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Öğe The association of gene polymorphisms of the angiotensin- converting enzyme and angiotensin II receptor type 1 with ischemic stroke in Turkish subjects of Trakya region(2009) Sipahi, Tammam; Güldiken, Babürhan Feyzullah; Güldiken, Sibel; Üstündağ, Sedat; Turgut, Nilda; Budak, Metin; Şener, SeralpAmaç: Bu çalışmanın amacı, Trakya bölgesinde yaşayan iskemik inme geçirmiş hastalarda ACE insersiyon/delesyon (I/D) ve AT1R (A1166C) gen polimorfizmlerinin sıklığını, vasküler risk faktörleri ve inme alt-grupları ile ilişkisini araştırmaktır. Hastalar ve Yöntemler: Çalışmaya 162 iskemik inme geçirmiş hasta ile 146 sağlıklı olgu alındı. İskemik inme hastaları, ORG 10172 Akut İnme Tedavisi (TOAST) kriterlerine göre büyük ve küçük damar hastalığı olarak inme alt gruplarına ayrıldı. ACE I/D polimorfizmi polimeraz zincir reaksiyonu (PZR), AT1R (A1166C) gen polimorfizmi ise PZR ve restriksiyon fragment uzunluk polimorfizmi (RFLP) yöntemleri kullanılarak yapıldı. Bulgular: Hasta grubundaki ACE I/D genotip dağılımı (DD=34.0%, ID=50.0%, II=16.0%), kontrol grubu ile karşılaştırıldığında (DD=34.3%, ID=49.7%, II=16.1%) fark bulunmadı. Ayrıca hasta grubundaki AT1R (A1166C) genotip dağılımları ile (AA=58.0%, CA=34.6% ve CC=7.4%) kontrol grubu ile karşılaştırıldığında (AA=60.1%, CA=35.7% ve CC=4.2%) anlamlı fark saptanmadı. Her iki inme alt grubu arasında ACE I/D ve AT1R (A1166C) polimorfizmlerinin dağılımı açısından farklılık bulunmadı. Sonuç: Çalışmamızda Trakya bölgesinde yaşayan insanlarda ACE I/D ve AT1R (A1166C) gen polimorfizmlerinin iskemik inme gelişmesinde genetik risk faktörleri olmadıkları belirlendi.Öğe The Association of Gene Polymorphisms of the Angiotensin-Converting Enzyme and Angiotensin II Receptor Type 1 with Ischemic Stroke in Turkish Subjects of Trakya Region(Aves Yayincilik, Ibrahim Kara, 2009) Sipahi, Tammam; Guldiken, Baburhan; Guldiken, Sibel; Ustundag, Sedat; Turgut, Nilda; Budak, Metin; Cakina, SuatObjectives: The aim of this study was to investigate the frequency of ACE insertion/deletion (I/D) and AT1R (A1166C) gene polymorphisms in ischemic stroke patients in Trakya region and the relation between these gene polymorphisms and stroke subtypes and vascular risk factors. Patients and Methods: The study involved 162 patients with ischemic stroke and 146 control subjects. Ischemic stroke patients were divided into large and small vessel disease subgroups according to ORG 10172 in Acute Stroke Treatment TOAST criteria. The ACE I/D polymorphism was investigated using polymerase chain reaction (PCR), and the AT1R (A1166C) polymorphism was identified using PCR and restriction fragment length polymorphism (RFLP) assay. Results: The ACE I/D genotype distribution in patients (DD=34.0%, ID=50.0%, II=16.0%) did not differ from those in controls (DD=34.3%, ID=49.7%, II=16.1%). The AT1R A1166C genotype distribution in patients (AA=58.0%, CA=34.6%, CC=7.4%) did not significantly differ from those in controls (AA=60.1%, CA=35.7%, CC=4.2%). There was also no difference among the stroke subgroups regarding the distribution of ACE I/D and AT1R (A1166C) polymorphisms. Conclusion: Our results show that ACE I/D and AT1R (A1166C) gene polymorphisms were not genetic risk factors for ischemic stroke in subjects in Trakya region.Öğe Cerebral infarction due to traumatic carotid artery dissection(Turkish Assoc Trauma Emergency Surgery, 2008) Kilincer, Cumhur; Tiryaki, Mehmet; Celik, Yahya; Turgut, Nilda; Balci, Kemal; Utku, Ufuk; Cobanglu, SebahattinWith the advent of improved neuroradiological methods, it has been determined that frequency of traumatic carotid artery dissections is higher than previously observed. Since delayed neurological deficits may develop in some asymptomatic undiagnosed cases, it is essential to consider the possibility of the carotid artery dissection and evaluate it properly in suspicious cases. In this article, a case of internal carotid artery dissection and subsequent cerebral infarction following a motor vehicle accident is presented. Pathogenesis, clinical features, diagnostic method choices and treatments in this rare but severe condition are discussed in light of the relevant literature in order to convey current knowledge.