Dilek YILMAZ OKUYAN, Seda ALADAĞ KURT, Aslıhan ONAY, Resul KARAKUŞ, Belgin KOÇER
Dilek YILMAZ OKUYAN, Seda ALADAĞ KURT, Aslıhan ONAY, Resul KARAKUŞ, Belgin KOÇER
Objective: Inflammation and migration of leukocytes to the brain parenchyma play a role in atherosclerosis and cerebral ischemic stroke. Migration occurs with
the help of adhesion molecules on the surface of cerebral endothelial cells and leukocytes. P-selectin, an adhesion molecule, is present on the platelet and endothelial
surface and allows leukocytes to loosely adhere to the endothelium, and its increase has been shown in acute ischemic stroke (AIS). Thrombin-activatable fibrinolysis
inhibitor (TAFI) is a procarboxypeptidase molecule that can be another marker of AIS, which has been shown to increase the risk of thromboembolism and stroke
6-fold. Intima-media thickness (IMT) is thought to be associated with atherosclerotic diseases in carotid ultrasonography (USG) and increased risk of ischemic
stroke has been found to be associated with increased carotid IMT. In this study, we investigated the relationship between P-selectin and TAFI levels, which have
been shown to be effective for AIS via carotid IMT, and is considered significant for atherosclerosis.
Materials and Methods: Forty patients with AIS and 22 healthy subjects were included in the study. In both groups, serum P-selectin and TAFI levels were
studied at the time of presentation, and on day 7, day 14, and at one month; carotid IMT and stenosis rates were measured by Doppler USG. P-selectin and TAFI
levels were compared with carotid IMT in both groups.
Results: There was no significant difference between P-selectin levels and carotid IMT between the groups; TAFI levels were significantly higher in the patient
group and were correlated with carotid IMT in both groups.
Conclusion: TAFI increase has been suggested to be a marker of early atherosclerosis in asymptomatic atherosclerosis and ischemic stroke. A positive correlation
between TAFI levels and carotid IMT and stenosis rates have been reported; however, the positive correlation between increased P-selectin levels in AIS and carotid
IMT was not detected in our study.
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Objective: Nutritional support has significant clinical importance in patients with poor or no oral intake admitted to neurology intensive care units (NICU).
Requirement for, administration methods, and benefits of active enteral feeding with feeding tubes remain a matter of dispute, particularly with respect to
patients with impaired swallowing function following central nervous system involvement. In this study, we evaluated the patient characteristics and percutaneous
endoscopic gastrostomy (PEG)-related problems in a group of patients in the NICU.
Materials and Methods: Patients undergoing PEG and admitted to our NICU between May 2016 and March 2018 were retrospectively examined. Age, sex,
duration of NICU stay, need for mechanical ventilation, occurrence of pneumonia, and PEG-related complications were recorded.
Results: A total of 789 patients admitted to the NICU were screened. PEG use was identified among 41 (5.2%) of these patients, of whom 23 (56.1%) were
female, with a mean age of 73.66±17.67 (range: 32-94) years. Twenty-nine (70.7%) of these patients with PEG use were diagnosed as having an ischemic
etiology, and 7 (17.1%) had hemorrhagic cerebrovascular disease. The mean duration of NICU stay was 48.8±30.6 (range: 13-150) days. On average, PEG was
used 29.12±7.97 (range: 13-42) days after admission. Twelve patients (29.3%) received mechanical ventilation, and 8 (19.5%) required a tracheostomy due to
prolonged mechanical ventilator support. Prior to PEG, 25 (61.4%) patients had a diagnosis of pneumonia, and 15 (36.6%) patients developed pneumonia after
PEG. PEG-associated nutritional intolerance developed in five (12.2%) patients.
Conclusion: In agreement with the published literature, PEG-related complications were low in frequency and there were no cases of PEG-related mortality.
