionals) and type (animation/slideshow, interview, and product introduction). Video features were recorded. Video content quality, reliability, and accuracy were measured by the Video Information and Quality Index (VIQI), the Journal of the American Medical Association (JAMA) benchmarks, the DISCERN Instrument, the Global Quality Scale (GQS), and the usefulness score. Data were analyzed using SPSS (IBM 29.0) at a 95% statistical significance level (p = 0.05). RESULTS: Out of 300 videos, 80 videos were included. Most of the videos were uploaded by dental professionals (n = 49). The average values of the VIQI, JAMA, DISCERN, and GQS scores were 15.33 out of 20.0, 1.38 out of 4.00, 49.24 out of 80.0, and 2.99 out of 5.00, respectively. Videos uploaded by dental professionals had significantly higher scores in VIQI, JAMA, DISCERN, GQS, and usefulness scores but exhibited a lower number of likes, comments, and views (p < 0.05). Of all included videos, 51% (n = 41) were categorized as "moderately useful" and 10% (n = 8) as "very useful." CONCLUSIONS: Mouthguard videos uploaded by dental professionals are more useful, accurate, and of higher quality. Therefore, patients should consider the information shared by dental professionals. Greater participation from dentists in sharing high-quality content would be beneficial.

Subclinical atherosclerosis in patients with hidradenitis suppurativa treated with TNF inhibitors.

BACKGROUND: Hidradenitis suppurativa (HS) is an independent risk factor for the development of subclinical atherosclerosis. Tumour necrosis factor (TNF) inhibitors are effective for the treatment of recalcitrant moderate-to-severe HS. However, the effect of treatment with TNF inhibitors on subclinical atherosclerosis in HS patients has not been previously investigated. OBJECTIVES: In this study, we aimed to assess changes in biochemical parameters (fasting blood glucose and lipid levels) and carotid intima-media thickness (CIMT) values in Hurley stage II and III HS patients undergoing treatment with TNF inhibitors. METHODS: This was a single center prospective study including 30 patients with Hurley stage II and III HS and 30 healthy controls (HCs). Baseline values of biochemical parameters and CIMT were compared to the values recorded after at least 6 months of TNF inhibitor therapy. RESULTS: CIMT values of the HS patients significantly exceeded those of HCs (for right p = 0.011 and for left p = 0.017). After at least 6 months of TNF inhibitor therapy, there was a statistically significant decrease in fasting blood glucose (p = 0.001), whereas total cholesterol levels significantly increased (p = 0.001). CIMT values also significantly increased (for right p = 0.02 and for left p = 0.01). STUDY LIMITATIONS AND CONCLUSIONS: Small sample size is limitation of the current study. Our study shows that patients with Hurley stage II and III HS undergoing TNF inhibitor therapy are under risk for progression of subclinical atherosclerosis.

Posterior Reversible Encephalopathy in Sepsis-Associated Encephalopathy: Experience from a Single Center.

BACKGROUND: Sepsis-associated encephalopathy (SAE) is frequently encountered in sepsis and is often accompanied by neuroimaging findings indicating ischemia, hemorrhage, and edema. Posterior reversible encephalopathy syndrome (PRES) has been vastly underrecognized in previously reported cohorts of patients with sepsis and SAE. Our aim was to determine the prevalence and distinguishing clinical, neuroimaging, and electroencephalography features of PRES in SAE. METHODS: In this prospective observational study, patients with radiologically identified PRES were selected from a consecutively enrolled cohort of 156 patients with SAE and assessed for neurological outcome using the extended Glasgow Outcome Scale for 12 months. Patients with SAE and PRES and other types of brain lesions were compared in terms of clinical and diagnostic workup features. RESULTS: Fourteen of 156 patients (8.9%) were determined to be radiologically compatible with PRES, whereas 48 patients displayed other types of acute brain lesions. Patients with PRES often showed lesions in atypical regions, including frontal lobes, the corpus callosum, and the basal ganglia. Source of infection was mostly gram-negative bacteria originating from pneumonia or intraabdominal infections. Patients with PRES were not different from other patients with SAE with brain lesions in terms of features of sepsis and neurological outcome. However, patients with PRES showed increased prevalence of seizures and intraabdominal source of infection. CONCLUSIONS: PRES is highly prevalent in SAE, often encompasses unusual brain regions, and usually presents with generalized seizures. Patients with SAE and PRES do not appear to have distinguishing clinical and diagnostic workup features. However, generalized seizures may serve as warning signs for presence of PRES in patients with SAE.

