Nerve conduction studies in the early diagnosis of amyotrophic lateral sclerosis and the importance of split-hand phenomenon

Aim: The heterogeneity of the Amyotrophic Lateral Sclerosis (ALS) clinical phenotypes leads to difficulties in early diagnosis. The ‘split hand’ sign is defined as the thenar muscles that are more prominently affected by hypothenar. In this study, the results of the initial nerve conduction study of the patients were compared with those of the controls in order to increase the findings supporting early diagnosis. Material and Method: Seventy-five patients who were diagnosed with ALS in our clinic were included in the study. The initial ENMG findings of the patients were compared with those of 70 healthy controls: Distal motor latency (DML), the compound muscle action potential (CMAP) amplitude, velocity in the motor conduction of median, ulnar, peroneal and tibial nerves; distal latency, amplitude, velocity in sensorial conduction were evaluated. Ulnar/median DML and ulnar/median CMAP amplitude ratios were examined. Results: In ALS group, DMLs of the median, ulnar, peroneal, and tibial nerves were significantly longer, and CMAP amplitudes were significantly smaller than those of the controls. The sensory conductions of the median, ulnar, and sural nerves were not statistically different between the groups. The ulnar/median DML ratio of the patients was lower than the ratio of controls (0.73/0.80;p=0.003); while the ulnar/median CMAP amplitude ratio was greater (1.40/1.11; p=0.002). Conclusion: Prolonged DML and reduced amplitudes were observed in the motor nerve conduction of ALS patients in the early period. The results of the present study also support the presence of split-hand phenomenon even in early period of limb-onset ALS (both upper and lower). These findings suggest that nerve conduction studies and electrophysiologically detected split-hand sign are important clues for the early diagnosis of ALS in case of heterogeneous clinical phenotype

Evaluation of Anterior and Posterior Clinoid Process Pneumatization with Sphenoid Sinus Types

INTRODUCTION: Anterior clinoid process (ACP) and posterior clinoid process (PCP) are usually excised for access to lesions in the surgery of sellar and parasellar tumors or aneurysms. Anatomical variations of these structures should be well known for a safe clinoidectomy. This study aimed to investigate the variations in pneumatization of ACP, PCP, and the sphenoid sinus. METHODS: The study was conducted by evaluating the images acquired by axial, coronal, and sagittal plane reconstructions of cranial computed tomography (CT) of 500 (245 female and 255 male) patients aged 15-93 years. Evaluating ACP, PCP, and sphenoid sinus pneumatization and pneumatization patterns, the concurrent occurrence of these variations was examined. RESULTS: ACP pneumatization was identified in 24% of the patients, with 8.8% being on the right, 6.4% on the left, and 8.8% bilaterally. PCP pneumatization was observed in 7% of the patients, with 2.2% being on the right, 2.2% on the left, and 2.6% bilaterally. The prevalence of concurrent CP and PCP pneumatization was 5.8%. ACP and PCP pneumatization was most frequently noted in patients with postsellar sphenoid sinus pneumatization, with rates of 19.2% and 6.6%, respectively. DISCUSSION AND CONCLUSION: The knowledge of variations in pneumatization of ACP, PCP and sphenoid sinus prevents neurovascular injuries that may occur during clinoidectomy and the formation of post-clinoidectomy cerebrospinal fluid (CSF) fistulas. These structures should be evaluated with preoperative cranial CT. Clinoidectomy should be avoided in order to prevent the formation of CSF fistulas, especially in cases of type 3 ACP and PCP pneumatization

The effect of C-reactive protein, Procalcitonin and Neutrophil/lymphocyte ratio on mortality in patients hospitalized in the intensive care unit

Effectiveness of using inflammatory markers for prognosis assessment in the intensive care units (ICU) is still not clear. The current study aimed to examines the relationship among procalcitonin, C-reactive protein, and neutrophil/lymphocyte ratio of patients who are getting treatment in the ICU during hospitalization and mortality. The study was carried out with a total of 788 patients who were hospitalized in the ICU longer than a day. All participants were over the age of 18 years old. C-reactive protein, procalcitonin, and neutrophil/lymphocyte ratios were compared between the groups of those who died and those who were discharged from the ICU.54.6% (n= 430) of 788 patients who were admitted to the study, were male whereas45.4% (n= 358) of them were female. The median age of the study group was calculated as 79 years (IQR = 19 years) (P [Med-Science 2023; 12(2.000): 383-8

Oral care frequency of patients with intensive care needs after surgery: A cross-sectional study