Öğe Chronic idiopathic demyelinating polyneuropathy (CIDP) associated with Kaposi's sarcoma(Springer, 2006) Celik, Yahya; Turgut, Nilda; Turgut, Burhan; Pamuk, Guelsuem E.; Demir, Muzaffer[Abstract Not Available]Öğe Cognitive dysfunction in patients with chronic obstructive pulmonary disease(Yerkure Tanitim & Yayincilik Hizmetleri A S, 2018) Pekel, Nilufer Buyukkoyuncu; Turgut, Nilda; Altiay, Gundeniz; Demir, Muzaffer; Turgut, Burhan; Erbas, Hakan; Sut, NecdetObjective: Chronic obstructive pulmonary disease (COPD) is characterized with air flow limitation. Cognitive problems can appear in advanced stage of COPD. There is relationship between COPD and levels of homocystein (hcy) and total antioxidant capacity (TAC). There is also relationship between cognitive dysfunction and levels of hcy and TAC. We aimed evaluation of cognitive functions in patients with COPD, and demonstration of the relationship between cognitive function and hcy and TAC. Methods: Twenty-eight hypoxic (group 1), 28 non-hypoxic COPD patients (group 2) and 25 healthy people (control group, group 3) were included to study. Hcy and TAC levels were measured in all subjects. Cognitive functions were evaluated in all subjects with standardized mini mental test (SMMT), clock drawing test (CDT), Blessed orientation memory concentration test (BOMCT), Benton's facial recognition test (BFRT) and clinical dementia rating scale (CDRS). Results: Hcy levels were high in group 1 (p=0.004), TAC levels were high in group 1 and 2 (p=0.04). SMMT (p=0.000) and CDT values were low in group1 (p=0.000), CDRS values were high in group1 and 2 (p=0.000), BFRT values were low in group1 and 2 (p=0.000), BOMCT values were high in group1 (p=0.000). There were a correlation between TAC and SMMT (r=0.582, p=0.001) and CDRS (r=-0.384, p=0.044). Conclusions: We demonstrated presence of cognitive dysfunction in COPD patients. Patients with hypoxic had more profound cognitive dysfunction. In addition, we demonstrated a relationship between TAC and cognitive dysfunction.Öğe Comparative neurophysiological study for the diagnosis of mild polyneuropathy in patients with diabetes mellitus and glucose intolerance(Taylor & Francis Ltd, 2006) Turgut, Nilda; Guldiken, Sibel; Balci, Kemal; Tugrul, Armagan; Berberoglu, Ufuk; Altun, Betul UgurThis article evaluates diagnostic sensitivity of minimal F-wave latency, sural/radial amplitude ratio ( SRAR), dorsal sural/radial amplitude ratio ( DSRAR), sympathetic skin response ( SSR), and R-R interval variability ( RRIV) for detecting early polyneuropathy in patients with glucose intolerance and diabetic patients. F-wave latencies were more prolonged in diabetic patients with normal and abnormal nerve conduction studies than control subjects ( p < .001). SRAR was lower, SSR latency was more prolonged, and RRIV was lower in diabetic patients with abnormal nerve conduction studies than healty controls ( p < .001). SSR latency was more prolonged and RRIV was lower in diabetic patients with normal nerve conduction studies than healty controls ( p < .01, p < .05, respectively). DSRAR was lower in diabetic patients with normal and abnormal nerve conduction studies than control subjects ( p < .001). DSRAR was also lower in patients with glucose intolerance than control subjects ( p < .01). DSRAR was the most sensitive and specific test in either of diabetic patients with normal nerve conduction studies ( sensitivity 66%, specificity 90%) and diabetic patients with abnormal nerve conduction studies ( sensitivity 100%, specificity 90%). DSRAR is the most reliable method for detection of early nerve pathology. Patients with glucose intolerance might have subclinical neuropathy that can be demonstrated with DSRAR analysis.