Comparison of 2017 ILAE and Semiological seizure classifications before and after video-EEG monitoring in childhood epilepsy.

OBJECTIVE: Our aim in this study is to evaluate epilepsy classification in children with epilepsy before monitoring (based on information received from the family) and after monitoring (based on video-EEG) by comparing two separate classification systems, namely the 2017 International League Against Epilepsy (ILAE) and Semiological Seizure Classification (SSC) systems. Classifications and methods were compared in terms of simplicity, intelligibility, and applicability during daily outpatient care. PATIENTS AND METHODS: The study was performed with 230 recorded seizures of 173 patients aged between 1 and 18 years who underwent video-EEG monitoring and clinical seizure recordings. Seizure types and video-EEG data of the patients were recorded. Seizures were first classified based on information obtained from the parents of the patients in interviews, recorded as "before video-EEG monitoring classification," and a second characterization, based on video EEG-monitoring, was subsequently recorded as "after video-EEG monitoring classification". The consistency of both seizure classifications was evaluated. RESULTS: For both classifications, autonomic seizures were the least congruent seizures (κ=0.27, κ=-0.005). The families generally described the seizures very well; the consistency before and after video-EEG monitoring was good. Focal seizures with impaired awareness were most common in the 2017 ILAE classification (κ=0.6), while for the SSC simple motor seizures were most common (κ=0.84). Among subtypes, clonic-tonic seizures were the most common, and the second most common subtype was dialeptic (κ=0.67). Overall, the harmony between the SSC and ILAE systems was good. The rate of good and excellent coefficients of concordance for both the SSC and 2017 ILAE was determined as 77.8% for the expanded SSC, 48% for the 2017 ILAE, 71.4% for the basic SSC, and 60% for the 2017 ILAE. CONCLUSIONS: In practice, it is difficult to determine seizure patterns reliably in cases of childhood epilepsy. Parents, however, can generally describe seizures very well. Although the SSC seems to be superior, both the SSC and 2017 ILAE systems can be applied in daily use. Such classification enables the rise of new concepts and a better understanding of disease groups. The continuing development of classification systems will lead to advancements for patients.

Electrical status epilepticus during sleep (ESES) in benign childhood epilepsy with Centrotemporal spikes (BCECTS): insights into predictive factors, and clinical and EEG outcomes.

OBJECTIVE: Benign childhood epilepsy with centro-temporal spikes (BCECTS), otherwise known as benign rolandic epilepsy, is the most common focal epilepsy in childhood. This study aimed to evaluate the development and resolution of ESES in children with BCECTS and evaluate the clinical and electroencephalography (EEG) parameters associated with prognosis. PATIENTS AND METHODS: Resolution of ESES was defined as the reduction of the spike-wave index (SWI) to <50%. The SWI short method, measurements from the first 180 s of non-rapid eye movement; and the conventional method, measurements from total NREM stage 2, SW count during the first 60 and 180 s of NREM, SW localization, and ESES type were determined. RESULTS: Of a total of 126 BCECTS patients, 33, including 13 females, 20 males, who developed ESES during follow-up, were included in the study. ESES remission was observed in 42.4% (n = 14) of the patients. The median time to remission was 10.5 months. The rate of resolution was 87.9 % for the entire population. The mean age at resolution was 9.8 ± 2.05 years and the mean time to resolution was 8.8 months. CONCLUSIONS: The data demonstrated that age at ESES diagnosis, the time between BCECTS diagnosis and the onset of ESES, time to resolution of ESES, ESES remission, and seizure freedom after ESES were significantly associated with prognosis. The early recognition of ESES evolution in children with BECTS, the better understanding of the relationship between age at ESES diagnosis and remission and prognosis, and timely intervention can prevent long-term sequelae.

Real world results of venetoclax combined with hypomethylating agents in relapsed/refractory AML.

