Neurology Outpatient Clinic Research Articles

Correlation of Vitamin D Level and Bone Mineral Density in Epilepsy Children Who Received Oral Antiepileptic Drug

BACKGROUND: Vitamin D plays an essential role in achieving adequate bone mineralization. Antiepileptic drug (AED) will cause a change in calcium serum levels and bone mineral density (BMD) through increase catabolism of Vitamin D in the liver, as well as having a direct effect on the bone. AIM: The aimed of this study was to know the correlation of Vitamin D [25(OH)D] level and BMD in epilepsy children who received oral AED. METHODS: This cross-sectional study was conducted from May to September 2016. Subjects were collected using consecutive sampling in 1−11-year-old epilepsy children who went to the pediatric Neurology and Endocrinology outpatient clinic at Sanglah Hospital. Age, sex, body weight, body height, type and number of AED used, and duration of treatment were recorded. Measurement of 25(OH)D level and BMD was performed. Pearson test was used to analyze the strength of correlation based on normality test result. RESULTS: Thirty subjects were collected, male (19/63.33%), mean age was 7.22 years, mean treatment duration was 1.71 years. Type of AED was inducer AED (18/60%) and non-inducer AED (12/40%). Mean Vitamin D level was 27.19 ng/mL and mean BMD was 0.78 g/cm2. Partial correlation test of Vitamin D level with BMD after controlling age found r = 0.118 with p = 0.54. CONCLUSION: There was weak correlation between Vitamin D level and BMD in epilepsy children who received oral AED, but the correlation analysis was not sufficient to prove the relationship.

Assessment of the profile of patients treated at neurology outpatient clinics within the scope of specialized care in the city of Barbacena-MG

Assessment of the profile of patients treated at neurology outpatient clinics within the scope of specialized care in the city of Barbacena-MG

Changes in the hippocampal volume in chronic migraine, episodic migraine, and medication overuse headache patients.

<p>Hippocampi are the structures located in the medial depths of both temporal lobes, mainly responsible for memory, navigation and regulation of emotions, and activated during the processing of pain and the modification of nociceptive stimuli. Chronic pain is thought to have stress-like detrimental modulatory effects on the hippocampal neurogenesis, and adults with chronic pain have been showed to have lower hippocampal volumes. The present study aims to show the relationship between headaches and hippocampal volume by comparing the right, left and total hippocampal volumes of patients with Episodic Migraine (EM), Chronic Migraine (CM) and Medication Overuse Headache (MOH) to those of the healthy control group using the Magnetic Resonance Imaging (MRI) technique, also by looking into the correlation between the number of painful days and attacks and the current hippocampal volumes.</p>. <p>A total of 30 patients (10 EM, 10 CM, 10 MOH) from 18 to 45 years of age diagnosed with migraine and also followed up by the neurology outpatient clinic from February to May 2022 and 30 healthy volunteers of similar ages and sexes to the patient group were included in the study. In addition to the routine cranial MRI protocols of all the participants, further cranial images were taken with the addition of the T1W 3D FSPGR sequence adjusted to the hippocampal body in the coronal plane and covering the whole brain. Hippocampal volumes were measured manually.</p>. <p>There were 27 females and 3 males in the patient group versus 28 females and 2 males in the control group, and no statistically significant differences in age and sex were found between the groups. The control group had higher average right, left and total hippocampal volumes than the whole patient group, but only the total hippocampal volume was significantly different between the groups. There was a negative correlation between the number of painful days and the measured right hippocampal and total hippocampal volumes; however, the measured values were not statistically significant.&nbsp;</p>. <p>It was concluded that the changes in the hippocampal volume in migraine might be associated with the pain characteristics of the disorder.&nbsp;</p>.

Effects of levetiracetam treatment on autonomic nervous system functions in pediatric epilepsy patients.

