Fakülteler / Faculties
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Item Is 25(OH)D Associated with Cognitive Impairment and Functional Improvement in Stroke? A Retrospective Clinical Study(2015) Yalbuzdag, Seniz Akcay; Sarifakioglu, Banu; Afsar, Sevgi Ikbali; Celik, Canan; Can, Asli; Yegin, Tugba; Senturk, Burcu; Guzelant, Aliye Yildirim; 0000-0002-4003-3646; 25922112; E-2103-2019Background: In recent years, vitamin D deficiency has been suggested as a risk factor for ischemic stroke and stroke severity in both animal models and clinical studies. In this retrospective study, we investigated the relationship between 25-hydroxyvitamin D [25(OH)D] levels and functional outcomes in stroke patients during neurological rehabilitation program. We also investigated whether there is an association between 25(OH)D levels and cognitive impairment. Methods: The study included the medical records of 120 stroke patients who participated in a neurological rehabilitation program. The motor and cognitive components of the Functional Independence Measurements of all patients at admission and discharge were recorded. The Functional Ambulatory Scale was used to assess motor functional status, and the Turkish-validated version of the minimental state examination test was used to assess cognitive status. Results: A significant correlation was found between 25(OH)D level and cognitive impairment among patients who had ischemic strokes. High levels of 25(OH)D were associated with greater functional gain during the rehabilitation program in both ischemic stroke patients and hemorrhagic stroke patients. Conclusions: High 25(OH)D levels might be associated with greater functional improvement and with less cognitive impairment in stroke patients.Item Gastrostomy in Hospitalized Patients with Acute Stroke: "NoroTek" Turkey Point Prevalence Study Subgroup Analysis(2022) Arlier, Zulfikar; Can, UfukObjective: 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 PrevAleNce and Associated Factors of InappropriaTe Dosing of Direct Oral AnticoaguLants in PAtients with Atrial Fibrillation: the ANATOLIA-AF Study(2022) Coner, Ali; https://orcid.org/0000-0002-5711-8873; 36527566; ABD-7321-2021Purpose Inappropriate dosing of direct oral anticoagulants is associated with an increased risk of stroke, systemic embolism, major bleeding, cardiovascular hospitalization, and death in patients with atrial fibrillation. The main goal of the study was to determine the prevalence and associated factors of inappropriate dosing of direct oral anticoagulants in real-life settings.Methods This study was a multicenter, cross-sectional, observational study that included 2004 patients with atrial fibrillation. The study population was recruited from 41 cardiology outpatient clinics between January and May 2021. The main criteria for inappropriate direct oral anticoagulant dosing were defined according to the recommendations of the European Heart Rhythm Association.Results The median age of the study population was 72 years and 58% were women. Nine-hundred and eighty-seven patients were prescribed rivaroxaban, 658 apixaban, 239 edoxaban, and 120 dabigatran. A total of 498 patients (24.9%) did not receive the appropriate dose of direct oral anticoagulants. In a logistic regression model, advanced age, presence of chronic kidney disease and permanent atrial fibrillation, prescription of reduced doses of direct oral anticoagulants or edoxaban treatment, concomitant use of amiodarone treatment, and non-use of statin treatment were significantly associated with potentially inappropriate dosing of direct oral anticoagulants.Conclusion The study demonstrated that the prevalence of inappropriate direct oral anticoagulant dosing according to the European Heart Rhythm Association recommendations was 24.9% in patients with atrial fibrillation. Several demographic and clinical factors were associated with the inappropriate prescription of direct oral anticoagulants.Item SARS-Cov-2 Infection Might Be A Predictor of Mortality in Intracerebral Hemorrhage(2023) Mowla, Ashkan; Shakibajahromi, Banafsheh; Shahjouei, Shima; Baharvahdat, Humain; Harandi, Ali Amini; Rahmani, Farzad; Mondello, Stefania; Rahimian, Nasrin; Cernigliaro, Achille; Hokmabadij, Elyar Sadeghi; Ebrahimzadeh, Seyed Amir; Ramezani, Mahtab; Mehrvar, Kaveh; Farhoudi, Mehdi; Naderi, Soheil; Fenderi, Shahab Mahmoudnejad; Pishjoo, Masoud; Alizada, Orkhan; Purroy, Francisco; Requena, Manuel; Tsivgoulis, Georgios; Zand, Ramin; 36455388Background: SARS-CoV-2 infection may be associated with uncommon