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Status epilepticus (SE) is a life-threatening emergency condition. In addition to well-known etiological factors, many rare causative factors have also been defined. Ecstasy (3,4-methylenedioxy-N-methylamphetamine) is an amphetamine derivative known to cause SE. Presently described is a case of recurrent SE in which ecstasy was an etiological factor.

Objectives:An analysis of clinical practice trends in use of conventional drugs to treat epilepsy versus newer antiepileptic drugs (AEDs) was conducted.Methods:Medical records of patients who presented at the clinic with diagnosis of epilepsy 2007-2012 were investigated retrospectively.Results:Data of 1126 patients were evaluated. Among them, 624 (55%) patients were treated using monotherapy, 449 (40%) patients received polytherapy, and 53 (5%) patients had no therapy. While 916 (81%) of the patients were using conventional AEDs, 447 (40%) of the patients were using newer AEDs. A total of 887 (79%) of the patients were using either valproate or carbamazepine. Of the 624 patients using monotherapy, 523 (84%) were on conventional AEDs and 101 (16%) patients were taking newer AEDs.Conclusion:In a previous study, the authors found the percentage choosing newer AEDs to be 1% before 1994, 10% in the period 1995– 2000, and 14% in the period 2000–2007. Although the present study indicates that there was an increase (40%) in the use of newer AEDs in 2007–2012, it seems that conventional AEDs are still a first-line treatment choice, at least in Turkish clinical practice. Yet as both epileptologists and patients gain experience with newer AEDs, the trend is likely to change.

OBJECTIVE: The aim of this study was to review the efficacy, adverse effects and contraindications of intravenous thrombolytic treatment in acute ischemic stroke and to determine the predictive value of stroke scales applied in the first 24 hours to the three months outcome. METHODS: We retrospectively evaluated the clinical data of 30 patients with ischemic stroke seen at our institution over the period October 2005 to October 2008; 12 of the patients received intravenous thrombolytic treatment while 18 patients were not treated despite being admitted within three hours. The neurological deficits were graded using NIHSS, RANKIN and BARTHEL scales. The relationship between time to treatment and clinical improvement and also the association between the scales at 24 hours and the three months clinical outcome were evaluated. The reasons for not treating the patients who were admitted within the therapeutic window were determined. RESULTS: Only 30 of 404 patients were admitted within three hours. Twelve patients were admitted within 134.58 ± 39.4 minutes of stroke onset. Clinical improvement, defined as an improvement of ≥ 25% NIHSS points, was observed in 6 of the 12 (50%) patients within 24 hours of therapy. An improvement of about 80% NIHSS points at three months was observed when compared with baseline scores. Two of the patients showed insufficient improvement, defined as an improvement of < 25% NIHSS points. Four patients died due to intracerebral hematoma, severe brain edema or cardiac causes. Of the 18 patients who did not receive treatment, this was due to contraindications in 17 and to failure to obtain consent for the treatment in 1. CONCLUSION: Our data suggest that an improvement of ≥ 25% NIHSS points at 24 hours predicts the prognosis at three months and supports the conclusion from previous studies that thrombolytic therapy is a reliable and feasible treatment in selected patients with acute ischemic stroke

Multiple system atrophy (MSA) is an adult-onset, sporadic, progressive neurodegenerative disease. According to the consensus criteria, patients with MSA are clinically classified into cerebellar (MSA-C) and parkinsonian (MSA-P) subtype. Besides the poor response to levodopa, and the additional presence of pyramidal or cerebellar signs (ataxia) or autonomic failure as major diagnostic criteria, certain other clinical features known as ‘‘red flags’’ or warning signs may raise the clinical suspicion of MSA. Case report: A 67-year-old woman was admitted to our hospital due to inability to walk. Neurological examination revealed severe Parkinsonism with poor response to levodopa therapy, ataxia. Brain MR imaging showed severe atrophy of the cerebellum, pons, minimal cerebrum, and revealed cross section at the pons in the axial section. Mini-Mental State Examination (MMSE) was normal, Median SEP within normal limits but left Tibial SEP was longer than right side (right: 41, left: 44.2). Although sympathetic skin response of upper extremities was normal, the sympathetic skin responses of lower extremities were absent. RR interval study and a graded head-up tilt test were consistent with autonomic dysfunction. We report a patient with MSA because in clinical practice a case who fullfits all criteria is really rare.