Öğe Differences in platelet-leukocyte aggregates among subtypes of acute cerebral ischemia(Elsevier, 2011) Turgut, Burhan; Turgut, Nilda; Celik, Yahya; Tekgunduz, Emre; Pamuk, Gulsum Emel; Demir, MuzafferBackground: Acute cerebral ischemia is caused by different pathophysiological mechanisms. The role of platelets and other blood cells can be different among the stroke subtypes. Methods: Seventy-two patients with acute ischemic cerebrovascular disease, including 31 patients with large vessel disease, 21 patients with cardioembolic disease, and 20 patients with small vessel disease, were evaluated. P-selectin (CD62P) expression and platelet leukocyte aggregates were measured with flow cytometry at the acute phase after the ischemic event. Markers were also measured in 37 control subjects. In all subjects, the serum high-sensitivity C-reactive protein (CRP) was also measured. Results: The platelet-monocyte aggregates (PMA) and platelet-granulocyte aggregates (PGA) in the large vessel disease group were higher than in control group (P=0.002, and P < 0.0001, respectively). The PMA and PGA in the small vessel disease group were also higher than in the control group (P=0.004 and P < 0.0001, respectively). In contrast, in the cardioembolic disease group, the PMA and PGA were not significantly different from the control group. CD62P expression was higher in all of the patient groups relative to the control group (P < 0.05 for all comparisons). Serum CRP levels were also higher in all of the patient groups than in the control group (P < 0.0001 for all comparisons). Conclusions: In contrast to large vessel and small vessel disease, it seems that platelet-leukocyte association does not play a crucial role in the pathogenesis of cardioembolic stroke. (C) 2011 Elsevier B.V. All rights reserved.Öğe Dorsal sural nerve conduction study in vitamin B12 deficiency with megaloblastic anemia(Blackwell Publishing, 2006) Turgut, Burhan; Turgut, Nilda; Akpinar, Seval; Balci, Kemal; Pamuk, Guelsuem E.; Tekguenduez, Emre; Demir, MuzafferPeripheral neuropathy is frequently observed in B-12 deficiency. In spite of this, there is little knowledge about peripheral neuropathy in B-12 deficiency because the severity of clinical involvement of the central nervous system clearly outweighs signs and symptoms due to peripheral nervous system involvement. We primarily investigated peripheral neuropathy with dorsal sural conduction study, which is a new method for detection of early peripheral neuropathy, in B-12 deficiency with megaloblastic anemia. Conventional nerve conduction studies and tibial sensory-evoked potential (SEP) recording were also performed. Twenty-eight B-12-deficient patients (15 male, 13 female, mean age 65.8 years) with megaloblastic anemia and 18 age- and sex-matched controls were included in the study. Although dorsal sural sensory nerve action potentials (SNAPs) were not recorded in 15 (54%) of 28 patients, only 9 (32%) of them were found to have polyneuropathy by conventional conduction studies. Furthermore, patients with dorsal sural SNAP had mean lower amplitude, mean longer latency, and slower velocity response when compared with controls. Twenty patients (71%) were diagnosed as having myelopathy by the combination of tibial SEP and neurological findings. Two patients whose dorsal sural SNAPs were not recorded had normal tibial SEP responses; therefore, these patients were considered to have isolated peripheral neuropathy. As a result, we conclude that dorsal sural nerve conduction study is a reliable method for detection of early peripheral neuropathy in B-12 deficiency.