Investigation of the relationship between serum irisin level in the idiopathic restless legs syndrome: Could be a marker independent of physical activity?

INTRODUCTION: Restless legs syndrome (RLS) is a common but underdiagnosed neurological syndrome. It is characterized by the feeling of discomfort and desire to move, especially in the lower extremities, which often occurs at night, and the cure or relief of symptoms with movement. Irisin is a hormonelike polypeptide that was first identified in 2012, weighs 22 kDa, consists of 163 amino acids, and is mainly synthesized in muscle. Its synthesis increases with exercise. Here in this study, we planned to investigate the relationship among serum irisin level, physical activity, lipid profile, and RLS. MATERIAL AND METHODS: A total of 35 patients with idiopathic RLS and 35 volunteers were included in the study. Then, venous blood was taken from the participants in the morning after 12 h of night fasting. RESULTS: The mean value of serum irisin level was 16.9 ± 14.1 ng/mL in the case group and 5.1 ± 5.9 ng/mL in the control group, which was statistically quite significant (p < .001). A significant efficiency (under the curve area 0.886 [0.804-0.967]) of irisin value was observed in the differentiation of patients in the case and control groups. DISCUSSION: Serum irisin level was significantly higher in the case group than in the control group. In conclusion, we suggest that irisin may play a role in the pathophysiology of RLS independently of the intensity and duration of physical activity and anthropometric data, such as body weight, body mass index, and waist/hip ratio.

Axillary mononeuropathy after herpes zoster infection misdiagnosed as neuropathic pain

Zoster-associated extremity paresis is a rare complication of herpes zoster (HZ) and is usually due to zoster-associated mononeuropathy. Complaints of a 77-year-old man started with pain in his right arm and 4 days later he developed itchy red HZ lesions in the same area. One week later, the patient developed weakness in his right arm. The patient was diagnosed with isolated axillary mononeuropathy by physical examination and electromyography. Here, we present a case of axillary mononeuropathy which is a rare complication of HZ infection and needs particular attention.

Effective INR Level May Be Delayed in Secondary Prevention of Stroke Due to Atrial Fibrillation with Warfarin in the Patients with Diabetes Mellitus.

INTRODUCTION: Warfarin is a drug used for anticoagulation in diseases, especially atrial fibrillation (AF). The effectiveness of warfarin is monitored by the International Normalized Ratio (INR) and should be kept between 2.0 and 3.0 in the AF clinic. This drug the significant variability in dose response and the narrow therapeutic index among individuals. However, the effective INR level may not be achieved due to some reasons, or the time to achieve the effective INR level may lengthen. Our aim in this study is to investigate whether there is a difference in terms of dose and duration in achieving the effective INR level by the warfarin treatment due to the coexistence of AF and stroke between patients with and without diabetes mellitus (DM). METHODS: A total of 70 patients whose warfarin treatment was initiated due to non-valvular AF and who were diagnosed with acute ischemic stroke were included in the study, 30 of these patients were DM patients and 40 were non-DM patients. The total dose and time values at achieving the effective INR level after the initiation of warfarin treatment according to the clinical protocol during follow-ups in hospital were statistically compared between the two groups. RESULTS: In the study, it was found that the total warfarin dose was significantly higher in the DM group compared to the non DM group (p<0.05). It was detected that the time to achieve the effective INR level was also significantly longer in the DM group than in the non-DM group (p<0.05). CONCLUSION: In the presence of DM diagnosis, the higher dose warfarin and longer follow-up are required to achieve effective INR levels in stroke patients whose warfarin treatment was initiated due to non-valvular AF.

Can high uric acid levels be an independent risk factor for acute ischemic stroke due to large-artery atherosclerosis?

BACKGROUND AND PURPOSE: Uric acid is a molecule that is known to act as a natural antioxidant in acute oxidative stress conditions such as acute ischemic stroke (AIS). Although there are several studies on the prognostic value of serum uric acid (UA) level, especially the AIS, its importance in ischemic stroke is still controversial. Our aim in this study is to investigate whether the serum UA level is an indicative biomarker in the large-artery atherosclerosis in the AIS etiology. METHODS: Of the patients admitted to Sakarya University Training and Research Hospital Department of Neurology between January 2017 and November 2017, 91 hospitalized patients, who had AIS diagnosis and had their uric acid levels measured, were analyzed retrospectively. Patients with diabetes mellitus (DM), hypertension (HT), smoking habit, obesity, gout, hyperlipidemia (HL) and renal failure were excluded from the study. Patients were classified as anterior system and posterior system infarct. Then, patients were divided into two groups, one with internal carotid artery (ICA) > 50% stenosis and the other with ICA < 50% stenosis according to carotid-vertebral artery doppler USG examination performed for etiology. Serum UA, total bilirubin, direct bilirubin and indirect bilirubin levels of both groups were statistically compared. RESULTS: In the comparison of serum UA values of ICA>50% stenosis and ICA<50% stenosis group of AIS patients, a statistically significant difference was found between the UA levels (p<0.000), but there was no difference between total bilirubin, direct bilirubin and indirect bilirubin values (p>0.05). CONCLUSION: High uric acid levels can be considered an independent, indicative risk factor for large-artery disease in AIS.

The effect of maternal migraine headache on their children's quality of life.

Migraine is an episodic disease characterized by a throbbing and generally unilateral headache, often accompanied by nausea, vomiting and light and sound sensitivity. Migraine is known to affect one's quality of life; not only the person with migraine but also his/her family and social environment are affected by this condition. Our study aimed to evaluate the effects of maternal migraine on children's quality of life. The patient group comprised 70 mothers with migraine diagnoses and their 111 healthy children, while 50 healthy mothers and their 86 children were included in this study as the control group. The Visual Analog Scale (VAS), Migraine Disability Assessment Scale, Beck Depression Index (BDI) and Beck Anxiety Index (BAI) were used for evaluation of mothers; 3 to 7-year old KINDL and 7- to 17-year-old KINDL-R Quality of Life Scales were used to evaluate the quality of life of children. The SPSS 21.0 program was used for statistical analysis and p < 0.05 was assumed to be statistically significant. The mean age of the migraine group was 37.09 ± 6.94 years, and the mean age of the control group was 38.2 ± 4.5. Symptoms of depression and anxiety were more frequently found in subjects with migraine (p < 0.05). In comparison with the control group: 3 to 7-year old KINDL total scores, self-esteem and school subscales, 7- to 17-year-old KINDL total scores, self-esteem and the social relationships subscale scores were lower in migraine group. It was found to be significant that VAS, BDI and BAI scores of the mothers were negatively correlated with the children's quality of life. Our study concluded that the presence of migraine-type headache in mothers worsen the relations in school, self-esteem and quality of life in younger children and social relations, relations in school and quality of life in older children. The maternal age, disease severity, and anxiety and depression symptoms were shown to predict the quality of life in children. Performing preventive interventions by individually assessing bio-psycho-social elements for the treatment of mothers with migraine will preserve other family member's and especially children's quality of life.