Injection Administration Features of the Patients who self-administer Subcutaneous Immunomodulator Injection and the Injection Site Reactions

OBJECTIVE: This study aims at examining the injection administration features of the patients with multiple sclerosis who self-administer subcutaneous immunomodulator injection and the injection site reactions they experience. METHODS: AA total of 50 patients who fit the inclusion criteria of the study and volunteered to participate were included in the sample. The data were collected by a questionnaire which was developed by the researchers and based on the literature. The data were analyzed by SPSS 15.0 statistical program pack. Means, standard deviations, frequencies and percentages were calculated following the descriptive statistics. Chi-square test and Mann-Whitney U test were used to analyze the differences between some variables and the injection site reactions. RESULTS: In our study, 74% of the patients have reported at least one injection site reaction. Pain and redness are among the most common injection site reactions and least developed reactions are abscess and lipoatrophy. No statistical difference was found between the development of the injection site reactions, and injection administration features, the type of the administered medications, the administration period of the medications, and the number of total injections (p˃0.05). A statistical significance was observed between the gender and the development of the injection site reactions (p˂0.05). CONCLUSION: Injection administration features were not effective factors in terms of the injection site reactions. Injection site reactions were more common in women than in men

MULTİPL SKLEROZ HASTALIK RİSKİ İLE D VİTAMİNİ METABOLİZMASINDA ROL ALAN CYP450 ENZİMLERİNİN VE D VİTAMİNİ RESEPTÖRÜNÜN GENETİK POLİMORFİZMLERİ ARASINDAKİ İLİŞKİNİN TÜRK POPULASYONUNDA İNCELENMESİ

Gen polimorfizmleri ırklar, etnik gruplar ve coğrafi bölgeler arasında farklılık göstermektedir. Bu çalışmanın amacı, Türkiye popülasyonunda vitamin D metabolizmasında rolü olan CYP27A1, CYP2R1, CYP24A1, CYP27B1 ve vitamin D reseptörü genlerinin şeçilmesi planlanan tek nokta polimorfizmlerine (SNP) RFLP yöntemi ile bakılması ve bu enzimlerin genetik polimorfizmleri ile MS hastalığı arasında bağlantı olup olmadığının incelenmesidir. Literatürde vitamin D metabolizmasında rol alan enzimlerin ve vitamin D reseptörünün genlerindeki polimorfizmlerin MS hastalığı ile bağlantısının Türk popülasyonunda incelendiği bir çalışma bulunmaması nedeniyle yapılacak olan bu çalışma ilk olma özelliğini taşımaktadır. Bu genlerdeki polimorfizm ile hastalık arasında bulunabilecek olası bir ilişki gelecekte kişilerde MS hastalığının riskinin belirlenmesine yardımcı olabilecektir

İskemik inme riski ile kolesterolü metabolize eden sitokrom P450lerin genetik polimorfizimleri arasındaki ilişkinin incelenmesi

İskemik inme, beyindeki damarların tıkanması sonucu gerekli olan oksijen ve besinin dokulara ulaşamamasıyla oluşan inme türüdür. Beyin damarlarının tıkanması, beyindeki veya boyundaki damarlarda pıhtı oluşması veya vücudun herhangi bir yerindeki pıhtının dolaşım yoluyla beyin damarına ulaşması ve burayı tıkayarak beyne kan iletimini engellemesi sonucu oluşabilir. Beyindeki sinir hücreleri oksijensiz ve besinsiz kaldığında fonksiyonlarını yerine getiremez. Bu inme türü hipertansiyon ve diyabet gibi bazı kronik hastalıklar, genetik ve çevresel faktörler tarafından tetiklenir. İskemik inme dünyada ölüme ve sakatlanmaya yol açan en önemli nedenlerden biridir. Araşidonik asitten eikosanoid üretimi, beyin bölgesindeki kan akışını düzenlemede ve nörovasküler eşleşmede önemli bir rol oynamaktadır. Epoksieikosanoid asitler iltihap söktürücü, ateş düşürücü, antitrombotik ve damar oluşumu başlatıcı özelliklere sahiplerdir. Hücreler siklooksijenaz, lipoksijenaz ve sitokrom P450 reaksiyonları olmak üzere üç ayrı şekilde eikosanoid üretimi yapabilir. Sitokrom P450 reaksiyonlarıyla üretilen epoksieikosatrionik asitlerin beyindeki kan akışını düzenlemenin yanı sıra yukarıda bahsedilen özelliklerinden dolayı iskemik beyin hasarlarını önleyici bir role de sahip oldukları bilinmektedir. İnsanda sitokrom P450 gen ailesi 57genden oluşmaktadır.Bu genler ilaç , yabancı kimyasallar,araşidonik asit ,eikosanoid ve kolesterol metabolizmalarında rol alan enzimleri kodlarlar.Kolesterolden safra as

Importance of NOS3 Genetic Polymorphisms in the Risk of Development of Ischemic Stroke in the Turkish Population

