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Objective:It has been shown that pain, depression, and fatigue related to Obstructive Sleep Apnea syndrome (OSAS) results in a significant socioeconomic burden. We aimed to determine the prevalence, demographic, and clinical properties of pain symptoms in OSAS patients.Materials and Methods:We evaluated 84 OSAS patients diagnosed after full-night polysomnography with the Brief Pain Inventory, Beck Depression Rating scale (BDS), Pittsburg Sleep Quality index (PSQI), Epworth Sleepiness scale (ESS), Fatigue Impact scale (FIS), and Fatigue Severity scale (FSS).Results:A total of 84 patients (62 males, 22 females) with a mean age of 54.37±11.03 years were included. Headache in 25 (43.1%), myofascial pain in 22 (37.9%), and other types of pain in 11 patients were defined. ESS, FSS, FIS total, physical, cognitive, and psychosocial scores were found to be significantly higher in patients with pain. The presence of pain did not differ according to the severity of OSAS, and no significant difference was found in any parameters between mild, moderate, and severe OSAS except for minimal O2 saturation. A positive correlation between last week pain severity and BDS scores, a negative correlation between PSQI scores and the decrease in pain rate as a result of the treatment, and a weak positive correlation between FIS-cognitive sub-score and pain intensity scores were found.Conclusion:In our study, excessive daytime sleepiness and the impact and severity of fatigue were found to be higher in patients with pain than in those without pain. The most obvious difference was seen in terms of cognitive, and psychosocial fatigue. Contrary to expectations, it was observed that OSAS severity did not affect pain according to our data.

We compared copeptin levels in relapsing-remitting multiple sclerosis (RRMS) patients with controls and investigated how plasma copeptin levels were changed with the disease period. Thirty patients with RRMS without a prior attack in the last twelve months, and 19 RRMS patients with a clinical acute attack and 30 healthy individuals were included into the study. Copeptin levels were significantly higher in all RRMS patient groups than healthy controls. Plasma copeptin levels were higher in patients in remission period compared with relapse period of 19 RRMS patients with an acute attack. We consider copeptin can be used as a potential biomarker for RRMS.

Restless legs syndrome (RLS) is a common sensorimotor disorder that, in case of severe symptoms, can be very distressing and negatively interfere with quality of life. Moreover, increasing evidences associate RLS with higher risk of cerebrovascular and cardiovascular disease (CVD). The purpose of this study was to quantify two proteins, previously identified by proteomics and potentially linked with CVD risk, namely kininogen-1 (KNG1) and alpha-1-antitrypsin (A1AT), in primary RLS patients at high severity grade (HS-RLS) in comparison to healthy control subjects. Proteins were quantified through enzyme-linked immunosorbent assay (ELISA) in plasma samples from 14 HS-RLS patients and 15 control individuals. The two groups were closely matched for age and gender. The expression level of KNG1 resulted significantly higher (p

BACKGROUND Multiple sclerosis (MS) is a neuroinflammatory disease and inflammation and oxidative stress play important roles in its pathology. Thiol/disulphide homeostasis (TDH) is a special oxidative stress biomarker that has been found to be affected in several disorders including MS. There is no study demonstrating the effects of attack status of the relapsing-remitting multiple sclerosis (RRMS) patients on TDH levels. Our aim was to determine TDH levels in three different periods of RRMS patients and healthy individuals. METHODS The study was carried out in 29 patients with RRMS without a prior attack in the last twelve months (MS Control), 21 RRMS patients having a clinical acute attack within the last week (MS relapse), 12 of 21 MS relapse patients one month after the onset of attack and following 1000 mg methylprednisolone for 7 days (MS Remission) and 30 age- and sex-matched healthy individuals. TDH status was determined using an automated spectrophotometric analysis method. TDH levels in all patient groups and control subjects were compared with each other. RESULTS The lowest native thiol, total thiol levels and native thiol/total thiol ratio were found in the MS relapse patients in comparison to the MS control, MS remission groups and healthy controls. In contrast, disulphide levels, disulphide/native thiol and disulphide/total thiol ratios were highest in the MS relapse group compared to the other patient groups and healthy subjects. CONCLUSION Our findings indicate that increased oxidative stress in RRMS patients is reflected with decreased native and total thiol and increased disulphide levels. Since the formation of disulphide bonds is reversible, the progression of RRMS involving abnormal TDH may be controlled, converting disulphides to thiols. So, we suggest determining the dynamic TDH status as a novel and special biomarker in the diagnosis and prognosis of the RRMS patients.

Objectives Restless legs syndrome (RLS) is a common neurological condition. Oxidative stress plays an important role in its pathogenesis. Thiol-disulphide homeostasis (TDH) is a new biomarker of oxidative stress. We studied plasma TDH to determine whether TDH could be used as a new biomarker for RLS and evaluated correlations between TDH and various disease severity rating scales. Methods A total of 25 RLS patients and 25 healthy controls were included into the study. TDH status was determined using an automated spectrophotometric analysis method and correlations were analyzed between the TDH status and various disease rating scales in the RLS patients. Results Plasma total (401±27 μmol/L) and native thiol (354±30 μmol/L) levels were significantly lower, but disulphide level (24±6 μmol/L) was significantly ( Conclusions Our findings indicate increased oxidative stress in the RLS patients reflected by decreased native and total thiol, and increased disulphide levels and positive correlations between the disulphide levels and various rating scores. We suggest dynamic TDH status to be used as a novel biomarker for the diagnosis and follow-up of the RLS patients.