Öğe The effect of social support, depression, and illness perception on treatment adherence in patients with multiple sclerosis(Marmara Univ, Fac Medicine, 2022) Girgin, Derya; Tosun, Zeynep; Turgut, Nilda; Guler, SibelObjective: This study was planned to determine the treatment adherence levels of multiple sclerosis (MS) patients and the factors affecting treatment adherence. Patients and Methods: This descriptive and cross-sectional study was conducted with 211 people with MS. Data for this study was obtained through face-to-face interviews with MS patients who presented at the neurology outpatient clinics of two university hospitals between April and October 2018. The Morisky, Green, and Levine Adherence Scale, Beck Depression Inventory, Multidimensional Perceived Social Support Scale, and the Illness Perception Scale were used in data collection. Results: The mean age of the sample was 40.03 +/- 10.82, and 70.1% were female. Treatment adherence was not good in half of the patients (51.7%). Patients with good adherence were found to have higher Multidimensional Perceived Social Support Scale scores (p<0.01) and lower Beck Depression Inventory scores (p<0.01). The illness perceptions of the patients regarding MS did not affect treatment adherence (p>0.05). Conclusion: Treatment adherence was insufficient in half of the MS patients. According to our findings, ensuring more cooperation with the families of patients, which constitute the strongest source of social support, increasing treatment adherence can be suggested as well as screening patients with regard to depressive symptomology during follow-up.Öğe An epidemiologic investigation of amyotrophic lateral sclerosis in Thrace, Turkey, 2006-2010*(Taylor & Francis Ltd, 2019) Turgut, Nilda; Saracoglu, Gamze Varol; Kat, Selahattin; Balci, Kemal; Guldiken, Baburhan; Birgili, Ozlem; Kabayel, LeventObjective: The aim of the study was to investigate the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in Thrace, Turkey in a five-year time period (2006-2010). Methods: Study population included residents of three provinces (Edirne, Tekirdag, Kirklareli) in the Thrace region. Cases were ascertained from all of the neurologic centers and hospitals of these provinces. Demographic and clinical information was collected for each patient. Newly diagnosed ALS patients who are fulfilling the El Escorial revised diagnostic criteria were enrolled into the study. Results: We identified a total of 145 patients (93 males, 52 females). The mean age at diagnosis was 57.0 +/- 13.6. According to El Escorial criteria, 60.0% of the cases were definite ALS, 24.8% were probable, and 15.2% were possible ALS. Thirty-two cases were bulbar (22.1%), 113 cases (77.9%) were spinal onset. Mean time delay from onset to diagnosis was 12.0 +/- 11.2 months. Age-gender standardized incidence rates with reference to Turkey, USA 2008 census were 1.9 (95% confidence interval (CI), 1.8-2.1), 1.9 (95%CI, 1.8-2.2) for overall. There were 112 living ALS patients at the end of the study. Crude point prevalence was calculated as 7.3 per 100,000 population (95%CI, 5.9-8.7). Conclusions: This is the first study to provide fundamental data about demographic and clinical characteristics about ALS in Thrace region of Turkey. Incidence and prevalence of ALS in Thrace region of Turkey appear to be comparable with European countries.Öğe Esansiyel trombositemiye bağlı yaygın serebral venöz tromboz(2000) Turgut, Nilda; Aydın, Nurgül; Çelik, Yahya; Turgut, Burhan; Demir, Muzaffer; Utku, Ufuk; Vural, ÖzdenSerebral venöz tromboz etyolojisinde birçok neden bulunmakla birlikte, hiperkoagulabilite önemli rol oynamaktadır. Bu çalışmada son bir aydır giderek artan başağrısı, bulantı, kusma nedeni ile servisimize yatan, daha önce hiçbir yakınması olmayan 34 yaşındaki bayan hasta bildirilmiştir. Hastanın yapılan nörolojik muayenesinde bilateral grade IV papil ödem mevcut olup, nöroradyolojik inceleme sonucunda yaygın (superior sagittal sinüs, konfluen sinium, her iki transvers ve sigmoid sinüsler) serebral venöz tromboz tespit edilmiştir. Tam kan sayımında Hb 17.1 g/dl, Hct % 48.4, Lökosit 28 500 /mm3 , Plt 674 000 /mm3 bulunması nedeni ile yapılan kemik iliği incelemesinde hastaya esansiyel trombositemi tanısı konmuş olup, antikoagulan tedavi yanısıra ribonükleotid redüktaz inhibitörü de tedaviye eklenmiştir. Literatürde olgumuzda olduğu gibi yaygın serebral venöz tromboz olguları nadiren bildirilmiş olup, bazı hematolojik hastalıkların, endokrin bozuklukların ve anatomik varyasyonların etyolojide yer alabileceği ifade edilmiştir.