Browsing by Author "Pirildar, T"

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    A multimodal ophthalmic analysis in patients with systemic sclerosis using ocular response analyzer, corneal topography and specular microscopy
    Mayali, H; Altinisik, M; Sencan, S; Pirildar, T; Kurt, E
    PurposeTo conduct a multimodal ophthalmic evaluation of systemic sclerosis (SSc) in patients using ocular response analyzer (ORA), Pentacam, and specular microscopy (SM).MethodsThirty-one SSc patients and a group of age- and sex-matched controls were enrolled in this cross-sectional study. Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with ORA. Anterior chamber depth (ACD), central corneal thickness (CCT), and corneal volume (CV) measurements were obtained using Pentacam. Corneal endothelial cell density (ECD) and CCT were evaluated by SM.ResultsSSc patients had significantly lower CH, ACD, and ECD values compared to the control group (p=0.018;<0.001;<0.001, respectively). There was no significant difference regarding CRF, IOP, CV, or CCT measurements acquired by Pentacam and SM. Regarding CCT, SM and Pentacam showed relatively better agreement in SSc patients.ConclusionsMultimodal imaging can provide more comprehensive and useful information regarding the ocular involvement of systemic diseases. The multimodal evaluation in our study demonstrated that the pathologic effects of SSc may manifest as reductions in ACD, corneal elasticity, and ECD before there are any detectable changes in corneal thickness or IOP.
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    Endothelial dysfunction in patients with primary Sjogren's syndrome
    Pirildar, T; Tikiz, C; Özkaya, S; Tarhan, S; Ütük, O; Tikiz, H; Tezcan, UK
    \The aim of this study was to determine the endothelial function in patients with primary Sjogren's syndrome ( SS). We also aimed to determine whether endothelial ( dys) function correlates with extraglandular manifestations, specific autoantibodies and the severity of salivary gland involvement of SS. Endothelium dependent vasodilation and endothelium- independent vasodilation of the brachial artery were assessed by a high- resolution ultrasound on 25 patients with primary SS and on 29 healthy controls. Patients with primary SS had significantly less mean endothelium- dependent vasodilation than did controls ( 3.0 +/- 0.4% vs 4.2 +/- 0.3%; p= 0.012). Endothelium- independent vasodilation induced by sublingual glycerol trinitrate was not different between the two groups ( 12.9 +/- 1.4% vs 14.1 +/- 1.2%; p= 0.86;). We concluded that endothelium- dependent vasodilation was impaired in primary SS patients, in particular those presenting with Raynaud's phenomenon, when compared with the healthy controls and this impairment was not associated with the presence of RF, ANA, anti- Ro/ SS- A, anti- La/ SS- B and with the other extraglandular manifestations of the disease.
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    Assessment of alveolar epithelial permeability in Behcet's disease with 99mTc-DTPA aerosol scintigraphy
    Gumuser, FG; Pirildar, T; Batok, D; Sakar, A; Ruksen, E; Sayit, E
    Objective Behcet's disease (BD) is a multisystem disorder characterized by vasculitis, and consists of a triad of recurrent ulcers of the oral and genital mucosa with relapsing uveitis. The prevalance of pulmonary involvement varies in the range of 1-10% in various studies and its complications are severe and life threatening. In this study, we investigated the changes of pulmonary epithelial permeability of patients with BD using technetium-99m diethylene triamine penta-acetic acid (Tc-99m-DTPA) aerosol scintigraphy, so as to begin the therapy regimen as soon as possible. Methods Twenty-one nonsmoking patients with BD (8 women, 13 men; mean age 38.67 +/- 8.86 years) and 15 healthy volunteer nonsmoking controls (8 women, 7 men; mean age 50.87 +/- 12.45 years) underwent Tc-99m-DTPA aerosol inhalation scintigraphy and pulmonary function tests (PFTs). Subjects inhaled 1480 MBq of Tc-99m-DTPA for 4 min in the supine position. Scintigraphic data were recorded dynamically (1 frame/min) in the posterior projection on a 64 x 64 matrix for a 30-min period using a double-headed gamma camera (Infinia, GE, Tirat Hacarmel, Israel) equipped with a low-energy all-purpose parallel hole collimator. Half time of Tc-99m-DTPA clearance (T (1/2)) was calculated by placing a mono-exponential fit on the curves. Penetration index (PI) was also calculated by dividing the peripheral total counts by the sum of the peripheral and central total counts on the first minute image, in order to quantify the distribution of the inhaled aerosol. Results The clearance half time of Tc-99m-DTPA radioaerosols in the BD patients (24.81 +/- 6.22 min) was faster than in the normal control group (46.53 +/- 22.41 min) (P = 0.004). There was also a significant difference between PI of the patients with BD (0.15 +/- 0.03) and that of the controls (0.21 +/- 0.06) (P = 0.002). No correlation was found between the mean T (1/2) values of Tc-99m-DTPA clearance or the spirometric measurements in the BD patients. Penetration indices were not correlated with PFT in the BD patients. Conclusions Lung epithelial permeability of the patients with BD was significantly higher than that of the normal subjects. The results of this study demonstrated that the assessment of lung epithelial permeability using Tc-99m-DTPA aerosol scintigraphy could predict the presence of lung involvement in the early stages of BD.
