Burhanettin Çiğdem

Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients

OBJECTIVE The inflammatory process is a very important stage in the development and prognosis of acute ischemic stroke (AIS). The monocyte to high-density lipoprotein (HDL) ratio (MHR) is accepted as a novel marker for demonstrating inflammation. However, the role of MHR as a predictor of mortality in patients with AIS remains unclear. METHODS We retrospectively enrolled 466 patients who were referred to our clinic within the first 24hours of symptom presentation and who were diagnosed with AIS between January 2008 and June 2016. Four hundred and eight controls of similar age and gender were also included. The patient group was classified into two groups according to 30-day mortality. The groups were compared in terms of monocyte counts, HDL, and MHR values. RESULTS The patient group had significantly higher monocyte counts and lower HDL levels; therefore, this group had higher values of MHR compared to controls. Additionally, the monocyte count and MHR value were higher, and the HDL level was lower in non-surviving patients (p<0.001). The MHR value was also observed as a significant independent variable of 30-day mortality in patients with AIS (p<0.001). The optimum cut-off value of MHR in predicting the 30-day mortality for patients with AIS was 17.52 (95% CI 0.95-0.98). CONCLUSION Our study demonstrated that a high MHR value is an independent predictor of 30-day mortality in patients with AIS.

The Effect of Eosinopenia on Mortality in Patients with Intracerebral Hemorrhage

INTRODUCTION Inflammation may determine the prognosis of intracerebral hemorrhage (ICH), which has high mortality and morbidity rates. Recent studies have increasingly demonstrated eosinopenia as a prognostic factor, particularly in bacteremia, chronic obstructive pulmonary disease, and myocardial and cerebral infarction. Nonetheless, its significance regarding the determination of prognosis in patients with ICH has not yet been clarified. MATERIALS AND METHODS Our study included 296 patients who presented to our clinic within 24 hours of the onset of symptoms and who were diagnosed with ICH between January 2008 and June 2016, along with 180 age- and sex-matched controls. During their hospitalization, 120 of these 296 patients died. Patients and controls were compared in terms of neutrophil count/percentage and eosinophil count/percentage; these were also compared between nonsurviving and surviving patients. The significance of eosinopenia in predicting mortality was also evaluated. RESULTS Patients had a significantly higher neutrophil count/percentage and a significantly lower eosinophil count/percentage than controls; these results were similar between nonsurviving and surviving patients (P < .001). Consequently, the patient group was divided into 4 subgroups depending on the presence of eosinopenia and/or neutrophilia. The mortality rate was highest (62%) in the group that had both eosinopenia and neutrophilia. Univariate and multivariate logistic regression analyses indicated that neutrophilia and eosinopenia were independent predictors of mortality in ICH (P = .002; P = .004) DISCUSSION: These results indicate that eosinopenia can occur in patients with ICH and that although the mechanism is unclear, eosinopenia is closely associated with mortality in these patients, particularly when accompanied by neutrophilia.

Severity and frequency of restless legs syndrome in patients with familial Mediterranean fever

Objective: Restless legs syndrome (RLS) is a common sensory motor disorder. RLS an urge to move the extremities that may be accompanied by dysesthesias, and significantly affects quality of life of affected patients. The frequency of RLS is higher in different systemic inflammatory diseases. Familial Mediterranean fever (FMF) is an inherited inflammatory disease characterized by attacks of polyserositis, arthritis, and fever. The prevalence of RLS in patients with FMF is unknown. This study aimed to evaluate the prevalence rate of RLS in a sample of patients with FMF and compare this prevalence with that of a matched normal population. Method: A total of 60 patients with FMF and 60 healthy controls were studied. All participants underwent a neurological examination. Diagnostic criteria as proposed by the International Restless Legs Syndrome Study Group (IRLSSG) were used to define RLS. The IRLSSG rating scale for the severity of RLS was applied to determine the severity of symptoms. Results: The prevalence of RLS was not significantly different between patients and controls. Although the mean International Restless Legs Syndrome Rating Scale (IRLSRS) scores tended to be higher in patients compared with controls, this difference was not significant. When each item of the severity scale was compared between the two groups, significantly higher scores were found in some items of the IRLSRS in patients with FMF compared with controls. Conclusion: According to this result, RLS symptoms in patients with FMF were more frequent and lasted longer than those in controls.

