The probable role of insulin resistance and SIRT1 proteins in the Alzheimer's disease.

OBJECTIVE: Recent evidence suggests that insulin resistance may play an important role in the pathogenesis of Alzheimer's disease (AD). In this study, the probable role of insulin resistance in the pathogenesis of AD was investigated in patients with Type 2 Diabetes Mellitus (T2DM). METHODS: Serum amyloid beta (Aß) (1-42), insulin like growth factor-1 (IGF-1), sirtuin1 (SIRT1) and leptin protein levels were measured in serum samples of control (n = 26), probable AD (n = 26), and probable AD+T2DM patients (n = 12) using ELISA method. Mini mental state examination (MMSE) was performed to the patient and control groups. RESULT: Serum IGF-1 significantly increased in the probable AD+T2DM group as compared to the control and probable AD groups (p ˂ 0.05). The levels of serum leptin significantly decreased in the probable AD and AD+T2DM groups as compared to the control (p ˂ 0.05). There were no statistically significant differences in serum Aß (1-42) and SIRT1 levels among groups (p > 0.05). CONCLUSION: The significant decrease in serum leptin levels in AD patients may indicate that it may be a therapeutic marker in AD. The level of serum Aß peptide and SIRT1 proteins can vary depending on the stage of the disease. Therefore, this study should be supported by more comprehensive studies in terms of the number of patients in advanced stage (Tab. 1, Fig. 4, Ref. 29).

Heparin-induced thrombocytopenia leading to stroke, lower extremity arterial occlusive disease, and skin necrosis: a case report.

Enoxaparin sodium is a low molecular weight heparin (LMWH) used to treat and prevent deep venous thrombosis (DVT). The common complications related to the use of heparin are bleeding, allergic reaction, and osteoporosis. A less common complications are thrombocytopenia and thromboembolism that may not be generally recognized. We present a case of low molecular weight (LMW) heparin-induced thrombocytopenia (HIT) causing stroke, lower extremity arterial occlusion, and skin necrosis. Monitoring the platelet count is essential for early diagnosis of HIT. All patients who undergo heparinization should have a baseline platelet count done before the regimen is started and should be monitored closely especially during the first weeks of treatment.

Cerebral blood flow velocity in migraine and chronic tension-type headache patients.

INTRODUCTION: The present study seeks to use transcranial Doppler ultrasound to evaluate cerebral blood flow velocities in anterior and posterior circulation arteries, during an attack-free episode in migraine patients, with and without aura, as well as in chronic tension-type headache patients who were not receiving prophylactic medication. METHODS: A total of 50 patients (35 female, 15 male) were evaluated during a headache-free episode: 30 migraine patients without aura (mean age: 32±8 years), 10 migraine patients with aura (mean age: 34±4 years), and 10 patients with chronic tension-type headache (mean age: 34±5 years). RESULTS: No significant difference was present between anterior, middle, and posterior cerebral and vertebral arteries' blood flow velocities between migraine patients, with and without aura, or in patients with a tension-type headache, and normal controls (p>0.05). However, a significant increase in basilar artery cerebral blood flow velocities relative to controls was present in patients with a tension-type headache (p>0.001). CONCLUSION: It is difficult to predict the main reason for the significant increase in basilar artery blood flow velocities in patients with chronic tension-type headache. It may be due to constriction of conductance or the dilatation of the resistance vessels.

Effect of combined exercise training on serum brain-derived neurotrophic factor, suppressors of cytokine signaling 1 and 3 in patients with multiple sclerosis.

