Does the stapes reflex remain the same after Bell's palsy?

Objective: The authors investigated the integrity and function of nervus stapedius 1 year after facial paralysis. Study Design: Patients with Bell's palsy were observed prospectively for 1 year and compared with healthy patients. Setting: The follow-up of patients was done in the outpatient clinic and tests were applied in the audiology unit. Patients: The mean age of 32 patients was 41.03 years. Eight of 32 patients were grade II (25%), 11 were grade III (35%), and 13 were grade IV (40%) according to House-Brackman grading system. The mean age of the control group (10 persons) was 36.5 years. Intervention: Contralateral stimulus was used in acoustic reflex test at 500 and 1,000 Hz with 80-, 90-, 100-, and 110-dB stimulus intensity. Tests were applied in three ways: normal position, eye-closed position, and grin position. Tests were done in the first 15 days of facial paralysis and repeated at least 1 year thereafter. The millimeter difference in amplitude of impedance recording of middle ear between the normal ear and paralyzed ear was accepted as criterion. Main Outcome Measures: There were 6- to 9-mm amplitude differences between normal side and healed side of grade IV patients with 100- and 110-dB stimuli. Results: In the second test (after 1 year), statistically significant differences were present between control group and grade IV patients on 1,000 and 500 Hz frequencies with 100- and 110-dB stimulus intensity (p < 0.05). Them were no significant differences between grade II and control group and between grade III and control group. Conclusions: A permanent partial denervation is present on the stapedial nerve, especially after grade IV paralysis, and it affects the function of stapes muscle in high decibel sounds. But it does not affect the stapes reflex threshold. No synkinetic innervation was found in the authors' patient group with their test method

Development of reversible posterior leukoencephalopathy syndrome after cyclophosphamide treatment in a patient with lupus nephritis

Renal involvement in systemic lupus erythematosus is a frequent and serious complication that significantly increases morbidity and mortality. Despite all studies and usage of new drugs, treatment of lupus nephritis continues to be a problem. Diffuse proliferative lupus nephritis has a poor prognosis and aggressive treatment must be undertaken. Cyclophosphamide is commonly used in treatment despite its side effects. Reversible posterior leucoencephalopathy syndrome is a clinico-radiological syndrome manifested by blood pressure elevation, headache, visual disturbances, confusion, seizures and sometimes focal neurological signs that can develop due to usage of cytotoxic drugs. We present a case of lupus nephritis in which reversible posterior leucoencephalopathy syndrome developed after intravenous cyclophosphamide administration and recovered spontaneously by symptomatic treatment in this article

A novel form of recessive limb girdle muscular dystrophy with mental retardation and abnormal expression of α-dystroglycan

The limb girdle muscular dystrophies are a heterogeneous group of conditions characterized by proximal muscle weakness and disease onset ranging from infancy to adulthood. We report here eight patients from seven unrelated families affected by a novel and relatively mild form of autosomal recessive limb girdle muscular dystrophy (LGMD2) with onset in the first decade of life and characterized by severe mental retardation but normal brain imaging. Immunocytochemical studies revealed a significant selective reduction of α-dystroglycan expression in the muscle biopsies. Linkage analysis excluded known loci for both limb girdle muscular dystrophy and congenital muscular dystrophies in the consanguineous families. We consider that this represents a novel form of muscular dystrophy with associated brain involvement. The biochemical studies suggest that it may belong to the growing number of muscular dystrophies with abnormal expression of α-dystroglycan. © 2003 Published by Elsevier B.V

In-situ incorporation of binder during sol-gel preparation of Pd-based sulfated zirconia for reduction of nitrogen oxides under lean-burn conditions: Effect on activity and wash-coating characteristics

We have developed a dual-catalyst aftertreatment system for reducing nitrogen oxides (NOx) in the exhaust stream of natural gas-fired lean-burn engines by utilizing the unburned hydrocarbons present in the engine exhaust. The dual-catalyst bed consists of a physical mixture of a reduction catalyst (Pd/SZ) and an oxidation catalyst (Co/CeO2). In order to make this dual-catalyst system viable for practical use in the real aftertreatment units, it is necessary to develop a catalytically active washcoat for loading it onto cordierite monolith cores. To be able to handle large throughputs of gases typical of aftertreatment units, irreversible loss of activity due to separation of the wash-coat from the monolith walls can be reducedby adding binders to improve the adhesive properties of the wash-coat. However, addition of such binders may affect the catalytic activity of the resulting dual-catalyst bed. In our study, we have incorporated binders such as alumina, boehmite, bentonite or silica to the Pd/SZ catalyst using a novel technique in which the binders were added in situ during the sol-gel synthesis rather than the conventional method of adding binders (ex-situ) in catalyst slurry. Surface area analysis, X-ray diffraction (XRD) and diffuse reflectance Fourier transform spectroscopy (DRIFTS) with pyridine show that in-situ addition of binder affects the textural properties, crystal phase of zirconia and the acidic properties of the resulting Pd/SZ catalyst respectively. Electron Paramagnetic Resonance (EPR) indicated the presence of Pd+, Pd3+ and Zr3+ species in the binder-free and in situ alumina-incorporated Pd/SZ catalysts. Furthermore, steady-state activity tests on the modified dual-catalyst bed with the alumina-incorporated Pd/SZ exhibit the best performance amongst the other binder-incorporated catalysts in the dual-catalyst bed. In-situ incorporation of binder during sol-gel synthesis yielded catalysts with far superior catalytic activity for NOx reduction than conventional ex-situ binder addition to the catalyst slurry for wash-coating. Time-on-stream experiments show that the alumina-incorporated Pd/SZ catalyst maintains the hydrothermal stability of the binder-free Pd/SZ in the mixed bed. Several parameters such as pH of the binder-incorporated catalyst slurry and calcination temperature of the wash-coat have also been optimized to develop a catalytically active wash-coat and its adhesivity and uniformity were tested using ultrasonication, cyclic thermal shock and SEM imaging. (C) 2016 Elsevier B.V. All rights reserved

The prevalence of microalbuminuria and relevant cardiovascular risk factors in Turkish hypertensive patients

Objectives: A growing body of data illustrates the importance of microalbuminuria (MAU) as a strong predictor of cardiovascular risk in the hypertensive population. The present study was designed to define the prevalence of MAU and associated cardiovascular risk factors among Turkish hypertensive outpatients. Study design: Representing the Turkish arm of the multinational i-SEARCH study involving 1,750 sites in 26 countries around the world, a total of 1,926 hypertensive patients from different centers were included in this observational and cross-sectional survey study. Patients with reasons for a false-positive MAU test were excluded. The prevalence of MAU was assessed using a dipstick test, and patients were inquired about comorbidities, comedication, and known cardiovascular risk factors. Results: The overall prevalence of MAU was 64.7% and there was no difference between genders. Most of the patients (82.5%) had uncontrolled hypertension, 35.6% had dyslipidemia, and 35.5% had diabetes, predominantly type 2. Almost one-third of the patients (26.4%) had at least one cardiovascular-related comorbidity, with 20.3% having documented coronary artery disease (CAD). Almost all patients (96.8%) had one or more risk factors for cardiovascular disease in addition to hypertension, including family history of myocardial infarction or CAD, diabetes, dyslipidemia, lack of physical exercise, and smoking. A trend towards higher MAU values in the presence of CAD was determined. Conclusion: Microalbuminuria tests should be routinely used as a screening and monitoring tool for the assessment of subsequent cardiovascular morbidity and mortality among hypertensive patients. © 2011 Turkish Society of Cardiology