Meryem Tuba Sönmez

Objective: This study aimed to evaluate the diagnostic accuracy of quantitative D-dimer levels in patients investigated for suspected cerebral venous thrombosis (CVT) and their relationship with clinical and radiological characteristics in patients diagnosed with CVT. Methods: Based on neuroimaging findings, 97 consecutive patients investigated for suspected CVT were divided into CVT (n = 54) and CVT-negative (n = 43) groups. Quantitative D-dimer levels were compared between the groups using a cutoff value of 0.5 mg/L. The sensitivity, specificity, positive and negative predictive values, likelihood ratios, and area under the ROC curve (AUC) of elevated quantitative D-dimer values for the diagnosis of CVT were calculated. In patients with CVT, correlations between quantitative D-dimer levels and sex, age, symptom duration, presence of neurological deficits, the National Institutes of Health Stroke Scale (NIHSS) score, number of thrombosed sinuses, and presence of parenchymal damage were examined. Results: Quantitative D-dimer levels were elevated in 90.7% of the CVT group and 4.7% of the CVT-negative group (p < 0.001). Quantitative D-dimer had a sensitivity of 90.74%, specificity of 95.35%, positive predictive value of 96.08%, negative predictive value of 89.13%, and AUC = 0.967 for CVT. Quantitative D-dimer levels were inversely correlated with symptom duration (p = 0.027), whereas no statistically significant correlations were found with sex (p = 0.443), age (p = 0.696), the presence of neurological deficits (p > 0.05), NIHSS score (p = 0.079), the number of thrombosed sinuses (p = 0.627), and the presence of parenchymal lesions (p > 0.05). Conclusions: Elevated quantitative D-dimer levels can support the clinical decision-making process in distinguishing CVT. Levels decrease as symptom duration increases.

OBJECTIVE: This study aimed to evaluate the independent and combined effects of fatigue and walking impairment on multiple sclerosis (MS)-specific quality of life (QoL) and to explore the influence of sociodemographic and clinical factors on these associations.MATERIAL AND METHODS: A multicenter, cross-sectional study was conducted including 181 individuals with MS from four tertiary care centers in Turkey. Patients completed the Fatigue Severity Scale (FSS), the 12-item MS Walking Scale (MSWS-12), and the Multiple Sclerosis Impact Scale (MSIS-29). Sociodemographic and clinical data were collected. Correlation analyses, subgroup comparisons, and multivariate linear regressions were performed to identify predictors of QoL.RESULTS: MSIS-29 scores were strongly associated with MSWS-12 (r=0.81) and moderately associated with FSS (r=0.54) (p<0.001 for both). Multivariate regression demonstrated that walking impairment (β=0.772) and fatigue (β=0.179) were independent predictors of QoL, jointly explaining 70% of the variance in MSIS-29 total scores (R²=0.703). MSWS-12 was the primary predictor of physical QoL, while both MSWS-12 and FSS contributed to psychological QoL. Lower education and comorbidities were associated with worse outcomes in univariate analyses, and female sex was associated with greater disease impact in the multivariable model.CONCLUSIONS: Fatigue and walking limitations are major determinants of reduced QoL in MS, with walking impairment exerting a stronger effect on physical functioning. These results highlight the importance of multidimensional care strategies that address both motor and non-motor symptoms, alongside sociodemographic and clinical characteristics, to optimize individualized MS management.