OBJECTIVE: Relapsed/refractory AML cases are much more resistant to chemotherapy. Venetoclax is a highly sensitive BCL-2 inhibitor. It was aimed to evaluate the effects of venetoclax therapy on real-world R/R AML survival outcomes, the effects of the cytogenetic characteristics of the patients and previous clinical applications on treatment response, and venetoclax treatment toxicity. PATIENTS AND METHODS: The study included patients who only received a venetoclax-based salvage on R/R AML patients from Turkey. The study included a total of 62 patients from 6 different centers in Turkey. Response to 2 cycles of venetoclax treatment was assessed by bone marrow blast rate. The demographic data, cytogenetic characteristics, AML type, MDS type, response rates and overall survival of the patients after venetoclax combination treatment were assessed. Median age of the patients was 65 (19-85). Mean number of prior treatments was 2.67 ±1.75. RESULTS: 13 patients (21%) had a history of allogenic stem cell transplantation. 58 (93.5%) had received HMA therapy before venetoclax. 36 patients (58.1%) had de-novo AML, and 25 (40.3%) previously had MDS. Treatment response was evaluated as complete remission (n = 21, 33.9%), partial response (n = 17, 27.4%), and treatment failure (n = 24, 38.7%). Patients in the TF group were significantly more likely to have poor cytogenetic and to have received allogeneic transplants. The mean estimated overall survival after the venetoclax treatment was 9.13 ± 0.75 months. CONCLUSIONS: The study population consisted of a group of patients who had relapsed or primary refractory disease with poor prognosis, despite numerous rounds of chemotherapy. It is our belief that the high response rates obtained with the combination of venetoclax/HMA, and having obtained positive results with poor risk patients, indicated a promising perspective for R/R AML patients.

Gamma glutamyl transferase activity: relationship with thoracic aortic intima media thickness and inflammation.

OBJECTIVE: Increased serum gamma-glutamyl transferase (GGT) activity is known to be associated with atherosclerotic diseases. Thoracic aortic intima-media thickness (IMT) was reported as a marker of preclinical atherosclerosis. However, there is a lack of research directly examining the relationship between serum GGT activity and thoracic aortic IMT. Therefore, we aimed to investigate the association between serum GGT activity and thoracic aortic IMT. PATIENTS AND METHODS: The study population consisted of 329 patients without coronary artery disease, who underwent transesophageal echocardiography (TEE) examination for various indications from January 2011 to April 2013. GGT, high-sensitivity C-reactive protein (hs-CRP) and other biochemical markers were measured in all patients. The patients were classified into tertiles according to their GGT activities (GGTlow < 19 U/l, GGTmid ≥ 19 U/l < 29 U/l, and GGThigh ≥ 29). RESULTS: The highest aortic IMT values were observed in the GGThigh group compared with the GGTmid and GGTlow groups (p < 0.05, for all). Also, aortic IMT values in the GGTmid group were higher than in the GGTlow group (p < 0.05). Multivariate regression analysis showed that GGT activity was independently associated with aortic IMT (ß = 0.487, p < 0.001) hs-CRP (ß = 0.282, p < 0.001), and triglyceride level (ß = 0.161, p = 0.007). CONCLUSION: The higher serum GGT concentrations within the "normal" range were associated with a greater IMT of the thoracic aorta. GGT activity may be a predictor of the extent of subclinical aortic atherosclerosis assessed with thoracic aortic IMT.

Role of neutrophil/lymphocyte ratio in assessing the risk of postoperative atrial fibrillation.

AIM: Atrial fibrillation is the most common arrhythmia and complication following coronary bypass surgery. Besides well-known risk factors, inflammatory parameters have gained popularity assessing the risk of postoperative atrial fibrillation. In this study, we aimed to document the relation between neutrophil/lymphocyte ratio and postoperative atrial fibrillation. METHODS: Between January 2011 and June 2012, 523 patients on normal sinus rhythm, undergoing elective on-pump coronary bypass operations were prospectively followed up for occurrence of postoperative atrial fibrillation. Total and differential white blood cell counts were made immediately before the operation and on postoperative day 2. Neutrophil/lymphocyte ratio was calculated from these measured values. RESULTS: Ninety-one (17.4%) patients developed postoperative atrial fibrillation The mean age of the patients maintaining normal sinus rhythm was lower compared to ones with atrial fibrillation (60.76±9.59 vs. 65.44±8.63, P<0.001). Preoperative and postoperative total and differential white blood cell counts did not have any effect on occurrence of atrial fibrillation. There were not statistically significant differences between normal sinus rhythm and atrial fibrillation groups when preoperative and postoperative neutrophil/lymphocyte ratios were considered (2.90±2.11 vs. 3.02±2.30, P=0.619; 10.07±21.97 vs. 9.34±6.73, P=0.752, respectively). CONCLUSION: Neutrophil/lymphocyte ratio was not found to be a predictor for new onset atrial fibrillation following coronary bypass surgery.

Characteristics of venous insufficiency in western Turkey: VEYT-I study.