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    Technetium-99m-hexamethylpropylene amine oxime lung scintigraphy findings in patients with Behcet's disease
    Gumuser, G; Pirildar, T; Tarhan, S; Batok, D; Ruksen, E; Sakar, A; Sayit, E
    Aim Behcet's disease (BD) is a multisystem disorder that is characterized by vasculitis, and consists of a triad of recurrent ulcers of the oral and genital mucosa with relapsing uveitis. The prevalence of pulmonary involvement varies in the range of 1-10% in various studies, and its complications are severe and life threatening. To objectively assess the degree of pulmonary vascular endothelial damage in BD, the lung uptake, and the clearance rate of technetium-99m-hexamethylpropylene amine oxirne (Tc-99m-HMPAO) were determined. Methods Twenty-three nonsmoking patients with BD (10 female, 13 male) and 11 (six female, five male) healthy nonsmoking controls underwent Tc-99m-HMPAO lung scanning, pulmonary function tests (PFT), chest radiograph examination, contrast-enhanced spiral chest computed tomography scanning, and high-resolution computed tomography examinations. Immediately after the bolus injection of 740 MBq of Tc-99m-HMPAO posterior sequential images were obtained at 1-s intervals for 150s and subsequent images were obtained at one frame per minute (min) over a 10-min period, using a double-headed gamma camera equipped with a low-energy all-purpose parallel hole collimator. Dynamic images were used to calculate the Tc-99m-HMPAO lung clearance rate (T(1/2)). Simultaneously, a static anterior image, including a large pad of the liver, was obtained of 5-min duration at 10 min after the injection. Regular regions of interests were drawn over the midportion of the right lung and the highest activity area of the liver parenchyma was selected and lung/liver (L/Li) uptake ratios were calculated to represent the degree of pulmonary vascular endothelial damage. Results Chest radiograph, high-resolution computed tomography, and computed tomography findings in patients with BD were nonspecific for BD. There was also a statistically significant difference between patients with BD (30.26 +/- 10.55s) and normal controls (19.53 +/- 6.24s) on their T(1/2) values (P=0.0004). The results show that the L/Li ratios on the Tc-99m-HMPAO lung scan were significantly higher in patients with BD (0.60 +/- 0.19) than those in normal controls (0.39 +/- 0.07) (P=0.0021). Using a cutoff value of 0.50, 15 of 23 (65%) patients with BD had increased L/Li ratios. No correlation was found between the mean T(1/2) values of Tc-99m-HMPAO clearance and the PFT in patients with BD. The L/Li ratios were not correlated with PFT in patients with BD. Conclusion The degree of pulmonary vascular endothelial damage was represented as increased L/Li ratios and decreased lung clearance rate measured on the Tc-99m-HMPAO lung scan in patients with BD. Our results indicated that determining the T(1/2) values and the L/Li ratios on Tc-99m-HMPAO lung imaging should be an objective method to assess subclinical pulmonary damage even in the early stages of BD in the patients. Nucl Med Commun 32:363-368 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
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    Stevens-Johnson syndrome: a case due to hydroxychloroquine
    Özgül Özdemir, RB; Bilgir, F; Pirildar, T; Kirmaz, C
    Stevens-Johnson syndrome is a rare but life-threatening mucocutaneous skin reaction that is often caused by drugs. The most common causes of mortality are sepsis, gastrointestinal bleeding and fluid-electrolyte imbalance. In this article, a patient with Stevens-Johnson syndrome due to hydroxychloroquine is reported.
