EPIDEMIOLOGY OF MULTIPLE SCLEROSIS IN TURKEY, EAST MEDITERANEAN AND NEAR EAST AREA, 2023
Abstract
Today, Multiple Sclerosis (MS) is one of the leading non-traumatic causes of permanent n... more Abstract Today, Multiple Sclerosis (MS) is one of the leading non-traumatic causes of permanent neurological disability in young and middle-aged populations. A 2020 statistical survey figures show that it affects 2.8 million people worldwide. This figure corresponds to an average of 1/3000 people, which figure is likely to rise further. Globally, the median estimated prevalence of MS is approximately 36 per 100,000 according to the international data, with 2.9 million people living with MS in the World in 2023. Regionally, the estimated median prevalence of MS is highest in Europe and the Americas. Regional differences in incidence generally run parallel to prevalence. A median prevalence and incidence was reported for Eastern Mediterranean area and Middle East but in the last decades this has tended to change. Also the incidence has increased in Mediterranean islands, but not all. Its prevalence increased from 40 per 100,000 to 100 per 100,000 in Turkey while in Greece, Cyprus, Basra Gulf and Middle East in general, a similarly increasing trend was observed in the recent years. The highest prevalence rates were reported in Iran (148.06 per 100,000) and higher incidence rates were estimated at 6.88 per 100,000 population in Kuwait. The same inceasing can be seen in some parts of Russia and Western Asia. In fact, the increasing trend in incidence can be seen even in the Far East, in China and Japan, where the prevalence and incidence were originally low. The gender distribution of MS in the region is also tending to change in the recent years, with more females having MS. Of the various risk factors cited for multiple sclerosis, especially migration seems to an important risk factor for the region, although there are some exceptions.
Turkish journal of trauma & emergency surgery, Jul 1, 2009
A 15-year-old boy sustained a high-voltage electrical injury with full-thickness scalp and calvar... more A 15-year-old boy sustained a high-voltage electrical injury with full-thickness scalp and calvarial bone necrosis in the parieto-occipital region. While necrotic soft tissues were debrided on the fifth day of injury, the devitalized calvaria was preserved. Bilayered coverage of the necrotic bone was achieved by transposition of 'bipedicled pericranial flap' and 'bipedicled scalp flap'. No complication was observed in the postoperative period. A bone resorption area, smaller than the original necrotic bone area, was observed in the long-term follow-ups.
Study aim: Sound knowledge of pressure ulcers is important to enable good prevention. There are l... more Study aim: Sound knowledge of pressure ulcers is important to enable good prevention. There are limited instruments assessing pressure ulcer knowledge. The Pressure Ulcer Prevention Knowledge Assessment Instrument is among the scales of which psychometric properties have been studied rigorously and reflects the latest evidence. This study aimed to evaluate the validity and reliability of the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI-T), an instrument that assesses knowledge of pressure ulcer prevention by using multiple-choice questions. Materials and methods: Linguistic validity was verified through front-to-back translation. Psychometric properties of the instrument were studied on a sample of 150 nurses working in a tertiary hospital in Istanbul, Turkey. Results: The content validity index of the translated instrument was 0.94, intra-class correlation coefficients were between 0.37 and 0.80, item difficulty indices were between 0.21 and 0.88, discrimination indices were 0.20e0.78, and the Kuder Richardson for the internal consistency was 0.803. Conclusions: The PUPKAI-T was found to be a valid and reliable tool to evaluate nurses' knowledge on pressure ulcer prevention. The PUPKAI-T may be a useful tool for determining educational needs of nurses on pressure ulcer prevention.
Aim: This study has been done to evaluate patients’ knowledge and understanding about their epile... more Aim: This study has been done to evaluate patients’ knowledge and understanding about their epilepsy, to asses which factors affect to conform to medical care, to put forward proposals which will guide in the planning of health care necessities and to emphasize necessity of epilepsy management for our country. Methods: This study was realized with 205 patients with epilepsy who applied to Neurology Outpatient Departments, between the dates of September 2005–March 2006. The Patient Interview Questionnaire has been used as a means of collecting data. Results: 87.3% of patients who participated to this study were male. 76.1% of the participants were single. Mean age at onset of epilepsy in the study population was 15.5±11.9 and the duration of disease was 10.0±7.2 years. 20.5% of patients had graduated from university. 50.25% of patients had no health insurance. It is found that education level is related with knowledge about illness (p
Introduction: Ocrelizumab is a newly introduced treatment in multiple sclerosis (MS). There is no... more Introduction: Ocrelizumab is a newly introduced treatment in multiple sclerosis (MS). There is no data in the pivotal trials about in which extent liver function tests (LFTs) and lymphocyte count are affected before second-half dose of ocrelizumab and in which extent these results will prevent us giving the second-half dose. This study was designed for better understanding of the patient management and to support the data that showed no safety issues about ocrelizumab with real-life data. Methods: The patients treated with ocrelizumab between May 20 and December 21, 2018 were retrospectively reviewed. Demographic and clinical data, side-effects due to ocrelizumab, laboratory results before and after the treatment were recorded. Results: There were 30 (58.8%) females and 21 (41.2%) males. The mean age was 44.02±9.62 (24-65) years. Twenty-six (51%) of them were followed up with relapsing-remitting MS (RRMS), 18 (35.3%) with secondary progressive MS (SPMS) and 7 (13.7%) with primary progressive MS (PPMS). The mean lymphocyte value one day after the first half-dose was lower than the value before the treatment (p<0.001). The mean lymphocyte level one month after the second half-dose was higher than the value one day after the first half-dose (p=0.001), while it was still lower than the value before treatment (p=0.006). No changes were seen in LFTs. Mild infusion-related reactions were observed in 4 patients. Conclusion: From our data, it is evident that ocrelizumab is safe in the short term. Long-term real-life studies are needed to assess the safety of ocrelizumab in the long term.
