Birsen Ince - Academia.edu (original) (raw)

Papers by Birsen Ince

Value in Health, May 1, 2013

direct and indirect costs of patients with AF-related stroke in China, producing an average cost ... more direct and indirect costs of patients with AF-related stroke in China, producing an average cost per patient per year and the economic burden of the whole AFrelated stroke Chinese population. METHODS: A cost-of-illness analyses was performed. Prevalence data on AF-related stroke for the Chinese population was collected from literatures. An observational retrospective study was conducted to collect the economic data. We recruited 156 patients diagnosed with AF and stroke in Beijing, Shanghai and Guangzhou between October 2012 and December 2012. Patients or their carers were interviewed about resource utilization and absenteeism from work in the past year. Direct medical costs included outpatient visit, hospitalization, ambulatory, drug, diagnostic tests, and physiotherapy costs. Indirect costs were estimated using a human capital approach. All costs referred to 2011. RESULTS: Among 156 patients with AFrelated stroke, 59.35% were male and the mean age was 67.9±30.2 years. 98.0% patients have at least one kind of health insurance. From the societal perspective, total costs per patient over 1 year amounted to Chinese Yuan (CNY) 25538 (median: CNY13342, IQR: CNY7662-CNY 38714), with direct costs accounting for 94.2% and indirect costs for 5.8% of the total. And for the direct costs, the informal care costs were CNY9162. The drug costs were CNY6293. Based on the prevalence of AF and AF-related stroke in China from literatures, there was about 0.968 million patients of AF-related stroke. Costs for the nation are estimated at CNY24.7 billion per year. CONCLUSIONS: The economic burden of AF-related stroke in China is considerable. The primary burden on patients was due to informal care and drugs.

Türk Beyin Damar Hastalıkları Dergisi, Dec 1, 1995

Türk Beyin Damar Hastalıkları Dergisi, 2015

In this section, in the light of evidence-based data concerning essentiality that the stoke patie... more In this section, in the light of evidence-based data concerning essentiality that the stoke patients should be treated in A stroke unit and related centers, a brief and current information about general stroke treatment of patients with stroke during acute phase will be offered.

European Neurology, 2020

Introduction: Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increase... more Introduction: Cerebral venous and sinus thrombosis (CVST) may lead to cerebral edema and increased intracranial pressure; besides, ischemic or hemorrhagic lesions may develop. Intracerebral hemorrhages occur in approximately one-third of CVST patients. We assessed and compared the findings of the cerebral hemorrhage (CH) group and the CVST group. Materials and Methods: In the VENOST study, medical records of 1,193 patients with CVST, aged over 18 years, were obtained from 35 national stroke centers. Demographic characteristics, clinical symptoms, signs at the admission, radiological findings, etiologic factors, acute and maintenance treatment, and outcome results were reported. The number of involved sinuses or veins, localizations of thrombus, and lesions on CT and MRI scans were recorded. Results: CH was detected in the brain imaging of 241 (21.1%) patients, as hemorrhagic infarction in 198 patients and intracerebral hemorrhage in 43 patients. Gynecologic causes comprised the larg...

Stroke Research and Treatment, 2020

Background. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproducti... more Background. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group. Methods. Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF. Results. The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34±9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cas...

Iranian Journal of Neurology, 2020

Although various advancements have been made to control incidence of stroke, the overall incidenc... more Although various advancements have been made to control incidence of stroke, the overall incidence, and the rate of morbidity of stroke, still increase in developing countries.1-3 In last years, the epidemiologic studies on ischemic stroke have been widely increased in Turkey and Iran.1-3 These two countries are located in similar geography with a similar historical background, though the environmental factors and lifestyle of general population in these two neighboring countries show peculiar differences. In this study, we aimed to make a comparison between data from Turkey and from Iran, in terms of etiologies and risk factors of ischemic stroke, to reveal region-related similarities or country-related differences. We reviewed the files of 2534 patients with ischemic stroke followed up for 15 years in our Cerebrovascular Outpatient Clinics in Faculty of Neurology, Istanbul University (Cerrahpasa), Istanbul, Turkey. Data collection in Iran was made from 2314 patients with ischemic ...