OBJECTIVES: Syndromes of venous hypertension and reduced venous clearance are important causes of morbidity and disability in patients with varicose venous disease. Published estimates of the prevalence of varicosities range from 7% to 55% in the adult population, with most studies demonstrating clinical varicose reflux in about 40% of the population where the frequency of venous insufficiency is believed to be higher in Westernized and industrialized nations, most likely due to differences in lifestyle and activity. Unfortunately, the prevalence in a Turkish population is not known. The goal of the VEYT-I study was to determine the characteristics of venous insufficiency in a Turkish population. METHOD: Randomized patients who applied to a health-care centre were included in this study. The Tübingen questionnaire was used to evaluate the signs and symptoms of venous insufficiency and their seriousness in a Turkish population. Patients were additionally questioned on demographic data, education, working, living habits, quality of life and actual health status. RESULTS: A total of 2167 patients were involved in this study. Four patients with chronic renal failure and 40 patients with congestive heart failure were excluded. In patients with venous insufficiency, 90.1% did not receive any therapy. In all, 51.53% of patients with venous insufficiency were men, and mean age was 56.9 ± 9.4. CONCLUSION: The prevalence of venous insufficiency seems to be somewhat higher when compared with Western populations. One of the most prominent facts is that about 90% of patients with venous insufficiency did not receive any therapy. Therefore, disease-related complications or discomfort might emerge soon, and so more importance should be given to venous insufficiency. The VEYT-I study is a continuing database study and the target is to enlarge the study population.

The effect of cold on the occurrence of bruising, haematoma and pain at the injection site in subcutaneous low molecular weight heparin.

The purpose of this study was to investigate the effect of local dry cold application on the occurrence of bruising, haematoma and pain at the injection site in subcutaneous low molecular weight heparin injections. The research involved 63 patients who had received 2 x 20 mg enoxaparine and who were divided into four treatment groups. In the first group, cold was not applied. Cold was applied to the injection site for 5 min before the injection in the second group, and for 5 min after the injection in the third group. In the fourth group, it was applied to the injection site for 5 min pre and post injection. Following each injection, the patients' pain intensity and duration were measured, and the presence of bruise and haematoma were measured at 48 and 72 h after the injection. Results showed that a haematoma did not occur at the injection site of any subject, and there was no significant difference in the incidence or size of bruise among the groups; however, the subjects' perception of pain was significantly less with ice application.

An ethical insight into nursing research in Turkey.

Scientific and technological improvements are accomplished only because of much research. The increase in the number of research studies causes a rise in ethical problems. Nursing research is no exception to this. The aim of this study is to identify and analyse ethical problems in nursing studies. This research is descriptive and partly analytical. It is retrospective in the sense that 169 Master of Science and 66 doctoral theses written between 1972 and 1998 in the Department of Nursing, Institute of Health Sciences, Hacettepe University, Ankara, Turkey, were examined. The following ethical rules were used as criteria: that no harm should be caused to the subject; the subject was informed about the research topic; permission was obtained from the subject; and the privacy of the subject was maintained. The evaluation was carried out by distributing the theses among background variables and by employing nonparametric tests. The research associated with the theses was not harmful to the participants in 93.2%, while 6.8% were considered to have caused harm. In 72.7% of the theses the subjects were not informed of the research; in 73.6%, the researchers did not obtain permission from the subjects; and in 8.5% their privacy was not kept. An ethical score was assigned to each thesis, which varied between 0 and 15. The mean score was 5.02.

Synthesis and antiviral activity of 6-benzoyl-benzoxazolin-2-one and 6-benzoyl-benzothiazolin-2-one derivatives.

The synthesis and antiviral activity of an original series of 6-benzoyl-benzoxazolin-2-one and 6-benzoyl-benzothiazolin-2-one derivatives are described. Several compounds were found to have a selective inhibitory activity against human cytomegalovirus (HCMV) and varicella-zoster virus (VZV) in vitro, being inactive against a variety of other DNA and RNA viruses. 6-(3-fluorobenzoyl)benzoxazolin-2-one, 6-(3-fluorobenzoyl)benzothiazolin-2-one, 6-(3-bromobenzoyl)benzothiazolin-2-one, 6-(3-iodobenzoyl)benzothiazolin-2-one, 3-methyl-6-(3-fluorobenzoyl)benzothiazolin-2-one, 3-benzyl-6-benzoyl-benzothiazolin-2-one, 3-benzyl-6-(3-fluorobenzoyl)benzothiazolin-2-one and 3-benzoyl-6-(3-fluorobenzoyl)benzothiazolin-2-one were the most active of the series against HCMV and VZV with a selectivity index (CC50/IC50) ranging from 10 to 20. They displayed similar activity against thymidine kinase competent (TK+) and deficient (TK-) VZV strains, and also proved to be active against clinical HCMV isolates that were resistant to ganciclovir (GCV). Time-of-addition experiments revealed a site of interaction with the HCMV replicative cycle that may be close or similar to that of GCV and cidofovir (HPMPC). The compounds showed poor, if any, activity against herpes simplex virus type 1 (HSV-1) and HSV-2, and were not inhibitory against human immunodeficiency virus and other DNA and RNA viruses. Therefore, these compounds may represent a novel lead for the development of specific HCMV and VZV drugs.

