Nergiz Huseyinoglu

ULTRASOUND ELASTOGRAPHIC EVALUATION IN THE DIAGNOSIS OF CARPAL TUNNEL SYNDROME: INITIAL FINDINGS

The purpose of this study was to investigate ultrasound (US)- and US elastography-detected changes in the median nerve of patients with carpal tunnel syndrome (CTS). Seventy-four wrists of 41 female patients with CTS (mean age, 47.73 ± 11.45 y) and 45 wrists of 24 asymptomatic female controls (mean age, 42.83 ± 10.66 y) were examined with US and US elastography. Electromyography results confirmed the diagnosis of CTS in the patients. The mean median nerve perimeter (MN-P = 15.26 ± 2.18 mm) and median nerve cross-sectional area (MN-CSA = 11.81 ± 4.05 mm²) of patients with CTS were higher than those of controls (12.08 ± 1.54 mm and 7.76 ± 1.40 mm², respectively) (p < 0.05). Mean tissue strain was lower in the patients with CTS (0.094 ± 0.045 than in the controls (0.145 ± 0.068) (p < 0.05). The most sensitive cut-off value for tissue strain was 0.0635, and the most specific was 0.19. US and US elastography, in addition to electromyography, proved to be beneficial in the diagnosis of CTS. US elastography is a new technique that may well find a place in the diagnosis of nerve entrapment syndromes.

Optic disc and retinal nerve fiber layer parameters as indicators of neurodegenerative brain changes in patients with obstructive sleep apnea syndrome

PurposeRetina is a unique part of the central nervous system (CNS) for visualizing the processes of axonal and neuronal degeneration. Optical coherence tomography (OCT) allows direct visualization and measurement of retinal nerve fiber layer (RNFL) thickness, macular volume, and optic disc (OD) parameters. One of the disorders associated with atrophy in different brain regions is obstructive sleep apnea syndrome (OSAS). In the present study, we aimed to determine OD and RNFL changes measured by OCT for investigating the progress of neurodegeneration development in OSAS, excluding all the other conditions that can directly affect RNFL thickness and optic nerve parameters.MethodsBoth eyes of 101 patients with OSAS and 20 controls were investigated by OCT. Full-night polysomnography (PSG) and ophthalmologic examination including automated visual field (VF) examination and OCT were performed in all of the patients.ResultsAccording to the OSAS grading, patients were grouped as mild (n = 15), moderate (n = 27), and severe (n = 59). We found significant decrease in RNFL thickness only in the patients with severe OSAS compared with the other groups and decreased macular ganglion cell thickness in the severe OSAS group compared with the control group. VF parameters were significantly worsened in all the OSAS subgroups compared to the control group. We found different data such as normal or increased optic nerve parameters as result of subtle OD edema, which may mask possible peripapillar axonal loss.ConclusionsWe think that evaluation of neurodegeneration in OSAS is not always possible by examining OD and RNFL because there are difficulties due to the confounding issues of cerebral atrophy and OD edema.

Prevalence and risk factors of epilepsy among school children in eastern Turkey.

Epilepsy is a serious chronic brain disorder of childhood. We performed a cross-sectional prevalence study, determined the prevalence of childhood epilepsy, and identified the significance of certain risk factors for epilepsy among 1625 primary-school students aged 6-14 years, living in the center of Kars province. A questionnaire was prepared according to the definitions and principles of the Commission on Epidemiology and Prognosis, International League Against Epilepsy. Twenty-two children were diagnosed as epileptic. The point prevalence of active epilepsy in males was 4.9/1000, and in females 12.4/1000, representing a total of 8.6/1000. The cumulative prevalence in males was 11.0/1000, and 16.1/1000 in females, representing a total of 13.5/1000. Febrile convulsions, family history of epilepsy, serious maternal illness during pregnancy, a history of head trauma, antenatal/postnatal problems, and a history of neonatal jaundice were statistically significantly related to the development of epilepsy.

