Distinctive sleep complaints and polysomnographic findings in antibody subgroups of autoimmune limbic encephalitis.

INTRODUCTION: Sleep disturbances are being increasingly recognized in association with autoimmune encephalitis (AIE). We investigated the prevalence of sleep-related symptoms and polysomnographic features of patients with AIE and the long-term outcomes in these patients in a multi-center, prospective study from Turkey. METHODS: We prospectively evaluated patients with definite AIE in a common database including demographics, AIE-related and sleep-related symptomatology. Maximum and latest modified Rankin scores (mRS) and Liverpool Outcome Score (LOS) were noted. RESULTS: Of 142 patients, 87 patients (61.3%) fulfilled the criteria for definite AIE (mean age, 46.8+18.8 years; 51.7% women; mean disease duration, 21.0+38.4 months). 78.9% of patients had at least one or more new onset or worsened sleep-related symptomatology: insomnia (55.3%), excessive daytime sleepiness (EDS, 28.0%), sleep apnea (18.7%), REM sleep behavior disorder (RBD, 17.3%), restless legs syndrome (10.7%) and oneiric stupor (9.3%). Sleep efficiency, N3 and REM sleep were decreased and N1 sleep was increased in patients with Ab[+] AIE. LOS points were highest in those with insomnia and sleep apnea, and lowest in those with EDS, RBD and oneiric stupor. RBD and sleep apnea were more common in anti-LG1 Ab[+] group than anti-NMDAR Ab[+] group. Index of periodic leg movements was highest in anti-LG1 Ab[+] group. Patients with EDS and oneiric stupor had more common memory problems. Maximum and latest mRS scores were positively correlated with EDS and oneiric stupor. EDS, RBD and oneiric stupor were negatively correlated with LOS points. CONCLUSION: Our study emphasizes the presence and importance of early diagnosis of sleep disturbances in AIE in regard to their deteriorative influences on disease prognosis.

An invisible cause of disability: stigma in migraine and epilepsy.

OBJECTIVE: Our purpose was to identify the ratio and severity of stigmatization in patients with migraine and epilepsy. We also collected demographic and clinical data to search for possible facilitators. METHODS: In total, 196 patients with migraine and 60 patients with epilepsy were enrolled. Neuro-QoL Stigma Scale was applied in an office setting by a neurologist in 3 different centers. Stigma scores were calculated as standardized T scores (total, enacted, and internalized). Demographics, clinical characteristics, and treatment status of the patients were also compared in terms of stigma scores. Kruskal-Wallis test or Mann-Whitney U tests were applied for comparisons. Spearman's correlation analysis was used for the evaluation of inter-parameter correlations. RESULTS: Eighty-one percent of the patients with epilepsy and 72% of the patients with migraine reported being stigmatized. Total T scores were significantly higher in the epilepsy group (50.78 ± 9.1) than the patients with migraine (44.9 ± 7.62), also than the chronic (45.86 ± 8.76) and episodic (44.7 ± 7.27) migraine subgroups (p < 0.05). T scores increased as the duration of disease increased; however, this correlation was significant for the epilepsy group only (p < 0.05). Migraine group with prophylactic treatment had significantly higher scores than the migraineurs without preventive therapy (p < 0.05). Enacted T scores were higher than internalized T scores in all analyzed groups and subgroups (p < 0.05). CONCLUSION: Patients with migraine and epilepsy are subjected to stigma. The ratio and intensity can change in different countries. We need to increase the awareness and search for better solutions. The standardized tests are important to compare results between studies.

PLASMA INTERLEUKIN-6 LEVELS MAY BE ASSOCIATED WITH THE LENGTH OF STAY TIME OF ADULT HYPERGLYCEMIC PATIENTS IN AN INTENSIVE CARE UNIT.