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    Sexual dysfunction in female subjects with fibromyalgia
    Tikiz, C; Muezzinoglu, T; Pirildar, T; Taskin, EO; Firat, A; Tuzun, C
    Purpose: We investigated sexual function in females with fibromyalgia (FM) and evaluate whether coexistent major depression (MD) has an additional negative effect on sexual function. Materials and Methods: A total of 100 female subjects were enrolled in the study, including 40 with FM only, 27 with FM plus MD and 33 healthy volunteers as a control group. The diagnosis of MD was made according to Structured Clinical Interview for Diagnostic and Statistical Manual-IV interview and the Hamilton Depression Rate Scale was used to grade depression. Widespread pain and quality of life were assessed with the Lattinen Pain Scale and Fibromyalgia Impact Questionnaire, respectively. The Female Sexual Function Index (FSFI) was used to assess sexual dysfunction. Results: All subjects were comparable in age, occupation and education. Mean FSFI total score +/- SD was significantly decreased in the FM and FM plus MD groups compared with that in healthy controls (21.83 +/- 5.84 and 22.43 +/- 7.0 vs 28.10 +/- 6.52, respectively, p = 0.001). However, the FSFI score was not significantly different between patients with FM only and FM plus MD (p > 0.05). Correlation analysis revealed a negative moderate correlation between total Lattinen pain score and FSFI score in the FM only and FM plus MD groups (r = -0.366, p = 0.047 and r = -0.403, p = 0.018, respectively). FSFI score did not correlate with FIQ and HDRS scores (p > 0.05). Conclusions: This study demonstrates that female patients with FM have distinct sexual dysfunction compared with healthy controls and coexistent MD has no additional negative effect on sexual function. Thus, female subjects with FM should be evaluated in terms of sexual function to provide better quality of life.
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    Sexual function in ankylosing spondylitis
    Pirildar, T; Müezzinoglu, T; Pirildar, S
    Purpose: We evaluated sexual function in male patients with ankylosing spondylitis (AS) using the validated International Index of Erectile Function (IIEF). We also assessed the frequency and association of erectile dysfunction with patient age, disease duration, morning stiffness, laboratory activity, disease severity, depression status and medication use in this patient group. Materials and Methods: We evaluated sexual function, in particular erectile dysfunction (ED), using the IIEF in male patients with AS followed regularly at the outpatient clinic of rheumatology and compared results with those in healthy controls. Patient age, disease duration, morning stiffness, laboratory activity, disease severity and medication use were obtained by reviewing the medical record. Affective patient and control states were measured by the Beck Depression Inventory. The Bath AS Functional Index was used to measure functional status in AS cases. Results: To our knowledge this is the first study of the frequency of ED in men with AS (8 of 65 or 12%). Compared to healthy controls patients with AS had significantly lower erectile function, orgasmic function, intercourse satisfaction and overall satisfaction scores according to the IIEF, whereas sexual desire scores were also lower, although not significantly. According to self-reported patient data ED was a prominent characteristic of our population. We were not able to relate any clinical features or laboratory findings to ED except the duration of morning stiffness. The 22 men with a high degree of morning stiffness (greater than 4 hours) had lower erectile function scores compared to the 12 with AS and a low degree of morning stiffness (less than 2 hours) (18.3+/-1.6 vs 26.5+/-2.4, p<0.05). Of 65 patients with AS 25 (38%) were depressed in our study group according to the Beck Depression Inventory, while no healthy controls were depressed when a score of greater than 13 was used as the cutoff. Conclusions: ED can be seen in the course of AS. The pathogenesis of ED in patients with AS is thought to be multifactorial with disease and treatment related factors. Thus, male patients with AS, in particular those with a high degree of morning stiffness, should be encouraged to talk about their sexuality.