complications such as intracerebral hemorrhage (ICH), with a high mortality rate. We compared a series of hospitalized ICH cases infected with SARS-CoV-2 with a non-SARS-CoV-2 infected control group and evaluated if the SARS-CoV-2 infection is a predictor of mortality in ICH patients.Methods: In a multinational retrospective study, 63 cases of ICH in SARS-CoV-2 infected patients admitted to 13 tertiary centers from the beginning of the pandemic were collected. We compared the clinical and radiological characteristics and in-hospital mortality of these patients with a control group of non-SARS-CoV-2 infected ICH patients of a previous cohort from the country where the majority of cases were recruited.Results: Among 63 ICH patients with SARS-CoV-2 infection, 23 (36.5%) were women. Compared to the non-SARS-CoV-2 infected control group, in SARS-CoV-2 infected patients, ICH occurred at a younger age (61.4 +/- 18.1 years versus 66.8 +/- 16.2 years, P = 0.044). These patients had higher median ICH scores ([3 (IQR 2-4)] versus [2 (IQR 1-3)], P = 0.025), a more frequent history of diabetes (34% versus 16%, P = 0.007), and lower platelet counts (177.8 +/- 77.8 x 109/L versus 240.5 +/- 79.3 x 109/L, P < 0.001). The in-hospital mortality was not significantly different between cases and controls (65% versus 62%, P = 0.658) in univariate analysis; however, SARS-CoV-2 infection was significantly associated with in-hospital mortality (aOR = 4.3, 95% CI: 1.28-14.52) in multivariable analysis adjusting for potential confounders.Conclusion: Infection with SARS-CoV-2 may be associated with increased odds of in-hospital mortality in ICH patients.Item The Correlation of TWEAK Level And with Involved Area on MRI in Stroke(2017) Yilmaz, Muhittin Serkan; Yilmaz, Murat; Isik, Bahattin; Yel, Cihat; Kavalci, Cemil; Demirci, Burak; Inan, Selim; Kavak, Rasime Pelin; Balamir, Ilhan; Turhan, Turan; 0000-0003-2529-2946; 0000-0001-6658-7260; AGG-1308-2022; AAD-2829-2021; ABG-1934-2020The aim of this study was to value of TWEAK protein in stroke diagnosis and the correlation between Tweak level and lesion size on diffusion MRI in patients admitted to emergency department for acute stroke. Our study was prospectively conducted in a group of patients diagnosed with stroke in the emergency department and a control group between 1 June 2014 and 31 August 2014. Age, sex, vital parameters, comorbid conditions, neurological deficit level, Tweak level, and involved volume on D-MRI were analyzed. Age, sex, vital parameters, comorbid conditions, and Tweak levels were compared between the patient and control groups. Tweak level was compared with neurological deficit and diffusion on D-MRI imaging in the patient group. The results were evaluated in a confidence interval of 95% and at a significance level of p<0.05. There were no significant differences between both groups with respect to age and sex distribution. The median Tweak level of the patient group was significantly higher (912.1 pg/ml vs 808.3 pg/ml, p<0.05). In the patient group NIHSS score had a positive correlation to MRI lesion size (p<0.05) but not to Tweak level (p>0.05). There was no correlation between Tweak level and the involved area on diffusion MRI (p>0.05). In conclusion, Tweak appears as a parameter that can be used in patients with a clinical presentation consistent with Stroke. It can be used for diagnostic purposes when cranial CT does not support the diagnosis or for supporting diagnosis when D-MRI is not available.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 Treatment of Left Ventricular Assist Device Thrombosis: Single-Center Experience(2018) Beyazpinar, D. Sarp; Ersoy, Ozgur; Gultekin, Bahadir; Aliyev, Anar; Avsever, Mert; Akay, H. Tankut; Ozkan, Murat; Sezgin, Atilla; Aslamaci, Sait; 29528019; ABA-9675-2021; ABA-7388-2021Heart failure is the one of the biggest health problem in the world. Because of limited donors for heart transplant procedures, the ventricular assist device has become a solution for heart failure therapy. With the increase in number of ventricular assist devices, the incidence of complications has also increased. One of the most important life-threatening complications is ventricular assist device thrombosis. Medical therapy and changes in the ventricular assist device are the main therapy methods for ventricular assist device thrombosis. In this study, we showed our clinical experience with treatment of ventricular assist device thrombosis.Item Neurologic Complications After Pediatric Heart Transplant: A Single-Center