Assessment of fibrinogen albumin ratio in patients with pregnancy-related cerebral venous thrombosis.

INTRODUCTION AND OBJECTIVE: Cerebral venous thrombosis (CVT) is a cerebrovascular disease observed more commonly in women of childbearing age. There is currently no biomarker used to predict the risk of CVT during the follow-up of pregnant/postpartum patients. In this context, the objective of this study is to investigate the importance of fibrinogen and albumin levels and fibrinogen-to-albumin ratio (FAR) values, which predispose to thromboembolism, in pregnant/postpartum patients. MATERIAL AND METHOD: The study sample consisted of 19 pregnant/postpartum patients with a diagnosis of CVT, 20 pregnant/postpartum patients without CVT. Albumin and fibrinogen levels and FAR values were compared between these two groups. RESULTS: Fibrinogen level was significantly higher in pregnant/postpartum CVT patients compared to pregnant/postpartum patients without CVT (p = 0.010). On the other hand, albumin level was significantly lower in pregnant/postpartum CVT patients compared to the other group (p = 0.010). Lastly, FAR level was significantly higher in pregnant/postpartum CVT patients compared to the other group (p = 0.011). There was no correlation between FAR values and modified Rankin score. CONCLUSION: The study findings indicated that high fibrinogen and low albumin levels and high FAR values are associated with an increased risk of CVT in pregnant/postpartum patients.

Immune responses following COVID-19 infection in multiple sclerosis patients using immunomodulatory therapy.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus type-2 (SARS-CoV-2), has quickly become a global pandemic. Most multiple sclerosis (MS) patients use disease-modifying treatments (DMTs), such as immunomodulators or immunosuppressants. By targeting different types of immune cells, DMTs affect cellular and/or humoral immunity. The potential effects of DMTs on the long-term immune response to COVID-19 is not fully known. Between 16.04.2020 and 15.07.2020, a total of 34 people, 17 of whom were diagnosed with MS according to the 2010 McDonald diagnostic criteria and a control group of 17 individuals who did not have a known systemic disease who were matched according to age, gender, and COVID-19 disease severity, where all received COVID-19 diagnosis with SARS-CoV-2 PCR positivity in nasopharyngeal swab test and immune responses were measured (SARS-CoV-2 IgM and IgG antibody levels COVID 19 ELISA kit), were included in our study. Demographic data of MS patients and the control group, SARS-CoV-2 immune responses, antibody titers and disease year of MS patients, EDSS scores, disease type, and disease duration were determined. All patients were symptomatic for COVID-19. COVID-19 disease severity was divided into three groups as mild, moderate, and severe according to the clinical condition of the patient. Demographic data of MS patients and the control group, SARS-CoV-2 immune responses, antibody titers and disease year of MS patients, EDSS scores, disease type, and disease duration were determined. All patients were symptomatic for COVID-19. COVID-19 disease severity was divided into three groups as mild, moderate, and severe according to the clinical condition of the patient. According to our study results, IgG-type long-term immune responses were lower in MS patients using DMTs than in the healthy population. We hope that our study will provide insight into the COVID-19 vaccine immune responses.

Relationship Between Acute Phase Reactants and Disability in Guillian-Barré Syndrome During the COVID-19 Pandemic.

