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Öğe Akut hepatit C hastalarımızın tedavi sonuçları(2024) Pekok, Abdullah Umut; Yabalak, Ahmet; Özkan, Sedef Tavukçu; Kement, Metin; Pekok, Mehmet; Pekok, Berfin SudeAmaç: Akut hepatit C virüs (HCV) enfeksiyonu tanısı, çoğunlukla asemptomatik seyrettiği için genel olarak bilinen bir risk teması olan hastalarda takip sırasında konulabilmektedir. Akut HCV enfeksiyonunun en erken göstergesi artmış HCV-RNA'dır. Anti-HCV serokonversiyonu da akut enfeksiyonun en güçlü kanıtıdır. Kronikleşme riski en az %80'dir. Akut HCV enfeksiyonu, yüksek kronikleşme oranı nedeniyle tedavi alternatifleri açısından yakından izlenmelidir. Akut viral hepatit C'de 8-12 hafta sonra spontan iyileşme görülebilmektedir. Bu nedenle spesifik tedaviye başlamak için 8-12 hafta beklenmesi önerilmektedir. Bu çalışma, kendi kliniğimizde akut HCV tanısı ile takip ettiğimiz hastaların verilerini değerlendirerek akut viral hepatit C’de en uygun tedavi başlama zamanını saptamak ve pegile-interferon (peg-IF) alfa 2a’nın akut viral hepatit C vakaları üzerindeki etkisini değerlendirmek amacıyla yapılmıştır. Gereç ve Yöntem: 2005-2015 yılları arasında kliniğimizde akut viral hepatit C tanısı alan hastaların verileri değerlendirildi. Bulgular: Akut viral hepatit C'li 12 hasta kliniğimizde takip edildi. Olguların 12'si de erkek olup, yaş ortalaması 38,8 ± 7 (aralık, 25-50) yıl idi. 8-12 haftalık takip sonrasında üç hastamızda spontan düzelme gözlendi (HCV-RNA PCR ile negatif, AST-ALT değerleri normaldi). Akut HCV tanısından üç ay sonra, spontan düzelme olmayan dokuz hastaya pegile interferon alfa 2a 180 mcg (1x1/hafta sc) başlandı ve altı ay tedavi uygulandı. 6 aylık ve 2 yıllık takiplerinde tedavi yanıtı%100’dü. Sonuç: Akut HCV enfeksiyonunda tanı konulduktan sonra spontan viral temizlenme için 8-12 hafta beklenmelidir. Akut viral hepatit C ilk üç ayda düzelmezse spesifik tedavi açısından değerlendirilmelidir.8-12 hafta sonra spontan viral klirens gelişmeyen hastalarda pegile interferon alfa 2a alternatif tedavide düşünülebilir.Öğe Can Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios Predict the Risk of Developing New Ischemic Lesions After Carotid Stenting?(Tıbbi Kayıtlar Derneği, 2023) Yabalak, Ahmet; Öğün, Muhammed NurAim: It has been reported that the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are associated with carotid artery stenosis rate, risk of restenosis after stenting, and clinical outcome after an ischemic stroke, and are also predictive markers. The objective of this study is to evaluate whether NLR and PLR values and the associated temporal changes are indicators of the risk for newly developing ischemic lesions. Material and Methods: Patients who underwent stenting in our clinic between November 2019 and January 2022 and who had a complete blood count and a diffusion magnetic resonance imaging scan before and after the procedure, were included in the study and evaluated in two groups; patients with and without newly developing ischemic lesions. Results: Newly developing ischemic lesions were detected in 27 of the 50 patients included in the study. There was no difference in baseline and 48th-hour NLR and PLR rates and the temporal variation of these rates between patients with and without newly developing ischemic lesions. Erythrocyte distribution width (RDW) and hemoglobin (HGB) values were higher in the without newly developing ischemic lesions group at 48 hours, but there was only a significant difference between the RDW temporal change between the two groups. In the correlation analysis, no significant correlation was found between NLR, PLR, and their temporal changes, ipsilateral and contralateral stenosis rates, age, and residual stenosis rates. Conclusion: There was no significant relationship between the development of newly developing ischemic lesions and NLR and PLR values and the associated temporal changes.Öğe Effectiveness of peripheral nerve blockage on the symptoms of both diseases in patients with fibromyalgia and chronic migraine coexistence(Assoc Medica Brasileira, 2022) Evcili, Gökhan; Yabalak, AhmetOBJECTIVE: Peripheral nerve blockage treatments reduce central sensitization and are effective in patients with migraine. We wanted to evaluate the efficacy of peripheral nerve blockage in patients with fibromyalgia and migraine whose etiology may be responsible for central sensitization, and their associations are common. METHODS: The files of patients with chronic migraine who had peripheral nerve blockage treatment in our clinic and had fibromyalgia were scanned. The patients underwent bilateral great