Acute-Phase Stroke Outcome and Lipids.

Objectives: The aim of the study is to investigate the relationship of lipid subgroups with short-term mortality in acute stroke (AS). Methods: This retrospective study included 698 patients with AS who presented within 24 h of symptom onset. A hemogram from peripheral venous blood samples was taken at admission. Total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), TC/HDL-C rate, and TG/HDL-C rate were recorded. Duration of follow-up was defined as 30 days. Results: 64 out of 698 patients died during the follow-up period. The mean TG, TG/HDL-C, and TC/HDL-C levels were significantly lower in the mortality group than the survival group. In the receiver operating characteristic (ROC) analysis, the cutoff values and area under the curve of the TG, TG/HDL-C, TC, and TC/HDL-C levels for short-term stroke mortality are as follows ([100.2 mg/dL, 0.648]; [2.52, 0.650]; [170.50 mg/dL, 0.598]; and [4.32, 0.640], respectively). In the Cox regression model, only TG and TG/HDL-C, according to their ROC cutoff values, were independent variables as short-term mortality predictors (TG ≤100.2 mg/dL, HR:2.413 , 95% CI: 1.345-4.327, P:0.004); (TG/HDL ≤2.56, HR: 2.720, 95% CI: 1.389-5.359, P:0.003, respectively). Conclusion: Dyslipidemia is a well-known as a risk factor of stroke. However, this study focused on the estimation that lower TG and TG/HDL-C levels at the time of hospital admission might be predictors of short-term mortality within a month of AS attack, which is a different subject from long term risk factors of stroke. Serum TG level may be a better indicator for mortality in the acute hypercatabolic trauma such as stroke.

The Effects of Antiepileptic Medications on Lipid Profile, Thyroid Panel, and Vitamin Level.

BACKGROUND: Conventional antiepileptic drugs (AEDs) have been used for many years to treat epilepsy, and physicians are generally familiar with their side-effect profiles and potential drug interactions. However, AEDs affect patient vitamin and mineral levels in a manner that is not well understood. The goal of this study was to determine the relationship between AEDs and patient vitamins and mineral levels. MATERIALS AND METHODS: We conducted a retrospective analysis of liver enzyme levels, thyroid hormone levels, lipid profiles, and vitamin values (e.g., B12 and folic acid) in patients treated with carbamazepine, valproic acid, or levetiracetam at our institution. Patients were included in the study if their medical data included total cholesterol, triglyceride levels, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels obtained on follow-up at least three months after the start of antiepileptic treatment with carbamazepine, valproic acid, or levetiracetam. Patients were grouped according to the antiepileptic drug used. We analyzed liver thyroid function tests, lipid profiles, levels of B12, and folic acid levels using laboratory test results and compared the findings from each group. RESULTS: Carbamazepine, valproic acid, and levetiracetam did not change the levels of liver enzymes such as aspartate transaminase and alanine aminotransferase (p values respectively: .802, .094). Cholesterol and LDL levels were lower in patients using carbamazepine (p values respectively: .005, .005), and no significant difference was observed for HDL and triglyceride levels (p values respectively: .400, .091). While thyroid-stimulating hormone levels were significantly higher in patients on medication than the control group (p=.007), the levels were still within reference ranges. No significant difference was found between tri-iodothyronine and thyroxine levels (p values respectively: .065, .053). The levels of B12 and folic acid were observed to be high in the group using carbamazepine (p values respectively: .049, .004). CONCLUSION: Valproic acid and carbamazepine do not induce a significant increase in liver enzymes compared to levetiracetam, a new-generation antiepileptic medication, and they had no impact on lipoproteins such as HDL that are protective against coronary artery disease. These medications do not affect the levels of thyroid hormones in comparison to levetiracetam and the control group. Although carbamazepine and valproic acid are metabolized in the liver, liver enzyme monitoring is required; they have only affected liver enzyme values as much as levetiracetam and the control group.

A Novel Predictive Marker for In-Hospital Mortality in Acute Cerebral Infarction: Low-Density Lipoprotein Cholesterol to Lymphocyte Ratio.

Objectives Neutrophil to eosinophil ratio, neutrophil to lymphocyte ratio, C-reactive protein to albumin ratio, and red blood cell distribution width (RDW) have been studied in patients with acute cerebral infarction (ACI). However, the low-density lipoprotein cholesterol (LDL-C) to lymphocyte ratio has never been studied. Hence, our objective was to study the LDL-C to lymphocyte ratio with regard to in-hospital mortality rates of patients with ACI. Materials and methods We retrospectively examined our patients diagnosed with ACI between January 2015 and December 2018. The patients' clinical data and imaging and laboratory results during the acute period were retrieved from our database and saved for statistical analysis. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of the variables and to calculate the cut-off values. Results A total of 172 patients with ACI, including 43 patients who died and 129 patients who survived in the hospital, were included in the study. The median age of the patients who died was significantly higher than that of those who survived (p: <0.001). Median triglyceride level, LDL-C to lymphocyte ratio, and RDW-SD values were significantly higher in patients who died (p = 0.017, p: <0.001, and p = 0.003, respectively). Areas under the ROC curve were found to be as follows: LDL-C to lymphocyte ratio: 0.774 (95% CI: 0.697-0.851), RDW-SD: 0.562 (95% CI: 0.456-0.669), and triglyceride level: 0.621 (95% CI: 0.531-0.732). The cut-off value of the LDL-C to lymphocyte ratio was 59.71 (sensitivity: 79.1%; specificity: 58.1%). Conclusions The LDL-C to lymphocyte ratio can be used as a marker to predict in-hospital mortality in patients with ACI. We recommend further studies to verify our findings.