Objectives Copeptin, the C-terminal fragment of antidiuretic hormone, is a new biomarker that has been found to be elevated in several disorders and could be related with prognosis. This study aimed to compare plasma copeptin levels in patients with restless legs syndrome (RLS) with healthy individuals and to investigate whether plasma copeptin levels were associated with the severity of disease. Material and methods 41 patients with primary RLS, who were followed in Bakirkoy Psychiatry and Neurology Research and Training Hospital and 41 age- and sex-matched healthy individuals were included into the study. RLS patients were divided into subgroups as mild-moderate, severe, and very severe according to the severity of symptoms. Sleep quality and excessive daytime sleepiness were determined according to Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale, respectively, and sleep quality scores were analyzed statistically among the groups divided according to disease severity. Copeptin levels in all the patients were compared to the controls. RLS subgroups were compared with each other to evaluate association between copeptin levels and disease severity. Results Plasma copeptin levels in RLS patients were significantly higher than controls (P

Objective Restless Legs Syndrome (RLS) is a common neurological disorder that affects patients’ sleep, emotional state and daily life negatively. In this study it was aimed to determine the sleep quality, daytime sleepiness and depression frequency in patients with RLS and their relation with duration and severity of illness. Materials and Methods In our center, 41 patients with primary RLS diagnosis were included in the study. Patients were divided into groups as mild, moderate, severe and very severe, according to the RLS severity scale of the International Restless Legs Syndrome Study Group. Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Beck Depression Inventory were filled in by all the patients, including identity and sociodemographic data with illness information. Statistical analysis was performed among groups divided according to disease severity. Depressive symptoms of the disease duration and its relation with sleep problems were investigated. Results In this study 41 patients, 30 (73.2%) female, 11 (26.8%) male, were included. Of the patients participating in the study, 2 patients (4.9%) had mild RLS while 7 (17.1%) were very severely ill. Fourteen patients (34.1%) had moderate disease and 18 (43.9%) had severe disease. Bad sleep quality was found in 68.3% (n=28) of patients with RLS, excessive daytime sleepiness in 14.6% (n=6) severe depression in 7.3% (n=3) and totally 29.3% of patients (n=12) depressive symptoms were observed. As the severity of illness increased, sleep quality deteriorated and depressive symptoms increased (p

Changes in blood homocysteine, vitamin B12 andfolic acid levels have been reported during multiple sclerosis (MS) andtreatment period; however, the exact mechanism has not been enlightened. We investigated the changes of serumB12, folic acid, and plasma homocysteine levels before and after high-dose IVmethylprednisolone treatment and after interferon-β treatment in patientsadmitted with an acute attack of MS.31 patients followed for clinicallydefinite MS (8 male, 23 female) and 10 control individuals were included in thestudy. 20 patients were admitted with an acute attack and were administered 1000 mg/day methylprednisolone for 7 days. 27patients started interferon-β treatment. Serum B12, folic acid, and plasmaHomocysteine levels measured before and after the 1 month after high dosesteroid treatment and after 3-month interferon-β treatment were compared withpre-treatment levels and healthy controls. Baseline B12 levels were lower in patients with MS than in healthycontrols, which is consistent with previous findings. Both methylprednisolone and interferon-β treatments increasedserum B12 and folic acid levels compared with baseline; however, only theincrease following methylprednisolone treatment was statistically significant.Inour study, elevated B12 and folic acid levels and decreasing of homocysteinelevels without reaching statistical significance following methylprednisolonehave caused different debates., Multipl Skleroz (MS) hastalığınınseyrinde ve tedavi sürecinde homosistein, vitamin B12 ve folik asitdüzeylerindeki değişiklikler bildirilmiş ancak tam mekanizmasıaydınlatılamamıştır. Çalışmamızda, akut atak ile başvuranhastalarda yüksek doz metilprednizolon tedavisi öncesinde, sonrasında ve interferon-β tedavisi sonrasındaserum B12, folik asit ve homosisitein düzeylerindeki değişikliklerincelenmiştir. Çalışmaya 1 yıl içinde akut atak ile başvuran,klinik kesin MS tanısı konarak takip edilen 31 hasta (8 erkek, 23 kadın) ve 10 kontrol olgusu dahil edildi. 20 hastaakut atak ile başvurdu 7 gün süreyle 1000 mg/gün metilprednizolon uygulandı. 27hastaya interferon-β tedavisibaşlandı. Yüksek doz steroid tedavi sonrası 1. ay düzeyleri ve interferon-β tedavisi alan hastaların 3. ay sonundaki serum vitamin B12, folik asit ve plazma homosistein düzeyleri ölçülerek kontrol grubu ve tedavisiöncesi düzeyleri ile karşılaştırıldı. Kontrol grubuna göre MS hastalarınınbazal B12 değerleri daha önceki bulgularla tutarlı olarak daha düşüktü. Hemmetilprednizolon, hem de interferon-β tedavisi sonrası B12 ve folik asid değerlerindeyükselme saptandı ancak sadece metilprednizolon tedavisi sonrasındaki artış istatikselolarak anlamlıydı. Çalışmamızda saptanan metilprednizolon sonrası yükselen B12 ve folik asid düzeylerive istatistiksel anlamlılığa ulaşmayan homosistein düzeylerindeki düşme eğilimi farklıtartışmalar yaratmaktadır.