BACKGROUND: Suppressors of cytokine signaling (SOCS) and brain-derived neurotrophic factor (BDNF) are important immunologic, and neurotrophic factors for MS pathogenesis. The impact of exercise on these factors is yet to be fully elucidated in patients with MS. OBJECTIVE: The primary aim of this study is to investigate the effect of 8-week combined exercise training on serum concentrations of SOCS1, SOCS3, and BDNF. The secondary aim is to determine the effects of combined exercise training on balance, functional exercise capacity, and fatigue in patients with MS. METHODS: Serum SOCS1, SOCS3, and BDNF levels were assessed in 36 MS patients and 18 healthy individuals. In addition, balance, functional exercise capacity, and fatigue were assessed in the patients with MS. The patients were randomly divided into the combined exercise group (MS-EX, n:18) and the control group (MS-C, n:18). MS-EX received an 8-week combined exercise training. RESULTS: The serum SOCS1, SOCS3, and BDNF levels were similar in the MS patients and healthy control (HC). In MS-EX, the serum BDNF level, balance, functional exercise capacity, and fatigue improved after 8weeks (p<0.05), but the serum SOCS1, and SOCS3 levels did not change significantly (p>0.05). In MS-C, the serum SOCS1 level, and fatigue increased significantly after 8weeks (p<0.05), but serum SOCS3, BDNF, balance and functional exercise capacity did not change (p>0.05). CONCLUSIONS: In summary, the combined exercise training improved BDNF, and physical performance in patients with MS. But, future studies are needed to clarify the role of SOCS proteins in MS pathogenesis and the effect of exercise on SOCS.

SSR abnormalities in chronic alcoholics.

We performed sympathetic skin response (SSR) studies on 29 male patients diagnosed as chronic alcoholics according to DSM-IV criteria. The average age was 43 years and the mean duration of alcohol abuse was 21 years, with all patients having a history of alcohol abuse for a minimum of 4 years. None of the patients had any symptoms and/nor signs related to autonomic nervous system dysfunction and all demonstrated normal nerve conduction velocities. Hand and foot latencies in alcoholics were prolonged relative to controls and the difference was statistically significant: reflected by p values of 0.02 and 0.004, respectively. Forty-four percent of patients demonstrated abnormal results. The unilateral prolongation of the lower extremity latency was the most commonly found abnormality (24%). Finding abnormal SSR in this patient population has made us aware that SSR has the potential to detect subclinical autonomic nervous system dysfunction even in patients who do not have autonomic complaints or neuropathy and to provide information about a part of the peripheral nervous system small unmyelinated C fibers that can not be assessed by currently performed techniques used in clinical EMG laboratories or by physical examination.

Event related potentials in children of alcoholics.

Assessment of ERPs (Event Related Potentials) is a special area of interest in research on vulnerability to alcoholism in human subjects. ERP not only provide information about potential neurofunctional anomalies in healthy individuals, but also relate those neurofunctional characteristics to the cognitive process involved. The aim of the present study is to evaluate the effects of chronic alcoholism and alcoholism risk on children of alcoholic fathers by using ERP parameters. 24 children of alcoholic fathers (9 boys, 15 girls) with a mean age of 18 +/- 3 (range: 15-25) and 17 control subjects (children of non-alcoholic fathers with out a family history of alcoholism) were included to the study. The age range was from 15 to 25 (mean: 21 +/- 3). N200 potential latency recorded from the parietal electrode position was significantly prolonged (p = 0.032) and amplitudes of P200 potential also recorded from the parietal region was significantly low (p = 0.043) relative to controls. However, the rest of the event-related potential parameters including P300 latency and amplitudes recorded from FZ, CZ, PZ electrode positions did not differ significantly from the children of non-alcoholic fathers. The difference in our results from the previous studies may be due to various factors. Genetic, gender, environmental, educational and social factors may have an overall effect on ERP and we believe these factors may be the cause of the differences seen in our study when compared to the previous ones. We believe the gender differences in our group may have had effected the overall results. Consecutive studies with more subject participation are needed to confirm and settle this issue.

The effects of Mat Pilates and Reformer Pilates in patients with Multiple Sclerosis: A randomized controlled study.

