Relationship between apnea-hypopnea index and oxygen desaturation in REM-sleep period and morning headache in patients with obstructive sleep apnea syndrome

Introduction: In patients with morning headache, REM sleep period decreases though little is known about its physiopathology. We evaluate the polysomnographic records of obstructive sleep apnea syndrome (OSAS) patients with the hypothesis that oxygen desaturations may be a better determinant in patients with morning headache, especially those in REM sleep periods. Methods: Patient group (group 1) with a total of 361 patients with OSAS and the controls (group 2) with 107 healthy individuals were evaluated. The presence of morning headache was compared between the groups, and sleep parameters were correlated with morning headache. Results: In group 1, patients with OSAS and morning headache, apneahypopnea index in the REM sleep period (26.7/hour, min-max: 0-108.4/hour) was higher than those in patients without morning headache (17.8/hour, min-max: 0-107.8/hour). The minimum oxygen saturation in REM sleep period and total sleep time (TST) was lower in patients with morning headache (REM sleep period: 82%, min-max: 50-94%; TST: 79%, min-max: 50-97%) in compared to patients without morning headache (REM sleep period: 84%, min-max: 50-93%; TST: 81%, min-max: 50-90%). Conclusion: Here we demonstrated that higher apnea-hypopnea index and lower oxygen saturation in REM sleep period were associated with morning headache in patients with obstructive sleep apnea syndrome

Latencies to first interictal epileptiform discharges in different seizure types during video-EEG monitoring

Purpose: Interictal epileptiform discharges (IEDs) have high diagnostic value concerning patients with epilepsy and the instances of obtaining IEDs increase with longer recording times. However, the merit of a single, extended electroencephalography (EEG) recording in detecting IEDs has not been substantiated. We aimed to determine the optimal duration of an EEG required to diagnose epilepsy in different seizure types. Methods: Overall, 84 patients—29 with generalised onset epilepsy and 55 with focal onset epilepsy—were evaluated. Long-term video electroencephalographic monitoring (VEM) was analysed to find the first definite IED besides assessing the first seizure and latency. Results: The median latency of the first IED (12 min, ranging from 1 to 440 min vs. 55 min, ranging from 2 to 7500 min; p= 0.014) and the median duration of a VEM recording (2 d, ranging from 1 to 10 d vs. 3 d, ranging from 1 to 10 d; p= 0.012) were found significantly lower in the generalised epilepsy group compared with that in the focal epilepsy group. Conclusions: Generalised onset epilepsy showed a significantly shorter latency to IED and VEM duration compared with focal onset epilepsy. In our data set, all the patients with generalised onset epilepsy had interictal IED within 10 h, but the patients with focal onset epilepsy required monitoring for three days to obtain IED

A Case of Pleiosomnia Following Traumatic Brain Injury

Sleep-wake disturbances are highly prevalent and often become persistent sequelae after traumatic brain injury. The most common disturbances are insomnia, excessive daytime sleepiness, and increased sleep need (pleiosomnia). Circadian rhythm sleep-wake disturbances and parasomnias are more rare disturbances. These disorders can affect the treatment process and exacerbate other problems such as cognitive, and psychiatric problems. Among these sleep disturbances, hypersomnia is the most damaging disorder for the patients functionality. In this case report, a patient who was complaining of increased sleep need after traumatic brain injury was presented

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

Kompozit Rezinlerin Renk Ve Translüsentliğinde Ev Ve Ofis Beyazlatma Ajanlarının Etkisi