The relationship between ABO blood types and development of cerebral venous sinus thrombosis

Objective: Several studies in the last few decades demonstrated that patients with non-O blood groups (A, B, AB) have increased prothrombic tendency. In addition, many thrombotic disorders have been shown to be closely related to the blood group. However, the role of blood types in cerebral venous sinus thrombosis (CVST) development is unknown. Method: Our study included 41 patients who visited the Neurology Department at Cumhuriyet University Hospital and who were diagnosed with CVST between the dates 01/01/2008 and 30/09/ 2016, together with 50 ageand sex-matched controls.The patient and control groups were compared in terms of blood group distribution. In addition, the patient group was divided into two groups according to whether they had parenchymal brain lesions or not, and the effect of the blood group on the prognosis was also assessed. Results: While the blood group distribution in the control group reflected the overall distribution of the Turkish population, the proportion of the non-O blood group in the patient group was higher than in the control group, however the difference between the two groups was not statistically significant. Similarly, there was no statistically significant difference in blood group distribution between patients with and without parenchymal lesions in the patient group. Logistic regression analysis showed that the blood group was not an independent variable in the development of CVST. Conclusions: As a result, the percentage of non-O blood group was higher in patients with CVST than healthy controls; however this is not statistically significant. There is a need for more prospective and extensive future studies on this issue.

A DWI study of the contralateral hemisphere in cerebral hemiatrophy

BACKGROUND AND AIM Cerebral hemiatrophy (CHA) is a congenital or acquired loss of volume in one hemisphere of the brain. The MR findings of the affected hemisphere have been a subject of many studies, however, the contralateral hemisphere has not been investigated. There is, in fact, an integrity between two hemispheres of the brain through transverse connection fibers. The aim of this study is to investigate the changes in the contralateral hemisphere in CHA. MATERIALS AND METHODS Apparent diffusion coefficient (ADC) values were measured in deep gray and white matter areas in the normal-appearing contralateral hemisphere in 23 patients with CHA, in order to get in vivo information about a possible Wallerian degeneration or microstructural changes. Results were compared with the control group. RESULTS Normal ADC values were encountered in the contralateral hemisphere in all (100%) CHA patients. The difference between the ADC values of gray and white matter in CHA patients and the control group was not statistically significant. CONCLUSION Normal ADC values in the contralateral hemisphere in CHA patients suggests a compensatory mechanism restricting Wallerian degeneration or diffusion alteration.

Diabetik polinöropatik hastalarda memantinin ağrı üzerine etkinliği

Diyabetik periferal noropati (DPN) klinik pratikte en sik karsilasilan kronik noropatik agri semptomlarindan birisidir. Diyabetik noropatili hastalarda cesitli tedavi yontemleri denenmektedir. Son yillarda primer afferent-spinotalamik noron sinapslarinda eksitator transmisyonun modulasyonu icin N-methyl-D-aspartate (NMDA) reseptor antagonistleri kullanilmaktadir. NMDA reseptor antagonistlerinin kronik agri durumlarinda opioid analjezikler kadar etkin oldugu da gosterilmistir. Bu calismada diabetik polinoropatili hastalarda prospektif olarak NMDA reseptor antagonisti Memantin’in farkli iki dozda, agri uzerine olan etkinligini degerlendirmeyi amacladik. Tip 2 diyabetli ve diabetik noropatisi olan 24 hasta calismaya dahil edildi. Diyabetik noropati tanisi klinik (anamnez, motor, duyusal ve refleks muayenesi) ve elektrofizyolojik testler ile konuldu. Hastalarin agri sikayetleri tedavi oncesi ve sonrasi Vizuel Agri Skalasi (VAS) ile degerlendirildi. Hastalara birinci hafta 10 mg, daha sonra alti hafta boyunca 20 mg memantin verildi. Yedinci hafta sonunda hastalar tekrar degerlendirildi. Tedaviye ara vermeksizin bir hafta 30 mg, daha sonra alti hafta boyunca 40 mg memantin uygulandi. Her iki tedavi grubunda kontrol grubuna kiyasla VAS degerlerinde anlamli duzelme gozlenirken, tedavi gruplari arasindaki farkda onemli bulundu. Sonuc olarak diyabetik polinoropatide Memantin tedavisi noropatik agrinin tedavisinde duzelme saglamaktadir