Browsing by Author "Yoldas, T"

Now showing 1 - 6 of 6
  • No Thumbnail Available
    Item
    Chiasmal decussation in tilted disc syndrome PVER in tilted disc
    Öztürk, F; Kurt, E; Yoldas, T; Ilker, SS; Inan, ÜÜ
    The tilted disc syndrome is a benign congenital abnormality of the optic nerve head. Since it can be confused with papilledema and chiasmal lesions, differential diagnosis is important. The tilting anomaly may be associated with other abnormalities along the optic nerve. Visual field defects may be similar to those in chiasmal lesions. In order to determine whether the normal crossover of nerve fibers at the chiasm is altered, the crossed and the uncrossed fibers were investigated using the pattern visual evoked responses (PVER) test. Thirty-four eyes of 17 patients diagnosed with tilted disc syndrome were evaluated for refraction, keratometry, color vision with Ishihara, visual field, and PVER. The presence of abnormal nerve fiber decussation was determined by recording PVER from the electrodes mounted on the scalp of both hemispheres. The amplitude and latency differences between the 'crossed' and 'uncrossed' fibers were not statistically significant (p>0.05). As a result, the tilting abnormality of papilla was found to be without chiasmal abnormal decussation.
  • No Thumbnail Available
    Item
    A woman who did her own caesarean section
    Yoldas, Z; Iscan, A; Yoldas, T; Ermete, L; Akyurek, C
  • No Thumbnail Available
    Item
    Nesfatin-1 and ghrelin levels in serum and saliva of epileptic patients: hormonal changes can have a major effect on seizure disorders
    Aydin, S; Dag, E; Ozkan, Y; Erman, F; Dagli, AF; Kilic, N; Sahin, I; Karatas, F; Yoldas, T; Barim, AO; Kendir, Y
    Nesfatin-1 and ghrelin are the two recently discovered peptide hormones involved in the control of appetite. Besides its main appetite-control function, ghrelin also has anticonvulsant effects, while nesfatin-1 causes depolarization in the paraventricular nucleus (PVN). The aims of this study, therefore, were to investigate: (i) whether there are differences in the concentrations of nesfatin-1 and ghrelin in saliva and serum samples between eplilepsy patients and normal controls and (ii) whether salivary glands produce nesfatin-1. The study included a total of 73 subjects: 8 patients who were newly diagnosed with primary generalized seizures and had recently started antiepileptic drug therapy; 21 who had primary generalized seizures and were continuing with established antiepileptic drug therapy; 24 who had partial seizures (simple: n = 12 or complex: n = 12) and were continuing with established antiepileptic drug therapy; and 20 controls. Salivary gland tissue samples were analyzed for nesfatin-1 expression by immunochemistry and ELISA. Saliva and serum ghrelin levels were measured by ELISA and RIA, and nesfatin-1 levels by ELISA. Nesfatin-1 immunoreactivity was detected in the striated and interlobular parts of the salivary glands and the ducts. The nesfatin-1 level in the brain was around 12 times higher than in the salivary gland. Before antiepileptic treatment, both saliva and serum nesfatin-1 levels were around 160-fold higher in patients who are newly diagnosed with primary generalized epilepsy (PGE) than in controls; these levels decreased with treatment but remained about 10 times higher than the control values. Saliva and serum nesfatin-1 levels from patients with PGE and partial epilepsies who were continuing antiepileptic drugs were also 10-fold higher than control values. Serum and saliva ghrelin levels were significantly (twofold) lower in epileptic patients before treatment than in controls; they recovered somewhat with treatment but remained below the control values. These results suggest that the low ghrelin and especially the dramatically elevated nesfatin-1 levels might contribute to the pathophyisology of epilepsy. Therefore, serum and saliva ghrelin and especially the remarkably increased nesfatin-1 might be candidate biomarkers for the diagnosis of epilepsy and for monitoring the response to anti-epileptic treatment.
  • No Thumbnail Available
    Item
    Gastrostomy in Hospitalized Patients with Acute Stroke: NoroTek Turkey Point Prevalence Study Subgroup Analysis
    Topçuoglu, 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, EM
    Objective: 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.
  • No Thumbnail Available
    Item
    Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek Study
    Topçuoglu, 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, S
    Objective: 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.
  • No Thumbnail Available
    Item
    Acute Stroke Management in Türkiye: Intravenous Tissue Plasminogen Activator and Thrombectomy NöroTek: Türkiye Neurology Single Day Study
    Topçuoglu, 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, S
    Objective: 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.