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Pamuk O.N.,Trakya University Medical Faculty | Kalyoncu U.,Hacettepe University | Aksu K.,Ege University | Omma A.,Ankara Numune Research and Education Hospital | And 20 more authors.
Rheumatology International | Year: 2016

In this multicenter, retrospective study, we evaluated the efficacy and safety of biologic therapies, including anti-TNFs, in secondary (AA) amyloidosis patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). In addition, the frequency of secondary amyloidosis in RA and AS patients in a single center was estimated. Fifty-one AS (39M, 12F, mean age: 46.7) and 30 RA patients (11M, 19F, mean age: 51.7) with AA amyloidosis from 16 different centers in Turkey were included. Clinical and demographical features of patients were obtained from medical charts. A composite response index (CRI) to biologic therapy—based on creatinine level, proteinuria and disease activity—was used to evaluate the efficacy of treatment. The mean annual incidence of AA amyloidosis in RA and AS patients was 0.23 and 0.42/1000 patients/year, respectively. The point prevalence in RA and AS groups was 4.59 and 7.58/1000, respectively. In RA group with AA amyloidosis, effective response was obtained in 52.2 % of patients according to CRI. RA patients with RF positivity and more initial disease activity tended to have higher response rates to therapy (p values, 0.069 and 0.056). After biologic therapy (median 17 months), two RA patients died and two developed tuberculosis. In AS group, 45.7 % of patients fulfilled the criteria of good response according to CRI. AS patients with higher CRP levels at the time of AA diagnosis and at the beginning of anti-TNF therapy had higher response rates (p values, 0.011 and 0.017). During follow-up after anti-TNF therapy (median 38 months), one patient died and tuberculosis developed in two patients. Biologic therapy seems to be effective in at least half of RA and AS patients with AA amyloidosis. Tuberculosis was the most important safety concern. © 2016, Springer-Verlag Berlin Heidelberg.


Direskeneli H.,Marmara University | Akkoc N.,Dokuz Eylül University | Bes C.,Abant Izzet Baysal University | Cakir N.,Fatih Sultan Mehmet Research and Education Hospital | And 27 more authors.
Clinical and Experimental Rheumatology | Year: 2014

Objective: Unmet needs of rheumatoid arthritis (RA) patients regarding physician/patient communication, treatment preferences and quality of life issues were investigated in a Turkish survey study. Methods: The study was conducted with the contribution of 33 rheumatologists, and included 519 RA patients. The study population included patients who had been on biologic therapy for >6 months and were still receiving biologic therapy (BT group), and those who were biologic naive, but found eligible for biologic treatment (NBT group). Of the RA patients, 35.5% initially had a visit to an internal disease specialist, 25.5% to a physical therapy and rehabilitation specialist, and 12.2% to a rheumatology specialist for their RA complaints. The diagnosis of RA was made by a rheumatologist in 48.2% of patients. Results: The majority of RA patients (86.3%) visit their doctor within 15-week intervals. Most of the physician-patient communication focused on disease symptoms (99.0%) and impact of the disease on quality of life (61.8%). The proportion of RA patients who perceived their health status as good/very good/excellent was higher in the BT group than in the NBT group (74.3% vs. 51.5%, p<0.001). However, of those RA patients in the NBT group, only 24.8% have been recommended to start a biologic treatment by their doctors. With respect to dose frequency options, once-monthly injections were preferred (80%) to a bi-weekly injection schedule (8%). Conclusion: In conclusion, RA patients receiving biologic therapy reported higher rates of improved symptoms and better quality of life and seemed to be more satisfied with their treatment in our study. © Clinical and Experimental Rheumatology 2014.


PubMed | Van Research and Education Hospital, Uludag University, Trakya University Medical Faculty, Hatay State Hospital and 11 more.
Type: Journal Article | Journal: Rheumatology international | Year: 2016

