Interleukin-2 gene polymorphism in Turkish patients with Behçet's disease and its association with ocular involvement.

Behçet's disease (BD) is a chronic immune-mediated systemic disease, characterized by oral and genital lesions and ocular inflammation. Several cytokine genes may play crucial roles in host susceptibility to BD, because the cytokine production capacity varies among individuals and depends on the cytokine gene polymorphisms. The association of the interleukin (IL)-2 gene polymorphisms with the susceptibility to BD was investigated in this study. DNA samples were obtained from a Turkish population of 97 patients with BD and 76 healthy control subjects. Polymorphisms of IL-2 gene at position -330 and +166 were determined using the polymerase chain reaction with sequence-specific primers. In the patients with BD, there was a significantly increased frequency of IL-2 -330 GT genotype. Interestingly, we demonstrated that the frequencies of IL-2 -330 GT and IL-2 + 166 GG genotypes were increased in BD patients with ocular involvement, whilst IL-2 -330 TT genotype was significantly decreased. Also, analysis of allele frequency demonstrated that the presence of G allele at position +166 of IL-2 seems to be a risk factor for ocular involvement. These results reveal that IL-2 -330 GT genotype may be a susceptibility factor for BD, whereas IL-2 -330 TT genotype seems to display a protective association with BD. Additionally, IL-2 gene polymorphisms might be associated with ocular involvement in BD.

Translation and validation of the Turkish version of the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire.

The Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire is a disease-specific measure of needs-based quality of life developed in the UK and the Netherlands. This study describes translation, validation, and reliability of the scale into Turkish population. The ASQoL was translated into Turkish using the dual-panel process. Content validity was assessed via cognitive debriefing interviews with ankylosing spondylitis (AS) patients. Patients with AS according to modified New York criteria were recruited into the study from 12 hospitals of all part of Turkey. Psychometric and scaling properties were assessed via a two administration survey involving the ASQoL, the Nottingham Health Profile (NHP), Bath AS Functional Index (BASFI), and Bath AS Disease Activity Index (BASDAI). Classical psychometrics assessed reliability, convergent validity (correlation of ASQoL with NHP, BASFI, and BASDAI) and discriminative validity (correlation of ASQoL with perceived AS-severity and general health). Cognitive debriefing showed the new Turkish ASQoL to be clear, relevant, and comprehensive. Completed survey questionnaires were received from 277 AS patients (80% Male, mean age 42.2/SD 11.6, mean AS duration 9.4 years/SD 9.4). Test-retest reliability was excellent (0.96), indicating low random measurement error for the scale. Correlations of ASQoL with NHP sections were low to moderate (NHP Sleep 0.34; NHP Emotional Reactions 0.83) suggesting the measures assess related but distinct constructs. The measure was able to discriminate between patients based on their perceived disease severity (p < 0.0001) and self-reported general health (p < 0.0001). The Turkish version of ASQoL has good reliability and validity properties. It is practical and useful scale to assess the quality of life in AS patients in Turkish population.

Effect of Pilates training on people with ankylosing spondylitis.

The objective of this study was to investigate the effects of Pilates on pain, functional status, and quality of life in patients with ankylosing spondylitis. The study was performed as a randomized, prospective, controlled, and single-blind trial. Fifty-five participants (30 men, 25 women) who were under a regular follow-up protocol in our Rheumatology Clinic with the diagnosis of AS according to the modified New York criteria were included in the study. The participants were randomly assigned into two groups: in group I, Pilates exercise program of 1 h was given by a certified trainer to 30 participants 3 times a week for 12 weeks, and in group II, designed as the control group, 25 participants continued previous standard treatment programs. In groups, pre-(week 0) and post treatment (week 12 and week 24) evaluation was performed by one of the authors who was blind to the group allocation. Primary outcome measure was functional capacity. Evaluation was done using the Bath Ankylosing Spondylitis Functional Index (BASFI). Exploratory outcome measures were Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Chest expansion, and ankylosing spondylitis quality of life (ASQOL) questionnaire. In group I, BASFI showed significant improvement at week 12 (P = 0.031) and week 24 (P = 0.007). In group II, this parameter was not found to have significantly changed at week 12 and week 24. Comparison of the groups showed significantly superior results for group I at week 24 (P = 0.023). We suggest Pilates exercises as an effective and safe method to improve physical capacity in AS patients. Our study is the first clinical study designed to investigate the role of Pilates method in AS treatment. We believe that further research with more participants and longer follow-up periods could help assess the therapeutic value of this popular physical exercise method in AS.

