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The concept of social security is used to describe the protection mechanisms created at the social level against future partial-risk situations. Turkey's ability to maintain good health outcomes depends on its strong health insurance system. At this point, the new health system will focus more on individual and social protection and will try to keep service use at a more acceptable level. To ensure that the system is sustainable, it is essential to create different coverage packages in line with income and desires within the scope of the Social Security Agency (SSA) and for individuals to act on the path drawn in line with these packages. During the pandemic, the health systems of every country have been given an important test. Many countries with inadequate health infrastructure have not been able to adapt quickly to the pandemic. COVID-19 has highlighted global inequalities, the spread of the epidemic, the adequacy of efforts to combat it, the capacity of health systems, and the insufficiencies in global health cooperation. On the other hand, countries with well-designed health infrastructure were able to respond quickly to the pandemic. Today, healthcare services in Turkey are conducted in public hospitals, private hospitals, private polyclinics, and private physician practices. All healthcare providers continue their services under the supervision and licensing of the Ministry of Health. The expansion of privatization policies in Turkey has brought with it a system based on a consumption economy, dependent on foreign investments. Considering the report data, which also reveal the dimensions of verbal and physical violence that doctors in Turkey have faced throughout their professional lives, the reasons for the inadequacy in the number of doctors per capita in Turkey are revealed more clearly. Therefore, improving the working and living conditions of health workers, especially doctors, is crucial in meeting the increasing demand for doctors in society. With the impact of the COVID-19 pandemic, the aspects of change that have emerged or are likely to occur in the Turkish health system have varied organizationally, sectorally, and socially. While the COVID-19 pandemic has revealed the positive and negative aspects of the individual, communities, and the global system, the Turkish health system has also had the opportunity to make a self-assessment of its current situation. At the macro level, due to the negative impact of COVID-19 on the world economy, Turkey has experienced an increase in the share allocated to health, financial and inflation problems, and difficulty in access to medicines and medical supplies.

Miller Fisher syndrome (MFS) was first recognized by Collier in 1932 as a clinical triad of ataxia, areflexia, and ophthalmoplegia. In 1956, three cases with this triad were published by Miller Fisher as a limited variant of Guillian-Barré syndrome (GBS), and the disease started to be called by his name. Since the beginning of the SARS-CoV-2 pandemic, there have been many reports of peripheral and central nervous system involvement. Until December 2022, a total of 24 cases, including four children associated with MFS, had been reported. This current review aimed to present the basic clinical and laboratory characteristics of patients with MFS and coronavirus disease-2019 (COVID-19). Since 2020, cases with different age and gender characteristics have been reported from eight different countries. Most cases were reported from Europe. SARS-CoV-2 infection was confirmed in seven of the cases. The youngest case reported was a 6-year-old boy from Turkey, while the oldest case was a 70-year-old female from Spain. All these reported cases and our past medical knowledge of MFS suggest that molecular mimicry is the main immunological mechanism. Despite all these data, more case reports, cohorts, and case-control studies will be needed to clarify the relationship between MFS and COVID-19.

Miller Fisher Syndrome (MFS) was first recognized by James Collier in 1932 as a clinical triad of ataxia, areflexia, and ophthalmoplegia. In 1956, three cases with this triad were published by Charles Miller Fisher as a limited variant of Guillian-Barré syndrome (GBS), and the disease started to be called by his name. Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, there have been many reports of peripheral and central nervous system involvement. Until December 2022, a total of 23 cases including two children associated with MFS had been reported. In this article, we present a case of SARS-CoV-2 with classic triad clinical findings, which started with the atypical clinic at an early age. Electrophysiological studies of the case were found to be consistent with sensory axonal polyneuropathy. AntiGQ1b antibody IgG and IgM were negative. The case was spontaneously remitted without IV immunoglobulin (IVIg) or plasma exchange (PE) treatment. A current review of the literature is presented with the smallest pediatric case reported. Based on this case, it was planned to emphasize the targets and highlights in the diagnostic parameters.

Background Cognitive dysfunction and depressive symptoms are common and closely related mental health issues in older people, significantly affecting their quality of life and social functioning. Nutritional factors play a key role in preventing and managing these conditions. This study aimed to examine the relationship between nutritional status and depressive symptoms and cognitive dysfunction in older people. Methods Data from 126 participants aged 65 and older with chronic neurological disorders, recruited from nursing homes in Izmir, Turkey (January 2023-February 2023), were used in this cross-sectional study. The Geriatric Depression Scale (GDS)-30 and Mini Nutritional Assessment (MNA) were used to assess depression and malnutrition, respectively. Cognitive functions were evaluated using the Standardized Mini-Mental State Examination (SMMSE). Binary logistic regression analyses were performed to determine the risk of depression among malnourished people and to measure the risk of malnutrition among depressed people. Data collection was conducted prospectively through random, face-to-face interviews in nursing homes. Results The average age of the participants in the study group was 77.05 ± 5.68 years, with a median age of 76.0 years. A statistically significant difference was observed between the median GDS score and the median age across MNA score categories ( p  < 0.05). The risk of malnutrition was roughly 10 times higher in patients with dementia (OR = 10.22, 95% CI: 4.33–24.11). Conclusions The results show a strong association between depression and malnutrition in older people. Malnutrition is a common occurrence among older people, and age is a significant risk factor. Similarly, depression is more common among older people living in nursing homes, and increasing age also raises depression levels. Therefore, future research should focus on conducting randomized, double-blind, placebo-controlled trials to confirm the effectiveness of nutritional interventions and oral nutritional supplements in treating depression and improving cognitive function.

