Evaluation of cognitive functions in gestational diabetes mellitus.

OBJECTIVE: To evaluate the association between cognitive functions and metabolic status in cases with gestational diabetes mellitus (GDM). METHODS: In this study 44 patients with GDM and 45 normal pregnant were included. Depression was evaluated with Beck's depression inventory (BDI). Cognitive functions were evaluated with Montreal cognitive assessment (MOCA), paced auditory serial addition test (PASAT), spatial recall test (SRT), symbol digit modalities (SDMT), and word list generation (WLG). RESULTS: The mean gestational age, educational level and account of previous birth of the subjects in the study were not statistically different between the groups. The mean scores of BDI of the 2 groups were not statistically different. MOCA score and SDMT was significantly decreased in GDM in comparison to NP (p=0.005, p=0.04 respectively). Also, SDMT score was inversely correlated with number of pregnancies, postprandial blood glucose and HbA1c.The scores of PASAT, SRT, SPART and WLG were statistically similar between the groups. CONCLUSIONS: Our findings may be a clue for early onset of impairment in cognitive functions in cases with new onset diabetes during pregnancy.

The epidemiology of post-stroke epilepsy according to stroke subtypes.

OBJECTIVES: Strokes represent the most common etiology of epilepsy in patients over the age of 60 years, with an incidence of 2-4% occurring in different studies. MATERIALS AND METHODS: In this observational study, 1,428 patients were included who had stroke and were admitted to our Stroke Unit between the years 1996 and 2005. RESULTS: Overall, 51 patients had post-stroke epilepsy (3.6%). Post-ischemic epilepsy occurred in 70.6% of the patients, post-hemorrhagic epilepsy occurred in 21.6% of the patients and epilepsy following venous infarctions occurred in 7.8% of all post-stroke epilepsy patients. Of 1,327 patients having ischemic stroke, 36 patients (2.7%), 11 out of 86 patients with hemorrhagic stroke (12.8%) and 4 of 15 patients with venous infarctions (26.6%) developed epilepsy. Compared with stroke patients without epilepsy, hemorrhagic (P<0.001) and venous infarctions were more common in patients with post-stroke epilepsy (P<0.001). The right hemisphere and the middle cerebral artery (MCA) territory were most commonly observed in ischemic and hemorrhagic stroke patients. CONCLUSIONS: Our results indicate that post-stroke epilepsy is more common among patients who have experienced venous infarctions. Hemorrhagic and venous infarctions are more commonly encountered in post-stroke epilepsy patients. Atherosclerotic and cardioembolic strokes were similar to those that occurred in post-stroke epilepsy patients. Localizations in post-stroke epileptic patients showed that the majority occurred in the right hemisphere, in the territory of the MCA. However, prospective, multicentered studies are needed for a better understanding of the epidemiology and social impact of post-stroke epilepsy.

Electrocardiographic findings and prognosis in ischemic stroke.

INTRODUCTION: Electrocardiographic (ECG) changes are observed in patients with acute stroke and are related with the prognosis. AIMS: To determine the frequency and significance of ECG changes in patients with acute ischemic stroke. MATERIAL AND METHODS: In a prospective hospital-based study 87 patients with cerebral infarction were observed for ECG changes during their stay in the hospital. All the patients had ischemic stroke for the first time. The ECG changes observed were compared with those of the control group consisting of 87 patients. RESULTS: Of the 87 patients of the study group, 47.1% were females and 52.9% males. The mean age was 65.5 +/- 11.9 (range 31-91 yrs). The control group consisted of 50.6% females and 49.4% males. The mean age was 64.5 +/- 11.9 (range 31-87 yrs). The frequency of the ECG changes observed in patients with cerebral infarct was 62.1% while it was 29.9% in the control group (P<0.0001). ECG changes observed were mostly related to myocardial ischemia. The six-month mortality rate in the patients with ECG changes was 38.9% whereas it was 15.2% in those with normal ECG (P<0.05). CONCLUSIONS: The observations of this study suggest that cardiac evaluation in patients with acute ischemic stroke is of prognostic importance.

Diabetes as a determinant of high-grade carotid artery stenosis: evaluation of 1,058 cases by Doppler sonography.

Our objective was to investigate the association of risk factors, especially diabetes mellitus, with high-grade carotid artery stenosis. The study group was chosen from the patients who were sent to our Doppler ultrasonography laboratory for detecting the vascular anatomy. Doppler sonography was performed in 1,058 patients. High-grade carotid artery stenosis with a diameter reduction of 70% to 99% was detected in 89 patients. In the moderate and mild stenosis groups, we had 85 and 884 patients, respectively. Patients in the moderate stenosis group had a 40% to 69% carotid stenosis, and patients in the mild group had a 0% to 39% stenosis or normal ultrasonographic findings. Parameters of age, sex, alcohol, smoking, ischemic heart disease, hypertension, and diabetes were considered potential risk factors for stenosis. Multivariate logistic regression model was used as the statistical test in comparing the 3 groups. In the high-grade stenosis group, sex distribution was 34.8% female and 65.2% male with a mean age of 64.48 +/- 10.19 years. In the second and third groups these distributions were 51.8% female and 48.2% male with a mean age of 65.15 +/- 9.66 years, and 54.30% female and 45.70% male with a mean age 59.56 +/- 12.37, respectively. Diabetes mellitus (odds ratio [OR] = 2.77), ischemic heart disease (OR = 1.67), age (OR = 1.02), and male gender (OR = 1.75) were found to be significantly associated with high-grade carotid stenosis. As a cost-effective, noninvasive, easily performed, and fast technique, Doppler sonography is used in vascular evaluation of patients. Early diagnosis of carotid artery disease in patients with modifiable risk factors like diabetes may play an important role in the prevention of a consequent stroke.

Prevalence of epilepsy in Silivri, a rural area of Turkey.

PURPOSE: To learn the prevalence of epilepsy in Silivri, a western town of Turkey, a randomized door-to-door survey was conducted using a standard questionnaire. The method of the study was adopted from the suggestions of the World Health Organization (WHO) for prevalence studies in developing countries, and the criteria were derived from Guidelines for Epidemiologic Studies on Epilepsy proposed by the Commission on Epidemiology and Prognosis, the International League Against Epilepsy (ILAE) 1993. METHODS: From June 1 to October 1, 1994, 4,803 people out of a total population of 70,394 were surveyed. The questionnaire, which was administered by practitioners and intern doctors, consisted of 15 questions, with a sensitivity of 99.9% and a specificity of 76%. After the survey, neurologists examined all of the 415 people suspected of having epilepsy and classified the seizures of the active cases. RESULTS: Of the 415 suspected cases, 49 people (24 women, 25 men) were determined as having epilepsy on the assessment day of October 1, 1994. The crude point prevalence of active epilepsy was 10.2 of 1,000 for the region. The prevalence of active epilepsy among women was 10.01 of 1,000 and among men was 10.39 of 1,000. Of the 49 cases, 40.8% had generalized seizures, 53.1% had partial onset seizures, and 6.1% could not be classified. Only 7.7% of the cases with partial onset seizures were defined as probable symptomatic cases. CONCLUSIONS: Onset of the disease peaked at the first decade of life. On the assessment day, 44.9% of those with epilepsy were receiving treatment, and 65.1% had visited religious figures at the onset or during the course of the disease, a figure that reveals the high prevalence of mystical beliefs about the disease in the study area.