Seden Demirci

The clinical significance of the neutrophil-to-lymphocyte ratio in multiple sclerosis

Multiple sclerosis (MS) is one of the main chronic inflammatory diseases of the central nervous system that causes functional disability in young people. The aim of this study was to investigate the neutrophil-to-lymphocyte ratio (NLR) in patients with MS and the relationship between the NLR and the severity of the disease. One hundred and two MS patients (31 patients were in relapse; 71 patients were in remission) and 56 healthy controls were included. Complete blood counts as well as demographic and clinical data from MS patients were evaluated retrospectively. The NLRs were calculated for all participants and were compared; the cut-off value was also determined for the NLR and Expanded Disability Status Scale (EDSS). MS patients had a significantly higher NLR (p < 0.001) than the control group. The NLR levels were significantly higher in patients who were in relapse than patients in remission (p = 0.039). The cut-off value for the NLR to predict an MS diagnosis and activity were determined to be 2.04 and 3.90, respectively. The NLRs were directly correlated with erythrocyte sedimentation rate levels (r = 0.795, p < 0.001). Logistic regression analysis with dichotomous EDSS score showed that a high NLR was an independent predictor of the progression of disability. The NLR may be a biomarker that has simple, quick, inexpensive and reproducible properties in MS to predict patients prognosis.

A Multicenter Study of 1144 Patients with Cerebral Venous Thrombosis: The VENOST Study

BACKGROUND Based on a number of small observational studies, cerebral venous sinus thrombosis has diverse clinical and imaging features, risk factors, and variable outcome. In a large, multicenter cerebral venous thrombosis (VENOST) study, we sought to more precisely characterize the clinical characteristics of Caucasian patients. METHODS All data for the VENOST study were collected between the years 2000 and 2015 from the clinical follow-up files. Clinical and radiological characteristics, risk factors, and outcomes were compared in terms of age and sex distribution. RESULTS Among 1144 patients 68% were women, and in older age group (>50 years) male patients were more prevalent (16.6% versus 27.8%). The most frequent symptoms were headache (89.4%) and visual field defects (28.9%) in men, and headache (86.1%) and epileptic seizures (26.8%) in women. Gynecological factors comprised the largest group in women, in particular puerperium (18.3%). Prothrombotic conditions (26.4%), mainly methylenetetrahydrofolate reductase mutation (6.3%) and Factor V Leiden mutation (5.1%), were the most common etiologies in both genders. 8.1% of patients had infection-associated and 5.2% had malignancy-related etiology that was significantly higher in men and older age group. Parenchymal involvement constitutively hemorrhagic infarcts, malignancy, and older age was associated with higher Rankin score. Epileptic seizures had no effect on prognosis. CONCLUSIONS Clinical and radiological findings were consistent with previous larger studies but predisposing factors were different with a higher incidence of puerperium. Oral contraceptive use was not a prevalent risk factor in our cohort. Malignancy, older age, and hemorrhagic infarcts had worse outcome.

The Serum Levels of Resistin and Its Relationship with Other Proinflammatory Cytokines in Patients with Alzheimer’s Disease

Objective The present study aims to analyze the levels of resistin, tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-6, IL-18, and C-reactive protein (CRP) in patients with Alzheimer’s disease (AD) and also investigate a potential relationship between resistin levels and TNF-α, IL-1β, IL-6, IL-18, and CRP levels in patients with AD. Methods The study included fifty patients with AD and 30 healthy controls with normal cognitive functions. The serum resistin, TNF-α, IL-1β, IL-6, IL-18, and CRP levels were assessed. We performed a Mini-Mental State Examination (MMSE) to evaluate the general cognitive performance. Results The mean serum resistin, IL-1β, IL-18, and TNF-α levels were significantly higher in patients with AD compared with the controls (p=0.026, p=0.002, p=0.003, and p=0.038, respectively). The IL-6 and CRP levels did not differ between the groups (p=0.874 and p=0.941). The resistin levels were positively correlated with the levels of CRP and IL-18 (r=0.526, p<0.001; r=0.402, p=0.004, respectively). MMSE scores and inflammatory markers were not correlated (p>0.05 for all). Conclusion Serum resistin levels were significantly increased and correlated with some inflammatory markers in AD patients, suggesting that resistin might play a role in the inflammatory process of AD.

Corneal and Tear Film Changes After Botulinum Toxin-A in Blepharospasm or Hemifacial Spasm.