Diagnostic value of shear-wave elastography for patellar tendinopathy in female volleyball and basketball athletes: a cross sectional case control study.

OBJECTIVES: We aim to investigate the accuracy of shear-wave elastography (SWE) in diagnosing patellar tendinopathy in female volleyball and basketball players. In addition, we compared different parts of the patellar tendon and investigated the effects of different knee angles on elastography measurements. METHODS: This cross-sectional case-control study evaluated 63 female athletes from professional basketball and volleyball teams (NCT06199583). Patellar tendinopathy diagnoses were made using clinical and ultrasonographic criteria. SWE measurements were taken at 30-degree knee flexion and extension. Rectangular regions of interest boxes were placed in three different parts of the tendon (proximal, middle, distal). The global SWE value was calculated by taking the mean of measurements in the three parts. Receiver operating characteristic (ROC) curves were used to identify significant cutoff points for SWE, and 2 × 2 tables were generated to determine sensitivity and specificity. RESULTS: Thirteen (20.6%) of the 63 athletes were diagnosed with patellar tendinopathy. The ROC curves have identified different cutoff scores for SWE measurements. The SWE score of 130.75 from the proximal part showed the highest sensitivity of 89% and specificity of 80% (p < 0.001) with a 4.45 likelihood ratio at the 30-degree knee flexion. The likelihood ratio is 1.5 at a 30-degree angle and 1.65 at a 0-degree angle when measuring the entire tendon, whereas other portions indicate a ratio ranging from 1.12 to 1.73. CONCLUSIONS: Shear-wave elastography is a reliable evaluation method for diagnosing patellar tendinopathy. It has more accuracy when applied to the proximal part and at 30-degree knee flexion compared to measurements taken at knee extension and other parts of the tendon.

Predictive Value of qEEG in Manic Switch of Depressed Patients.

Backgrounds: More than half of the patients with bipolar disorder (BD) had depressive episodes at the onset of BD. Despite some suggested clinical predictors, there are no certain criteria for predicting which unipolar depression patient switch to manic episodes during the treatment course. Electrophysiological markers can address this issue. Methods: Pretreatment quantitative electroencephalography (qEEG) records of patients diagnosed with major depressive disorder (MDD) or BD at the first visit were included in the study. Patients with MDD were also grouped with manic switch (MS) or MDD based on the diagnosis of later visits. The qEEG spectral power was analyzed across 3 groups, that is, MS, MDD, and BD. Results: Compared to patients whose diagnosis did not change, patients with MS had accelerated high-frequency activities predominantly in the left hemisphere (central-parietal-occipital regions). In contrast, they showed increased slow wave activity predominantly in the right hemisphere (parietal-occipital regions). Conclusion: It can be concluded that searching for electrophysiological markers, which have distinct advantages of repeatability, noninvasiveness, and cost-effectiveness, can facilitate the prediction of the MS.

The role of severity and duration of inflammation and hematological parameters on the outcome of subacute thyroiditis.

Background: The role of severity and duration of inflammatory findings on the development of persistent hypothyroidism and anemia has not been clarified in subacute thyroiditis (SAT). Methods: Demographic data and laboratory parameters of patients with SAT were analyzed retrospectively. Results: Permanent hypothyroidism was observed in 28.1% of patients. Baseline elevated erythrocyte sedimentation rate as defined >74.5 mm/h was found to be associated with permanent hypothyroidism, but the duration of inflammation was not different between the recovered and hypothyroid patients. Baseline hemoglobin values improved without specific therapy in 3.5 months. Conclusion: The initial severity but not the duration of inflammation increases the risk for the development of permanent thyroid dysfunction, and anemia improves with the resolution of inflammation.