Interleukin-4 gene polymorphisms confer Behçet's disease in Turkish population.

Several cytokine genes may play crucial roles in host susceptibility to Behçet's Disease (BD), because the cytokine production capacity varies among individuals and depends on the cytokine gene polymorphisms. The association of the IL-4 and IL-4Rα gene polymorphisms with the susceptibility to BD was investigated in this study. DNA samples were obtained from a Turkish population of 97 patients with BD and 76 healthy control subjects. All genotyping (IL-4 and IL-4Rα) experiments were performed using PCR sequence-specific primers. When compared with the healthy controls, the frequency of IL-4 -1098 TG and -590 CT genotypes was higher in the patients with BD. Analysis of allele frequencies showed that IL-4 -1098 G and IL-4 -590 T alleles were more common in the patients with BD when compared with healthy controls. Also, IL-4 TTC and haplotypes were found to confer BD. Interestingly, we demonstrated that IL-4Rα gene polymorphism seems to be associated with the Pathergy test positivity in patients with BD. Our data suggest that IL-4 gene promoter polymorphisms may affect susceptibility to BD and increase risk of developing the disease. However, in order to confirm and assess the association of IL-4 and IL-4Rα gene polymorphisms with the BD, large cohort studies are needed.

IL-1 cluster gene polymorphisms in Turkish patients with Behçet's disease.

Several cytokine genes may play crucial roles in host susceptibility to Behçet's Disease (BD), since the cytokine production capacity varies among individuals and depends on the cytokine gene polymorphisms. The association of the IL-1 cluster gene polymorphisms with the development of BD was investigated in this study. DNA samples were obtained from a Turkish population of 97 patients with BD, and 77 healthy control subjects. All genotyping (IL-1α, IL-1ß, IL-1R and IL-1Ra) experiments were performed using sequence specific primers PCR (PCR-SSP). When compared to the healthy controls, the frequencies of IL-1Ra IL-1α and IL-1R gene polymorphisms were not significantly different in BD patients. The frequency of IL-1ß-511 TT genotype was higher in the BD group in comparison to the control group. Interestingly, we demonstrated that IL-1 ß +3962 gene polymorphism seems to be associated with the presence of Erythema nodosum in BD patients. Our data suggest that polymorphisms in IL-1ß gene may affect host susceptibility to BD. In order to confirm the biological significance of our results, further studies should be performed in a large-scale study and/or in different ethnic groups.

Cytokine gene polymorphisms in Behçet's disease and their association with clinical and laboratory findings.

The association of the cytokine gene polymorphisms with the development of Behçet's Disease (BD) was investigated in this study. DNA samples were obtained from a Turkish population of 97 unrelated patients with BD, and 127 unrelated healthy control subjects.All genotyping (IL-6, IL10, IFN-gamma, TGF-Beta1 and TNF-alpha) experiments were performed using sequence-specific primers PCR. The frequency of TGF-Beta1 codon 25 GG genotype was found significantly lower in BD patients compared to healthy control subjects. The IL-10 -1082 GA genotype was more frequent whereas the AA genotype was less common in the BD group compared to the control group. The association between clinial findings and cytokine gene polymorphisms was further investigated in the patients with BD. The frequency of IFN-gamma AA genotype was lower in the patients with genital ulcer. Additionally, it was found that the frequency of IL-6 -174 GG genotype was lower in the patients with Pathergy positivity. These results suggest that TGF-Beta1 and IL-10 gene polymorphisms may affect host susceptibility to BD. Also, to confirm the biological significance of our results, further studies should be performed on other population groups and in large number of cases.

Arterial elasticity measurement in renal transplant recipients.