Aim: The purpose of this in-vitro study was to assess the effect of two bleaching agents on the color and translucency of aged composite resin materials (Filtek Z250, Estelite Flow Quick, and Tetric N-Ceram), as compared to re-polishing. Material and Methods: Thirty composite discs from each material were made using circular molds, and were subjected to a thermocycling process for 5000 cycles, then immersed in the prepared staining solution. The aged samples were randomly divided into three treatment groups: re-polishing, 16% carbamide peroxide (Opalescence), or 35% hydrogen peroxide (Whiteness HP). After aging and whitening treatments, the color reading was performed via a spectrophotometer. Color change (?E00) and translucency parameters were calculated. Data were evaluated by two-way ANOVA and Tukey’s test (p < 0.05). Results: Bleaching agents produced significantly higher color change in composite resins compared to repolishing (p < 0.05). Bleaching agents caused similar color change in each composite resin, but carbamide peroxide caused significantly higher color change in Filtek Z250 than hydrogen peroxide. Bleaching increased significantly the translucency of all aged composite resins. When bleaching agents were compared to re-polishing, only carbamide peroxide significantly increased the translucency of Filtek Z250. The re-polishing treatment did not significantly affect the translucency of Filtek Z250 and Estelite Flow Quick, whereas the translucency of Tetric N-Ceram significantly increased. Conclusions: The applied treatments generated clinically perceptible whitening. The performance of bleaching agents was higher than that of re-polishing. The effect of bleaching agents on the translucency of composite resins depended on the material used and the treatment applied.Amaç: Bu çalışmanın amacı, yaşlandırılmış kompozit rezinlerin renk ve translüsentliğinde iki farklı beyazlatma ajanının etkisini re-polisaj işlemi ile karşılaştırmalı olarak değerlendirmektir. Gereç ve Yöntem: Silindirik kalıplar kullanılarak her bir kompozit materyalden 30 adet silindir örnek hazırlandı. Örnekler 5000 kez termal döngüye maruz bırakıldı, daha sonra renklendirici solüsyonda bekletildi. Yaşlandırılmış örnekler rastgele 3 tedavi grubuna ayrıldı; re-polisaj, %16 karbamit peroksit (Opalescence), ve %35 hydrojen peroksit (Whiteness HP). Renk ölçümü yaşlandırma ve beyazlatma tedavilerinden sonra spektrofotometre ile gerçekleştirildi. Renk değişimi (?E00) ve translüsentlik parametreleri hesaplandı. Veriler iki yönlü ANOVA ve Tukey’s testi ile değerlendirildi (p < 0.05). Bulgular: Beyazlatma ajanları re-polisaj işlemi ile karşılaştırıldığında önemli derecede yüksek renk değişikliği oluşturdu. Beyazlatma ajanları her bir kompozit rezinde benzer renk değişikliğine sebep oldu, yalnızca Filtek Z250 de karbamit peroksit hidrojen peroksitten yüksek renk değişikliği sağladı. Beyazlatma ajanları re-polisaj işlemi ile karşılaştırıldığında yalnızca karbamit peroksit Filtek Z250’nin translüsentliğini önemli derecede artırdı. Repolisaj işlemi Tetric N-Ceram’ın translüsentliğini artırmasına karşın, Filtek Z250 ve Estelite Flow Quick’in translüsentliğini etkilemedi. Sonuç: Uygulanan tedaviler klinik olarak algılanabilir beyazlatma sağladı. Beyazlatma ajanlarının performansı re-polisaj işleminden yüksekti. Kompozit rezinlerin translüsentliğinde beyazlatma ajanlarının etkisi kullanılan materyal ve uygulanan tedaviye bağlıdır

A Case of Resistant SUNCT that Gave Response to Steroid Treatment

Conjunctival injection and tearing with unilateral short lasting neuralgiform headache syndrome is called as SUNCT. Even though these headaches are reported seldomly, the prevalence is possibly higher than known. It is of importance to recognize these uncommon disorder, since its management differs from common primary headaches. Until today, it was reported to be treated with different types of drugs. We here reported a 30 years old male patient with normal neurological examination, blood examination and neuroimaging. Our patient gave no response to indomethacin, gabapentine and carbamazepine treatments. This case is an example of SUNCT case treated with steroi

