Fakülteler / Faculties
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Item Do Mean Platelet Volume and Platelet Distribution Width Have An Association with White Matter Hyperintensities in Migraine Patients?(2023) Iyigundogdu, Ilkin; Derle, Eda; 37970292Objective: Increased prevalence of white matter hyperintensities (WMH) is reported in migraine patients; however, the pathophysiology and the progression of these lesions are not definitely clear. Mean platelet volume (MPV) and platelet distribution width (PDW) are easily obtained markers for platelet activity. The aim of this study is to evaluate the relationship between the presence of WMH and MPV and PDW in patients with migraine in order to determine the role of platelet activity in the pathophysiology of WMH.Methods: Patients who were admitted to the neurology outpatient clinics of Baskent University Hospital from January 2011 to December 2015 with migraine and between 18 and 55 years of age were evaluated retrospectively. The blood samples were taken and total blood count parameters including MPV and PDW were analyzed. Brain magnetic resonance images were evaluated.Results: Totally, 218 patients were evaluated in this study. Forty-eight (22.0%) patients had WMH in the brain magnetic resonance imaging. In patients with WMH, the median of age was higher than the patients without WMH and the difference was statistically significant (P < 0.05). There was no statistically significant difference between MPV, PDW values, and the presence of WMH.Conclusions: There are multiple theories suggested for the mechanism of WMH, but the major cause and pathophysiology are still undetermined. Our data suggested that increased platelet activity is insufficient by itself to explain the pathophysiology of WMH in migraine patients and to improve the knowledge on this issue further large longitudinal studies should be performed.Item Neutrophil to lymphocyte ratio, stroke severity and short term clinical outcomes in acute ischemic stroke(2021) Iyigundogdu, Ilkin; Derle, Eda; Kibaroglu, Seda; Can, Ufuk; 0000-0001-7860-040X; 0000-0002-3964-268X; AAJ-2053-2021; AAJ-2956-2021Background: Neutrophil to lymphocyte ratio is an easily evaluated systemic inflammation indicator. However, there are limited reports on neutrophil to lymphocyte ratio and functional outcome in ischemic stroke. In this study, we aimed to evaluate the association of neutrophil to lymphocyte ratio and stroke severity, short term functional outcomes and mortality in patients with acute ischemic stroke. Methods: The clinical data of patients who were > 18 age-old and hospitalized with acute ischemic stroke in Baskent University Hospital, Ankara, Turkey between January 2018 and May 2019 were studied retrospectively. Neutrophil to lymphocyte ratio were measured. The neutrophil to lymphocyte ratio and National Institute of Health Stroke Scale (NIHSS) score at admission, mortality during hospitalization and Modified Rankin Scale (mRS) score at discharge of the patients with acute ischemic stroke were correlated. Results: Among the acute ischemic stroke patients due to the exclusion criteria, the data of 134 patients were evaluated. Median age of the patients were 76 +/- 12.5 years and 82 patients (61.2%) were male. The median NIHSS scores of the patients at admission was 5 +/- 4.5. Mortality during the hospitalization was seen in 8 patients (6%). The median neutrophil to lymphocyte ratio value of the patients at admission were found to be 2.6 +/- 3.4. Neutrophil to lymphocyte ratio and NIHSS scores of the patients at admission, duration of the hospitalization, mRS scores at discharge and mortality during hospitalization were found to be positively correlated. Conclusion: Neutrophil to lymphocyte ratio is a simple and easily measured marker and can be used as a potential indicator for prognosis in acute ischemic stroke. However further prospective multicenter investigations are required to confirm the role of neutrophil to lymphocyte ratio for predicting the prognosis in