Objectives:The present study aimed to evaluate the efficacy and safety of intravenous metoclopramide for acute migraine treatment. Materials and methods:A double-blind, randomized, parallel-group, placebo-controlled trial was carried out in an academic emergency department. After the patients were assessed for eligibility via the International Headache Society criteria for migraines, they were randomized into 10 mg intravenous metoclopramide and normal saline groups. The headache intensity was evaluated using an 11-point numeric rating scale (NRS) score. The primary outcome measure was determined as the median between-group change in the score at the 30th minute. The secondary outcome measures were rescue medication needs, adverse events, and emergency department (ED) revisits after discharge. Results: A total of 148 patients were randomized into two equal groups with similar baseline characteristics, including the baseline NRS scores (8 points). The median reduction in the NRS scores at the 30th minute was 4 [interquartile range (IQR): 2-6)] in the metoclopramide group and 3 (IQR: 1-4) in the normal saline group [median difference: −1.0, 95% confidence interval (CI): −2.1 to 0.1]. No serious adverse events were observed, and the rescue medication needs were similar in both groups. Conclusion: No difference was found between intravenous metoclopramide and placebo regarding efficacy and safety in patients with acute migraines. K E Y W O R D S emergency department (MeSH Database), headache, metoclopramide, migraine How to cite this article: Doğan NÖ, Pekdemir M, Yılmaz S, et al. Intravenous metoclopramide in the treatment of acute migraines: A randomized, placebo-controlled trial.

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SUMMARYHypokalemic periodic paralysis is a rare but serious disorder that is typically caused by a channelopathy. Thyrotoxicosis, heavy exercise, high carbohydrate meal and some drugs can trigger channelopathy in genetically predisposed individuals. A 33-year-old male patient presented to the emergency department with weakness in the lower extremities. He stated that he had done heavy physical activity during the previous week. The patient exhibited motor weakness in the lower extremities (2/5 strength) during the physical examination. Initial laboratory tests showed a potassium level of 1.89 mEq/L. The initial electrocardiogram demonstrated T wave inversion and prominent U waves. The patient was treated in the emergency department with oral and intravenous potassium. The physical and ECG symptoms resolved within 16 hours of potassium supplementation and biochemical tests showed normal serum potassium levels. The patient was discharged shortly after the resolution of the symptoms. Weakness is an important but nonspecific symptom that may be brought on by a number of underlying physiological processes. Hypokalemic periodic paralysis is a rare disease that may be triggered by heavy physical activity and presents with recurrent admissions due to weakness.

ÖzetçeGöze ait klinik elektrofizyolojik testler, görme yollarını bir bütün olarak değerlendirmemizi sağlayan oftalmolojide ve nörooftalmolojide önemli yere sahiptir. Bu testlerden elektroretinografi'ler (ERG) ise rod ve konilerden amakrin hücrelerine kadar olan retinal tabakaların elektriksel cevabının incelenmesinde sıklıkla kullanılanılmaktadır. ERG sinyallerinde hekim tarafından incelenen iki önemli potansiyel vardır. Bunlar negatif a dalgası ve pozitif b dalgası ile bu dalgaların gecikme zamanlarıdır. Ancak ERG işaretlerinin genlikleri µV'lar seviyesinde olduğu için ve hasta göz hareketliliğinin oluşturduğu artefaktlardan dolayı ERG işaretleri gürültülü olmaktadır. Gürültülü sinyaller hekimin sinyalleri değerlendirmesinde yanılgıya sebep olabilir. Bu çalışmada hekimin daha kolay inceleme yapabileceği gürültüsüz ERG sinyali elde edebilmek için durağan ve doğrusal olmayan sinyallerin analizinde etkili bir yöntem olduğu bilinen Ampirik kip ayrışım yöntemi kullanılmıştır. Bu metotla ERG işaretleri esas mod bileşenlerine ayrıştırılmıştır ve gürültü bileşenleri yok edilerek işaret gürültü oranı 10dB veya altında olacak şekilde gürültüsüz ERG sinyalleri yüksek bir başarı ile elde edilmiştir. Abstract Clinical Electrophysiologic tests derived from human eyes are the tests that use to review whole visual pathways and they are important for ophthalmology and neuro ophthalmology. Electroretinographies is one of the electrophysiological tests often used to investigate the electrical response of the retinal layers from retinal pigment epithelium up to the occipital cortex. ERG signals have two important amplitudes that are used to diagnose diseases by doctors. These are negative a wave and positive b wave. Implicit times of the a and b waves are also meaningful to diagnose. ERG signals have small amplitudes (about µV). Because of this reason it is significant to separate the signal from the noise and interference that occurs as a result of movement. In this study, we propose using a new technique, called the empirical mode decomposition to denoised ERG responses. The Empirical Mode Decomposition is a signal processing method for analyzing nonlinear and nonstationary signals. ERG signals which are nonstationary signals are decomposed into a series of Intrinsic Mode Functions and then noise and interference are eliminated. Finally ERG signals which have signal to noise ratio less or equal than 10dB are reconstructed. As a result we successfully obtained denoised ERG signals.

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