In this multicenter, retrospective study, we evaluated the efficacy and safety of biologic therapies, including anti-TNFs, in secondary (AA) amyloidosis patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). In addition, the frequency of secondary amyloidosis in RA and AS patients in a single center was estimated. Fifty-one AS (39M, 12F, mean age: 46.7) and 30 RA patients (11M, 19F, mean age: 51.7) with AA amyloidosis from 16 different centers in Turkey were included. Clinical and demographical features of patients were obtained from medical charts. A composite response index (CRI) to biologic therapy-based on creatinine level, proteinuria and disease activity-was used to evaluate the efficacy of treatment. The mean annual incidence of AA amyloidosis in RA and AS patients was 0.23 and 0.42/1000 patients/year, respectively. The point prevalence in RA and AS groups was 4.59 and 7.58/1000, respectively. In RA group with AA amyloidosis, effective response was obtained in 52.2% of patients according to CRI. RA patients with RF positivity and more initial disease activity tended to have higher response rates to therapy (p values, 0.069 and 0.056). After biologic therapy (median 17months), two RA patients died and two developed tuberculosis. In AS group, 45.7% of patients fulfilled the criteria of good response according to CRI. AS patients with higher CRP levels at the time of AA diagnosis and at the beginning of anti-TNF therapy had higher response rates (p values, 0.011 and 0.017). During follow-up after anti-TNF therapy (median 38months), one patient died and tuberculosis developed in two patients. Biologic therapy seems to be effective in at least half of RA and AS patients with AA amyloidosis. Tuberculosis was the most important safety concern.


Aktas I.,Fatih Sultan Mehmet Research and Education Hospital | Ofluoglu D.,Baskent University | Akgun K.,Istanbul University
Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi | Year: 2011

Objective: Benign joint hypermobility syndrome (BJHS) can present with a wide variety of musculoskeletal problems. Lumbar disc herniation (LDH) is a common cause of low back pain. On the other hand, low back pain may be a presenting symptom in patients with BJHS. The purpose of this study was to identify the relationship between BJHS and LDH. Materials and Methods: The study included 184 patients diagnosed with LDH. All patients were assessed for existing hypermobility using the revised (Brighton 1998) criteria. Results: The mean age of the patients was 40.9±11.6 years (range: 18-76 years); 50 (27.2%) were male and 134 (72.8%) female. The mean Beighton score was 2.04±2.2. Out of 184 cases, 123 (68.4%) had hypermobility according to the revised Brighton criteria. In addition, there was a positive correlation between LDH and BJHS (r=0.15, p=0.0018). Conclusion: We suggest that BJHS may be a risk factor for LHD. As such, BJHS may be considered a concomitant problem in patients with low back pain due to LDH. © Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing.


Yuksel M.,Marmara University | Okur H.K.,Fatih Sultan Mehmet Research and Education Hospital | Pelin Z.,Hasan Kalyoncu University | Ogunc A.V.,Marmara University | Ozturk L.,Trakya University
Clinics | Year: 2014

Objectives: Obstructive sleep apnea syndrome is characterized by repetitive obstruction of the upper airways, and it is a risk factor for cardiovascular diseases. There have been several studies demonstrating lowlevels of nitric oxide in patients with obstructive sleep apnea syndrome compared with healthy controls. In this study, we hypothesized that reduced nitric oxide levels would result in high arginase activity. Arginase reacts with L-arginine and produces urea and L-ornithine, whereas L-arginine is a substrate for nitric oxide synthase, which produces nitric oxide. Methods: The study group consisted of 51 obstructive sleep apnea syndrome patients (M/F: 43/8; mean age 49±10 years of age) and 15 healthy control subjects (M/F: 13/3; mean age 46±14 years of age). Obstructive sleep apnea syndrome patients were divided into two subgroups based on the presence or absence of cardiovascular disease. Nitric oxide levels and arginase activity were measured via an enzyme-linked immunosorbent assay of serum samples. RESULTS: Serum nitric oxide levels in the control subjects were higher than in the obstructive sleep apnea patients with and without cardiovascular diseases (p<0.05). Arginase activity was significantly higher (p<0.01) in obstructive sleep apnea syndrome patients without cardiovascular diseases compared with the control group. Obstructive sleep apnea syndrome patients with cardiovascular diseases had higher arginase activity than the controls (p<0.001) and the obstructive sleep apnea syndrome patients without cardiovascular diseases (p<0.05). Conclusions: Low nitric oxide levels are associated with high arginase activity. The mechanism of nitric oxide depletion in sleep apnea patients suggests that increased arginase activity might reduce the substrate availability of nitric oxide synthase and thus could reduce nitric oxide levels. © 2014 CLINICS.