Amaç: Papilödem, serebral venöz sinüs trombozunun (SVST) klinik açıdan önemli bir bulgusudur ve bozulmuş venöz dönüşe bağlı intrakraniyal hipertansiyonu yansıtır. Ancak şiddeti ve zaman içindeki seyri yeterince tanımlanmamıştır. Bu çalışmada, SVST hastalarında papilödemin uzunlamasına seyrinin değerlendirilmesi ve persistan papilödem ile ilişkili klinik ve radyolojik faktörlerin belirlenmesi amaçlandı. Gereç ve Yöntemler: Bu prospektif gözlemsel çalışmaya, radyolojik olarak doğrulanmış SVST tanılı 37 erişkin hasta dahil edildi. Papilödem şiddeti başlangıçta ve altıncı ayda Frisén derecelendirme ölçeği kullanılarak değerlendirildi. Persistan papilödem, takipte herhangi bir derecede papilödem varlığı (≥1) olarak tanımlandı. Venöz sinüs tutulumu ve rekanalizasyon durumu dahil olmak üzere klinik ve radyolojik değişkenler analiz edildi. Bulgular: Başlangıçta 14 hastada (%37,8) papilödem mevcuttu. Altıncı ayda 5 hastada düzeldi, 9 hastada ise devam etti (kohortun %24,3’ü). Başlangıçta Frisén evre 3–4 papilödem görülme sıklığı, persistan papilödemi olan hastalarda olmayan hastalara göre anlamlı derecede daha yüksekti (%66,7’ye karşı %7,1; p<0,001). Manyetik rezonans görüntüleme (MRG) verileri 25 hastada mevcuttu ve tam rekanalizasyon, persistan papilödem olmayan hastalarda daha sık görüldü (p = 0,007). Demografik, klinik veya diğer radyolojik değişkenlerle anlamlı ilişki saptanmadı. Sonuç: Papilödem, SVST’li hastaların önemli bir kısmında persiste edebilir. Daha yüksek başlangıç papilödem dereceleri, persistan papilödemi olan hastalarda daha sık gözlenirken; tam rekanalizasyon, persistan papilödemi olmayan hastalarda daha sık görüldü. Bu bulgular, SVST’de yapılandırılmış nöro-oftalmolojik takibin önemini desteklemektedir.

Background: Pregnancy is a distinct neuroendocrine and immunological state in women with multiple sclerosis (MS). Relapse activity typically decreases during gestation and increases after delivery, but the relationship between peri-pregnancy brain volumetric measures and disability remains unclear. Methods: This retrospective longitudinal pilot study included 14 women with relapsing-remitting MS who underwent MRI examinations before pregnancy and after delivery. Thirty-eight MRI scans were analyzed, with a mean of 2.71 ± 0.99 timepoints per patient. Global and regional brain volumes were measured using the longitudinal FreeSurfer pipeline. Choroid plexus (CP) volume was evaluated as an exploratory neuroimmune imaging marker. Associations between volumetric measures and Expanded Disability Status Scale (EDSS) scores were assessed using linear mixed-effects modeling with forward stepwise selection. Results: The final EDSS model retained bilateral ventral diencephalon (ventral DC) volumes, left amygdala volume, right pallidum volume, left nucleus accumbens volume, and cerebral cortex volume. The most prominent association involved the left ventral DC, where lower volume was associated with higher EDSS scores (p = 0.0008). CP volume showed no significant longitudinal change across peri-pregnancy MRI timepoints (p = 0.21) and was not retained in the final EDSS model. Conclusion: Regional brain volumetric measures, particularly ventral DC volumes, were associated with disability across the peri-pregnancy period despite low EDSS levels. To our knowledge, this is the first longitudinal evaluation of CP volume across the peri-pregnancy period in women with MS; no significant change was observed over time. These exploratory findings require confirmation in larger prospective studies using standardized serial MRI protocols.

Introduction: Given the involvement of monocytes in multiple sclerosis (MS) pathogenesis, we aimed to compare the pan-immune-inflammation value (PIV) with the systemic immune-inflammation index (SII) in differentiating MS patients from healthy controls and in detecting relapse (attack) periods of disease activity. Methods: This case–control study included 43 newly diagnosed, treatment-naïve MS patients and 44 healthy controls. Blood neutrophil, lymphocyte, platelet, and monocyte counts were measured, and the SII and PIV values were calculated. Samples from patients with MS were collected during both the relapse and remission phases. SII and PIV were then compared between the patient and control groups and between relapse and remission states in the MS cohort. Results: Neither SII nor PIV differed significantly between patients with MS and healthy controls or between the relapse and remission phases (p>0.05 for all comparisons). In contrast, the median Expanded Disability Status Scale (EDSS) score was significantly higher during relapses than during remission (median 2.5 vs. 1.0, p<0.001), confirming greater disability during attack periods. Notably, although statistically non-significant, PIV yielded lower p-values than SII, which may indicate a weak trend requiring further study in larger samples. in the relapse vs remission comparison (PIV, p=0.261; SII, p=0.819). Conclusions: Hemogram-derived inflammatory indices, such as SII and PIV, appear insufficient for diagnosing MS or distinguishing relapses from remission. However, the consistently lower p-values observed with PIV suggest that it may be a slightly more sensitive marker than SII. Further large-scale studies, including both newly diagnosed and treated MS populations, are warranted to clarify the potential role of PIV in monitoring MS disease activity.

