Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Diffusion MR Imaging in Sporadic Creutzfeldt-Jakob Disease(2014) Pekoz, Burcak Cakir; Alkan, Ozlem; Giray, Semih; Demir, Senay; Altinkaya, Naime; 0000-0001-7526-3460; 0000-0003-1348-8167; 0000-0002-4209-9075; 0000-0002-0722-3181; AAM-4169-2021; AAM-5169-2021; AAK-9310-2021; AAH-1091-2020Creutzfeldt-Jakob disease (CJD) is a rare dementing disease and is thought to caused by a prion. It is characterized by rapidly progressive dementia, ataxia, myoclonus, akineticmutism and eventual death. Brain biopsy or autopsy is required for a definitive diagnosis of CJD. Diffusion-weighted imaging became an important tool for early diagnosis of CJD because of the high sensitivity. We present 59-year-old female patient diagnosed as sporadic CJD with typical MR imagings.Item Effects of Enteral Protein Supplements on Nutritional Status and Clinical Outcome in Unconscious Elderly Malnourished Patients(2014) Gulsen Atalay, Betul; Yagmur, Cahide; Nursal, Tarik; Atalay, Hakan; Sezgin, Nurzen; Giray, Semih; Selcuk, Haldun; https://orcid.org/0000-0002-0722-3181; https://orcid.org/0000-0002-8445-6413; IQV-1169-2023; AAH-1091-2020; AAJ-6976-2021Aim: Unconscious malnourished patients have reduced serum proteins. Enteral protein supplements may improve their nutritional status and clinical outcome. Our aim for the present study was to determine the effect on nutritional status and patient prognosis of enteral protein supplementation in tube-fed hospitalised unconscious elderly malnourished patients. Methods: In total, 20 patients were fed a standard enteral nutrition formula during the four-day adaptation period. The study group (n = 10) received an enteral protein supplement (2 g/kg/day protein) and the control group (n = 10) received only standard enteral nutrition (1 g/kg/day protein) during the 12-day study period. Nutritional status and clinical outcome were assessed. Results: No difference was observed between the groups with regard to biochemical, inflammatory parameters, anthropometric measurements or nitrogen balance (P > 0.05). Triceps and subscapular skinfold thickness mean levels were elevated in the study group at the end of the study compared with the beginning of the study (P < 0.05). No significant difference was observed between the groups with regard to complications or mortality rate (P > 0.05). Conclusions: In the present study, the use of enteral protein support (EPS) in unconscious malnourished patients provided some advantages in the early stages of medical treatment. Triceps skinfold thickness and subscapular skinfold thickness mean levels were increased significantly in our study group. Although there was no significant difference, serum insulin-growth factor, retinol-binding protein and prealbumin mean values showed a tendency to increase in the study group at the end of the study. We believe that further research is required to determine the effects of EPS on these values in malnourished elderly patients.Item Hypertension Alters Phosphorylation of VASP In Brain Endothelial Cells(2015) Arlier, Zulfikar; Basar, Murat; Kocamaz, Erdogan; Kiraz, Kemal; Tanriover, Gamze; Kocer, Gunnur; Arlier, Sefa; Giray, Semih; Nasircilar, Scher; Gunduz, Filiz; Senturk, Umit K.; Dernir, Necdet; 0000-0003-2645-648X; 24894047; ACE-7635-2022Hypertension impairs cerebral vascular function. Vasodilator-stimulated phosphoprotein (VASP) mediates active reorganization of the cytoskeleton via membrane ruffling, aggregation and tethering of actin filaments. VASP regulation of endothelial barrier function has been demonstrated by studies using VASP(-/-) animals under conditions associated with tissue hypoxia. We hypothesize that hypertension regulates VASP expression and/or phosphorylation in endothelial cells, thereby contributing to dysfunction in the cerebral vasculature. Because exercise has direct and indirect salutary effects on vascular systems that have been damaged by hypertension, we also investigated the effect of exercise on maintenance of VASP expression and/or phosphorylation. We used imnnunohistochemistry, Western blotting and immunocytochemistry to examine the effect of hypertension on VASP expression and phosphorylation in brain endothelial cells in normotensive [Wistar-Kyoto (WKY)] and spontaneously hypertensive (SH) rats under normal and exercise conditions. In addition, we analyzed VASP regulation in normoxia- and hypoxia-induced endothelial cells. Brain endothelial cells exhibited significantly lower VASP immunoreactivity and phosphorylation at the Ser157 residue in SHR versus WKY rats. Exercise reversed hypertension-induced alterations in VASP phosphorylation. Western blotting and immunocytochemistry indicated reduction in VASP phosphorylation in hypoxic versus normoxic endothelial cells. These results suggest that diminished VASP expression and/or Ser157 phosphorylation mediates endothelial changes associated with hypertension and exercise may normalize these changes, at least in part, by restoring VASP phosphorylation.Item Real World Data Estimation: Management and Cost-analysis of Stroke in Tertiary Hospitals in Turkey and the Impact of Co-morbid Malnutrition(2016) Arsava, Ethem Murat; Ozcagli, Tahsin