WOS: 000348845400013 PubMed ID: 28360659 Introduction: Olfactory dysfunction is an early and common symptom in idiopathic Parkinson's disease (IPD). Recently, the relation between olfactory dysfunction and cognitive loss in IPD has been reported. In our study, we aimed to investigate the relation between olfactory dysfunction and cognitive impairments in early IPD related with this theory. Methods: In this study, we included 28 patients with stage 1 and stage 2 IPD according to the Hoehn-Yahr (H-Y) scale and 19 healthy participants. The University of Pennsylvania Smell Identification Test (UPSIT) was performed for evaluating olfactory function. For cognitive investigation in participants, the clock drawing test, Stroop test, verbal fluency test, Benton face recognition test (BFR), Benton line judgment orientation test (BLO), and Auditory Verbal Learning Test (AVLT) were performed. Results: We found significantly lower UPSIT scores in the patient group compared to controls (p=0.018). In the neuropsychological investigation, only Stroop test and BLOT test scores were significantly lower in the patient group compared to controls (p=0.003, p=0.002, respectively). We found a negative correlation between UPSIT scores and Stroop time (p=0.033) and Stroop error (p=0.037) and a positive correlation between UPSIT scores and SBST long-term memory scores (p=0.016) in patients. Conclusion: In our study, we found mild cognitive impairment related with visuospatial and executive functions in early-stage IPD compared to controls. But, in the patient group, we detected a different impairment pattern of memory and frontal functions that correlated with hyposmia. This different pattern might be indicating a subgroup of IPD characterized by low performance in episodic verbal memory, with accompanying olfactory dysfunction in the early stage. Giriş: Olfaktör disfonksiyon, İdyopatik Parkinson Hastalığının (IPH) erken ve sık görülen bir semptomudur. Son zamanlarda, olfaktör disfonksiyon ile kognitif kayıp arasında ilişki olduğu bildirilmiştir. Çalışmamızda, bu teori ile ilişkili olarak, erken evre IPH’da olfaktör disfonksiyon ve kognitif bozukluklar arasındaki ilişkiyi araştırmayı amaçladık. Yöntem: Bu çalışmaya, Hoehn- Yahr (H-Y) evrelemesine göre evre 1 ve evre 2 IPH tanısı almış 28 hasta ve 19 sağlıklı birey dahil ettik. Olfaktör fonksiyonu değerlendirmek için University of Pennsylvania Smell Identification Test (UPSIT) uygulandı. Hastalarda kognitif fonksiyonu değerlendirmek için, Saat çizme testi, Stroop testi, verbal akıcılık testi, Benton face recognition testi (BFR), Benton line judgement orientation test (BLO), Sözel bellek süreçleri testi (SBST) uygulandı. Bulgular: Kontroller ile mukayese edildiğinde hasta grubunda UPSIT skorlarını anlamlı olarak daha düşük bulduk (p=0.018). Nöropsikolojik değerlendirmede sadece Stroop testi ve BLOT testi kontroller ile mukayese edildiğinde hasta grubunda anlamlı olarak daha düşüktü (sırasıyla p=0,003, p=0,002). UPSIT skorları ile Stroop zamanı ve Stroop hata skorları arasında negatif korelasyon (p=0,037), UPSIT skorları ile SBST uzun süreli bellek skorları arasında pozitif korelasyon bulduk. Sonuç: Çalışmamızda, daha önceki çalışmalardaki gibi, erken evre IPH’da vizyospasyal ve yürütücü fonksiyonlarla ilişkili hafif kognitif bozukluk saptadık. Fakat hasta grubunda hiposmi ile korele şekilde bellek ve frontal fonksiyonlarda farklı bir bozulma paterni saptadık. Bu farklı patern, IPH’ın erken döneminde koku bozukluğu eşliğinde epizodik verbal bellekte performans düşüklüğü görülmesi şeklinde bir alt gruba işaret ediyor olabilir

WOS: 000344525600003 PubMed ID: 25223839 BackgroundSeveral studies have shown that obstructive sleep apnea increases incidence of cardiovascular morbidity and mortality. The high systemic oxidative stress in obstructive sleep apnea has been considered as a major pathogenic mechanism leading to cardiovascular disease. Oxidative stress-related lipid and DNA oxidation in obstructive sleep apnea have been reported in the previous studies. In contrast, there is limited and contradictory information regarding protein oxidation in obstructive sleep apnea patients such as ischaemia-modified albumin and advanced oxidation protein products. Therefore, we aimed to investigate plasma ischaemia-modified albumin and advanced oxidation protein products and their correlation with total oxidative status and total antioxidative capacity in the obstructive sleep apnea patients. MethodsPlasma ischaemia-modified albumin, advanced oxidation protein products, total oxidative status and total antioxidative capacity were measured in 25 healthy volunteers and 59 obstructive sleep apnea patients diagnosed with polysomnography. ResultsPlasma total antioxidative capacity was significantly lower (P=0012) and total oxidative status was significantly higher (P

