Prognostic importance of nutritional assessment in patients with acute ischemic stroke undergoing endovascular thrombectomy.

OBJECTIVE: The prevalence of malnutrition in patients with acute ischemic stroke (AIS) can range from 8% to 34%. It has been shown that prognostic nutritional index (PNI) and control nutritional status (CONUT) scores can provide an opportunity to make prognostic predictions in some disease groups. Previous studies have shown a close relationship between malnutrition scores and stroke prognosis. We evaluated the effect of nutritional scores on in-hospital and long-term mortality in AIS patients undergoing endovascular therapy (EVT). PATIENTS AND METHODS: 219 patients who underwent EVT for the AIS were included in this retrospective design and cross-sectional study. The primary endpoint of the study was accepted as all-cause death including in-hospital death, 1-year death, and 3-years death. RESULTS: A total of 57 patients died in the hospital. In-hospital mortality rate was higher in the high CONUT group [36 (49.3%), 10 (13.7%), 11 (15.1%), p<0.001]. A total of 78 patients died within one year, and 1-year mortality was higher in the high CONUT group [43 (58.9%), 21 (28.8), 14 (19.2), p<0.001]. At the end of the 3-year follow-up, 90 patients had died, and the 3-year mortality rate was significantly higher in groups with a high CONUT score than in those with a low CONUT score (p<0.001). CONCLUSIONS: A higher CONUT score, calculated easily by simple scoring with parameters studied from peripheral blood before the EVT procedure, is an independent predictor of in-hospital, 1-year, and 3-years all-cause mortality.

Serum endocan levels in multiple sclerosis relapse and remission.

OBJECTIVE: Endocan has been defined as an important marker of inflammatory diseases, vascular and endothelial injury, tumour progression, cell adhesion and angiogenesis. In our study, we compared the serum endocan, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) levels of relapsing-remitting multiple sclerosis (RRMS) patients in remission and in relapse. PATIENTS AND METHODS: This study included 53 RRMS remission patients, 30 RRMS relapse/post-relapse patients and 44 healthy volunteers. Blood samples were collected once from RRMS patients in remission and from the control group, and twice from RRMS relapse patients: once when relapsing and another 1 month after relapse. The endocan, CRP and NLR levels of the RRMS patients measured while in relapse, 1 month after relapse and while in remission were compared to those of the control group. The studied parameters were compared with the disease duration, relapse frequency, Expanded Disability Status Scale (EDSS) score, applied treatment and lesion burden assessed using magnetic resonance imaging (MRI). RESULTS: The endocan, CRP and NLR levels were significantly higher in the RRMS group than in the control group (p < 0.05). The serum endocan levels were found to be significantly higher in the RRMS relapse group than in the post-relapse and control groups (p < 0.05). There were no significant correlations between the disease duration, EDSS score, relapse frequency and lesion burden on MRI and the endocan, CRP and NLR values (p > 0.05). According to the correlation analysis, there was a statistically strong positive relationship between the MRI lesion localisation and the EDSS score, disease duration and relapse frequency (p < 0.001). CONCLUSIONS: Endocan increase is a marker of the endothelial injury that develops secondary to the inflammatory process in MS patients. It can thus be considered a moderately good indicator of relapse.

Neuroprotective effects of carvacrol and pomegranate against methotrexate-induced toxicity in rats.

