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Öğe An Insidious Clinical Picture: Optic Nerve Involvement in Patients with COVID-19(Galenos Publ House, 2022) Ocak, Ozgul; Şahin, Erkan Melih; Sener, Alper; Ocak, BarisObjective: Many neurological symptoms due to central nervous system, peripheral nervous system and musculoskeletal system damage have been reported in more than a third of patients with coronavirus disease-2019 (COVID-19). Although optic neuritis has been reported in patients with COVID-19, they are extremely rare. The aim of this study was screening optic nerve involvement in COVID-19 with visual evoked potential (VEP) in asymptomatic patients without a history of visual impairment. Materials and Methods: Pattern reversal VEP measurements were made in 101 adult patients with COVID-19 without a history of visual impairment after they completed COVID-19 treatments and the quarantine period. VEPs were recorded with the 4-channel electromyography-evoked device in a dark room. P100 latencies and amplitudes were analyzed by the same neurologist. Results: A total of 34 (33.7%) patients had P100 latency prolongation. There was no significant difference in terms of gender, age or outpatient/inpatient treatment status. There was no significant correlation between the time of polymerase chain reaction diagnosis and VEP values. Conclusion: Contrary to previous studies, asymptomatic optic nerve involvement after COVID-19 was detected by VEP measurements. Prolongation of P100 latency shows the probable linkage between COVID-19 virus and angiotensin converting enzyme 2 receptors in human eyes.Öğe An Uncommon Complication: Hypoglossal Nerve Palsy After Carotid Endarterectomy(Emergency Medicine Physicians Assoc Turkey, 2020) Ocak, Ozgul; Celik, Hamit; Varisli, BehcetCarotid artery stenosis is the important causes of ischemic stroke, and it may result in death. Many complications can occur during carotid endarterectomy (CEA), which is the standard revascularization procedure for treating severe carotid artery stenosis. CEA is applied for prevention of stroke occurred by atherosclerotic plaque which is located at the common carotid artery bifurcation and, commonly, internal carotid artery. In addition to serious complications, such as stroke, infection, myocardial infarction, postoperative bleeding and death, non-fatal complications, such as cranial nerve palsy, can also occur rarely. Cranial nerve injury is a well-recognized complication' of carotid endarterectomy. Although major injuries are rare, in several series where thorough pre and postoperative neurologic examinations were performed, the incidence of cranial nerve dysfunction after carotid surgery ranged from 9.7% to 39% Here we present the an 80-year-old male patient with hypoglossal nerve palsy after carotid endarterectomy as it is a rare complication.Öğe Assessment of Emergency Service Attendance Due to Rabies Suspect Animal Bites in the Van Region(Emergency Medicine Physicians Assoc Turkey, 2019) Varisli, Behcet; Yildirim, Sinan; Celik, Hamit; Bulut, Mehtap; Ocak, OzgulAim: Rabies is a zoonotic viral disease transmitted by the bite of an animal. In Turkey, 100,000 individuals are administered prophylaxis annually after contact with animals carrying the risk of rabies. In this study, we investigated compliance with treatment and the affecting factors. Materials and Methods: The study assessed data from a total of 813 patients with potential animal bites throughout the year 2013. Results: The mean age of participants in the study was 22.6 +/- 16.8 years, and 80.6% (n=655) were male. Participants of both sexes mainly attended in the spring and summer months; however, it was identified that the rate of women attending in winter was higher than men. Also, five doses of vaccination were ordered for nearly all patients, independent of immunoglobulin administration; however, the rate of patients completing all five doses remained at about 30%. Conclusion: Increasing awareness of rabies will aid in the control of the significant public health problem of potential bite cases. As the young population is at risk, it is necessary to take precautions for the childhood age group.