The mediator role of treatment response on oral health related quality of life in Behçet's syndrome.

BACKGROUND: The aim of the study was to analyse the effects of Treatment Response with oral ulcers on oral health related quality of life in Behçet's syndrome (BS). MATERIAL AND METHODS: In the cross-sectional study, 339 BS patients (F/M: 179/160, mean age: 36,13±9,81 years) were included. Data were collected by clinical examinations and patient reported outcome measures (PROMs) regarding Oral Health Impact Profile-14 (OHIP-14) questionnaire and self-reported Treatment Responses coded by a 5-point Likert-type scale (1: symptoms were cured- 5: symptoms were worsened). Moderated Mediation analysis (MA) was used to understand how oral ulcer activity (independent variable; X) influenced OHIP-14 score (outcome variables, Y) through self-reported Treatment Response (M1) and age (M2) as possible mediator variables (M) and disease course (mucocutaneous and musculuskeletal involvement vs. major organ involvement) as a possible moderator variable (W) on these relationships. RESULTS: In Moderated MA, OHIP-14 score (Y) was mediated by the presence of oral ulcer (X) (p=0.0000), the negative Treatment Response (M1) (p=0.0001) and being young (M2) (p=0.0053) with mucocutaneous involvement (W)(p=0.0039). CONCLUSIONS: Self-reported Treatment Response as an underestimated issue has a Mediator role in relation to oral ulceration on oral health related quality of life in the framework of patient empowerment strategies. Therefore, study results give clues to assist physicians and dentists for better understanding of patients' perspective.

Endothelial dysfunction, thrombophilia, and nailfold capillaroscopic features in livedoid vasculopathy.

BACKGROUND: Livedoid vasculopathy (LV) is a rare, disabling disease characterized by painful ulcers, livedo reticularis and atrophy blanche. Hypercoagulation, endothelial, and microcirculatory dysfunction are believed to be responsible for the pathogenesis of this difficult-to-treat disease. OBJECTIVES: This study sought to investigate the frequency of endothelial dysfunction, hypercoagulability, and nailfold capillaroscopic features in LV patients to shed light on its etiology. METHODS: This case-control study included 16 patients with LV, 24 with systemic sclerosis (SSc), and 23 control subjects. Serum markers of endothelial dysfunction soluble endoglin, endocan, endothelin-1, lipoprotein a, plasminogen activator inhibitor-1 (PAI-1), soluble thrombomodulin, and von Willebrand factor were measured using enzyme-linked immunosorbent assays. Flow-mediated dilation and carotid intima-media thickness were examined as markers of endothelial dysfunction, and microcirculation was assessed with nailfold capillaroscopy. Thrombophilia-related parameters, including gene polymorphisms of factor V Leiden, prothrombin, PAI-1 genes, methylenetetrahydrofolate reductase (MTHFR) and factor XIII mutation and serum levels of protein C, protein S, antithrombin, homocysteine, D-dimer and antiphospholipid antibodies were investigated in LV patients. RESULTS: Plasminogen activator inhibitor-1 and soluble thrombomodulin levels were significantly higher in LV patients compared to control subjects (2.3 [2.05-2.79] ng/ml vs. 1.89 [1.43-2.33] ng/ml, p = 0.007; 1.15 [0.88-1.4] ng/ml vs. 0.76 [0.56-0.9] ng/ml, p = 0.004, respectively). Flow-mediated dilation was 25.4 % lower in the LV patients compared to the control group (14.77 % [11.26-18.26] vs. 19.80 % [16.47-24.88], p = 0.034). Capillaroscopic features, including ramifications (75 % vs. 8.7 %, p < 0.001), avascular areas (25 % vs. 0 %, p = 0.011) and dilatations (33.2 % vs. 0 %, p = 0.016), were significantly higher in LV patients than in controls. LV patients had multiple biochemical or genetic abnormalities related to thrombophilia, including heterozygous factor V Leiden mutations (6.3 %), MTHFR (C677T) mutations (heterozygous 43.8 %, homozygous 18.8 %), MTHFR (A1298C) mutations (heterozygous 37.5 %, homozygous 12.5 %), factor XIII heterozygous mutation (12.5 %), antithrombin deficiency (31.3 %), protein S deficiency (12.5 %), hyperhomocysteinemia (31.3 %), D-dimer elevation (25 %), anti-ß2-glycoprotein I (12.5 %), lupus anticoagulant antibodies (6.3 %), and anticardiolipin antibodies (6.3 %). CONCLUSIONS: In conclusion, LV patients were characterized by an increased presence of thrombophilia-related parameters, and also exhibited vascular endothelial and microcirculatory dysfunction, resembling SSc. These findings support the complex interaction of thrombophilia, endothelial dysfunction, and microcirculation dysregulation in the pathogenesis of LV. Thus, the treatment of LV patients should be individualized, based on the identification of the predominant pathological pathways.

