AİBÜ İzzet Baysal tıp fakültesi dergisi, Apr 29, 2022
This study aims to examine the changes between the measurements done in the morning and evening i... more This study aims to examine the changes between the measurements done in the morning and evening in some acoustic analyses of patients having myasthenia gravis (MG). Materials and Methods: Twenty-four MG patients diagnosed with Phase-2A (Mildly Generalized MG) according to the classification of Osserman and Genkins by a neurology specialist were involved. Videolaryngostroboscopic examinations and acoustic analyses of these patients were performed in the Ear, Nose, and Throat (ENT) clinic. Perceptual voice assessments were performed using the GRBASI scale, Fo, Shimmer, Jitter, NHR (Noise to harmonic ratio), MPT (Maximum Phonation Time), and s/z rates were calculated. Results: When the morning and evening vocal measurements of patients were compared according to the GRBASI scale, a significant difference was found between B and A and S values, while no statistically significant difference was found between G, R, and I value. Statistically significant differences were found between cases' Fo, Shimmer, NHR, s/z Ratio, and VHI (voice handicap index) measurements made in the morning and the evening. But no difference was found between the Jitter measurements. A statistically significant difference was found between the morning and evening values of men's Fo and MPT measurements. Again, a statistically significant difference was found between the morning and evening values of women's Fo and MPT measurements. Conclusion: For Myasthenia Gravis patients, the decrease in muscle power within the day and the tiredness in larynx muscles are an expected process, and it is objectively presented in this study. In addition, further studies are needed to show that possible communication problems can be prevented with sound therapies by evaluating the morning and evening acoustic analyses of MG patients.
Zenodo (CERN European Organization for Nuclear Research), Mar 8, 2023
Acute transverse myelitis is a spinal cord inflammatory disease that can occur at various spinal ... more Acute transverse myelitis is a spinal cord inflammatory disease that can occur at various spinal levels. It is extremely rare but can cause severe disability and even death. In this study, we aimed to evaluate the clinical findings, etiologic factors, and their effects on prognosis in a group of patients with acute transverse myelitis. Material and Method: The study included 30 patients with acute transverse myelitis who were hospitalized at our clinic between January 2012 and December 2018. Hospitalization and discharge modified Rankin Scales, basic demographic data, treatments, lesion level, imaging, and CSF findings were recorded. Results: Sixteen (53%) of the patients were male and 14 (47%) were female. The mean age was 54 years (16-84 years). While 13.3% of the cases developed into multiple sclerosis during follow-up, the etiology was malignancy in 16.6%, neuromyelitis optica in 6.6%, and infectious pathologies in 6.6%. Gender, age, parity of sphincter involvement, CSF protein, high hospitalization MRS score, and number of hospitalization days were identified as prognostic factors (p values were p=0.017, p=0.002, p=0.0013, p=0.019, p=0.001, p=0.002, respectively). High hospitalization rankin score and increased number of hospitalization days were correlated with poor prognosis at discharge (Pearson correlation coefficient r=0.886, p<0.001; r=0.675, p<0.001, respectively). Conclusion: Acute transverse myelitis may have many different etiologies. Even in patients who meet the diagnostic criteria, multiple sclerosis can develop during follow-up. Long-term monitoring and paraneoplastic processes should be considered in myelitis. Furthermore, determining the factors affecting prognosis is useful in predicting the long-term clinical course of patients and guiding treatment.
Giriş ve Amaç: Vertigo ve ataksi ile gelen hastalarnörolojik muayene ve kranial görüntülemeler aç... more Giriş ve Amaç: Vertigo ve ataksi ile gelen hastalarnörolojik muayene ve kranial görüntülemeler açısındaniyi değerlendirilmelidir. Posterior sistem enfarktlarındaerken dönemde endovasküler tedavi hayati önemtaşımaktadır.Gereç ve Yöntem: 32 yaşında erkek hasta 3 günden beriolan baş dönmesi, bulantı şikayetleri ile acil servisebaşvurdu. Daha öncesinde yapılan muayenesindeşikayetleri periferik vertigo olarak değerlendirilmiş.Semptomatik tedavi verilmiş. Ancak şikayetleri giderekartış göstermiş. Özgeçmişinde özellik olmayan hastanınnörolojik muayenesinde motor defisit saptanmadı ancakşuuru uykuya meyilli, kooperasyonu kısıtlı idi. Diffüzyon&nbsp;MRG’de sağ serebellumda ve sağ bulbusda flairda daoturmuş enfarkt alanları görüldü. Bu nedenleendovasküler tedavi düşünülmedi. Hastaya çekilenbilgisayarlı tomografi anjıografi(BTA), kontrastzamanlaması iyi olmadığı için vasküler yapılar iyideğerlendirilemedi. Hastanın genel durumu uygunolmadığından tekrarı yapılamadı. Servis takibinde şuurugerileyen hastanın kontrol tomografisinde ödem artışı ve4.ventriküle bası izlenmesi üzerine dekompresyonyapıldı. Cerrahi sonrası 5. gününde entübe olarak, ağrılıuyaranla sağda 1 kuvvet muayenesiyle tedavisine devamedildi.Bulgular: Olgumuz geç dönemde başvuru nedeniyleendovasküler tedavi düşünülmeyerek medikal takibealındı. Fakat serebellar ödemde artış ve şuurda