The presence of anti-gliadin antibodies (AGA) and their relationship with intestinal permeability... more The presence of anti-gliadin antibodies (AGA) and their relationship with intestinal permeability and prevalence of undiagnosed coeliac disease (CD) in ankylosing spondylitis (AS) were investigated. Blood samples from 30 AS patients and 19 age- and sex-matched controls were analysed for human leucocyte antigen (HLA)-B27, AGA and endomysial antibodies (EMA). Immunoglobulin (Ig) A-type AGA and IgG-type EMA were determined by enzyme-linked immunosorbent assay. AGA-positive patients were examined by gastroduodenoscope and proximal small-bowel mucosa biopsies were performed. Eleven (36.7%) AS patients were AGA positive (compared with none of the control subjects) and three (10.0%) of these AS patients were also EMA positive. The presence of AGA was not associated with more severe AS. Mild-to-severe villous atrophy and hyperplasia of crypts with increased chronic inflammatory cells in the lamina propria, which is typical of CD, was only observed in one AGA/EMA-positive AS patient; CD was ...
A mean percentage of 5% was reported for neurological involvement in researches related to Behçet... more A mean percentage of 5% was reported for neurological involvement in researches related to Behçet's disease. The neurological involvement may be characterized by headache, neuropsychiatric symptoms, brain stem involvement, cerebral venous thrombosis or peripheral nervous system involvement. Sometimes neurological involvement may be seen without any neurological sign or symptom. In our study, we aimed to evaluate the cognitive, psychiatric, and neurophysiological responses in Behçet's disease without neurological sign and symptom. This study was performed on patients with Behçet's disease without neurological signs and symptoms and healthy volunteers that would make the control group. The patients were assessed with Mini-Mental State Examination (MMSE), Hamilton rating scale for depression (HRSD), nerve conduction study (NCS), and visually evoked potential (VEP). A total of 27 male patients (age: 24.88±5.45 years) were enrolled in the study. Neurological examinations of all the patients were normal. Mean MMSE score of the patients was 29.62±0.79 (2 patients had loss of focus, 2 patients had disturbance in the copying function) and 2 patients had mild depression in HRSD. In the NCS, 2 patients had a right sensory-motor carpal tunnel syndrome (CTS), 1 patient had right sensory-motor CTS-bilateral ulnar nerve entrapment. In the VEP examination, 8 patients had prolonged P100 latency, decreased amplitude, and disturbance of wave morphology. VEP examination may be used as a conductive method to detect the subclinical neurological pathologies in Behçet's disease. The possible silent neurological involvement should be evaluated with further neuro-screening methods.
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2011
To investigate elastic characteristics of the aorta in patients with epilepsy. Seventy five patie... more To investigate elastic characteristics of the aorta in patients with epilepsy. Seventy five patients with a diagnosis of epilepsy through clinical and EEG findings and age and sex matched, 50 healthy controls were included. Systolic and diastolic blood pressures plus systolic and diastolic diameter of the aortic root was measured. Aortic strain (AS) and aortic distensibility (AD) and aortic distensibility index (BSI) were calculated. The average age of the epilepsy group was 23.8.8 +/- 8.2 years, and of the control group it was 24.1 +/- 6.2 years (p > 0.05). AS and AD were lower in the epileptic group while the aortic stiffness index was higher (10.4 +/- 4.2 vs 16.9 +/- 0.2, p: 0.001, for AS; 8.7 +/- 4.0 vs 17.2 +/- 0.1, p: 0.001, for AD and 20.1 +/- 0.1 vs 3.5 +/- 1.2, p: 0.001 for BSI). Elastic characteristics of the aorta change in epileptic patients, with a decrease of the distensibility of the aorta and an increase of the stiffness. After this preliminary study, new controll...
All primary degenerative diseases causing dementia are usually present with a prominent primary a... more All primary degenerative diseases causing dementia are usually present with a prominent primary anatomical tendency (which is unchangeable) and a related clinical presentation. Alzheimer's disease is a degenerative illness characterized by progressive cognitive deterioration, which typically starts with deficits in memory followed by affected executive, language, and visuospatial functions (1). Focal degenerative syndromes that are not typical for Alzheimer's disease have been described. These are progressive visuospatial deficit, primary progressive amnesia, primary progressive aphasia, and primary behavioral changes (2). In this case report we describe a 73-year-old female patient with atypical presentation of AD.
To determine the frequency of cardiac valvulopathy in patients with Parkinson disease (PD) treate... more To determine the frequency of cardiac valvulopathy in patients with Parkinson disease (PD) treated with or without dopamine agonists. Methods: We obtained transthoracic echocardiography and EKG in 210 consecutive patients with PD admitted to our hospital between September 2004 and September 2005. We analyzed the frequency according to the type of dopamine agonist. A case-control design was adopted with dopamine agonist nontreated group as the reference group, and multiple logistic regression analysis was conducted considering age, sex, and duration of illness to examine the relationships between each dopamine agonist and the presence of valvular abnormalities. Results: The frequency of valvulopathy was significantly higher in the cabergoline-treated group (68.8%, 11/16; affected patients/total) than in the dopamine agonist nontreated control group (17.6%, 15/85). The frequency was not different between the pergolide group (28.8%, 19/66) and the pramipexole group (25%, 4/16). The adjusted odds ratio was significantly higher in the cabergoline group (12.96, 95% CI ϭ 3.59 to 46.85), compared with the pergolide group (2.18, 95% CI ϭ 0.90 to 5.30) and pramipexole group (1.62, 95% CI ϭ 0.45 to 5.87). The mean daily dose was 3.8 mg for cabergoline, 1.4 mg for pergolide, and 1.7 mg for pramipexole. The cumulative dose and treatment duration of cabergoline in the valvulopathy subgroup were significantly higher than in the nonvalvulopathy subgroup. Conclusion: The frequency of valvulopathy was significantly increased in the cabergoline group. Our results indicate that high cumulative dose and long-term treatment with cabergoline are risk factors for valvulopathy in patients with Parkinson disease.