Background/Objectives: Greater occipital nerve blockade (GONB) is a minimally invasive intervention used to treat primary headaches. However, the evidence regarding its role in craniofacial pain syndromes and its potential impact on analgesic use remains limited. Previous studies have reported that GONB is an effective method in patients with cranial neuralgia, but its efficacy is limited in persistent idiopathic facial pain (PIFP). Methods: This study was a retrospective cohort trial examining the medical records of 26 patients who applied to our Headache Clinic due to facial pain and cranial neuralgia between April 2023 and April 2025. Of these patients, 12 were trigeminal neuralgia (46%), 6 were occipital neuralgia (23%), 4 were trigeminal neuropathic pain (15%), and 4 were PIFP (15%) patients. In our study, the landmark-based GONB technique was used to determine the greatest tenderness to palpation (TTP) area. A standard 2.5 mL mixture of 30 mg 2% lidocaine and 4 mg dexamethasone was injected bilaterally as a single dose into the nerve region of all patients. After GONB, all patients were routinely contacted by phone or addressed face to face once a week for the first month and monthly thereafter, and medical changes were recorded with a standard-case follow-up form file. The case follow-up form allowed regular monitoring of parameters, such as the Visual Analog Scale (VAS), self-assessment scales for patients’ clinical responses, sensitivity to triggers, possible side effects, duration of effect, and the number of analgesics used. Results: A positive response with at least 50% overall improvement compared to the patient’s baseline level was found in 22 of 26 patients. Response to treatment was observed in 10 patients in the trigeminal neuralgia group (83%), 3 patients in the trigeminal neuropathic pain (75%) and PIFP groups (75%), and all in the occipital neuralgia group (100%). There was no statistically significant difference in response rates between the diagnostic groups. A significant difference was found in terms of response rates according to gender (p = 0.022). Accordingly, while response was observed in all 15 female patients, response was observed in 7 of 11 male patients (64%). Pre-GONB VAS values of those responding to treatment were found to be higher. Patients with positive responses to GONB had a significantly higher median value of the VAS total score (5; 95% CI: 1.83–4.52) in comparison to those with negative responses (8.32; 95% CI: 8.17–12.12) (p < 0.001). Post-GONB Intensity (VAS) and Post-GONB sensitivity to triggers decreased significantly (p < 0.001, p < 0.001). In those who responded, the decrease in analgesic use after GONB compared to before was statistically significant in the first and second months (p < 0.001, p < 0.003, respectively). Although the decrease continued in the third month, this difference did not reach statistical significance (p = 0.551). Conclusions: GONB reduces the duration, frequency, and intensity of headaches, and the need for acute analgesic use in CN and PIFP patients.

Introduction: The presence of oligoclonal bands in cerebrospinal fluid of multiple sclerosis patients is now well established to support the clinical diagnosis. On the other hand, a single band response can represent the initial stage of an oligoclonal response, before the other antibody clones become visible. Method: The aim of the current study was to evaluate the presence of an isolated cerebrospinal fluid single immunoglobulin band, and to analyse the clinical and radiological diagnosis of the samples with a single immunoglobulin band. In this study, 3524 cerebrospinal fluid samples were re-examined using agarose gel isoelectric focusing, and ones with an isolated cerebrospinal fluid immunoglobulin band were detected. Results: A single band in cerebrospinal fluid was detected in 1.4% samples. A clinically isolated syndrome was diagnosed in 27.5%of them, relapsing remitting multiple sclerosis in 49%, secondary progressive multiple sclerosis in 11.8%, and radiologically isolated syndrome in 2%. No primary progressive multiple sclerosis patient was found. All Barkhoff criteria were met in 90.1% of them. The remaining were diagnosed with other inflammatory neurological diseases (9.8%). Conclusion: The presence of an isolated cerebrospinal fluid monoclonal immunoglobulin band is rare. Although most of the samples were diagnosed as multiple sclerosis according to both clinical and paraclinical (magnetic resonance imaging) parameters, they had only a single immunoglobulin band in cerebrospinal fluid. Not only oligoclonal bands, but also an isolated cerebrospinal fluid single band might be a cornerstone for the diagnosis of multiple sclerosis at least for some patients.