CONTEXT: Estimation of intensive care unit (ICU) length of stay time (LOS) may be challenging, and pro-inflammatory cytokines can be used as a marker for this purpose. OBJECTIVE: The current study aimed to investigate the association between pro-inflammatory cytokine levels and LOS in hyperglycemic patients admitted to adult ICU. DESIGN: This is a prospective observational study. SUBJECTS AND METHODS: All adult ICU patients with a blood glucose level higher than 250 mg/dL, during the study period were included. Hospitalization day demographics were recorded, and plasma IL-6, IL1-ß, and TNF-α concentrations were measured. RESULTS: A total of 74 patients were enrolled in the study. Diabetic ketoacidosis (DKA) was positive in 31 patients, and the remaining 43 were in the non-DKA (NDKA) group. There was no difference between the two groups in terms of age, gender, LOS, hemoglobin, hematocrit, lactate levels, and platelets count. IL-6, IL-1ß, and TNF-α levels did not show any difference between DKA and NDKA groups (p=0.784, 0.413, and 0.288, respectively). There was a positive correlation between IL-6 levels and LOS (n=74, Pearson correlation=0.330; p=0.004). CONCLUSIONS: Among pro-inflammatory cytokines, IL-6 showed a better performance for the prediction of LOS than IL-1ß, TNF-α, and CRP.

The Relationship Between Serum Uric Acid Levels and Clinical Features in Essential Tremor.

INTRODUCTION: In this study, we aimed to investigate the effect of uric acid on the disease, its severity and progression in ET patients with partially co-clinical features with Parkinson's disease (PD). METHODS: Serum UA levels of 87 consecutive ET patients were measured and were matched according to age and sex with 87 healthy controls. Fahn-Tolosa-Marin scale was used for the severity of tremor. Sociodemographic characteristics, type of ET, duration of disease, and treatment modalities were evaluated. RESULTS: The mean uric acid level was calculated as 4.986±2.1458 mg/dL and 6.004±1.523 mg/dL in the patient and control groups, respectively (p≤0.005). The blood UA level of patients with sporadic (n: 61) ET was found to be lower than the familial ET (n: 26) (p≤0.005). The tremor severity of the family ET patients was lower than the sporadic ET. (n: 61) (p≤0.005). The mean blood UA level (4.429±1.216 mg/dL) in the patients with high total tremor severity scores (n: 48) was found lower than in the patients with low total tremor severity scores (n: 39) (5.673±2.106 mg/dL) (P=0.000). The serum UA level was significantly lower in the patients whose disease duration longer than 5 years than in patients whose duration of the disease was shorter than 5 years. 5.732±1.240 for ≥5 years; 6.438±0.286≤5 years) (P=0.001). CONCLUSION: We hypothesize that as a result of high antioxidant properties of high serum uric acid levels, it is a biomarker that can show disease risk and progression in patients with ET as well as PD.

Upper Extremity Capability Tests in Multiple Sclerosis.

Multiple sclerosis is a chronic demyelinating disease. Since attacks are accompanied by psychiatric and physical disabilities, additional symptoms such as withdrawal from the social environment and psychiatric disorders are also observed. It is very important to evaluate patients adequately and correctly, to determine the disability, and treat them with appropriate clinical approach. For this reason, Expanded Disability Status Scale score and upper extremity capacity measurement tests are used in many studies by investigators. These tests provide detailed examination on the patient's upper limbs, and indirectly provide information about their cognitive function. A multi-disciplinary approach for multiple sclerosis patients is the most crucial factor in clinical follow-up and treatment success.

Serum soluble lectin-like oxidized low-density lipoprotein receptor-1 levels in patients with restless legs syndrome.