BACKGROUND: Pilates is an exercise method which increases strength and endurance of core muscles and improves flexibility, dynamic postural control and balance. OBJECTIVE: To analyze and compare the effects of Mat and Reformer Pilates methods in Patients with Multiple Sclerosis (MS). METHODS: Thirty-eight patients with MS were included in the study. Participants were randomly divided into 3 groups as Mat Pilates, Reformer Pilates and control groups. The subjects in the Pilates groups did Mat or Reformer Pilates for 8 weeks, 2 days a week. The control group did breathing and relaxation exercises at home. Balance, functional mobility, core stability, fatigue severity and quality of life were evaluated. RESULTS: Balance, functional mobility, core stability, fatigue severity and quality of life improved after Pilates in Mat and Reformer Pilates groups (p < 0.05). On the other hand, we could not find any changing in the control group (p > 0.05). When the gain obtained in the Pilates groups is compared, it has been observed that progress has been more in trunk flexor muscle strength in the Reformer Pilates group (p < 0.05) and that the gain has been similar in the other parameters (p > 0.05). CONCLUSIONS: As a result, patients with MS have seen similar benefits in Reformer Pilates and Mat Pilates methods.

Cerebral cladosporiosis.

A 49-year-old woman was admitted to Hacettepe Medical Faculty Hospital with the complaints of headache, nausea, vomiting, lethargy, and weakness on her right side. She revealed a history of pulmonary Cryptococcus infection 5 years before and she had been treated with amphotericin B. After clinical and laboratory investigation she was thought to have an intracranial mass, but her deteriorating situation did not allow any surgical intervention; she died within 7 days. On necropsy, hard, gray-white nodular pulmonary lesions, ranging 0.1-4 cm in diameter, basal meningitis, infarcts, and a nodular lesion 1.5 cm in diameter similar to those of the lung were present in the white matter of the right hemisphere of the brain. Microscopic examination revealed granulomatous inflammation caused by Cladosporium, which had brown pigment and septate hyphae.

Facial nerve conduction in diabetic neuropathy.

Diabetes mellitus (DM) has a severe influence on the nervous system and it is more likely to occur on the nerves of the upper and lower extremities than on the cranial nerves. According to the statistics, the incidence of cranial nerve involvement ranges anywhere from 3% to 14%. The aim of this study is to perform facial nerve conduction studies in diabetic patients with peripheral neuropathy, confirmed by electrophysiological methods, to determine the frequency of affection of a cranial nerve conduction in a neuropathy which mainly occurs in a distal, symmetric fashion. The study was conducted in a group of 20 diabetics who had electrophysiologically confirmed polyneuropathy. All of the patients had type 2 DM. Sixteen of the patients were receiving insulin therapy and 4 were treated with oral hypoglycaemic agents only. We found prolonged facial nerve distal latency at least on one tested side in 70% of patients. Distal latency and amplitudes of muscle responses to facial nerve stimulation showed a statistically significant difference from controls (p < 0.001). This study has shown that proximal nerves like cranial nerves are affected in a high proportion of cases in a neuropathy which mainly occurs in a distal symmetric fashion. The facial nerve is one of the most easily accessible nerves in the proximal part of the body (head-face) and makes it suitable for routine evaluation. We believe this conduction abnormality may give us the chance to classify these neuropathies as more severe than the ones that only have limb conduction abnormalities. Further studies should be performed in order to confirm these findings.

Serum nitric oxide metabolites in patients with multiple sclerosis.

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system characterized by myelin breakdown. The free radical nitric oxide (NO), which is considered to be a major metabolite in immune function and in autoimmune disorders, is among the possible mediators causing the inflammatory reactions in MS. Consequently, NO has been implicated in the pathogenesis of MS and its animal model experimental allergic encephalomyelitis (EAE). In this study, stable metabolites of NO (NO(2-)+NO(3-)) levels were determined in sera of MS patients (n=23) and control subjects (n=16). NO(2-)+NO(3-) levels were higher in MS patients when compared to control subjects. However, there was not any correlation with serum NO(2-)+NO(3-) values and clinical features of the disease such as duration of sickness, the time elapsed from the last attack and EDSS values. Our results imply that nitric oxide may be involved in the pathogenesis of MS although further studies are required to elucidate underlying mechanisms.

The correlation between cerebrospinal fluid findings and evoked potentials during an acute MS attack.