Patients with end stage chronic renal failure could have a sign of polyneuropathy. Aim: In this s... more Patients with end stage chronic renal failure could have a sign of polyneuropathy. Aim: In this study we investigate how the duration on continues ambulatory peritoneal dialysis (CPD) influent on nerve conduction velocity (NCV). Method: We investigate 62 patients on CPD with mean duration on CPD 26, 6 ± 39, 22 mount, mean age 58.2 ± 12.1 years. We measure MCV of peroneal and tibial nerve, as well as SCV of sural nerve. We also registered glycemia, creatinin and urea in those patients. Results: In this study we found that the duration of CPD is in correlation with increase of level of the creatinine (p < 0.05). Also we registered a significant influence of glycemia and creatinine (p < 0.05) on reduced MCV on peroneal and tibial nerve, and significant influence of level of glycema, urea and creatinin (p < 0.05) on prolonged a latency of F wave. From 62 patients 53 patients had pathological findings; either reduced or unrecordable SCV of sural nerve. Conclusion: Specific predictors that herald appearance of clinical sign have not been identified, but in our study, we registered a high degree of correlation between urea and creatinine and NCV. The most sensitive parameter could be a latency of F wave, and the Earl's detectable sing is pathological findings of SCV of sural nerve.
Hyperbaric oxygen treatment (HBOT) involves some risk of central nervous system (CNS) oxygen toxi... more Hyperbaric oxygen treatment (HBOT) involves some risk of central nervous system (CNS) oxygen toxicity, which may be revealed by various signs and symptoms including seizures in patients breathing O2 at pressures of 2 ATA or higher. The aim of this study was to determine the incidence of such seizures in the Underwater and Hyperbaric Medicine Departments of two university hospitals. We retrospectively evaluated 80,679 patient-treatments for 9 clinical indications to determine the incidence of seizures attributable to CNS O2 toxicity. Because different protocols were used for HBOT, the treatments were studied in four groups according to the chamber type used and the medical facility at which it was located. Only 2 seizures were documented, yielding an incidence of 2.4 per 100,000 patient-treatments. Both cases occurred in a multiplace chamber pressurized to 2.4 ATA with O2 delivered by mask for three x 30 min with 5-min air breaks. The seizure incidence reported here is lower than oth...
Journal of Stroke and Cerebrovascular Diseases, 2015
In this study, we evaluated the microembolic signals (MES) frequency with transcranial Doppler ul... more In this study, we evaluated the microembolic signals (MES) frequency with transcranial Doppler ultrasound (TCD) in patients with atrial fibrillation (AF) under anticoagulant therapy, and we compared the treatment groups. Ninety-nine patients with nonvalvular AF with a history of stroke using warfarin (46%), 67 patients using rivaroxaban (31%), and 49 patients using dabigatran (23%), that is, a total of 215 patients, who have been referred to the stroke outpatient section of our department from May 2013 to November 2014, were included in the study. CHA(2)DS(2)VASc scoring was made for all patients, and International Normalized Ratio (INR) value was evaluated in patients using warfarin. All patients were monitored with TCD on the middle cerebral arteries bilaterally for 30 minutes. Embolic signals were evaluated according to their density and the mean number of signals in 2 consecutive recordings. The incidence of emboli in the treatment group was 32 (32%) for warfarin, 24 (36%) for rivaroxaban, and 17 (35%) for dabigatran. The analysis of variance revealed that there was no statistically significant differences between the treatment groups in terms of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; age (P = .145), CHA(2)DS(2)VASc scores (P = .968), and the number of emboli (P = .783). As CHA(2)DS(2)VASc score increases, number of emboli increase. A statistically significant negative correlation between the number of emboli and INR scores was found in the warfarin group. The number of emboli decreases as INR decreases. As we aim to reduce the risk of emboli to a minimum with anticoagulant therapy, this screening for MES can give us an idea for the risk of stroke.
Background: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impair... more Background: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impairment in quality of life (QoL), disruption in treatment (DIT), and posttraumatic stress disorder (PTSD) in chronic neurological diseases (CNDs). To reach this information, a multicenter, cross-sectional study (COVQoL-CND) was planned. Parkinson’s disease (PD), headache (HA), multiple sclerosis (MS), epilepsy (EP), polyneuropathy (PNP), and cerebrovascular disease (CVD) were selected as the CND. Methods: The COVQoL-CND study includes demographic data, the World Health Organization Quality of Life short form (WHOQOL-BREF), and Impact of Event Scale-Revised (IES-R) forms. Results: The mean age of a total of 577 patients was 49 ± 17 (19–87 years), and the ratio of female/male was 352/225. The mean age of patients with PD, HA, MS, EP, PNP, and CVD were 65 ± 11, 39 ± 12, 38 ± 10, 47 ± 17, 61 ± 12, and 60 ± 15 years, respectively. The IES-R scores were found to be higher in the younger group, th...
Objective: In this study the factors that trigger the seizures in epileptic patients over the age... more Objective: In this study the factors that trigger the seizures in epileptic patients over the age of 50 was investigated and the frequency of seizures was analyzed regarding different age, gender, type of seizure and etiological groups. Background: For this purpose, 387 patients were included in the study who were admitted to neurology outpatient clinic with the diagnosis of epilepsy. Methods: The patients are divided into groups based on those characteristics: male / female, generalized seizure / partial seizure, age between 50 and 65 / age over 65. Results: The most common precipitating factor in all groups were found as stress (37[percnt]), sleeplessness (27[percnt]) and forgetting to take the medication (20[percnt]). 31[percnt] of the patients were on Carbamazepine, 21[percnt] were on Levetiracetam and 19[percnt] were on Valproic Asid. The most common etiological causes were identified as idiopathic (39[percnt]), poststroke(24[percnt]) and dementia (15[percnt]). Regarding the tr...