OBJECTIVE: The aim of this study was to assess the predisposition for atherosclerosis in patients with RLS through serum sLOX-1 (serum Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1) measurements. BACKGROUND: Recent epidemiological studies have suggested an association of RLS with certain chronic conditions such as diabetes mellitus (DM), obesity, hypertension (HT), and hyperlipidemia. LOX-1 is expressed in endothelial cells, macrophages, and in smooth muscle cells under the effect of proatherogenic conditions. METHODS: This study was a prospective, cross-sectional, case-controlled. We measured the serum sLOX-1 levels in 37 restless legs syndrome patients and 38 controls. RESULTS: Serum sLOX-1 level was significantly lower in the patient group. The two groups were similar in glucose, HbA1c, creatinine, LDL cholesterol, TG, HDL, total protein, albumin, AST, ALT, GGT, ALP, HGB, HCT, MCV, transferrin saturation rate (TSR), ferritin, CRP, TSH, FT4, FT3, B12, and folic acid levels. Also the two groups were similar with respect to age at menarche, number of previous births, number of abortions and/or curettage, total duration of breastfeeding, percentage of patients in menopause, and age at menopause. CONCLUSION: Our results may suggest a lower atherosclerotic risk among RLS patients as compared to the general population (Tab. 3, Ref. 33).

Primary idiopathic chylopericardium presenting with cardiac tamponade.

Primary idiopathic chylopericardium is an extremely rare condition especially in children and young adults. Although the exact pathophysiology of primary chylopericardium has not been established, the reflux of chylous fluid into the pericardial space was suggested as the etiology. Damage to the thoracic duct valves and the communication of the thoracic duct to the pericardial lymphatics or abnormally elevated pressure in the thoracic duct could cause chylous fluid reflux. In this report, we described the case of a 4-year-old boy with primary idiopathic chylopericardium presenting as cardiac tamponade who was treated with video-assisted thoracoscopic window and then surgical duct ligation.

Comparison of home-based and outpatient clinic-based intravaginal electrical stimulation for the treatment of urinary incontinence.

AIM: Aim of the study was to compare the effects of outpatient clinic-based versus home-based intravaginal electrical stimulation (ES) for the treatment of urinary incontinence. METHODS: Women applying with the complaint of urinary incontinence and offered ES treatment were divided into outpatient clinic-based or home-based ES. Patients were instructed about home-based ES at the outpatient clinic by certified physiotherapy nurses. Bladder diary, 1-hour pad test, and King's-Health-Questionnaire (KHQ) were performed before and after treatment. ES was applied for 20 minutes, 6-8 weeks with pulses of 10-50 Hz square waves at a 300 µs or 1 ms pulse duration and a maximal output current of 24 to 60 mA with 5-10 Hz frequency, three times/week. RESULTS: Twenty-four patients received outpatient clinic-based, 22 patients received home-based ES. Pad test, bladder diary and pelvic floor muscle strength parameters in both groups improved significantly after treatment, with no significant difference between the two groups. Seven patients (31.8%) were cured, six patients (27.3%) were much improved, and seven patients (31.8%) were improved in the home-based ES group. Nine patients (37.5%) were cured, six patients (25%) were much improved, and six patients (25%) were improved and in the outpatient clinic-based ES group. There was an improvement in quality of life in all domains in both groups when the pretreatment and post-treatment KHQ results were compared, with no significant difference between the two groups. CONCLUSION: Home-based ES is as effective in the treatment of urinary incontinence as outpatient clinic-based ES with significant improvement in objective and subjective parameters.

Hypercholesterolemia as one of the risk factors of intracerebral hemorrhage.

Stroke is still a major cause of morbidity and mortality throughout the world, although better stratification and treatment modalities are being developed. As compared to ischemic stroke, intracerebral hemorrhage (ICH) possesses many unknown data and lacks guidelines for better prophylaxis. In this study, we aimed to investigate patients with ICH hospitalized in our neurology department within 5 years in terms of risk stratification. A total of 4,449 patients were hospitalized; 1,378 of patients (31%) were diagnosed as having cerebrovascular disease and of these 165 patients (3.7%) had ICH. The risk factors of patients with ICH were investigated and compared with age- and gender matched 75 healthy subjects. We observed that hypercholesterolemia (p = 0.002) was one of the most common risk factors in patients with ICH as compared to controls, together with hypertension (p = 0.010). On the other hand, hypolipidemia (LDL-cholesterol level < 50 mg/dl) was not present in any of the patients. As our purpose as neurologists is to reduce the occurrence and fatal outcome of cerebrovascular events, we aimed to emphasize the importance of risk factors to be well defined, for which every effort should be exhibited for both primary and secondary prevention.