This study investigated the effects of levetiracetam (LEV) treatment on cardiac rhythm and heart rate variability. The study included two groups of patients diagnosed with non-lesional epilepsy who had not yet been treated and who presented to the outpatient pediatric neurology clinic at Van Training and Research Hospital, Van, Turkey, between 2019 and 2020. The heart rate variability (HRV) of 47 patients in the first group, before and at the 3rd month of treatment, and intravenous (IV) LEV loading in 13 patients in the second group was evaluated by Holter electrocardiography (ECG). It was determined that the values of triangular index, standard deviation of the RR intervals over a 24-hour period (SDNN), standard deviation of all 5-minute mean RR intervals (SDANN), mean of standard deviations of all normal RR intervals (SDNNI), the percentage of RR intervals with >50-millisecond variation (PNN50), and the square root of mean squared differences of successive RR intervals (RMSSD). HRV of 47 patients under LEV treatment significantly increased in the 3rd month of treatment compared to baseline (p < 0.05). No difference was found in HRV between the intravenous loading and the control group (p > 0.05). Our study suggests that the sympathovagal balance before treatment in the patient group is in favor of the sympathetic nervous system and that the sympathovagal imbalance improves after treatment. Our results show that LEV monotherapy and loading have no negative effect on HRV and potential cardiac arrhythmia risk in children with epilepsy.

Adaptation into Turkish and Psychometric Properties of Athens Insomnia Scale.

The study aimed to adapt the "Athens Insomnia Scale" developed by Soldatos et al. into Turkish and to conduct validity and reliability analysis. This research was conducted on 215 patients with insomnia complaints and applied to Family Medicine, Neurology (Sleep Polyclinic), and Psychiatry outpatient clinics. Introductory Information Form, 8-item Athens Insomnia Scale, and Pittsburg Sleep Quality Index were administered to the participants. After the language adaptation of the scale, Cronbach's alpha value was used as the consistency coefficient for reliability analysis. Exploratory factor analysis was examined for structural validity, and correlation coefficients between the Athens Insomnia Scale and its subscales and the Pittsburg Sleep Quality Index were examined for concurrent validity. Cronbach's alpha coefficient was calculated as 0.87. "Kaiser-Meyer-Olkin value was calculated for factor analysis." In the Exploratory Factor Analysis, a two-factor structure with eigenvalues >1.0 and explaining 73.4% of the variance was obtained. According to the Exploratory Factor Analysis results for the Atina Insomnia Scale, the absolute value of the factor loadings of the eight items ranged between 0.650 and 0.865. The correlation coefficients between the total score and sub-dimensions of the Athens Insomnia Scale and the Pittsburg Sleep Quality Index-a scale assessing sleep quality were between 0.489-0.725 (p<0,01). For discriminant validity, Athens Insomnia Scale discriminated well between patients and healthy volunteers (Z=2.630, p=0,009). The Athens Insomnia Scale has been shown to have adequate reliability and validity in Turkish.

Reliability and validity of the Turkish version of the 39-item Parkinson Disease Questionnaire.

<p>This study aims to investigate the validity and reliability of the Turkish Version of the 39-item Parkinson Disease Questionnaire.</p>. <p>A total of 100 patients with Parkinson&rsquo;s disease who were admitted to the outpatient neurology clinic in Koc University and Istanbul University were enrolled. 39-item Parkinson Disease Questionnaire, Parkinson Disease Quality of Life Questionnaire, Unified Parkinson&rsquo;s Disease Rating Scale, Hoehn-Yahr Scale, and Short Form Health Survey-36 were administered to all participants. 39-item Parkinson Disease Questionnaire was repeated 2 weeks later.</p>. <p>The internal consistency coefficient of the 39-item Parkinson Disease Questionnaire was 0.957. Test-retest correlation ranged between r = 0.693-0.979. Reliability of Turkish version of the 39-item Parkinson Disease Questionnaire was found to be very high with the exclusion of one item (30th item). The scale was found to be consistent over time and correlated positively with&nbsp;Hoehn-Yahr Scale, and negatively with Unified Parkinson&rsquo;s Disease Rating Scale, Parkinson Disease Quality of Life Questionnaire, and Short Form Health Survey-36.</p>. <p>Turkish version of the 39-item Parkinson Disease Questionnaire, with the exclusion of the 30th item can be used reliably in assessing the quality of life of Parkinson&rsquo;s patients.</p>.