Purpose: To investigate changes in corneal parameters and the tear film after botulinum toxin-A (BTX-A) injection in patients with blepharospasm or hemifacial spasm. Methods: Twelve patients with benign essential blepharospasm and 30 with hemifacial spasm treated with BTX-A were included in this study. Disease severity was evaluated using the Jankovic scale. Corneal parameters were measured by the Pentacam. The Schirmer test score, tear breakup time, corneal fluorescein staining value, and Ocular Surface Disease Index score were also evaluated. Results: The BTX-A treatment relieved spasms in all of the patients. There was a statistically significant difference in disease severity between pretreatment and the third week (2.7 ± 0.8 and 1.3 ± 0.6, respectively; P < 0.001), but there was no statistically significant difference between pretreatment and the third month (2.7 ± 0.8 and 2.7 ± 0.8, respectively; P = 0.8). The tear breakup time was found to be significantly higher at both 3 weeks and 3 months after injection (6.6 ± 4.0 at pretreatment, 8.1 ± 3.9 at the third week, and 7.8 ± 4.2 at the third month; P = 0.04 and P = 0.02, respectively). The Schirmer test score, corneal fluorescein staining values, and Ocular Surface Disease Index score were lower 3 weeks after injection, but these values increased again by 3 months after injection. Corneal astigmatism decreased significantly at 3 weeks and at 3 months after injection [1.4 ± 1.2 diopters (D) at pretreatment, 1.2 ± 0.8 D at the third week, and 1.1 ± 0.8 D at the third month, respectively; P = 0.02, for both], but other corneal parameters did not change. Conclusions: BTX-A injection therapy was affected the tear film in patients with blepharospasm or hemifacial spasm. However, there were no changes in corneal parameters, except corneal astigmatism, in these patients after treatment.

Physiological parameters as a tool in the diagnosis of fibromyalgia syndrome in females: A preliminary study.

AIMS Although fibromyalgia (FM) syndrome is associated with many symptoms, there is as yet no specific finding or laboratory test diagnostic of this syndrome. The physical examination and laboratory tests may be helpful in figuring out this syndrome. MATERIALS AND METHODS The heart rate, respiration rate, body temperature (TEMP), height, body weight, hemoglobin level, erythrocyte sedimentation rate, white blood cell count, platelet count (PLT), rheumatoid factor and C-reactive protein levels and electrocardiograms (ECG) of FM patients were compared with those of control individuals. In addition, the predictive value of these tests was evaluated via receiver operating characteristic (ROC) analysis. KEY FINDINGS The results showed that the TEMP and the PLT were higher in the FM group compared with the control group. Also, ST heights in ECGs which corresponds to a period of ventricle systolic depolarization, showed evidence of a difference between the FM and the control groups. There was no difference observed in terms of the other parameters. According to the ROC analysis, PLT, TEMP and ST height have predictive capacities in FM. SIGNIFICANCE Changes in hormonal factors, peripheral blood circulation, autonomous system activity disorders, inflammatory incidents, etc., may explain the increased TEMP in the FM patients. The high PLT level may signify a thromboproliferation or a possible compensation caused by a PLT functional disorder. ST depression in FM patients may interrelate with coronary pathology. Elucidating the pathophysiology underlying the increases in TEMP and PLT and the decreases in ST height may help to explain the etiology of FM.

The effect of cigarette smoking on retinal nerve fiber layer thickness in patients with migraine

Abstract Context: Migraine is a frequent and disabling chronic neurological condition with complex pathophysiology. Both cigarette smoking and migraine may cause damage to the optic nerve. Objective: The primary objective of this study was to investigate the effect of cigarette smoking on retinal nerve fiber layer (RNFL) thickness in patients with migraine. Materials and methods: Eighty-four consecutive patients diagnosed with migraine (34 smokers and 50 nonsmokers) and 66 age- and gender-matched healthy non-smoker controls were enrolled for this observational cross-sectional study. RNFL thickness was measured using spectral-domain optical coherence tomography (OCT) and then RNFL thickness in patients with migraine who smoke was compared to nonsmoking patients with migraine and healthy subjects. Results: The average, superior, nasal and inferior RNFL thicknesses were significantly thinner in patients with migraine compared to the control group (p < 0.001, p = 0.02, p < 0.001 and p = 0.04, respectively). The average and inferior RNFL thicknesses were significantly reduced in smoker patients with migraine compared to the nonsmokers (p = 0.011, p = 0.045, respectively). Nonsmoker patients with migraine had significantly thinner average and nasal RNFL thicknesses than the control group (p = 0.001, p = 0.001, respectively). Conclusion: Cigarette smoking may cause significant RNFL thinning in patients with migraine. OCT may be a feasible technique for determination of smoking-induced ocular damage in patients with migraine.