gerilemeolması üzerine cerrahi müdahale yapıldı. Genişserebellar enfarktlarda 4. ventrikül komşuluğu nedeniyleyakın şuur takibi önemlidir. Ve ödeme sekonder gelişenbası bulguları açısından cerrahi tedavi medikal tedaviyeüstünlük göstermektedir.Sonuç: Posterior sistem inmeleri tüm inmelerin %10-15ini oluşturmaktadır. Genellikle kötü prognozludur ve %80 oranında ise mortal seyretmektedir. Vertigo ilebaşvuran hastalar periferik vertigo ile karışmasınedeniyle genellikle geç dönemde tanı almaktadırlar.Fakat erken dönemde yapılacak olan endovaskülertedavi ile baziler oklüzyonu olan hastalarda başarı şansı%45 civarında iken, mortalite oranı %16 civarındabildirilmiştir. Bu sebeple akut dönemde vertigo ve ataksiile başvuran hastalarda nörolojik muayene, ayrıntılıanemnez ve görüntüleme yöntemleri hasta bazındahayati önem taşımaktadır
Medical records-international medical journal, Sep 1, 2021
Aim: This study aimed to investigate the effect of blood groups on the risk and prognosis of seve... more Aim: This study aimed to investigate the effect of blood groups on the risk and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the infected/source cases and contact individuals. Material and Method: This study was designed as a descriptive and retrospective study. The individuals who were in contact with the SARS-CoV-2main/source cases and followed at home were included in the study.The distribution of the participants according to their blood groups was assessed. Patients were divided into three groups as group 1 including source/main cases, group 2 including SARS-CoV-2contacts who were living in the same house with the source case and followed up, and group 3 including contacts who were followed up in the same house but did not develop SARS-CoV-2 during the follow-up. Results: While the rate of Non-O blood group was the highest (n=365, 39.4%) in group 2the rate of O blood group was the highest (n=190, 42.8%) in group 3 (p:0.028). While the rate of Rh positive blood group was high in group 1 that of Rh negative blood group was higher in group 3 (p:0.000). For other variables, the presence of a chronic disease was more in group 1 (p:0.000). Rh (+) blood group (OR:0.464, p:0.010, %95 Cl: 0.306 ~ 0.703) was among the factors affecting the development of the infection. Conclusion: Patients infected with SARS-CoV-2 mostly had A, Non-O blood group and Rh positivity. Having Rh (+) blood group may have increased the rate of infection development in high-risk household contacts. After patients in this blood group were detected as contacts a closer follow-up may be necessary to decrease morbidity.
Friedreich’s Ataxia (FRDA) is the most common form of autosomal recessive ataxia. The disease pri... more Friedreich’s Ataxia (FRDA) is the most common form of autosomal recessive ataxia. The disease primarily results from a GAA trinucleotide repeat expansion within the FXN gene in up to 97% of patients. The clinical presentation begins approximately between the ages of 5 and 15. The major clinical findings of FRDA are progressive extremity and gait ataxia. Although it is known that the disease is caused by low levels of functional protein in the target tissues, there is no effective treatment available for this pathology. However, significant improvements have been achieved in the research into pharmacological treatments for FRDA in recent years. Interferon-gamma (IFN-γ) has been shown to induce frataxin production in many cell types. In this study, the clinical features, tolerability, and the prognosis of individuals with FRDA to whom IFN-γ was administered in a university hospital were evaluated retrospectively and the results were discussed. To the best of our knowledge, this is the first study conducted in our country to evaluate the effect of IFN gamma on this patient group.
Online türk sağlık bilimleri dergisi, Dec 10, 2022
Objective: Neurological symptoms occur due to central and peripheral nervous system involvement w... more Objective: Neurological symptoms occur due to central and peripheral nervous system involvement with different mechanisms in coronavirus disease 2019 (COVID-19). Microvascular thrombosis develops with prothrombotic activation along with the increase in cytokines in COVID-19 infection. We aimed to investigate the incidence of cerebrovascular disease and concomitant risk factors in COVID-19 positive patients.Materials and Methods: Acute and temporally related cerebrovascular diseases with a diagnosis of COVID-19 were evaluated. Cerebrovascular events were assessed in 4 groups as ischemic and hemorrhagic events, transient ischemic attacks, and cerebral venous thrombosis. Risk factors for cerebrovascular disease in these patients were also assessed, and which risk factors for cerebrovascular diseases in COVID-19 patients are high risk were examined.Results: Of the 1000 patients with COVID-19 disease were evaluated. Ischemic cerebrovascular disease and/or transient ischemic attack were found in 14 patients (1.4%). The most common symptoms related to COVID-19 were fever and respiratory distress in 14 patients with acute ischemic stroke diagnosed with COVID-19.Conclusion: COVID-19 increases the risk of stroke in patients with multiple risk factors. Close follow-up should be performed more carefully, especially in patients with pulmonary involvement and acute ischemic stroke, because mortality is likely to be higher.
Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are i... more Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69±14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.
Bu çalışmada, Alzheimer Demans (AD) ve Vasküler demans (VaD)'lı hastalarda serum lipid düzeyleri ... more Bu çalışmada, Alzheimer Demans (AD) ve Vasküler demans (VaD)'lı hastalarda serum lipid düzeyleri ile yağda eriyen vitamin düzeylerinin demans ile ilişkilerinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya uluslarası kriterlere göre tanıları konulmuş 60 AD, 52 VaD hastası ile 61 kontrol vakası alındı. Serum lipid profilleri ve yağda eriyen vitamin düzeyleri (D, K) çalışıldı. Bulgular: Serum D vitamini değerleri AD ve VaD hasta gruplarında, kontrol grubuna göre daha düşük bulundu. Vitamin K açısından ise anlamlı bir fark görülmedi. Grupların lipid profilleri incelendiğinde total kolesterol(TK) değerlerinin, her iki hasta grubunda kontrol grubuna göre daha yüksek olduğu saptandı. Kontrol grubunda, TK ile D vitamini arasında negatif bir ilişki gözlendi. Hasta gruplarında D vitamini ile ve tüm gruplarda K vitamini ile lipidler arasında bir ilişki bulunmadı. Yüksek dansiteli lipoprotein (HDL), trigliserid (TG) ve düşük dansiteli lipoprotein (LDL) değerleri açısından hasta grupları ve kontrol grubu arasında fark bulunmadı. Sonuç: Vitamin D düşüklüğü ile TK yüksekliği AD ve VaD hastalığı ile birliktelik göstermektedir. Bu iki demans tipi arasında bu parametreler açısından bir fark saptanmamıştır. Sağlıklı kontrol vakalarında vitamin D ile TK arasında saptanan ters ilişki demans hastalarında gözlenmemiştir. Verilerimiz; demans hastalarında, vitamin D ve TK ilişkisinin daha ayrıntılı incelenmesinin gerektiğini ortaya koymaktadır.
Akut inme klinik pratiğinde intravenöz tromboliz ya da trombektomi / aspirasyon gibi nörogirişims... more Akut inme klinik pratiğinde intravenöz tromboliz ya da trombektomi / aspirasyon gibi nörogirişimsel tedavilerin başarıyı yakalayabilmesi için iki uygulama ile desteklenmesi gerekir. Bunların ilki akut hastaların merkezlere zamanında ve güvenli triyajını sağlayacak olan "akut inme sevk ve idare sistemi", diğeri ise bu hastaların akut dönem hastane kalışındaki uygulamalarıdır. Hastane uygulamaları nöroloji yoğun bakım veya inme ünitelerinde başlayan bir süreç olup sonuçları hemşirelik uygulamalarının kalitesinden doğrudan etkilenir. Akut inme hemşireliği inme spesifik tedavilerin etkin ve güvenli uygulaması, kan basıncı, kan şekeri, yutma, nütrisyon ve hidrasyonun yönetimi; hastanın postür, mobilizasyon, erken dönem fizik tedavi ve rehabilitasyon planı; bilinç ve nörolojik muayenenin takibi; ayrıca venöz tromboembolizm, gastrik ve enfeksiyon proflaksisi; KIBAS, enfeksiyon, solunumsal yetmezlik ve kanama gibi komplikasyonların önlenmesi ile yoğun bakımda hasta takibi ve çok etkili hasta, hasta yakını ve takım etkileşimi ve iletişimini içerir. Bu derleme akut inme hemşireliğinin birçok güncel rehberinin ülkemiz için adapte edilmiş temel uygulama ve metriklerini sunar.