BACKGROUND: Studies related to the use of various antioxidant and anti-inflammatory drugs to decrease the toxic side effects related to MTX have been carried out. However, since no medicine providing full protection against the side effects of MTX has been discovered, the discovery of new agents is required. AIM: The aim of this study was to determine whether methotrexate (MTX) causes oxidative stress and an inflammatory response in sciatic nerve, as well as whether carvacrol (CAR) and pomegranate (POM) have protective effects against the resulting oxidative stress and inflammatory response. MATERIALS AND METHODS: 32 adult male Wistar albino rats were used in the study. The animals were divided into 4 groups: Group C: the rats were not given any medication; Group MTX: On study day 2, the rats were given a single dose of 20 mg/kg MTX, administered intraperitoneally; Group MTX+CAR: On study day one, the rats were administered a single dose of 73 mg/kg CAR intraperitoneally. On study day two, a single dose of 20 mg/kg MTX was administered intraperitoneally; Group MTX+POM: For seven days starting from the study day one, rats were given 225 mg/kg POM extract once a day through orogastric gavage. On study day two, a single dose of 20 mg/kg MTX was administered intraperitoneally. All animals were sacrificed on the day eight. TOS, TAS, MDA, TNF-α and IL-1ß levels were evaluated in the sciatic nerve tissue. RESULTS: In comparison to the control group, a decrease in TAS levels and an increase in TOS, MDA, IL-1ß and TNF-α levels were detected in the MTX group. Compared to the MTX group, the MTX+CAR group had a significant increase in TAS level and significant decreases in TOS, MDA, IL-1ß and TNF-α levels. In comparison to the MTX group, the MTX+POM group had a significant decrease in MDA, IL-1ß and TNF-α levels. When the MTX+CAR and MTX+POM groups were compared, the TNF-α level measured was lower in the MTX+CAR group. CONCLUSIONS: In this work, we have shown that MTX causes a significant oxidative stress and inflammatory response in rats' sciatic nerve tissue and that CAR had an antioxidant effect in this system. Furthermore, we have proven, for the first time, that both CAR and POM decreased the pro-inflammatory response.

Effects of estrogen, estrogen/progesteron combination and genistein treatments on oxidant/antioxidant status in the brain of ovariectomized rats.

INTRODUCTION: The aim of this study was to investigate the antioxidative effects of estradiol (E), E plus progesteron (P) combination (E/P) and genistein (G) treatment in the brain of ovariectomized (OVX) rats. MATERIALS AND METHODS: Adult female Sprague-Dawley rats were divided into five groups, with each group including ten rats. Rats were anesthetized and bilateral ovariectomy was performed under general anaesthesia in all groups except for the sham operation group. Groups included: Sham-operated, control (OVX), estrogen treated group (OVX+ E), E/P combination group (OVX+E/P) and G treated group (OVX+G). Treatments were applied for 8 weeks. The total anti-oxidant status (TAS), total oxidant status (TOS), nitric oxide level (NO), glutathione peroxidase activity (GSH-Px) and oxidative stress index (OSI) were analysed in the brain tissue of rats from each treatment category. RESULTS: Ovariectomy lead to an increase in brain TOS and OSI levels compared to the sham group (p < 0.05). Also, ovariectomy resulted in a decrease in brain TAS levels compared to the sham group that approached statistical significance (p = 0.078). Significant decreases in TOS, OSI, GSH-Px and a significant increases in TAS and NO levels were observed in the E-treatment group compared to the control group (p < 0.001). The E/P combination group exhibited a significantly decreased TOS and OSI and significantly increased TAS and NO levels relative to the control group (p < 0.05). Genistein treatment resulted in a significant decrease in TOS and OSI compared to the control group (p < 0.05). CONCLUSIONS: Oxidative stress markers increase in the brain tissue of OVX rats. Conversely, estradiol, E/P and G supplementation decreases oxidative stress markers and increases antioxidant activity. Using G may prevent neural pathologies result in menopause-related oxidative stress.

The relationship of the mean platelet volume and C-reactive protein levels with mortality in ischemic stroke patients.