Effect of pregabalin on post-dural-puncture headache following spinal anesthesia and lumbar puncture

In this study, we aimed to investigate the effect of pregabalin on post-dural-puncture headache (PDPH). Forty patients who developed PDPH after spinal anesthesia or diagnostic and/or therapeutic lumbar puncture were divided into two groups and followed for 5 days. The first group received 150 mg/day oral pregabalin for the first 3 days, then 300 mg/day for a further 2 days. The second group received a placebo for the same length of time. Patient headaches were scored using the visual analog scale, and diclofenac sodium and pethidine requirements were recorded. Relative to the placebo group, the group administered pregabalin had significantly lower visual analog scale scores after the second day of treatment, and had significantly lower diclofenac sodium requirements. Our results indicate that pregabalin may be useful for the management of PDPH.

Advanced oxidation protein products and ischaemia-modified albumin in obstructive sleep apnea

Several studies have shown that obstructive sleep apnea increases incidence of cardiovascular morbidity and mortality. The high systemic oxidative stress in obstructive sleep apnea has been considered as a major pathogenic mechanism leading to cardiovascular disease. Oxidative stress‐related lipid and DNA oxidation in obstructive sleep apnea have been reported in the previous studies. In contrast, there is limited and contradictory information regarding protein oxidation in obstructive sleep apnea patients such as ischaemia‐modified albumin and advanced oxidation protein products. Therefore, we aimed to investigate plasma ischaemia‐modified albumin and advanced oxidation protein products and their correlation with total oxidative status and total antioxidative capacity in the obstructive sleep apnea patients.

Occupational Exposure to Lead Decreases Macular, Choroidal, and Retinal Nerve Fiber Layer Thickness in Industrial Battery Workers

Abstract Purpose: To evaluate the toxic effects of chronic lead (Pb) exposure on retinal nerve fiber layer thickness (RNFLT), macular thickness (MT) and choroidal thickness (CT) in battery industry workers. Materials and Methods: Male factory workers (n = 50) and healthy non-employees (n = 20) participated in the study. Group 1 (n = 22) comprised lead workers; Group 2 (n = 16), box makers; Group 3 (n = 12), assistant personnel; and Group 4 (n = 20), healthy non-employees. All participants were given Best-Corrected Visual Acuity (BCVA) tests, full ophthalmologic examinations, and Spectral Domain Optical Coherence Tomography (SD-OCT) of the optic nerve head, RNFL, macula, and choroid. Blood lead levels (BLL) in venous blood samples were determined. The duration of exposure to lead varied, and is expressed in months. Results: Average (mean ± SD) ages of participants were 27.55 ± 4.00, 28.69 ± 3.48, 32.00 ± 3.38, and 29.85 ± 5.48 yrs (Groups 1–4, respectively). BLL were 46.2 ± 2.32, 29.31 ± 3.30, 16.9 ± 1.9, and 2.85 ± 0.98 µg/dL (Groups 1–4, respectively). Durations of exposure to lead were 43.86 ± 10.81, 42.81 ± 4.86, and 49.42 ± 6.14 mo (Groups 1–3, respectively). OCT averages for RNFL were 101.68 ± 5.32, 119.50 ± 13.47, 127.67 ± 8.92, and 130.9 ± 6.63 μm (Groups 1–4, respectively). Although RNFLTs of Group 1 were significantly less than those of for Groups 2–4, and, RNFLTs of Groups 2 and 3 were significantly less than that of Group 4, there were no significant differences between Group 2 and 3. MTs were 94.50 ± 6.78, 105.63 ± 5.43, 111.50 ± 6.74 and 147.95 ± 6.67 μm, (Groups 1–4, respectively). CTs were 176.41 ± 15.39, 222.19 ± 17.79, 239.17 ± 15.64, and 251.50 ± 10.98 μm (Groups 1–4, respectively). Both MTs and CTs displayed significant differences among the four groups. Conclusions: Ocular changes in individuals who are chronically exposed to lead include decrease in RNFT, MT, and CT, and thus these parameters should be evaluated during ophthalmologic examination of individuals working in lead-based industries.

Ultrasonographic and Electrophysiological Evaluation of the Ulnar Nerve in Patients Diagnosed With Carpal Tunnel Syndrome.