Evaluation Of Enamel Bond Stength Of Universal Adhesives

Amaç: Bu çalışmanın amacı dört farklı üniversal adezivin mineye makaslama bağlanma dayanımını iki aşamalı bir self-etch adezivle karşılaştırmalı olarak incelemektir. Gereç ve Yöntem: 100 adet sağlam üçüncü molar diş bukkal ve lingual iki parçaya bölündü. Örnekler adeziv ajanlara göre rastgele 5 gruba ayrıldı; OptiBond XTR, Clearfil Universal Bond, All Bond Universal, Single Bond Universal, Clearfil SE Bond. Düzleştirilmiş mine yüzeylerine herbir adeziv ajan self-etch ya da totaletch yöntemleri kullanılarak uygulandı ve kompozit rezin yerleştirildi. Örnekler 24 saat 37°C'de distile su içerisinde bekletildikten sonra ya da 5.000 termal siklus uygulandıktan sonra makaslama bağlanma testine maruz bırakıldı. Veriler 3 yönlü varyans analizi ve Tukey post-hoc testi (p = 0.05) kullanılarak analiz edildi. Bulgular: İstatistiksel sonuçlar adeziv ajanın tipi ve uygulama yönteminin mineye bağlanma dayanıklılığını önemli derecede etkilediğini gösterdi (p 0.05). Total-etch yöntemi ile elde edilen taranmış elektron mikroskop görüntüleri uzun rezin tagları ve iç içe geçmiş polimerik ağları göstermektedir. Sonuç: Self-etch tekniği ile Clearfil SE Bond, üniversal adezivlerden daha fazla mineye makaslama bağlanma dayanıklılığı bakılmaksızın üniversal adezivlerin mineye bağlanma dayanıklıkları arasında önemli bir farklılık bulunamadı. Mineyi asitleme tüm adezivlerin makaslama bağlanma dayanıklılığını önemli derecede arttırdıAim: The aim of this study was to evaluate the shear bond strength of four universal adhesives to enamel compared to two-step self-etch adhesive. Material and Methods: One hundred human third molars were sectioned into two fragments (buccal and lingual) and randomly assigned to five groups according to adhesive agents (OptiBond XTR, ClearfilUniversal Bond, All Bond Universal, Single Bond Universal, and Clearfil SE Bond). Each adhesive agent was applied to a flattened enamel surface by using the self-etch or etch-and-rinse strategy, and the composite resin was constructed onto the bonded enamel surface. The specimens were stored for 24 h in 37°C distilled water or were thermocycled for 5,000 cycles. Then shear bond strength testing was performed. Data were analyzed using three-way analysis of variance and the Tukey post-hoc test (p = 0.05). Results: The type of adhesive agent and application strategy had a significant effect on the enamel bond strength (p 0.05). Scanning electron microscopy images obtained with the etch-and-rinse strategy showed long resin tags and an interpenetrated polymeric network. Conclusion: Clearfil SE Bond with self-etch strategy had significantly higher shear bond strength to enamel than did the universal adhesives. No significant differences were found among the enamel bond strengths of studied universal adhesives regardless of application strategy. The pre-etching treatment of enamel significantly improved the shear bond strength of all of the adhesives teste

Temporal lob epilepsi cerrahisinin cerrahi komplikasyon spektrumu: Tek merkezli çalışma

AMAÇ: İlaca dirençli epilepsilerin azaltılmasında ya da ortadan kaldırılmasında en etkili yöntem cerrahi olsa da, hastanın yaşam kalitesinin azalmasını önlemek için, beklenen veya beklenmeyen cerrahi komplikasyonlar da akılda bulundurulmalıdır. Bu çalışmanın amacı da, temporal lob epilepsi cerrahisinin cerrahi komplikasyonlarını ve bunun temporo-mezial yapılardan kaynaklanan, ilaca dirençli temporal lob epilepsili hastaların seyri üzerindeki etkilerini değerlendirmektir. YÖNTEM ve GEREÇ: Ocak 2000 ve Ağustos 2010 tarihleri arasında Gülhane Askeri Tıp Akademisi’nde temporal lobektomi ve/veya selektif amigdalahippokampektomi yapılan toplam 58 hastanın cerrahi işlem sırasında ve sonrasında ortaya çıkan komplikasyonlar retrospektif olarak değerlendirilmiştir. BULGULAR: Hastaların 7’sinde (12) cerrahi komplikasyon gözlendi. En sık görüleni 2 hastada (%2.9)gözlenen enfeksiyon idi. Diğer komplikasyonlar, hemorajik infarkt, sol fasiyal sinirin frontal dalında parezi, anksiyete bozukluğu, depresif bozukluk ve geç başlangıçlı psikoz idi. SONUÇ: Çalışmamızın sonuçları, epilepsi cerrahisinden sonraki başarılı sonuçların, cerrahi sonrası bakımın ve hastaların uzun süreli takibinin önemine işaret etmektedir.AIM: Although surgery is the most effective means of eliminating or reducing seizures in cases of medically refractory epilepsy, the expected or unexpected surgical complications must also be kept in mind in order not to decrease patients' quality of life. The aim of this present study was to assess the surgical complications of temporal lobe epilepsy surgery and their effects on the disease course in patients with intractable epilepsy arising from the temporo-mesial structures. MATERIAL and METHODS: The records of 58 patients who underwent temporal lobectomy and/or selective amygdalahippocampectomy at G&uuml;lhane Military Medical Academy between January 2000 and August 2010 were reviewed for peri- and post-surgical complications. RESULTS: Post-surgical complications were detected in 7 patients (12%). The most common complication of ES was infection in 2 patients (2.9%). Other complications were hemorrhagic infarction, paresis of the frontal branch of the left facial nerve, subdural effusion, anxiety disorder, depressive disorder and late-onset psychosis. CONCLUSION: The results of our study suggest the importance of post-operative care and long-term follow up in order to achieve favorable seizure outcome after epilepsy surgery