Synthesis and anticonvulsant activity of 2(3H)-benzoxazolone and 2(3H)-benzothiazolone derivatives.

A series of 2(3H)-benzoxazolone and 2(3H)-benzothiazolone derivatives were synthesized and evaluated for anticonvulsant activity. The compounds were assayed, intraperitoneally in mice and per os in rats, against seizures induced by maximal electroshock (MES) and pentylenetetrazole (scMet). Neurologic deficit was evaluated by the rotarod test. The compounds were prepared to determine the relationship between the 2(3H)-benzoxazolone and 2(3H)-benzothiazolone derivatives' structures and anticonvulsant activity. Several of these compounds showed significant anticonvulsant activity. Compounds 43 and 45 were the most active of the series against MES-induced seizures with ED50 values of 8.7 and 7.6 mg/kg, respectively. Compound 45 displayed good protection against MES-induced seizures and low toxicity in rats with an oral ED50 of 18.6 mg/kg and a protective index (PI = TD50/ED50) of < 26.9. In vitro receptor binding studies revealed that compounds 43 and 45 bind to sigma 1 receptors with nanomolar affinities.

2(3H)-benzoxazolone and 2(3H)-benzothiazolone derivatives: novel, potent and selective sigma1 receptor ligands.

A series of original 2(3H)-benzoxazolone and 2(3H)-benzothiazolone derivatives were evaluated for their affinity at sigma1 and sigma2 receptor subtypes in competition binding experiments, using [3H](+)-pentazocine or [3H]1,3-di-o-tolyl-guanidine (DTG) in the presence of 100 nM (+)-N-allylnormetazocine (NANM) in guinea-pig brain membranes. Several of these derivatives showed preferential selectivity for sigma1 binding sites. Compound 1 [3-(1-piperidinoethyl)-6-propylbenzothiazolin-2-one] emerged as a potent sigma1 receptor ligand (Ki = 0.6 nM) and displayed a moderate selectivity over the sigma2 receptor subtype (Ki for sigma2/Ki for sigma1 = 29). Compounds 2 [3-(1-piperidinopropyl)-6-propanoylbenzothiazolin-2-one] and 3 [3-(1-piperidinopropyl)-6-propanoylbenzoxazolin-2-one] still showed rather high affinities for sigma1 binding sites with Ki values of 2.3 and 8.5 nM, respectively. On the contrary, they had 87- and 58-fold less affinity at sigma2 receptors, respectively. Unlike their potent affinity for sigma binding sites, these compounds had negligible affinity for mu-, delta- and kappa-opioid receptors, 5-HT2, dopamine D2, and muscarinic M2 receptors. Sigma receptor ligands may affect neuronal transmission and display, in animal models, antipsychotic, cognitive, motor, neuroprotective and anticonvulsant activity. Therefore, on the basis of these findings, these novel sigma receptor ligands were assayed, in mice, in three tests: maximal electroshock, subcutaneous pentylenetetrazol and rotarod neurotoxicity. Compound 1, administered intraperitoneally, was the most effective against maximal electroshock-induced seizures and was devoid of significant neurotoxic effects.

Identification of image and blur parameters in frequency domain using the EM algorithm.

We extend a method presented previously, which considers the problem of the semicausal autoregressive (AR) parameter identification for images degraded by observation noise only. We propose a new approach to identify both the causal and semicausal AR parameters and blur parameters without a priori knowledge of the observation noise power and the PSF of the degradation. We decompose the image into 1-D independent complex scalar subsystems resulting from the vector state-space model by using the unitary discrete Fourier transform (DFT). Then, by applying the expectation-maximization (EM) algorithm to each subsystem, we identify the AR model and blur parameters of the transformed image. The AR parameters of the original image are then identified by using the least squares (LS) method. The restored image is obtained as a byproduct of the EM algorithm.