Obstructive sleep apnea (OSA) is characterized by recurrent respiratory disorders associated with increased cardiovascular morbidity and mortality. The increment of systemic inflammation in OSA has been considered as the major pathogenic mechanism leading to cardiovascular diseases. There is limited and conflicting information in the literature investigating myeloperoxidase (MPO) activity and soluble tumor necrosis factor receptor-1 (sTNF-R1) levels in OSA patients. The aim of our study is to assess the clinical utility of plasma MPO activity and sTNF-R1 levels as risk markers for systemic inflammation and development of cardiovascular diseases in OSA patients.59 OSA patients diagnosed with polysomnograhpy for Apnea-Hypopnea index (AHI), and 26 healthy volunteers enrolled into the study. Plasma MPO activity was measured using a spectrophotometric method. An enzyme-linked immunosorbent assay (ELISA) method was used to detect plasma sTNF-R1 levels.Plasma MPO activity and sTNF-R1 levels were significantly higher (43.2 ± 21.65 vs. 30.44 ± 8.05 p = .0046; 2.379 ± 1.2 vs. 1.086 ± 0.86 p.0001, respectively) in the total OSA patients compared to the control group. There was a significant weak correlation between MPO activity and disease severity indicator AHI (p = .03 r = .27).Elevated plasma MPO activity and sTNF-R1 levels in the OSA patients indicate increased systemic inflammation and oxidative stress which might contribute to the higher incidence of cardiovascular diseases. Therefore, we recommend measurement of plasma MPO activity and sTNF-R1 levels in the OSA patients as potential risk predictors for cardiovascular diseases.

Objectives: This study aims to determine the bifid median nerve (BMN) frequency in patients with carpal tunnel syndrome (CTS) and to investigate the possible association between CTS and BMN in this patient population. Patients and methods: A total of 194 wrists of 131 patients in whom CTS was diagnosed clinically and electrophysiologically and 73 healthy volunteers without any symptom or sign of CTS were examined with ultrasonography. Results: Bifid median nerve was detected in 22 wrists (11.3%) in CTS group and 15 wrists (10.2%) in the control group. There was no statistically significantly difference in the incidence of BMN among patients with CTS and healthy volunteers (p=0.891). Conclusion: Our study results showed that the incidence of BMN was similar among CTS patients and healthy volunteers. Therefore, we conclude that BMN may not be a predisposing factor for CTS.

Cerebral venous sinus thrombosis: gender differences in ten years experience Objective: Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke. CVST is much more common in women than men with a ratio of three to one. This women preponderance is attributed to gender-specific risk factors (GSRF). In many patients, symptoms develop over days or weeks. In some patients, clinical presentations are nonspesific. Patients and Methods: We reviewed the records of patients with CVST treated at Neurology department of Haseki Training and Research Hospital between 2001-2011, which diagnoses were confirmed with cranial magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Thirty- four patients were included the study. Women/men ratio was 3.25/1. We analyzed the demographic features, comorbid conditions, clinical presentation, neuroradiological findings. Results: Thirty- four patients were included the study. Headache was present in all patients and it was present as isolated in 47.1% (n=16) of the patients. In 52.9% (n=18) of the patients onset of the symptoms were subacute, 29.4% (n=10) chronic, 17.6 (n=6) acute. Of all patients, 76.5% (n=26) were women. Transverse sinus was the mostly affected sinus as either isolated or with the other CSVT in both groups (in 20 women and 8 men). The most common presentation symptom (43.78%) in women was headache whereas; it was intracranial hypertension (34.78%) in men. Half of our women patients with GRSF; 7 (26.92%) women were oral contraceptives user and 5 (15.38%) women were in pregnancy or puerperium period. Conclusion: We have found differences between women and men in the presentation and risk factors.

The purpose of this study was to investigate ultrasound (US)- and US elastography-detected changes in the median nerve of patients with carpal tunnel syndrome (CTS). Seventy-four wrists of 41 female patients with CTS (mean age, 47.73 +/- 11.45 y) and 45 wrists of 24 asymptomatic female controls (mean age, 42.83 +/- 10.66 y) were examined with US and US elastography. Electromyography results confirmed the diagnosis of CTS in the patients. The mean median nerve perimeter (MN-P = 15.26 +/- 2.18 mm) and median nerve cross-sectional area (MN-CSA = 11.81 +/- 4.05 mm(2)) of patients with CTS were higher than those of controls (12.08 +/- 1.54 mm and 7.76 +/- 1.40 mm(2), respectively) (p < 0.05). Mean tissue strain was lower in the patients with CTS (0.094 +/- 0.045 than in the controls (0.145 +/- 0.068) (p < 0.05). The most sensitive cut-off value for tissue strain was 0.0635, and the most specific was 0.19. US and US elastography, in addition to electromyography, proved to be beneficial in the diagnosis of CTS. US elastography is a new technique that may well find a place in the diagnosis of nerve entrapment syndromes. (E-mail: gunesorman@yahoo.com) (c) 2013 World Federation for Ultrasound in Medicine & Biology.

