Fakülteler / Faculties
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Item Aspirin Resistance in Cerebrovascular Disease and the Role of Glycoprotein IIIa Polymorphism in Turkish Stroke Patients(2016) Derle, Eda; Ocal, Ruhsen; Kibaroglu, Seda; Celikkol, Ceyda; Bayraktar, Nilufer; Verdi, Hasibe; Atac, Belgin F.; Can, Ufuk; https://orcid.org/0000-0002-3964-268X; https://orcid.org/0000-0002-7886-3688; https://orcid.org/0000-0003-0591-009X; https://orcid.org/0000-0001-6868-2165; https://orcid.org/0000-0001-8689-417X; 26809135; V-3553-2017; AAJ-2956-2021; Y-8758-2018; V-5499-2017; ABG-9966-2020; AAJ-2999-2021Aspirin resistance occurs in 5-45% of high-risk patients, with various mechanisms proposed for its development. This study aimed to determine the relationships among aspirin resistance, aspirin dosage, type of aspirin and glycoprotein IIIa P1A1/A2 polymorphism in patients with vascular risk factors. Two hundred and eight (75 symptomatic, 133 asymptomatic) patients with vascular risk factors who were using aspirin for primary or secondary prevention were prospectively included. The symptomatic group was further classified into two groups according to aspirin use at the time of stroke. Aspirin resistance was measured by the PFA-100 system (collagen/epinephrine cartridge) and glycoprotein IIIa P1A1/A2 polymorphism was determined by PCR. The overall prevalence of aspirin resistance was 32.2%. The mean age of patients with aspirin resistance was significantly higher than that in those who did not have resistance (P=0.009). The prevalence of aspirin resistance was similar for the symptomatic and asymptomatic under aspirin therapy groups. The resistance rate was found to be highest with 100mg enteric-coated preparation use (39.3%). Increasing the aspirin dosage and/or shifting to uncoated preparations caused a change in aspirin sensitivity of 36-60%. Repeated measurements showed development of aspirin resistance in 14% of patients who were sensitive to aspirin in previous measurements. Glycoprotein IIIaP1A1/A2 polymorphism, aspirin resistance and development of atherothrombotic stroke were not significantly related. The effect of aspirin can change by time, dosage and type of preparation used. There are no relationships among glycoprotein IIIa P1A1/A2 polymorphism, aspirin resistance and development of atherothrombotic stroke. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.Item Association between Hypoxia Parameters with White Matter Hyperintensity and Silent Cerebral Infarcts on Brain Magnetic Resonance Images in Patients with Obstructive Sleep Apnea(2016) Avci, Aynur Yilmaz; Avci, Suat; Lakadamyali, Huseyin; Lakadamyali, Hatice; Can, Ufuk; 0000-0003-2155-8014; 0000-0001-9004-9382; 0000-0001-8689-417X; O-3636-2018; F-6770-2019; AAJ-2999-2021Objective: This study evaluated the association between hypoxia parameters with white matter hyperintensity (WMH) and silent cerebral infarcts (SCI) on brain magnetic resonance (MR) images of patients with obstructive sleep apnea (OSA). Methods: In this retrospective study, the study group was composed of 453 patients who were evaluated by overnight polysomnography (PSG). Data on hypoxia parameters, such as total sleep duration with oxygen saturation < 90% (ST90), percentage of cumulative time with oxygen saturation < 90% (CT90), and the lowest oxygen saturation (min SaO(2)), were obtained from PSG. The presence of WMH and SCI was evaluated in all participants using brain MR images. Results: Hypoxia parameters, such as ST90, CT90, and min SaO(2), were significantly associated with WMH (P < 0.001). The multiple regression analysis showed that CT90 was independently associated with SCI (P = 0.038). In addition, when participants were divided into two groups according to CT90 < 10% and CT90 = 10%, age (P = 0.002), sex (P = 0.015), body mass index, Apnea-Hypopnea Index score, Epworth Sleepiness Scale score, and the presence of WMH, hypertension, and diabetes mellitus were significantly higher in the CT90 = 10% group compared with the CT90 < 10% group (P < 0.001 for all parameters). CT90 = 10% increased the risk of WMH 2.34-fold (95% confidence interval, 1.44-3.85; P = 0.006). Conclusion: The severity of nocturnal intermittent hypoxia may contribute to the pathogenesis of WMH and SCI in patients with OSA.Item Alteratıon of Mean Platelet Volume in The Pathogenesıs of Acute Ischemıc Stroke: Cause or Consequence?(2018) Ayas, Zeynep Ozozen; Can, Ufuk; https://orcid.org/0000-0001-8689-417X; 29465900; AAJ-2999-2021Introduction - Platelets have a crucial role on vascular disease which are involved in pathogenesis of ischemic stroke. Platelet size is measured as mean platelet volume (MPV) and is a marker of platelet activity. Platelets contain more dense granules as the size increases and produce more serotonin and tromboglobulin (p-TO) than small platelets. In this study, the alteration of MPV values were investigated in patients with acute stroke, who had MPV values before stroke, during acute ischemic stroke and 7 days after the stroke. The relationship between this alteration and risk factors, etiology and localization of ischemic stroke were also investigated. Methods - Sixty-seven patients with clinically and radiologically established diagnoses of ischemic stroke were enrolled into the study and stroke etiology was classified by modified Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification and, modified Bamford classification was used for localization and stroke risk factors were also evaluated. The platelet counts and MPV values from patient files in patients who had values before stroke (at examination for another diseases), within 24 hours of symptom onset and after 7 further days were analysed. Results - MPV values increased after stroke (10.59 +/- 2.26) compared with acute stroke values (9.84 +/- 1.64) and the values before stroke (9.59 +/- 1.72) (p<0.0001); this alteration of MPV values occured 7 days after stroke (p<0.016). There was a positive correlation between age and MPV values during acute stroke (r=0.270; p<0.05). Patients with atrial fibrillation had higher alteration in the time of MPV compared with patients without atrial fibrillation (p>0.006). We assessed for gender, men (n=38) had a higher alteration in the time of MPV compared with women (n=29) (p=0.013). Conclusion - Although there was no alteration of platelet counts, MPV values were increased 7 days after stroke in patients with acute ischemic stroke.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 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 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 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.