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Karadag A.S.,Yuzuncu Yil University | Tutal E.,Ankara Kecioren Research and Training Hospital | Akin K.O.,Ankara Kecioren Research and Training Hospital
Acta Dermato-Venereologica | Year: 2011

Besides suppressing sebum production, the exact mechanism of action of isotretinoin in acne vulgaris is not known. Several hormones have been linked to the pathogenesis of acne. In this study, we investigated the effects of isotretinoin on the pituitary-adrenal axis, whose activity may be increased in acne. Various hormone systems were evaluated before and after 3 months of isotretinoin treatment in 47 acne patients. Free triiodothyronine (T3), thyroidstimulating hormone and thyroid-stimulating hormone receptor antibody levels decreased significantly during isotretinoin treatment (p < 0.001, p < 0.02 and p < 0.02, respectively), as did those of luteinising hormone, prolactin and total testosterone (p < 0.005), as well as morning cortisol and adrenocorticotropic hormone (p < 0.005 and p < 0.05, respectively). We conclude that isotretinoin causes mild suppression of pituitary hormone levels, which may be beneficial for tackling the pathogenesis of acne. © 2011 The Authors.


Karadag A.S.,Yuzuncu Yil University | Akin K.O.,Ankara Kecioren Research and Training Hospital | Bilgili S.G.,Yuzuncu Yil University
Clinical and Experimental Dermatology | Year: 2012

Few studies have investigated the role of vitamin B12 metabolism in vitiligo. We tested the hypothesis that vitamin B12 and folate metabolism might have an influence on the pathogenesis of vitiligo. Full blood count and levels of folic acid, vitamin B12, homocysteine and holotranscobalamine were examined for 69 patients with vitiligo and 52 controls. The vitiligo group had higher levels of homocysteine (P < 0.01) and haemoglobin (P < 0.01) levels, and lower levels of vitamin B12 (P < 0.01) and holotranscobalamine (P < 0.0001) than the control group. Folic acid levels were similar for both groups. In a risk analysis, hyperhomocysteinaemia (≥ 15 μmol/L, P < 0.01) and vitamin B12 deficiency (< 200 pg/mL, P < 0.01) were significant risk factors for vitiligo. Patients with holotranscobalamine levels in the lowest quartile had an increased risk for co-occurrence of vitiligo (P < 0.005). Vitamin B12 deficiency and hyperhomocysteinaemia may share a common genetic background with vitiligo. © 2011 The Author(s).


Karadag A.S.,Yuzuncu Yil University | Ertugrul D.T.,Ankara Kecioren Research and Training Hospital | Tutal E.,Ankara Kecioren Research and Training Hospital | Akin K.O.,Ankara Kecioren Research and Training Hospital
Turkish Journal of Medical Sciences | Year: 2011

Aim: Telogen effluvium (TE) is an abnormality of hair cycling. Vitamin D promotes hair follicle differentiation. The importance of vitamin D in hair growth is evident in patients with hereditary vitamin D receptor deficiency. The role of vitamin D in the pathogenesis of TE has not been investigated before. We investigated the role of vitamin D, ferritin, and zinc in the pathogenesis of TE. Materials and methods: We measured serum hemoglobin, ferritin, zinc, calcium, phosphate, parathormone, magnesium, 25 and 1,25-hydroxyvitamin D3, and bone alkaline phosphatase and thyroid stimulating hormone levels in 63 female patients and 50 control subjects. Twenty-nine of the TE patients were classified in the acute TE group and 34 were classified in the chronic TE groups. Results: Ferritin (acute TE; 17.0 ± 12.8, chronic TE; 19.6 ± 15.2, control; 35.5 ± 31.8, P < 0.001) and hemoglobin (acute TE; 12.7 ± 1.7, chronic TE; 13.3 ± 1.0, control; 14.2 ± 1.2, P < 0.0001) levels were significantly lower in the TE group than in the control group. However, 25-hydroxyvitamin D3 levels were significantly higher in the TE group than in the control group (acute TE; 18.5 ± 9.2, chronic TE; 24.4 ± 11.2, control; 15.6 ± 15.8, P < 0.01). Vitamin D levels increased gradually from control groups to acute and chronic TE groups. However, active D vitamin levels (1,25-hydroxyvitamin D3) were similar. Conclusion: Iron deficiency anemia seems to be the main triggering factor for the development of TE and the increase in serum 25-hydroxyvitamin D3 levels may be related to increased exposure to UV light due to TE. © TÜBİTAK.


