Vildan Altunayoglu Cakmak

Electrodiagnosis of carpal tunnel syndrome in patients with diabetic polyneuropathy.

OBJECTIVE Diagnosis of carpal tunnel syndrome (CTS) is difficult in patients with diabetic polyneuropathy as both conditions may affect median nerve conduction in a similar manner. There is no agreement about which electrodiagnostic tests are more efficient in determining CTS accurately in these patients. In this study, we aimed to define the best electrodiagnostic test in the diagnosis of CTS in diabetic polyneuropathy patients. METHODS We prospectively investigated 72 patients with CTS (140 hands), 32 patients with diabetic polyneuropathy without CTS (61 hands), 35 patients with diabetic polyneuropathy with CTS (62 hands) and 43 healthy controls (86 hands). Standard nerve conduction studies, segmental and comparative median nerve conduction tests were performed in all subjects. Cut-off values, sensitivities and specificities of each test for the diagnosis of CTS in diabetic polyneuropathy patients were determined by using receiver operating characteristic (ROC) curve. RESULTS Distoproximal latency ratio (DPLR) with a sensitivity of 90% and specificity of 81% for the cut-off value of 1 and median and ulnar sensory latency difference to digit 4 (MUDD4) with a sensitivity of 90% and specificity of 85% for the cut-off value of 0.35 showed the highest sensitivity and specificity in the diagnosis of CTS in diabetic polyneuropathy patients among all nerve conduction tests. Wrist-palm median sensory conduction velocity (W-P SCV) and median and radial sensory latency difference to digit 1 (MRDD1) also showed high sensitivity and specificity. CONCLUSIONS Segmental median nerve conduction studies like DPLR and W-P SCV and sensory comparative tests such as MUDD4 and MRDD1 in combination with standard nerve conduction tests should result in more accurate diagnosis of CTS in diabetic polyneuropathy patients. SIGNIFICANCE These results could be helpful to overcome the diagnostic difficulty of CTS in patients with diabetic polyneuropathy.

Personality traits of patients with multiple sclerosis and their relationship with clinical characteristics.

Abstract Few studies have investigated personality characteristics in people with multiple sclerosis (MS), and little is known about the relationship between personality and clinical characteristics in these patients. We aimed to investigate the personality traits of MS patients and their relationship with clinical characteristics. The study population consisted of 74 MS patients and age-matched, sex-matched, and education level–matched healthy controls. All participants were instructed to complete the self-administered 240-item Temperament and Character Inventory and the Beck Depression Inventory. The MS patients exhibited higher harm avoidance (HA) and lower self-directedness scores than the control group, although these differences disappeared after controlling for depression. Duration of the disease was positively correlated with HA and negatively correlated with novelty-seeking scores. Expanded Disability Status Scale scores were negatively correlated with reward dependence. Our results suggest a possible relationship between personality characteristics and the stage of the disease or the degree of damage in MS patients.

Evaluation of Temperament and Character Features as Risk Factors for Depressive Symptoms in Patients with Restless Legs Syndrome

Background and Purpose Restless legs syndrome (RLS) is a common sleep-related movement disorder that is frequently associated with psychological disturbances. Personality traits are of considerable importance with respect to coping with chronic illness and disease vulnerability. This study assessed the temperament and character traits of RLS patients using an approach that involves the psychobiological model of personality. Methods The personality features of 65 newly diagnosed and untreated RLS patients with no neurological or psychiatric diseases and 109 healthy controls were determined using the Temperament and Character Inventory and compared using covariance analyses. The International RLS Study Group Severity Scale was used to assess the severity of the RLS symptoms, and the Beck Depression Inventory was used to assess the presence and severity of depressive symptoms. Results RLS patients scored significantly higher than healthy controls on the temperament dimension of harm avoidance (HA, p=0.02) and significantly lower on self-directedness (SD, p=0.001). No significant difference was observed in terms of the temperament dimension of novelty seeking (p=0.435). HA scores were significantly correlated with the BDI score but not with the RLS severity or duration. Conclusions High HA and low SD scores are the main characterizing personality features of RLS patients. These personality dimensions may be among the factors predisposing patients to development of the depressive symptoms that are frequently associated with RLS.

Prevalence of restless legs syndrome in Trabzon in the northeast Black Sea Region of Turkey: co-morbidities, socioeconomic factors and biochemical parameters

Abstract Objectives: Factors including heritability, climate features, co-morbid diseases and methodological differences between studies may underlie variation in the prevalence of restless legs syndrome (RLS). The purpose of this study was to assess the prevalence of RLS in Trabzon and to evaluate associated factors by including biochemical investigations. Methods: This community-based study was conducted among a random sample of 3789 adults. The criteria suggested by the International RLS Study Group were used in the assessment of RLS. Individuals responding affirmatively to at least one question were interviewed and examined by neurologists for definitive diagnosis of RLS. Age- and gender-matched RLS-negative individuals were enrolled in the control group. Blood samples from RLS patients and control subjects were collected after 12-hour fasting to evaluate fasting blood glucose, ferritin, vitamin B12, folic acid and creatinine. Results: The prevalence of RLS was 4.5%. Age, female gender and educational level were identified as independent risk factors for RLS. Peak prevalence rates were observed in the fourth decade in women and in the sixth decade in man. A familial history of RLS, low ferritin and vitamin B12 levels and multiparity were more common in women with RLS. Fasting blood glucose, folic acid and creatinine levels were not significantly different between the patients and controls. Discussion: The prevalence of RLS is relatively consistent in different regions of Turkey. Women with RLS may have different risk factors from men with RLS that may lead to increased prevalence at earlier ages. Low socioeconomic status may also affect the prevalence of RLS.

