Wos İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4807
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Item Left Atrial Mechanics For Secondary Prevention From Embolic Stroke Of Undetermined Source(2022) Sade, Leyla Elif; Keskin, Suzan; Can, Ufuk; Colak, Ayse; Yuce, Deniz; Ciftci, Orcun; Ozin, Bulent; Muderrisoglu, Haldun; https://orcid.org/0000-0003-3737-8595; 33206942; AAQ-7583-2021Aims Anticoagulation is not justified unless atrial fibrillation (AF) is detected in cryptogenic stroke (CS) patients. We sought to explore whether left atrial (LA) remodelling is associated with embolic stroke of undetermined source (ESUS). Methods and results In this prospective study, we evaluated consecutively 186 patients in sinus rhythm who presented with an acute ischaemic stroke (embolic and non-embolic) and sex- and age-matched controls. We performed continuous electrocardiogram (ECG) monitoring to capture paroxysmal AF episodes as recommended by the guidelines. After 12 months of follow-up, continuous ECG monitoring was repeated in patients with undetected AF episodes. We quantified LA reservoir and contraction strain (LASr and LASct) by speckle-tracking, LA volumes by 3D echocardiography. Out of 186 patients, 149 were enrolled after comprehensive investigation for the source of ischaemic stroke and divided into other cause (OC) (n = 52) and CS (n = 97) groups. CS patients were also subdivided into AF (n = 39) and ESUS (n = 58) groups. Among CS patients, LA strain predicted AF independently from CHARGE-AF score and LA volume indices. ESUS group, despite no captured AF, had significantly worse LA metrics than OC and control groups. AF group had the worst LA metrics. Moreover, LASr predicted both CS (embolic stroke with and without AF) and ESUS (embolic stroke with no detected AF) independently from LAVImax and CHA(2)DS(2)-VASc score. LASr >26% yielded 86% sensitivity, 92% specificity, 92% positive, and 86% negative predictive values for the identification of ESUS (areas under curve: 0.915, P < 0.0001, 95% confidence interval: 0.86-0.97). Conclusion Echocardiographic quantification of LA remodelling has great potential for secondary prevention from ESUS.Item Comparison of non-vitamin K antagonist oral anticoagulants and well-controlled warfarin in octogenarians with non-valvular atrial fibrillation: Real-world data from a single tertiary center(2021) Akgun, Arzu Neslihan; Karacaglar, Emir; Bal, Uğur Abbas; Ozin, Mehmet Bulent; 34236320Objective: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, and its prevalence increases with age. Nevertheless, data about the use of oral anticoagulants (OACs) among patients with >= 80 years remains limited. This study aimed to evaluate the efficacy and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and warfarin in octogenarians with non-valvular AF (NVAF). Methods: Medical records of 387 patients who were >= 80 years and diagnosed with NVAF in our hospital between January 2017 and December 2019 were evaluated retrospectively. Patients with NVAF were divided into 2 groups (NOACs and warfarin), and the incidence of stroke/systemic embolism and major bleeding were analyzed. Results: A total of 322 patients were included in the study. The median follow-up duration was 10.9 months for the NOACs group and 12.1 months for the warfarin group. The primary efficacy outcome was stroke/systemic embolism, and the primary safety outcome was major bleeding. A total of 220 patients were taking NOACs, and the most preferred NOACs were apixaban (53.6%), rivaroxaban (29.5%), dabigatran (13.2%), and edoxaban (3.6%) in this order. During a mean follow-up of 302.7 patient-years, the incidence of stroke or systemic embolic events was slightly higher among patients with warfarin but the difference was not statistically significant (p=0.862). The incidence rates of major bleeding events were similar between the treatment groups (p=0.824). Conclusion: Our study revealed that the safety and efficacy outcomes are similar between the 2 treatment groups in octogenarians with NVAF.Item Effect of decompressive hemicraniectomy in patients with acute middle cerebral artery infarction 2050(2021) Suner, Halil İbrahim; Tanburoglu, Anil; Durdag, Emre; Civi, Soner; Gunesli Yetisken, Aylin; Kardes, Ozgur; Andic, Cagatay; Tufan, Kadir; 0000-0002-5957-8611; 0000-0003-2854-941X; 0000-0001-9627-3502; 0000-0001-8581-8685; 33890450; AAJ-5381-2021; P-5895-2018; AAK-1876-2021; AAM-1671-2021Background/aim: We aimed to determine in which cases this procedure may be more effective based on the data of patients who underwent