Browsing by Author "Erdogan, M"
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Item Pulsatile Proptosis and Sphenoid Wing Dysplasia with no Evidence of Neurofibromatosis Type 1: A Case Report and Review of the LiteratureAkgün, YD; Erdogan, M; Altinisik, M; Mayali, H; Ilker, SSIn this study, we aimed to present a rare case of pulsatile proptosis due to sphenoid wing dysplasia without the features of neurofibromatosis type 1 (NF1). A 17-year-old male patient presented with swelling in the superotemporal region of the right eye. Physical examination revealed facial asymmetry with a pulsatile, ill-defined, soft lesion with in the superotemporal region of the right orbit associated with pulsatile proptosis, downward dystopia, and hypotropia. Computer tomography imaging to establish a differential diagnosis showed temporal lobe herniation secondary to sphenoid wing dysplasia. The patient was assessed for NF1, which is most commonly associated with sphenoid wing dysplasia, but no evidence supporting the diagnosis was found. Patients presenting with proptosis should be carefully examined for pulsation and murmurs, and a trauma history should be investigated. Radiological imaging should be used to facilitate the differential diagnosis, and the current clinical condition should be managed with a multidisciplinary approach.Item Effects of metformin and pioglitazone combination on apoptosis and AMPK/mTOR signaling pathway in human anaplastic thyroid cancer cellsKutbay, NO; Avci, CB; Yurekli, BS; Kurt, CC; Shademan, B; Gunduz, C; Erdogan, MAnaplastic cancer constitutes 1% of thyroid cancers, and it is one of the most aggressive cancers. Treatment options are external radiation therapy and/or chemotherapy. The success rate with these treatment modalities is not satisfactory. We aimed to evaluate the effects of metformin (MET) and pioglitazone (PIO) combination on apoptosis and AMP-activated protein kinase/mammalian target of rapamycin (mTOR) signaling pathway in human anaplastic thyroid cancer cells. In this study, we evaluated the effects of MET and PIO individually and the combination of the two drugs on the cellular lines SW1736 and C643 ATC. Genes contained in the mTOR signaling pathway were examined using human mTOR Signalization RT(2)Profiler PCR Array. In C643 and SW1736 cell lines, IC(50)doses of MET and PIO were found out as 17.69 mM, 11.64 mM, 27.12 mu M, and 23.17 mu M. Also, the combination of MET and PIO was determined as an additive according to isobologram analyses. We have found the downregulation of the expression levels of oncogenic genes:AKT3, CHUK, CDC42, EIF4E, HIF1A, IKBKB, ILK, MTOR, PIK3CA, PIK3CG, PLD1, PRKCA, andRICTORgenes, in the MET and PIO combination-treated cells. In addition, expression levels of tumor suppressorgenes, DDIT4, DDIT4L, EIF4EBP1, EIF4EBP2, FKBP1A, FKBP8, GSK3B, MYO1C, PTEN, ULK1, andULK2, were found to have increased significantly. The MET + PIO combination was first applied to thyroid cancer cells, and significant reductions in the level of oncogenic genes were detected. The decreases, particularly, inAKT3, DEPTOR, EIF4E, ILK, MTOR, PIK3C, andPRKCAexpressions indicate that progression can be prevented in thyroid cancer cells and these genes could be selected as therapeutic targets.Item Aspergillus Endogenous Endophthalmitis as a Clue to Identifying a Delayed Lumbosacral OsteomyelitisAltinisik, M; Akgun, YD; Erdogan, M; Mutawakkil, AF; Gazi, HPurposeTo present a case of aspergillus-induced endogenous endophthalmitis evolving into delayed lumbosacral osteomyelitis, initially misdiagnosed as ankylosing spondylitis (AS) in an immunocompetent patient.MethodCase Report.ResultsA 38-year-old woman, initially treated for pneumonia, experienced sudden loss of vision in her