The prevalence and clinical importance of incidental soft-tissue findings in cervical CT scans of trauma population.

OBJECTIVES: To define the age-related prevalence of incidental soft-tissue findings in cervical CT scans of a trauma population and to investigate their clinical importance. METHODS: The original diagnostic radiology reports and the CT images of the 357 patients with cervical trauma were retrospectively evaluated. Incidental soft-tissue findings were investigated. All findings were grouped according to age. The findings were classified based on their clinical importance into three categories: Category 1: no clinical importance, Category 2: possible clinical importance requiring further investigation and Category 3: obvious clinical importance. In addition, the medical records of the patients were investigated. The follow-up ratio of the pathologies mentioned in the original radiology report was recorded. RESULTS: The most frequently encountered findings in Categories 2 and 3 were carotid artery calcification (n = 89, 24.9%) and tonsillolith (n = 115, 32.2%), respectively. The reporting ratio in the original reports of Categories 1, 2 and 3 findings was 1.1% (n = 4), 9% (n = 27) and 34.5% (n = 64), respectively. No further investigations and follow-up was accomplished for Category 1 lesions, whereas 11.1% of Category 2 and 35.9% of Category 3 lesions were subjected to further investigations and follow-up. CONCLUSIONS: The cervical CT scans of trauma patients reveal many clinically important soft-tissue incidental findings. Cervical region incidental findings may be followed up on an outpatient basis, rarely being of life-threatening value. The ratio of reporting and follow-up of incidental findings increases parallel to the clinical importance of the lesions.

Isotretinoin has no negative effect on attention, executive function and mood.

BACKGROUND: According to some animal data, impairments in learning and memory are seen with isotretinoin. Isotretinoin has been shown to affect human brain metabolism, but the data on human neural functions is lacking. OBJECTIVES: To evaluate whether isotretinoin treatment affects cognitive functions, causes depression and anxiety or alters anger level and anger expression. METHODS: Neuropsychological tests of attention and executive functions, behavioural tests measuring anger and depression and measures assessing acne severity were applied to 63 severe and/or resistant acne patients from four medical centres including one primary care institute and three university hospitals at the beginning, at the end of first month, third month and at end of treatment with isotretinoin. RESULTS: From a total of 63 patients, 15 missed the final visit and 48 were evaluated. Overall, 11 (six women, five men) and five (all women) patients reported anger and depression, respectively, during treatment. Eleven of these 16 patients improved spontaneously. No detrimental effects of isotretinoin treatment on either executive functions or mood were found. Several executive functions and control of anger trait were found to be improved. Clearing of acne was obtained in 94.6% of patients. LIMITATIONS: Improvement of several measures may be related to learning effect of repeated testing. Investigating brain functions is a complex process and various methods can be used. CONCLUSION: The test battery used in this study, which is commonly used to evaluate mental status both in adults and children, did not show any negative effect of isotretinoin on executive functional parameters in acne patients.

Stage III xanthogranulomatous pyelonephritis treated with antibiotherapy and percutaneous drainage.

