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Öğe Assessment of Arterial Stiffness in Female and Male Gout Patients(TAYLOR & FRANCIS INC, 2013) Yilmaz, Sema; Celik, Gulperi; Gundogdu, AliThe aim of this study was to investigate the relationship between central blood pressures (BP), pulse wave velocity (PWV) meaurements, and biochemical parameters in female and male gout patients and controls. This study included 12 (23.5%) females and 39 (76.5%) males with gout disease. 24-hour diastolic BP, day diastolic BP and day diastolic exceeding limit value were higher in male gout patients than female gout patients. In male gout patients, more prominent inflammatory changes in the vascular wall may be an explanation for the result of this our study, because history of hypertension and smoking habits were frequent in this group.Öğe Association between Serum Total Antioxidant Status and Coronary Microvascular Functions in Patients with SLE(WILEY, 2012) Yilmaz, Sema; Caliskan, Mustafa; Kulaksizoglu, Sevsen; Ciftci, Ozgur; Caliskan, Zuhal; Gullu, Hakan; Guven, AytekinMortality from cardiovascular disease has been found to be increased in patients with systemic lupus erythematosus (SLE). Coronary flow reserve (CFR) measurement is used both to assess epicardial coronary arteries and to examine the integrity of coronary microvascular circulation. Oxidative stress, enhancing modification of plasma lipids, is also associated with atherosclerotic events in lupus patients. Impairment of CFR and TAS has been shown to be an early manifestation of coronary atherosclerosis. Forty patients with SLE and 33 healthy volunteers were included in this study. Echocardiographic examination included left ventricular myocardial velocity measurements and coronary flow reserve (CFR) measurement. Serum total antioxidant status levels (TAS) also were measured using TAS kit. Lateral myocardial early peak velocity (Em) and lateral Em/Am ratio did not differ between the groups, but lateral myocardial atrial peak velocity (Am) was significantly higher in SLE group than the control group. Baseline coronary diastolic peak flow velocity (DPFV) of left anterior descending was similar in both the groups. However, hyperemic DPFV and CFR (2.50 +/- 0.42 vs. 3.09 +/- 0.45, P < 0.0001) were significantly lower in the SLE group than in the control group. CFR significantly and inversely correlated with CRP and significantly correlated with TAS. Subclinical coronary microvascular dysfunction can occur in SLE patients without traditional cardiovascular risk factors, probably associated with underlying inflammation and impairment of TAS. (Echocardiography 2012;29:1218-1223)Öğe Asymmetric dimethylarginine and arginine levels in patients with rheumatoid arthritis(WALTER DE GRUYTER GMBH, 2013) Vatansev, Husamettin; Ozturk, Bahadir; Yilmaz, Sema; Sivrikaya, Abdullah; Dagli, Mehmet; Kiyici, Aysel; Unlu, AliObjective: Rheumatoid arthritis (RA) is a chronic inflammatory disease and it is associated with premature atherosclerosis development. RA patients have multiple factors to develop premature atherosclerosis. Enhanced asymmetric dimethylarginine (ADMA) is considered as a risk factor for the development of atherosclerosis by inducing endothelial dysfunction. The aim of this study was to investigate the role of asymmetric dimethylarginine, arginine and citrulline levels in patients with RA and their relation to the disease activity parameters for possible role on the disease activity. Methods: 92 patients with RA and 34 healthy controls were included the study. Patients and control blood samples collected for ADMA, arginine and citrulline levels. ADMA, arginine and citrulline levels were measured by pre-column derivatization fluorescence HPLC method. CRP and ESR levels examined on the same day were taken from the patient records. Results: While ADMA levels significantly increased, arginine levels decreased in the patient group. There was no difference in