Comparison of semen profile and frequency of chromosome aneuploidies in sperm nuclei of patients with varicocele before and after varicocelectomy.

Semen profile and meiotic segregation products are important for assessing aneuploidy risk and risk of resulting infertility. To determine the effect of varicocelectomy on semen profile and aneuploidy frequency, we investigated semen profile and aneuploidy frequency of selected chromosomes in patients with varicocele before and after varicocelectomy. Chromosomal aneuploidy for selected chromosomes was evaluated using chromosome-specific DNA fluorescence in situ hybridisation (FISH) probes. There was a significant difference in the level of normal sperm morphology before and after varicocelectomy (P > 0.007). There were no significant differences in aneuploidy frequency of chromosomes 1, 16, 17 and 18 in sperm nuclei obtained from patients before varicocelectomy compared with 6-7 months after varicocelectomy (P > 0.05), although FISH analysis with chromosomes 17 and 18 combination showed a higher aneuploidy frequency before varicocelectomy than after varicocelectomy (7.81 +/- 9.67 versus 4.03 +/- 1.46 respectively). In conclusion, varicocele seems to affect the semen profile but minimally affects aneuploidy frequency. Varicocelectomy demonstrates a repairing effect on the semen profile and contributes to a slight decrease in aneuploidy frequency in some but not all chromosomes.

Effect of gender on slaughter and carcass traits in Anatolian water buffalo.

This study determined the effect of gender on slaughter and carcass traits in Anatolian water buffalos reared under free range conditions in Turkey. Sixteen four-years-old Anatolian water buffalo were divided into two groups of eight males in one group and eight females in the other. The slaughter and carcass traits, carcass measurement, amount of worthy meat from each animal and phenotypic correlations among some carcass traits were determined. Chilling loss, slaughter weight and hot and cold carcass weights were 5.27%, 496.44 kg, 234.60 kg and 222.16 kg, respectively in males and 5.43%, 515.34 kg, 236.08 kg and 223.00 kg, respectively for females (P > 0.05). The ratio of skin and four leg weights (P < 0.05) and skin, head and the legs weights to the live-weight (P < 0.01) were found significantly higher in males than in female buffalos. In addition, from worthy meat, short loin was higher in males compared to females (P < 0.05). In this study, it is concluded that, generally carcass yield and amount of worthy meat in carcass tends to be higher in male water buffalo compared to females.

[Outcome for acute grade III acromioclavicular dislocations using Neviaser's method for surgical treatment]. / Neviaser yöntemi ile tedavi edilen akut grade III akromioklavikular çikiklarda sonuçlar.

There are the different opinions on the methods used in the treatment of acute grade III acromioclavicular dislocations and their results. In this study, the results of 10 patients treated with Neviaser's method and followed in The Department Orthopaedics and Traumatology of Atatürk University Medical School were evaluated. All patients were males and the average age was 36.5 (25 to 45) years. The causes of dislocations were falls on the shoulder in 5 cases (50%), traffic accidents in 4 cases (40%) and direct trauma to the shoulder in 1 case (10%). The mean interval between injury and operation time was 10.2 (5 to 20) days. The cases were followed up with an average period of 13.1 months (6 months 2 years). The excellent and good results were obtained in 9 cases (90%) and the complication was observed in not one of the patients. We consider that Neviaser's method is a good alternative in the treatment of acute grade III acromioclavicular dislocations that operation is indicated.