Purpose: Retina is a unique part of the central nervous system (CNS) for visualizing the processes of axonal and neuronal degeneration. Optical coherence tomography (OCT) allows direct visualization and measurement of retinal nerve fiber layer (RNFL) thickness, macular volume, and optic disc (OD) parameters. One of the disorders associated with atrophy in different brain regions is obstructive sleep apnea syndrome (OSAS). In the present study, we aimed to determine OD and RNFL changes measured by OCT for investigating the progress of neurodegeneration development in OSAS, excluding all the other conditions that can directly affect RNFL thickness and optic nerve parameters. Methods: Both eyes of 101 patients with OSAS and 20 controls were investigated by OCT. Full-night polysomnography (PSG) and ophthalmologic examination including automated visual field (VF) examination and OCT were performed in all of the patients. Results: According to the OSAS grading, patients were grouped as mild (n=15), moderate (n=27), and severe (n=59). We found significant decrease in RNFL thickness only in the patients with severe OSAS compared with the other groups and decreased macular ganglion cell thickness in the severe OSAS group compared with the control group. VF parameters were significantly worsened in all the OSAS subgroups compared to the control group. We found different data such as normal or increased optic nerve parameters as result of subtle OD edema, which may mask possible peripapillar axonal loss. Conclusions: We think that evaluation of neurodegeneration in OSAS is not always possible by examining OD and RNFL because there are difficulties due to the confounding issues of cerebral atrophy and OD edema. © 2013 Springer-Verlag.

Copeptin, the C-terminal fragment of antidiuretic hormone (ADH), is a new biomarker that has been found to be elevated in several cardiovascular disorders and is related with prognosis. Patients with obstructive sleep apnea demonstrate a tendency to develop coronary and cerebral atherosclerotic disease. Our aim was to investigate copeptin levels in untreated new diagnosed obstructive sleep apnea patients without manifest cardiovascular disorders in order to determine whether copeptin could be used as a biomarker in this group.A total of 60 patients with obstructive sleep apnea, diagnosed with polysomnography, and 23 healthy volunteers were enrolled into this study. Blood samples were collected after overnight fasting, and copeptin level was measured with an enzyme immunoassay method.Patients with obstructive sleep apnea had a higher incidence of hypertension and body mass index but lower serum copeptin level (0.48 ± 0.24. vs. 0.64 ± 0.28 ng/ml, p = 0.007) compared with the healthy controls. There was no significant difference regarding to serum copeptin levels between the moderate (n = 13) and severe (n = 47) obstructive sleep apnea patients (0.42 ± 0.18 vs. 0.49 ± 0.26 ng/ml, p = 0.409).Rather than reflecting a reduced risk for cardiovascular disorders, we consider that reduced copeptin level is related with disturbed ADH secretion in obstructive sleep apnea patients. Therefore, it would not be advisable to measure copeptin levels in obstructive sleep apnea patients to determine cardiovascular risk, while this marker could be valuable to demonstrate impairment in ADH regulation in this patient group.

Bu çalıșmada Mardin il merkezindeki diyaliz ünitelerinde hemodiyaliz tedavisi alan kronik böbrek yetmezliği hastalarında huzursuz bacak sendromu sıklığının ve huzursuz bacak sendromu saptanan hastaların demografik özellikleri arasındaki olası ilişkilerin araștırılması lanmıștır.YÖNTEM: Çalıșmaya Mardin ilindeki mevcut iki diyaliz merkezine bașvuran, en az üç aydır hemodiyaliz programında olan, 18 yaș üstü, Kt/V >1,4 olan tüm kronik böbrek yetmezliği hastaları alındı. Huzursuz bacaklar sendromu tanısı için Uluslararası Huzursuz Bacaklar Sendromu Çalıșma Grubu (The International Restless Legs Syndrome Study Group) tarafından hazırlanmıș tanı formu kullanıldı. Hastalar huzursuz bacaklar sendromu varlığı ve yokluğuna göre iki gruba ayrıldı. İki grubun demografik ve laboratuar özellikleri karșılaștırıldı.BULGULAR: Çalıșmaya hemodiyaliz tedavisi alan 90 olgu alındı ve olguların sekizinde (%8,9) huzursuz bacaklar sendromu saptandı. Hemodiyaliz tedavi süreleri huzursuz bacaklar sendromu saptanan grupta daha yüksek olmakla beraber, farklılık istatistiksel olarak anlamlı değildi (p=0,06). Katılımcılarda huzursuz bacaklar sendromunun varlığı ya da yokluğuna göre biyokimyasal parametreler ve demografik özellikler açısından istatistiksel anlamlı bir farklılık saptanmadı (p>0,05). Tüm hastaların %44,4’ünde diyabetes mellitus ve %43,3’ünde eșlik eden hipertansiyon vardı.SONUÇ: Hemodiyaliz tedavisi alan KBY hastalarında %8,9 oranında HBS görüldü. HBS saptanan ve saptanmayanlar arasında demografik özellikler benzerdir., In this study, we aimed to investigate the frequency of restless legs syndrome and the probable relation between demographic characteristics of the patients diagnosed in patients on hemodialysis treatment program for chronic renal failure in Mardin, Turkey.METHODS: In this study, chronic renal failure patients over 18 years of age, with a Kt/V >1.4 value admitted to the two dialysis centers in Mardin and under hemodialysis program for at least three months were included. For the diagnosis of restless legs syndrome, the diagnosis form of The International Restless Legs Syndrome Study Group was used. The patients were divided into two groups depending on the presence or absence of restless legs syndrome. Demographical and laboratory characteristics of the two groups were compared.RESULTS: The study included all of the 90 patients receiving hemodialysis treatment and restless legs syndrome was diagnosed in eight (8.9%) of these cases. Although the mean duration of hemodialysis treatment was longer in patients with restless legs syndrome, the difference was not signifi cant (p=0.06). The demographic and biochemical characteristics showed no difference between the two groups (p >0.05). Diabetes Mellitus and hypertension were detected in 44 and 43% of all participants, respectively.CONCLUSION: Restless legs syndrome was detected in 8.9% of chronic renal failure patients receiving hemodialysis treatment. The demographic characteristics of patients in the presence or absence of restless legs syndrome are similar.