INTRODUCTION Migraine is a primary headache disorder that is most commonly characterized by recur... more INTRODUCTION Migraine is a primary headache disorder that is most commonly characterized by recurrent headaches described as a bio-psychosocial phenomenon with different genetic and environmental etiologies. Many physicians all over the world are inadequately educated on migraine, even though migraine has been known since 1955 by the Vahlquist criteria. Recently, both the national headache societies and international headache societies have prepared certain educational programs not only for primary care physicians but also for neurologists (1,2,3). Statistical data have revealed that migraine is the third reason for global disability by causing apparent incapacity (4). In the United States, about 6% men and 18% women get a migraine in a given year, with a lifetime risk of about 18% and 43%, respectively (2,5). In Europe, migraine affects 12%-28% people in a period of their lives, with about 6%-15% adult men and 14%-35% adult women getting at least 1 migraine yearly (6). It has been estimated that migraine is the most costly neurological disorder in the European Community, costing more than €27 billion per year (7,8). In the United States, the direct cost of migraine on the economy reaches up to $17 billion per year (2). Migraine diagnosis is based on signs and symptoms in history taking and the characteristic features of headaches (7). Generally, neuroimaging tests are not necessary to diagnose migraines (8,9). It is believed that a substantial number of people with migraines remain undiagnosed. In this study, we aimed to understand the basic knowledge of primary care physicians on the subject of migraines and to evaluate the main scope of future educational programs. METHODS This study was conducted in November and December 2014 by primary care physicians. Ethics committee of Erciyes University approvals and the necessary permissions for the study were obtained from the Kayseri Public Health Directorate. All primary care physicians (371) who were working within the Kayseri provincial borders were asked to participate in our study. Since it was aimed to include all physicians, sampling was
Migraine is a neurological disorder that is associated with severe headaches and seriously affect... more Migraine is a neurological disorder that is associated with severe headaches and seriously affects the lives of patients. Diagnosing Migraine Disease (MD) can be laborious and time-consuming for specialists. For this reason, systems that can assist specialists in the early diagnosis of MD are important. Although migraine is one of the most common neurological diseases, there are very few studies on the diagnosis of MD, especially electroencephalogram (EEG)-and deep learning (DL)-based studies. For this reason, in this study, a new system has been proposed for the early diagnosis of EEG- and DL-based MD. In the proposed study, EEG signals obtained from the resting state (R), visual stimulus (V), and auditory stimulus (A) from 18 migraine patients and 21 healthy control (HC) groups were used. By applying continuous wavelet transform (CWT) and short-time Fourier transform (STFT) methods to these EEG signals, scalogram-spectrogram images were obtained in the time-frequency (T-F) plane. ...
Aim: This study aims to investigate the clinical, laboratory, electrophysiological, and demograph... more Aim: This study aims to investigate the clinical, laboratory, electrophysiological, and demographic characteristics of patients with Guillain-Barre Syndrome (GBS) who were admitted to our clinic and underwent treatment and the factors contributing to the prognosis at discharge.Materials and Methods: The study included 138 patients admitted to our clinic for treatment between January 2013 and December 2017, whose patient records were reviewed retrospectively. The Hughes scores, demographic characteristics, and clinical and laboratory data of the patients at admission and discharge were recorded.Results: The study sample comprised 61 female (44.2%) and 77 male (55.8%) patients with a mean age of 58.1 years. In evaluations of the Hughes scores at admission and discharge, 117 patients were considered to have a good prognosis and 21 patients to have a poor prognosis at discharge. In the poor prognosis group, advanced age (p=0.028), being in the acute motor axonal neuropathy (AMAN) subtyp...
Objective: A limited number of studies focus on pharmacy technicians (PT) and their knowledge lev... more Objective: A limited number of studies focus on pharmacy technicians (PT) and their knowledge level regarding migraines. The present study aimed to determine their level of awareness and knowledge regarding migraines and migraine treatment. Materials and Methods: This cross-sectional study was conducted at Erciyes University Faculty of Medicine in Kayseri, Türkiye. It was conducted from February 2019 to May 2019 and completed with the participation of 324 PTs (75.8% response rate). Forms containing questions about the diagnosis of migraines, the characteristics, and the treatments were administered to the PTs in person and then evaluated by a neurologist. Results: The ratio of PTs who knew of a drug therapy that reduced migraine attacks was 10.2%. Most PTs (85.2%) had no training in migraine treatment and obtained knowledge from their work experience. Ninety-one participants (28.1%) recommended medication to patients who visited the pharmacy due to headaches. When asked about the drug they recommend for migraines, 29.6% suggested ergotamine, 26.9% suggested analgesics, and 15.7% suggested triptans. Conclusion: The results of this study revealed that PTs working in pharmacies that support primary care services might not have sufficient awareness and knowledge about migraine treatments, and appropriate training should be provided on this subject.
Mental workload (MWL) can be estimated according to the state of cognitive capacity after an acti... more Mental workload (MWL) can be estimated according to the state of cognitive capacity after an activity. In this study, it is aimed to classify MWL levels from Electroencephalogram (EEG) signals recorded from a task moment. Using the proposed one-dimensional convolutional neural network (1D-CNN) model in the study, low (L) and high (H) level WL states were classified. The classification process was carried out in two stages. EEG signals passed through the preprocessing stage were classified with 1D-CNN in the first stage. In the second step, these signals were decomposed into subbands by applying Empirical Mode Decomposition (EMD) and classified with 1D-CNN. As a result of the classification process, accuracy (Acc), sensitivity (Sens), and specificity (Spe) values were obtained and evaluated in this study. As a result of the evaluation, the most successful Acc rate was 98.4%, Sens rate 97.62%, and Spe rate 98.94%
Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are i... more Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69±14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.