occipital nerve, lesser occipital nerve, and supraorbital nerve blockage at baseline and in the second week. The revised Fibromyalgia Impact Questionnaire, Migraine Disability Assessment Scale, Visual Analog Scale scores, the number of days in pain, and the number of analgesics taken in the last month were recorded. RESULTS: In the third month, Fibromyalgia Impact Questionnaire, Migraine Disability Assessment Scale, and Visual Analog Scale scores were significantly lower from baseline. While Fibromyalgia Impact Questionnaire scores in the third month were significantly lower than in the first month, no significant difference was observed between Visual Analog Scale scores. In the third month, the number of days in pain and the number of analgesics taken in the last month was significantly lower than the baseline but higher than the first month. CONCLUSION: Peripheral nerve blockage has been found to be an effective treatment for the symptoms of both diseases in patients with migraine and fibromyalgia coexistence.Öğe Effects of Smoking on Pattern Visual Evoked Potentials(Tıbbi Kayıtlar Derneği, 2023) Eski, Mehmet Tahir; Yabalak, Ahmet; Şahan, Halime; Ayaslı, Alper; Sezer, TahaAim: The aim of the study is to get a better understanding of the side effects of smoking by evaluating the effect of recently elevated smoking rate on Visual Evoked Potentials (VEP) and to determine whether it is necessary to use different normals when evaluating the VEP measurements of smoking patients. Material and Methods: The patients who have applied to our ophthalmology and neurology outpatient clinics during 2021-2022 are included to the study. Detailed ophthalmologic examination of the patients as well as their VEP test is completed followed by a dilated fundus examination assessment. The patients with normal results are included to the study. The smoking rate is calculated on pack/year basis. Pattern VEP (PVEP) recording is performed based on Keypoint (Dantec, Denmark) and International Society for Clinical Electrophysiology of Vision (ISCEV) criteria. Data obtained through the study are analyzed by SPSS 21.0 version software. Countable variables with normal distribution between two independent groups are analyzed with Independent Sample T test whereas variables without normal distribution are analyzed with Mann Whitney U test. Chi-square test is used for comparing categorical variables. Results: 71 patients were included to the study where 33 of them were placed in smoking group and 38 in non-smoking group (control group). Smoking group had a yearly cigarette package consumption of 5.20±8.93 (0.2-40). VEP latency and amplitude changes were compared and according to the obtained results; there was P100 latency prolongation in between left and right eye of the patients in the control group and smoking group but it did not have any statistical significance (p=0.910 and p=0.697 respectively). There was no statistically significant difference in either left nor right eye in terms of smoking and P100 and N70 latencies (p=0.707, p=0.838, p=0.717 and p=0.621 respectively). Similarly, there was no significant correlation between yearly package consumption and P100 and N70 latencies and amplitudes of left and right eyes (p=0.503, p=0.410, p=0.776 and p=0.940 respectively). Conclusion: No significant effect of smoking is found on VEP values thus leading us to believe that the same normal intervals can be used in the evaluation of VEP results of both smoking and non-smoking patients.Öğe Evaluation of the efficacy of peripheral nerve block alone in episodic and chronic migraine patients(Assoc Arquivos Neuro- Psiquiatria, 2023) Evcili, Gokhan; Yabalak, AhmetBackground Peripheral nerve block (PNB) is usually performed in patients with migraine who are resistant to treatment with medications.Objective To compare the efficacy of PNB alone and PNB combined with prophylactic medications in migraine patients.Method The data on migraine patients who underwent PNB in our clinic between November 2019 and January 2022 were retrospectively reviewed. Blocks of the greater occipital nerve (GON), lesser occipital nerve (LON) and supraorbital nerve (SON) were performed upon admission and in the second week.Results The study included 116 patients. While 21 out of 39 episodic migraine (EM) patients continued to use prophylactic medications, 18 were followed up with PNB alone. While 49 out of 77 chronic migraine (CM) patients continued to use prophylactic medications, 28 were followed up with PNB alone. Comparison of the admission and second-month data of the patients who only underwent PNB and those who continued