Türkiye’nin kuzey doğu populasyonunda pulpa taşlarının değerlendirilmesi

Amaç: Bu çalı?manın amacı bir Türk populasyonunda dijital panoramik radyografiler kullanarak arka grup di?lerde pulpa ta?larının sıklık ve dağılımını değerlendirmekti. Gereç ve Yöntemler: Ya?ları 15 ile 35 arasında deği?en 3113 hastanın panoramik radyografileri pulpa ta?larının sıklık ve dağılımını belirlemek için retrospektif olarak incelendi. Tüm veriler hastalara ait kayıtlardan elde edildi. Üçüncü büyük azı di?leri dı?ındaki tüm azı di?leri incelendi. Elde edilen veriler her iki arkta cinsiyetlere göre kayd edildi ve ayrıca her iki çenede di? tipine göre sağ ve sol tarafta var ya da yok olarak kaydedildi. Pearson ki -kare ve Fisher exact testi istatistiksel farklılığı kar?ıla?tırmak için kullanıldı (P<0.05). Bulgular: 3113 hastanın 395’i (%12.6) bir ya da daha fazla pulpa ta?ı bulunan di?e sahipti. Pulpa ta?ları kadınların %14.7’sinde ve erkeklerin %9.7’sinde gözlemlendi. Erkekler ve kadınlar arasındaki farklılık önemliydi (P<0.05). 38225 di?in 1122’sinde (%2.9) pulpa ta?ı belirlendi. Pulpa ta?ı üst çenede (%4. 3) alt çeneden (%1.4) daha fazlaydı ve çeneler arasındaki farklılık önemliydi (P<0.05). Pulpa ta?ları her iki çenede birinci ve ikinci azı di?lerinde çok yaygındı. Pulpa ta?ları üst ve alt çenede simetrik olarak daha sık bulundu. Sonuç: Hastaların %12.6’sı nda pulpa ta?ı bulundu ve cinsiyetler arasındaki farklılık istatistiksel olarak önemliydi. Pulpa ta?ı üst birinci azı di?lerinde çok sık bulundu. Pulpa ta?ları alt ve üst çenede çoğunlukla simetrik olarak gözlemlendi.Aim : To evaluate the prevalence and distribu - tion of pulp stones in posterior teeth by u sing digital panoramic radiographs in a Turki sh subpopulation. Materials and method : Panoramic radiographs of 3,113 patients ranging in age from 15 to 35 (1,836 females and 1,277 males) were retrospectively examined to determine the prevalence and distribution of the pulp stones. All data were obtain ed from dental records. All posterior teeth were investigated except third molars, and the d ata obtained were recorded as present or absent according to genders in both arches, in the left and right side according to tooth type in both arches. Pearson’s ch i -squared and Fisher’s exact tests were used for difference comparisons (P<0.05). Result : Of the 3,113 patients, 395 (12.6%) had one or more teeth that contained pulp stones. Pulp stones were noted in 14.7% of females and in 9.7% of males, with significan t difference between genders (P<0.05). Pulp stones were detected in 1,122 of the 38,225 teeth (2.9%). Pulp stones were more common in the maxilla (4.3%) than in the mandible (1.4% ), with significant difference between arches (P<0.05). The prevalence of pu lp stones was more frequent in the first and second molars in each dental arch. Pulp stones were more frequent as the bilateral than unilateral in the maxilla and mandible. Conclusion: The prevalence of pulp stones was found in 12.6% of dental patients, wi th gender difference. Maxillary first molars were most commonly found to have pulp stones. Pulp stones were more frequent as the bilateral in the maxilla and mandible