Evaluation of life quality and sleep problems in children presenting with headache to the pediatric neurology outpatient clinic

Evaluation of life quality and sleep problems in children presenting with headache to the pediatric neurology outpatient clinic

The diagnostic value of electroencephalography in pediatric patients presenting with syncope Running title: The yield of electroencephalography in pediatric syncope

Aim: In the investigation of the diagnosis of pediatric syncope, it was aimed to evaluate the rate of abnormal EEG findings and the diagnostic yield of the EEG in the electroencephalography (EEG) taken following their neurological examination. Materials and Methods: EEG records of 332 patients younger than 18 years of age who presented to the pediatric neurology outpatient clinic with syncope were retrospectively analyzed. The EEG results were classified as normal and abnormal. Based on the abnormal EEG results, four subgroups were formed as focal epileptiform discharge, generalized epileptiform discharge, focal slowing and generalized slowing. Abnormal EEG results were categorized according to age and gender. Results: Of the cases included in the study, 195 (58.7%) were female and 137 (41.3%) were male. The mean age of the patients was calculated as 12.67±3.21 years. Analysis of the EEG results revealed that 92.5% were normal and 7.53% were abnormal. The most common abnormal EEG finding was focal slowing, which was detected in 12 (3.6%) patients, followed by focal epileptiform discharge which was detected in eight (2.4%) and generalized epileptiform discharge which was detected in five (1.5%) patients. Conclusion: EEG should not be routinely performed to evaluate the diagnosis of pediatric syncope. Therefore, EEG should be performed only on patients to be selected based on their medical history and the results of their neurological examination. In this way, it will be possible to derive more benefits out of EEG and to reduce the associated medical costs.

Sleep disturbances and associated factors amongst stroke survivors in North Central, Nigeria.

Sleep disturbance is common in persons with stroke and when unrecognised and untreated may hinder rehabilitation efforts and lead to poor functional outcome. It may also result in increased risk for stroke recurrence. We investigated the frequency and associated factors of sleep disturbances amongst stroke survivors. One hundred and ten stroke survivors attending the neurology outpatient clinics of two tertiary hospitals, from February 2021 to January 2022, were interviewed after obtaining ethical approval and informed consent. We used a structured questionnaire to obtain their socio-demographic, clinical characteristics and sleep disturbances. Excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Data were analysed with statistical significance set at P < 0.05. Eighty (72.7%) patients were males with a mean age of 61.4 ± 11.8, slightly older than the females (30, 27.3%) with a mean age of 60.9 ± 2.9. Their median follow-up duration was 7.5 months. Majority (84, 76.4%) had ischaemic stroke, and the frequency of sleep disturbances was 37 (33.6%) consisting of insomnia (19, 17.3%), hypersomnia (10, 9.0%), sleep-disordered breathing (5, 4.5%) and sleep-related movement disorder (3, 2.7%), respectively. Using the ESS score, 22 (20.0%) had mild, 10 (9.0%) had moderate and 7 (6.4%) had severe ESS scores, respectively. Univariate analysis showed depression to be significantly associated with ESS (P = 0.006) whereas multivariate analysis revealed age and sex as significant associated factors (P = 0.008 and P = 0.009) of ESS. More than one-third of participants reported sleep disturbances with depression, age and gender as associated factors.

Do Mean Platelet Volume and Platelet Distribution Width Have An Association with White Matter Hyperintensities in Migraine Patients?

Abstract Objective: Increased prevalence of white matter hyperintensities (WMH) is reported in migraine patients; however, the pathophysiology and the progression of these lesions are not definitely clear. Mean platelet volume (MPV) and platelet distribution width (PDW) are easily obtained markers for platelet activity. The aim of this study is to evaluate the relationship between the presence of WMH and MPV and PDW in patients with migraine in order to determine the role of platelet activity in the pathophysiology of WMH. Methods: Patients who were admitted to the neurology outpatient clinics of Baskent University Hospital from January 2011 to December 2015 with migraine and between 18 and 55 years of age were evaluated retrospectively. The blood samples were taken and total blood count parameters including MPV and PDW were analyzed. Brain magnetic resonance images were evaluated. Results: Totally, 218 patients were evaluated in this study. Forty-eight (22.0%) patients had WMH in the brain magnetic resonance imaging. In patients with WMH, the median of age was higher than the patients without WMH and the difference was statistically significant (P &lt; 0.05). There was no statistically significant difference between MPV, PDW values, and the presence of WMH. Conclusions: There are multiple theories suggested for the mechanism of WMH, but the major cause and pathophysiology are still undetermined. Our data suggested that increased platelet activity is insufficient by itself to explain the pathophysiology of WMH in migraine patients and to improve the knowledge on this issue further large longitudinal studies should be performed.