Background: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impair... more Background: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impairment in quality of life (QoL), disruption in treatment (DIT), and posttraumatic stress disorder (PTSD) in chronic neurological diseases (CNDs). To reach this information, a multicenter, cross-sectional study (COVQoL-CND) was planned. Parkinson’s disease (PD), headache (HA), multiple sclerosis (MS), epilepsy (EP), polyneuropathy (PNP), and cerebrovascular disease (CVD) were selected as the CND. Methods: The COVQoL-CND study includes demographic data, the World Health Organization Quality of Life short form (WHOQOL-BREF), and Impact of Event Scale-Revised (IES-R) forms. Results: The mean age of a total of 577 patients was 49 ± 17 (19–87 years), and the ratio of female/male was 352/225. The mean age of patients with PD, HA, MS, EP, PNP, and CVD were 65 ± 11, 39 ± 12, 38 ± 10, 47 ± 17, 61 ± 12, and 60 ± 15 years, respectively. The IES-R scores were found to be higher in the younger group, th...
Type I complex regional pain syndrome (reflex sympathetic dystrophy) developing on the background... more Type I complex regional pain syndrome (reflex sympathetic dystrophy) developing on the background of carpal tunnel syndrome
EPIDEMIOLOGY OF MULTIPLE SCLEROSIS IN TURKEY, EAST MEDITERANEAN AND NEAR EAST AREA, 2023
Abstract
Today, Multiple Sclerosis (MS) is one of the leading non-traumatic causes of permanent n... more Abstract Today, Multiple Sclerosis (MS) is one of the leading non-traumatic causes of permanent neurological disability in young and middle-aged populations. A 2020 statistical survey figures show that it affects 2.8 million people worldwide. This figure corresponds to an average of 1/3000 people, which figure is likely to rise further. Globally, the median estimated prevalence of MS is approximately 36 per 100,000 according to the international data, with 2.9 million people living with MS in the World in 2023. Regionally, the estimated median prevalence of MS is highest in Europe and the Americas. Regional differences in incidence generally run parallel to prevalence. A median prevalence and incidence was reported for Eastern Mediterranean area and Middle East but in the last decades this has tended to change. Also the incidence has increased in Mediterranean islands, but not all. Its prevalence increased from 40 per 100,000 to 100 per 100,000 in Turkey while in Greece, Cyprus, Basra Gulf and Middle East in general, a similarly increasing trend was observed in the recent years. The highest prevalence rates were reported in Iran (148.06 per 100,000) and higher incidence rates were estimated at 6.88 per 100,000 population in Kuwait. The same inceasing can be seen in some parts of Russia and Western Asia. In fact, the increasing trend in incidence can be seen even in the Far East, in China and Japan, where the prevalence and incidence were originally low. The gender distribution of MS in the region is also tending to change in the recent years, with more females having MS. Of the various risk factors cited for multiple sclerosis, especially migration seems to an important risk factor for the region, although there are some exceptions.
Turkish journal of trauma & emergency surgery, Jul 1, 2009
A 15-year-old boy sustained a high-voltage electrical injury with full-thickness scalp and calvar... more A 15-year-old boy sustained a high-voltage electrical injury with full-thickness scalp and calvarial bone necrosis in the parieto-occipital region. While necrotic soft tissues were debrided on the fifth day of injury, the devitalized calvaria was preserved. Bilayered coverage of the necrotic bone was achieved by transposition of 'bipedicled pericranial flap' and 'bipedicled scalp flap'. No complication was observed in the postoperative period. A bone resorption area, smaller than the original necrotic bone area, was observed in the long-term follow-ups.
Study aim: Sound knowledge of pressure ulcers is important to enable good prevention. There are l... more Study aim: Sound knowledge of pressure ulcers is important to enable good prevention. There are limited instruments assessing pressure ulcer knowledge. The Pressure Ulcer Prevention Knowledge Assessment Instrument is among the scales of which psychometric properties have been studied rigorously and reflects the latest evidence. This study aimed to evaluate the validity and reliability of the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI-T), an instrument that assesses knowledge of pressure ulcer prevention by using multiple-choice questions. Materials and methods: Linguistic validity was verified through front-to-back translation. Psychometric properties of the instrument were studied on a sample of 150 nurses working in a tertiary hospital in Istanbul, Turkey. Results: The content validity index of the translated instrument was 0.94, intra-class correlation coefficients were between 0.37 and 0.80, item difficulty indices were between 0.21 and 0.88, discrimination indices were 0.20e0.78, and the Kuder Richardson for the internal consistency was 0.803. Conclusions: The PUPKAI-T was found to be a valid and reliable tool to evaluate nurses' knowledge on pressure ulcer prevention. The PUPKAI-T may be a useful tool for determining educational needs of nurses on pressure ulcer prevention.