BACKROUND: Guillain-Barré syndrome (GBS) is an immune-mediated disease that affects the peripheral nervous system and may occur after some bacterial-viral infections. AIM: The aim of this study is to determine and compare the epidemiological, clinical and laboratory characteristics of the patients followed up in our clinic with the diagnosis of GBS in the 15 month periods before and after March 2020. At the same time, we aimed to examine the importance of these markers as prognostic indicators by investigating the relationship of D-dimer, CRP, albumin and transferrin levels with Hughes functional grading scale score (HFGSS). MATERIAL AND METHODS: The medical files of the patients who were followed up with the diagnosis of GBS between December 2018 and May 2021 were retrospectively analyzed. The patients were divided into groups as pandemic, pre-pandemic, post-COVID-19 and non-COVID-19. Epidemiological and clinical characteristics of GBS patients and plasma D-dimer, serum albumin, CRP and transferrin levels were recorded. RESULTS: No significant difference was found between the pandemic and pre-pandemic periods in terms of age, gender, GBS subtype, seasonal distribution and treatment characteristics of GBS patients. PostCOVID-19 GBS patients had significantly higher HFGSS both at admission and at discharge (p <0.05). In post-COVID-19 GBS patients good-excellent negative correlation between transferrin and albumin levels and HFGSS at hospital admission and discharge, positive correlations with CRP levels were observed. CONCLUSION: Post-COVID-19 GBS patients had worse HFGSS at both admission and discharge. CRP was positively correlated with HFGSS whereas transferrin and albumin showed negative correlation with HFGSS.

Vitamin D levels and C-reactive protein/albumin ratio in pregnant women with cerebral venous sinus thrombosis.

Changes in coagulation system during pregnancy have been put forth as risk factors for cerebral venous sinus thrombosis (CVT), yet we still have limited knowledge on markers for predicting the risk of CVT in pregnant women. Therefore, we aimed to investigate the significance of vitamin D (VD) levels and C-reactive protein (CRP)/albumin ratio (CAR), an inflammation marker, as risk factors for CVT in pregnant women. 23 pregnant women who were followed up for CVT, 26 healthy pregnant women who had no pregnancy complications, and 31 non-pregnant fertile women were included in the study. CAR and VD levels were compared between groups. CAR was significantly higher in the pregnant CVT group compared to the other two groups (p < 0.001). CAR was also significantly higher in the healthy pregnant group than the non-pregnant fertile group (p < 0.001). VD levels were determined to be statistically significantly lower in the pregnant CVT group compared to the other two groups (p < 0.001). However, VD levels did not significantly differ between healthy pregnant group and non-pregnant fertile group (p > 0.05). We found no significant correlation between CAR and VD levels in any of the three groups. Pregnant women with CVT were found to have a high rate of severe VD deficiency. Low VD levels and high CAR levels in pregnant women may be associated with an increased risk of CVT.

[Idiopathic orbital myositis masked by migraine diagnosis: A case report]. / Migren tanisinin maskeledigi idiyopatik orbital miyozit: Olgu sunumu.

Idiopathic orbital myositis is an inflammatory disease of the extraocular muscles and is a rare disease of orbit. Diagnosis is based on clinical and radiological findings. Demonstration of edema and thickening of extraocular muscles in orbital magnetic resonance imaging and dramatic response to corticosteroids are considered a pathognomonic finding for orbital myositis. In this case, we aimed to discuss a rare case and emphasize the importance of differential diagnosis in headaches.

Oxidative stress activity of fingolimod in multiple sclerosis.

OBJECTIVE: Multiple sclerosis (MS) is a demyelinating chronic inflammatory disease of the central nervous system (CNS). Recent studies have shown that oxidative stress plays an important role in MS pathogenesis. This study aimed to investigate the relationship between total oxidative stress (TOS) and total antioxidant capacity (TAC), which were reported to be effective in the pathogenesis of MS, and therapeutic efficacy of fingolimod used in the treatment of MS. MATERIALS AND METHODS: Serum TOS and total TAC levels of 25 patients with relapsing-remitting MS (RRMS) were measured before fingolimod treatment was initiated and in the third month of treatment and compared with those of 40 healthy individuals. Measurement of TOS activity was performed with TOS Assay Kit (Rel Assay Diagnostics, Turkey). Measurement of TAC activity was also performed with TAC Assay Kit (Rel Assay Diagnostics, Turkey). RESULTS: A statistically significant increase was observed in the TOS levels measured before fingolimod treatment in the patient group compared to the control group. The TOS levels measured in the third month of the treatment were found to decrease significantly compared to the pre-treatment TOS levels. An increase was observed in TAC levels after the treatment; however, no significant difference was found between the groups in terms of TAC levels. There was a positive correlation between the pre- and post-treatment Expanded Disability Status Scale (EDSS) scores and TOS values whereas no significant correlation was observed between the pre- and post-treatment EDSS scores and TAC values. CONCLUSION: The present study has revealed that fingolimod reduced oxidative stress. There was a positive correlation between the pre- and post-treatment EDSS and TOS values, which confirmed that there was a close correlation between the MS and oxidative stress. There are some limitations in this study. The small number of patients and the short follow-up times can be listed among these limitations. Our study does not contain a definitive answer to what is the mechanism of increased TOS in MS patients and how fingolimod reduces TOS levels. More detailed studies are needed on this subject.