decompressive hemicraniectomy (DHC). Material and methods: Overall, 47 patients who underwent DHC due to acute middle cerebral artery (MCA) infarction between January 2014 and january 2019 were retrospectively investigated. These patients were divided into two groups: those who died after DHC (Group A) and those who survived DHC (Group B). The groups were compared in terms of various parameters. We investigated whether the patient's modified Rankin scale (mRS) status changed depending on age (> 60 and < 60 years). Results: The median age of all patients was 65 (37-80) years; groups A and B had median ages of 66.5 (37-80) and 61 (44-79) years (p = 0.111), respectively; 55.3% patients were male. The elapsed times until hospitalization after the onset of symptoms were 4.5 and 3 h in groups A and B, respectively (p = 0.014). The median GCS score at the time of admission was 7 (5-12) and 10 (8-14) in groups A and B, respectively (p = 0.0001). At the time of admission, 63.3% patients in group A had anisocoria, whereas no patient in group B had anisocoria (p = 0.0001). In postoperative period, 40% patients in group A and all patients in group B received AC/AA treatment. The survival of patients aged < 60 and > 60 years who underwent DHC for MCA infraction was 61.5% and 26.5%, respectively (p = 0,041). The median mRS of patients < 60 and > 60 years were 4 (1-6) and 6 (1-6), respectively (p = 0.018). Conclusion: Age, DHC timing, and elapsed time until hospitalization or access to treatment directly affect the functional outcome and survival in MCA-infarcted patients who underwent DHC. In patients in whom the medical treatment fails, early DHC administration will increase survival without waiting for neurological worsening once herniation is detected radiologically.Item Acute-Phase Stroke Outcome and Lipids(2021) Kaya, Ahmet; 35317377Objectives: The aim of the study is to investigate the relationship of lipid subgroups with short-term mortality in acute stroke (AS). Methods: This retrospective study included 698 patients with AS who presented within 24 h of symptom onset. A hemogram from peripheral venous blood samples was taken at admission. Total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low- density lipoprotein cholesterol (LDL- C), TC/HDL-C rate, and TG/HDL-C rate were recorded. Duration of follow-up was defined as 30 days. Results: 64 out of 698 patients died during the follow-up period. The mean TG, TG/HDL-C, and TC/HDL-C levels were significantly lower in the mortality group than the survival group. In the receiver operating characteristic (ROC) analysis, the cutoff values and area under the curve of the TG, TG/HDL-C, TC, and TC/HDL- C levels for short-term stroke mortality are as follows ([100.2 mg/dL, 0.648]; [2.52, 0.650]; [170.50 mg/dL, 0.598]; and [4.32, 0.640], respectively). In the Cox regression model, only TG and TG/HDL-C, according to their ROC cutoff values, were independent variables as short-term mortality predictors ( TG =100.2 mg/dL, HR:2.413, 95% CI: 1.345-4.327, P:0.004); ( TG/HDL =2.56, HR: 2.720, 95% CI: 1.389-5.359, P:0.003, respectively). Conclusion: Dyslipidemia is a well-known as a risk factor of stroke. However, this study focused on the estimation that lower TG and TG/HDL-C levels at the time of hospital admission might be predictors of short-term mortality within a month of AS attack, which is a different subject from long term risk factors of stroke. Serum TG level may be a better indicator for mortality in the acute hypercatabolic trauma such as stroke.Item Effects of Bihemispheric Transcranial Direct Current Stimulation on Upper Extremity Function in Stroke Patients: A randomized Double-Blind Sham-Controlled Study(2020) Alisar, Dilek Cetinkaya; Ozen, Selin; Sozay, Seyhan; 0000-0002-8460-7699; 0000-0002-7290-8558; 0000-0002-9610-2153; 31699572; AAJ-2936-2021; ABC-1305-2020Background and Purpose: Transcranial direct current stimulation (tDCS) is a treatment used in the rehabilitation of stroke patients aiming to improve functionality of the plegic upper extremity. Currently, tDCS is not routinely used in post stroke rehabilitation. The aim of this study was to establish the effects of bihemspheric tDCS combined with physical therapy (PT) and occupational therapy (OT) on upper extremity motor function. Methods: Thirty-two stroke inpatients were randomised into 2 groups. All patients received 15 sessions of conventional upper extremity PT and OT over 3 weeks. The tDCS group (n = 16) also received 30 minutes of bihemispheric tDCS and the sham group (n = 16) 30 minutes of sham bihemispheric