Aim: This study has been done to evaluate patients’ knowledge and understanding about their epile... more Aim: This study has been done to evaluate patients’ knowledge and understanding about their epilepsy, to asses which factors affect to conform to medical care, to put forward proposals which will guide in the planning of health care necessities and to emphasize necessity of epilepsy management for our country. Methods: This study was realized with 205 patients with epilepsy who applied to Neurology Outpatient Departments, between the dates of September 2005–March 2006. The Patient Interview Questionnaire has been used as a means of collecting data. Results: 87.3% of patients who participated to this study were male. 76.1% of the participants were single. Mean age at onset of epilepsy in the study population was 15.5±11.9 and the duration of disease was 10.0±7.2 years. 20.5% of patients had graduated from university. 50.25% of patients had no health insurance. It is found that education level is related with knowledge about illness (p
Introduction: Ocrelizumab is a newly introduced treatment in multiple sclerosis (MS). There is no... more Introduction: Ocrelizumab is a newly introduced treatment in multiple sclerosis (MS). There is no data in the pivotal trials about in which extent liver function tests (LFTs) and lymphocyte count are affected before second-half dose of ocrelizumab and in which extent these results will prevent us giving the second-half dose. This study was designed for better understanding of the patient management and to support the data that showed no safety issues about ocrelizumab with real-life data. Methods: The patients treated with ocrelizumab between May 20 and December 21, 2018 were retrospectively reviewed. Demographic and clinical data, side-effects due to ocrelizumab, laboratory results before and after the treatment were recorded. Results: There were 30 (58.8%) females and 21 (41.2%) males. The mean age was 44.02±9.62 (24-65) years. Twenty-six (51%) of them were followed up with relapsing-remitting MS (RRMS), 18 (35.3%) with secondary progressive MS (SPMS) and 7 (13.7%) with primary progressive MS (PPMS). The mean lymphocyte value one day after the first half-dose was lower than the value before the treatment (p<0.001). The mean lymphocyte level one month after the second half-dose was higher than the value one day after the first half-dose (p=0.001), while it was still lower than the value before treatment (p=0.006). No changes were seen in LFTs. Mild infusion-related reactions were observed in 4 patients. Conclusion: From our data, it is evident that ocrelizumab is safe in the short term. Long-term real-life studies are needed to assess the safety of ocrelizumab in the long term.
The presence of anti-gliadin antibodies (AGA) and their relationship with intestinal permeability... more The presence of anti-gliadin antibodies (AGA) and their relationship with intestinal permeability and prevalence of undiagnosed coeliac disease (CD) in ankylosing spondylitis (AS) were investigated. Blood samples from 30 AS patients and 19 age- and sex-matched controls were analysed for human leucocyte antigen (HLA)-B27, AGA and endomysial antibodies (EMA). Immunoglobulin (Ig) A-type AGA and IgG-type EMA were determined by enzyme-linked immunosorbent assay. AGA-positive patients were examined by gastroduodenoscope and proximal small-bowel mucosa biopsies were performed. Eleven (36.7%) AS patients were AGA positive (compared with none of the control subjects) and three (10.0%) of these AS patients were also EMA positive. The presence of AGA was not associated with more severe AS. Mild-to-severe villous atrophy and hyperplasia of crypts with increased chronic inflammatory cells in the lamina propria, which is typical of CD, was only observed in one AGA/EMA-positive AS patient; CD was ...
A mean percentage of 5% was reported for neurological involvement in researches related to Behçet... more A mean percentage of 5% was reported for neurological involvement in researches related to Behçet's disease. The neurological involvement may be characterized by headache, neuropsychiatric symptoms, brain stem involvement, cerebral venous thrombosis or peripheral nervous system involvement. Sometimes neurological involvement may be seen without any neurological sign or symptom. In our study, we aimed to evaluate the cognitive, psychiatric, and neurophysiological responses in Behçet's disease without neurological sign and symptom. This study was performed on patients with Behçet's disease without neurological signs and symptoms and healthy volunteers that would make the control group. The patients were assessed with Mini-Mental State Examination (MMSE), Hamilton rating scale for depression (HRSD), nerve conduction study (NCS), and visually evoked potential (VEP). A total of 27 male patients (age: 24.88±5.45 years) were enrolled in the study. Neurological examinations of all the patients were normal. Mean MMSE score of the patients was 29.62±0.79 (2 patients had loss of focus, 2 patients had disturbance in the copying function) and 2 patients had mild depression in HRSD. In the NCS, 2 patients had a right sensory-motor carpal tunnel syndrome (CTS), 1 patient had right sensory-motor CTS-bilateral ulnar nerve entrapment. In the VEP examination, 8 patients had prolonged P100 latency, decreased amplitude, and disturbance of wave morphology. VEP examination may be used as a conductive method to detect the subclinical neurological pathologies in Behçet's disease. The possible silent neurological involvement should be evaluated with further neuro-screening methods.
Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 2011
To investigate elastic characteristics of the aorta in patients with epilepsy. Seventy five patie... more To investigate elastic characteristics of the aorta in patients with epilepsy. Seventy five patients with a diagnosis of epilepsy through clinical and EEG findings and age and sex matched, 50 healthy controls were included. Systolic and diastolic blood pressures plus systolic and diastolic diameter of the aortic root was measured. Aortic strain (AS) and aortic distensibility (AD) and aortic distensibility index (BSI) were calculated. The average age of the epilepsy group was 23.8.8 +/- 8.2 years, and of the control group it was 24.1 +/- 6.2 years (p > 0.05). AS and AD were lower in the epileptic group while the aortic stiffness index was higher (10.4 +/- 4.2 vs 16.9 +/- 0.2, p: 0.001, for AS; 8.7 +/- 4.0 vs 17.2 +/- 0.1, p: 0.001, for AD and 20.1 +/- 0.1 vs 3.5 +/- 1.2, p: 0.001 for BSI). Elastic characteristics of the aorta change in epileptic patients, with a decrease of the distensibility of the aorta and an increase of the stiffness. After this preliminary study, new controll...
All primary degenerative diseases causing dementia are usually present with a prominent primary a... more All primary degenerative diseases causing dementia are usually present with a prominent primary anatomical tendency (which is unchangeable) and a related clinical presentation. Alzheimer's disease is a degenerative illness characterized by progressive cognitive deterioration, which typically starts with deficits in memory followed by affected executive, language, and visuospatial functions (1). Focal degenerative syndromes that are not typical for Alzheimer's disease have been described. These are progressive visuospatial deficit, primary progressive amnesia, primary progressive aphasia, and primary behavioral changes (2). In this case report we describe a 73-year-old female patient with atypical presentation of AD.