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    The effect of anti-tumor necrosis factor (TNF)-alpha therapy with etanercept on endothelial functions in patients with rheumatoid arthritis
    Tikiz, H; Arslan, Ö; Pirildar, T; Tikiz, C; Bayindir, P
    Objective: To investigate the effects of tumor necrosis factor (INF)-alpha antagonism with etanercept (ENC) on endothelial functions in patients with active rheumatoid arthritis (RA). Methods: A total of 21 patients with RA were enrolled in this prospective study. Eleven of them (8 women, 3 men mean age 47.0 +/- 10.1 years) with high disease activity despite the conventional treatment were assigned to Group 1 and were given ENC treatment twice a week (25 mg SC injection) for 12 weeks. Ten patients with RA (8 women, 2 men mean age 55.0 +/- 6.4 years) under conventional methotrexate and prednisone therapy were assigned as Control group (Group 2). Endothelium-dependent and -independent vasodilator responses of the brachial artery were assessed by high-resolution ultrasound. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were also measured at baseline and at the post treatment period. Mann-Whitney U and Wilcoxon tests were used to compare the data and correlation analysis was performed using Pearson correlation test. Results: Endothelium-dependent vasodilatation improved from 5.2 +/- 0.8% to 7.9 +/- 1.3% (p=0.04) in ENC group, while no significant change was observed in the control group (from 6.6 +/- 1.1% to 7.0 +/- 1.8% p=0.67). No significant changes were found in endothelium-independent vasodilatation and baseline brachial artery diameters in both groups. A significant reduction in ESR and CRP were observed in patients receiving ENC (from 16.2 +/- 6.8 to 9.2 +/- 5.1 mm/h, p=0.003 and from 14.68 +/- 3.4 to 9.25 +/- 3.7 mg/L, p=0.003, respectively). Conclusion: Treatment with ENC for 12 weeks significantly improved endothelial function in patients with active RA compared to those under conventional therapy. The findings of the present study support the hypothesis that the use of TNF-alpha blockers in patients with active RA may reduce the high incidence of cardiovascular complications. (Anadolu Kardiyol Derg 2010; 10: 98-103)
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    Corneal Hysteresis, Corneal Resistance Factor, and Intraocular Pressure Measurement in Patients with Scleroderma Using the Reichert Ocular Response Analyzer
    Emre, S; Kayikçioglu, Ö; Ates, H; Çinar, E; Inceoglu, N; Yargucu, F; Pirildar, T; Oksel, F
    Purpose: The Reichert ocular response analyzer (ORA) measures corneal biomechanical properties in vivo by monitoring and analyzing the corneal behavior when its structure is submitted to a force induced by an air jet. This study was designed to examine corneal biomechanical properties and intraocular pressure in patients with systemic sclerosis (SSc) and to compare with control eyes. Patients and Methods: ORA measurements were performed on the right eyes of 29 patients with SSc (group 1) and 29 healthy people who served as the control group (group 2). Corneal hysteresis, conical resistance factor (CRF), and intraocular pressure [Goldmann correlated (IOPg) and conical compensated] were recorded with ORA. Results: Mean age of patients with SSc and control groups were 51.7 +/- 11.1 and 50.3 +/- 10.8 years, respectively. Mean (+/- SD) of the corneal hysteresis and CRF readings were 9.8 +/- 1.7 versus 9.5 +/- 1.2 mm Hg (P>0.05) and 10.0 +/- 1.5 versus 9.2 +/- 1.4 mm Hg (P<0.05), in groups 1 and 2, respectively. Mean (+/- SD) of the IOPg and intraocular pressure corneal-compensated recordings were 15.9 +/- 2.5 versus 14.1 +/- 2.4 mm Hg (P<0.05) and 16.9 +/- 3.2 versus 15.6 +/- 2.9 mm Hg (P>0.05), in groups 1 and 2, respectively. Statistical analysis revealed significant differences for CRF and IOPg between the study groups. Conclusions: The mean CRF and IOPg values of patients with SSc were higher when compared with normal controls. According to the results of our study, one can conclude that corneal biomechanical properties would be changed in patients with SSc and this can be determined by CRF.