Ocular flutter (OF) is a rare oculomotor syndrome. The most common etiologies are paraneoplastic, postinfectious and toxic-metabolic. However post-vaccinal etiology was rarely reported in OF. Here, we reported a post-vaccinal clinical syndrome characterized by OF-myoclonus and ataxia associated with oligoclonal bands (OCBs). A 60-year-old male who presented with dizziness, unsteady gait, involuntary movements, involuntary conjugate eye oscillations and extremity jerks that started 3 days after the second dose of mRNA BNT162b2 Covid-19 vaccine. Routine biochemical and serological analysis were within normal limits. No pathological finding was detected in brain MRI. Paraneoplastic and autoimmune encephalitis tests were unremarkable in cerebrospinal fluid (CSF). Oligoclonal bands were positive in CSF. This is the first description of the relationship between vaccines against SARS-CoV-2 and the clinical syndrome of OF, Myoclonus and Ataxia (OFMAS). Humoral immune mechanisms seem to play an important role in OFMAS. Presence of OCBs in CSF may also be associated with this condition.

This study aimed to validate the Turkish version of the Behavioral and Psychological Symptoms of Dementia Knowledge Scale (BPSD-T) among caregivers. The goal was to assess the scale's psychometric properties, ensuring it accurately measures caregivers' knowledge of dementia-related behavioral and psychological symptoms in a Turkish context. In this cross-sectional study, the data were collected from 212 caregivers providing home-based care to dementia patients across Turkey. Participants completed a 12-item Behavioral and Psychological Symptoms of Dementia (BPSD) knowledge questionnaire along with a sociodemographic form. To examine the factor structure of the scale, both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted. Sample adequacy for EFA was assessed using the Kaiser- Meyer-Olkin (KMO) measure and Bartlett's test of sphericity. For CFA, model fit was evaluated using fit indices such as χ2/df, Goodness of Fit Index (GFI), Comparative Fit Index (CFI), Normed Fit Index (NFI), and Root Mean Square Error of Approximation (RMSEA). The internal consistency of the scale was assessed with Cronbach's alpha coefficient. The findings showed that the BPSD-T has strong internal consistency (Cronbach's alpha=0.85) and a robust factor structure. Factor loadings ranged from 0.396 to 0.744, supporting the construct validity of the scale. Item-total correlations ranged from 0.437 to 0.711, with the item \"BPSD are the major source of caregiving burden\" having the highest correlation (r=0.711). The results indicate that the BPSD-T is a reliable instrument for assessing caregivers' knowledge of behavioral and psychological symptoms associated with dementia. The BPSD-T provides an effective means of identifying knowledge gaps among caregivers in Turkey and serves as a valuable tool for developing training programs aimed at improving the management of BPSD. This study contributes to the literature by validating the scale in a non-Western context, suggesting that enhancing caregivers' knowledge of BPSD can have positive impacts on clinical management and patient care. In this regard, the implementation of the BPSD-T may support the more effective management of behavioral and psychological symptoms in dementia patients.

Optic neuritis, myelitis, and neuromyelitis optica spectrum disorder (NMOSD) have been associated with antibodies against myelin oligodendrocyte glycoprotein-immunoglobulin G (anti-MOG-IgG). Furthermore, patients with radiological and demographic features atypical for multiple sclerosis (MS) with optic neuritis and myelitis also demonstrate antibodies against aquaporin-4 and anti-MOG-IgG. However, data on the diagnosis, treatment, follow-up, and prognosis in patients with anti-MOG-IgG are limited. To evaluate the clinical, radiological, and demographic characteristics of patients with anti-MOG-IgG. Multicenter, retrospective, observational study. Patients with blood samples demonstrating anti-MOG-IgG that had been evaluated at the Neuroimmunology laboratory at Ondokuz Mayıs University’s Faculty of Medicine were included in the study. Of the 104 patients with anti-MOG-IgG, 56.7% were women and 43.3% were men. Approximately 2.4% of the patients were diagnosed with MS, 15.8% with acute disseminated encephalomyelitis (ADEM), 39.4% with NMOSD, 31.3% with isolated optic neuritis, and 11.1% with isolated myelitis. Approximately 53.1% of patients with spinal involvement at clinical onset demonstrated a clinical course of NMOSD. Thereafter, 8.8% of these patients demonstrated a clinical course similar to MS and ADEM, and 28.1% demonstrated a clinical course of isolated myelitis. The response to acute attack treatment was lower and the disability was higher in patients aged > 40 years than patients aged < 40 years at clinical onset. Oligoclonal band was detected in 15.5% of the patients. For patients with NMOSD and without anti-NMO antibodies, the diagnosis is supported by the presence of anti-MOG-IgG. Furthermore, advanced age at clinical onset, Expanded Disability Status Scale (EDSS) score at clinical onset, spinal cord involvement, and number of attacks may be negative prognostic factors in patients with anti-MOG-IgG.