acute ischemic stroke patients.Item Hyperprolactinemia and galactorrhea with duloxetine in neuropathic pain management(2021) Derle, Eda; Can, Ufuk; 34671951Duloxetine is a serotonin-norepinephrine reuptake inhibitor that is widely used in chronic pain treatment in various diseases. Hyperprolactinemia and galactorrhea are rare side effects of this medication. Here, we reported a 34-year-old female with multiple sclerosis who used duloxetine for pain management and mood disorder and experienced galactorrhea.Item Clinical results of carotid artery stenting versus carotid endarterectomy(2016) Derle, Eda; Akinci, Tuba; Kibaroglu, Seda; Harman, Ali; Kural, Feride; Cinar, Pinar; Kilinc, Munire; Akay, Hakki T.; Can, Ufuk; Benli, Ulku S.; 0000-0002-7386-7110; 0000-0002-4226-4034; 0000-0002-9975-3170; 0000-0003-2122-1016; 0000-0002-3964-268X; 0000-0001-8689-417X; 27744460; AAI-8830-2021; AAJ-2956-2021; K-9824-2013; AAL-9808-2021; AAJ-4403-2021; AAJ-2999-2021Objective: To review our results of carotid artery stenting (CAS) and carotid endarterectomy (CEA). Methods: We evaluated the medical records of patients undergoing carotid artery revascularization procedure, between 2001 and 2013 in Baskent University Hospital, Ankara, Turkey. Carotid artery stenting or CEA procedures were performed in patients with asymptomatic carotid stenosis (=70%) or symptomatic stenosis (=50%). Demographic data, procedural details, and clinical outcomes were recorded. Primary outcome measures were in 30-day stroke/transient ischemic attacks (TIA)/amaurosis fugax or death. Secondary outcome measures were nerve injury, bleeding complications, length of stay in hospital, stroke, restenosis (ICA patency), and all-cause death during long-term follow-up. Results: One hundred ninety-four CEA and 115 CAS procedures were performed for symptomatic and/or asymptomatic carotid artery stenosis. There is no significant differences 30-day mortality and neurologic morbidity between CAS (13%) and CEA procedures (7.7%). Length of stay in hospital were significantly longer in CEA group (p=0.001). In the post-procedural follow up, only in symptomatic patients, restenosis rate was higher in the CEA group (p=.045). The other endpoints did not differ significantly. Conclusions: Endovascular stent treatment of carotid artery atherosclerotic disease is an alternative for vascular surgery, especially for patients that are high risk for standard CEA. The increasing experience, development of cerebral protection systems and new treatment protocols increases CAS feasibility.Item Spontaneous Spinal Subarachnoid Hemorrhage with Residual Arachnoid Cyst: A Case Report(2017) Derle, Eda; Iyigundogdu, Ilkin; Yilmaz, Cem; 0000-0003-2122-1016; 0000-0001-7860-040X; 0000-0002-2353-8044; 27593750; AAI-8830-2021; AAJ-2053-2021; AAK-2948-2021Spinal subarachnoid hemorrhage is a rare condition that usually occurs because of secondary causes and idiopathic spontaneous ones are extremely rare. We report a 56-year-old woman who presented with severe headache, neck pain and urinary retention. Magnetic resonance imaging revealed subarachnoid hemorrhage that extended from T1 to lumbar vertebrae. She was treated conservatively and symptoms were resolved within 1 month. An asymptomatic arachnoid cyst was observed on the follow-up magnetic resonance imaging after 3 months with no neurologic deterioration. She was still stable clinically and radiologically at the end of 19 months. Spinal subarachnoid hemorrhage is a surgical emergency, although in some cases a conservative approach may be useful.Item Vasküler risk faktörleri bulunan asemptomatik ve semptomatik hastalarda aspirin direnci ve trombosit glikoprotein IIIa gen polimorfizminin rolü(Başkent Üniversitesi Tıp Fakültesi, 2007) Derle, Eda; Can, UfukVasküler hastalıklardan korunmada yaygın olarak kullanılan aspirin, her hastada istenen etkinliği gösterememekte ve aspirin tedavisi altında tekrarlayıcı iskemik olaylar görülebilmektedir. Gelisiminde birçok mekanizmanın öne sürüldüğü, “aspirin direnci” olarak