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Prevalence of Multiple Sclerosis Door-to-Door Survey in Maltepe, Istanbul, Turkey

Background: The prevalence of multiple sclerosis (MS) in Istanbul, Turkey, is unknown. We investigated the prevalence of MS in the district of Maltepe, Istanbul, Turkey. Methods: This was a cross-sectional field research study using door-to-door sampling. Maltepe is a district of Istanbul beside the sea of Marmara (population 359,298 from 2000 census). The two-phase study screened 32,531 subjects using the Poser criteria for clinical diagnosis. The χ2 test was used for analyses of frequency distributions. Results: 33 of 32,531 people were diagnosed with MS. Their average age was 41 ± 12.0 years (43 ± 12.7 years for females and 37 ± 9.6 years for males). The prevalence of MS in Maltepe was 101.4/100,000 within the total population (118.7/100,000 in the female and 76.0/100,000 in the male populations). Conclusions: The prevalence rates of MS in the Turkish population living in a district of Istanbul are considerably higher than we thought. And the prevalence rate is much higher than neighboring countries. They are similar to those recently recorded in Sicily and Germany. These figures suggest that the prevalence rate of MS is not totally dependent upon geographical variation. However, the research of our results needs to be confirmed with further investigations in order to determine the prevalence of MS in Turkey with confidence.

Use of the International Classification of Headache Disorders, Second Edition, criteria in the diagnosis of primary headache in schoolchildren: epidemiology study from eastern Turkey.

We aimed to determine the prevalence of primary headache among schoolchildren in the city of Agri, located in eastern Turkey, where geographical, climatic and socio-economic conditions differ greatly from those of other regions of Turkey. A cross-sectional school-based (ages ranging from 11 to 18) study was conducted from January to April 2006. Diagnosis was based on the second edition of the International Classification of Headache Disorders. This population was evaluated by a two-stage clustered sampling procedure. In the first phase, 1385 children were asked whether they had had a headache within the past year. For the second-step interview, 540 children (38.9%) with a complaint of headache were selected. Five children who had complained of headaches in the first interview did not agree to participate in the second stage. Of the remaining 535, 473 were identified as having primary headache and 62 as having secondary headache. Overall, one-year prevalence of headache subtypes was 14.3% for migraine, 3.5% for probable migraine, 8.6% for pure tension-type headache, 4.6% for migraine plus tension-type headache, and 3.0% for probable migraine plus tension-type headache. The prevalence of migraine was higher in our study than in previous studies.