Cardiovascular Therapeutics, 2019

Aim. Though combination of clopidogrel added to aspirin has been compared to aspirin alone in pat... more Aim. Though combination of clopidogrel added to aspirin has been compared to aspirin alone in patients with stroke or transient ischemic attack, limited data exists on the relative efficacy and safety between clopidogrel and aspirin monotherapy in patients with a recent ischemic stroke. We aimed to compare clopidogrel versus aspirin monotherapy in this population. Methods. PubMed, Embase, and CENTRAL databases were searched from inception to May 2018 to identify clinical trials and observational studies comparing clopidogrel versus aspirin for secondary prevention in patients with recent ischemic stroke within 12 months. Pooled effect estimates were calculated using a random effects model and were reported as risk ratios with 95% confidence intervals. Results. Five studies meeting eligibility criteria were included in the analysis. A total of 29,357 adult patients who had recent ischemic stroke received either clopidogrel (n=14,293) or aspirin (n=15,064) for secondary prevention. Pa...

Journal of Stroke and Cerebrovascular Diseases, 2019

Aim: Systemic lupus erythematosus (SLE) is an unusual risk factor for cerebral venous sinus throm... more Aim: Systemic lupus erythematosus (SLE) is an unusual risk factor for cerebral venous sinus thrombosis (CVST). As few CVST patients with SLE have been reported, little is known regarding its frequency as an underlying etiology, clinical characteristics, or long-term outcome. We evaluated a large cohort of CVST patients with SLE in a multicenter study of cerebral venous thrombosis, the VENOST study, and their clinical characteristics. Material and Method: Among the 1144 CVST patients in the VENOST cohort, patients diagnosed with SLE were studied. Their demographic and clinical characteristics, etiological risk factors, venous involvement status, and outcomes were recorded. Results: In total, 15 (1.31%) of 1144 CVST patients had SLE. The mean age of these patients was 39.9 § 12.1 years and 13 (86.7%) were female. Presenting symptoms included headache (73.3%), visual field defects (40.0%), and altered consciousness (26.7%). The main sinuses involved were the transverse (60.0%), sagittal (40.0%), and sigmoid (20.0%) sinuses. Parenchymal involvement was not seen in 73.3% of the patients. On the modified Rankin scale, 92.9% of the patients scored 0-1 at the 1-month follow-up and 90.9% scored 0-1 at the 1-year follow-up. Conclusions: SLE was found in 1.31% of the CVST patients, most frequently in young women. Headache was the most common symptom and the CVST onset was chronic in the majority of cases. The patient outcomes were favorable. CVST should be suspected in SLE patients, even in those with isolated chronic headache symptoms with or without other neurological findings.

Rheumatology (Oxford, England), Jan 9, 2018

This study was performed to determine the rate of cerebral venous sinus thrombosis (CVST) among c... more This study was performed to determine the rate of cerebral venous sinus thrombosis (CVST) among cases of Behçet's disease (BD) included in a multicentre study of cerebral venous sinus thrombosis (VENOST). VENOST was a retrospective and prospective national multicentre observational study that included 1144 patients with CVST. The patients were classified according to aetiologic factors, time of CVST symptom onset, sinus involvement, treatment approach and prognosis. BD was shown to be a causative factor of CVST in 108 (9.4%) of 1144 patients. The mean age of patients in the BD group was 35.27 years and 68.5% were men, whereas in the non-BD CVST group, the mean age was 40.57 years and 28.3% were men (P < 0.001). Among the aetiologic factors for patients aged 18-36 years, BD was predominant for men, and puerperium was predominant for women. The onset of symptoms in the BD group was consistent with the subacute form. The transverse sinuses were the most common sites of thrombosi...

Journal of Stroke and Cerebrovascular Diseases, 2017

Background: Based on a number of small observational studies, cerebral venous sinus thrombosis ha... more Background: Based on a number of small observational studies, cerebral venous sinus thrombosis has diverse clinical and imaging features, risk factors, and variable outcome. In a large, multicenter cerebral venous thrombosis (VENOST) study, we sought to more precisely characterize the clinical characteristics of Caucasian patients. Methods: All data for the VENOST study were collected between the years 2000 and 2015 from the clinical follow-up files. Clinical and radiological characteristics, risk factors, and outcomes were compared in terms of age and sex distribution. Results: Among 1144 patients 68% were women, and in older age group (>50 years) male patients were more prevalent (16.6% versus 27.8%). The most frequent symptoms were headache (89.4%) and visual field defects (28.9%) in men, and headache (86.1%) and epileptic seizures (26.8%) in women. Gynecological factors comprised the largest group in women, in particular puerperium (18.3%). Prothrombotic conditions (26.4%), mainly methylenetetrahydrofolate reductase mutation (6.3%) and Factor V Leiden mutation (5.1%), were the most common etiologies in both genders. 8.1% of patients had infection-associated and 5.2% had malignancy-related etiology that was significantly higher in men and older age group. Parenchymal involvement constitutively hemorrhagic infarcts, malignancy, and older age was associated with higher Rankin score. Epileptic seizures had no effect on prognosis. Conclusions: Clinical and radiological findings were consistent with previous larger studies but predisposing factors were different with a higher incidence of puerperium. Oral contraceptive use was not a prevalent risk factor in our cohort. Malignancy, older age, and hemorrhagic infarcts had worse outcome.