In neurologic conditions associated with chronic and severe sequela requiring long-term nutritional support, PEG may be preferred on the basis of its ability to
provide safe and physiologic nutrition, ease of use, and a low rate of complications.
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Beuy JOOB, Viröj WIWANITKIT
Beuy JOOB, Viröj WIWANITKIT
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Nörolojik hastalıklar bütün dünyada en fazla sağlık yükü oluşturan hastalık gruplarındandır. Çoğu kronik ve iyi takip edilmesi gereken risk faktörlerine bağlı olan
nörolojik hastalık alanına yeni koronavirüs hastalığı-19 (COVID-19) pandemisi ile yeni ve ağır bir yük daha eklenmiştir. Nörolojik sisteme etkileri giderek daha
fazla yayımlanmakta olan Severe Acute Respiratory syndrome-Coronavirus-2’nin nörolojik tutulum yapma sıklığı ve mekanizmaları multidisipliner ekip içinde
nörologların da yer alması ile daha iyi anlaşılabilecektir. Diğer bir önemli durum ise, COVID-19 nedeniyle yapılan olağanüstü düzenlemelerin kronik gidişli, sık
ve düzenli kontrol gerektiren, akut müdahale gerektiren hastaların izlem ve tedavilerini aksatabilme durumudur. Nöroloji uzmanlarının bu dengeleri koruyarak
sahadaki sorumluluklarını yerine getirecek düzenlemeler yapılması hayati önemdedir.
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Atypical Parkinsonian syndromes include multiple systems atrophy (MSA), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and dementia
with Lewy bodies (DLB). These conditions show signs of dopamine deficiency, but unlike Parkinson’s disease (PD), they do not respond to dopaminergic treatments
and usually have a worse outcome compared with idiopathic PD. The Atypical Parkinsonian syndromes have no specific treatment or cure. Up to now, there are just
a few therapeutic approaches that place emphasis on symptomatic and supportive therapies. These approaches are based on palliative care, physical or occupational
therapy, neuropsychology, speech pathology, psychiatry, and social works. Pharmacotherapy with levodopa, dopamine agonists, amantadine, co-enzyme Q10,
botulinum toxin, cholinesterase inhibitors, and selective serotonin reuptake inhibitors may improve some symptoms of PSP and CBD. In this review, we categorize
some of the recent studies on therapeutic strategies as follows: autologous transplantation of stem cells, deep transcranial magnetic stimulation, intravenous
immunoglobulin, intranasal insulin, and pimavanserin. By classifying and comparing the most recent advances in treatment strategies of the atypical parkinsonian
syndromes, we provide a benchmark for further studies to introduce new effective therapeutic methods.
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Objective: Although Aquaporin-4 (Aqp-4) gene polymorphisms have been extensively studied in neuromyelitis optica spectrum disorder (NMOSD), there is
little evidence on the involvement of Aqp-4 in the pathogenesis of relapsing optic neuritis (RON).
Materials and Methods: In our study, we recruited patients who were followed by Istanbul University, Istanbul Faculty of Medicine, Department of Neurology,
Multiple Sclerosis and Myelin Disorders Unit between 1979 and 2015. Blood samples of the patients were genotyped for potential variants in the exons and the
nearby regions of Aqp-4 gene.
Results: The Aqp-4 gene was sequenced in 15 patients with RON who were seronegative, 33 patients with NMOSD, and 30 healthy controls. None of the
patients showed previously described single nucleotide polymorphisms (SNPs). Three new SNPs were identified in non-exonic regions of the gene. One intronic
SNP located in close proximity to the fifth exon had a higher prevalence in patients with RON than patients with NMOSD and healthy controls.
Conclusion: Aqp-4 SNPs show a considerable heterogeneous geographic distribution and might be involved in RON pathogenesis.
