Haydar Sur

Botulinum toxin and intractable trigeminal neuralgia.

The effects of botulinum toxin have been demonstrated in pain syndromes such as migraine, tension headache, and postherpetic neuralgia. With this background data in hand, the authors planned a randomized, open-ended study to investigate the efficacy of botulinum injections in cases of refractory trigeminal neuralgia. In 8 patients with trigeminal neuralgia, 100 U botulinum toxin was injected into the region of the zygomatic arch. The results of their statistical analyses demonstrated that the medication can be effective in treating trigeminal neuralgia. The patients did not develop any significant adverse effects. Botulinum toxin can be used in the treatment of refractory trigeminal neuralgia.

Prevalence of Multiple Sclerosis Door-to-Door Survey in Maltepe, Istanbul, Turkey

Background: The prevalence of multiple sclerosis (MS) in Istanbul, Turkey, is unknown. We investigated the prevalence of MS in the district of Maltepe, Istanbul, Turkey. Methods: This was a cross-sectional field research study using door-to-door sampling. Maltepe is a district of Istanbul beside the sea of Marmara (population 359,298 from 2000 census). The two-phase study screened 32,531 subjects using the Poser criteria for clinical diagnosis. The χ2 test was used for analyses of frequency distributions. Results: 33 of 32,531 people were diagnosed with MS. Their average age was 41 ± 12.0 years (43 ± 12.7 years for females and 37 ± 9.6 years for males). The prevalence of MS in Maltepe was 101.4/100,000 within the total population (118.7/100,000 in the female and 76.0/100,000 in the male populations). Conclusions: The prevalence rates of MS in the Turkish population living in a district of Istanbul are considerably higher than we thought. And the prevalence rate is much higher than neighboring countries. They are similar to those recently recorded in Sicily and Germany. These figures suggest that the prevalence rate of MS is not totally dependent upon geographical variation. However, the research of our results needs to be confirmed with further investigations in order to determine the prevalence of MS in Turkey with confidence.

Characteristic and Overlapping Features of Migraine and Tension-Type Headache

Objective.—This epidemiological survey was conducted to investigate comprehensive characteristic and overlapping features of migraine and tension‐type headache (TTH) disorders classified based on International Classification of Headache Disorders‐II.

Prevalence of essential tremor: A door-to-door survey in Şile, Istanbul, Turkey

The aim of this study was to determine the prevalence of essential tremor (ET) in a Turkish population living in Sile, a rural town located on Black Sea coast of Istanbul. This study was designed as a descriptive cross-sectional field study. People aged 18 years and over were selected for the study. Tremor surveillance questionnaire was applied by door-to-door visits. Subsequently, all subjects who answered the questionnaire had a standard tremor examination. Diagnosis was made based on Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) diagnosis and clinical evaluation scale. A total of 2227 people was screened. The prevalence of ET was found to be 3.09% (95% Cl=2.42-3.91%) in Turkish population aged over 18 years. The prevalence of ET increased by age in both genders.

Use of the International Classification of Headache Disorders, Second Edition, criteria in the diagnosis of primary headache in schoolchildren: epidemiology study from eastern Turkey.

We aimed to determine the prevalence of primary headache among schoolchildren in the city of Agri, located in eastern Turkey, where geographical, climatic and socio-economic conditions differ greatly from those of other regions of Turkey. A cross-sectional school-based (ages ranging from 11 to 18) study was conducted from January to April 2006. Diagnosis was based on the second edition of the International Classification of Headache Disorders. This population was evaluated by a two-stage clustered sampling procedure. In the first phase, 1385 children were asked whether they had had a headache within the past year. For the second-step interview, 540 children (38.9%) with a complaint of headache were selected. Five children who had complained of headaches in the first interview did not agree to participate in the second stage. Of the remaining 535, 473 were identified as having primary headache and 62 as having secondary headache. Overall, one-year prevalence of headache subtypes was 14.3% for migraine, 3.5% for probable migraine, 8.6% for pure tension-type headache, 4.6% for migraine plus tension-type headache, and 3.0% for probable migraine plus tension-type headache. The prevalence of migraine was higher in our study than in previous studies.