Arterial distensibility is reduced in chronic kidney disease (CKD) and after kidney transplantation. Pulse counter analysis provides an assessment of compliance or elasticity of the large conduit arteries (C1) and small arteries (C2). Decreased compliance has been shown to be predictive of primary coronary events in CKD patients. The aim of the present study was to compare elasticity measurements in hemodialysis (HD) patients, renal transplant recipients (RTR), and healthy subjects whose coronary angiographies were without lesion. Twenty-three RTRs, 18 HD patients, and 20 healthy subjects were included in the study. Pulse wave analysis was used to determine large and small vessel compliances. The C1 and C2 levels were significantly lower in HD patients compared with recipients and healthy subjects. Recipients showed lower C2 level compared with healthy subjects. There was no difference in C1 and C2 measurements between recipients receiving tacrolimus versus cyclosporine. Transplantation improves large and to some extend small artery elasticities in CKD patients.

A modified yoga-based exercise program in hemodialysis patients: a randomized controlled study.

AIM: To evaluate the effects of a yoga-based exercise program on pain, fatigue, sleep disturbance, and biochemical markers in hemodialysis patients. MATERIALS AND METHODS: In 2004 a randomized controlled trial was carried out in the outpatient hemodialysis unit of the Nephrology Department, Uludag University Faculty of Medicine. Clinically stable hemodialysis patients (n=37) were included and followed in two groups: the modified yoga-based exercise group (n=19) and the control group (n=18). Yoga-based exercises were done in groups for 30 min/day twice a week for 3 months. All of the patients in the yoga and control groups were given an active range of motion exercises to do for 10 min at home. The main outcome measures were pain intensity (measured by the visual analogue scale, VAS), fatigue (VAS), sleep disturbance (VAS), and grip strength (mmHg); biochemical variables-- urea, creatinine, calcium, alkaline phosphatase, phosphorus, cholesterol, HDL-cholesterol, triglyceride, erythrocyte, hematocrit--were evaluated. RESULTS: After a 12-week intervention, significant improvements were seen in the variables: pain -37%, fatigue -55%, sleep disturbance -25%, grip strength +15%, urea -29%, creatinine -14%, alkaline phosphatase -15%, cholesterol -15%, erythrocyte +11%, and hematocrit count +13%; no side-effects were seen. Improvement of the variables in the yoga-based exercise program was found to be superior to that in the control group for all the variables except calcium, phosphorus, HDL-cholesterol and triglyceride levels. CONCLUSION: A simplified yoga-based rehabilitation program is a complementary, safe and effective clinical treatment modality in patients with end-stage renal disease.

Laser acupuncture in knee osteoarthritis: a double-blind, randomized controlled study.

OBJECTIVE: The purpose of this study was to investigate the effects and minimum effective dose of laser acupuncture in knee osteoarthritis (KOA), and to determine if it is superior to placebo treatment (sham) in the evaluation of clinical-functional outcome and quality of life. METHODS: In this randomized, placebo-controlled study, patients with grade 2 and 3 primary KOA were selected. Group I (n = 27) received 904-nm low-level laser irradiation with 10 mW/cm(2) power density, 4 mW output power, 0.4 cm(2) spot size, 0.48 J dose per session, and 120-sec treatment time on the medial side of the knee to the acupuncture point Sp9. Group II (n = 25) received placebo-laser therapy at the same place on the same point. Patients in both of the groups had treatment 5 days per week (total duration of therapy was 10 days) and 20 min per day. The study was comprised of a 2-week (10-session) intervention. Participants were evaluated before treatment (baseline), after treatment (2nd week), and at the 12th week. In this double-blind study, a blind examiner carried out all outcome assessments. The main outcome measures were as follows: pain on movement (pVAS), 50-foot walking time (50 foot w), knee circumference (KC), medial tenderness score (MTS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and Nottingham Health Profile (NHP). RESULTS: Statistically significant improvement was observed in PVAS, 50 foot w, and KC in group 1. In Group II, statistically significant improvement was observed in PVAS, 50 foot w, and WOMAC. When groups were compared with each other, the improvement observed in KC was superior in Group I at the 2(nd) week (p = 0.005). CONCLUSION: Laser acupuncture was found to be effective only in reducing periarticular swelling when compared with placebo laser.

To evaluate the differences of risk factors in patients with lower extremity venous disease.