Experience(2022) Orgun, Ali; Erdogan, Ilkay; Varan, Birgul; Sezer, Taner; Tokel, N. Kursad; Ozkan, Murat; Sezgin, Atilla; 33797352Objectives: Neurologic complications that can lead to serious mortality and morbidity in pediatric heart transplant recipients have been reported to range from 23.6% to 45%. In this study, the frequency, time, cause, and characteristics of neurologic complications in pediatric heart transplant recipients were evaluated. Materials and Methods: We retrospectively reviewed data of 37 pediatric heart transplant recipients aged <18 years who were seen at our hospital between 2007 and 2017. Medical records were reviewed to identify neurologic complications. Clinical features were compared between pediatric heart transplant patients with and without neurologic complications. Results: The rate of posttransplant neurologic complications in pediatric heart transplant was 27% (10/37). Median age of patients with neurologic complications was 12 years (range, 11-18 years). Median time for neurologic complications was 3 days (range, 2-46 days). Primary diagnoses of these 10 recipients were dilated cardiomyopathy (n = 7) and restrictive cardiomyopathy (n = 3). There were no significant differences between recipients with and without neurologic complications (P>.05). The etiologies of neurologic complications were posterior reversible encephalopathy syndrome in 3 patients (8.1%), stroke in 2 patients (5.4%), peripheral neuropathy in 2 patients (5.4%), hypertensive encephalopathy in 1 patient (2.7%), and drug encephalopathy in 1 patient (2.7%). Conclusions: Neurologic complications may lead to serious mortality and morbidity in pediatric heart transplant patients. Seizures, posterior reversible encephalopathy syndrome, stroke, peripheral neuropathy, transient ischemic attack, and cerebral infections are the most common neurologic complications, which are seen in the perioperative period in particular. Careful follow-up of pediatric heart transplant patients, with detection and early treatment of neurologic findings, will contribute to lower rates of sequelae. To our knowledge, this is the largest study to show a detailed experience of neurologic complications in pediatric heart transplant patients from a single center in Turkey.Item Computer Game Assisted Task Specific Exercises in the Treatment of Motor and Cognitive Function and Quality of Life in Stroke: A Randomized Control Study(2021) Ozen, Selin; Senlikci, Huma Boluk; Guzel, Sukran; Yemisci, Oya Umit; 0000-0001-6771-3265; 0000-0002-7290-8558; 0000-0001-9852-0917; 34293643; AAX-8965-2021; ABC-1305-2020; AAG-3148-2021Objectives: Computer game assisted task specific exercises (CGATSE) are rehabilitation gaming systems (RGS) used in stroke rehabilitation to facilitate patient performance of high intensity, task based, repetitive exercises aiming to enhance neuroplasticity. CGATSE maybe an appealing option in home based rehabilitation of stroke patients, especially during the COVID-19 pandemic. This study aimed to determine the effects of CGATSE on hemiplegic arm-hand function, cognitive function and quality of life in stroke. Materials and methods: Thirty stroke patients were randomized into two groups. All participants received twenty sessions of physical therapy. In addition, the therapy group undertook thirty minutes of CGATSE using the Rejoyce gaming system; while the control group undertook thirty minutes of occupational therapy (OT). Motor function was evaluated before and after treatment using the Fugl Meyer upper extremity (FMUE), Brunnstrom stages of stroke recovery (BSSR) arm and hand. The CGATSE group also completed the Rejoyce arm hand function test (RAHFT). Cognitive function was evaluated using the mini mental state examination, Montreal Cognitive Assessment (MoCA) and Stroke Specific Quality of Life (SS-QOL) scale. Results: The FMUE, BSSR arm and SSQOL improved in both groups (p < 0.05). BSSR of the hand improved only in the CGATSE group (p = 0.024). RAHFT scores improved in the CGATSE group (p = 0.008). MoCA scores significantly improved in the control group (p = 0.008). Conclusions: CGATSE may be beneficial in providing continuation of care after stroke, especially during the Covid-19 pandemic when home based rehabilitation options are becoming increasingly important. Benefits of CGATSE in improving cognitive function is less clear. RGS aimed at improving motor function may be compared to gaming systems designed to target cognitive development and more detailed higher cortical function deficit tests can be used as outcome measures.