tDCS simultaneously to OT. Patients were evaluated before and after treatment using the Fug1 Meyer upper extremity (FMUE), functional independence measure (FIM), and Brunnstrom stages of stroke recovery (BSSR) by a physiatrist blind to the treatment group Results: The improvement in FIM was higher in the tDCS group compared to the sham group (P = .001). There was a significant within group improvement in FMUE, FIM and BSSR in those receiving tDCS (P = .001). There was a significant improvement in FIM in the chronic (> 6months) stroke sufferers who received tDCS when compared to those who received sham tDCS and when compared to subacute stroke (3-6 months) sufferers who received tDCS/sham. Conclusions: Upper extremity motor function in hemiplegic stroke patients improves when bihemispheric tDCS is used alongside conventional PT and OT. The improvement in functionality is greater in chronic stroke patients.Item Post-stroke bilateral heterotopic ossification: An acute problem with long-lasting consequences(2020) Ozen, Selin; Senlikci, Huma Boluk; Yemisci, Oya Umit; 0000-0002-7290-8558; 0000-0002-0501-5127; 32584742; ABC-1305-2020; AAJ-8820-2021Heterotopic ossification (HO) is a complication of injury to the central nervous system in which production of lamellar bone within the soft tissues occurs resulting in pain, reduced range of motion ( ROM) and loss of functional capacity. Heterotopic ossification is rarely seen in stroke patients and mostly affects the paretic side. In this article, we present a case of established bilateral HO of the hips soon after stroke onset. A 77-year-old female patient with a five-month history of stroke presented to our rehabilitation clinic. Physical examination revealed sensorimotor aphasia, right-sided hemiplegia, bilateral painful limited ROM of the hips and left knee contracture. An anteroposterior X-ray of the pelvis revealed previously undiagnosed bilateral HO of the hips. The patient and her relatives declined operative interventions. The patient was discussed in the departmental meeting and it was agreed that she would not be able to partake in an active inpatient rehabilitation program. She was discharged with a home exercise plan. This case highlights the importance of HO, of both the paretic and non-paretic side, being included in the differential diagnosis of post-stroke patients presenting with joint pain and reduced ROM, both acutely and in the long-term. This may aid the timely diagnosis and management of HO, a pathology which has detrimental effects on functionality.Item A CASE OF ISCHAEMIC STROKE FOLLOWING CERASTES CERASTES SNAKE BITE IN LIBYA(2020) Ozen, Selin; Guzel, Sukran; 0000-0001-9852-0917; 0000-0002-7290-8558; AAG-3148-2021; ABC-1305-2020Background: Cerastes cerastes is a venomous species of viper native to the deserts of northern Africa and parts of the Middle East. Reported cases of ischaemic stroke following a Cerastes cerastes bite are extremely few. Here we describe a case of ischaemic stroke occurring four days after envenomation by C.cerastes. Case presentation: A 26-year-old male was admitted to our rehabilitation unit with a history of ischaemic stroke and right sided hemiplegia. Four months previously he had been bitten by a C.cerastes viper in Libya. Four days after envenomation the patient developed sudden onset of aphasia and right sided weakness. Brain magnetic resonance imaging (MRI) revealed ischaemia in the territory of the left middle cerebral artery. On admission to our hospital, routine blood tests, coagulopathy and vasculitis screening was normal. Colour doppler ultrasound imaging of the carotid and vertebral arteries, MR angiography, transthoracic and transoesophageal echocardiography and Holter electrocardiogram were normal. A daily dose of aspirin 100 mg and physical therapy program was commenced. Conclusion: Only three cases of ischaemic stroke following C.cerastes bite have been reported in the literature. Hypotension, endothelial injury, hypercoagulability and vasculitis have been suggested as possible mechanisms for its occurrence. This probable case of stroke due to envenomation shows that stroke may occur as late as four days after the snake bit and highlights the importance of early administration of antivenom. Patient education on this subject maybe considered an important public health issue in areas of Africa and Asia in which viper bites occur.Item Glucagon-Like Polypeptide-1 and Brain(2020) Bakiner, Okan Sefa; Ozsahin, Akadli KursadGlucagon-like polypeptide-1 has specific effects on the central nervous system, including