OBJECTIVE: To determine whether there is a difference between risk factors in patients diagnosed to have clinically documented lower extremity venous disease after confirming the diagnosis radiologically by ultrasonographic and venographic evaluation. METHODS: This study was performed from January 2002 to January 2005 in Bursa, the fourth biggest city of Turkey, situated in the west of the country in the Marmara Region. The study center is a private imaging center working in conjunction with the Department of Health, which performs diagnostic, and therapeutic vascular protocols in the region. Five hundred and fifty-three cases with clinically and radiologically documented diagnoses were evaluated with Multi-Variate Statistical Package 3.13 for the presence of pre-defined clusters of 14 different variables. Other statistical analyses were performed by the Statistical Package for Social Sciences, version 13.0. RESULTS: Three different clusters were defined. The variables used to define the clusters were: age, gender, educational level, presence of smoking, amount of smoking (pack/per year), disease symptoms, presence of heart disease, and radiologically documented diagnosis. CONCLUSION: Chronic venous insufficiency and varicose veins are venous system diseases that are most commonly present in association with more than one concomitant risk factor.

Efficacy of sildenafil in male dialysis patients with erectile dysfunction unresponsive to erythropoietin and/or testosterone treatments.

The aim of this study was to evaluate the effects of recombinant human erythropoietin (Epo), testosterone (T) or a combination of them in the treatment of erectile dysfunction (ED) in hemodialysis patients, as well as the efficacy of sildenafil in patients unresponsive to combination treatment. A total of 23 patients with ED were divided into two groups. The international index of erectile function (IIEF) was used to evaluate ED and treatment response. Patients received Epo or T treatments for 12 weeks. Later on both groups received combination treatment for another 12 weeks. Although IIEF scores increased significantly in both groups after the combination treatment, the score changes were similar. After combination treatment, 16 patients still having IIEF score <26 were given sildenafil treatment in combination with Epo while T was discontinued. Although the IIEF scores increased significantly in all patients (17.4%), only eight of them attained an IIEF score of > or =26. The baseline IIEF scores of the patients with satisfactory response to the sildenafil treatment were higher than those with unsatisfactory response. The patients with a score of > or =22 responded better to the treatment. Although Epo and/or T therapies could partially improve ED in male dialysis patients besides correcting renal anemia and hypogonadism, sildenafil treatment could improve ED in unresponsive patients. Especially, those with higher baseline IIEF scores benefited more.

Tissue Doppler echocardiography and myocardial performance index in patients with scleroderma.

In this study, left and right ventricular functions were examined echocardiographically in 22 patients with scleroderma and 22 healthy volunteers. Conventional and tissue Doppler echocardiography and myocardial performance indexes were used as measures of right and left ventricular global functions. Mitral early diastolic E wave deceleration time, isovolumetric contraction time and left ventricular myocardial performance index and peak tricuspid A wave velocity were significantly higher in the scleroderma group compared with the control group. Mitral and tricuspid E/A ratios were significantly lower in patients with scleroderma. In addition, mitral annular and tricuspid annular isovolumetric relaxation times and the tricuspid E/E' ratio were significantly increased in scleroderma patients compared with the control group. In conclusion, in scleroderma patients the global left ventricular functions were depressed and diastolic function abnormalities were seen in both right and left ventricles. In addition, longitudinal muscle functions of the ventricles were depressed in scleroderma patients, as shown by tissue Doppler imaging parameters.

The effect of vitamin E therapy on plasma and erythrocyte lipid peroxidation in chronic hemodialysis patients.

The effect of vitamin E therapy on plasma and erythrocyte (RBC) lipid peroxidation was investigated in patients undergoing chronic hemodialysis. Before vitamin E therapy, both plasma and RBC lipid peroxidation values of chronic hemodialysis patients were significantly higher than those of healthy controls. Treatment with vitamin E (300 mg/day) for 1 month resulted in a significant decrease of lipid peroxidation. Vitamin E therapy may be a promising approach to prevent peroxidation of membrane lipids in chronic renal failure.

A renal transplant recipient with pulmonary tuberculosis and visceral leishmaniasis: review of superimposed infections and therapy approaches.