Xanthogranulomatous pyelonephritis (XPN) is a rare inflammatory condition usually secondary to chronic obstruction caused by nephrolithiasis and resulting in infection and irreversible destruction of the renal parenchyma. Its standard therapy consists of total or partial nephrectomy. A case of stage III xanthogranulomatous pyelonephritis treated with antibiotherapy and percutaneous drainage is presented in this paper.

Two- and three-dimensional reformatted computed tomography imaging analysis of the lumbosacropelvic structure in degenerative anterolisthesis.

AIM: To evaluate the differences in the lumbosacropelvic structure between normal individuals and those with pseudospondylolisthesis. MATERIALS AND METHODS: The renal stone protocol abdominal CT images of 452 patients were retrospectively analysed. Twenty individuals who had degenerative anterolisthesis at the L5-S1 level were included in the study. Moreover, a control group of individuals was formed, similar in age and gender to the study group. A number of linear and angular lumbosacral morphological parameters were evaluated using two- and three-dimensionally reformatted CT images. The data of the two groups were compared using the t-test and Mann-Whitney U-test. RESULTS: There was an association between spondylolisthesis and decreased thickness of the transverse process (p=0.01), the height of the iliac crest (p=0.028), lumbar angle (p=0.041), sacral table angle (p=0.033), sacral table index (p=0.0001), sacral kyphosis (p=0.025), sacral slope (p=0.007), and width of the transverse process (p=0.038), and increased transverse articular dimension of the facet joint (p=0.003), axial angle of the facet joint (p=0.002), sagittal angle of the facet joint (p=0.012), S1 vertebra interfacet index (p=0.003), the distance between the L5 vertebral transverse process and the iliac crest (p=0.003), pelvic incidence (p=0.016), L5 vertebra posterior angle (p=0.001), and intersacroiliac joint angle (p=0.024). CONCLUSION: The lumbosacropelvic morphology in patients with degenerative spondylolisthesis is quite different from that of normal individuals. These abnormalities should be revealed using imaging methods as they can be defining for pseudospondylolisthesis development and have important effects on therapy planning.

CT and MRI in the evaluation of extraspinal sciatica.

Sciatica is the most frequently encountered symptom in neurosurgical practice and is observed in 40% of adults at some point in their lives. It is described as pain of the hip and the lower extremity secondary to pathologies affecting the sciatic nerve within its intraspinal or extraspinal course. The most frequent cause is a herniating lumbar disc pressing on the neural roots. Extraspinal causes of sciatic pain are usually overlooked because they are extremely rare and due to intraspinal causes (lumbar spinal stenosis, facet joint osteoarthritis, fracture, and tumors of the spinal cord and spinal column) being the main consideration. Early diagnosis of sciatica significantly improves the likelihood of relieving symptoms, as well as avoiding any additional neurologic injury and unnecessary surgery. We evaluate histolopathologically confirmed extraspinal causes of sciatica cases, accompanied by their presented computed tomography and/or magnetic resonance imaging findings.

A dermoid cyst of the round ligament clinically misdiagnosed as incarcerated inguinal hernia.

We present a case of a dermoid cyst located in the round ligament in a patient with a preliminary diagnosis of inguinal hernia. The dermoid cyst was diagnosed based on MRI findings and confirmed histopathologically. Dermoid cyst (mature teratoma) is a congenital cystic tumour formed by the well-developed (mature) tissues of at least two of the three germinal layers. It is mainly encountered in the gonads. Location within the round ligament is quite rare. Due to the anatomical localization of the round ligament, dermoid cysts within it or other inguinal canal masses are usually misdiagnosed as inguinal hernia. However, when an inguinal canal mass is encountered, despite the higher hernia frequency, a proper suspicion and investigation with regard to masses in this area could be extremely important in preventing intraoperative surprises.

Association of salivary S. mutans colonisation and mannose-binding lectin deficiency with gender in Behçet's disease.