Emel Oguz Akarsu1, Hurtan Acar2, Feriha Ozer3, Sefer Gunaydin2, Ozger Akarsu4, Tuba Aydemir Ozcan3, Serkan Ozben5, Aytul Mutlu2, Mithat Bedir6, Gulsun Cinarli Gul2, Ozlem Cokar2, Mehmet Burak Aktuglu7 1Umraniye Training and Research Hospital, Neurology Clinic, Istanbul, Turkey 2Haseki Training and Research Hospital, Neurology Clinic, Istanbul, Turkey 3Ordu University Faculty of Medicine, Department of Neurology, Ordu, Turkey 4Kartal Training and Research Hospital, Nephrology Clinic, Istanbul, Turkey 5Kafkas University Faculty of Medicine, Department of Neurology, Kars, Turkey 6Mardin State Hospital, Neurology Clinic, Mardin, Turkey 7Haseki Training and Research Hospital, Family Medicine Clinic, Istanbul, Turkey Original Article / Ozgun Arastirma DO I:10.4274/Tnd.13471

Epilepsy is a serious chronic brain disorder of childhood. We performed a cross-sectional prevalence study, determined the prevalence of childhood epilepsy, and identified the significance of certain risk factors for epilepsy among 1625 primary-school students aged 6-14 years, living in the center of Kars province. A questionnaire was prepared according to the definitions and principles of the Commission on Epidemiology and Prognosis, International League Against Epilepsy. Twenty-two children were diagnosed as epileptic. The point prevalence of active epilepsy in males was 4.9/1000, and in females 12.4/1000, representing a total of 8.6/1000. The cumulative prevalence in males was 11.0/1000, and 16.1/1000 in females, representing a total of 13.5/1000. Febrile convulsions, family history of epilepsy, serious maternal illness during pregnancy, a history of head trauma, antenatal/postnatal problems, and a history of neonatal jaundice were statistically significantly related to the development of epilepsy.

Aspirin is used in ischemic stroke therapy. However, some patients are not responsive to the antithrombotic action of aspirin. The aim of this study was to assess the prevalence of aspirin resistance in stroke patients and its association with mortality. One-hundred and six patients (mean age 64.9 ± 14.6 years, 53 male) with acute ischemic stroke were consecutively recruited. All subjects were taking aspirin regularly. Aspirin responsiveness was determined by Ultegra Rapid Platelet Function Assay-ASA (VerifyNow Aspirin). Aspirin resistance was defined as aspirin reaction unit (ARU) ≥ 550. Aspirin resistance was detected in 35 patients. There were not any significant differences in age, gender and comorbidities between aspirin-resistant and aspirin-sensitive patients. The mean National Institute of Health Stroke Scale (NIHSS) scores of the aspirin-resistant and aspirin-sensitive patients were 15 ± 3 and 12 ± 5, respectively (p = 0.006). Twenty-seven patients had a history of prior ischemic stroke and eight of them had aspirin resistance. Eleven patients died in-hospital and a total of 43 patients died during 2 years. Both the in-hospital and 2-year mortality rates were significantly higher in patients with aspirin resistance (20 vs. 5.6%, p = 0.038 and 60.0 vs. 31.0%, p = 0.004, respectively). Regression analysis revealed aspirin resistance [odds ratio (OR) 3.097, 95% confidence interval (CI) 1.070-8.959, p = 0.037] as an independent predictor of 2-year mortality, as well as age (OR 1.051, 95% CI 1.003-1.102, p = 0.038) and NIHSS scores (OR 1.208, 95% CI 1.016-1.437, p = 0.033). Aspirin resistance is not uncommon in patients with acute ischemic stroke and is associated with short and long term mortality in these patients.