It has been reported that sagittal spinal alignment may become abnormal in patients with hip osteoarthritis. There is limited data in the literature on how spinopelvic parameters change after total hip arthroplasty (THA) with femoral shortening in unilateral Crowe type IV dysplastic hips. We aimed to investigate the effects of THA with femoral shortening in unilateral Crowe type IV dysplastic hips on sagittal spinopelvic parametres. Patients who underwent THA for Crowe type IV dysplastic hips at our institution between 2014-2019 were included in the study. Pre- and postsurgical standing anteroposterior and lateral spine X-Ray images of the each patient were uploaded to SURGIMAP© (Nemaris Inc.. USA) (https://www.surgimap.com/). The radiographic data of all patients were reviewed and measurements performed for each patient by two senior spinal surgeons. All of the parameters were retrieved from the SURGIMAP© measurement system. There were 18 patients aged 27-60 (mean, 45.5±7.9) years. The mean follow-up duration was 27.5 ± 8.9 (range, 13–42) months. There was no statistically difference between pre-and postoperative values of Sacral Slope (SS), Pelvic incidence (PI) Lumbar Lordosis (LL), PI-LL mismatch and Thoracic Kyphosis (TK), Global Tilt (GT), T1 Pelvic Angle (TPA), Cervical Lordosis (CL) and T1 slope (T1S). We also found no significant change between pre-and postsurgical values of global alignment and proportion (GAP) scores. The only significant change was in detected pre-and postsurgical values of PT, T1Spi, T9Spi ( p = 0.022, p = 0.035, and p = 0.033 respectively). THA with femoral shortening in unilateral Crowe type-IV dysplastic hips does not effect a change in sagittal spinopelvic parameters. Except for PT, T9SPi, and T1SPi do. [Med-Science 2022; 11(2.000): 734-9]

Abstract Background Although more than a year past since COVID-19 was defined, there is no specific treatment yet. Since COVID-19 management differs over time, it is hard to determine which therapy is more efficacious. In this study, we aimed to evaluate the efficacy of the regimen with Favipiravir (FPV) and determine if the timing of FPV addition offers any improvement. Methods A retrospective observational case-controlled cohort study was performed between March and September 2020, including adults with COVID-19 in a single-center in Turkey. We categorized patients into age-sex matched three groups, group 1 (n = 48) and group 2 (n = 48) included patients treated with the combination of FPV plus Hydroxychloroquine (HQ) early and late, respectively. Group 3 (n = 48) consisted of patients on HQ monotherapy. In Group 2, if the respiratory or clinic condition had not improved sufficiently, FPV was added on or after day 3. Results We found that starting FPV early had an impact on PCR negativity and the progression of the disease. 'No progression' was defined as the absence of a new finding in the control radiological examination and the absence of accompanying clinical deterioration. Also, the decrease in C-reactive protein (CRP) was greater in Group 1 than Group 3 (p