Although oral care for critical patients when applied effectively, minimizes important health risks, no study has been found that determines the oral care frequentness after surgery. This study was conducted to determine the oral care frequentness requirements and related factors of surgical patients admitted to the postoperative intensive care unit. It was a cross-sectional study. It was conducted with 110 surgical patients who were hospitalized in the postoperative intensive care unit and whose oral care was not yet performed within the first 6 hours. "Sociodemographic and Clinical Characteristics Form" and "Intensive Care Oral Care Frequency Assessment Scale" were used to collect data. Descriptive statistics and Chi-square automatic interaction detection analysis were applied in the analysis of the data. The mean score of the Intensive Care Oral Care Frequency Assessment Scale of the patients after surgery was 21.60±3.02. The oral care needs frequency score of 23.6% of the patients was between 10-19 points, they were identified as needing oral care should be at least 8 to 12 hours, and oral care needs of 76.4% were between 20-29 points and they were identified as needing oral care should be at least 6 hours. It was determined that the oral care frequentness score of the patients over 65 was higher than the other age groups and it was statistically significant that they needed oral care should be at least 6 hours (p [Med-Science 2023; 12(3.000): 764-71

A Dyskinesia Case Induced by Pramipexole, Pregabalin and Gabapentin After Cardiopulmonary Resuscitation

Drug-induced dyskinesias can be seen occasionally in clinical practice. Here we present a 70-year-old patient who developed a noticeable dyskinesia after the use of pramipexole, gabapentin, pregabalin respectively for the restless legs syndrome. Prior to this condition, he had been hospitalized in intensive care unit for the myocardial infarction required cardiopulmonary resuscitation, and he had been discharged with no neurological deficits. The case presented here is a good example indicating the importance of being alert for drug-induced dyskinesias after hypoxic-ischemic encephalopathy, even though everything else seems righ

The Importance of Hypothermia in the Effects of Paracetamol on the Electrical Activity of the Brain in Pentylenetetrazole Induced Experimental Status Epilepticus in Rats

Objectives:Paracetamol is a commonly used analgesic and antipyretic agent. In studies investigating the effects of paracetamol on seizure activity, to our knowledge, the hypothermic effect has not been evaluated in studies investigating the hypothermic effects of paracetamol, its activity on seizures has not been evaluated. In this study, we aimed to evaluate the effects of paracetamol on seizure and intracranial temperature simultaneously in rats.Methods:Status epilepticus (SE) was induced with pentylenetetrazole (PTZ). In the control group (Group I), SE was induced with PTZ and paracetamol was not administered. Paracetamol was administered in Group II and after 30 minutes, PTZ was injected. Paracetamol was injected immediately after PTZ injection in Group III. Electrocorticography recording was taken for 120 min in all groups and the intracranial temperature was measured.Results:In groups given paracetamol, the spike frequency was significantly lower than that of the control group for 120 min. In paracetamol-treated groups (Groups II and III), the intracranial temperature statistically decreased from the baseline at 30 minutes and hypothermia developed. Both the spike frequency and the intracranial temperature in Group II were statistically significantly lower than those of Group III at 60th min while at the 120th minute, the values for Group III were determined to be lower than those for Group II.Conclusion:The parallel decrease in spike frequency and intracranial temperature suggests that paracetamol reduces intracranial temperature to prevent epileptic activity. Rather than being a prodrug, paracetamol may be an effective drug in the treatment of status epilepticus

Occult Hepatitis B Prevalence Among the Patients with Isolated Anti-HBc IgG Positivity

Occult hepatitis B (OHB) is defined by the presence of hepatitis B virus (HBV)-DNA in the serum in absence of HBV surface antigen (HBsAg). Isolated hepatitis B core antibody (anti-HBc IgG) positivity in the serum may represent OHB infection. The aim of this study was to investigate OHB prevalence among the patients who were tested for HBV serological markers before operation. During two years period, the patients attending to department of anesthesiology for pre-operation HBV serological control were evaluated. Among these patients, subjects in whom isolated anti-HBc IgG positivity was detected were included in the study. Alanine aminotransferase (ALT), aspartat aminotransferase (AST), gamma-glutamil transpeptidase (GGT), antihepatitis C virus (HCV) antibody (by using ELISA), serum HBV-DNA levels (by using real-time polymerase chain reaction) were tested in all subjects. HBV “S” gen region mutation was investigated in all serum samples of patients detected as OHB. At the end of the study, we found that 465 patients admitted to department of anesthesiology during two years. Isolated anti-HBc IgG positivity was found in 56 (12%) of them. Thirty nine of the patients with isolated anti-HBc IgG positivity, were included in the study. In 30 (76.9%) of them isolated anti-HBc IgG positivity was confirmed and in six (20%) of them OHB was found. In none of the patients with OHB, HBV “S” gen region mutation was determined. In conclusion; OHB prevelance determined in this study is concordant to the literature. According to our results, different probable mechanisms, except for “S” gen region mutation, may cause OHB