Ozbek E.,Okmeydani Research and Education Hospital | Simsek A.,Okmeydani Research and Education Hospital | Ozbek M.,Diskapi Research and Education Hospital | Somay A.,Fatih Sultan Mehmet Research and Education Hospital
Archivio Italiano di Urologia e Andrologia | Year: 2013

Because of the positive corelation between healthy cardiovascular system and sexual life we aimed to evaluate the effect of caloric restriction (CR) on endothelial and neuronal nitric oxide synthase (eNOS, nNOS) expression in cavernousal tissues and eNOS expression in the internal iliac artery in young and aged rats. Young (3 mo, n = 7) and aged (24 mo, n = 7) male Sprague-Dawley rats were subjected to 40% CR and were allowed free access to water for 3 months. Control rats (n = 14) fed ad libitum had free access to food and water at all times. On day 90, rats were sacrified and internal iliac arteries and penis were removed and parafinized, eNOS and nNOS expression evaluated with immunohistochemistry. Results were evaluated semiquantitatively. eNOS and nNOS expression in cavernousal tissue in CR rats were more strong than in control group in both young and old rats. eNOS expression was also higher in the internal iliac arteries of CR rats than in control in young and old rats. As a result of our study we can say that there is a positive link between CR and neurotransmitter of erection in cavernousal tissues and internal iliac arteries. CR has beneficial effect to prevent sexual dysfunction in young and old animals and possible humans.


Hunuk A.,Fatih Sultan Mehmet Research and Education Hospital | Hunuk B.,Maltepe Cik State Hospital | Kusken O.,Fatih Sultan Mehmet Research and Education Hospital | Onur O.E.,Fatih Sultan Mehmet Research and Education Hospital
Annals of Noninvasive Electrocardiology | Year: 2016

Brugada syndrome (BrS) is an important cause of sudden cardiac death (SCD) with well-defined ST-segment elevation patterns on V1–V3. Observation of BrS-Type-electrocardiogram (ECG) patterns in medical conditions without true BrS is called “Brugada Phenocopy” (BrP). We present a case of 61-year-old male patient with hyperkalemia, hyponatremia, and BrS-Type-1 ECG pattern in the setting of acute postrenal failure. He was denying any syncope or family history of SCD. With normalization of electrolyte levels, BrS-Type-1-ECG resolved. Electrolyte disturbances are one of the most common reasons of BrP. Being aware of BrPs and differentiating from an unmasked BrS-ECG pattern could prevent patients from lethal consequences and unnecessary treatments. © 2016 Wiley Periodicals, Inc.


PubMed | Istanbul University and Fatih Sultan Mehmet Research and Education Hospital
Type: | Journal: Cardiovascular and interventional radiology | Year: 2017

The aim of the study was to evaluate the results of ultrasonography (US)-guided percutaneous radiofrequency ablation (RFA) in hyperparathyroid patients who refused surgery or had high surgical risks.Five patients with hyperparathyroidism (HPT) underwent US-guided RFA for a single hyperfunctioning parathyroid lesion. Post-ablation serum calcium and parathormone (PTH) assays were performed. All patients underwent imaging studies 6months after the ablation to visualize the post-ablation change in the size of the treated parathyroid lesions.All patients were normocalcemic on the post-ablation 1st day and 6th month. The post-ablation PTH levels were normal in three patients but remained elevated in two patients. The size of the parathyroid lesion was30mm in the two patients with elevated PTH, whereas the lesion was smaller than 30mm in those with normal post-ablation PTH values.Although this is a limited case series, it demonstrates the potential feasibility of RFA for HPT. Benefits were achieved particularly in patients with small parathyroid lesions.


PubMed | Maltepe Cik State Hospital and Fatih Sultan Mehmet Research and Education Hospital
Type: Case Reports | Journal: Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc | Year: 2016

Brugada syndrome (BrS) is an important cause of sudden cardiac death (SCD) with well-defined ST-segment elevation patterns on V1 -V3 . Observation of BrS-Type-electrocardiogram (ECG) patterns in medical conditions without true BrS is called Brugada Phenocopy (BrP). We present a case of 61-year-old male patient with hyperkalemia, hyponatremia, and BrS-Type-1 ECG pattern in the setting of acute postrenal failure. He was denying any syncope or family history of SCD. With normalization of electrolyte levels, BrS-Type-1-ECG resolved. Electrolyte disturbances are one of the most common reasons of BrP. Being aware of BrPs and differentiating from an unmasked BrS-ECG pattern could prevent patients from lethal consequences and unnecessary treatments.

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