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    The Evaluation of the Relationship between sTREM-1, VEGF-B, and VEGF Gene Expression Levels with Disease Activity of Behcet's Patients
    Harmanci, K; Akan, OY; Pirildar, T; Ortan, P; Ulman, C
    Background. There is no specific marker that shows the disease activity in Behcet's disease. Aim. In this study, we aimed to investigate VEGF-B and VEGF gene expressions and sTREM-1 levels in association with the activation of Behcet's disease. Study Design. Case-control study. Methods. Clinical features of patients who applied in the rheumatology clinic and were diagnosed with BD according to the international working group's criteria were investigated. 30 healthy volunteers and 30 patients in the active period according to the EBDCAF scoring were studied. VEGF-B and VEGF gene expressions and sTREM-1 levels were studied in the serum samples of the patients and the control subjects. Results. The VEGF-B expressions and sTREM-1 levels were higher in the BD than those in the healthy group, but this difference did not reach statistical significance. VEGF gene expression was statistically significant (p = 0 008). Behcet's disease patients with oral aphthae, genital ulcer, eye, joint, vascular, skin, and neurological involvement were analyzed separately as subgroups. We find that VEGF gene expression level of Behcet's disease patients with joint involvement (arthritis/arthralgia) and also VEGF-B and VEGF gene expression of Behcet's disease with vascular involvement (DVT/thrombophlebitis) were significantly higher (p = 0 035, p = 0 021). Each subgroup was analyzed with the control group. We determined that VEGF gene expression in all subgroups was significantly higher than that in the control group. At the same time, VEGF-B levels of patients with genital ulcer and vascular involvement (DVT/thrombophlebitis) were significantly higher than those in the control group. Conclusion. VEGF-B and VEGF gene expressions can be activity indicators for BD. In addition, this study shows that new treatment options should be explored for Behcet's disease patients with joint and vascular involvement. In the following years, new treatment methods are needed to investigate for revealing the role of the etiopathogenesis of BD and the activation and prognosis of VEGF by examining this study and providing much more participation. In our study group, the sTREM-1 levels were high but the results did not reach statistical significance. More studies are needed with larger groups in order the highlight the exact role of STREM-1 in Behcet's disease.
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    Arthritis induced by interferon-alpha therapy in a patient with essential thrombocythemia
    Çabuk, M; Pirildar, T; Ceylan, C; Koral, L; Kirmaz, C; Kiliççioglu, B; Özdemir, E
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    The Relationship of Carotid Intima-Media Thickness with Cell Adhesion Molecules and Pentraxin-3 in Patients with Psoriatic Arthritis
    Gündüz, ÖS; Alptürker, KA; Sen, MG; Can, F; Erdal, S; Ulman, C; Pirildar, T
    Aim Cardiovascular morbidity is increased in patients with psoriatic arthritis (PsA) compared to the general population. Several recent studies have indicated that pentraxin 3 (PTX-3) and cell adhesion molecules (CAMs) might be independent biomarkers of subclinical atherosclerosis. In this study, we aimed to determine the relationship of CAMs and PTX-3 with carotid intima media thickness (CIMT) in patients with PsA and to compare CIMT and serum levels of these biomarkers in patients with healthy controls (HCs). Method PsA patients fulfilling the CASPAR (Classification criteria for Psoriatic Arthritis) criteria without traditional cardiovascular (CV) comorbidity and HCs without autoimmune and/or CV disease were included in this cross-sectional study. Carotid artery Doppler ultrasound examinations were conducted by a single radiologist blinded to the participants' clinical characteristics. Serum vascular adhesion molecule 1 (VCAM-1), intercellular adhesion molecule 1 (ICAM-1), E-selectin, and PTX-3 concentrations were analized. Results 43 PsA patients (27 females, mean age 42.49 +/- 11.70 years, and a mean disease duration of 9.37 +/- 7.96 years) and 37 HCs (28 females, mean age 42.16 +/- 11.38 years) were included. In regression analyses, age and PTX-3 were found to be the best predictors of CIMT in patients with PsA. CIMT was significantly higher in PsA patients compared with HCs (0.63 +/- 0.18 vs. 0.49 +/- 0.10 mm, p<0.01). In te PsA group, serum levels of PTX-3, ICAM-1, and VCAM-1 were also significantly higher than HCs. CIMT correlated positively with age, disease duration, PTX-3, ICAM-1, and VCAM-1 (p<0.05). Conclusion In our study, age and serum level of PTX-3 were found to be the predictors of CIMT in patients with PsA without CV comorbidity. This outcome highlights the importance of monitoring CIMT and serum level of PTX-3 as CV risk factors in PsA patients.