Introduction The prognosis of malignant pleural mesothelioma (MPM) is poor, with a limited survival time. In this study, we aimed to examine expression levels of genes selected from relevant literature and to utilize in silico methods to determine genes whose expression could reflect the prognosis of patients with MPM by ex-vivo validation experiments. Material and methods The study group consisted of 54 MPM patients treated with chemotherapy. Expression of 6 genes – midkine (MDK), syndecan-1 (SDC1), hyaluronan synthase-2 (HAS2), sestrin-1 (SESN1), laminin subunit alpha-4 (LAMA4), and fibulin-3 (FBLN3) – was examined by qPCR in tumor tissues. Sestrin-1 and LAMA4 were identified using an in house R-based script: Unsupervised Survival Analysis Tool. Midkine, SDC1, HAS2, and FBLN3 were selected from current literature. We used two housekeeping genes, i.e. glucose-6-phosphate dehydrogenase and TATA-box binding protein, as controls. Results Of the patients, 43 (79.6%) had epithelioid mesothelioma. The median survival for all patients was 10 (±1.2 SE) months (95% CI: 7.7–12.3). In multivariate analyses, MDK (p = 0.007), HAS2 (p = 0.008) and SESN1 (p = 0.014) expression levels were related to survival time in the whole group. In epithelioid type MPM patients, MDK (p = 0.014), FBLN3 (p = 0.029), HAS2 (p = 0.014) and SESN1 (p = 0.045) expression was related to survival time in multivariate analyses. Conclusions High HAS2 and SESN1 expressions and low MDK are potential biomarkers of good prognosis in MPM. High HAS2 and SESN1 expression and low MDK and FBLN3 can also be utilized as biomarkers of good prognosis for epithelioid MPM. Those results should be further investigated in sera, plasma, and pleural effusions.

INTRODUÇÃO: O período de silêncio cutâneo (PSC) é um reflexo protetor inibitório da coluna vertebral e seus aferentes consistem em fibras nervosas A-delta. Nosso objetivo foi avaliar pacientes com fibromialgia (FM) e controles saudáveis para determinar as diferenças entre os grupos em relação à duração e latência do PSC, e quando presente, determinar se há alguma relação com as características da doença, distúrbios psicológicos e qualidade de vida. MATERIAIS E MÉTODOS: Trinta e dois pacientes com FM e 32 voluntários saudáveis foram incluídos no estudo. Os dois grupos foram comparados em relação à latência e duração do PSC em ambos os membros superiores e inferiores. Características da doença, distúrbios psicológicos e qualidade de vida dos pacientes foram avaliados utilizando o Fibromyalgia Impact Questionnaire (FIQ), e o Short Form-36 (SF-36). Os pacientes com medida de PSC igual ou inferior às do grupo controle foram comparados com aqueles com valores mais elevados do que os controles em termos de características da doença, estado psicológicos e qualidade de vida. RESULTADOS: Latências significativamente prolongadas de PSC nos membros superiores e inferiores foram determinadas em pacientes comparados com os controles. Observou-se que a prolongamento da latência do PSC no membro inferior estava associado com a gravidade da doença e incapacidade funcional. CONCLUSÕES: Latências do PCS nos membros superiores e inferiores em pacientes com FM são mais longas do que em voluntários saudáveis. Além disso, o prolongamento da latência do PSC no membro inferior está associado com a gravidade da doença e incapacidade funcional física.

Purpose. To determine the normal anatomical features and variations of the vertebrobasilar circulation and its branches in patients who underwent multidetector computed tomography (CT) or magnetic resonance (MR) angiographies of the brain. Methods. 135 patients (male, 83 and female, 52; mean age, 50.1 years) who underwent CT or MR angiographies of the vertebrobasilar vasculature for various reasons were analyzed retrospectively. The right and left distal vertebral arteries (VAs), posterior inferior cerebellar arteries (PICAs), anterior inferior cerebellar arteries (AICAs), superior cerebellar arteries (SCAs), posterior cerebral arteries (PCAs), and posterior communicating arteries (PCoAs) were analyzed individually. Results. In 24.4% of the cases (33/135) right PICA, in 19.3% of the cases (26/135) left PICA, in 17.8% of the cases (24/135) right AICA, and in 18.5% of the cases (25/135) left AICA were absent. In cases without PICA or AICA, there was a statistically significant, moderately or well-developed AICA or PICA on the same side, respectively . The most common variation was isolated absence of right PICA and was seen in 17.8% of the cases. Conclusions. The anatomic features of the branches of the vertebrobasilar circulation may be different from well-known normal anatomy. CT and MR angiographies allow a precise and detailed evaluation of vertebrobasilar circulation.