OBJECTIVE: The present study aimed to investigate the interactions among salivary S. mutans colonisation, serum mannose binding lectin level (MBL), oral ulcer activity and disease course in patients with Behçet's disease (BD). METHODS: One hundred and six BD patients, 25 patients with rheumatoid arthritis (RA) and 42 healthy controls (HC) were included in the study. BD patients were grouped as active (n=52) or inactive (n=54) according to oral ulcer status of the previous 3 months. Salivary colonisation of S. mutans levels were investigated by standard Caries Risk Test (CRT) Bacteria kits (Ivoclar, Vivadent). S. mutans colonies were categorized as high (> or =10(5) colony forming unit (CFU)/ml of saliva) or low (10(5)CFU/ml). Serum mannose binding lectin (MBL) levels were measured by ELISA. RESULTS: High levels of salivary S. mutans colonisation was significantly more present in BD (50%) than HC (28.6%)(p=0.039), whereas no significant difference was observed between RA and other groups (p>0.05). S. mutans presence in saliva was associated with oral ulcers (61.5% in patients with active oral ulcers vs 38.9% in inactives) (p=0.020). S. mutans colonisation in saliva was significantly higher among male BD patients with a severe disease course than a milder disease (p=0.04). Increased salivary S. mutans colonisation was also related to very low serum MBL (<100 ng/ml) in BD compared to controls (p=0.04). CONCLUSION: The relationship between increased presence of S. mutans and MBL deficiency with active disease pattern may indicate an impaired innate immune response in BD patients which may predispose to oral infections and a severe disease course.

Assessment of minimal clinically important improvement by using Oral Health Impact Profile-14 in Behçet's disease.

OBJECTIVE: The aim of this prospective study was to detect minimal clinically important improvement (MCII) of oral health impact profile-14 (OHIP-14) for assessing the effect of treatments for oral ulcers in Behçet's disease (BD). METHODS: BD patients with active oral ulcers (F/M:36/22) were selected. Baseline and follow-up data were collected by clinical examinations and questionnaires. Patients rated their global impression of change (PGIC) measured by a transitional question. MCII was defined as the difference in mean change from baseline in OHIP-14 between patients with no response to therapy and patients with next higher level of response. RESULTS: Approximately one third (29.3 %) of the patients expressed an improvement during control examinations. A significant correlation was observed between raw change in OHIP-14 score and change in number of oral ulcers (r=0.69 p=0.017). Inactive patients increased from 44.1% in baseline to 58.8% in follow-up examination. A trend towards decreased number of oral ulcers was observed in follow-up (0.64+/-0.93) compared to baseline (1.44+/-1.92) in the improved group (p=0.096). According to regression analysis, PGIC was a significant predictor of change in raw OHIP-14 score. The threshold levels generated from the ROC analyses in OHIP-14 score best associated with clinically important improvement were -3.5 points (sensitivity: 80%, specificity: 88.6%) and -38.1% (sensitivity: 86.7%, specificity: 97.1%) respectively. CONCLUSION: Changes in OHIP-14 scores seem to be a sensitive and valuable tool for the determination of MCII during follow-up of Behçet's disease patients for oral disease assessment.

A composite index for determining the impact of oral ulcer activity in Behcet's disease and recurrent aphthous stomatitis.

BACKGROUND: Although number, frequency and healing time of oral ulcers and pain are generally used for clinical practice and studies in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS), no standardized activity index is currently present to monitor clinical manifestations associated with oral ulcers. The aim of this study was to develop a standardized composite index (CI) to assess oral ulcer activity in BD and RAS. METHODS: In this cross-sectional study, 121 patients with BD and 45 patients with RAS were included. Sixty-five percentage of BD and 68.9% of RAS patients were in active stage during the previous 3 months. The developed CI included the presence of oral ulcers, ulcer-related pain and functional status and was evaluated in patients with both active and inactive disease for content validity. RESULTS: Composite index score was observed to be higher in active patients with RAS (6.94 + or - 2.19) compared with active BD patients (6.01 + or - 2.04) (P = 0.04). The number of oral ulcers and healing time of oral ulcers were significantly higher in RAS compared with BD (P = 0.018, P = 0.001 respectively). CI score correlated with the number of oral ulcers in both BD and RAS (P = 0.000, P = 0.002 respectively). CI score was '0' for inactive patients without oral ulcer in BD and RAS. CONCLUSIONS: The presented CI as an oral ulcer activity index seems to be a reliable and suitable tool for evaluating the clinical impact and disease-specific problems in BD and RAS.