Neurological Sciences, 2017

Atherosclerosis Supplements, 2007

76th Congress of the European-Atherosclerosis-Society -- JUN 10-13, 2007 -- Helsinki, FINLANDWOS:... more 76th Congress of the European-Atherosclerosis-Society -- JUN 10-13, 2007 -- Helsinki, FINLANDWOS: 000247869100417European Atherosclerosis So

Stroke; a journal of cerebral circulation, 2013

To the Editor: The need for pregenetic screening tools was discussed in a recent study published ... more To the Editor: The need for pregenetic screening tools was discussed in a recent study published in Stroke by Pescini et al, 1 and the Cerebral Autosomal-Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy (CADASIL) scale was introduced comprising mainly clinical and radiological findings. MRI is the most relevant tool for monitoring cerebral pathology in CADASIL with very high sensitivity. 2 Although definitive diagnosis could be made by demonstrating highly stereotyped mutations on NOTCH3 gene, genetic analysis is costly and time-consuming because it is a long gene with mutations located at any point. 2 In addition, there is growing body of literature reporting a considerable number of patients with clinical and neuroimaging features suggestive of CADASIL but with negative NOTCH3 mutation. Because there is currently no understanding of correlation between clinical and neuroimaging features, 2,3 in addition to wide variability in clinical phenotypes throughout the world, the use of a simple and enough accurate screening tool for clinicians to select patients with high suspicion of CADASIL before genetic testing is considerably important from practical point of view. Of our 23 patients, NOTCH3 mutation was demonstrated in 10 patients, whereas no mutation was found in 13 patients. In comparison with risk factors, sex, age at disease onset, history of migraine (with/without aura), recurrent stroke and family history of stroke were not found significantly different. Of radiological data, besides from temporal pole involvement, being more common in patients with positive NOTCH3 mutation (P=0.001), involvement of temporal or periventricular white matter or extreme capsule did not show significant difference. CADASIL scale constituted by Pescini et al 1 was applied to our study population. The mean score of CADASIL scale was 14.0+3.4 points (between 9 and 19 points) in NOTCH3-positive patients and 10.8+2.1 points (between 6 and 16 points) in NOTCH3-negative patients. The mean score of CADASIL scale was significantly higher in patients with mutation (P=0.031), compatible with authors' results. Although different attempts of diagnostic strategies for CADASIL have previously been made, they could not reach wide acceptance. The need for pregenetic screening attributable to a significant number of negative pathogenic mutations in patients with clinical and radiological features suggestive of CADASIL has led many researches to build different criteria. Because clinical suspicion of CADASIL displays variability according Letter to the Editor (Stroke. 2013;44:e18.

Neurology India, 2006

Asymmetrical, simultaneous multiple cranial nerve palsies and mild signs of peripheral neuropathy... more Asymmetrical, simultaneous multiple cranial nerve palsies and mild signs of peripheral neuropathy in diabetic patients may cause difficulties in diagnosis as they are relatively rare. A case of a 55-year-old diabetic woman who developed simultaneous right VII and left III, IV, VI cranial nerve palsies with spared pupils is presented here. We also discuss the role of intravenous immunoglobulin (IVIG) in the management of this condition and suggest that simultaneous multiple cranial palsies may have a good response to IVIG treatment.

Turkish Journal of Cerebrovascular Diseases, 2013

European Neurology, 2014

Background: The diversity of clinical presentation and neuroimaging findings of CADASIL (cerebral... more Background: The diversity of clinical presentation and neuroimaging findings of CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) from different regions of the world has not yet been studied in depth. Here we investigated the variability of clinical, radiological and genetic data of 48 patients analyzed for NOTCH3 mutation in Turkey. Methods: Clinical evaluation was made according to a preformed questionnaire. Cranial neuroimaging findings were determined on the basis of T1, T2, FLAIR and proton-density magnetic resonance scans. For genetic analysis, polymerase chain reaction was performed with primers flanking exons 2-6 and 11 of NOTCH3 gene. Results: Twenty-five patients (52.1%) were diagnosed as CADASIL with NOTCH3 mutation, while 23 patients (47.9%) had no mutation (NOTCH3-negative patients). The mean age and age at stroke onset were lower in male CADASIL patients (p < 0.03). A family history of migraine (p = 0.012), stroke (...

Value in Health, 2013