Cardiac valvulopathy has been reported in patients with Parkinson's disease treated with pergolide. The aim of this study was to clarify the frequency and severity of valvular heart disease (VHD) in patients treated with pergolide, levodopa or both. We evaluated VHD by transthoracic echocardiography in 25 patients who were taking pergolide, 29 patients taking levodopa and 20 patients taking both levodopa and pergolide. All groups were compared with two separate age-matched control groups. There was no increase in the frequency of any type of echocardiographically-significant valvulopathy in the pergolide groups. Echocardiographically significant aortic regurgitation was found in 8% of the patients in the pergolide group and in 37.9% of the patients in the levodopa group. There was no correlation between VHD and pergolide dose, cumulative dose or duration of therapy. The mean pergolide dose was 2.6+/-1.4 mg/day in the pergolide monotherapy group. We did not find any unequivocal evidence that pergolide causes significant valvular regurgitation. However, the mean pergolide dosage in our study was lower than in previous studies.

Repetitive obstruction of larynx during sleep can lead to daytime pulmonary hypertension and alterations in right ventricular morphology and function in a small fraction of obstructive sleep apnea syndrome (OSAS) patients. Environmental effects, particularly high altitude, can modify the effects of OSAS on pulmonary circulation, since altitude-related hypoxia is related with pulmonary vasoconstriction. This potential interaction, however, was not investigated in previous studies. A total of 41 newly diagnosed OSAS patients were included in this study after pre-enrolment screening. Two-dimensional, three-dimensional, and Doppler echocardiographic data were collected after polysomnographic verification of OSAS. Three-dimensional echocardiograms were analyzed to calculate right ventricular volumes, volume indices, and ejection fraction. Systolic pulmonary artery pressure (38.35 ± 8.60 vs. 30.94 ± 6.47 mmHg; p = 0.002), pulmonary acceleration time (118.36 ± 16.36 vs. 103.13 ± 18.42 ms; p = 0.001), right ventricle (RV) end-diastolic volume index (48.15 ± 11.48 vs. 41.48 ± 6.45 ml; p = 0.009), and RV end-systolic volume index (26.50 ± 8.11 vs. 22.15 ± 3.85; p = 0.01) were significantly higher in OSAS patients, with similar RV ejection fraction (EF) between groups. No significant differences were noted in other two-dimensional, Doppler or speckle-tracking strain, measurements. Both RVEF and pulmonary acceleration time were predictors of disease severity. A greater degree of RV structural remodeling and higher systolic pulmonary pressure were observed in OSAS patients living at high altitude compared to healthy highlanders. The reversibility of these alterations with treatment remains to be studied.

Studies that explored the anterior visual pathway in the patients with multiple sclerosis (MS) have demonstrated contradictory results about the correlation between structural and functional status of optic nerve and retina. We aimed to investigate the functional and structural findings in our cohort of mildly disabled relapsing-remitting MS patients. A total of 134 eyes (80 eyes of the patients with MS and 54 eyes of the control group) were investigated. Eyes of MS patients were divided into two groups as eyes with history of optic neuritis (ON group) and without history of optic neuritis (NON group). Ophthalmological investigation including visual evoked potentials, standard automated perimetry, and optical coherence tomography were performed for all participants. Retinal and macular thicknesses were significantly decreased in ON and NON groups compared with controls. Also, visual evoked potential latencies and visual field loss were worse in the both MS groups compared with control group. We did not find any correlation between visual evoked potentials and retinal or macular thickness values but visual field parameters were correlated between retinal and macular layer loss in the NON group. According to our results and some previous studies, although both functional and structural changes were detected in patients with MS, functional status markers do not always show parallelism (or synchrony) with structural changes, especially in eyes with history of optic neuritis. © 2014 Informa Healthcare USA, Inc.

We aimed to investigate the relationship between olfactory function and olfactory bulbus (OB) volume, disease duration and Unified Parkinson-s disease rating scale (UPDRS) scores in early stage idiopathic Parkinson-s disease patients. The University of Pennsylvania Smell Identification Test (UPSIT) was used for the evaluation of olfactory function. UPSIT scores for patients with Parkinson-s disease were significantly lower than controls. There was no significant difference between stage 1 and stage 2 patients. OS volumes were higher in stage 1 and 2 patients than controls, but there was no statistical difference between the three groups. No significant correlation was found between UPSIT and UPDRS total scores, nor between UPSIT scores and disease duration in stage 1 and 2 patients. According to our results, we propose UPSIT be used as a screening test to diagnose presymptomatic patients, but not OB volumes. (C) 2013 Elsevier Ltd. All rights reserved.

Determinants of sexual dysfunction in male and female patients with parkinson’s disease Objective: Due to the complex nature of Parkinson’s disease (PD) and distinct sexual physiologies, male and female patients might have different patterns of sexual dysfunction (SD) in PD. The aim of this study was to assess determinants of SD in female and male patients with PD. Methods: Seventy nine outpatients with idiopathic PD (46 male, 33 female; mean age: 67.51±8.27) were recruited between December 2007 and February 2011. Unified Parkinson’s Disease Rating Scale and Hoehn– Yahr stages, Hamilton depression and anxiety scales, Mini-Mental State Examination and Arizona Sexual Experiences scale were the measures. Results: Determinants of SD in the whole group were age and anxiety. Age at disease onset and anxiety designated SD in female group, while age and severity of motor symptoms designated SD in male group. Conclusion: Both in males and females, gonadal steroids decline with advancing age. Dopamine has role in desire, erection, reward-seeking behavior phases of sexuality. Dopamine depletion may cause SD with its dual effects, including erectile dysfunction as well as motor disturbances in PD in male patients. Anxiety effect females more than males due to affected body image and perception of the self.