BACKGROUND AND OBJECTIVES: The relationship of the mean platelet volume (MPV) and C-reactive protein (CRP) values with mortality in patients with ischemic stroke is not clear. Besides, the correlation between CRP and MPV in patients with ischemic stroke has not been adequately studied yet. In the present study, our aim is to investigate the interrelationship of the CRP and MPV parameters together with their influence on mortality in patients with acute ischemic stroke. PATIENTS AND METHODS: Sixty-three patients with acute ischemic stroke have been enrolled in the study. The stroke patients were divided into 2 groups as those who died within the first 10 days and those who survived. The MPV and CRP in both groups have been compared. Also, the MPV obtained from the ischemic stroke patients were compared with the MPV of the healthy volunteers. RESULTS: A statistically significant difference (p = 0.027) was observed between the MPV of the stroke patients (8.6±1.95 fL) and the control group (7.93±0.82 fl). The MPV (9.24±1.98 fL) and CRP (10.8±7.0 mg/l) of those ischemic stroke patients who died were statistically significantly higher (p < 0.05) than the MPV (8.09±1.75 fl) and CRP (3.2±3.5 mg/l) of the patients who survived. There was also a positive correlation between the MPV and CRP of the ischemic stroke patients (r = 0.31, p = 0.029). CONCLUSIONS: The fact that there is a relationship between the MPV and CRP in ischemic stroke patients and that the CRP and MPV are higher in the ischemic stroke patients who died in comparison to those who survived may be an indication of the roles these markers play in the mortality of stroke patients.

Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack.

OBJECTIVES: This investigation was conducted to test the value of Neutrophil Lymphocyte Ratio (NLR), which has been shown in some recent studies to be a prognostically important and an easy-to-measure inflammatory marker, in patients presenting to Emergency Service with stroke (ischemic and hemorrhagic) and transient ischemic attack. MATERIALS AND METHODS: A total of 868 patients were enrolled, who presented to our Emergency Service with cerebrovascular accident (stroke and transient ischemic attack) and admitted to Neurology Clinic. Demographic characteristics and comorbidities of patients were recorded. The patients were divided into 3 groups as acute ischemic stroke (AIS), acute hemorrhagic stroke (AHS) and transient ischemic attack (TIA). Patients with AIS were classified into subgroups in terms of TOAST (trial of 10172 stroke treatment) criteria. Admission NLR levels were compared across all groups. RESULTS: A total of 868 patients were enrolled, 51.6% of which were male and 48.4% were female. AIS rate was 75.3%, AHS rate was 14.3% and TIA rate was 10.7%. In all of patients, mortality rate was 10.7%. NLR was significantly higher in patients who died (p < 0.001). NLR level in patients with TIA was significantly lower than those of AIS and AHS groups (p < 0.001). Among AIS subgroups, NLR level was significantly higher in group with great artery atherosclerosis or atherothrombosis compared to other groups (p < 0.001). CONCLUSIONS: NLR may be used as a simple and easy-to-measure marker for prediction of short-term prognosis and in-hospital mortality in both ischemic and hemorrhagic stroke patients.

Post-stroke sexual functioning in first stroke patients.

BACKGROUND AND PURPOSE: Although physical problems after stroke have been well studied, there is little information on one of the crucial aspects of the quality of life of those patients, namely sexual functioning and satisfaction. The aim of this study was to assess the impact of stroke on sexual functioning in a stable cohort of Turkish stroke patients with mild or no disability and to assess the relationship between post-stroke sexuality and a number of socio-demographic, clinical and laboratory variables. METHODS: The sexual functioning of 103 Turkish stroke patients with no disability or mild disability was assessed in two consecutive interviews along with clinical and sociodemographic features. NIH stroke, Glasgow coma, Barthel, and Rankin scales were also applied to assess neurologic status and disability. RESULTS: Most of the patients were male (61%) and illiterate (70%). There was a significant difference between the baseline and post-stroke frequency of sexual activity of the patients. The differences between baseline and post-stroke vaginal lubrication, orgasms and satisfaction were all statistically significant. This latter difference was significant for both genders. Frequency of coitus both prior to and after the stroke was significantly different between males and females. Erection and ejaculation of the males was significantly affected by the stroke, and lubrication and orgasm was affected in the females. Interestingly, fear of recurrent stroke did not differ between genders. DISCUSSION AND CONCLUSION: Our study has shown that Turkish stroke survivors have sexual health needs during the rehabilitation process, though this has not been addressed previously. Sexual health needs seem to be affected by cultural factors and biases.