citrulline levels between both groups. Only citrulline and arginine showed a weak positive correlation. ADMA, arginine, and citrulline levels showed no correlation with either biochemical parameters such as CRP or ESR, or disease activity or disease severity. Conclusion: Our study has shown that an increase in ADMA levels with the decrease in arginine levels suggests an increase in arginine turnover to ADMA. Increased ADMA levels can be used for an increased risk for premature development of atherosclerosis in patients with RA. Since high ADMA levels prevent the NO-dependent vasodilatation, a possible role of ADMA in development of premature atherosclerosis may be independent from inflammation.Öğe Asymmetric dimethylarginine levels in Behcet's disease(WALTER DE GRUYTER GMBH, 2014) Ozturk, Bahadir; Vatansev, Husamettin; Taner, Alpaslan; Yilmaz, Sema; Dagli, Mehmet; Unlu, AliObjective: Behcet's disease (BD) is a chronic, inflammatory, multisystem vasculitis and the etiology is not yet fully understood. Nitric Oxide (NO) is an important molecule for the vascular system which synthesised by the Nitric Oxide Synthase (NOS) enzyme. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NOS. Therefore, we aimed to investigate levels of the ADMA and its relation with exacerbations in BD patients. Methods: The subjects enrolled in this study were recruited from 34 patients with BD and 34 healthy controls. Serum levels of ADMA, arginine and citrulline were measured by HPLC with fluorescence detection. The ESR and CRP levels analyzed by routinely used methods. Results: In contrast to information in the literature, ADMA levels were found to be decreased in BD patients when compared to control. Inversely, Arginine and Citrulline levels were significantly increased in BD patients. Increased Arginine/ADMA ratios were found in the patient group. There was an inverse relation between ADMA and CRP levels. Arginine values were also correlated CRP and Citrulline levels. Conclusion: One of the reasons of high number of BD attacks in young age may be low levels of ADMA. Our study suggests that the reduced levels of ADMA in patients group may impose a possible preventive role to ADMA through decrease of NO-mediated inflammation and exacerbations of BD with aging.Öğe A CASE OF SJOGREN'S SYNDROME ACCOMPANIED BY SIGNS OF NON-CARDIAC PULMONARY EDEMA AND INFECTION(NOBEL ILAC, 2013) Sumer, Sua; Efe, Pakize Basak; Ural, Onur; Yilmaz, SemaAt first presentation connective tissue diseases may mimic infectious diseases. But recurrent non-cadiac pulmonary edema accompanied by serious infectious signs is observed rarely This patient presented with signs of pneumonia, and developed recurrent non-cadiac pulmonary edema, and had to be intubated despite appropriate treatment and Sjogren's syndrome was diagnosed after examinations and detailed history which were warranted by lath of treatment response. She was treated with hydroxychloroquine. This patient's problem was thought to be due to both findings of systemic involvement of connective tissue disease and increased frequency of infectious diseases in these patients.Öğe Central arterial characteristics of gout patients with chronic kidney diseases(WILEY, 2017) Celik, Gulperi; Yilmaz, Sema; Kebapcilar, Levent; Gundogdu, AliBackground: The aim of this study was to investigate the relationship between central blood pressure, arterial stiffness parameters and renal function parameters in gout patients with chronic kidney disease (CKD) and without CKD. Methods: The study enrolled 48 gout patients and 32 control subjects. Central blood pressure, arterial stiffness parameters and renal function parameters in gout patients were investigated. The vascular measurements were performed with an arteriograph. Results: Of the gout patients, 40.1% had CKD. The 24-h pulse pressure (PP) (P < 0.001), central systolic blood pressure (SBP) (P < 0.001), central diastolic blood pressure (DBP) (P < 0.001), cardiac