To determine the frequency of cardiac valvulopathy in patients with Parkinson disease (PD) treate... more To determine the frequency of cardiac valvulopathy in patients with Parkinson disease (PD) treated with or without dopamine agonists. Methods: We obtained transthoracic echocardiography and EKG in 210 consecutive patients with PD admitted to our hospital between September 2004 and September 2005. We analyzed the frequency according to the type of dopamine agonist. A case-control design was adopted with dopamine agonist nontreated group as the reference group, and multiple logistic regression analysis was conducted considering age, sex, and duration of illness to examine the relationships between each dopamine agonist and the presence of valvular abnormalities. Results: The frequency of valvulopathy was significantly higher in the cabergoline-treated group (68.8%, 11/16; affected patients/total) than in the dopamine agonist nontreated control group (17.6%, 15/85). The frequency was not different between the pergolide group (28.8%, 19/66) and the pramipexole group (25%, 4/16). The adjusted odds ratio was significantly higher in the cabergoline group (12.96, 95% CI ϭ 3.59 to 46.85), compared with the pergolide group (2.18, 95% CI ϭ 0.90 to 5.30) and pramipexole group (1.62, 95% CI ϭ 0.45 to 5.87). The mean daily dose was 3.8 mg for cabergoline, 1.4 mg for pergolide, and 1.7 mg for pramipexole. The cumulative dose and treatment duration of cabergoline in the valvulopathy subgroup were significantly higher than in the nonvalvulopathy subgroup. Conclusion: The frequency of valvulopathy was significantly increased in the cabergoline group. Our results indicate that high cumulative dose and long-term treatment with cabergoline are risk factors for valvulopathy in patients with Parkinson disease.
Patients with end stage chronic renal failure could have a sign of polyneuropathy. Aim: In this s... more Patients with end stage chronic renal failure could have a sign of polyneuropathy. Aim: In this study we investigate how the duration on continues ambulatory peritoneal dialysis (CPD) influent on nerve conduction velocity (NCV). Method: We investigate 62 patients on CPD with mean duration on CPD 26, 6 ± 39, 22 mount, mean age 58.2 ± 12.1 years. We measure MCV of peroneal and tibial nerve, as well as SCV of sural nerve. We also registered glycemia, creatinin and urea in those patients. Results: In this study we found that the duration of CPD is in correlation with increase of level of the creatinine (p < 0.05). Also we registered a significant influence of glycemia and creatinine (p < 0.05) on reduced MCV on peroneal and tibial nerve, and significant influence of level of glycema, urea and creatinin (p < 0.05) on prolonged a latency of F wave. From 62 patients 53 patients had pathological findings; either reduced or unrecordable SCV of sural nerve. Conclusion: Specific predictors that herald appearance of clinical sign have not been identified, but in our study, we registered a high degree of correlation between urea and creatinine and NCV. The most sensitive parameter could be a latency of F wave, and the Earl's detectable sing is pathological findings of SCV of sural nerve.
Hyperbaric oxygen treatment (HBOT) involves some risk of central nervous system (CNS) oxygen toxi... more Hyperbaric oxygen treatment (HBOT) involves some risk of central nervous system (CNS) oxygen toxicity, which may be revealed by various signs and symptoms including seizures in patients breathing O2 at pressures of 2 ATA or higher. The aim of this study was to determine the incidence of such seizures in the Underwater and Hyperbaric Medicine Departments of two university hospitals. We retrospectively evaluated 80,679 patient-treatments for 9 clinical indications to determine the incidence of seizures attributable to CNS O2 toxicity. Because different protocols were used for HBOT, the treatments were studied in four groups according to the chamber type used and the medical facility at which it was located. Only 2 seizures were documented, yielding an incidence of 2.4 per 100,000 patient-treatments. Both cases occurred in a multiplace chamber pressurized to 2.4 ATA with O2 delivered by mask for three x 30 min with 5-min air breaks. The seizure incidence reported here is lower than oth...
Journal of Stroke and Cerebrovascular Diseases, 2015
In this study, we evaluated the microembolic signals (MES) frequency with transcranial Doppler ul... more In this study, we evaluated the microembolic signals (MES) frequency with transcranial Doppler ultrasound (TCD) in patients with atrial fibrillation (AF) under anticoagulant therapy, and we compared the treatment groups. Ninety-nine patients with nonvalvular AF with a history of stroke using warfarin (46%), 67 patients using rivaroxaban (31%), and 49 patients using dabigatran (23%), that is, a total of 215 patients, who have been referred to the stroke outpatient section of our department from May 2013 to November 2014, were included in the study. CHA(2)DS(2)VASc scoring was made for all patients, and International Normalized Ratio (INR) value was evaluated in patients using warfarin. All patients were monitored with TCD on the middle cerebral arteries bilaterally for 30 minutes. Embolic signals were evaluated according to their density and the mean number of signals in 2 consecutive recordings. The incidence of emboli in the treatment group was 32 (32%) for warfarin, 24 (36%) for rivaroxaban, and 17 (35%) for dabigatran. The analysis of variance revealed that there was no statistically significant differences between the treatment groups in terms of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; age (P = .145), CHA(2)DS(2)VASc scores (P = .968), and the number of emboli (P = .783). As CHA(2)DS(2)VASc score increases, number of emboli increase. A statistically significant negative correlation between the number of emboli and INR scores was found in the warfarin group. The number of emboli decreases as INR decreases. As we aim to reduce the risk of emboli to a minimum with anticoagulant therapy, this screening for MES can give us an idea for the risk of stroke.
Background: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impair... more Background: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impairment in quality of life (QoL), disruption in treatment (DIT), and posttraumatic stress disorder (PTSD) in chronic neurological diseases (CNDs). To reach this information, a multicenter, cross-sectional study (COVQoL-CND) was planned. Parkinson’s disease (PD), headache (HA), multiple sclerosis (MS), epilepsy (EP), polyneuropathy (PNP), and cerebrovascular disease (CVD) were selected as the CND. Methods: The COVQoL-CND study includes demographic data, the World Health Organization Quality of Life short form (WHOQOL-BREF), and Impact of Event Scale-Revised (IES-R) forms. Results: The mean age of a total of 577 patients was 49 ± 17 (19–87 years), and the ratio of female/male was 352/225. The mean age of patients with PD, HA, MS, EP, PNP, and CVD were 65 ± 11, 39 ± 12, 38 ± 10, 47 ± 17, 61 ± 12, and 60 ± 15 years, respectively. The IES-R scores were found to be higher in the younger group, th...