Visceral leishmaniasis (VL) is an acute or subacute disease that is almost invariably fatal if untreated. It is a rare disease in renal transplant recipients and frequently reported together with other infectious agents. A 39-year-old renal transplant patient was admitted to hospital for elective coronary surgery. In the post-operative period, he developed spiking fever and non-productive cough and his general condition deteriorated. While he was taking medication for non-specific pneumonia, a cavitary lesion occurred in his lung, and he had the diagnosis of pulmonary tuberculosis and antituberculous treatment was started. Despite treatment, his fever continued. As the patient developed pancytopenia and splenomegaly, a bone marrow aspiration was done. Evaluation of bone marrow aspirate indicated Leishmania parasites. He was successfully treated with a more intensive liposomal amphotericin (L-AmB). Complete cure was achieved during follow-up period of 10 months without clinical relapse. In the existence of fever and long-standing pancytopenia, VL should be suspected although the patient had another proved infection and did not live or visit an endemic area. L-AmB usage can be safely preferred for treatment of selected renal transplant recipients with VL as first-line therapy.

Survival analysis of the factors affecting in mortality in injured patients requiring dialysis due to acute renal failure during the Marmara earthquake: survivors vs non-survivors.

BACKGROUND: We reviewed medical records of dialyzed patients admitted to our hospital after the Marmara earthquake and evaluated the factors affecting mortality in survivors and non-survivors according to the survival times. PATIENTS AND METHODS: Crush syndrome (CS) was diagnosed in 110 patients. Dialysis treatment was initiated in 60 patients; 21 of all died. The patients were divided into 2 groups which consisted of 39 survivors (Group A, 25 male, 14 female, mean age: 31 +/- 2.2 years) and 21 non-survivors (Group B, 9 male, 12 female, mean age: 27 +/- 3.0 years). Victims treated by any form of renal replacement therapy, including daily or intermittant hemodialysis and/or continuous venovenous hemodiafiltration. Clinical and laboratory findings were recorded regularly. Statistical analysis was performed with Kaplan-Meier method, log rank test and Cox regression analysis for the survival functions. RESULTS: APACHE II scores were 13.5 +/- 0.5 for Group A and 13 +/- 0.9 for Group B. Dialysis support was started to patients in Group A in a mean period of 2.8 +/- 0.2 days and in Group B in a mean period of 3.7 +/- 0.6 days after the earthquake (p > 0.05). The most frequent site of trauma was lower extremity (61.5%) and upper + lower extremities (23%) in Group A, and lower extremity (38.1%) and trunk + lower extremity (23.8%) in Group B. The frequencies of abdominal trauma, pelvic fracture and thoracic trauma in Group B were 23.8%, 19% and 14.2%, respectively. Multiple trauma was more frequent in Group B than in Group A (42.8% vs 2.5%). The rates of fasciotomy, amputation and surgery were similar in both groups. The frequency of sepsis was higher in non-survivors. In our center, the overall mortality rate was 8%, mortality rate in CS was 21% and in dialyzed patients it was 35%. Mortality was mainly associated with sepsis. Survival periods (52.3 +/- 4.0 days) in Group A were longer than in Group B (17.3 +/- 2.5 days). With Cox regression analysis, the parameters such as systolic hypotension on admission, female gender, high serum peak creatine kinase (> 20,000 U/l) and multiple trauma including thoracic and abdominal regions, were factors increasing risk of mortality. CONCLUSION: As a result, sepsis, multiple trauma and severe crush injury were the main factors increasing mortality risk in dialyzed injuries after the earthquake.

Catheterization of the femoral vein for chronic hemodialysis.

Over the last ten years (1976-1986), 3,041 hemodialyses have been performed with 6,082 femoral vein catheterization in 336 patients with chronic renal failure. In the 3,041 hemodialyses, severe hematoma (0.29%), superficial hematoma (5.55%), and retroperitoneal hematoma (0.06%) have been observed. In 29 patients whose hemodialyses have been performed successively with femoral vein catheterization over a period of three to twelve months, subcutaneous fibrosis was observed in 24 and femoral vein regional narrowing was seen in 2.

Effects of sublingual administration of nifedipine on arterial pressure, plasma renin activity, and glomerular filtration rate in essential hypertension.

Effects of sublingual administration of nifedipine on systemic arterial pressure (BP), plasma renin activity (PRA), aldosterone level (AL), and serum sodium (Na) and potassium (K) levels, have been determined. A significant decrease was observed in systolic and diastolic blood pressure five minutes after the sublingual administration of nifedipine in 21 patients with mild or moderate essential hypertension. Furthermore, in an observation period of six hours, it was also established that the effect of nifedipine on systolic and diastolic blood pressure continued. An increase was observed in glomerular filtration rate, whereas there were no changes in PRA, AL, or serum Na and K levels.