tanımlanan bu durumun sıklığı, yüksek riskli hastalarda %5-45 olarak bildirilmektedir. Çalısmamız vasküler risk faktörleri bulunan hastalarda, aspirin direnci oranı ile aspirin dozu, preparat özelliği ve glikoprotein IIIa PlA1/A2 polimorfizmi arasındaki iliskiyi belirlemek amacıyla planlanmıstır. Vasküler risk faktörü bulunan, birincil ya da ikincil korunma için aspirin kullanan 208 hasta çalısmaya alındı. Hastalar aspirin kullanımlarına ve kliniklerine göre gruplandırıldı. Akut iskemik inme kliniği ile basvuran 75 hasta semptomatik, inme dısı nedenlerle takip edilen 133 hasta ise asemptomatik kabul edildi. Semptomatik olan hastalar, inme sırasındaki aspirin kullanma durumlarına göre iki gruba ayrıldı. Hastalarda PFA-100 sistemi (Col/Epi kartusu) ile aspirin direnci ölçüldü ve glikoprotein IIIa PlA1/A2 polimorfizmleri PCR tekniği ile belirlendi. Tüm gruplar bir arada değerlendirildiğinde aspirin direnci oranı %32,2 olarak saptandı. Direnç saptanan hastaların yas ortalaması istatistiksel olarak anlamlı oranda yüksekti (p=0,009). Asemptomatik grup ile “aspirin kullanırken semptomatik olan” grubun direnç oranları benzerdi. En yüksek direnç oranı (%39,3)100 mg enterik kaplı preparat kullanan hastalarda saptandı. Aspirin dozunun artırılması ve/veya enterik kaplı olmayan preparatlara geçilmesi %36 ile %60 arasında değisen oranlarda aspirine duyarlılık sağladı. Daha önce aspirine duyarlı olduğu gösterilen hastalarda tekrarlayan ölçümlerde zaman içinde %14 oranında aspirin direnci gelisimi olduğu gözlendi. GpIIIa PlA1/A2 polimorfizmi ile aspirin direnci ve aterotrombotik inme gelisimi arasında anlamlı iliski saptanmadı. Sonuç olarak aspirinin etkisinde doz ve preparat özelliğine bağlı olarak ve zaman içinde değisiklik görülebilmektedir. GpIIIa PlA1/A2 polimorfizmi ile aspirin direnci ve aterotrombotik inme gelisimi arasında iliski gösterilememistir. Aspirin, a widely used drug for prevention from vascular diseases, may not reveal the desired effect in all patients and recurrent ischemic events may occur despite aspirin therapy. Defined as “aspirin resistance”, this entity is reported in 5–45% of high risk patients and various mechanisms have been proposed for its development. This study is planned to determine whether there is a relationship between aspirin resistance and aspirin dosage, preparation type and glycoprotein IIIa P1A1/A2 polymorphism in patients with vascular risk factors. 208 patients with vascular risk factors, using aspirin for primary or secodary prevention were included.in the study. Patients were classified according to their clinical presentations and aspirin usage. Seventy-five patients, with acute ischemic stroke presentation were grouped as symptomatic and the remaining 133 patients were grouped as asymptomatic. Symptomatic group was further classified into two groups, according to the aspirin usage status at the time of stroke. Aspirin resistance was measured by PFA-100 system (Col/Epi cartridge) and glycoprotein IIIa P1A1/A2 polymorphism were determined by PCR. The overall prevalance of aspirin resistance was 32,2%. The mean age of patients with aspirin resistance were significantly higher (p=0,009). The prevalance of aspirin resistance were similar for both “symptomatic under aspirin therapy” and asymptomatic groups. The resistance rate was found to be highest with 100 mg enteric coated preparation usage (39,3%). Increasing the aspirin dosage and/or shifting to non-enteric coated preparations revealed aspirin sensitivity change between 36% and 60%. Repeated measurements revealed aspirin resistance development in time course in 14% of patients shown to be aspirin sensitive before. No significant relationship between glycoprotein IIIa P1A1/A2 polymorphism and aspirin resistance and atherotrombotic stroke development is found. In conclusion, the effect of aspirin can change by time, dosage and preparation.type used. A relationship between glycoprotein IIIa P1A1/A2 polymorphism and aspirin resistance and atherotrombotic stroke development cannot be found.