Objective: In this study the factors that trigger the seizures in epileptic patients over the age... more Objective: In this study the factors that trigger the seizures in epileptic patients over the age of 50 was investigated and the frequency of seizures was analyzed regarding different age, gender, type of seizure and etiological groups. Background: For this purpose, 387 patients were included in the study who were admitted to neurology outpatient clinic with the diagnosis of epilepsy. Methods: The patients are divided into groups based on those characteristics: male / female, generalized seizure / partial seizure, age between 50 and 65 / age over 65. Results: The most common precipitating factor in all groups were found as stress (37[percnt]), sleeplessness (27[percnt]) and forgetting to take the medication (20[percnt]). 31[percnt] of the patients were on Carbamazepine, 21[percnt] were on Levetiracetam and 19[percnt] were on Valproic Asid. The most common etiological causes were identified as idiopathic (39[percnt]), poststroke(24[percnt]) and dementia (15[percnt]). Regarding the tr...
Background: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impair... more Background: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impairment in quality of life (QoL), disruption in treatment (DIT), and posttraumatic stress disorder (PTSD) in chronic neurological diseases (CNDs). To reach this information, a multicenter, cross-sectional study (COVQoL-CND) was planned. Parkinson’s disease (PD), headache (HA), multiple sclerosis (MS), epilepsy (EP), polyneuropathy (PNP), and cerebrovascular disease (CVD) were selected as the CND. Methods: The COVQoL-CND study includes demographic data, the World Health Organization Quality of Life short form (WHOQOL-BREF), and Impact of Event Scale-Revised (IES-R) forms. Results: The mean age of a total of 577 patients was 49 ± 17 (19–87 years), and the ratio of female/male was 352/225. The mean age of patients with PD, HA, MS, EP, PNP, and CVD were 65 ± 11, 39 ± 12, 38 ± 10, 47 ± 17, 61 ± 12, and 60 ± 15 years, respectively. The IES-R scores were found to be higher in the younger group, th...
Type I complex regional pain syndrome (reflex sympathetic dystrophy) developing on the background... more Type I complex regional pain syndrome (reflex sympathetic dystrophy) developing on the background of carpal tunnel syndrome
COVID-19 hastalarında nörolojik belirtiler görülmektedir
(59,60,61). Araştırmacılar SARS koronavi... more COVID-19 hastalarında nörolojik belirtiler görülmektedir (59,60,61). Araştırmacılar SARS koronavirüs nükleik asit bileşenini hastaların BOS ve virüsü otopsilerde beyin dokusunda da saptamışlardır (62). Nörolojik tutulumlar literatürde olgu bildirimleri ile de desteklenmiştir. Hastaların üçte birinden fazlasında santral sinir sistemi (SSS) tutulumu, periferik sinir sistemi (PSS) tutulumu ve iskelet kası hasarını içeren çeşitli nörolojik belirtiler bildirilmiştir (60). SSS tutulumuna işaret eden belirti ve hastalıklar olarak; sersemleme, vertigo, uyku bozukluğu, baş ağrısı, bilinç kaybı, ataksi, nöbet, akut serebrovasküler hastalık, menenjit ve ensefalit bildirilmiştir (54,59,60,63,64,65). PSS tutulumuna işaret eden belirtiler, tat ve koku alma bozukluğu, görme bozukluğu ve nöralji olarak bildirilmiştir (66). PSS belirtileri olan hastalarda en sık görülen şikayetler tat ve koku alma bozuklularıdır (60). Bu hastalarda bildirilen hipozmi virüsün nörotropik potansiyelini göstermektedir. Virüsün olfaktör siniri ve bulbusu ya da alternatif olarak beyin sapından itibaren solunum yolundaki larinks, trakea ve akciğerler gibi farklı organları innerve eden vagus sinirinin duysal liflerini invaze ettiği düşünülmektedir. Erken dönemde koku alma kaybı, ataksi ve konvülziyon görülen hastaların SARSCoV-2’nin SSS tutulumu açısından ileri araştırmaya tabi tutulması önerilmektedir. Çeşitli ülkelerdeki kliniklerden bildirilen Guillain Barré sendromu (GBS) ile sunulan COVID-19 olguları da literatürde izlenmektedir (67,68,69,70). Gutierrez-Ortiz ve ark. (71) tarafından 50 ve 39 yaşlarında Miller Fisher sendromu ve multipl kraniyal nöropati tanısı alan COVID-19’lu iki olgu bildirilmiştir. Zhao ve ark. (72) tarafından 66 yaşında COVID-19 tanılı bir erkek hastada postenfeksiyöz miyelit tanımlanmıştır. Wei ve ark. (73) tarafından 62 yaşında COVID-19 tanılı ve okülomotor sinir felci olan bir olgu bildirilmiştir. İskelet kası hasarını işaret eden belirtiler, kaslarda yorgunluk ve ekstremitelerde ağrı olarak bildirilmiştir. Kreatin kinaz (CK) seviyelerinde hafif yükseklikler olabilmekle birlikte kas hasarı, kas ağrısı olduğunda ve serum CK seviyesi anlamlı derecede yüksek olduğunda tanımlanmaktadır (60). Ek organ hasarlarının eşlik ettiği rabdomiyoliz olguları (CK düzeyleri: 525- 12216 U/L) bildirilmiştir (60). SARS koronavirüsün miyokardiyal enflamasyonda da rol oynadığı bilinmektedir.