Öğe Evaluation of R-R interval variability with electromyography following coronary artery bypass grafting(2005) Turgut, Nilda; Canbaz, Suat; Balcı, Kemal; Ege, Turan; Halıcı, Ümit; Duran, Enver; Yavuz, EbruAmaç: R-R interval değişkenliği (RRİD) analizi kalbin otonomik fonksiyonu hakkında bilgi verir. Koroner arter bypass cerrahisi sonrasında RRİD belirgin olarak azalmaktadır. Çalışmamızda, koroner arter bypass cerrahisi uygulanan hastalarda alternatif bir yöntem olarak elektromiyografi (EMG) ile RRİD değerlendirildi. Çalışma planı: Çalışmaya koroner arter bypass cerrahisi yapılan 19 hasta (6 kadın, 13 erkek; ort. yaş 57.8±10.2) alındı. Tüm hastalarda istirahat ve hiperventilasyon sırasında olmak üzere, ameliyat öncesinde ve ameliyattan bir ve iki ay sonrasında EMG ile RRİD analizi yapıldı. Bulgular: Ameliyat öncesiyle karşılaştırıldığında, ameliyattan bir ay (R-R, istirahat, p=0.001; R-R, hiperventilasyon, p=0.009) ve iki ay (R-R, istirahat, p=0.001; R-R, hiperventilasyon, p=0.006) sonra istirahat ve hiperventilasyon sırasında elde edilen ortalama RRİD değerleri anlamlı derecede düşük bulundu. Ameliyattan bir ay sonraki ortalama RRİD değerleri, ikinci ay sonundaki değerlerden anlamlı derecede düşük idi (R-R, istirahat, p=0.01; R-R, hiperventilasyon, p=0.001). R-R interval değişkenliği ile yaş, cinsiyet, hipertansiyon, sigara içme, total kolesterol ve trigliserid düzeyleri, beden kütle indeksi; cerrahi, kardiyopulmoner bypass, kros klemp, mekanik ventilasyon ve yoğun bakımda kalma süreleri arasında ilişki görülmedi. Sonuç: Bulgularımız, koroner arter bypass ameliyatından sonraki ilk iki ayda RRİD değerlerinin anlamlı derecede düştüğünü, ikinci aydaki değerlerde kısmi düzelme meydana geldiğini gösterdi. R-R interval değişkenliğinin EMG ile analizi, koroner arter bypass ameliyatı uygulanan hastalarda zaman kaybına yol açmayan, EMG laboratuvarında kolaylıkla yapılabilen ve kalbin otonomik fonksiyonunu yansıtan bir seçenektir.Öğe Geniş supratentoriel infarktlarda erken dönem klinik ve BT bulguları(2001) Turgut, Nilda; Utku, Ufuk; Ekuklu, Galip; Kılınçer, CumhurGeniş supratentorial infarktlar, tüm iskemik strokların yaklaşık %10'nunu oluştururlar ve mortalite oranı çeşitli serilerde % 17-80 olarak tespit edilmiştir. Prognozun oldukça kötü olduğu bu hastalarda gerekli yoğun medikal ve cerrahi tedavinin yapılabilmesi için erken dönem klinik ve BT bulgularının tanınması önem kazanmaktadır. Bu çalışmada Ocak 1998-Eylül 1999 tarihleri arasında kliniğimize başvuran ve kontrol BT'sinde geniş supratentoriel infarkt tespit edilen 64 hastadan sadece transtentorial herniasyonla ölen 28 hastanın erken dönem (10±2 saat) BT ve klinik bulguları yaşayan hastalarla karşılaştırıldı. Sonuçta, ağır motor güçsüzlüğün (p=0.013), bilinç bozukluğunun (p=0.024), orta hat şiftinin (p=0.013), kortikomedüller kontrast (CMC) azalmasının (p=0.002) ve silvian fissur silikliğinin (p=0.011) iki grup arasında anlamlı olarak farklı bulunduğu gözlendi. Mortalitesi oldukça yüksek olan geniş supratentoriel infarktlarda, erken dönem klinik ve BT bulguları prognoz tayini açısından yol göstericidir.