Alexithymia and Coping With Stress in Patients With Multiple Sclerosis: A Comparative Study

BACKGROUND: Multiple sclerosis (MS), which is frequently seen in young adults, affects mental health because of disease symptoms and cognitive disorders. This study was conducted to evaluate the presence of alexithymia and problem- or emotion-focused coping strategies with stress in MS patients, determine the relationship between these variables, and compare the results of MS patients with those of healthy individuals. METHODS: This descriptive, cross-sectional, and comparative study was carried out with the participation of 120 MS patients presenting to a neurology clinic and outpatient clinic of a university hospital and 120 healthy individuals. Data were collected using a personal information form, the Toronto Alexithymia Scale, and the Ways of Coping Scale. RESULTS: The 40.8% rate of alexithymia in the MS patients was higher than that in the healthy individuals (21.7%). Compared with healthy individuals, MS patients use emotion-focused coping methods, such as a lack of self-confidence approach and a submissive approach, more frequently ( P < .05). A significant negative correlation was found between the alexithymia and problem-focused coping strategies of MS patients ( P < .01). CONCLUSION: Alexithymia is more common in MS patients than in healthy individuals. Alexithymia negatively affects the methods patients use to cope with stress. In the treatment and care of MS patients, nurses should plan interventions for the ability of these patients to recognize and express their emotions and develop positive coping methods.

Evaluation and Neurodevelopmental Outcomes of Infants with Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia: A Single Center Experience

Hypoxic ischemic encephalopathy (HIE) is an important cause of mortality and morbidity in newborns. Our study aimed to determine the neurodevelopmental outcomes, risk factors, and the relationship between risk factors and prognosis of cases followed up with HIE diagnosis and who were treated with hypothermia treatment. Medical records of 23 patients who were followed up with HIE diagnosis in the pediatric neurology outpatient clinic between January 1, 2018, and December 31, 2021, and treated with therapeutic hypothermia in the newborn period were retrospectively reviewed. Denver Developmental Screening Test II was used in the developmental evaluation. Neurodevelopment was normal in 12 (52.2%) of 23 cases and retarded for age in 11 (47.8%) cases. Variables such as Sarnat encephalopathy score in the neonatal period, need for prolonged ventilation, presence of severe acidosis at birth, Apgar scores at the 1st and 5th minutes, and abnormal cranial magnetic resonance (Mrg) findings were determined to be major factors in determining neurodevelopmental prognosis in asphyxic cases. The male gender was found to be riskier in terms of prognosis. Of the patients with HIE, retardation was determined for fine motor skills in 52.2%, speaking in 39.1%, gross motor skills in 26.1%, and personal development in 21.7%. Epilepsy, cerebral palsy, and speech disorders were the most common chronic period problems in patients with HIE. Despite therapeutic hypothermia treatment, neurodevelopmental problems are still observed in newborns with HIE. We found that male gender, low Apgar score, severe acidosis, and abnormal cranial Mrg findings in the neonatal period are risk factors in determining the neurodevelopmental prognosis of newborns with HIE. Monitoring and supporting the development of HIE cases with risk factors from the first months of life and intervening in developmental problems promptly are crucial in order to improve long-term outcomes.