Relationship between generalized epileptic seizure and neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and neutrophil mediated inflammation.

Aim: There is a close relationship between systemic inflammation and epileptic seizure. Recently, neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been defined as significant inflammation biomarkers. In the present study, it was aimed to determine levels of NLR, PLR, and mean platelet volume (MPV) during generalized tonic clonic epileptic seizures, and to investigate their relationships with epileptic seizures.Methods: The present study was conducted on 72 patients with epilepsy who applied with primary and secondary generalized tonic clonic epileptic seizures according to classification of the International League Against Epilepsy (ILAE), and 72 healthy individuals as the control group. Neutrophil and lymphocyte counts, NLR, PLR, and MPV values of patients were evaluated both in acute (in the first hour of epileptic seizure) and subacute (in hour 72 of epileptic seizure) phases by biochemical analysis.Results: Statistically significant differences were determined in laboratory values of white blood cell (WBC) (p < 0.001), neutrophil (p < 0.001), lymphocyte (p < 0.001), NLR (p < 0.001), MPV (p < 0.05), platelet (p < 0.001), C-reactive protein (CRP) (p < 0.05) in acute phase; and in lymphocyte (p < 0.05), NLR (p < 0.05), platelet (p < 0.001), and CRP (p < 0.001) in subacute phase between patients and healthy controls. Statistically significant differences were determined in laboratory values of WBC (p < 0.001), neutrophil (p < 0.001), lymphocyte (p < 0.05), NLR (p < 0.001), CRP (p < 0.001), and PLR (p < 0.05) in patient group between acute and subacute phases. In patient group, mean lymphocyte count was determined lower in acute phase than subacute phase (p < 0.05).Conclusion: The most striking finding of the present study is determination of 1 unit increase in NLR results in 1.95 folds increase in epileptic seizure risk in binary logistic regression analysis. Additionally, it indicates that epileptic seizure is correlated with NLR, PLR, and neutrophil mediated inflammation. To the best of authors knowledge, this is the first report indicating that there is a relationship between epileptic seizure and PLR, neutrophil mediated inflammation, and that 1 unit increase in NLR increases epileptic seizure risk by 1.95 folds.

Effects of Inappropriate Sexual Behaviors and Neuropsychiatric Symptoms of Patients With Alzheimer Disease and Caregivers' Depression on Caregiver Burden.

OBJECTIVE: We investigated the effects of inappropriate sexual behaviors (ISBs) and neuropsychiatric symptoms (NPSs) of patients with Alzheimer disease (AD), and of caregivers' depression, on the caregiver burden. METHOD: One hundred forty three patients with AD and their caregivers were included in the study. Sixty-five patients without AD who needed care due to their disability and their caregivers were enrolled for the comparison. Depression in caregivers was diagnosed using The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (SCID-I). The Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Scale were used to evaluate the severity of AD. The Neuropsychiatric Inventory (NPI) was used to assess the NPSs of patients. Caregiver burden was evaluated using the Zarit Burden Interview (ZBI). RESULTS: Inappropriate sexual behaviors were found in 13 (9.1%) of the AD group. Inappropriate sexual behaviors were more common in moderate or severe AD (P = .009, χ2 = 9.396). The prevalence of depression (n = 38, 26.6%) was higher in caregivers of AD group with ISBs (P = .000, χ2 = 24.69). The ZBI scores of caregivers of patients with AD were higher than the comparison group. In addition, the ZBI scores of caregivers of patients with AD were significantly higher in the AD group with ISB, a high total score of NPI, and a low score of MMSE. The caregivers of AD group with depression had higher ZBI scores (P < .05). CONCLUSIONS: The severity of AD, the presence of NPSs in patients, and major depression in caregivers were risk factors for an increased caregiver burden.

Correlation of neutrophil/lymphocyte and platelet/lymphocyte ratios with the severity of idiopathic carpal tunnel syndrome.

BACKGROUND: The aim of the present study was to investigate the correlation of the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio with the severity of idiopathic carpal tunnel syndrome (CTS). METHODS: A total of 407 patients with idiopathic CTS (neurophysiologically 150 mild, 144 moderate, and 113 severe) and 206 subjects without CTS were included (control group). RESULTS: There was a positive correlation between the severity of CTS and NLR (r = 0.224; P < 0.001), age (r = 0.333; P < 0.001), and body mass index (r = 0.251; P < 0.001). A 1-unit increase in NLR level was associated with an approximately 1.7-fold higher incidence of CTS (P = 0.002; odds ratio = 1.668; 95% confidence interval = 1.199-2.319). CONCLUSIONS: Our results suggest that neurophysiologically more severe CTS is associated with higher NLR levels. The role of systemic inflammation in CTS should be investigated in further studies.

Evaluation of the Clinical Features, Management, and Prognoses of Patients With Charles Bonnet Syndrome.

Charles Bonnet syndrome (CBS) is characterized by visual hallucinations with preservation of cognitive abilities. The hallucinations consist mostly of vivid (realistic) objects and tend to reoccur. Here, we evaluate the etiologies, symptoms, treatments, and prognoses of 13 CBS cases. All patients had visual hallucinations but were normal on cognitive and psychiatric assessments. Patient demographic and clinical characteristics, treatment options, and 3-month follow-up data were retrospectively reviewed. The possible causes of CBS and what the patients perceived during their hallucinations were recorded. Antipsychotic agents, such as risperidone and quetiapine, and anticonvulsants, such as levetiracetam, may be effective in some cases.