In the present study, we aimed to investigate the relationship between endothelial nitric oxide synthase 3 (NOS3) G894T, T-786C, and intron 4 variable number of tandem repeat (VNTR) variants, alone or in combination, and the risk of incidence of ischemic stroke in the Turkish population. The genotypes for all polymorphisms were determined by polymerase chain reaction/restriction fragment length polymorphism techniques on 245 ischemic stroke patients and 145 controls. In the case-control analysis, no significant difference was observed between stroke patients and controls with respect to NOS3 G894T, T-786C, and intron 4 VNTR polymorphisms genotype and allele frequency distribution. However, the copresence of G894T and intron 4 VNTR risk-elevating genotypes in the same individual increased the risk of stroke seven times (odds ratio=7.083, 95% confidence interval=0.866-57.963, p=0.029)

Relationship Between Characteristics of Stenotic Plaque in Carotid Artery and Ischemic Stroke Recurrence

OBJECTIVE: Quantification of stenosis, plaque morphology and surface characteristics by doppler sonography and prediction of plaque rupture risk are important for treatment options in ischemic stroke. OBJECTIVE: We evaluated the association of carotid plaque characteristics and the risk of recurrent ischemic stroke. METHODS: Carotid plaques were ultrasonographically evaluated within ten days in 79 acute anterior circulation ischemic stroke patients without source of cardiac emboli. The subsequent incidence of transient ischemic attack, minor and major stroke was investigated wtihin six months period. During follow-up, 20 strokes occurred. Logistic regression analysis was used to determine the relation between plaque morphology and recurrent stroke risk. RESULTS: Patients with an ulcerated plaque had an 8.7-fold higher risk of recurrent stroke than those without ulceration (p<0.001). Patients with a hypoechogenic plaque had a 1.78-fold higher risk of recurrent stroke than those with hyperechogenic plaque (p<0.001). Patients with a functional stenosis greater than 70% had a 5.25-fold higher risk of recurrent stroke than those with a functional stenosis lesser than 70% (p<0.001). CONCLUSION: Plaque ulceration, hypoechogenicity and increased stenosis are independently associated with a higher risk of stroke recurrenc

Relation of Climate Temperature to Intracerebral Hemorrhage Volume

OBJECTIVE: In our study we aimed to investigate the correlation between volumes of intracerebral parenchymal hemorrhage, control of hypertension and daily weather temperature changes. METHODS: Data of total 88 patients (49 male-39 female, age 66.50 ± 15.00) with parenchymal hemorrhage were analysed retrospectively (June 2004-June 2009). Hypertension in medical history, arterial blood pressure levels at the time of referral to our clinic, antihypertensive drug usage, hemorrhage volume measured in computerized tomography and daily highest weather temperature were analysed. RESULTS: There was no correlation between volume of hemorrhage and existence of hypertension and drug usage (p> 0.05). There was no correlation between patients’s age and volume of hemorrhage (p> 0.05). There was no correlation between daily weather temperature and volume of hemorrhage in the normotensive patients according to our results. Furthermore there was statistically significant negative correlation between weather temperature and volume of hemorrhage in hypertensive patients without any effect of being on antihypertensive treatment (correlation factor: -0.254) (p< 0.05). CONCLUSION: The volume of hemorrhage in hypertensive patients with hemorrhagic stroke during colder weather seems to be larger. Thus their prognosis are worse. Probably change in the blood viscosity might be responsibl

Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

OBJECTIVE: The aim of this study was to review the efficacy, adverse effects and contraindications of intravenous thrombolytic treatment in acute ischemic stroke and to determine the predictive value of stroke scales applied in the first 24 hours to the three months outcome. METHODS: We retrospectively evaluated the clinical data of 30 patients with ischemic stroke seen at our institution over the period October 2005 to October 2008; 12 of the patients received intravenous thrombolytic treatment while 18 patients were not treated despite being admitted within three hours. The neurological deficits were graded using NIHSS, RANKIN and BARTHEL scales. The relationship between time to treatment and clinical improvement and also the association between the scales at 24 hours and the three months clinical outcome were evaluated. The reasons for not treating the patients who were admitted within the therapeutic window were determined. RESULTS: Only 30 of 404 patients were admitted within three hours. Twelve patients were admitted within 134.58 ± 39.4 minutes of stroke onset. Clinical improvement, defined as an improvement of ≥ 25% NIHSS points, was observed in 6 of the 12 (50%) patients within 24 hours of therapy. An improvement of about 80% NIHSS points at three months was observed when compared with baseline scores. Two of the patients showed insufficient improvement, defined as an improvement of < 25% NIHSS points. Four patients died due to intracerebral hematoma, severe brain edema or cardiac causes. Of the 18 patients who did not receive treatment, this was due to contraindications in 17 and to failure to obtain consent for the treatment in 1. CONCLUSION: Our data suggest that an improvement of ≥ 25% NIHSS points at 24 hours predicts the prognosis at three months and supports the conclusion from previous studies that thrombolytic therapy is a reliable and feasible treatment in selected patients with acute ischemic strok

Vitamin D, Vitamin D Reseptörü ve Vitamin D Metabolizmasında Rol Alan CYP450 İzozimlerinin Hayvan Modelinde Multipl Skleroz (MS) Hastalığının Patofizyolojisine Etkilerinin Moleküler Düzeyde Araştırılması

Multipl skleroz (MS), santral sinir sistemi beyaz cevherinin karmaşık, tekrarlayıcı, sıklıkla progressif seyirli inflamatuar demiyelinizan hastalığıdır (Noseworthy, Lucchinetti, Rodriguez, & Weinshenker, 2000). Hastalık 20-40 yaş arasında, kadınlarda erkeklere göre daha fazla görülmektedir. Hastalık riski ekvatoral kuşaktan uzaklaştıkça artmaktadır ve prevalansı 100.000 de 2 ile 200 arasında değişmektedir (World Health Organisation, 2008). Ekvatoral kuşakta MS hastalığının prevalansının düşüklüğünün güneş ışınlarının Vitamin D biyosentezi için daha elverişli olmasından kaynaklanabileceği düşünülmüş ve vitamin D ile MS arasında bağlantı bulan birçok yayın yapılmıştır. İmmünizasyon ile MS modeli oluşturulmuş hayvanlarda yapılan çalışmalarda vitamin D takviyesinin MS hastalığının ataklarındaki şiddeti azalttığı gözlemlenmiştir (Farias et al., 2013). Ayrıca MS hastaları ve sağlıklı bireylerden alınan kanlarda Vitamin D miktarları karşılaştırıldığında vitamin D miktarının hastalarda önemli oranda düşük olduğu rapor edilmiştir (van der Mei et al., 2007). Vitamin D dört halkadan oluşan bir sterol türevidir. İki önemli formda bulunur. Bunlar diyet ile alınan bitkisel kökenli ergosterolden türeyen ergokalsiferol (vitamin D2) ve hayvansal kökenli olup deride kolesterolün oksitlenme ürünü olan 7-dehidrokolesterolden türeyen kolekalsiferol (vitamin D3). İnsan vücudunda sadece vitamin D3 sentezlenir. Deride üretilen ya da diyet ile alınan vitamin D2 ve D3 dolaşım sistemine girerek karaciğerde CYP27A1 enzimi ile hidroksilasyona uğrar. Bu enzimatik reaksiyon sonucunda 25-hidroksivitamin D2 ve 25-hidroksivitamin D3 ara ürünleri oluşur. Daha sonra bu ara ürünler böbrekte CYP27B1enziminin katalizörlüğünde 1,25-dihidroksivitamin D2/D3’e dönüştürülür. 1,25-dihidroksivitamin D3 aktif vitamin metaboliti olarak kabul edilmektedir. Bu metabolit hormon özelliği göstermekte olup vitamin D reseptörüne bağlanarak birçok genin ekspresyonunu kontrol eder. Ancak bu aktif metabolit CYP24A1 enzimi tarafından inaktif edilerek kalsitorik asit olarak safra ile vücuttan atılır. Vitamin D ile multipl skleroz hastalığı arasında ilişki olduğu gösterilmişse de bu ilişkinin moleküler düzeyde incelendiği çalışma sayısı çok azdır. Ayrıca MS hayvan modelinde Vitamin D’nin patofizyolojik etkilerinin, Vitamin D reseptörü ve Vitamin D metabolizmasında rol alan CYP27A1, CYP27B1 ve CYP24A1 enzimlerinin mRNA ve protein ekspresyonları düzeyinde inceleneceği ilk çalışma olacaktır. Vitamin D metabolizmasında rol alan enzimlerin ve vitamin D reseptörünün hastalık ile bağlantısının ortaya konması ile hastalığın tedavisine dönük ilaç üretilmesinde hedef olabilecek yeni bir yolak belirlenmiş olacaktır

Association analysis of Glutathione S-transferase omega-1 and omega-2 genetic polymorphisms and ischemic stroke risk in a Turkish population

Objectives: Oxidative stress is a known risk factor for the pathogenesis of atherosclerosis, the main cause of ischemic stroke. Glutathione S-transferase (GST) omega-1 and omega-2, members of phase II enzymes, play a role in the antioxidant system. The single nucleotide polymorphisms (SNPs), C419A and A424G in GST omega genes can cause a decrease in enzyme activity. The aim of this study was to investigate the possible association between these polymorphisms and ischemic stroke risk in a Turkish population. Methods: The genotypes and allele frequencies for 239 patients and 130 controls were determined by the PCR/RFLP method. No significant differences were found between patients and controls in terms of genotype and allele frequencies. Results: The frequency of the polymorphic ‘A’ allele was 0.358 in patients and 0.342 in controls for the C419A polymorphism in the GSTO1 gene. The frequency of the polymorphic ‘G’ allele for GSTO2 A424G SNP was 0.370 in patients and 0.404 in controls. The combined homozygous wild type genotype ‘CCAG’ was significantly higher in control group than in the patients. Conclusion: No significant difference was observed between the stroke patients and controls in terms of genotypes and allele distributions. Double combine haplotype CCAA was found to be protective against ischemic stroke when compare to other haplotypes. However, different genotypes of GSTO1 and GSTO2 were observed to have effects on stroke risk in subgroups of diabetics and smokers. In conclusion, the current study is the first to report this finding.Middle East Technical University Research Project Fun