output (CO) (P < 0.001) and peripheral resistance (P = 0.004) were significantly higher in the all patients with gout compared to healthy control subjects. Moreover, when the gout patients with and without CKD were compared, the gout patients with CKD had higher 24-h PP (P = 0.009), 24-h augmentation index standardized to a heart rate of 75 beats per min (AIx@75) (P < 0.023), daytime PP (P = 0.001), daytime AIx@75 (P = 0.027), and nighttime PP (P = 0.035) than the gout patients without CKD. Conclusions: In our study, gout patients with CKD had worse and more emphasized evidence of arterial stiffness than gout patients without CKD. Further investigations with large sample sizes are needed to evaluate the effect of CKD on the arterial stiffness of gout patients.Öğe Evaluation of Sexual Dysfunction in Females With Ankylosing Spondylitis(TURKISH LEAGUE AGAINST RHEUMATISM, 2016) Akkurt, Halil Ekrem; Yilmaz, Halim; Yilmaz, Sema; Parlak, Lutfiye; Ordahan, Banu; Salli, AliObjectives: This study aims to evaluate sexual function in females with ankylosing spondylitis (AS), compare them with healthy controls, and demonstrate the effects of AS on female sexual functions. Patients and methods: Fifty-four AS patients (mean age 39.33 +/- 8.57 years; range 20 to 55 years) and 56 similar aged healthy controls were included in the study. Depression levels and sexual functions of all participants were evaluated by the Beck Depression Inventory and Female Sexual Function Index (FSFI), respectively. Other assessment methods included the visual analog scale for pain, fatigue, and importance of sexual life; Bath Ankylosing Spondylitis Disease Activity Index for disease activity, Bath Ankylosing Spondylitis Functional Index for functionality, Bath Ankylosing Spondylitis Metrology Index for spinal mobility, and Short Form-36 (SF-36) for quality of life. Results: Total FSFI and all FSFI subscale scores and number of weekly sexual intercourse were significantly lower while Beck Depression Inventory score was significantly higher in females with AS when compared to controls. In AS patients with depression, total FSFI score and FSFI subscales scores of desire and arousal were significantly lower than those without depression. In females with AS, there were negative correlations between total FSFI score and duration of complaint, Beck Depression Inventory score, Bath Ankylosing Spondylitis Metrology Index score, visual analog scale score, age, and duration of marriage while positive correlations existed between total FSFI score and visual analog scale importance of sexual life score and number of weekly sexual intercourse, SF-36 fatigue, SF-36 social function, SF-36 pain, and SF-36 mental component scores. Conclusion: Sexual dysfunction was more common in female AS patients without marked impairment in body image and hip involvement when compared to normal population. Sexual problems which are generally neglected should be handled regardless of disease activity when evaluating patients with AS and establishing a treatment plan.Öğe A male patient with Takayasu's arteritis presenting with recurrent hemoptysis(CUKUROVA UNIV, FAC MEDICINE, 2019) Limon, Muhammet; Gulcemal, Semral; Tezcan, Dilek; Yilmaz, SemaTakayasu's arteritis is a chronic granulomatous inflammatory large vessel vasculitis of unknown etiology. Takayasu's arteritis primarily affects the aorta and its primary branches. Women are affected in 80 to 90 percent of cases, with an age of onset that is usually between 10 and 40 years. The onset of clinical symptoms in Takayasu's arteritis are variably. Symptoms of vascular disease are cyanosis and/or pain in arms or legs, lightheadedness or other symptoms of reduced blood flow, or nonspecific constitutional symptoms. Pulmonary hemorrhage is rare in Takayasu's arteritis. This case is presented because of the progress of cavitary lesion in the lung due to aspergilloma by immunosuppressive treatment.