left eye, prompting a thorough examination that revealed a distinct chorioretinal infiltrate. Microbiological analysis of the patient's vitreous samples detected Aspergillus fumigatus, leading to the diagnosis of endogenous endophthalmitis. Treatment involved vitrectomy, intravitreal injections, and intravenous amphotericin B. Two months later, she was referred for lower back pain, misdiagnosed as AS. Lumbosacral biopsy confirmed Aspergillus involvement once more, necessitating antifungal therapy.ConclusionThis case highlights the atypical progression of Aspergillus-induced endogenous endophthalmitis to delayed lumbosacral osteomyelitis in an immunocompetent individual. It highlights the crucial role of a meticulous medical history examination and interdisciplinary collaboration in diagnosing and managing diseases, especially in cases with atypical presentations.Item Two siblings with horizontal gaze palsy and ROBO3 gene mutation: A double case studyOrak, SA; Erdogan, M; Yilmaz, C; Atasever, AK; Kubur, CC; Polat, MHorizontal gaze palsy along with progressive scoliosis (HGPPS) is rare and autosomal recessive disease related to the mutations in the ROBO3 gene located on chromosome 11q23-25. We present here two siblings from parents of consanguineous marriage, who were diagnosed with bilateral horizontal gaze restriction and scoliosis associated with homozygous mutation within ROBO3 gene and at the same time having neuroimaging findings. With HGPSS's typical findings, we detected a homozygous c.1366G> T (p.Gly456Ter) variant in the ROBO3 gene in our patients. HGPPS should be confirmed by ROBO3 gene analysis, and the brain MRI may be the first diagnostic technique.Item Histopathological Results of Conjunctival Masses with Suspected Malignancy Based on Slit-lamp BiomicroscopyErdogan, M; Mayali, H; Malgaz, S; Altinisik, M; Ilker, SSObjective: To evaluate the histopathological results of conjunctival masses suspected to be malignant based on biomicroscopic exami-nation.Study Design: Observational study.Place and Duration of the Study: Department of Ophthalmology, Celal Bayar University, Hafsa Sultan Hospital, Manisa, Turkiye, from November 2013 to February 2021.Methodology: Patients who underwent excision for the diagnosis and treatment of conjunctival surface masses with clinical suspicion of malignancy were evaluated retrospectively. The masses were categorised as benign, premalignant, and malignant lesions according to the histopathological results. The distribution of conjunctival masses was analysed according to patients' gender and age groups.Results: The study included 98 conjunctival masses in 98 patients (57.1% men, mean age 48.6 & PLUSMN;21.85 years). On pathological examina-tion, 63 of the masses were found to be benign (64.3%), 22 were premalignant (22.4%), and 13 were malignant (13.3%). The most common benign lesion was nevus (n=21, 21.4%). All detected premalignant lesions were conjunctival intraepithelial neoplasms (CIN), detected in 22 patients (22.4%). Of these, 13 patients (13.3%) had carcinoma in situ (CIN III). Thirteen (13.3%) of the masses were malignant, the most common being squamous cell carcinoma (n=10, 10.2%). The frequency of premalignant and malignant lesions increased with age (p<0.001). There was no statistical relationship between malignancy and gender (p=0.619). Conclusion: Most conjunctival masses in this series were benign, with nevi being the most common. The most common premalignant and malignant lesions were intraepithelial neoplasia and squamous cell carcinoma, respectively. Malignant conjunctival lesions were more common in older patients.Item Acute Posterior Multifocal Placoid Pigment Epitheliopathy: A Rare Presentation of Anklylosing Spondylitis or a Paradoxical Reaction