Relation between anterior ethmoidal artery course on computed tomography and supraorbital ethmoid cell and Keros classification

PURPOSE

The anterior ethmoidal artery (AEA) is an important risk area in endoscopic sinus surgery. This study aimed to evaluate the course of AEA according to the Keros classification and the presence of supraorbital ethmoid cell (SOEC) and to prevent possible complications by emphasizing the importance of preoperative paranasal computed tomography (CT) imaging. This approach will increase the effectiveness of endoscopic sinus surgery and improve patient safety.

METHODS

The paranasal CT scan images of patients aged > 18 years between October 2020 and November 2021 from our center were retrospectively analyzed. The images were primarily evaluated in the coronal plane, and the sagittal and axial planes were utilized to evaluate variations in AEA regarding the skull base. Furthermore, the relation of AEA course with Keros classification and SOEC was evaluated. The study included 1000 patients aged 18-80 years (right and left, a total of 2000 samples).

RESULTS

Grade 3 AEA was the most common regarding the skull base. Keros Type 2 was the most common classification. Overall, 48.7% patients had SOEC. The incidence of Grade 3 AEA was higher among patients with SOEC and a higher Keros classification compared with those without SOEC and a lower Keros classification. Furthermore, Keros Type 3 was the most associated with SOEC presence.

CONCLUSION

Consistent with the literature, the probability of Grade 3 AEA in patients with high Keros classification and SOEC was significantly higher in our study. Therefore, we consider that preoperative imaging according to Keros classification and SOEC presence can predict AEA course and guide surgery.

2D:4D Digit Ratios in Adults with Gender Dysphoria: A Comparison to Their Unaffected Same-Sex Heterosexual Siblings, Cisgender Heterosexual Men, and Cisgender Heterosexual Women

We compared gender dysphoria (GD) patients and their same-sex siblings in terms of their 2D:4D ratios, which may reflect prenatal exposure to androgen, one of the possible etiological mechanisms underlying GD. Sixty-eight GD patients (46 Female-to-Male [FtM]; 22 Male-to-Female [MtF]), 68 siblings (46 sisters of FtMs; 22 brothers of MtFs), and 118 heterosexual controls (62 female; 56 male) were included in the study. FtMs were gynephilic and MtFs were androphilic. We found that 2D:4D ratios in the both right hand (p < .001) and the left hand (p = .003) were lower in male controls than in female controls. Regarding right hands, FtM GD patients had lower 2D:4D ratios than female controls (p < .001) but their ratios did not differ from those of their sisters or male controls. FtM GD patients had no significant difference in their left-hand 2D:4D ratios compared to their sisters or female and male controls. While there was no significant difference in right hands between FtM's sisters and male controls, left-hand 2D:4D ratios were significantly higher in FtM's sisters (p = .017). MtF GD patients had lower right-hand 2D:4D ratios than female controls (p <.001), but their right-hand ratios did not differ from those of their brothers and male controls. There was no significant difference in left-hand 2D:4D ratios between MtF GD patients, and their brothers, or female and male controls. FtM GD patients showed significantly masculinized right-hand 2D:4D ratios, while there was no evidence of feminization in MtF GD patients.

2D:4D Finger Length Ratios in Individuals with Gender Dysphoria

OBJECTIVE

The neurobiological basis of Gender Dysphoria (GD) is not yet fully known. In recent years, the role of prenatal exposure to testosterone has been emphasized in the development of the GD. The aim of this study was to compare the 2D:4D digit ratio, which is considered to be a morphological indicator of exposure to testosterone in the prenatal period, in individuals with GD.

METHOD

The study included 99 participants diagnosed with GD comprising 54 assigned the female gender at birth [AFB-GD], 45 assigned the male gender at birth [AMB-GD], and 58 female and 58 male participants making up the control group. The right and the left hands of the participants were photocopied and finger lengths were measured using digital calipers.

RESULTS

The 2D:4D digit ratio on the right hand of the AFB-GD group was significantly lower (p=0.028) than that of the female controls, but it did not differ significantly as compared to male controls. The ratio on the left hand of the AFB-GD group did not significantly differ from that of the female controls, but it was higher than that of the male controls (p=0.045). The 2D:4D digit ratio on the right hand of the AMB-GD group did not differ significantly from that of the male controls, but they had a lower finger ratio as compared to the female controls (p<0.001). The ratio on the left hand of the AMB-GD group did not differ significantly from those of the male and female controls.

CONCLUSION

The results of this study present suggestive evidence that the AFB-GD individuals were exposed to testosterone in the prenatal period.

Successful use of electroconvulsive therapy in a patient with anorexia nervosa and severe acute-onset obsessive-compulsive disorder

Anorexia nervosa (AN) is a complex condition that is often accompanied by several serious comorbidities that may require a variety of treatment modalities throughout the course of the illness. Obsessive-compulsive disorder (OCD), which is common in patients with AN, may occasionally cause serious interruptions to the daily functioning of the patient. We report on a 24-year-old male patient with chronic AN. During the beginning of his illness, he had a major depressive episode that was followed by AN onset. Throughout his illness, he also experienced chronic moderate depressive symptoms and later developed severe OCD. He experienced complete remission from the OCD and an improved mood after undergoing a course of bilateral electroconvulsive therapy (ECT). His OCD symptoms did not recur during the first year of follow-up. ECT may prove to be a fast and effective treatment strategy for severe and disabling acute-onset OCD that occurs during the course of comorbid AN. The case described herein shows how a comorbid psychiatric disorder in a patient suffering from chronic AN may disrupt the daily functioning of the patient if it is not urgently treated.

Decreased Expression of α-Synuclein, Nogo-A and UCH-L1 in Patients with Schizophrenia: A Preliminary Serum Study

OBJECTIVE

α-synuclein, Nogo-A and Ubiquitin C-terminal hydrolase L1 (UCH-L1) have neuromodulatory roles for human brain. Therefore, abnormalities of these molecules are associated with neuropsychiatric disorders. Although some serum studies in the other disorders have been made, serum study of α-synuclein, Nogo-A and UCH-L1 is not present in patients with schizophrenia and healthy controls. Therefore, our aim was to compare serum levels of α-synuclein, Nogo-A and UCH-L1 of the patients with schizophrenia and healthy controls.

METHODS

Forty-four patients with schizophrenia who is followed by psychotic disorders unit, and 40 healthy control were included in this study. Socio-demographic form and Positive and Negative Syndrome Scale (PANSS) was applied to patients, and sociodemographic form was applied to control group. Fasting bloods were collected and the serum levels of α-synuclein, Nogo-A and UCH-L1 were measured by ELISA method.

RESULTS

Serum α-synuclein [patient: 12.73 (5.18-31.84) ng/mL; control: 41.77 (15.12-66.98) ng/mL], Nogo-A [patient: 33.58 (3.09-77.26) ng/mL; control: 286.05 (136.56-346.82) ng/mL] and UCH-L1 [patient: 5.26 (1.64-10.87) ng/mL; control: 20.48 (11.01-20.81) ng/mL] levels of the patients with schizophrenia were significianly lower than healthy controls (p<0.001).

CONCLUSION

Our study results added new evidence for explaining the etiopathogenesis of schizophrenia on the basis of neurochemical markers.