Oral health and related quality of life status in patients from UK and Turkey: a comparative study in Behcet's disease.

BACKGROUND: The aim of this study was to evaluate and compare oral health-related quality of life (oral QoL) in patients from UK and Turkey with Behcet's disease (BD). METHODS: Thirty-one BD patients from UK (F/M: 18/13, mean age: 41.8 +/- 11.5 years) and Turkey (F/M: 18/13, mean age: 41.5 +/- 10.3) who were matched according to age and gender were included in the study. All patients had active oral ulcers. Oral QoL was assessed by Oral Health Impact Profile-14 (OHIP-14). Oral health was evaluated by dental and periodontal indices. RESULTS: No significant difference was found in OHIP-14 scores between patients from UK (22.7 +/- 14.4) and Turkey (20.4 +/- 14.3) (P = 0.709). The OHIP-14 score correlated with the healing time of oral ulcers in UK (r = 0.4, P = 0.04) and the number of oral ulcers in Turkey (r = 0.4, P = 0.012). The number of oral ulcers per month was significantly higher in UK (3.3 +/- 2.8) compared with that in Turkey (1.5 +/- 2.5) (P = 0.014). However, the number of filled teeth and frequency of tooth brushing were significantly lower in patients from Turkey compared with those in UK (P = 0.000). Similarly, the duration since the last dental visit (5.1 +/- 7.2 months) was significantly lower in UK compared with that in Turkey (28.6 +/- 23.7 months) (P = 0.000). CONCLUSIONS: Oral QoL was similar in patients from UK and Turkey with active oral ulcers. However, the number of oral ulcers was observed to be higher in UK. As expected, a lower utilization rate of dental services might have led to a poorer oral health in patients from Turkey.

Serum levels of free heat shock protein 70 and anti-HSP70 are elevated in Behçet's disease.

OBJECTIVES: As heat shock proteins (HSPs) are described as candidate self-antigens in Behçet's disease (BD), free HSP70 and anti-HSP70 levels were measured in the sera of patients to investigate their role in the pathogenesis of BD. METHODS: Free human HSP70 levels were measured in the sera of patients with BD and compared to disease controls [patients with rheumatoid arthritis (RA) or recurrent oral ulcerations (ROU)] and healthy controls (HC) using ELISA. Anti-HSP70 antibody levels were also determined. RESULTS: Free human HSP70 levels were significantly elevated in BD sera (1.12+/-0.86 ng/ml) compared to HC (0.67+/-0.46 ng/ml, BD vs. HC: p<0.001). However similarly elevated levels were also present in ROU (0.95+/-1.01 ng/ml, p<0.05) and RA (1.1+/-23.3 ng/ml, p<0.01). Anti-HSP70 antibody levels were also significantly higher in BD (668+/-658 microg/ml) compared to HC (490+/-742.05 microg/ml, p<0.05). However no significant anti-HSP70 antibody responses were observed in ROU (634.7+/-548.21 microg/ml) and RA (431.8+/-840.98 microg/ml). No association of any organ manifestation, the disease duration, or treatment with HSP70 or anti-HSP70 antibody levels were observed in BD. A correlation between HSP70 and anti-HSP70 levels was only found in HC (p=0.007). CONCLUSION: Free human HSP70 and anti-HSP70 antibodies are both elevated in patients with BD. HSP70-mediated innate and adaptive immune responses may participate in proinflammatory cytokine activation and tissue destruction in BD.

Serum leptin levels, skin leptin and leptin receptor expression in psoriasis.