Turkish validity and reliability study of disease-related fear scale in patients with epilepsy

ObjectiveThis study was conducted to examine the validity and reliability of the Turkish disease-related fear scale (D-RFS) for adult patients with epilepsy. MethodsThis methodological study was conducted with 154 patients with epilepsy who were referred to the neurology clinic and outpatient clinic of Firat University Hospital between December 2021 and March 2022. Content and construct validity were evaluated after the scale was translated into Turkish. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted for construct validity. Item analyses and internal consistency analyses were conducted for reliability. Convergent validity was also evaluated. ResultsAs a result of the evaluations and analyses, the content validity index of the scale was found to be 0.97. Exploratory factor analysis showed that the value of total variance explained by two factors was 74.77%. Factor loading of all items was found to be between 0.60 and 0.93. Cronbach’s alpha values of the factors were found to be 0.97, while the total Cronbach’s alpha value was found to be 0.95. As a result of the EFA and CFA, the 27-item, 2-factor disease-related fear scale was confirmed without changes to the original form of the scale. Good fit index values were obtained as a result of CFA. ConclusionThe Turkish version of the disease-related fear scale for adult patients with epilepsy is a valid and reliable measurement tool to evaluate the disease-related fear of adult patients with epilepsy and to use in clinical practice.

Wait times and patient throughput after the implementation of a novel model of virtual care in an outpatient neurology clinic: A retrospective analysis

Introduction Neurology wait times — from referral to consultation — continue to grow, leading to various adverse effects on patient outcomes. Key elements of virtual care can be leveraged to improve efficiency. This study examines the implementation of a novel virtual care model – Virtual Rapid Access Clinics – at the Neurology Centre of Toronto. The model employs a patient-centred care workflow, involving multidisciplinary staff and online administrative tools that are synthesized to expedite care and maintain quality. Methods Virtual Rapid Access Clinic efficacy was studied by determining average wait times and patient throughput, calculated from anonymous data that was extracted from the clinic patient database (n = 1542). Comparative analysis focused on new patient consultations during the 12-month periods prior to (pre-Virtual Rapid Access Clinic, n = 456) and following (post-Virtual Rapid Access Clinic, n = 1086) Virtual Rapid Access Clinic implementation. Results After Virtual Rapid Access Clinic implementation, there was a mean 15-day wait time reduction, and a monthly average 52-patient increase in patient throughput. Wait time reductions and increased patient throughput were observed in all three Virtual Rapid Access Clinic sub-clinics – epilepsy, headache and concussion. Respectively, average wait times reduced significantly by 26.4 and 18.9 days and insignificantly by 1.1 days; monthly average patient throughputs increased by 235%, 95% and 161%. Discussion These findings demonstrated that the Virtual Rapid Access Clinic model of care is effective at reducing patient wait times and increasing patient throughput. While the Virtual Rapid Access Clinic presents a feasible model both during and after pandemic restrictions, further research exploring its scalability in other care contexts, potential changes in care quality and efficiency outside of pandemic restrictions must be performed.

Electrophysiological profile of serum vitamin B12 levels, correlation with serum methylmalonic acid levels, and determination of subclinical peripheral nerve involvement

Background/Aim: Vitamin B12 is essential for normal neural conduction in peripheral nerves. This study aimed to investigate the electrophysiological profile for varying degrees of serum B12 levels and to determine whether a correlation existed between electrophysiological profiles and serum methylmalonic acid (MMA) levels. Also, determination of subclinical peripheral nerve involvement with cold administration was planned in serum B12 levels. Methods: A total of 101 (63 females, 38 males) subjects with known serum vitamin B12 levels were selected randomly from the neurology outpatient clinic for this study. The subjects were divided into three groups based on the serum total Vitamin B12 levels: (1) B12 deficiency (&lt;126 pg/mL), (2) low B12 (126-250 pg/mL), and (3) normal B12 (250–500 pg/mL). Serum MMA and nerve conduction studies (NCS) were assessed and compared between the three groups. After the cooling procedure was applied to the ulnar and sural nerves, NCS was repeated. Results: There were 13 subjects in the B12 deficiency group, 44 subjects in the low B12 group, and 44 subjects in the normal group. We found that ulnar sensory nerve action potential amplitudes were significantly decreased (P = 0.009), ulnar F latency (P = 0.003; P &lt; 0.001)) was prolonged, and peroneal combined muscle action potential amplitudes decreased (P = 0.026) in the B12 deficiency when compared with the low and normal B12 groups. Sural nerve amplitude and conduction velocities were found to be significantly abnormal after the cold application in all groups (P &lt; 0.001). The increase in sural nerve sensory nerve amplitude potentials (SNAP) amplitudes was higher in the B12 deficiency group than in the other groups. Mean serum MMA levels were high in all groups. A correlation of nerve conduction study (NCS) changes with serum vitamin B12 and MMA was not observed in the groups after cold application. Conclusion: Vitamin B12 deficiency may cause subclinical sensorial and motor axonal nerve conduction changes. Nerve conduction changes may not always reach pathological values based on electrophysiological studies but may be detected after cooling administration even in the normal serum B12 levels. A correlation between serum MMA and vitamin B12 levels was found. Therefore, serum levels of vitamin B12, which is important for nerve conduction, should be carefully evaluated in clinical practice.