Gokcem; Berktas, Mehmet; Giray, Semih; Guler, Ayse; Gungor, Levent; Ozdemir, Ozcan; Uluc, Kayihan; Yaka, Erdem; Yesilot, Nilufer; https://orcid.org/0000-0002-0722-3181; AAH-1091-2020Objective: To evaluate the management and cost analysis of first-ever stroke patients in Turkey and determine the impact of comorbid malnutrition. Methods: This study was based on expert's view on the management and cost analysis of stroke patients with or without malnutrition via standardized questionnaire forms filled by experts according to their daily clinical practice. Cost items were related to medical treatment, healthcare resources utilization, tests, consultations and complications. Per admission and total annual direct medical costs were calculated with respect to co-morbid malnutrition. Results: Malnutrition was evident in 7.8(3.6)% [mean(standard error of mean; SEM)] of patients at admission; an additional 7.1(4.8)% and 0.9(0.6)% patients developed malnutrition during Neuro-ICU and stroke unit hospitalization, respectively. Length of hospital stay (LOS) was almost 2-fold in patients with malnutrition (P<0.01 for all hospital units). During the 1-year follow-up period a mean(SEM) of 93.8(15.4)% with and 43.3(3.7)% without malnutrition were expected to experience at least 1 complication. The mean (SEM) per patient annual cost of stroke was US$5201(740) in patients with malnutrition and US$3619(614) in patients without malnutrition, while the corresponding figures for per admission were US$3061(513) and US$1958(372), respectively. Conclusions: In conclusion, our findings revealed that management of stroke and its complications have a relatively high burden on the Turkish health reimbursement system. Furthermore, co-morbid malnutrition, being not uncommonly encountered, increased the overall costs and was associated with longer LOS and higher rate of expected complications during 1-year follow up.Item Does Stroke Etiology Play A Role in Predicting Outcome of Acute Stroke Patients Who Underwent Endovascular Treatment With Stent Retrievers?(2017) Giray, Semih; Ozdemir, Ozcan; Bas, Demet F.; Inanc, Yusuf; Arlier, Zulfikar; Kocaturk, Ozcan; 28017193Aims: The goal of the study was to identify whether the stroke etiology play a role in the recanalization and outcome of patients who underwent mechanical thrombectomy with stent retrievers. Methods and results: A retrospective analysis of a prospectively collected database included consecutive patients treated with stent retrievers. We included patients with cardioembolic stroke and large vessel atherosclerotic disease and compared risk factors for stroke, baseline NIHSS and Alberta Stroke Program Early CT scores (ASPECTS), stroke outcome, recanalization rate, onset-to-recanalization, onset-to-groin puncture time and the procedural time between two groups. Male sex was statistically more common in patients with large vessel atherosclerotic disease. Mean time from symptom onset- to the achievement of recanalization in patients with LVAD was 242 +/- 72.4 compared with cardioembolic stroke patients (301 +/- 70.7; p = 0.014). Time for groin puncture to recanalization was longer in patients with cardioembolic stroke compared to LVAD group (97.5 +/- 44.3 vs 58.2 +/- 21.8; p = 0.002). Time for microcatheter to successful recanalization or procedural termination was longer in patients with cardioembolic stroke compared to LVAD group (63.6 +/- 30.2 vs 34.2 +/- 19.4; p < 0.001) with cardioembolic stroke had significantly worse long-term outcome (mRS 3-6) compared to those with LVAD (60.6% vs 26.3%; p = 0.036). Conclusion: Stroke etiology may play a role in the outcome of acute stroke patients who underwent endovascular stroke therapy. Cardioembolic strokes may be more resistant to endovascular acute stroke treatment. (C) 2016 Elsevier B.V. All rights reserved.Item Parathyroid Hormone and Ischemic Cerebrovascular Event(2019) Altay, Hakan; Altin, Cihan; Coner, Ali; Muderrisoglu, Haldun; Giray, Semih; 0000-0002-9635-6313; 0000-0002-0722-3181; 30806331; AAG-8233-2020; AAH-1091-2020Background: Increased parathyroid hormone (PTH) level is associated with coronary artery disease, hypertension and left ventricular hypertrophy which are all predisposing factors for the ischemic cerebrovascular event ( ICVE). Carotid intima-media thickness (CIMT) and aortic distensibility are the two early, subclinical predictors of atherosclerosis. The relation of PTH with CIMT and aortic distensibility in patients with ICVE has not been previously studied. Objective: Our aim was to study the relationship of PTH levels with aortic distensibility and CIMT in patients with ICVE. Methods: Sixty-four ICVE patients and 50 control group were enrolled in the study. PTH levels, aortic distensibility and CIMT were measured in all individuals. Results: PTH levels were significantly higher in ICVE patients than in the controls (60.1 +/- 21.6 vs. 52.3 +/- 6.2 pg/ml) (p=0. 008). PTH levels were found to be inversely correlated with aortic distensibility (r= -0. 420, p=0.001) and positively correlated with CIMT ( r:0, 285, p=0,002). Conclusion: The present study shows that PTH levels are increased in patients with acute ischemic cerebrovascular event compared to the control group. It also demonstrates that PTH levels are inversely related to aortic distensibility of ascending aorta and positively associated with CIMT.