Santral uyku apne sendromu, uyku sırasında solunum çabasının yokluğu nedeniyle oluşan tekrarlayıcı apneler ile karakterize bir hastalıktır. Santral uyku apnesinin çeşitli kardiyolojik ve metabolik nedenleri tanımlanmıştır. Beyin sapını etkileyen farkı nörolojik hastalıklar da santral uyku apnesinin gelişiminden sorumlu tutulmuştur. Burada nörolojik, kulak- burun- boğaz ve kardiyolojik muayeneleri normal olan, santral uyku apne sendromlu dört hastayı sunduk. Daha ileri ve ayrıntılı nörolojik inceleme için beyin manyetik rezonans görüntüleme incelemesi yaptık ve sonunda beyin sapında santral apnelere neden olabilecek araknoid kist ve menenjiomlar saptadık., Central sleep apnea syndrome is a disorder characterized by the recurrent episodes of apnea during sleep resulting from transient pause of ventilatory effort. Various cardiologic and metabolic causes of the central sleep apnea have been described. In addition, various neurological diseases affecting brainstem have been implicated in the development of the sleep apnea. In this report, we presented four patients with central sleep apnea syndrome and normal neurologic, otorhinolaryngologic and cardiovascular findings. For a further and detailed neurologic examination we performed a magnetic resonance imaging examination and eventually detected pathological fi ndings associated with arachnoid cyst and meningiomas.

Optical coherence tomography is supported and used as a technique for visualisation of neuro-axonal loss in multiple sclerosis, but there are also a few studies expressing the opposite view. The aim of our study was to investigate retinal nerve fibre layer and optic nerve head parameters in patients with multiple sclerosis without a history of prior optic neuritis and symptoms of a new clinical attack during the follow-up for a total of 20-month period. Full ophthalmic evaluation was performed for all of the participants. The baseline retinal nerve fibre layer and macular thicknesses and focal and global loss of macular volume values were significantly lower in the eyes of the patients with multiple sclerosis compared with the healthy controls. No significant change between baseline and follow-up scans were found in all optical coherence tomography parameters in the multiple sclerosis group. Statistical analyses revealed significant retinal nerve fibre layer and macular thickness differences between baseline and second measurements in the controls. No significant difference in percent change between baseline and second measurements was observed between the patient and control groups. We conclude that whereas healthy subjects have an age-related tendency toward a decrease in retinal nerve fibre layer thickness, patients with multiple sclerosis patients are likely to pass through different stages of retinal thinning and thickening due to subclinical optic neuritis and, as a result, we could not detect any statistically significant change between baseline and second measurements in our multiple sclerosis patients. © Informa Healthcare USA, Inc.

Our findings showed that p53 mRNA expression levels are upregulated in epicardial adipose tissue (EAT) from patients with heart failure (HF). This upregulation was also found in myocardium [2]. Our group have described its upregulation in EAT by sympathetic system. This article is protected by copyright. All rights reserved.

Acute movement disorder associated with bilateral basal ganglia lesions is an increasingly recognized syndrome in patients with end-stage renal disease, especially in the setting of diabetes mellitus. The exact mechanism of the basal ganglia lesions is unclear. We report a patient with end-stage diabetic nephropathy admitted to our clinic with acute onset bilateral ballistic movements.

Objectives REM sleep behavior disorder (RBD) has been documented to precede or to co-occur with Parkinson's disease (PD). Parkinson's disease is one of the most common neurological conditions associated with visual hallucinations. Cognitive dysfunction is present in PD, even at the early stages of these diseases. In this study we aimed to investigate the relationship between visual hallucinations and RBD in patients with idiopathic Parkinson's disease (IPD). Additionally, we evaluated the association of the cognition and the pattern of cognitive impairment with VHs and RBD, effects of factors like duration and severity of the disease and duration of levodopa usage. Patients and methods Seventy-nine patients, diagnosed as PD, were included the study and then, patients were divided into four groups; with RBD and VHs (group 1), with RBD but no VHs (group 2), with VHs but no RBD (group 3), without RBD and VHs (group 4). We compared each group with the others according to demographic characteristics and neuropsychological test scores. Results Of all patients, in 46% ( n =36) RBD and in 48% ( n =38) VHs were observed. Our study established VHs in 58% of patients with RBD, and RBD in 55% of patients with VHs. However, due to a 40% incidence of VHs in patients without RBD, RBD and VHs were not found to be correlated. All of the neuropsychometric test scores did not reveal significant difference between groups. Conclusion Although it seems like there is a small association between RBD and VHs in our patients, it was not significant. Group 1 presented with significantly worse scores in UPDRS total scores and I, II subscores.

Syphilis is still a significant public health problem in developing countries. Although chorea is a very rare manifestation of neurosyphilis, it might be on occasions the initial symptom. This report presents a patients with neurosyphilis who had chorea as the initial presenting symptom.