Objective: Demyelinating optic neuritis (ON) and non-arteritic anterior ischemic optic neuropathy (NAION) represent distinct clinical entities with different pathophysiological mechanisms, yet both are believed to involve systemic inflammatory responses. This study aimed to compare systemic inflammatory indices derived from complete blood count (CBC), including the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV), in patients with ON and NAION. Material and Methods: Inflammatory indices (SII, SIRI, PIV, NLR, PLR, and MLR) were calculated using CBC parameters obtained before corticosteroid treatment. A total of 18 patients with demyelinating ON and 25 with NAION were included, along with age- and sex-matched healthy control groups (16 for ON, 11 for NAION). ROC analyses were performed for SII and PIV in the NAION group to assess diagnostic performance. Results: SII (p = 0.015), PIV (p = 0.004), and SIRI (p = 0.001) were significantly elevated in the NAION group compared to controls. ROC analyses demonstrated AUC values of 70.1% for SII and 73.8% for PIV, indicating moderate diagnostic utility in distinguishing NAION. No significant differences in these indices were observed between the ON group and their respective controls. In the direct comparison between disease groups, patients with NAION exhibited higher SIRI and monocyte levels than those with ON. Conclusions: Composite inflammatory indices derived from CBC, particularly SII, SIRI, and PIV, were significantly elevated in patients with NAION. These findings support the role of systemic inflammation in NAION pathophysiology and highlight the potential diagnostic and prognostic value of these indices. Further prospective studies with larger cohorts are warranted to validate their clinical relevance.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Large language model-based chatbots are increasingly used by the public to access medical information. While these tools offer considerable potential in terms of accessibility and scalability, their accuracy, transparency, and clarity remain insufficiently evaluated for rare and diagnostically complex conditions such as myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Objective: This study aimed to evaluate the quality, comprehensibility, transparency, and readability of responses generated by widely used AI chatbot platforms in response to a standardized, patient-centered question about MOGAD. Methods: We conducted a cross-sectional content analysis using the query: “What is MOGAD, and how is MOGAD treated?” Ten widely used chatbot platforms were selected to reflect diversity in architecture, access model, and functional design. Responses were collected on the same day, anonymized, and independently evaluated by seven blinded neurologists. Validated instruments were used, including DISCERN (treatment quality), PEMAT-P (understandability), Web Resource Rating (WRR; citation transparency), and two readability metrics: Flesch–Kincaid Grade Level (FKGL) and Coleman–Liau Index (CLI). Chatbots were also compared by access type (free vs paid) and functional focus (conversation-based vs search-based). Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs). Results: Significant differences were observed across platforms in DISCERN, PEMAT-P, and WRR scores (all p < 0.001). Paid chatbots demonstrated higher treatment quality (p = 0.020) and citation transparency (p = 0.001) compared to free versions. Search-based models produced more understandable responses than conversation-based ones (p = 0.035). However, none of the chatbot responses achieved the recommended readability threshold for public-facing health communication (FKGL < 8). Inter-rater agreement was excellent across all expert-rated measures (ICC ≥ 0.838). Conclusions: AI chatbot responses to patient queries about MOGAD vary widely in quality, clarity, and transparency. These findings highlight the need for structured benchmarking, transparent evaluation frameworks, and thoughtful oversight in the use of generative AI tools for digital health communication, particularly in the context of rare and clinically complex diseases.