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Does categorizing scale scores with cutoff points affect hypothesis-testing results?

BACKGROUND: The aim of this study is to evaluate the hypothesis test results after categorizing the scale scores with cut-off points and to assess whether similar results would be obtained in that best represent the categories. METHODS: This cross-sectional study was conducted between March 15 and 20, 2023 via the Lime Survey. The questionnaire included questions about the sociodemographic and life characteristics of the participants and the Beck Depression Inventory II (BDI-II). Four groups (minimal, mild, moderate, severe depression) were formed using the cutoff points. Data analysis was performed with all participants and referred to as the conventional analysis group. Then, six subanalysis groups were determined to best represent the groups formed according to the BDI-II. In each BDI-II category, six subanalysis groups were created, including those between Q1-Q3 (IQR group), including those within ± 1 std, including those between 5p-95p (90% of the sample), including those between 2.5p-97.5p (95% of the sample). In addition, 100 different samples were randomly selected containing 50% of each group. RESULTS: Of the 1950 participants, 84.7% (n = 1652) were female and 15.3% (n = 298) were male. In terms of depression, it was observed that the significance varied in the analysis groups for sex (p = 0.039), medication use (p = 0.009) and age (p = 0.010) variables. However, these variables were not significant in some of the subanalysis groups. On the other hand, a p < 0.001 value was obtained for income, physical activity, health perception, body shape perception, life satisfaction, and quality of life variables in terms of depression in the conventional analysis group, and it was seen that the significance continued in all subanalysis groups. CONCLUSIONS: Our findings showed that variables with p < 0.001 in the conventional analysis group maintained their significance in the other analysis groups. In addition, as the p value got closer to 0.05, we observed that the significance changed according to different cutoff points in the analysis groups. In addition, 50% randomly selected samples support these results. At the end of our study, we reached results that support the necessity of secondary tests in the evaluation of scales. Although further studies are needed, we anticipate that our study will shed light on other studies.

Peak Force of Insertion During Ureteral Access Sheath Placement In An Ex-Vivo Experimental Model With Different Commercially Available Access Sheaths.

OBJECTIVE: To measure the force necessary to win the resistance during insertion of ureteral access sheaths (UAS) in an experimental homemade model and to compare the peak force of insertion (PFOI) of different commercially available UASs. METHODS: Three investigators (2 novice and 1 expert) inserted the UASs into 2 different adapters with diameters of 10 Fr and 8 Fr. The force of insertion was continuously measured with a digital force gauge connected to the UAS during each insertion. Four different brands of UAS with different diameters, totally 11 different UASs were used for the experiment. The PFOI of each UAS was compared among each other and adapter diameters. RESULTS: The mean PFOI in adapters 1 and 2 were 1.85 N and 5.32 N, respectively. All of the mean PFOIs were significantly lower in adapter 1 compared to adapter 2, regardless of the novice vs expert surgeons and the UASs. (P <.001) In adapter 1, the mean PFOI was lowest with the UAS-1 and highest with the UAS-8. In adapter 2, the mean PFOI was lowest with the UAS-3 and highest with the UAS-9. For adapters 1 and 2, no statistical difference was found when comparing an expert and the 2 novice surgeons. CONCLUSION: The PFOI during UAS placement is not solely correlated with UAS thickness and adapter diameters. Other factors such as hydrophilic coating, UAS flexibility, inner dilator properties, UAS smoothness, and the actual measured external diameter of UASs should be taken into consideration. The clinical relevance and ureteral injury risk of the UAS PFOI need to be studied.

NLRP3 gene variants and serum NLRP3 levels in periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome.