BACKGROUND: Recent studies support the relation of psoriasis with obesity and cardiovascular disease. Leptin, a peptide hormone secreted predominantly from adipose tissue, is involved in the regulation of energy intake and expenditure. Recently, it has been shown to have several immunological effects including induction of proinflammatory cytokine production. OBJECTIVES: To investigate the possible role of leptin in psoriasis pathogenesis. METHODS: Forty-three patients with psoriasis, 10 diseased and 10 healthy controls with normal body mass index were included. Serum fasting leptin levels of the study group were examined by enzyme-linked immunosorbent assay. Tissue leptin and leptin receptor expression of both patients and controls were investigated by immunohistochemistry. RESULTS: Serum leptin levels, tissue leptin and leptin receptor expression were significantly higher in patients with severe psoriasis than patients with mild-moderate psoriasis and controls (P < 0.05). Serum leptin levels showed a positive correlation with Psoriasis Area and Severity Index and involved body surface area in patients with psoriasis. In addition, serum leptin levels, tissue leptin and leptin receptor expression showed a positive correlation with disease duration in patients with psoriasis (P < 0.01, r = 0.979; P < 0.01, r = 0.691; P < 0.01, r = 0.428, respectively). CONCLUSIONS: We assume that leptin might serve as a marker of severity in psoriasis and also may be a pathogenetic cofactor contributing to chronicity of the disease. Consequently, its role in obesity and cardiovascular disease in patients with psoriasis deserves to be studied. In addition, drugs targeting the proinflammatory effects of leptin may be a new adjuvant therapeutic approach in psoriasis.

Thorax CT findings in symptomatic hemodialysis patients.

The goal of the present study was to discuss thoracic problems in symptomatic hemodialysis patients based on the CT findings among 64 uremic patients including 34 females and 30 males of age range 14 to 83 years (mean = 61 years). We retrospectively documented complaints of cough, dyspnea, low-grade pyrexia, malaise, and weight loss. Atelectasis (79.7%), cardiomegaly (59.3%), parenchymal fibrosis-scar (50%), pleural effusion (45.3%), and ground-glass opacity (45.3%) were the most common findings. Pulmonary artery caliber was greater than 32 mm in 19 (29.7%) patients. Staphylococcus aureus (26.6%) and Mycobacterium tuberculosis (13.3%) were the most common infectious agents in patients who had parenchymal infiltrations, respectively. Chronic renal failure patients may display many thoracic and extrathoracic complications. The radiologic findings in these patients were multiple and complex, but, in most of cases, imaging techniques (predominantly CT) offered an accurate, noninvasive diagnostic approach.

Thalidomide has both anti-inflammatory and regulatory effects in Behcet's disease.

Thalidomide is shown to be an effective treatment for mucocutaneous symptoms of Behcet's disease (BD). In this study, the effects of thalidomide on peripheral blood mononuclear cells were investigated ex vivo. In an open prospective study, ten patients were given 200 mg/day thalidomide for 12 weeks and cluster of differentiation 4 (CD4), CD8, CD11a, CD11b, CD16, CD18, CD28, CD44, CD45RO, CD45RA, CD56, CD120a and gammadelta+ T cells were analysed with flow cytometry at 0, 3, 7, 30 and 90 days. Two patients were excluded from the analysis for attacks of uveitis within the first 2 weeks. At day 7, tumour necrosis factor-alpha (TNF-alpha) receptor+ (CD120a; 12% vs 5%), CD8/CD11b+ (12% vs 6%) and CD16/CD56+ (16% vs 9%) cells decreased in BD patients compared to day 0. On the other hand, CD4+CD45RO+ T cells (24% vs 34%) at day 30 and gammadelta+ T cells (11% vs 21%) at day 90 increased after treatment. These results suggest that thalidomide tends to decrease TNF-alpha receptor levels, CD8/CD11b+ T cells and natural killer cells in early treatment and increases CD4+CD45RO+ memory T and gammadelta+ T cells later in BD.