Low serum Α-SYNUCLEIN and oligomer Α-SYNUCLEIN levels in multiple sclerosis patients.

INTRODUCTION: Multiple sclerosis (MS) is an autoimmune, inflammatory, demyelinating neurodegenerative disease progressing with attacks. Alpha-synuclein (α-Syn), a neuronal protein, has been previously associated with the inflammation and development of neurodegenerative diseases. Although the cause of neurodegeneration in multiple sclerosis is mainly associated with inflammation, α-Syn may play a role in the pathogenesis of MS, as in other classical neurodegenerative diseases such as synucleinopathies. In multiple sclerosis, α-Syn has been directly studied in central nervous system lesions and cerebrospinal fluid (CSF). However, there are few studies approaching variations in peripheral α-Syn in MS. The aim of our study was to investigate the correlation between disease progression and other clinical parameters by measuring serum α-Syn and oligomer α-Syn levels in MS patients. MATERIAL AND METHOD: The study included 60 MS patients aged 18 years or older who were admitted to the Department of Neurology between 01.02.2020-01.04.2020 and diagnosed with MS according to the 2010 MC Donald criteria, and 60 age- and sex-matched healthy controls. Those who were in the MS attack period and received cortisone treatment in the past three months were excluded from the study. The serum α-Syn and oligomer α-Syn levels of the individuals in both groups were measured. The correlation between the serum α-Syn, oligomer α-Syn, oligomer α-Syn/α-Syn ratio levels of the MS patients and their age, disease duration, number of attacks, annualized relapse rate (ARR), disease type, EDSS scores and immunomodulatory drug type used was investigated. Statistical analysis was performed using the SPSS 22.0 software. RESULTS: In our study, 73.3% of the MS patients were female and the mean age of the patients was 36.18 ± 9.5 years. The most common MS disease type was RRMS with 83.3%. Serum α-Syn (79.52 ± 34.81) and oligomer α-Syn (18.79 ± 10.48) levels were significantly lower in the MS patients compared to the control group (p < 0.001). Serum oligomer α-Syn/α-Syn ratio was higher in the MS patients compared to the control group and in SPMS compared to RRMS, but was not statistically significant. There was no significant correlation between the serum α-Syn, oligomer α-Syn and oligomer α-Syn/α-Syn ratio ratio of the MS patients and their age, disease duration, disease type, EDDS, ARR and immunomodulatory treatments. There was a significant positive correlation between α-Syn and oligomer α-Syn in MS patients (r: 0.29, p: 0.02). CONCLUSION: In our study, serum α-Syn and oligomer α-Syn levels were lower in the MS patients compared to the control group. Low levels of α-Syn in MS may play a role in the development of neuroinflammation and may be a result of the diffuse neuronal and synaptic loss. There is a need for further studies on this subject.

Biotinidase deficiency in differential diagnosis of neuromyelitis optica spectrum disorder.

We present a case of biotinidase deficiency mimicking neuromyelitis optica spectrum disorder (NMOSD) with tetraparesis and transverse myelitis, who was diagnosed with profound biotinidase deficiency after developing optic atrophy and hearing loss before the age of one year, and was untreated for six months. Biotinidase deficiency should be considered in the differential diagnosis of seronegative NMOSD.