Lack of Association between Pulse Steroid Therapy and Bone Mineral Density in Patients with Multiple Sclerosis

Multiple sclerosis (MS) has been associated with reduced bone mineral density (BMD). The purpose of this study was to determine the possible factors affecting BMD in patients with MS. We included consecutive 155 patients with MS and 90 age- and sex-matched control subjects. Patients with MS exhibited significantly lower T-scores and Z-scores in the femoral neck and trochanter compared to the controls. Ninety-four (61%) patients had reduced bone mass in either the lumbar spine or the femoral neck; of these, 64 (41.3%) had osteopenia and 30 (19.4%) had osteoporosis. The main factors affecting BMD were disability, duration of MS, and smoking. There was a negative relationship between femoral BMD and EDSS and disease duration. No association with lumbar BMD was determined. There were no correlations between BMD at any anatomic region and cumulative corticosteroid dose. BMD is significantly lower in patients with MS than in healthy controls. Reduced BMD in MS is mainly associated with disability and duration of the disease. Short courses of high dose steroid therapy did not result in an obvious negative impact on BMD in the lumbar spine and femoral neck in patients with MS.

The Significance of the Relative Lymphocyte Count as an Independent Predictor of Cardiovascular Disease in Patients with Obstructive Sleep Apnea Syndrome.

Objective: The aim of this study was to determine whether or not relative lymphocyte count (RLC) is associated with cardiovascular disease (CVD) in patients with obstructive sleep apnea syndrome (OSAS). Subjects and Methods: In this study, 141 patients diagnosed with OSAS using polysomnography were enrolled. Patients were classified according to the severity of OSAS as determined by the apnea-hypopnea index (AHI) and presence of CVD. Lymphocyte count and other hematological parameters at complete blood count were determined and compared between patients with and without CVD. Multivariate regression analysis was used to estimate the associated factors for presence of CVD. Results: Absolute and relative lymphocyte counts were lower in the OSAS patients with CVD compared to those without CVD (mean absolute lymphocyte counts: 2.0 × 103 vs. 2.5 × 103 µl, p = 0.004, and mean RLC: 28.3 vs. 33.9%, p = 0.001, respectively). OSAS patients with CVD (14.2) had higher red cell distribution width values than the patients without CVD (13.4) (p = 0.005). Multivariate analysis identified RLC as an independent predictor of CVD in patients with OSAS (odds ratio = 0.9, 95% CI: 0.85-1.0, p = 0.042). Conclusion: RLC was identified as an independent predictor of CVD in patients with OSAS. Since RLC is a widely available diagnostic tool with no additional costs over the routinely performed complete blood count, it can be used for predicting CVD in patients with OSAS.

The diagnostic value of the neutrophil-lymphocyte ratio in distinguishing between subarachnoid hemorrhage and migraine

Objective: Migraine and subarachnoid hemorrhage (SAH) patients present to emergency departments with the similar symptoms as headache, nausea, and vomiting. This study investigated whether the neutrophil‐lymphocyte ratio (NLR) could distinguish patients with SAH from those with migraine. Methods: This retrospective study was performed after research ethics committee approval. Data were gathered from the ED and neurology clinics of a university hospital between January 2015 and January 2016, from patients with symptoms of headache (primarily), nausea and vomiting. One hundred and twenty one with SAH, 123 patients with migraine and 987 with other primary headache syndromes were considered. Neutrophil‐lymphocyte ratios (NLR‐1) were compared between groups on admission. In SAH patients NLR taken on the 24th–30th hour of admission (NLR‐2) was compared to admission NLR. Results: NLR values, showed that the median NLR values of SAH patients were significantly higher than migraine and other headaches group values (p < 0.001; p < 0.001). There was no statistically significant difference between the NLR values of the migraine and control groups (p > 0.05). An NLR cut‐off value of 4.02 produced 85.95% sensitivity, 97.46% specificity, a 33.79 positive likelihood ratio (LR+), and a 0.14 negative likelihood ratio (LR‐). A statistically significant increase was observed in median NLR‐2 values compared to median NLR‐1 values in SAH patients (p < 0.001). Conclusion: In this retrospective analysis, NLR distinguished patients with SAH from those with migraine. Presence of SAH should be evaluated from discharged and readmitted patients (with headache symptoms) when an increase in NLR between initial and readmission levels is observed.