AİBÜ İzzet Baysal tıp fakültesi dergisi, Apr 29, 2022
This study aims to examine the changes between the measurements done in the morning and evening i... more This study aims to examine the changes between the measurements done in the morning and evening in some acoustic analyses of patients having myasthenia gravis (MG). Materials and Methods: Twenty-four MG patients diagnosed with Phase-2A (Mildly Generalized MG) according to the classification of Osserman and Genkins by a neurology specialist were involved. Videolaryngostroboscopic examinations and acoustic analyses of these patients were performed in the Ear, Nose, and Throat (ENT) clinic. Perceptual voice assessments were performed using the GRBASI scale, Fo, Shimmer, Jitter, NHR (Noise to harmonic ratio), MPT (Maximum Phonation Time), and s/z rates were calculated. Results: When the morning and evening vocal measurements of patients were compared according to the GRBASI scale, a significant difference was found between B and A and S values, while no statistically significant difference was found between G, R, and I value. Statistically significant differences were found between cases' Fo, Shimmer, NHR, s/z Ratio, and VHI (voice handicap index) measurements made in the morning and the evening. But no difference was found between the Jitter measurements. A statistically significant difference was found between the morning and evening values of men's Fo and MPT measurements. Again, a statistically significant difference was found between the morning and evening values of women's Fo and MPT measurements. Conclusion: For Myasthenia Gravis patients, the decrease in muscle power within the day and the tiredness in larynx muscles are an expected process, and it is objectively presented in this study. In addition, further studies are needed to show that possible communication problems can be prevented with sound therapies by evaluating the morning and evening acoustic analyses of MG patients.
Zenodo (CERN European Organization for Nuclear Research), Mar 8, 2023
Acute transverse myelitis is a spinal cord inflammatory disease that can occur at various spinal ... more Acute transverse myelitis is a spinal cord inflammatory disease that can occur at various spinal levels. It is extremely rare but can cause severe disability and even death. In this study, we aimed to evaluate the clinical findings, etiologic factors, and their effects on prognosis in a group of patients with acute transverse myelitis. Material and Method: The study included 30 patients with acute transverse myelitis who were hospitalized at our clinic between January 2012 and December 2018. Hospitalization and discharge modified Rankin Scales, basic demographic data, treatments, lesion level, imaging, and CSF findings were recorded. Results: Sixteen (53%) of the patients were male and 14 (47%) were female. The mean age was 54 years (16-84 years). While 13.3% of the cases developed into multiple sclerosis during follow-up, the etiology was malignancy in 16.6%, neuromyelitis optica in 6.6%, and infectious pathologies in 6.6%. Gender, age, parity of sphincter involvement, CSF protein, high hospitalization MRS score, and number of hospitalization days were identified as prognostic factors (p values were p=0.017, p=0.002, p=0.0013, p=0.019, p=0.001, p=0.002, respectively). High hospitalization rankin score and increased number of hospitalization days were correlated with poor prognosis at discharge (Pearson correlation coefficient r=0.886, p<0.001; r=0.675, p<0.001, respectively). Conclusion: Acute transverse myelitis may have many different etiologies. Even in patients who meet the diagnostic criteria, multiple sclerosis can develop during follow-up. Long-term monitoring and paraneoplastic processes should be considered in myelitis. Furthermore, determining the factors affecting prognosis is useful in predicting the long-term clinical course of patients and guiding treatment.
Giriş ve Amaç: Vertigo ve ataksi ile gelen hastalarnörolojik muayene ve kranial görüntülemeler aç... more Giriş ve Amaç: Vertigo ve ataksi ile gelen hastalarnörolojik muayene ve kranial görüntülemeler açısındaniyi değerlendirilmelidir. Posterior sistem enfarktlarındaerken dönemde endovasküler tedavi hayati önemtaşımaktadır.Gereç ve Yöntem: 32 yaşında erkek hasta 3 günden beriolan baş dönmesi, bulantı şikayetleri ile acil servisebaşvurdu. Daha öncesinde yapılan muayenesindeşikayetleri periferik vertigo olarak değerlendirilmiş.Semptomatik tedavi verilmiş. Ancak şikayetleri giderekartış göstermiş. Özgeçmişinde özellik olmayan hastanınnörolojik muayenesinde motor defisit saptanmadı ancakşuuru uykuya meyilli, kooperasyonu kısıtlı idi. Diffüzyon&nbsp;MRG’de sağ serebellumda ve sağ bulbusda flairda daoturmuş enfarkt alanları görüldü. Bu nedenleendovasküler tedavi düşünülmedi. Hastaya çekilenbilgisayarlı tomografi anjıografi(BTA), kontrastzamanlaması iyi olmadığı için vasküler yapılar iyideğerlendirilemedi. Hastanın genel durumu uygunolmadığından tekrarı yapılamadı. Servis takibinde şuurugerileyen hastanın kontrol tomografisinde ödem artışı ve4.ventriküle bası izlenmesi üzerine dekompresyonyapıldı. Cerrahi sonrası 5. gününde entübe olarak, ağrılıuyaranla sağda 1 kuvvet muayenesiyle tedavisine devamedildi.Bulgular: Olgumuz geç dönemde başvuru nedeniyleendovasküler tedavi düşünülmeyerek medikal takibealındı. Fakat serebellar ödemde artış ve şuurda