Clinically definite Multiple Sclerosis (MS) cases have an index greater than 0.7. Evoked potentials using geometrical patterns and click stimuli respectively and electrical stimulation of mixed nerve trunks evokes low level electrical impulses along a nerve. Prolonged latencies and changes in amplitude in these evoked potentials are thought to reflect sensory loss. This study is performed to determine whether there is a correlation between cerebrospinal fluid (CSF) findings and evoked potentials in MS during an acute MS attack. 10 male and 10 female patients' (20-55) mean (37.75) were included in to the study. They were diagnosed as definite MS with their clinical and MRI findings. During the acute attack 10 (50%) patients out of 20 had high Ig G index and one (10%) had oligoclonal band positivity. Of these 10 patients 8 (4 M, 4 F) had pathology in their evoked potentials while two had normal evoked potential findings. 8 of (80%) 10 patients whom had normal Ig G index during the acute attack had evoked potential pathology while (20%) had normal Ig G index and evoked potentials during the acute attack. Of the 8 patients which had high Ig G index and pathological evoked potential findings during acute attack were evaluated. VEP, BAEP latencies were found to be prolonged as Ig G index increased. (p < 0.05) However the same correlation can not be found with SEP parameters.

Sympathetic skin response in diabetic neuropathy.

Autonomic neuropathy is a complication of diabetes mellitus (DM) in substantial proportion of cases and may cause definite autonomic symptoms. Because conventional electrophysiological methods do not assess the autonomic nervous system, simple reproducible tests were developed. One of them is sympathetic skin response (SSR) which provides useful information about the status of sympathetic postganglionic function. The aim of this study is to perform SSR in diabetic patients to see whether this test can be used as an electrophysiological method for the diagnosis and confirmation of diabetic autonomic neuropathy. 20 diabetic patients who had electrophysiologically confirmed polyneuropathy but showed no symptoms or signs referable to autonomic system dysfunction were included. 14 (70%) patients demonstrated abnormal SSR. 2 abnormal patterns were observed. An absent response in at least one tested lower extremity (50%) and prolonged foot with normal hand latency (20%). 6 patients (30%) demonstrated no abnormalities. Foot and hand latencies in diabetics did not differ significantly from those of normal controls (p: 0.4, p: 0.1) and no correlation could be found with latencies and duration of sickness, patient's age and HbA1c values. We believe latency measurement is an objective measure of conduction in multineural pathways and can detect subclinical involvement of sympathetic nervous system in diabetics who do not manifest symptoms or signs referable to autonomic system dysfunction.

[The role of viral antibodies in the pathogenesis of degenerative and demyelinating diseases]. / Dejeneratif ve demiyelinizan hastaliklarin patogenezinde viral antikorlarin rolünün degerlendirilmesi.

Serologic investigations were carried on samples of sera and cerebrospinal fluid from patients aged between 6 and 67 years with degenerative and demyelinating disease with the aim of determining the pathogenetic role of viruses in these disorders. Increased titers of complement fixation antibodies against the measles virus were detected in patients with subacute sclerosing panencephalitis and multiple sclerosis, whereas high titers of complement fixation antibodies against Herpes Simplex Virus Type I were found in Parkinsonian cases. Demonstration of high titers of heterophil antibodies in patients with Parkinson's disease seemed to be a significant contribution to this matter. Although HSV type I and heterophil antibodies were high in patients with amyotrophic lateral sclerosis, small number of samples hampered satisfactory interpretation.

[Virologic and immunologic considerations in Parkinson's disease]. / Parkinson hastagliginda virolojik ve immunolojik görüsler.

The investigations related to the etiological role of various viruses in parkinson's Disease are in progress. The role of influenza virus virus was implied, although not definitely proved in post-encephalitic parkinson's Disease. Recent virological and immunological studies are concentrated on influenza and Herpes simplex viruses in idiopathic Parkinsonism. However the evidence obtained is conflicting. More elaborate and detailed research is needed to elucidate the relations between Parkinsonism and the viruses; especially the Herpes simplex virus.

[Humoral and cellular immunity in uremia]. / Uremide hümöral ve hücresel bagisiklik.

Uremia is a metabolic imbalance accompanied by an acquired immunologic deficiency state. Fatal infections frequently met with uremia may be explained both by cellular and humoral immunologic disorders. In this article, the cellular immune status was investigated via intradermal skin test, and the serum and cerebrospinal fluid (CSF) immunoglobulins were detected. Results indicated that a cellular and humoral immunologic deficiency, which deteriorated in accordance with the clinical status, existed and a CSF immunoglobulin increase, presumably due to changes in the blood - CSF barrier, was noted.

