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Öğe Autoimmune thyroid disease in ankylosing spondylitis(Springer London Ltd, 2014) Emmungil, Hakan; Erdogan, Mehmet; Kalfa, Melike; Karabulut, Gonca; Kocanaogullari, Hayriye; Inal, Vedat; Aksu, Kenan; Oksel, Fahrettin; Kabasakal, Yasemin; Keser, GokhanAlthough autoimmune thyroid disease is well known to be associated with primary Sjogren's syndrome (SjS) and with various autoimmune diseases, it is less clear whether a similar association also exists for ankylosing spondylitis (AS). Therefore, we investigated the frequency of autoimmune thyroid disease in patients with AS. In this cross sectional study, 80 patients with AS fulfilling the 1984 Modified New York Criteria and 80 healthy subjects, age and sex-matched with AS patients, were included. As the positive control group, 62 female patients with primary SjS were also studied. All cases underwent thyroid ultrasonography (USG) by a single endocrinologist. Thyroid function tests and thyroid autoantibodies were measured. The diagnosis of Hashimoto's thyroiditis (HT) was made if the patient had thyroid autoantibody positivity plus at least one of the following criteria: diffuse goiter with physical examination, abnormality in thyroid function tests, and parenchymal heterogeneity with USG. The chi-squared test and Fisher's exact test were used to compare cases and controls. The p values < 0.05 were considered statistically significant. The frequencies of parenchymal heterogeneity with USG (30 vs 11.3 %, p = 0.045), thyroid autoantibody positivity (13.8 vs 2.5 %, p = 0.017), and concomitant diagnosis of HT (10 vs 1.3 %, p = 0.034) were significantly higher in AS group compared to healthy controls. Among AS patients having HT, subclinical hypothyroidism was detected only in a single patient. Frequency of autoimmune thyroid disease was significantly higher in AS group, compared to healthy controls. Prospective studies are needed to see the clinical relevance of these findings and outcome in the long term.Öğe Cigarette smoking in primary Sjogren's syndrome: positive association only with ANA positivity(Taylor & Francis Ltd, 2011) Karabulut, Gonca; Kitapcioglu, Gul; Inal, Vedat; Kalfa, Melike; Yargucu, Figen; Keser, Gokhan; Emmungil, Hakan; Gokmen, Nihal Mete; Kocanaogullari, Hayriye; Aksu, KenanSmoking is well known to contribute to the pathogenesis and severity of some systemic autoimmune rheumatic diseases and especially to the production of certain autoantibodies. Primary Sjogren's syndrome (pSS) is an autoimmune disease, affecting primarily the exocrine glands. It may also cause extraglandular involvement in some cases. In this study, we aimed to determine the frequency of smoking habits in our cohort of pSS patients and to investigate whether the frequencies of autoantibody positivity and extraglandular involvement were significantly different between patients with and without smoking. In this cross-sectional study, 207 patients with pSS (F/M 203/4), fulfilling the United States-European Consensus Criteria, and 602 healthy controls (F/M 534/68) were included. Patients and controls were classified into five groups: never smokers, current smokers, former smokers; ever smokers, and passive smokers. The chi(2) and Kruskal-Wallis tests were used for statistical analysis; a p value of less than 0.05 was accepted as statistically significant. While the frequency of current smokers was significantly lower in the pSS group compared with the healthy controls (11.6 vs 22.3%), the frequencies of former smokers (30.4 vs 11.8%), ever smokers (42.0 vs 34.1%), and passive smokers (47.3 vs 37.5%) were significantly higher in the pSS group compared with the healthy controls. In pSS patients, only antinuclear antibody (ANA) positivity was significantly associated with smoking habits, while there was no significant association with other autoantibodies or with the presence of extraglandular involvement. We found that in pSS patients smoking was significantly associated only with ANA positivity. Unlike the deleterious effects of smoking upon disease severity and anti-cyclic citrullinated protein (CCP) antibody production in rheumatoid arthritis, we could not find any association of smoking with extraglandular involvement and/or anti-Ro/anti-La antibody positivity in pSS. These results are indeed in line with the limited number of previous studies reported in the literature. Further studies with higher numbers of pSS patients are required to confirm the seemingly negative association of smoking with pSS.Öğe CROSS-Sectional Assessment of Damage in Takayasu Arteritis with A Validated Tool.(Wiley-Blackwell, 2012) Omma, Ahmet; Erer, Burak; Karadag, