Spastik gülme ve ağlama olgularında beyin sapı reflekslerinin elektrofizyolojik olarak değerlendirilmesi

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.ÖZET: Bu çalışmada spastik gülme ve ağlamanın fizyopatolojisine ışık tutmak amacıyla spastik gülme-ağlama gözlenen 23 olgunun klinik ve radyolojik bulguları incelenmiş,beyin sapı refleksleri elektrofizyolojik olarak değerlendirilip normallerle farklılığı araştırılmıştır. Sonuçta; 1) Göz kırpma refleksinde habituasyon azalmıştır. R2 süresi uzamıştır. 2) Çene refleksinde normalde olması beklenen fasilitasyon görülmemiştir. 3) Masseter sessiz periyodda normale oranla farklılık olmamıştır. 4) Palmomental refleksde yoğun bir refleks artış saptanmıştır. Özetle beyin sapı reflekslerinde polisinaptik nosiseptif tipte olanlarda bir arüş söz konusudur. Bu da supraspinal inhibisyonun azalması ile igüi olabilir. Beyin sapı reflekslerini elektrofizyolojik olarak inceleme yolu ile spastik gülme ve ağlamanın fizyopatolojisine net bir açıklama getirmek şu an için olası değildir. Ancak spatik gülme ve ağlamanın bir beyin sapı irritasyon fenomeni olmadığı daha çok supraspinal bir tonik inhibisyonun kalkmasına bağlı olduğu söylenebilir. Bu konuda daha ileri çalışmalara gerek vardır. 5

Retrospective analysis of effectiveness of fingolimod in real life setting in Turkey (REFINE)

Background/aim: During multiple sclerosis (MS) treatment different modes of action such as lateral (interferon beta to glatiramer acetate or glatiramer acetate to interferon beta) or vertical (interferon beta/glatiramer acetate to fingolimod) drug switch can be performed. This study aims to investigate the clinical effectiveness of switching from the first-line injectable disease modifying treatments (iDMTs) to fingolimod (FNG) compared to switching between first-line iDMTs.Materials and methods: This is a multicenter, observational and retrospective study of patients with relapsing-remitting MS who had lateral and vertical switch. The observation period included three key assessment time points (before the switch, at switch, and alter the switch). Data were collected from the MS patients' database by neurologists between January 2018 and June 2019. The longest follow-up period of the patients was determined as 24 months after the switch.Results: In 462 MS patients that were included in the study, both treatments significantly decreased the number of relapses during the postswitch 12 months versus preswitch one year while patients in the FNG group experienced significantly fewer relapses compared to iDMT cohort in the postswitch 12 months period. FNG cohort experienced fewer relapses than in the iDMT cohort within the postswitch 2 year. The mean time to first relapse after the switch was significantly longer in the FNG group.Conclusion: The present study revealed superior effectiveness of vertical switch over lateral switch regarding the improvement in relapse outcomes. Patients in the FNG cohort experienced sustainably fewer relapses during the follow-up period after the switch compared the iDMT cohort. Importantly, switching to FNG was more effective in delaying time to first relapse when compared with iDMTs

Retrospective analysis of effectiveness of fingolimod in real life setting in Turkey (REFINE)

Background/aim: During multiple sclerosis (MS) treatment different modes of action such as lateral (interferon beta to glatiramer acetate or glatiramer acetate to interferon beta) or vertical (interferon beta/glatiramer acetate to fingolimod) drug switch can be performed. This study aims to investigate the clinical effectiveness of switching from the first-line injectable disease modifying treatments (iDMTs) to fingolimod (FNG) compared to switching between first-line iDMTs. Materials and methods: This is a multicenter, observational and retrospective study of patients with relapsing-remitting MS who had lateral and vertical switch. The observation period included three key assessment time points (before the switch, at switch, and after the switch). Data were collected from the MS patients’ database by neurologists between January 2018 and June 2019. The longest follow-up period of the patients was determined as 24 months after the switch. Results: In 462 MS patients that were included in the study, both treatments significantly decreased the number of relapses during the postswitch 12 months versus preswitch one year while patients in the FNG group experienced significantly fewer relapses compared to iDMT cohort in the postswitch 12 months period. FNG cohort experienced fewer relapses than in the iDMT cohort within the postswitch 2 year. The mean time to first relapse after the switch was significantly longer in the FNG group. Conclusion: The present study revealed superior effectiveness of vertical switch over lateral switch regarding the improvement in relapse outcomes. Patients in the FNG cohort experienced sustainably fewer relapses during the follow-up period after the switch compared the iDMT cohort. Importantly, switching to FNG was more effective in delaying time to first relapse when compared with iDMTs

The relationship between severity of overactive bladder symptoms and cognitive dysfunction, anxiety and depression in female patients with multiple sclerosis: Running head: OAB-V8, BICAMS and HAD scale in MS

© 2022 Elsevier B.V.Background: Overactive bladder (OAB), cognitive dysfunction, depression and anxiety are common problems encountered in MS. This study was planned to investigate the relationship between the severity of OAB symptoms and cognitive function, anxiety and depression in MS. Methods: 100 patients with MS diagnosis with OAB symptoms were recruited. OAB symptoms was assessed with the OAB-V8 questionnaire. Symbol Digit Modalites Test (SDMT), California Verbal Learning Test II (CVLT-II) and Brief Vasospatial Memory Test-Revised (BVMT-R) in BICAMS Battery were used to evaluate cognitive function. Depression and anxiety were assessed with the Hospital Anxiety Depression (HAD) Scale. Results: The mean age of the patients was 40.9±12.3, the duration of the disease was 9.03±6.89 years, and the mean OAB-V8 score was 17.6±8.9. SDMT test (r=-0.299, p<0.01) showed a moderately significant, CVLT-II (r= -0.219, p<0.05) and BVMT-R (r=-0.218, p<0.05) tests showed a weakly significant negative correlation with OAB-V8 score. There was a moderate positive correlation between the OAB-V8 score and HAD-D (r=0.279, p=0.005) and HAD-A (r=0.318, p=0.001) scores. SDMT and BVMT-R scores were significantly lower in anticholinergic (Ach) drug users (especially oxybutynin users) compared to those who did not use Ach drugs. Conclusions: It has been observed that the severity of OAB symptoms is related to worsening of information processing speed and an increase in depression and anxiety. It has been determined that there is a significant effect on information processing speed, visual learning and memory in patients using Ach drugs, especially in those using oxybutynin, compared to those who do not use Ach drugs

Biomarkers in Carcinoma of Unknown Primary

The determination of primary focus in metastasis is crucial. CDX2 and SATB2 for colorectal, TTF-1 and Napsin-A for lung, GCDFP-15 and GATA-3 for breast, and PSA, PSAP, and NKX3.1 for prostate carcinomas are the most useful site-specific biomarkers. Most metastatic carcinomas in the liver are adenocarcinomas. The most common primary sites are the colon-rectum, breast, lung, stomach, and pancreas. A panel including CK7, CK20, CDX2, GATA-3, TTF-1, and PAX-8 in women and CK7, CK20, CDX2, TTF-1, and NKX3.1 in men seems reasonable for metastatic adenocarcinoma in the liver if the tissue is limited. If available, adding SATB2, Napsin-A, and PSA/PSAP to the panel&nbsp;increases the diagnostic value. In other types of carcinomas, morphological features are more important to decide on a panel which may contain CK7, CK20, p40, GATA-3, chromogranin A, synaptophysin, RCCMa/PAX-8, SF-1, arginase-1, HepPar1, etc. Breast, colon, and prostate&nbsp;carcinomas often metastasize to the lung, whereas the most common sources are the prostate, breast, lung, and kidney in the bone. Similar panels may be useful in detection of the primary in most cases. The differential diagnosis of primary site in lymph nodes varies according to the region. Although there is no specific marker for primary focus in squamous cell carcinomas, determination of EBV and HPV, especially in cervical lymph node metastases, is significant for the nasopharynx or oropharynx primary.</p