OBJECTIVES: Although most of the autoinfammatory disorders have a confirmed genetic cause, periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome still has an unknown genetic background. However, familial cases of PFAPA syndrome have been reported suggesting a genetic its basis. PFAPA syndrome may also be considered an infammasome disorder as variants in infammasome-associated genes such as CARD8, NLRP3, and MEFV have been reported to contribute to the disease. METHODS: Polymerase chain reaction (PCR)/Sanger sequencing analysis was performed for the detection of the variations in 71 PFAPA patients and 71 healthy controls. NLRP3 concentrations in serum were measured in 71 PFAPA patients and 71 healthy controls. RESULTS: No statistically significant differences were observed in the allele or genotype frequencies of the NLRP3 polymorphisms between the controls and patients (P > 0.05). We found no significant differences for NLRP3 serum levels between PFAPA patients and controls (p > 0.05). Mutations in the MEFV gene were detected in 32.5% of our patients (13/40). CONCLUSIONS: It seems that the synergistic effect of different genes plays a role in the formation of PFAPA syndrome. For this reason, it may be useful to examine the presence of mutations in genes such as NLRP3, MEFV, and CARD8 together while investigating the genetics of PFAPA syndrome. Key points • Familial cases of PFAPA syndrome have been reported suggesting a genetic basis for this syndrome. • Elevated serum or plasma levels of IL-1ß, IL-6, and IL-18 have been demonstrated during PFAPA flares in several studies. • It seems that the synergistic effect of different genes plays a role in the formation of PFAPA syndrome.

Quantitative Electroencephalography Findings in Patients With Diabetes Mellitus.

Objective. Diabetes mellitus (DM) causes structural central nervous system (CNS) impairment, and this situation can be detected by quantitative electroencephalography (QEEG) findings before cognitive impairment is clinically observed. The main aim of this study is to uncover the effect of DM on brain function. Since QEEG reflects the CNS functioning, particularly in cognitive aspects, we expected electrophysiological clues to be found for prevention and follow-up in DM-related cognitive decline. Since a majority of the psychiatric population have cognitive dysfunction, we have given particular attention to those people. It was stated that a decrease was observed in the posterior cortical alpha power due to the hippocampal atrophy by several previous studies and we hypothesize that decreased alpha power will be observed also in DM. Methods. This study included 2094 psychiatric patients, 207 of whom were diagnosed with DM and 1887 of whom were not diagnosed with DM, and QEEG recordings were performed. Eyes-closed electroencephalography data were segmented into consecutive 2 s epochs. Fourier analysis was performed by averaging across 2 s epochs without artifacts. The absolute alpha power in the occipital regions (O1 and O2) of patients with and without DM was compared. Results. In the DM group, a decrease in the absolute alpha, alpha 1, and alpha 2 power in O1 and O2 was observed in comparison with the control group. It was determined that the type of psychiatric diagnosis did not affect QEEG findings. Conclusion. The decrease in absolute alpha power observed in patients diagnosed with DM may be related to the CNS impairment in DM. QEEG findings in DM can be useful while monitoring the CNS impairment, diagnosing DM-related dementia, in the follow-up of the cognitive process, constructing the protocols for electrophysiological interventions like neurofeedback and transcranial magnetic stimulation and monitoring the response to treatment.

Deep Transcranial Magnetic Stimulation Effects on the Electrophysiological Parameters in Obsessive-Compulsive Disorder.