Karadag A.S.,Yuzuncu Yil University | Ertugrul D.T.,Ankara Kecioren Research and Training Hospital | Bilgili S.G.,Yuzuncu Yil University | Takci Z.,Ankara Kecioren Research and Training Hospital | And 2 more authors.
British Journal of Dermatology | Year: 2012

Background In vitro studies have shown that retinoids influence T-cell differentiation. Objectives To study the effect of isotretinoin on T-cell differentiation markers in patients with acne. Methods A total of 37 patients with acne vulgaris (25 female, 12 male, age 19·6 ± 3·7 years) and 30 age- and sex-matched healthy controls (19 female, 11 male, age 20·5 ± 4·4 years) were included in the study. Screening for biochemical parameters in serum samples were done just before initiation (pretreatment) and after 3 months of isotretinoin treatment (post-treatment) in the acne group. Results Baseline levels of tumour necrosis factor (TNF)-α (P < 0·0001), interleukin (IL)-4 (P < 0·0001), IL-17 (P < 0·0001) and interferon (IFN)-γ (P = 0·002) were significantly higher in the acne group compared with the control group. TNF-α (P < 0·0001), IL-4 (P < 0·0001), IL-17 (P < 0·0001) and IFN-γ (P < 0·0001) levels decreased after isotretinoin treatment. TNF-α and IL-4 values after isotretinoin treatment were similar to those of the control group. However, levels of IL-17 (P < 0·0001) after isotretinoin treatment were higher than those of the control group, despite a significant decline after treatment. Levels of IFN-γ (P < 0·0001) after isotretinoin treatment were lower than those of the control group. Conclusions This study shows that isotretinoin treatment significantly decreases TNF, IL-4, IL-17 and IFN-γ levels in patients with acne. We failed to show that isotretinoin redirects naive T helper (Th) differentiation preferentially towards the Th2 cell lineage. © 2012 The Authors. BJD © 2012 British Association of Dermatologists.


Karadag A.S.,Yuzuncu Yil University | Tutal E.,Ankara Kecioren Research and Training Hospital | Ertugrul D.T.,Ankara Kecioren Research and Training Hospital | Akin K.O.,Ankara Kecioren Research and Training Hospital
International Journal of Dermatology | Year: 2011

Isotretinoin (Iso) has been used for the treatment of acne. Some previous studies reported elevated homocysteine (Hcy) levels after treatment with Iso. Some side effects have clinical presentations similar to vitamin B12, folic acid deficiencies, and hyperhomocysteinemia. In the present study we evaluated the plasma Hcy levels, the vitamins involved in its metabolism (vitamin B12 and folic acid), and holotranscobalamin (HoloTC), a transport system for vitamin B12 absorption in patients receiving Iso treatment for acne vulgaris. A total of 66 patients with acne vulgaris between the ages of 18 and 40years were included. Screening for hemoglobin, creatinine, SGOT, SGPT, total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and very low-density lipoprotein cholesterol (VLDL-C), folic acid, vitamin B12, Hcy, and HoloTC were done just before initiation (pretreatment) and after fourmonths of Iso treatment (posttreatment). Posttreatment vitamin B12, folic acid, and HoloTC levels were significantly lower while Hcy levels were significantly higher compared with initial values. Posttreatment total cholesterol, LDL-C, triglycerides, VLDL-C, SGPT, and SGOT levels were also higher, and HDL-C levels were lower compared with initial values while there was no change in hemoglobin levels during Iso treatment. We found that Iso usage might cause decreased vitamin B12, folic acid, and HoloTC. These Iso side effects might contribute to the missing link between Iso usage, hyperhomocysteinemia, and neuropsychiatric disorders. Trials may be made with the aim of demonstrating (clearly) if starting vitamin B12 and folic acid replacement therapies with Iso treatment initialization could be useful for preventing hyperhomocysteinemia and possibly related disorders. © 2011 The International Society of Dermatology.


Karadag A.S.,Yuzuncu Yil University | Tutal E.,Baskent University | Ertugrul D.T.,Ankara Kecioren Research and Training Hospital
Acta Dermato-Venereologica | Year: 2011

The aim of this study was to evaluate the relationship between vitiligo and insulin resistance (IR). A total of 96 subjects were included in the study; 57 patients with vitiligo and 39 subjects in an age and a body mass index-matched control group. In fasting blood samples, insulin, C-peptide, glucose, total cholesterol, triglyceride, low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C) were measured. IR was calculated with the homeostasis model assessment- IR (HOMA-IR) method. Comparison of the vitiligo and the control groups revealed that patients with vitiligo had higher IR (2.3 vs. 2.0, p < 0.01), higher insulin and C-peptide levels (p < 0.001, p < 0.001, respectively), higher LDL/ HDL ratio and lower HDL-C levels (p < 0.01, p < 0.0001, respectively). Systolic blood pressures of patients with vitiligo were also higher compared with control subjects (p < 0.01). Further experimental and clinical studies are needed to elucidate the molecular mechanisms underlying this association. ©2011 The Authors.