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Amaç: Bu çalışmada, kognitif bozukluğu olmayan erken-orta evre Parkinson hastalığı (PH) olan hastalarda, düşme için risk faktörü olarak daha önceki çalışmalarda
belirlenmiş motor bulgular ile PH’de yürüme hızının ölçülmesinde kullanılan on metre yürüme testine (10MYT) eklenen bellek, basit dikkat ve karmaşık dikkat
kognitif çift görev aktivitelerinin ve PH’nin non-motor bulgularının hangilerinin gelecekteki düşmeyi daha iyi tahmin ettireceğinin araştırılması amaçlanmıştır.
Gereç ve Yöntem: Çalışmaya dahil edilmek üzere 62 kişi değerlendirildi. Dahil edilme kriterlerine uyan 36 kişi çalışmaya alındı. Olguların demografik
özellikleri ve klinik bulguları sorgulandı. Motor ve non-motor bulgular Hareket Bozuklukları Derneği Birleşik PH Derecelendirme ölçeği Türkçe versiyonu
(HBD-BPDHÖ) ile değerlendirildi. Yürüme hızı 10MYT ve 10MYT’ye eklenen farklı kognitif çift görev aktiviteleri kullanılarak ölçüldü. İlk değerlendirmeden
sonra altı ay içindeki düşme hikayesi kaydedildi.
Bulgular: Olguların önceki düşme öyküsünün olması, HBD-BPHDÖ 1.A, HBD-BPHDÖ 1.B ve HBD-BPHDÖ 2 skorlarının yüksek olması, 10MYT (tek
görev) hızı ile 10MYT bellek, ileri ve geri sayı menzili ve yürütücü işlev çift görev aktiviteleri hızlarının daha düşük olması, altı ay içinde düşme meydana gelmesi
ile anlamlı olarak ilişkiliydi (p<0,05). Bu değişkenler kullanılarak yapılan çoklu lojistik regresyon analizi sonucuna göre; hastaların altı ay içinde düşme riskini
10MYT hızındaki artışın 0,76 kat azalttığı, HBD-BPHDÖ 1.B skorundaki artışın 2,06 kat artırdığı görüldü.
Sonuç: PH’de düşme ile ilgili bilinen olası risk faktörlerinin bir arada incelendiği çalışmamızda, bilinen kognitif bozukluğu olmayan, erken-orta evre hastaların
düşme riskini yürüme hızı ile birlikte non-motor bulgulardan uyku bozukluğu, duysal sorunlar ve otonom bulguların bir arada sorgulandığı HBD-BPHDÖ 1.B
skorunun öngördüğü bulunmuştur. Bu bulguların desteklenebilmesi için daha geniş hasta popülasyonunda daha uzun takipli çalışmalar gerekmektedir
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Objective: Bell’s palsy is an acute onset, unilateral, self-limiting paresis or paralysis of the facial nerve. The objective in treatment is to increase facial functions
and to accelerate recovery by suppressing this inflammatory process. Steroids and acyclovir (singly or in combination) are used in medical treatment. The objective
of this study was to determine the clinical profile of Bell’s palsy in childhood and to compare the efficacy of combined acyclovir-prednisolone therapy with that
of prednisolone therapy alone.
Materials and Methods: Eighty-six patients diagnosed as having Bell’s palsy were enrolled in the study. All patients were assessed in terms of facial nerve
dysfunction and recovery time using the House-Brackman Facial Nerve Grading scale (HBFNGS) at initial presentation and at the 15th day, and the first, third,
and sixth months. Grade 4 and above was assessed as severe, and lower grades were regarded as mild.
Results: The mean age of the patients was 9.5 (±2.4) years. Forty-six (57.6%) patients received prednisolone therapy only, and 34 (42.4%) were started on a
combination of oral acyclovir and prednisolone therapy, 29 of whom were in the severe category. Analysis of HBFNGS at one month revealed that the addition of
acyclovir to treatment had no effect on the recovery period. However, combination therapy seems more beneficial in severe cases.
Conclusion: Bell’s palsy frequently resolves entirely in childhood, and an acyclovir plus prednisolone combination is not superior to prednisolone alone except
in severe cases.
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