Clinical, neuroimaging and genetic findings in children with hereditary ataxia: single center study.

The genetics of hereditary ataxia (HA) are complex and multigenic. The diversity of genes that cause ataxia varies considerably between populations. We aimed to investigate the clinical, neuroimaging, and genetic findings of HA in children from a tertiary center in Turkey. The clinical and neuroimaging evaluations of patients, laboratory investigations, and molecular genetic evaluations of those with ataxia were performed at the pediatrics, pediatric neurology, and genetics outpatient clinics between October 2020 and October 2021. With repeated expansions in the ATXN 1, 2, 3, 7, and 8 genes for spinocerebellar ataxia (SCA) and FXN genes for Friedreich's ataxia (FA), whole-exome sequencing (WES) was used to analyze every patient. 25 patients from 24 families had ataxia and an unsteady gait as their main symptoms. The patients had a mean age of 8.5 ± 3.78 years, and the symptoms had begun at a mean age of 2 ± 0.62 years; five of these were males and three were females. A genetic cause of ataxia was found in 8/25 patients (32%). Seven of the eight gene mutations detected in the patients were novel mutations. Spinocerebellar ataxia was found in 16% of cases (n = 4), L-2-Hydroxyglutaric aciduria was found in 12% of cases (n = 3), and ataxia-telangiectasia was found in 4% of cases (n = 1). Our research adds to the body of knowledge by describing the clinical and genetic traits of HA patients in our area and by finding unusual gene changes linked to ataxia.

Reduction of No-Show Rate for New Patients in a Pediatric Neurology Clinic.

The rate of patients not keeping their appointments at our children's hospital outpatient pediatric neurology clinic (no-shows) was high. We conducted a quality improvement project to reduce no-show rates and improve operational efficiency. Specifically, we aimed to decrease the new patient no-show mean rate from 7% to 4% at the main campus and from 17% to 12% at the south campus. After reviewing the previous literature on this topic and institutional data, we used the simplified failure mode and effects analysis (sFMEA) to identify the key drivers. Of the patients at the main campus who failed to keep their appointment, 84% had not confirmed their appointment. Errors in inpatient/family contact information, limited use of the electronic patient portal, and miscommunication were other key drivers identified. Three Plan-Do-Study-Act (PDSA) cycles were completed over seven months. The key interventions we implemented were bidirectional text triage, telephone reminders, and promoting the use of the electronic patient portal. A run chart was used to assess the results of these interventions. A statistically significant shift was noted in the run chart for the median rate of no-shows, which declined from 7% to 4% at the main campus and 17% to 10% at the south campus. We were able to successfully reduce no-shows among new patients in the neurology clinic. The limitations of our study include unknown external factors, the potential impact of COVID-19, and the brief length of the study.

Longitudinal Use of Telehealth During the COVID-19 Pandemic and Utility of Asynchronous Testing for Subspecialty-Level Ophthalmic Care