Öğe Evaluation of Neuropatic Pain Features in COVID-19 Patients(Wolters Kluwer Medknow Publications, 2022) Ocak, Ozgul; Şahin, Erkan MelihBackground: Pain is a common complaint in COVID-19 disease. Neurotrophic features of the COVID virus are reported. Neuropathic pain is seen during many viral infections and observed during the COVID-19 pandemic part of the clinical presentations. Objective: The aim of this is to evaluate neuroptic pain as presenting symptom in COVID-19 patients. Materials and Methods: In this cross-sectional descriptive study, adult patients (18 years and older) who applied to the COVID Outpatient Clinic completed the demographic data form and the neuropathic pain questionnaire. The patients were divided into positive and negative according to the PCR test results and the presence of neuropathic pain was compared. Results: In total, 440 participants included in the study. Among 301 who stated to had any complaints, 197 (65.4%) had pain. The intensity of their pain was 5.8 +/- 2.4 (0 - no pain and 10 - the most severe pain of life). Neuropathic pain component was present in 29.2% of the patients. Among the first admissions, neuropathic pain component was observed significantly higher in those with positive PCR test (55.0%) than negative ones (23.8%), and the Odd's ratio was calculated as 3.911. Conclusions: COVID-19 virus is thought to have neuroinvasion and neurotropic effects. In this study, neuropathic pain specifically was evaluated in COVID-19 patients, and the frequency of neuropathic pain was significantly higher in PCR confirmed COVID-19 patients at the onset of the disease.Öğe Interleukin-23R Gene Polymophisms in Patients with Diabetic Peripheral Polyneuropathy(Duzce Univ, Fac Medicine, 2022) Ocak, Ozgul; Sılan, FatmaObjective: Proinflammatory and neurovascular changes are blamed in the pathogenesis of diabetic neuropathy. Although it is accepted that diabetes is a trigger for vascular inflammation, it has been suggested that inflammation itself may trigger diabetes. Interleukin-23 (IL-23) is a pro-inflammatory cytokine secreted by activated macrophages and dendritic cells. Interleukin-23R is known to have a critical role in chronic inflammatory diseases. The aim of this study is to determine the relationship between IL-23R polymorphism and diabetic peripheral neuropathy. Methods: 50 diabetic peripheral neuropathy patients who applied to Neurology outpatient clinic, and 52 healthy controls compatible with the patient group in terms of age and gender were included. Electromyography was performed on all of the volunteers, who agreed to participate in the study, and 2 ml of blood samples were taken into tubes with EDTA, and the IL-23R gene polymorphism was analyzed using the pyrosequencing method. Results: IL-23R gene variants rs2201841, rs199542433, rs201052419, rs11209026 were analyzed in diabetic peripheral neuropathy (DPN) patients and control group. While we investigate IL23R polymorphisms we didn't find any significant differences between patient and control groups. But when we use odds ratios, rs2201841 seems to have a protective role, and rs199542433 in both dominant and recessive models and rs11209026 only recessive model seem to be related 10 fold higher risks for DPN. Conclusions: IL-23R gene polymorphism has been shown to be associated with many autoimmune and inflammatory diseases. It is known that inflammation has an important effect on diabetes. The frequency of IL-23R gene polymorphism was not significant in diabetic peripheral neuropathy. Our study is the only and first study investigating the role of IL -23R gene polymorphism in diabetic peripheral neuropathy. Ethnicity is very important in genetic studies, and it will give us more clear information for the future to carry out this study in patients with other ethnic origins and to recruit larger study groups.Öğe Is Ischemic Stroke Declines During the COVID-19 Pandemic?(Galenos Publ House, 2024) Ocak, Ozgul; Şahin, Erkan Melih; Toraman, CetinObjective: A decrease in the number of ischemic strokes has been reported during the coronavirus disease-2019 (COVID-19) pandemic period. The aim of this study was to determine the effect of COVID-19 and associated risk factors on the number of ischemic strokes in hospitalizations during the COVID-19 period. Methods: This cross-sectional study was conducted using hospital records. Data of patients who underwent a COVID-19 real -time reversetranscriptase polymerase chain reaction (RT-PCR) test between 2020 and 2021 were included. In addition to RT-PCR test results, the diagnosis of ischemic stroke and known risk factors for ischemic stroke (gender, age, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, hypercholesterolemia, congestive heart failure, coronary artery disease, peripheral vascular disease, chronic kidney disease) were evaluated. Results: According to the inclusion criteria, 25,522 patient records were included in the analysis. There were 123 (0.6%) acute ischemic stroke patients among 19,051 COVID-19-negative patients and 23 (0.4%) among 6471 positive patients. Among the covariates, age and diabetes have a significant effect on acute ischemic stroke. In path analysis, the negative direct effect of RT-PCR positivity on acute ischemic stroke was reversed through the mediator variable effect of diabetes and age. Patients with diabetes and higher age have an increased risk of acute ischemic stroke if they have COVID-19. Conclusion: Evidence is not satisfactory to determine the effect of COVID-19 on ischemic stroke. Reports of a decrease in the number of hospitalizations due to ischemic stroke are accumulating. This result may be due to the direct effect of COVID-19, the lack of recognition of clinical symptoms, or the decrease in hospital admissions of patients without a severe clinical picture. In the presence of accompanying risk factors such as age and diabetes that will aggravate the stroke clinic, the reducing effect of COVID-19 on the number of ischemic strokes disappears.Öğe Melatonin receptor gene polymorphisms as a risk factor in patients with diabetic peripheral neuropathy(Wiley, 2022) Ocak, Ozgul; Sılan, Fatma; Şahin, Erkan MelihAims Oxidative stress plays an important role in the pathogenesis of diabetic peripheral neuropathy (DPN). Melatonin is one of the most powerful endogenous antioxidants and has anti-inflammatory properties. We investigated how the gene polymorphism of melatonin differs in patients with DPN compared to an healthy control group. Materials and Methods A total of 54 diabetic peripheral neuropathy patients who applied to the Neurology outpatient clinic between 2020 and 2021, and 53 healthy controls comparable with the patient group in terms of age and gender were included in the study. Electromyography was performed and the melatonin gene polymorphism was analysed using the pyrosequencing method. Results Melatonin gene variants rs2119882, rs13140012, and rs10830963 were analysed in patients and controls. The rs2119882 (G allele) has a protective role, and rs13140012 polymorphism has a related 5-fold higher risk of DPN in the recessive model. Conclusions Melatonin gene polymorphisms have been shown to be associated with DPN. This is the first and only study investigating the relationship between melatonin gene polymorphisms and DPN. Ethnicity is very important in genetic studies, and it will give us more information on the role of melatonin gene variants in larger study groups of diabetic patients of other ethnic origin.Öğe Osmotic Demyelination Syndrome in A Normonatremic Patient with Chronic Kidney Disease(Galenos Yayincilik, 2020) Ocak, Ozgul; Urfali, Furkan Erturk; Korkmazer, Bora; Karaman, Handan Isin OzisikOsmotic demyelination syndrome (ODS), also known as central pontine myelinolysis, is a neurological disorder characterised by myelin loss in the central pons and other parts of the brain, such as the basal ganglia, lateral geniculate bodies, external and internal capsules and cerebellum. ODS is a demyelinating disorder associated with rapid correction of hyponatraemia. Classically, this is associated with hyponatraemia, but it can also occur in the presence of normonatremia. Changes in osmolality are found to be responsible in the pathogenesis of the lesions. Rarely, pontine myelinosis with delirium was also described in normonatremic patients. We report the clinical and radiological findings of a normonatremic 45-year-old female patient with chronic kidney disease, who experienced central pontine myelinolysis. This report aims to show that pontine myelinolysis may also occur in normonatremic circumstances, and early, rapid management of the disorder is important to prevent permanent damage.Öğe Relationship between genetic polymorphisms MTHFR (C677T, A1298C), MTR (A2756G) and MTRR (A66G) genes and multiple sclerosis: a case-control study(Termedia Publishing House Ltd, 2019) Cakina, Suat; Ocak, Ozgul; Ozkan, Adile; Yucel, Selma; Karaman, Handan Isin OzisikRecent studies have reported elevated plasma homocysteine and reduced folate and vitamin B levels in patients with multiple sclerosis (MS). In this study, we aimed to investigate the association between MS and the following four DNA polymorphisms: MTR A[2756]G, MTHFR C[677]T, MTHFR A[1298]C and MTRR A[66]G. The DNA polymorphisms were genotyped in 80 patients with confirmed MS and 80 healthy control age- and gender-matched subjects using PCR-RFLP approach. Our results show that the frequency of the T/T genotype homozygotes for the MTHFR C[677]T polymorphism was significantly higher in patients than in controls (p = 0.04, OR: 3.16, 95% CI: 1.23-8.17). In turn, the A/A genotype of the MTHFR A[1298]C polymorphism was more frequent in controls than in patients (41.3% vs. 32.5%, p = 0.04). There were no differences in distribution of genotypes for the MTR A[66]G and MTR A[2756]C polymorphisms between patients with MS and controls (p > 0.05). Our findings suggested that the MTHFR C[677]T and MTHFR A[1298] C gene polymorphisms might be associated with MS as genetic factors influencing the risk of the disease.