the drug treatment together with PNB in both the EM and the CM group showed that the number of days with pain, number of analgesics taken and scores on the Visual Analog Scale (VAS) and the Migraine Disability Assessment (MIDAS) were significantly reduced in both groups ( p < 0.01). Comparison of the second-month data of the patients followed up with PNB alone and those followed up with PNB together with prophylactic medications showed that there was no significant difference between the EM and CM patients ( p > 0.05).Conclusion Bilateral GON, LON and SON block with lidocaine injection seems to be an effective treatment on its own, without the need for prophylactic medications, in both EM and CM patients during a two-month follow-up.Öğe Evaluation of the relationship between computed tomography angiography collateral scores and clinical outcome(Assoc Arquivos Neuro- Psiquiatria, 2024) Yabalak, Ahmet; Ogun, Muhammed Nur; Onalan, Aysenur; Murat Yilmaz, Murat; Tokmak, Hilmiye; Ersoy, Sadettin; Bilgili, FatmaBackground The relationship between collateral circulation and prognosis after endovascular treatment in anterior circulation strokes has been reported in many studies. Objective In this study, we aimed to compare the predictive power of clinical outcome by comparing five different collateral scores that are frequently used. Methods Among the patients who underwent endovascular treatment in our clinic between November 2019 and December 2021, patients with premorbid mRS < 3, intracranial ICA and/or MCA M1 occlusion, and a pre-procedural multiphase CTA examination were included in the study. Demographic, technical, and duration information about the procedure, major events after the procedure, and clinical outcomes at 3 months were recorded. The mCTA, Tan, Maas, Miteff, and rLMC collateral scores of the patients were evaluated. Results Clinical outcome at 3 months were good in 37 of the 68 patients included in the study (mRS <= 2). Only the mCTA and rLMC collateral scores were statistically significantly higher in those with a good clinical outcome. Significant correlation with 3-month mRS was detected only in mCTA and rLMC scores. Although rLMC and mCTA collateral scores showed a statistically significant association with prognosis, they were not sufficient to be an independent predictor of prognosis. Conclusion mCTA and rLMC were found to have the highest predictive power of clinical outcome and the highest correlation with the 3-month clinical outcome. Our study suggests that it would be beneficial to develop a new scoring system over multiphase CTA, which combines regional and temporal evaluation, which are the strengths of both collateral scoring.Öğe Investigation of penicillin-induced epilepsy model in female rats with different estrous cycles by ECoG method(Wolters Kluwer Medknow Publications, 2023) Cetinkaya, Ayhan; Kara, Sinem; Bozat, Bihter; Yabalak, AhmetAim: Epilepsy is a chronic neurological disease characterized by recurrent seizures resulting from an imbalance in neuronal excitation. It is known that there is a tendency for seizures to cluster in both men and women at certain periods. This study aims to compare electrocorticogram (ECoG) recordings in an experimentally induced epilepsy model using penicillin, conducted at different estrous cycles of female rats. Subjects and Methods: Prior to commencing the epilepsy experiments, vaginal smears were collected from the animals every morning for 1 week, at the same time each day, for cytological examination. After confirming that the estrous cycles (proestrus, estrous stage, metestrus, and diestrus) of the animals were normal and healthy, the experiment was initiated. Additionally, H and E staining was performed on the ovaries of the rats sacrificed at the end of the experiment to validate the estrous cycle phases. A total of 32 adult female Wistar rats were divided into four groups (proestrus, estrus, metestrus, and diestrus), each consisting of eight rats. The penicillin-induced epilepsy model involved anesthetizing the rats with 1.25 mg/kg urethane intraperitoneally, followed by the injection of penicillin G (500 IU, 2.5 mu L, i.c.) into the cortex region through a skull opening. ECoG recordings were conducted using PowerLab analysis for 180 min. Statistical analysis of the results was performed using the SPSS program version 22 (IBM Corp., Armonk, NY, USA). One-way analysis of variance (ANOVA) and independent samples t-test were employed for groups with normally distributed data, while the Kruskal-Wallis test and Mann-Whitney U-test were used for groups with nonnormally distributed data. Statistical