regulation of glucose metabolism, positive cardiovascular effects, slowing intestinal motility, immune modulation, and regulation of appetite and energy expenditure. Recently, positive effects of GLP-1 on brain energy utilization, inhibition and restoration of neurodegeneration, response to stress, and protection against ischemic neuron damage have been demonstrated. Herein, the effects of glucagon-like polypeptide-1 on the central nervous system will be discussed.Item Does the presence of ideomotor apraxia in stroke patients adversely affect rehabilitation outcomes? A prospective study(2020) Cosar, Sacide Nur Saracgil; Ozen, Selin; Selcuk, Selin Taflan; Yemisci, Oya Umit; 0000-0001-8306-463X; AAF-1085-2021Background and Objectives: Ideomotor apraxia is an inability to perform a gesture following a verbal command despite having intact knowledge of the task. The presence of ideomotor apraxia may negatively affect functional outcome of stroke patients. The aim of this study was to evaluate the effect of ideomotor apraxia on rehabilitation outcomes following first ever stroke. Methods: A cross sectional observational study of 35 stroke patients admitted to a rehabilitation unit for treatment. Patients were evaluated for ideomotor apraxia using the ideomotor apraxia test. Function was assessed before and after treatment using the Functional Independence Measure, motricity index and functional ambulation scale. Cognitive function was evaluated using the Functional Independence Measure and mini mental state examination. Results: Ideomotor apraxia was present in 31.4% of patients. Mean Functional Independence Measure motor and cognitive scores of apraxic patients on admission and at discharge were lower than those of non-apraxic patients, (p<0.05). The cognitive and total Functional Independence Measure scores and motricity scores in the ideomotor apraxia group on discharge had not reached the admission values of the non-ideomotor apraxia group. Conclusion: The presence of ideomotor apraxia following stroke has a negative impact on overall function, both before and after rehabilitation, when compared to stroke patients without ideomotor apraxia. Stroke patients must be assessed for ideomotor apraxia prior to commencement of a rehabilitation program in order to guide treatment and determine realistic treatment goals.Item Antithrombotic treatment patterns and stroke prevention in patients with atrial fibrillation in Turkey: Inferences from GARFIELD-AF registry(2019) Sayin, Begum Yetis; Okutucu, Sercan; Yilmaz, Mehmet Bircan; Ozdemir, Kurtulus; Aydinlar, Ali; Sahin, Durmus Yildiray; Altun, Armagan; Acikel, Sadik; Okuyan, Ertugrul; Sucu, Murat; Ongen, Zeki; Ersanli, Murat Kazim; Yilmaz, Ozcan; Demir, Mesta; Pekdemir, Hasan; Topsakal, Ramazan; Sahiner, Mehmet Levent; Aras, Dursun; Oto, Ali; 31062761; ABB-5844-2020Objective: The corner stone of atrial fibrillation therapy includes the prevention of stroke with less adverse effects. The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) study provided data to compare treatment strategies in Turkey with other populations and every-day practice of stroke prevention management with complications. Methods: GARFIELD-AF is a large-scale registry that enrolled 52,014 patients in five sequential cohorts at > 1.000 centers in 35 countries. This study was initiated to track the evolution of global anticoagulation practice, and to study the impact of NOAC therapy in AF. A total of 756 patients from 17 enrolling sites in Turkey were in cohort 4 and 5. Treatment strategies at diagnosis initiated by CHA(2)DS(2)-VASc score, baseline characteristics of patients, treatment according to stroke and bleeding risk profiles, and INR values were analyzed in cohorts. Additionally, event rates during the first year follow up were evaluated. Results: AF patients in Turkey were mostly seen in young women. Stroke risk according to the CHADS(2) score and CHA(2)DS(2)-VASc score compared with world data. The mean of risk score values, including HAS-BLED score were lower in Turkey than in the world data. The percentage of patients receiving FXa inhibitor with or without an antiplatelet usage was more than the other drug groups. All-cause mortality was higher in Turkey. Different form world data when HAS-BLED score was above 3, the therapy was mostly changed to antiplatelet drugs in Turkey. Conclusion: In addition to deficiencies in available treatment options, patient care and clinical outcomes of patients with AF, the data of GARFIELD-AF provide data from Turkey about therapeutic strategies and best practices.