gerilemeolması üzerine cerrahi müdahale yapıldı. Genişserebellar enfarktlarda 4. ventrikül komşuluğu nedeniyleyakın şuur takibi önemlidir. Ve ödeme sekonder gelişenbası bulguları açısından cerrahi tedavi medikal tedaviyeüstünlük göstermektedir.Sonuç: Posterior sistem inmeleri tüm inmelerin %10-15ini oluşturmaktadır. Genellikle kötü prognozludur ve %80 oranında ise mortal seyretmektedir. Vertigo ilebaşvuran hastalar periferik vertigo ile karışmasınedeniyle genellikle geç dönemde tanı almaktadırlar.Fakat erken dönemde yapılacak olan endovaskülertedavi ile baziler oklüzyonu olan hastalarda başarı şansı%45 civarında iken, mortalite oranı %16 civarındabildirilmiştir. Bu sebeple akut dönemde vertigo ve ataksiile başvuran hastalarda nörolojik muayene, ayrıntılıanemnez ve görüntüleme yöntemleri hasta bazındahayati önem taşımaktadır
Medical records-international medical journal, Sep 1, 2021
Aim: This study aimed to investigate the effect of blood groups on the risk and prognosis of seve... more Aim: This study aimed to investigate the effect of blood groups on the risk and prognosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the infected/source cases and contact individuals. Material and Method: This study was designed as a descriptive and retrospective study. The individuals who were in contact with the SARS-CoV-2main/source cases and followed at home were included in the study.The distribution of the participants according to their blood groups was assessed. Patients were divided into three groups as group 1 including source/main cases, group 2 including SARS-CoV-2contacts who were living in the same house with the source case and followed up, and group 3 including contacts who were followed up in the same house but did not develop SARS-CoV-2 during the follow-up. Results: While the rate of Non-O blood group was the highest (n=365, 39.4%) in group 2the rate of O blood group was the highest (n=190, 42.8%) in group 3 (p:0.028). While the rate of Rh positive blood group was high in group 1 that of Rh negative blood group was higher in group 3 (p:0.000). For other variables, the presence of a chronic disease was more in group 1 (p:0.000). Rh (+) blood group (OR:0.464, p:0.010, %95 Cl: 0.306 ~ 0.703) was among the factors affecting the development of the infection. Conclusion: Patients infected with SARS-CoV-2 mostly had A, Non-O blood group and Rh positivity. Having Rh (+) blood group may have increased the rate of infection development in high-risk household contacts. After patients in this blood group were detected as contacts a closer follow-up may be necessary to decrease morbidity.
Friedreich’s Ataxia (FRDA) is the most common form of autosomal recessive ataxia. The disease pri... more Friedreich’s Ataxia (FRDA) is the most common form of autosomal recessive ataxia. The disease primarily results from a GAA trinucleotide repeat expansion within the FXN gene in up to 97% of patients. The clinical presentation begins approximately between the ages of 5 and 15. The major clinical findings of FRDA are progressive extremity and gait ataxia. Although it is known that the disease is caused by low levels of functional protein in the target tissues, there is no effective treatment available for this pathology. However, significant improvements have been achieved in the research into pharmacological treatments for FRDA in recent years. Interferon-gamma (IFN-γ) has been shown to induce frataxin production in many cell types. In this study, the clinical features, tolerability, and the prognosis of individuals with FRDA to whom IFN-γ was administered in a university hospital were evaluated retrospectively and the results were discussed. To the best of our knowledge, this is the first study conducted in our country to evaluate the effect of IFN gamma on this patient group.
Online türk sağlık bilimleri dergisi, Dec 10, 2022
Objective: Neurological symptoms occur due to central and peripheral nervous system involvement w... more Objective: Neurological symptoms occur due to central and peripheral nervous system involvement with different mechanisms in coronavirus disease 2019 (COVID-19). Microvascular thrombosis develops with prothrombotic activation along with the increase in cytokines in COVID-19 infection. We aimed to investigate the incidence of cerebrovascular disease and concomitant risk factors in COVID-19 positive patients.Materials and Methods: Acute and temporally related cerebrovascular diseases with a diagnosis of COVID-19 were evaluated. Cerebrovascular events were assessed in 4 groups as ischemic and hemorrhagic events, transient ischemic attacks, and cerebral venous thrombosis. Risk factors for cerebrovascular disease in these patients were also assessed, and which risk factors for cerebrovascular diseases in COVID-19 patients are high risk were examined.Results: Of the 1000 patients with COVID-19 disease were evaluated. Ischemic cerebrovascular disease and/or transient ischemic attack were found in 14 patients (1.4%). The most common symptoms related to COVID-19 were fever and respiratory distress in 14 patients with acute ischemic stroke diagnosed with COVID-19.Conclusion: COVID-19 increases the risk of stroke in patients with multiple risk factors. Close follow-up should be performed more carefully, especially in patients with pulmonary involvement and acute ischemic stroke, because mortality is likely to be higher.
Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are i... more Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69±14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.
Bu çalışmada, Alzheimer Demans (AD) ve Vasküler demans (VaD)'lı hastalarda serum lipid düzeyleri ... more Bu çalışmada, Alzheimer Demans (AD) ve Vasküler demans (VaD)'lı hastalarda serum lipid düzeyleri ile yağda eriyen vitamin düzeylerinin demans ile ilişkilerinin incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya uluslarası kriterlere göre tanıları konulmuş 60 AD, 52 VaD hastası ile 61 kontrol vakası alındı. Serum lipid profilleri ve yağda eriyen vitamin düzeyleri (D, K) çalışıldı. Bulgular: Serum D vitamini değerleri AD ve VaD hasta gruplarında, kontrol grubuna göre daha düşük bulundu. Vitamin K açısından ise anlamlı bir fark görülmedi. Grupların lipid profilleri incelendiğinde total kolesterol(TK) değerlerinin, her iki hasta grubunda kontrol grubuna göre daha yüksek olduğu saptandı. Kontrol grubunda, TK ile D vitamini arasında negatif bir ilişki gözlendi. Hasta gruplarında D vitamini ile ve tüm gruplarda K vitamini ile lipidler arasında bir ilişki bulunmadı. Yüksek dansiteli lipoprotein (HDL), trigliserid (TG) ve düşük dansiteli lipoprotein (LDL) değerleri açısından hasta grupları ve kontrol grubu arasında fark bulunmadı. Sonuç: Vitamin D düşüklüğü ile TK yüksekliği AD ve VaD hastalığı ile birliktelik göstermektedir. Bu iki demans tipi arasında bu parametreler açısından bir fark saptanmamıştır. Sağlıklı kontrol vakalarında vitamin D ile TK arasında saptanan ters ilişki demans hastalarında gözlenmemiştir. Verilerimiz; demans hastalarında, vitamin D ve TK ilişkisinin daha ayrıntılı incelenmesinin gerektiğini ortaya koymaktadır.
Akut inme klinik pratiğinde intravenöz tromboliz ya da trombektomi / aspirasyon gibi nörogirişims... more Akut inme klinik pratiğinde intravenöz tromboliz ya da trombektomi / aspirasyon gibi nörogirişimsel tedavilerin başarıyı yakalayabilmesi için iki uygulama ile desteklenmesi gerekir. Bunların ilki akut hastaların merkezlere zamanında ve güvenli triyajını sağlayacak olan "akut inme sevk ve idare sistemi", diğeri ise bu hastaların akut dönem hastane kalışındaki uygulamalarıdır. Hastane uygulamaları nöroloji yoğun bakım veya inme ünitelerinde başlayan bir süreç olup sonuçları hemşirelik uygulamalarının kalitesinden doğrudan etkilenir. Akut inme hemşireliği inme spesifik tedavilerin etkin ve güvenli uygulaması, kan basıncı, kan şekeri, yutma, nütrisyon ve hidrasyonun yönetimi; hastanın postür, mobilizasyon, erken dönem fizik tedavi ve rehabilitasyon planı; bilinç ve nörolojik muayenenin takibi; ayrıca venöz tromboembolizm, gastrik ve enfeksiyon proflaksisi; KIBAS, enfeksiyon, solunumsal yetmezlik ve kanama gibi komplikasyonların önlenmesi ile yoğun bakımda hasta takibi ve çok etkili hasta, hasta yakını ve takım etkileşimi ve iletişimini içerir. Bu derleme akut inme hemşireliğinin birçok güncel rehberinin ülkemiz için adapte edilmiş temel uygulama ve metriklerini sunar.