Vision Loss and RNFL Thinning after Internal Carotid Arter Occlusion and Middle Cerebral Artery Infarction

Introduction: Ischaemic, traumatic or neoplasmic damage to the optic chiasm, optic tract or lateral geniculate nucleus affects the retinal ganglion cell (RGC) axons, detected as reduced retinal nerve fiber layer (RNFL) thickness around the optic nerve head. We report a case of vision loss and reduced RNFL thickness after internal carotid artery (ICA) occlusion and middle cerebral artery (MCA) infarction. Case report: A 33-year-old woman with a 3-month history of vision loss in right eye and left hemiplegia. The best corrected visual acuity was 1.0 in left eye and there was no light perception in the right eye. Ocular motility, intra-ocular pressure, anterior segments were normal in the both eyes. Her fundus examinations were normal except optic atrophy in the right eye. Visual field test was not performed because of cooperation difficulties. Magnetic resonance imaging (MRI) revealed an infarction of the right MCA. Computed tomographic angiography showed right ICA occlusion. Optical coherence tomography (OCT) demonstrated 6 clock hours of RNFL thinning in the right eye. Average RNFL thickness of the right and left eyes were 53µm, 96 µm respectively. Conclusions: Our findings show that a relatively short period of ICA occlusion and MCA infarction can cause vision loss and thinning of the RNFL.

Is Retinal Nerve Fiber Layer Thickness Change Related to Headache Lateralization in Migraine

Purpose To evaluate retinal nerve fiber layer (RNFL) thickness in migraine patients with unilateral headache. Methods A total of 58 patients diagnosed with migraine headache consistently occurring on the same side and 58 age- and sex-matched healthy subjects were evaluated in this cross-sectional study. RNFL thickness was measured using spectral-domain optical coherence tomography, and the side with the headache was com-pared with the contralateral side as well as with the results of healthy subjects. Results The mean patient age was 33.05 ± 8.83 years, and that of the healthy subjects was 31.44 ± 8.64 years (p = 0.32). The mean duration of disease was 10.29 ± 9.03 years. The average and nasal RNFL thicknesses were significantly thinner on the side of headache and on the contralateral side compared to control eyes (p < 0.05, for all). Thinning was higher on the side of the headache compared to the contralateral side; however, this difference was not statistically significant. Conclusions The RNFL thicknesses were thinner on the side of the headache compared to the contralateral side in the migraine patients with unilateral headache, but this difference was not statistically significant.

The effects of temperament and character traits on perceived social support and quality of life in patients with epilepsy

OBJECTIVES This study aimed to investigate the effect of temperament and character traits on perceived social support and quality of life in patients with epilepsy (PWE). METHODS Fifty-two PWE and 54 healthy controls were included in this study. Demographics and clinical data were recorded. Temperament and Character traits were investigated using Temperament and Character Inventory (TCI), Perceived Social Support was evaluated by Multidimensional Scale of Perceived Social Support Scale (MSPSS), and quality of life was assessed using a 36-Item Short-Form Health Survey (SF-36). Participants also completed the Hospital Anxiety Depression Scale (HADS). RESULTS TCI and MSPSS scores showed no significant difference between the groups (p>0.05). Mental and physical subscales of SF-36 were significantly lower in PWE than the controls (p=0.012, p=0.020, respectively). Multiple linear regression analysis indicated that Reward Dependence and Cooperativeness were independent predictors for perceived social support, and Persistence score was an independent predictor for the physical subscale of SF-36 even after adjustment for confounding background variables (p<0.05, for all). CONCLUSION Temperament and character traits may affect perceived social support and quality of life in PWE. Thus, an evaluation of temperament and character traits may play a significant role in preventing negative effects on perceived social support and quality of life in PWE.

Galactorrhea with normal prolactin levels associated with duloxetine.

2015 Wolters Kluwer Health, Inc. All rights re antipsychotics, gastrointestinal motility– enhancing agents, and verapamil can cause galactorrhea. Antidepressant drugs such as fluoxetine, paroxetine, and escitalopram may rarely lead to galactorrhea. We found only 3 case reports of galactorrhea associated with the use of duloxetine in the literature. This article presents a case study of galactorrhea without hyperprolactinemia in a woman being treated with duloxetine.