Öğe Non-dipping blood pressure patterns and arterial stiffness parameters in patients with Behcet's disease(NATURE PUBLISHING GROUP, 2015) Celik, Gulperi; Yilmaz, Sema; Esmen, Serpil ErguluBehcet's disease is a multisystemic vasculitis involving veins and arteries of various sizes. Non-dipping status, augmentation index and pulse wave velocity are important determinants of cardiovascular mortality and morbidity. We investigated the non-dipping status and arterial stiffness in patients with Behcet's disease. In this cross-sectional study, we examined the vascular parameters of 96 patients with Behcet's disease (53% female) and 60 age- and sex-matched control subjects. The non-dipping status and arterial distensibility were assessed using a Mobil-O-Graph Arteriograph, an automatic oscillometric device. In total, 65.6% of 96 patients were systolic non-dippers, and 34.4% exhibited high augmentation indices. Ten percent of the control subjects were systolic non-dippers, and 11.7% exhibited high augmentation indices. Nocturnal decreases in systolic blood pressure correlated with central systolic blood pressure and diastolic blood pressure, as well as nocturnal decreases in diastolic blood pressure. Furthermore, non-dipper patients with Behcet's disease exhibited higher nocturnal cardiac outputs than did dipper patients with Behcet's disease. Augmentation index correlated negatively with C-reactive protein and correlated positively with both 24 h and nocturnal peripheral resistance, as well as 24 h pulse wave velocity. The patients with high augmentation indices exhibited lower creatinine clearance, as well as lower nocturnal cardiac outputs, higher 24 h peripheral resistance and higher 24 h pulse wave velocities. Non-dipping status and arterial stiffness may exacerbate the harmful cardiovascular effects of the other. In addition to conventional risk factors, non-dipping status and arterial stiffness should be examined during the follow-up evaluations of patients with Behcet's disease.Öğe Pegylated interferon alfa-2B induced lupus in a patient with chronic hepatitis B virus infection: case report(SPRINGER, 2009) Yilmaz, Sema; Cimen, Kadriye AkarDrug-induced lupus is defined as a lupus-like syndrome temporally related to continuous drug exposure which resolves after discontinuation of the offending drug. Newer biological agents such as interferons (IFN) and anti-tumor necrosis factor-alpha therapies have been involved in the induction of lupus-like syndromes. Prompt recognition and discontinuation of the suspected drug are associated with excellent outcomes in most cases. In this article, we present the case who developed lupus during therapy with pegylated-IFN alpha-2b for chronic hepatitis B virus infection after 8 months.Öğe THE RATE AND CAUSES OF SWITCHING AMONG THE RHEUMATIC PATIENTS UNDER BIOLOGIC THERAPY: FINDINGS FROM TURKISH RHEUMATOLOGY DATABASE-ROMADIGITAL(OXFORD UNIV PRESS, 2011) Karadag, Omer; Yilmaz, Sedat; Kisacik, Bunyamin; Kalyoncu, Umut; Tezcan, Engin; Yilmaz, Sema; Ozgen, Metin[Abstract not Available]Öğe Serum Prohepcidin and Hepcidin Levels in Patients with Ankylosing Spondylitis: A Prospective Study(DERMAN MEDICAL PUBL, 2016) Dagli, Mehmet; Yilmaz, Sema; Sivrikaya, Abdullah; Ozturk, BahadirAim: Anemia is a common complication in patients with inflammatory diseases such as ankylosing spondylitis. Recent data suggest that hepcidin is a major mediator of anemia with a central role in iron homeostasis and metabolism. The aim of this study was to evaluate the serum levels of hepcidin and its prohormone, prohepcidin, in patients with ankylosing spondylitis in comparison with healthy controls. Material and Method: Forty patients with ankylosing spondylitis (13 with anemia and 27 without anemia). 