Öğe The Relationship of Thyroid Hormone Levels and Motor Symptoms in Parkinson's Disease(Duzce Univ, Fac Medicine, 2022) Ocak, Ozgul; Şahin, Erkan Melih; Cam, MustafaAim: This study aimed to investigate the relationship between thyroid hormone levels and the motor symptoms of Parkinson's patients. Material and Methods: Neurology clinic logs of the patients diagnosed with Parkinson's disease and whose thyroid function tests were measured between 01.01.2018 and 01.04.2021 were selected. Those with primary thyroid hormone disorder were excluded. Motor symptom stages were determined according to the modified Hoehn and Yahr scale (mHYS) by records. According to the thyroid function test results, whether there was a difference in motor symptoms, duration of the disease, and effects of the drugs were examined. Results: Of the 93 patients included in the study, 53 (57.0%) were male and 40 (43.0%) were female. The median age of the patients was 71 years. The motor symptoms of the patients were classified as stage 1 in 21 (22.6%), stage 1.5 in 18 (19.4%), stage 2 in 29 (31.2%), stage 2.5 in 13 (14.0%), stage 3 in 4 (4.3%), stage 4 in 6 (6.5%), and stage 5 in 2 (2.2%) patients. The median levels of TSH, fT3, and fT4 were 2.075 uIU/ml, 2.925 ng/dl, and 1.235 ng/dl, respectively. There was no significant correlation between the mHYS stages of the patients and TSH (r=-0.148, p=0.164), fT3 (r=-0.073, p=0.623), and fT4 levels (r=0.075, p=0.491). Conclusion: There was no relationship between the severity of motor symptoms and hormone levels in patients with normal thyroid functions. Thyroid dysfunction may mimic many motor findings, but they do not affect the severity of motor findings in Parkinson's patients.Öğe Value of neutrophil/lymphocyte ratio in the diagnosis of diabetic neuropathy(Springer India, 2023) Ocak, Ozgul; Şahin, Erkan MelihBackground Peripheral diabetic neuropathy (PDN) had been demonstrated as a chronic inflammation state and one of the most common complications of type 2 diabetes mellitus (T2DM). Neutrophil-to-lymphocyte ratio (NLR) is a novel marker to reflect many kinds of chronic inflammation disease including diabetes. We aim to evaluate the association between NLR and PDN and to determine whether NLR could be a new indicator of PDN in T2DM. Methods Hospital records of the patients who underwent electroneuromyography studies with the diagnosis of T2DM in the Neurology Outpatient Clinic between 01/01/2018 and 01/04/2021 were divided into two groups as those with normal results and those with polyneuropathy. The NLR was calculated from the hemogram tests. Results Eighty-nine (52.7%) normal and 80 (47.3%) PDN patients included in the study, of them 77 (45.6%) were male and 92 (54.4%) were female. The mean age of the patients was 58.92 +/- 13.88 years. According to the records examined, the mean NLR value was significantly higher in patients with PDN (2.70 +/- 1.99) than in those with normal results (1.98 +/- 0.80). According to the ROC analysis, the sensitivity is 0.875 and the specificity is 0.292 for 1.46, which is determined as the optimal cut-off value for the NLR value in the diagnosis of PDN. Conclusion The results of our study have shown that there was a significant correlation between NLR and PDN, implying that inflammation and endothelial dysfunction could be an integral part of PDN. NLR was significantly and independently raised in patients with T2DM.Öğe Vitamin D receptor gene polymorphisms in multiple sclerosis disease: A case-control study(Univ Press, 2018) Cakina, Suat; Ocak, Ozgul; Ozkan, Adile; Yucel, Selma; Karaman, Handan Isin OzisikMultiple sclerosis (MS) is a common neurologic disorder that is a chronic inflammatory, demyelinating, and neurodegenerative disease of the central nervous system (CNS). Its etiology remains unknown. Several recent studies have found that decreased susceptibility to vitamin D deficiency is also associated with a decreased risk of MS. The role of vitamin D receptor (VDR) gene and its polymorphisms are highlighted as susceptible components. In this study, we aimed to identify the relationship between Apal (rs7975232), BsmI (rs 1544410), and TaqI (rs731236) gene polymorphisms with MS. Apal, Bsml, and TaqI genotypes were determined in 70 patients with MS and in 70 control subjects. DNA was isolated from blood samples, and then Apal, BsmI and TaqI gene polymorphisms were identified using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay. The distribution of BsmI and TaqI polymorphisms did not show any significant differences in MS patients and controls; however, increased A allele of Apal polymorphism was found in MS patients. Our findings suggest that the Apal gene polymorphism might be associated with MS. Investigation of a larger population and functional work on these gene structures and function in MS patients are recommended.