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Papers by Erdem Togrol
Today, Multiple Sclerosis (MS) is one of the leading non-traumatic causes of permanent neurological disability in young and middle-aged populations. A 2020 statistical survey figures show that it affects 2.8 million people worldwide. This figure corresponds to an average of 1/3000 people, which figure is likely to rise further. Globally, the median estimated prevalence of MS is approximately 36 per 100,000 according to the international data, with 2.9 million people living with MS in the World in 2023. Regionally, the estimated median prevalence of MS is highest in Europe and the Americas. Regional differences in incidence generally run parallel to prevalence. A median prevalence and incidence was reported for Eastern Mediterranean area and Middle East but in the last decades this has tended to change. Also the incidence has increased in Mediterranean islands, but not all. Its prevalence increased from 40 per 100,000 to 100 per 100,000 in Turkey while in Greece, Cyprus, Basra Gulf and Middle East in general, a similarly increasing trend was observed in the recent years. The highest prevalence rates were reported in Iran (148.06 per 100,000) and higher incidence rates were estimated at 6.88 per 100,000 population in Kuwait. The same inceasing can be seen in some parts of Russia and Western Asia. In fact, the increasing trend in incidence can be seen even in the Far East, in China and Japan, where the prevalence and incidence were originally low. The gender distribution of MS in the region is also tending to change in the recent years, with more females having MS. Of the various risk factors cited for multiple sclerosis, especially migration seems to an important risk factor for the region, although there are some exceptions.
Today, Multiple Sclerosis (MS) is one of the leading non-traumatic causes of permanent neurological disability in young and middle-aged populations. A 2020 statistical survey figures show that it affects 2.8 million people worldwide. This figure corresponds to an average of 1/3000 people, which figure is likely to rise further. Globally, the median estimated prevalence of MS is approximately 36 per 100,000 according to the international data, with 2.9 million people living with MS in the World in 2023. Regionally, the estimated median prevalence of MS is highest in Europe and the Americas. Regional differences in incidence generally run parallel to prevalence. A median prevalence and incidence was reported for Eastern Mediterranean area and Middle East but in the last decades this has tended to change. Also the incidence has increased in Mediterranean islands, but not all. Its prevalence increased from 40 per 100,000 to 100 per 100,000 in Turkey while in Greece, Cyprus, Basra Gulf and Middle East in general, a similarly increasing trend was observed in the recent years. The highest prevalence rates were reported in Iran (148.06 per 100,000) and higher incidence rates were estimated at 6.88 per 100,000 population in Kuwait. The same inceasing can be seen in some parts of Russia and Western Asia. In fact, the increasing trend in incidence can be seen even in the Far East, in China and Japan, where the prevalence and incidence were originally low. The gender distribution of MS in the region is also tending to change in the recent years, with more females having MS. Of the various risk factors cited for multiple sclerosis, especially migration seems to an important risk factor for the region, although there are some exceptions.
(59,60,61). Araştırmacılar SARS koronavirüs nükleik asit
bileşenini hastaların BOS ve virüsü otopsilerde beyin dokusunda
da saptamışlardır (62). Nörolojik tutulumlar literatürde olgu
bildirimleri ile de desteklenmiştir. Hastaların üçte birinden
fazlasında santral sinir sistemi (SSS) tutulumu, periferik sinir
sistemi (PSS) tutulumu ve iskelet kası hasarını içeren çeşitli
nörolojik belirtiler bildirilmiştir (60).
SSS tutulumuna işaret eden belirti ve hastalıklar olarak;
sersemleme, vertigo, uyku bozukluğu, baş ağrısı, bilinç kaybı,
ataksi, nöbet, akut serebrovasküler hastalık, menenjit ve ensefalit
bildirilmiştir (54,59,60,63,64,65). PSS tutulumuna işaret eden
belirtiler, tat ve koku alma bozukluğu, görme bozukluğu ve
nöralji olarak bildirilmiştir (66). PSS belirtileri olan hastalarda en
sık görülen şikayetler tat ve koku alma bozuklularıdır (60). Bu
hastalarda bildirilen hipozmi virüsün nörotropik potansiyelini
göstermektedir. Virüsün olfaktör siniri ve bulbusu ya da alternatif
olarak beyin sapından itibaren solunum yolundaki larinks, trakea
ve akciğerler gibi farklı organları innerve eden vagus sinirinin
duysal liflerini invaze ettiği düşünülmektedir. Erken dönemde
koku alma kaybı, ataksi ve konvülziyon görülen hastaların SARSCoV-2’nin SSS tutulumu açısından ileri araştırmaya tabi tutulması
önerilmektedir. Çeşitli ülkelerdeki kliniklerden bildirilen
Guillain Barré sendromu (GBS) ile sunulan COVID-19 olguları
da literatürde izlenmektedir (67,68,69,70). Gutierrez-Ortiz ve
ark. (71) tarafından 50 ve 39 yaşlarında Miller Fisher sendromu
ve multipl kraniyal nöropati tanısı alan COVID-19’lu iki olgu
bildirilmiştir. Zhao ve ark. (72) tarafından 66 yaşında COVID-19
tanılı bir erkek hastada postenfeksiyöz miyelit tanımlanmıştır. Wei
ve ark. (73) tarafından 62 yaşında COVID-19 tanılı ve okülomotor
sinir felci olan bir olgu bildirilmiştir.
İskelet kası hasarını işaret eden belirtiler, kaslarda
yorgunluk ve ekstremitelerde ağrı olarak bildirilmiştir. Kreatin
kinaz (CK) seviyelerinde hafif yükseklikler olabilmekle birlikte
kas hasarı, kas ağrısı olduğunda ve serum CK seviyesi anlamlı
derecede yüksek olduğunda tanımlanmaktadır (60). Ek organ
hasarlarının eşlik ettiği rabdomiyoliz olguları (CK düzeyleri: 525-
12216 U/L) bildirilmiştir (60). SARS koronavirüsün miyokardiyal
enflamasyonda da rol oynadığı bilinmektedir.