Backgrounds. Deep Transcranial Magnetic Stimulation (dTMS) is a non-invasive treatment cleared by FDA as a safe and efficient intervention for the treatment of depression and obsessive-compulsive disorder (OCD). Objectives. In this retrospective single-center study, the effects of dTMS on the electrophysiological parameters and the clinical outcomes of patients with OCD were tested. Methods. Thirty sessions of dTMS were administered to 29 OCD patients (15 female and 14 male). Quantitative electroencephalography (QEEG) recordings and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) were measured at baseline and endpoint. Paired sample t-test was used to measure the change in Y-BOCS scores and QEEG activity after dTMS practice. Results. All 29 patients responded to the dTMS intervention by indicating at least 35% reduction in Y-BOCS scores. QEEG recordings revealed a significant decrease in theta, alpha and the beta rhythms. The decrease in the severity of OCD symptoms correlated with the decrease in beta activity at left central region. Conclusions. Historically, excess fast oscillations in OCD are correlated with the unresponsiveness to selective serotonin reuptake inhibitor (SSRI) treatment. We hypothesize that the decrease in the power of beta bands by deep TMS is related to the mechanism of the therapeutic response.

A novel survival algorithm in COVID-19 intensive care patients: the classification and regression tree (CRT) method.

BACKGROUND/AIM: The present study aimed to create a decision tree for the identification of clinical, laboratory and radiological data of individuals with COVID-19 diagnosis or suspicion of Covid-19 in the Intensive Care Units of a Training and Research Hospital of the Ministry of Health on the European side of the city of Istanbul. MATERIALS AND METHODS: The present study, which had a retrospective and sectional design, covered all the 97 patients treated with Covid-19 diagnosis or suspicion of COVID-19 in the intensive care unit between 12 March and 30 April 2020. In all cases who had symptoms admitted to the COVID-19 clinic, nasal swab samples were taken and thoracic CT was performed when considered necessary by the physician, radiological findings were interpreted, clinical and laboratory data were included to create the decision tree. RESULTS: A total of 61 (21 women, 40 men) of the cases included in the study died, and 36 were discharged with a cure from the intensive care process. By using the decision tree algorithm created in this study, dead cases will be predicted at a rate of 95%, and those who survive will be predicted at a rate of 81%. The overall accuracy rate of the model was found at 90%. CONCLUSIONS: There were no differences in terms of gender between dead and live patients. Those who died were older, had lower MON, MPV, and had higher D-Dimer values than those who survived.

Borderline Personality and Bipolar Disorders Cannot Be Differentiated Electrophysiologically.

Objectives. Certain studies have claimed that borderline personality disorder (BPD) could be evaluated as a subtype of bipolar disorder (BD), whereas others have argued that BPD should be regarded as an independent disorder because of its distinct clinical features. The aim of this study was to investigate if there was a difference between these 2 disorders biologically based on EEG recordings. Methods. A total of 111 subjects (11 healthy, 25 BPD, 75 BD) who had resting EEG recordings were included. The EEGs were analyzed to compute absolute power values. Results. One-way analysis of variance results revealed statistically significant differences among the 3 groups on 55 out of 229 EEG variables. However, post hoc analysis indicated that all of the significant changes were between healthy and patient groups and no significant differences were found between 2 clinical groups. Conclusion. The findings suggested that these 2 clinical entities are biologically similar; however, further research should be performed to explain the basis clinical differences between the 2 disorders.

High-Gamma: A biological marker for suicide attempt in patients with depression.

BACKGROUND: Quantitative EEG (qEEG) analysis can be used to evaluate brain correlates of human psychology in all aspects. As the gamma oscillations of qEEG rhythms are related to depression, and particularly to treatment resistance, they may also be related to suicidality. AIM: The present study aimed to identify the neural correlates of suicidal ideation and suicide attempt in depression using qEEG, based on the hypothesis that gamma rhythm in patients with depression would be higher in patients with suicidal ideation and suicide attempt. METHOD: qEEG were recorded in 533 participants (276 female). Groups were divided into the following: Non-suicidal (n = 218), Suicide Ideation (n = 211), Suicide Attempt (n = 74), and control (n = 30). RESULTS: High-gamma power at the F4, Fz, C4, Cz, O2, F8, T5 and T6 regions was significantly higher in the Suicide Ideation than the other groups. CONCLUSION: If confirmed by further studies, high-gamma rhythm has the potential to be used as a biomarker for screening suicidality.