Telehealth in ophthalmology has traditionally focused on preventive disease screening with limited use in outpatient evaluation. The unique conditions of the COVID-19 pandemic afforded the opportunity to evaluate different implementations of teleophthalmology at scale, providing insight into expanding teleophthalmology care. To compare telehealth use in ophthalmology with other specialties and assess the feasibility of augmenting ophthalmic telehealth encounters with asynchronous testing during the COVID-19 pandemic. This quality improvement study evaluated retrospective, longitudinal, observational data from the first 18 months of the COVID-19 pandemic (January 1, 2020, through July 31, 2021) for 881 080 patients receiving care from outpatient primary care, cardiology, neurology, gastroenterology, surgery, neurosurgery, urology, orthopedic surgery, otolaryngology, obstetrics/gynecology, and ophthalmology clinics of the University of California, San Francisco. Asynchronous testing was evaluated for teleophthalmology encounters. A hybrid care model wherein ophthalmic testing data were acquired asynchronously and used to augment telehealth encounters. Telehealth as a percentage of total volume of ambulatory care and use of asynchronous testing for ophthalmic conditions. The volume of in-person outpatient visits dropped by 83.3% (39 488 of 47 390) across the evaluated specialties at the onset of shelter-in-place orders for the COVID-19 pandemic, and the initial use of telehealth increased for these specialties before stabilizing over the 18-month study period. In ophthalmology, telehealth use peaked at 488 of 1575 encounters (31.0%) early in the pandemic and returned to mostly in-person visits as COVID-19 restrictions lifted. Elective use of telehealth was highest in gastroenterology, urology, neurology, and neurosurgery and lowest in ophthalmology. Asynchronous testing was combined with 126 teleophthalmology encounters, resulting in change of clinical management for 32 patients (25.4%) and no change for 91 (72.2%). Telehealth increased across various specialties during the COVID-19 pandemic. Combining teleophthalmic visits with asynchronous testing suggested that this approach is feasible for subspecialty-level evaluation. Additional study is needed to evaluate whether asynchronous testing outside the same institution could provide an effective and lasting approach for expanding the reach of ophthalmic telehealth.

Characteristics of methylphenidate prescriptions in a pediatric neurology outpatient clinic

RESUMO O metilfenidato não é disponibilizado pelo Sistema Único de Saúde (SUS), pois não faz parte da Relação Nacional de Medicamentos Essenciais. Todavia, o metilfenidato 10 mg é disponibilizado pela rede pública em Maringá-PR de acordo com a Política da Assistência Farmacêutica do município. Objetivou-se analisar as características das prescrições médicas de metilfenidato para crianças em ambulatório de neuropediatria vinculado ao SUS no município. Estudo transversal observacional retrospectivo de caráter quantitativo, realizado por meio da coleta de dados dos prontuários cadastrados no Sistema Gestor da rede pública de saúde do município, pelo ambulatório de neuropediatria na Unidade Básica de Saúde, Zona 7, entre janeiro de 2017 e novembro de 2019. Analisaram-se os dados por frequência relativa e absoluta. Emitiram-se 339 prescrições pelo neuropediatra responsável do ambulatório para 107 pacientes de 6 a 11 anos. Notou-se distribuição geográfica desigual das crianças atendidas conforme bairro da cidade, o que denota influência socioeconômica na prescrição de medicamentos. Ressaltam-se picos de prescrições coincidindo com o período do ano letivo escolar. Concluiu-se que o acompanhamento especializado adequado é premissa para o tratamento, não dispensando a rede longitudinal de assistência. Ademais, evidencia-se o impacto das condições socioeconômicas, tanto na prescrição como na aquisição do medicamento.

Illness perception and quality of life in patients with migraine and tension-type headache

ABSTRACT Introduction Migraine and tension-type headache (TTH) are important health problems because cause loss of workforce, affect quality of life and are frequently associated with anxiety and depression. Illness perception is defined as a cognitive aspect of illness. The aim of this study is to determinethe relationship of migraine and TTH with quality of life, illness perception, anxiety and depression. Materials and Methods Demographic information and headache characteristics of 160 patients (80 migraine, 80 TTH) who has applied to our hospital’s neurology outpatient clinics were recorded. Hospital anxiety depression scale, illness perception questionnaire and quality of life short form-36 (SF-36) were applied to these patients. Results Headache severity and duration were higher in migraine patients. Migraine sufferers believed that their illness would last longer and the results would be worse. Negative emotional representations were more common in TTH patients. Understanding of the disease was higher in younger and those with higher levels of education. Social functionality and bodily pain scores were worse than those of TTH patients. Headache severity and duration were higher in women. Anxiety and depression were associated with headache frequency, duration, and severity. It was determined that the severity, duration and frequency of headache also affected the quality of life. Conclusion Informing patients in detail about their diseases and increasing their education level can contribute to the improvement of headache representations. In addition, screening and treatment of anxiety and depression may be other interventions that can improve patients’ adherence to treatment and quality of life.