Öğe Glu298Asp polymorphism of the endothelial nitric oxide synthase gene in Turkish patients with ischemic stroke(Springer, 2009) Guldiken, Baburhan; Sipahi, Tammam; Guldiken, Sibel; Ustundag, Sedat; Budak, Metin; Turgut, Nilda; Ozkan, HulyaThe low plasma nitric oxide concentrations and reduced vascular reactivity are considered major proatherogenic mechanisms in cardiovascular diseases. The present study aimed to assess the allelic frequency and the genotypic distribution of the Glu298Asp gene polymorphism at exon 7 of endothelial nitric oxide synthase (eNOS) gene in Turkish ischemic stroke patients compared to appropriate healthy controls, and to correlate the genetic findings with stroke subtypes. The study population included 146 (75 males, 71 females) patients with ischemic stroke which were categorized according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and 133 (34 males, 99 females) healthy subjects. The eNOS polymorphism was identified with a PCR followed by RFLP with the restriction enzyme BanII. Genotypes were defined as GG, GT, and TT according to the presence of the G and T alleles. In this case-control study, we did not find any significant difference in either the genotypic distribution or allelic frequency of Glu298Asp gene polymorphism between the patients and the controls. In addition, there was also no significant difference for the genotype distribution and the allelic frequency among the stroke subtypes. The results suggested the lack of the association between the Glu298Asp gene polymorphism and ischemic stroke or subtypes of ischemic stroke in the Turkish population.Öğe Insulin resistance and high sensitivity C-reactive protein in migraine(Cambridge Univ Press, 2008) Guldiken, Baburhan; Guldiken, Sihel; Demir, Muzaffer; Turgut, Nilda; Kabayel, Levent; Ozkan, Hulya; Ozcelik, EmineBackground: A relationship between migraine and vascular disorders such as hypertension, stroke, and coronary ischemia has been recently reported. Insulin resistance and endothelial dysfunction. which commonly underlies these disorders, have not been widely investigated in migraine patients. In this study. we aimed to investigate the existence of insulin resistance and endothelial dysfunction, and their relationship to vascular risk factors in patients with migraine. Methods: We evaluated insulin resistance and high-sensitivity C-reactive protein (hs-CRP), a marker of endothelial dysfunction, in 60 migraine patients and 25 healthy control subjects. Multiple analysis of covariance test was used to adjust for known confounding factors that can influence insulin metabolism and endothelial Function, Such as obesity, blood pressure. and lipid parameters. Results: Insulin resistance, as measured homeostasis model assessment (HOMA)-R levels, was significantly higher in the migraine group (p < 0.001). After adjustment for confounding variables. the relationship between migraine and the HOMA-R levels remained significant (p < 0.001). The hs-CRP levels did not differ between the migraine and control groups. Conclusions: Our data show that insulin resistance is present in migraine patients. Endothelial dysfunction is not found during the headache-free period. Further studies are needed to explain the role of insulin resistance in migraine pathogenesis.Öğe İskemik ve hemorajik stroklarda mekanik ventilatör kullanımı: Endikasyon ve prognoz(2002) Uzunca, İlkay; Ekuklu, Galip; Balcı, Kemal; Utku, Ufuk; Turgut, NildaStroklu hastalarda yoğun bakım ünitelerinin kurulması ve tedavide invaziv yöntemlerin kullanılması (dekompresyon, tromboliz vb.) ile mortalite giderek azalsa da mekanik ventilator kullanılan hastalarda prognoz hala oldukça kötüdür. Bu çalışmada, kliniğimizde strok tanısı ile yatırılarak izlenen, mekanik ventilator gereksinimi olan hastaların klinik, radyolojik özellikleri ve prognozları incelenmiştir. Çalışmamızda Aralık 1999-Haziran 2001 tarihleri arasında strok yoğun bakım ünitemizde yatan ve mekanik ventilator kullanılan iskemik ve hemorajik stroklu hastalar yaş, cinsiyet, Glasgow Koma Skala Skoru (GKS), strok tipi (iskemik, hemorajik), lezyon lokalizasyonu (iskemik stroklu hastalar için karotis sistemi ve vertebrobaziler sistem, hemorajik stroklu hastalar için supra ve infratentoriyal), entübasyon nedeni (nörolojik, nöroloji dışı nedenler), entübasyon zamanı, entübe kalış süresi, prognoz özelliklerine göre incelenmiştir. Terapötik hiperventilasyon için entübe edilen hastalar çalışmaya alınmamıştır. 