Increased plasma homocysteine levels in multiple sclerosis

Sir The pathophysiology of multiple sclerosis (MS) is strongly related to inflammation. In recent years, it has become particularly important to investigate the relationship between the immune and neurohormonal systems [1]. Homocysteine (Hcy) is a neurotoxic amino acid, which accumulates in various neurodegenerative disorders, including stroke and dementia [1,2]. In the current medical literature, only a few authors have reported that there is an elevation of Hcy levels in MS [2 4]. For this reason, we aimed to investigate the plasma Hcy levels in a sample of Turkish MS patients. We studied 30 consecutive patients with relapsing-remitting (RR) MS (12 females, aged 22 48 years, mean: 309/6.3; and 18 males, aged 22 46 years, mean: 429/4.2) with MS, and 21 healthy subjects (10 females and 11 males, aged 21 46 years, mean 309/5.7) as a control group. The diagnosis of MS was based on the McDonald criteria. Duration of the disease from the first symptom was mean 99/5 years. None of the patients had a new attack in the previous six months and no patient was on current steroid or other immunomodulatory therapy. Patients who had major depressive illness, current septic illness, epilepsy and other inflammatory diseases were not included in the study. None of the patients and controls had received vitamin B12 and folate supplementation for at least eight months. This study was approved by the Institutional Ethics Committee, and written informed consent was obtained from each subject. Vitamin B12 and folate levels were measured in serum samples and Hcy levels were measured in plasma samples. The Hcy levels were detected by fluorescence polarisation immunoassay (IMX; Abbot, USA). Vitamin B12 and folate levels were measured by immunoassay chemiluminescence (Access-Beckman-Coulter, USA). Results were statistically analysed by using ordinary ANOVA, and a P value B/0.05 was regarded as statistically significant. The non-parametric Spearman rank correlation test was used for the regression analysis to compare the individual parameters with each other. We found that there was no correlation between Hcy and vitamin B12 (r /0.18) and folate (r /0.23) levels. Vitamin B12 and folate levels were not statistically different for both genders in the patient groups when compared to control groups (P /0.66). Hcy was significantly higher in both male and female MS patients when compared to the control groups. Mean and standard deviation (SD) values of biochemical parameters, including Hcy, vitamin B12 and folic acid, from male subjects are shown in Table 1, and from female subjects are shown in Table 2. The mean Expanded Disability Status Scale (EDSS) score of the patients was 3.169/2.9, and there was no correlation between EDSS score and Hcy (r /0.20), vitamin B12 (r /0.18), folate (r / 0.14) levels. In our study, serum vitamin B12 and folate levels, being in the reference limits according to the age and sex groups, were not correlated with the Hcy levels. However, there are some other studies reporting low correlation between vitamin B12 and Hcy levels [2,5]. We studied 12 female and 18 male consecutive patients with RRMS. Turk Boru et al . have investigated the prevalence of MS in the district of Maltepe, Turkey in a previous study, and they found that high prevalence rates in females (average 2-fold), similar to like other countries [6]. The excess number of male patients in our current study seems to be completely incidental. In the present study, mean age of male MS patients was 10 years more than the male control group. Although Hcy levels are known to vary with age, especially due to the age-related changes in vitamin B12 [7], the difference between the patient and the control group was so high, it cannot be explained solely by age. Moreover, statistically there was no difference between the two groups in vitamin B12 levels. We did not find a correlation between Hcy levels and EDSS scores. This finding is concordant with the study of Ramsaransing et al . [4]. Our results demonstrate that Hcy levels in MS patients of both genders were significantly higher than healthy subjects. The multisystem toxicity of Hcy is attributed to its spontaneous chemical reaction with many biologically important

Comparison of postoperative pain after open and endoscopic carpal tunnel release: A randomized controlled study

Background: Results of open and endoscopic carpal tunnel surgery were compared with many studies done previously. To the best of our knowledge, difference in pain after endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR) has not been objectively documented in literature. The aim of the study was to compare the pain intensity in the early postoperative period in patients undergoing OCTR versus those undergoing ECTR. Materials and Methods: Fifty patients diagnosed with carpal tunnel syndrome were randomized into two groups using “random number generator” software (Research Randomizer, version 3.0); endoscopic surgery group [(21 female, 1 male; mean age 49 years (range 31–64 years)] and open surgery group [(25 female, 3 male; mean age 45.1 years (range 29–68 years)] and received carpal tunnel release. Surgery was performed under regional intravenous anesthesia. The patients’ pain level was assessed at the 1st, 2nd, 4th, and 24th postoperative hours using a visual analog scale (VAS) score. Results: Mean age, gender and duration of symptoms were found similar for both groups. Boston functional scores were improved for both groups (P < 0.001, P < 0.001). Pain assessment at the postoperative 1st, 2nd, 4th and 24th hours revealed significantly low VAS scores in the endoscopic surgery group (P = 0.003, P < 0.001, P < 0.001, P < 0.001). Need for analgesic medication was significantly lower in the endoscopic surgery group (P < 0.001). Conclusion: Endoscopic carpal tunnel surgery is an effective treatment method in carpal tunnel release vis-a-vis postoperative pain relief.

Myasthenia Gravis and Autoimmune Addison Disease in a Patient With Thymoma

The association of thymoma with myasthenia gravis has been well documented. However, the relationship between these two syndromes and Addison disease are very rarely encountered in clinical practice. We report on a 32-year-old man who underwent a resection for thymoma 48 months ago. The diagnosis of Addison disease was made followed by a diagnosis of myasthenia gravis on the basis of a high titer of acetylcholine receptor levels. The treatment of oral prednisolone 7.5 mg/day and oral prostigmine 180 mg/day was initiated. His symptoms and physical signs were improved after this treatment. To our knowledge, this is the fourth reported case of thymoma synchronously associated with myasthenia gravis and Addison disease.