Karabulut H.,Ankara Kecioren Research and Training Hospital | Dagli M.,Ankara Numune Research and Training Hospital | Ates A.,Ankara Numune Research and Training Hospital | Karaaslan Y.,Ankara Numune Research and Training Hospital
Journal of Laryngology and Otology | Year: 2010

The aim of the current study was to investigate hearing loss and cochlear function in patients with systemic lupus erythematosus, using audiology, distortion product otoacoustic emissions and transient evoked otoacoustic emissions. Study design: Prospective, case-control study. Methods: The study included 26 randomised patients with systemic lupus erythematosus (52 ears) and 30 healthy control subjects (60 ears). Pure tone audiometry was performed at 250 and 500Hz and at 1, 2, 4, 6, 8, 10, 12, 14 and 16kHz. Distortion product otoacoustic emissions and transient evoked otoacoustic emissions were measured using Biologic System equipment with Scout Acoustic Emissions System software. Results: The distortion product otoacoustic emission signal responses were significantly different only at 750Hz, while the distortion product otoacoustic emission signal-noise ratios were significantly different at 750Hz and 6kHz (p<0.05), comparing patients and controls. The transient evoked otoacoustic emission signal-noise ratios were significantly different at 2 and 3kHz, comparing patients and controls (p<0.05). The transient evoked otoacoustic emission total signal-noise ratios were significantly different, comparing patients and controls (p<0.05). In addition, the pure tone audiometry thresholds were significantly different at 250 and 500Hz and at 1, 2, 10 and 12kHz, comparing patients and controls (p<0.05). Conclusion: Our findings do not completely agree with those of previous temporal bone histopathological studies. However, our results do support a general picture of low frequency hearing loss in systemic lupus erythematosus patients. We consider these results to be related to endolymphatic and cochlear hydrops, and we suggest that electrocochleography could be performed in further studies for clarification of this subject. Copyright © JLO (1984) Limited 2009.


Ulusan Z.,Ankara Kecioren Research and Training Hospital
Cardiovascular journal of Africa | Year: 2011

Behçet's disease is a multisystem inflammatory disorder that is classified among the vasculitides and can affect all types and sizes of blood vessels. Vascular manifestations of Behçet's disease are venous and arterial occlusion, and arterial aneurysms. As vasculitis of the vasa vasorum is the main pathological hallmark of Behçet's disease, it is generally seen as superficial thrombo-phlebitis or occlusion of the major veins; however arterial obstruction and aneurysms may also be seen to a lesser extent. Iliac artery stenosis is highly uncommon. Here, a case of common iliac stenosis in a 48-year-old patient with Behçet's disease is reported. As the risk of aneurysm during an operation was high in this patient, he was treated with vascular stent implantation. Due to stent occlusion two months after the operation, percutaneous transluminal angioplasty was performed with an 8-mm balloon. During the three-year follow up, no obstruction was observed.


Karadag A.S.,Ankara Kecioren Research and Training Hospital | Guler Simsek G.,Ankara Kecioren Research and Training Hospital
Turkish Journal of Medical Sciences | Year: 2010

Primary cutaneous amyloidosis is a rare progressive disease that is characterized with the deposition of amyloid under the skin instead of internal organs. Major types are the macular, papular, nodular types. Amyloidosis cutis dyschromica is a very rare specific type of vitiliginous amyloidosis. A 16 year-old female patient and 22 year-old male patient, siblings, referred to the hospital with the complaint of non-pruritic diffuse hyperpigmentation beginning from trunk and spreading to all body. The histopathologic findings and crystal violet stain were consistent with amyloidosis cutis dyschromica. All other investigations were normal. There are few reported cases related with this amyloidosis type and it was seldom reported as familial. This case is the first familial case from Turkey. © Tübi̇tak.


Ertugrul D.T.,Ankara Kecioren Research and Training Hospital | Karadag A.S.,Ankara Kecioren Research and Training Hospital | Tutal E.,Ankara Kecioren Research and Training Hospital | Akin K.O.,Ankara Kecioren Research and Training Hospital
Dermatologic Therapy | Year: 2011

Isotretinoin is an effective therapy for severe nodulocystic acne. Several experimental studies suggest that it may have an effect on vitamin D physiology. In the present study, the authors aimed to investigate the effect of isotretinoin treatment on the metabolism of vitaminDin acne patients. A prospective analysis of 50 consecutive acne patients who were treated with isotretinoin for 3 months was done. Before and after 3months of treatment, 25 hydroxy vitamin D, 1,25 dihydroxy vitamin D, and bone alkaline phosphatase, calcium, phosphate, and parathormone levels were measured. The 25 hydroxy vitamin D and serum calcium levels decreased significantly (p < 0.0001, p < 0.05, respectively), whereas 1,25 dihydroxy vitamin D, parathormone, and bone alkaline phosphatase levels increased significantly after 3 months of isotretinoin treatment (p < 0.005, p < 0.005, p < 0.0001, respectively). Aspartate aminotransferase, total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels also increased significantly after isotretinoin treatment. This prospective clinical study showed that isotretinoin has an effect on vitamin D metabolism. Further clinical studies with longer periods of follow-up are needed to understand the effect of isotretinoin on vitamin D and bone metabolism. © 2011 Wiley Periodicals, Inc.

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