157 hemorajik ve 639'u iskemik olmak üzere 796 strok hastasında yapılan çalışmada toplam 49 hastada mekanik ventilator kullanılmıştır. Hemorajik stroklu hastalar içerisinde mekanik ventilasyon ihtiyacı olan hastaların oranı % 10.82 (n=17), iskemik stroklu hastalar içerisinde ise %5.008 (n=32) olarak tespit edilmiştir. Hastalarımızın 37'si (%75.5) nörolojik, 12'si (%24.5) nörolojik kötüleşme dışı sebeplerle entübe edilmiştir. Serimizde mortalite oranı %97 olarak bulunmuştur. Hastaların entübasyon zamanı strok gelişiminden 117.2 ±166.5 saat sonra ve mekanik ventilatörde kalış süreleri ortalama 47.8±103.9 saat olarak saptanmıştır. Mekanik ventilator kullanılan stroklu hastalarda prognoz kötü ve mortalite yüksektir. Serimizde mortalite oranı %97 olarak bulunmuş olup bu oran daha önceki çalışmalarla benzerdir. Mekanik ventilator kullanılan hemorajik stroklu hastaların oranı iskemik stroklu hastalarla kıyaslandığında yaklaşık olarak iki kat daha yüksek bulunmuştur.Öğe Low leptin levels in migraine: A case control study(Wiley, 2008) Guldiken, Baburhan; Guldiken, Sibel; Demir, Muzaffer; Turgut, Nilda; Tugrul, ArmaganBackground.-Obesity has been shown to be a risk factor for transformation of episodic migraine to chronic form, and adipocytokines have been implicated to modulate some of the cytokins such as interleukin-6 and tumor necrosis factor, which also act in the neurogenic inflammation in migraine. The aim of the study was to assess leptin levels, one of the adipocytokines, in headache-free period of migraine patients and investigate its relation to vascular risk factors. Material and Methods.-Sixty-one patients with episodic migraine headaches and 64 control subjects were enrolled in the study. Demographic data and anthropometric measurements were obtained from all participants; body mass index and fat mass values were calculated. Glucose and lipid parameters were measured by oxidase technique and cholesterol esterase enzymatic assays, and leptin levels were measured by ELISA in serum samples obtained after an overnight fasting. Results.-Leptin levels were found significantly lower in migraineurs than controls (40.1 +/- 21.2 ng/mL, 48.5 +/- 24.5 ng/mL; P < .05). Although body mass index did not differ between 2 groups, fat mass, and fat percentages were significantly lower in migraine patients (19.4 +/- 8.8 kg, 26.0 +/- 8.7 kg; P < .001 and 28 +/- 9%, 34 +/- 5%; P < .001, respectively). Conclusion.-Migraine patients have low leptin levels and fat mass which may be related to the pathogenesis of migraine. The importance and impact of our findings on the prevalence, characteristics, and treatment of migraine needs to be investigated in further detailed studies.Öğe Migraine in Metabolic Syndrome(Lippincott Williams & Wilkins, 2009) Guldiken, Baburhan; Giddiken, Sibel; Taskiran, Bengur; Koc, Gonul; Turgut, Nilda; Kabayel, Levent; Tugrul, ArmaganObjectives: Recent studies suggest that insulin resistance is In ore common in patients with migraine. Insulin resistance underlies the pathogenesis of obesity, diabetes. and hypertension that are components of metabolic syndrome. As migraine is associated with an increased risk of vascular disorders, such as stroke. and migraine patients have higher diastolic blood pressure than healthy individuals, we aimed to investigate the I-year prevalence of migraine in metabolic syndrome. Methods: Two hundred ten patients with metabolic syndrome were enrolled in the study. Migraine was diagnosed according to International Classification of Headache Disorders-II criteria. Results: Migraine prevalence was estimated its 11.9% in men and 22.5% in women with metabolic syndrome. Of the metabolic syndrome Components, diabetes, increased waist circumference, and body mass index were significantly more frequent in patients with migraine in contrast to those without migraine (P <0.05). Hypertension and dyslipidemia frequencies showed no difference between 2 groups. Conclusions: Our results demonstrate that migraine prevalence it) metabolic syndrome was higher than in file general population.