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    Technetium-99m Hexamethylpropylene Amine Oxime Lung Clearance Rate in Patients with Behcet's Disease
    Gumuser, G; Pirildar, T; Tarhan, S; Kararmaz, M; Sakar, A; Sayit, E
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    Effect of trimethoprim-sulfamethaxazole in Blastocystis hominis infection
    Ok, ÜZ; Girginkardesler, N; Balcioglu, C; Ertan, P; Pirildar, T; Kilimcioglu, AA
    OBJECTIVE: Blastocystis hominis (B. hominis) is a common intestinal parasite that has long been considered nonpathogenic. Recently there have been many reports supporting a role for the organism as a potential pathogen. We performed a study to examine the pathogenicity of B. hominis and the effect of trimethoprim-sulfamethaxazole (TMP-SMX) on this organism. METHODS: Stool samples of patients, who came to the Department of Parasitology, Faculty of Medicine, Celal Bayar University, were examined by direct wet-mount, trichrome staining, formalin-ethyl acetate concentration, and Kinyoun acid fast techniques for intestinal parasites, and bacteriological stool cultures were performed. Fifty-three symptomatic patients (38 children and 15 adults) with two consequent stool samples positive for abundant B, hominis (five or more organisms per x400 field! and negative for other parasitic and bacterial pathogens were treated with TMP-SMX for 7 days, children 6 mg/kg TMP, 30 mg/kg SMX, and adults 320 mg TMP, 1600 mg SMX, daily. On the seventh day, at the end of treatment, stool samples of all patients were examined by same methods, and clinical symptoms were again evaluated. RESULTS: B. hominis was eradicated in 36 of 38 (94.7%) children, and 14 of 15 (93.3%) adults. Clinical symptoms disappeared in 39 (73.6%), decreased in 10(18.9%), and no change was observed in one (1.9%) patient, whereas symptoms persisted in all three (5.7%) patients in whom B. hominis could not be eradicated. Mean number of stools per day was significantly decreased from 4.3 to 1.2 in the 33 children (p < 0.001), and decreased from 3.5 to 1.0 in the four adults (p = 0.06) With diarrhea. CONCLUSIONS: These results suggested that B. hominis may be pathogenic, especially when it is present in large numbers, and TMP-SMX is highly effective against this organism. Although there are some anecdotal reports, to our knowledge this is the first study examining the effect of TMP-SMX on B. hominis in humans. (C) 1999 by Am. Coil. of Gastroenterology.
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    IL-2R, IL-6 and IL-8 Levels in Behcet's Disease
    Inanir, I; Onur, E; Pirildar, T; Gündüz, K; Var, A
    Background and Design: Immunological factors are considered to have an important role in the multifactorial ethiopathogenesis of Behcet's disease (BD). Especially, Th1 cells function by expressing proinflammatory cytokines and neutrophil-attracting chemokines. Levels of IL-2R, IL-6 and IL-8 were evaluated in patients with BD in this study. Material and Method: Sixty-six patients with BD (36 with inactive and 30 with active) composed the study group and 22 subjects the control group. Cytokine analyses were done with ELISA method by using commercial kits. ESR and CRP levels were also measured. Results: IL-2R, IL-6 and IL-8 levels in all patients, including the inactive ones, were not different from those in controls. CRP and ESR levels in patients were higher than in controls. IL-8 and CRP levels were increased in patient with active BD (p<0.05) when compared to those with inactive BD. Conclusion: Our study demonstrated elevated levels of serum IL-8, a chemokine activating monunuclear cells and neutrophils, in patients with active BD. IL-8 may be considered as an activity marker for BD. (Turkderm 2010; 44: 213-5)