significance was set at P < 0.05. Results: Histological evaluation confirmed that vaginal smears and ovarian histopathology were consistent with each other, validating the data pertaining to the groups. In the ECoG recording results, the spike-wave frequency between 6 and 10 min was higher in the metestrus group compared to the proestrus (P = 0.004), estrus (P = 0.046), and diestrus (P = 0.025) groups. No significant differences were observed among the groups in terms of spike-wave amplitude and latency. Conclusion: Our study using a penicillin-induced epilepsy model in female Wistar rats demonstrated that the spike-wave frequency was highest during the metestrus phase. This finding provides valuable insights for future studies aiming to understand and mitigate the sensitivity observed during the metestrus phase, which is characterized by rapid progesterone withdrawal.Öğe A rare spinal reflex in brain death: Bilateral plantar flexion in nuchal rigidity examination(Asean Neurological Assoc, 2023) Deniz, Mustafa; Yabalak, Ahmet; Dinler, KahramanA 74-year-old female patient, who developed a hypoxic brain injury after cardiopulmonary arrest, was diagnosed with brain death on the 4th day of the clinical onset depending on the absence of brainstem reflexes and the intracranial blood circulation in magnetic resonance angiography, and positive apnea test. Bilateral plantar flexion response to the neck flexion was observed while lifting the head for the examination of oculocephalic reflex during the in-service nurse training. The plantar flexion response was observed every time the neck flexion was performed. This finding was interpreted primarily in favor of spinal reflex and the repeated brain death tests confirmed the diagnosis. Regarding the literature, spinal reflexes may emerge in patients with brain death and plantar flexion is among the most common reflexes. These reflexes are usually observed following painful stimuli, during the apnea test or when the patient is taken off the mechanical ventilation. Although the nuchal rigidity examination is not included in the routine diagnosis procedure of brain death, in this paper we report bilateral plantar flexion as a response to the neck flexion in a patient with brain death in the light of the studies found in the literature. We conclude that the introduction of the above-mentioned examination to the diagnosis of brain death will contribute to the improvement of the diagnosis procedure and prevent delays in the preparation of the potential donors.Öğe Yoğun Bakım Ünitemizde Candida Skoru ve Candida Kolonizasyon İndeksi'nin Kandidemi İnsidansındaki Azalmaya Etkisinin Karşılaştırılması(Ege University, 2024) Pekok, Abdullah Umut; Yabalak, Ahmet; Özkan, Sedef Tavukçu; Kement, Metin; Pekok, Mehmet; Pekok, Berfin SudeAim: Since candidemia is an important cause of mortality and morbidity in hospitals, especially in intensive care units (ICU), those hospitalized in the ICU; In patients with risk factors such as invasive device use and undergoing abdominal surgery, early empirical antifungal therapy is recommended to reduce mortality according to the results of candida score (CS) and candida colonization index (CCI). In this study, the data of the patients who were followed up in the ICU, who were started on empirical treatment according to KS and CCI, were evaluated and their effects on the incidence of candidemia were analyzed. Method: Cultures taken from 100 patients hospitalized in the intensive care unit where adult patients were followed between 01.06.2018 and 01.08.2021 were examined. While investigating the colonization index of each patient, swab samples were taken once during the hospitalization from five main sites: mouth, nose, skin, perineum, and catheter. Samples taken with sterile swabs were inoculated on Sabouraud dextrose agar (SDA) plates and the plates were incubated at 35°C for 48 hours. The yeast colonies formed were defined according to their microscopic appearance and biochemical properties. CCI and CS of the patients were evaluated and fluconazole prophylaxis was started in patients with KS ?3 or CCI ?0.5. Results: A total of 500 culture samples from 100 non-neutropenic adult patients were analyzed (Mean of 5 cultures/patient). No growth was detected in any of the samples in 32 (32 %) of 100 patients, and growth was detected in at least one of the samples taken from 68 patients (68 %). Reproduction was detected from a total of 118 samples. Of the yeasts, 104 were identified as Candida albicans, 10 as Candida glabrata and 4 as Candida inconspicua. CS? 3 and CCI ?0.5 in 11 (11%) patients, and CS?3, CCI