Öğe Migren Hastalarında Endotelyal Nitrik Oksit Sentaz ve Anjiyotensin Dönüştürücü Enzim Gen Polimorfizmleri(2013) Sipahi, Tammam; Palabıyık, Orkide; Güldiken, Babürhan Feyzullah; Kabayel, Levent; Özkan, Hülya; Kılıç, Tülay Okman; Turgut, NildaGiriş: Bu çalışmada migren ile endotelyal nitrik oksit sentaz (eNOS) geni intron 4de, 27 bazlık tekrarlardan oluşan Ardışık Kopya Sayısı Tekrarları (VNTR) ve anjiyotensin dönüştürücü enzim (ADE) genindeki insersiyon/delesyon polimorfizmlerinin ilişkisi araştırıldı. Yöntemler: Çalışmaya 105 migren başağrısı olan ve 97 sağlıklı kadın birey alındı. Migren hastaları auralı ve aurasız olmak üzere iki gruba ayrılırken, migren atak sıklığı ve şiddeti kaydedildi. eNOS VNTR (eNOS 4a/b) ve ADE insersiyon/delesyon polimorfizmleri (ADE I/D) polimorfizmleri polimeraz zincir reaksiyonu yöntemi ile belirlendi. Bulgular: eNOS 4 a/b gen polimorfizminin alel ve genotip sıklıkları migren ile kontrol grubu arasında farklılık göstermedi. ADE I/D gen polimorfizminin migren grubunda genotipik dağılımı kontrol grubundan anlamlı olarak farklı bulundu. DD ve ID genotiplerinin II genotipine göre migren olasılığını 2,571 (%95 CI- 1,138-5,811) ile 4,453 (%95 CI- 2,006-9,883) oranında artırdığı saptandı. Aynı risk artışı auralı migren alt grubunda her iki genotip için sürerken, aurasız migren grubunda sadece ID genotipi için korundu (OR- 3,750, %95 CI- 1,493-9,420). Migren sıklığı ve şiddeti ile gen polimorfizmleri arasında ilişki gözlenmedi. Sonuç: Çalışmamız ADE I/D gen polimorfizmi ile migren ilişkisini desteklemiştir. Ancak eNOS 4 a/b gen polimorfizmi ile migren arasında ilişki gösterilememiştir. (Nöropsikiyatri Arflivi 2013; 50: 274-278)Öğe Miyokard infarktüsünden sonra gelişen iskemik stroklar(2002) Utku, Ufuk; Ekuklu, Galip; Birgili, Özlem; Özçelik, Fatih; Turgut, NildaMiyokard infarktüsünden (MI) sonra iskemik strok riskinin artış gösterdiği bilinmektedir. Az sayıda çalışmada, MI sonrası strok sıklığı, MI lokalizasyonu ile olan ilişkisi ve iskemik strokun prognozu incelenmiştir. Çalışmamızda iskemik stroklu hastalarımızdan, akut MI sonrası altı hafta içinde strok gelişenlerinde klinik, kardiyolojik ve radyolojik özellikler kontrol grubu ile karşılaştırılarak araştırılmıştır. Ocak 1997-Haziran 2001 tarihleri arasında, kliniğimize akut iskemik strok nedeniyle yatırılarak izlenen 2276 vakadan, son 6 hafta içerisinde MI geçiren 23'ü (%1.01) çalışmaya alınmıştır. Kontrol grubu oluşturulurken her hasta ile benzer özellik gösteren, MI öyküsü olmayan 2 akut iskemik stroklu hasta rasgele olarak seçilmiştir. Her iki grup yaş, cins, risk faktörleri, klinik bulgular, strok etyolojisi ve prognoz özelliklerine göre karşılaştırılmıştır. Ayrıca hasta grubunda kardiyolojik muayene, EKG ve ekokardiyografi ile MI özellikleri incelenmiştir. İncelenen değişkenlerden sadece strok etyolojisi (hasta grubunda kardiyoemboli %82.6, kontrol grubunda %47.8; p<0.05, hasta grubunda küçük damar hastalığı %0, kontrol grubunda %9 p<0.05) ve klinik bulgular (hasta grubunda TACI+PACI %56.5, kontrol grubunda %34.8 p<0.05) farklılık gösterirken, yaş, cins, diğer risk faktörleri ve prognoz yönünden bir farklılık bulunmamıştır. Hasta grubumuzun %47.8'inde anterior, %43.4'ünde inferior lokalizasyonda MI tespit edilmiştir. Bu çalışmada da gösterildiği gibi Ml'dan sonra gelişen iskemik strok diğer iskemik stroklardan bazı klinik ve radyolojik farklılıklar göstermektedir. Ayrıca MI lokalizasyonu iskemik strok gelişiminde belirleyici bir faktör olarak belirlenmektedir.