20 healthy adults were prospectively enrolled. Complete blood count, erythrocyte sedimentation rate, serum levels of hepcidin, prohepcidin, iron, total iron binding capacity, ferritin, transferrin, and C-reactive protein were measured. Results: Serum levels of prohepcidin and hepcidin were significantly higher in patients with ankylosing spondylitis compared to healthy controls (p<0.005). Positive correlation was determined between the serum hepcidin and prohepcidin levels in patients with ankylosing spondylitis (r=0.725, p <0.001). Discussion: To the best of our knowledge, this is the first report of serum levels of prohepcidin and hepcidin in the patients with ankylosing spondylitis. Serum levels of prohepcidin and hepcidin are closely associated with disease activity in patients with ankylosing spondylitis and might play a role in the pathogenesis of anemia of chronic disease associated with ankylosing spondylitis.Öğe Serum Prohepcidin and Hepcidin Levels in Patients withAnkylosing Spondylitis: A Prospective Study(2016) Dagli, Mehmet; Yilmaz, Sema; Sivrikaya, Abdullah; Ozturk, BahadirAmaç: Anemi, Ankilozan spondilit (AS) gibi enflamatuar hastalıklarda sık görülen bir komplikasyondur. Son veriler hepsidinin demir homeostaz ve metabolizmasında rol aldığını ve aneminin önemli bir aracısı olduğunu göstermektedir. Bu çalışmanın amacı, AS'li hastalarda ve sağlıklı kontrollerde serum hepsidin ve hepsidinin prohormonu olan prohepsidin düzeylerinin değerlendirilmesidir. Gereç ve Yöntem: Bu çalışmaya, AS'li kırk hasta (13 anemi olan ve 27 anemi olmayan) ile 20 sağlıklı katılımcı prospektif olarak alındı. Tam kan sayımı, eritrosit sedimantasyon hızı, serum hepsidin, prohepsidin, demir, total demir bağlama kapasitesi, ferritin, transferrin, ve C-reaktif protein düzeyleri ölçüldü. Bulgular: Serum prohepsidin ve hepsidin düzeyleri sağlıklı kontrol ile karşılaştırıldığında, AS'li hastalarda anlamlı olarak yüksek (p 0.005) bulundu. AS'li hastalarda, serum hepsidin ve prohepsidin düzeyleri arasında pozitif korelasyon ( 0.725 r, p 0.001) arasında saptandı. Tartışma: Bizim bilgilerimize göre bu çalışma AS'li hastalarda serum prohepsidin ve hepsidin düzeylerinin araştırıldığı ilk çalışmadır. AS'li hastalarda serum prohepsidin ve hepsidin düzeylerinin hastalığın aktivitesi ile yakından ilişkili olabileceği ve AS ile kronik hastalık anemisinin patogenezinde rol oynayabileceği düşünülmektedir.Öğe An uncommon presentation of Sjogren's syndrome and brucellosis(PERGAMON-ELSEVIER SCIENCE LTD, 2014) Celik, Gulperi; Ozturk, Ercument; Ipekci, Suleyman Hilmi; Yilmaz, Sema; Colkesen, Fatih; Baldane, Suleyman; Kebapcilar, LeventWe describe herein a case of hypokalemia due to proximal renal tubular acidosis (RTA) and Fanconi's syndrome (FS) and nephrogenic diabetes insipidus with DIC - a rare complication of Sjogren's syndrome (SS) and brucellosis. The interesting feature of this case was the presentation with severe hypokalemia, causing acute flaccid quadriparesis with cardiac arrest which is extremely rare. The patient was a 48-year-old woman who suffered cardiopulmonary arrest an hour after hospitalization. Analysis of a blood sample obtained before her cardiopulmonary arrest yielded surprising results: laboratory investigations showed profound hypokalemia (1.1 mEq/L) with renal K wasting, hyperchloremic metabolic acidosis with normal anion gap, hypophosphatemia with hypouricemia, glucosuria, and proteinuria. A diagnosis of RTA and FS were made. On the seventh day, she looked acutely ill, temperature 38.8 C and pale, and her physical examination revealed purpuric skin lesions on both legs. The serum antibrucella titration agglutination test was found to be 1 of 160 positive with a nosocomial infection. The clinical and laboratory findings were consistent with disseminated intravascular coagulation (DIC). She was unable to concentrate her urine and so a diagnosis of nephrogenic diabetes insipidus (NDI) was reached. A thorough survey for the cause of FS, RTA and NDI revealed that she had xerophthalmia and xerostomia accompanied by high anti-Ro antibody, positive Schirmer test, confirming the diagnosis of SS. (C) 2014 Elsevier Ltd. All rights reserved.