to Secukinumab?Altinisik, M; Delibay, Y; Erdogan, MPurpose: To describe an atypical presentation of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in a patient with ankylosing spondylitis (AS) receiving secukinumab. Methods: Retrospective chart review. Results: A 48-year-old female patient with AS receiving secukinumab complained of impaired vision in her left eye. Left eye examination revealed multiple yellow-white lesions at the posterior pole and central subfoveal fluid.The lesions regressed without scarring. The case was diagnosed with clinically APMPPE. Conclusion: In AS patients, posterior uveitis can manifest as APMPPE. It should be recorded as an entity to be considered in the differential diagnosis.Item Relationship between ace genotype and short duration aerobic performance developmentCerit, M; Colakoglu, M; Erdogan, M; Berdeli, A; Cam, FSWe have previously demonstrated that, ACE D allele may be related with a better performance in short duration aerobic endurance in a homogeneous cohort with similar training backgrounds. We aimed to study the variation in the short-duration aerobic performance development amongst ACE genotypes in response to identical training programs in homogeneous populations. The study group consisted of 186 male Caucasian non-elite Turkish army recruits. All subjects had undergone an identical training program with double training session per day and 6 days a week for 6 months. Performances for middle distance runs (2,400 m) were evaluated on an athletics track before and after the training period. ACE gene polymorphisms were studied by PCR analysis. The distribution of genotypes in the whole group was 16.7% II, n = 31; 46.2% ID, n = 86; 37.1% DD, n = 69. Subjects with ACE DD genotype had significantly higher enhancement than the ID (P < 0.01) and II (P < 0.05) genotype groups. Around 2,400 m performance enhancement ratios showed a linear trend as ACE DD > ACE ID > ACE II (P value for Pearson chi(2) = 0.461 and P value for linear by linear association = 0.001). ACE DD genotype seems to have an advantage in development in short-duration aerobic performance. This data in unison with the data that we have obtained from homogenous cohorts previously is considered as an existence of threshold for initiation of ACE I allele effectiveness in endurance performance. This threshold may be anywhere between 10 and 30 min with lasting maximal exercises.Item Gastrostomy in Hospitalized Patients with Acute Stroke: NoroTek Turkey Point Prevalence Study Subgroup AnalysisTopçuoglu, MA; Özdemir, AÖ; Aykaç, Ö; Milanoglu, A; Gökçe, M; Bavli, S; Çabalar, M; Yayla, V; Erdogan, HA; Özkul, A; Günes, A; Degirmenci, B; Aluçlu, U; Kozak, HH; Güngör, L; Erdogan, M; Acar, ZÖ; Cenikli, U; Kablan, Y; Yilmaz, A; Genç, H; Nazliel, B; Çaglayan, HB; Gencer, ES; Ay, H; Demirbas, H; Akdogan, Ö; Emre, U; Yildiz, ÖK; Bolayir, A; Demir, T; Tanriverdi, Z; Tekan, ÜY; Akpinar, ÇK; Özkan, E; Ilik, F; Sirin, H; Güler, A; Önder, H; Bektas, H; Öcek, L; Bakar, M; Ongun, N; Krespi, Y; Isikay, CT; Aslanbaba, E; Sorgun, M; Gürkas, E; Karadeli, HH; Midi, I; Ilgezdi, I; Bilgiç, AB; Akyol, S; Epçeliden, MT; Atmaca, MM; Kursun, O; Keskin, O; Sirinocak, PB; Baydemir, R; Akçakoyunlu, M; Öztürk, S; Özel, T; Ünal, A; Dora, B; Yürekli, VA; Arlier, Z; Eren, A; Yilmaz, A; Kisabay, A; Acar, B; Bastan, B; Acar, Z; Niflioglu, B; Güven, B; Kaya, D; Afsar, N; Yazici, D; Aytaç, E; Yaka, E; Toplutas, E; Degirmenci, E; Ince, FB; Büyükserbetçi, G; Aydin, I; Çetiner, M; Sen, M; Turgut, N; Kale, N; Çoban, E; Yesilot, N; Ekizoglu, E; Kizek, Ö; Birgili, Ö; Yevgi, R; Kunt, R; Giray, S; Akkas, SY; Senadim, S; Yoldas, T; Asil, T; Duman, T; Atasoy, T; Çinar, BP; Demir, T; Can, U; Ünsal, YÖ; Eskut, N; Aslan, Y; Bas, DF; Sener, U; Yilmaz, Z; Bozdogan, Z; Alioglu, Z; Arsava, EMObjective: Nutritional status assessment, dysphagia evaluation and enteral feeding decision are important determinants of prognosis in acute neurovascular diseases. Materials and Methods: NoroTek is a point prevalence study conducted with the participation of 87 hospitals spread across all health sub regions of Turkey conducted on 10-May-2018 (World Stroke Awareness Day). A total of 972 hospitalized neurovascular patients [female: 53%, age: 69 +/- 14; acute ischemic stroke in 845; intracerebral hematoma (ICH) in 119 and post-resuscitation encephalopathy (PRE) in 8] with complete data were included in this sub-study. Results: Gastrostomy was inserted in 10.7% of the patients with ischemic stroke, 10.1% of the patients with ICH and in 50% of the patients with PRE. Independent predictors of percutaneous endoscopic gastrostomy (PEG) administration were The National Institutes of Health Stroke Scale score at admission [exp (ss): 1.09 95% confidence interval (CI): 1.05-1.14, per point] in ischemic stroke; and mechanical ventilation in ischemic [exp (ss): 6.18 (95% CI: 3.16-12.09)] and hemorrhagic strokes [exp (ss): 26.48 (95% CI: 1.36-515.8)]. PEG was found to be a significant negative indicator of favorable (modified Rankin's scale score 0-2) functional outcome [exp (ss): 0.032 (95% CI: 0.004-0.251)] but not of in-hospital mortality [exp (ss): 1.731 (95% CI: 0.785-3.829)]. Nutritional and swallowing assessments were performed in approximately two-thirds of patients. Of the nutritional assessments 69% and 76% of dysphagia assessments were completed within the first 2 days. Tube feeding was performed in 39% of the patients. In 83.5% of them, tube was inserted in the first 2 days; 28% of the patients with feeding tube had PEG later. Conclusion: The NoroTek study provided the first reliable and large-scale data on key quality metrics of nutrition practice in acute stroke in Turkey. In terms of being economical and accurate it makes sense to use the point prevalence method.Item Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek StudyTopçuoglu, MA; Arsava, EM; Özdemir, AÖ; Aykaç, Ö; Çetiner, M; Gencer, ES; Günes, A; Krespi, Y; Yaka, E; Öcek, L; Tanriverdi, Z; Tekan, ÜY; Özkul, A; Özkan, E; Sirin, H; Güler, A; Kursun, O; Kunt, R; Cenikli, U; Acar, B; Kablan, Y; Yilmaz, A; Isikay, CT; Aslanbaba, E; Sorgun, M; Bektas, H; Çabalar, M; Yayla, V; Erdogan, HA; Gökçe, M; Bavli, S; Ongun, N; Keskin, AO; Akdogan, Ö; Emre, U; Yildiz, ÖK; Bolayir, A; Akpinar, ÇK; Karadeli, HH; Özel, T; Ünal, A; Dora, B; Arlier, Z; Eren, A; Milanoglu, A; Nazliel, B; Çaglayan, HB; Güven, B; Erdogan, M; Acar, ZÖ; Bakar, M; Giray, S; Senadim, S; Asil, T; Demir, T; Ünsal, YÖ; Eskut, N; Aslan, Y; Bas, DF; Sener, U; Degirmenci, B; Aluçlu, U; Bastan, B; Acar, Z; Niflioglu, B; Yazici, D; Aytaç, E; Ince, FB; Ay, H; Önder, H; Kozak, HH; Ilgezdi, I; Bilgiç, AB; Akyol, S; Güngör, IL; Atmaca, MM; Sen, M; Yevgi, R; Akkas, SY; Yoldas, T; Atasoy, HT; Çinar, BP; Yilmaz, A; Genç, H; Kisabay, A; Ilik, F; Demirbas, H; Midi, I; Sirinocak, PB; Duman, T; Demir, T; Can, U; Yürekli, VA; Bozdogan, Z; Alioglu, Z; Kaya, D; Afsar, N; Gürkas, E; Toplutas, E; Degirmenci, E; Büyükserbetçi, G; Aydin, I; Epçeliden, MT; Turgut, N; Kale, N; Çoban, E; Yesilot, N; Ekizoglu, E; Kizek, Ö; Bilgili, Ö; Baydemir, R; Akçakoyunlu, M; Yilmaz, Z; Öztürk, SObjective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis.Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received effective treatment [international normalization ratio >= 2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.Conclusion: NoroTekTR revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF.Item Acute Stroke Management in Türkiye: Intravenous Tissue Plasminogen Activator and Thrombectomy NöroTek: Türkiye Neurology Single Day StudyTopçuoglu, MA; Özdemir, AÖ; Arsava, EM; Günes, A; Aykaç, Ö; Gencer, ES; Çabalar, M; Yayla, V; Erdogan, HA; Erdogan, M; Acar, ZÖ; Giray, S; Kablan, Y; Tanriverdi, Z; Tekan, ÜY; Asil, T; Akpinar, ÇK; Yürekli, VA; Acar, B; Sirin, H; Güler, A; Baydemir, R; Akçakoyunlu, M; Öcek, L; Çetiner, M; Nazliel, B; Çaglayan, HB; Ongun, N; Eren, A; Arlier, Z; Cenikli, U; Gökçe, M; Bavli, S; Yaka, E; Özkul, A; Degirmenci, B; Aluçlu, U; Isikay, CT; Aslanbaba, E; Sorgun, M; Aytaç, E; Ay, H; Kunt, R; Senadim, S; Ünsal, YÖ; Eskut, N; Alioglu, Z; Yilmaz, A; Genç, H; Yilmaz, A; Milanoglu, A; Gürkas, E; Degirmenci, E; Bektas, H; Ilgezdi, I; Bilgiç, AB; Akyol, S; Güngör, L; Kale, N; Çoban, E; Yesilot, N; Ekizoglu, E; Kizek, Ö; Kursun, O; Yildiz, ÖK; Bolayir, A; Kisabay, A; Bastan, B; Acar, Z; Niflioglu, B; Güven, B; Kaya, D; Afsar, N; Yazici, D; Toplutas, E; Özkan, E; Ilik, F; Ince, FB; Büyükserbetçi, G; Önder, H; Karadeli, HH; Kozak, HH; Demirbas, H; Midi, I; Aydin, I; Epçeliden, MT; Atmaca, MM; Bakar, M; Sen, M; Turgut, N; Keskin, O; Akdogan, Ö; Emre, U; Bilgili, Ö; Sirinocak, PB; Yevgi, R; Akkas, SY; Yoldas, T; Duman, T; Özel, T; Ünal, A; Dora, B; Atasoy, T; Çinar, BP; Demir, T; Demir, T; Can, U; Aslan, Y; Bas, DF; Sener, U; Yilmaz, Z; Bozdogan, Z; Özdemir, G; Krespi, Y; Öztürk, SObjective: To reveal the profile and practice in patients with acute stroke who received intravenous tissue plasminogen activator (IV tPA) and/or neurointerventional therapy in Turkiye. Materials and Methods: On World Stroke Awareness Day, May 10, 2018, 1,790 patients hospitalized in 87 neurology units spread over 30 health regions were evaluated retrospectively and prospectively. Results: Intravenous tPA was administered to 12% of 859 cases of acute ischemic stroke in 45 units participating in the study. In the same period, 8.3% of the cases received neurointerventional treatment. The rate of good prognosis [modified Rankin score (mRS) 0-2] at discharge was 46% in 83 patients who received only IV tPA [age: 67 +/- 12 years; National Institutes of Health Stroke Scale (NIHSS): 12 +/- 6; hospital stay, 24 +/- 29 days]; 35% in 51 patients who underwent thrombectomy (MT) alone (age: 64 +/- 13 years; NIHSS: 14.1 +/- 6.5; length of hospital stay, 33 +/- 31 days), 19% in those who received combined treatment (age: 66 +/- 14 years; NIHSS: 15.6 +/- 5.4; length of hospital stay, 26 +/- 35 days), and 56% of 695 patients who did not receive treatment for revascularization (age: 70 +/- 13 years; NIHSS: 7.6 +/- 7.2; length of hospital stay, 21 +/- 28 days). The symptom-to-door time was 87 +/- 53 minutes in the IV treatment group and 200 +/- 26 minutes in the neurointerventional group. The average door-to-needle time was 66 +/- 49 minutes in the IV tPA group. In the neurothrombectomy group, the door-to-groin time was 103 +/- 90 minutes, and the TICI 2b-3 rate was 70.3%. In 103 patients who received IV tPA, the discharge mRS 0-2 was 41%, while the rate of mRS 0-1 was 28%. In 71 patients who underwent neurothrombectomy, the mRS 0-2 was 31% and mRS 0-1 was 18%. The door-to-groin time was approximately 30 minutes longer if IV tPA was received (125 +/- 107 and 95 +/- 83 minutes, respectively). Symptomatic bleeding rates were 4.8% in IV recipients, 17.6% among those who received only MT, and 15% in combined therapy. Globally, the hemorrhage rate was 6.8% in patients receiving IV tPA and 16.9% in MT. Conclusion: IV thrombolytic and neurointerventional treatment applications in acute ischemic stroke in Turkiye can provide the anticipated results. Heterogeneity has begun to be reduced in our country with the dissemination of the system indicated by the Directive on Health Services to be Provided to Patients with Acute Stroke.