Treatment and control of hypertension in Turkish population: a survey on high blood pressure in primary care (the TURKSAHA study)

Although the management and the control rates of hypertension are generally low throughout the world, there are substantial differences between the countries. The aim of this study was to determine the control rate of blood pressure and the characteristics of the patients who have been admitted to primary care units in Turkey. Our study included 16 270 patients aged above 18 years who were diagnosed as hypertensive in representative nationwide sample of 1000 primary care units in Turkey. The mean age of the patients was 60±11 years (60.1% women). Of 16 270 patients, 15 187 (93.3%) were on an antihypertensive treatment, whereas 1083 (6.7%) were receiving no treatment. The patients who were women, diabetic, smoker, obese, and those who had a concomitant cardiovascular disease (CVD) had a higher rate of antihypertensive treatment. Of 15 187 treated patients, 4912 (30.2%) had a controlled systolic blood pressure, 7063 (43.4%) a controlled diastolic blood pressure, and in 3931 (24.2%), both were under control. A logistic regression analysis demonstrated that age (OR 1.33), diabetes (OR 4.96), body mass index (OR 1.41) and the presence of a CVD (OR 1.19) were predictors for blood pressure being under control. The blood pressure control rates ranged between 16.6 and 30.5% among seven geographical regions. In the primary care units in Turkey, the blood pressure control rate is consistently low in treated hypertensive patients. In addition, there are differences between the geographical regions in both the proportion of those receiving medications and the blood pressure control rates.

Prevalence of multiple sclerosis: door-to-door survey in three rural areas of coastal Black Sea regions of Turkey.

Background: Little information exists on multiple sclerosis (MS) in Turkey. With a door-to-door survey in an urban part of Istanbul, we recently reported a prevalence rate of 101/100,000 population. We therefore investigated three rural areas of Turkey at the same latitude. Methods: The same survey methods were used for total populations of two rural areas (Kandıra and Geyve) near Istanbul, and for half the population of Erbaa, all near 40° north latitude on the Black Sea coast. Results: In Kandıra, 5 of 8 suspects were diagnosed as having MS among 8,171 screened, resulting in a prevalence rate of 61/100,000. Geyve with 7 MS cases in 17,016 screened had a prevalence of 41/100,000, and Erbaa with 15 MS cases in 28,177 screened one of 53/100,000. Together they showed a prevalence of 51/100,000. Of the 27 patients, 20 were women; 25 had definite and 2 possible MS, the former all with abnormal laboratory findings. Average ages were 30.5 years at onset and 39.1 years at diagnosis. Clinical features and course were typical of European MS. Conclusion: These findings indicate that Turkey is a high-risk MS area, similar to most regions of Mediterranean Europe, where all recent increases are likely due to (undefined) environmental factors.

Vitamin E does not reduce the side-effects of isotretinoin in the treatment of acne vulgaris.

Background  Isotretinoin is widely used in the treatment of severe, recalcitrant, nodular acne. Mucocutaneous side‐effects are seen in the great majority of patients and some of them have elevations in their serum lipid and liver enzyme profiles. Recently, it has been shown that addition of vitamin E decreased the toxicity of high‐dose retinoids.

Predictive factors for acne flare during isotretinoin treatment

Flare of acne is common at the beginning of isotretinoin treatment. However, severe flare is rare. Multiple comedones, male gender and young age are reported as promoting factors. However, detailed information is still limited. Our aim was to investigate the incidence, types and course of acne flare and the predictive factors for its occurrence. 244 patients were enrolled. Acne grade was defined according to global acne grading system (GAGS) score. Flare was classified according to the increase in number of inflammatory nodules and treatment requirements of the patients. Risk factors (age, sex, duration of acne, basal acne grade, baseline numbers of comedones, papule-pustules, nodules, hyperandrogenism, and presence of sinuses) were investigated. 161 patients completed the study. 79 patients (32%) had facial and/or truncal flare. Flare was mild in 18% (n = 44), moderate in 10% (n = 24), and severe in 4.5% (n = 11) of the patients. For severe flare, male sex, severe acne, GAGS cut-off score greater than 28, presence of more than 44 facial comedones and 2 facial nodules and presence of truncal nodules were found to be predictive. Recognizing predictive factors for severe flare may help to take early precautions and to prevent severe flares which may result with permanent scars.

Ethical Conduct in Health Services in Turkey

The survey aims to explore the attitudes of physicians, nurses, pharmacists, pharmaceutical representatives, and patients from two provinces of Turkey, Nevsehir and Istanbul, in context of ethical conduct within the health services and the relation between the health services and its suppliers, particularly the pharmaceutical industry. Quantitative and qualitative methods were used together. The questionnaire interviews were conveyed to a total of 1540 people and eight focus group discussions to 85 people during April–May 2009. The most common unethical acts in medical practice are “knife payment”/additional informal payment, self-referral, patient discrimination, discrediting other physicians, unnecessary tests—interventions—prescriptions, accepting promotion and demand for personal–household goods, preferring products that come along with promotion, getting cash per box, sponsored vacations in the form of medical congress. Eliminating monetary relationship between the physician and the patient; discouraging close contact of the physician and the healthcare institution with the pharmaceutical industry; implementing commissions in hospitals to supervise physicians for preventing patient discrimination and unnecessary interventions within the framework of good clinical practices; building a supreme board of medical journalism to prevent artificial demand for medical interventions and creation of false hopes, are the proposed precautions for corruption in health services.