INTRODUCTION Migraine is a primary headache disorder that is most commonly characterized by recur... more INTRODUCTION Migraine is a primary headache disorder that is most commonly characterized by recurrent headaches described as a bio-psychosocial phenomenon with different genetic and environmental etiologies. Many physicians all over the world are inadequately educated on migraine, even though migraine has been known since 1955 by the Vahlquist criteria. Recently, both the national headache societies and international headache societies have prepared certain educational programs not only for primary care physicians but also for neurologists (1,2,3). Statistical data have revealed that migraine is the third reason for global disability by causing apparent incapacity (4). In the United States, about 6% men and 18% women get a migraine in a given year, with a lifetime risk of about 18% and 43%, respectively (2,5). In Europe, migraine affects 12%-28% people in a period of their lives, with about 6%-15% adult men and 14%-35% adult women getting at least 1 migraine yearly (6). It has been estimated that migraine is the most costly neurological disorder in the European Community, costing more than €27 billion per year (7,8). In the United States, the direct cost of migraine on the economy reaches up to $17 billion per year (2). Migraine diagnosis is based on signs and symptoms in history taking and the characteristic features of headaches (7). Generally, neuroimaging tests are not necessary to diagnose migraines (8,9). It is believed that a substantial number of people with migraines remain undiagnosed. In this study, we aimed to understand the basic knowledge of primary care physicians on the subject of migraines and to evaluate the main scope of future educational programs. METHODS This study was conducted in November and December 2014 by primary care physicians. Ethics committee of Erciyes University approvals and the necessary permissions for the study were obtained from the Kayseri Public Health Directorate. All primary care physicians (371) who were working within the Kayseri provincial borders were asked to participate in our study. Since it was aimed to include all physicians, sampling was
Migraine is a neurological disorder that is associated with severe headaches and seriously affect... more Migraine is a neurological disorder that is associated with severe headaches and seriously affects the lives of patients. Diagnosing Migraine Disease (MD) can be laborious and time-consuming for specialists. For this reason, systems that can assist specialists in the early diagnosis of MD are important. Although migraine is one of the most common neurological diseases, there are very few studies on the diagnosis of MD, especially electroencephalogram (EEG)-and deep learning (DL)-based studies. For this reason, in this study, a new system has been proposed for the early diagnosis of EEG- and DL-based MD. In the proposed study, EEG signals obtained from the resting state (R), visual stimulus (V), and auditory stimulus (A) from 18 migraine patients and 21 healthy control (HC) groups were used. By applying continuous wavelet transform (CWT) and short-time Fourier transform (STFT) methods to these EEG signals, scalogram-spectrogram images were obtained in the time-frequency (T-F) plane. ...
Aim: This study aims to investigate the clinical, laboratory, electrophysiological, and demograph... more Aim: This study aims to investigate the clinical, laboratory, electrophysiological, and demographic characteristics of patients with Guillain-Barre Syndrome (GBS) who were admitted to our clinic and underwent treatment and the factors contributing to the prognosis at discharge.Materials and Methods: The study included 138 patients admitted to our clinic for treatment between January 2013 and December 2017, whose patient records were reviewed retrospectively. The Hughes scores, demographic characteristics, and clinical and laboratory data of the patients at admission and discharge were recorded.Results: The study sample comprised 61 female (44.2%) and 77 male (55.8%) patients with a mean age of 58.1 years. In evaluations of the Hughes scores at admission and discharge, 117 patients were considered to have a good prognosis and 21 patients to have a poor prognosis at discharge. In the poor prognosis group, advanced age (p=0.028), being in the acute motor axonal neuropathy (AMAN) subtyp...
Objective: A limited number of studies focus on pharmacy technicians (PT) and their knowledge lev... more Objective: A limited number of studies focus on pharmacy technicians (PT) and their knowledge level regarding migraines. The present study aimed to determine their level of awareness and knowledge regarding migraines and migraine treatment. Materials and Methods: This cross-sectional study was conducted at Erciyes University Faculty of Medicine in Kayseri, Türkiye. It was conducted from February 2019 to May 2019 and completed with the participation of 324 PTs (75.8% response rate). Forms containing questions about the diagnosis of migraines, the characteristics, and the treatments were administered to the PTs in person and then evaluated by a neurologist. Results: The ratio of PTs who knew of a drug therapy that reduced migraine attacks was 10.2%. Most PTs (85.2%) had no training in migraine treatment and obtained knowledge from their work experience. Ninety-one participants (28.1%) recommended medication to patients who visited the pharmacy due to headaches. When asked about the drug they recommend for migraines, 29.6% suggested ergotamine, 26.9% suggested analgesics, and 15.7% suggested triptans. Conclusion: The results of this study revealed that PTs working in pharmacies that support primary care services might not have sufficient awareness and knowledge about migraine treatments, and appropriate training should be provided on this subject.
Mental workload (MWL) can be estimated according to the state of cognitive capacity after an acti... more Mental workload (MWL) can be estimated according to the state of cognitive capacity after an activity. In this study, it is aimed to classify MWL levels from Electroencephalogram (EEG) signals recorded from a task moment. Using the proposed one-dimensional convolutional neural network (1D-CNN) model in the study, low (L) and high (H) level WL states were classified. The classification process was carried out in two stages. EEG signals passed through the preprocessing stage were classified with 1D-CNN in the first stage. In the second step, these signals were decomposed into subbands by applying Empirical Mode Decomposition (EMD) and classified with 1D-CNN. As a result of the classification process, accuracy (Acc), sensitivity (Sens), and specificity (Spe) values were obtained and evaluated in this study. As a result of the evaluation, the most successful Acc rate was 98.4%, Sens rate 97.62%, and Spe rate 98.94%
Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are i... more Objective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NöroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69±14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (β): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (β): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (β): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (β): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (β): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NöroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.
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