Purpose: In this study, we evaluated the ulnar nerve of patients diagnosed with carpal tunnel syndrome (CTS) using electrophysiology and ultrasonography. Methods: The study included 86 patients (136 hands) and 39 controls (78 hands) with normal electrophysiological assessment. According to Blands classification, patients were divided into group 1 (grades 1–3 CTS) or group 2 (grades 4–6 CTS). The ulnar nerve was evaluated at the wrist using nerve conduction studies and ultrasonography. Results: The sensory velocity was slower in group 2 than in group 1 (P < 0.001), slower in group 2 than in controls (P < 0.001), and slower in group 1 than in controls (P < 0.005). Although the ultrasonography results showed a reduction in the ulnar nerve cross-sectional area in group 1 compared with controls, the difference was not statistically significant. However, the reduction was significant in group 2 compared with group 1 and controls (P < 0.001). Conclusions: Based on our study results, the ulnar nerve is affected electrophysiologically and morphologically in patients with CTS, especially those with advanced-stage CTS.

A Case of Systemic Lupus Erythematosus with Peripheral Neuropathy Misdiagnosed as Brucellosis

Brucellosis and systemic lupus erythematosus are two diseases with different origin and treatment targets characterized by multi-organ involvement particularly affecting central and peripheral nervous systems. It is known, that clinical symptoms of brucellosis are non-specific and can mimic many other diseases. Previously, it has been reported that slightly positive serological tests in some diseases (such as lymphoma, typhoid fever and malaria) have led to misdiagnosis of brucellosis. In our paper we report a case of systemic lupus erythematosus with bilateral “drop foot” misdiagnosed as brucellosis which recovered after appropriate treatment aimed at lupus.

Choroidal Thickening in Patients with Sleep Apnea Syndrome

Abstract Sleep apnoea syndrome (SAS) is characterised by repetitive episodes of cessation of breathing during sleep, resulting in hypoxaemia and hypercapnia. Ophthalmological consequences such as glaucoma, non-arteritic anterior ischaemic neuropathy and papilloedema are relevant to hypoxaemia. The choroid is a vascular structure that performs several regulatory functions for the retina. Defects in this structure contribute to degenerative, inflammatory, and neovascular changes in the retina. The authors examined the choroidal thickness (CT) in sleep apnoea patients using optical coherence tomograpy (OCT). The sleep apnoea patients were divided into subgroups according to their apnoea-hypopnoea index (AHI) scores, and statistical analysis was performed using the AHI and minimal arterial oxygen saturation (min. Spo2) values. There was a medium-high negative correlation between CT and AHI (Spearman rho: r = −0.744, p = 0.000), and a positive correlation between CT and min. Spo2 values (Pearson correlation: r = 0.308, p = 0.000).

Is there a Relationship Between Sleep Apnea and Central Corneal Thickness

Abstract Purpose: The objective of this study was to determine the central corneal thickness (CCT) measurements in patients with Sleep Apnea Syndrome (SAS) and the relationship between the severity of SAS and minimal arterial oxygen saturation (min. SpO2) with respect to CCT. Materials and methods: Two hundred and fourteen eyes of 107 patients (58 males, 49 females) who were diagnosed as SAS and 80 eyes of 40 healthy subjects (20 males, 20 females) were included in the study. The SAS patients were divided into subgroups according to their Apnea–Hypopnea Index (AHI) values as: AHI values between 5 and 15 as subgroup 1, between 15 and 30 as subgroup 2, and the values ≥30 as subgroup 3. The CCT was measured by an ultrasonic pachymetric system. Statistical analyses were an analysis of variance test and, for post-hoc analysis, the Dunnett C test. Results: Mean age was 52.5 ± 10.96 years in the study group, and 40.7 ± 10.14 years in the control group. There were 58 (54.2%) males and 49 (45.8%) females in the study group, and 20 (50%) males and 20 (50%) females in the control group. Mean CCT values were 526.65 ± 25.06, 525.26 ± 29.25, 512.93 ± 43.20 and 539.90 ± 17.28 in subgroup 1, subgroup 2, subgroup 3 and the control group, respectively. There were no statistically significant differences between gender and age groups with respect to CCT (p > 0.05). When the mean CCT values of each subgroups were compared with the control group, the differences were statistically significant (p < 0.05). There was a negative correlation between CCT and AHI values and a positive correlation between CCT and min. SpO2 values. Conclusions: CCT measurements differ significantly in patients with SAS compared with healthy control subjects. It should be taken into consideration that SAS may reduce CCT over time and that CCT should be measured in each ophthalmic examination.