[Leukotrienes and neurological diseases]. / Leukotrienler ve nörolojik hastaliklar.

Assessment of Leukotriene C4 (LTC4) activity in the serum and cerebrospinal fluid (CSF) specimens of patients with multiple sclerosis (MS), Parkinson's disease, amyotrophic lateral sclerosis (ALS), Myasthenia gravis (MG), Behçet's disease and neuro-Behçet, as well as in normal controls were carried out in order to determine its role in the pathogenesis of neurologic disorders. LTC4 levels were found to be elevated in MS and Behçet patient in comparison with controls. Augmentation of LTC4 levels underlines the fact that leukotrienes may be held responsible the pathogenesis of these disorders.

[The viral etiology of amyotrophic lateral sclerosis]. / Amyotrofik lateral sklerozda viral etyolojinin arastirilmasi.

Roles of immunologic factors and slow virus infections in the aetiopathogenesis of amyotrophic lateral sclerosis (ALS) have recently gained significance. For this purpose, presence of poliovirus type I, measles and herpes simplex (HSV) type I antibodies were determined in the sera of ALS patients by complement fixation technique. Significant increase in antibody titers for poliovirus type I and HSV type I were determined in sera of ALS patients in comparison with controls and patients with other neurologic disorders.

Multiple sclerosis and optic nerve: an analysis of retinal nerve fiber layer thickness and color Doppler imaging parameters.

PURPOSE: To compare both retinal nerve fiber layer thickness and orbital color Doppler ultrasonography parameters in patients with multiple sclerosis (MS) versus healthy controls. METHODS: This is an observational case-control study. Forty eyes from MS patients and twenty eyes from healthy volunteers were examined. Eyes were classified into three groups as group 1, eyes from MS patients with previous optic neuritis (n=20); group 2, eyes from MS patients without previous optic neuritis (n=20); and group 3, eyes from healthy controls (n=20). Following complete ophthalmologic examination and retinal nerve fiber layer thickness measurement for each group, blood flow velocities of posterior ciliary arteries, central retinal artery, ophthalmic artery, and superior ophthalmic vein were measured. Pourcelot index (resistive index), an indicator of peripheral vascular resistance, was also calculated. The statistical assessment was performed with the assistance of Pearson's Chi-square test, Mann-Whitney U-test, Kruskal-Wallis test, and Spearman's correlation test. RESULTS: The studied eyes exposed similar values in terms of intraocular pressure and central corneal thickness, implying no evidence in favor of glaucoma. All nerve fiber layer thickness values, except superior nasal quadrants, in group 1 were found to be significantly thinner than groups 2 and 3. Blood flow velocity and mean resistivity index parameters were similar in all the groups. CONCLUSIONS: In MS patients, especially with previous optic neuritis, diminished retinal nerve fiber layer thickness was observed. Contrary to several studies in the current literature, no evidence supporting potential vascular origin of ocular involvement in MS was found.

Iron-Deficiency Anemia Leading to Transient Ischemic Attacks due to Intraluminal Carotid Artery Thrombus.

Reactive thrombocytosis secondary to iron-deficiency anemia (IDA) is a rare but recognized cause of stroke. We report the case of a patient with iron-deficiency anemia presenting with multiple transient ischemic attacks (TIA) due to intraluminal thrombus of an internal carotid artery. The putative mechanisms underlying anemia and stroke syndromes are not completely understood, and it is believed that iron deficiency may cause ischemic stroke by several potential mechanisms. Thrombocytosis is often associated with iron deficiency, and microcytosis produces a reduction in the red cell deformability and could produce a hypercoagulable state. The platelet count and function observed in iron-deficiency anemia could act synergistically to promote thrombus formation, especially in the setting of an underlying atherosclerotic disease. The presence of floating thrombus in a patient with clinical and MRI evidence of stroke represents a significant therapeutic dilemma and requires immediate decision about treatment.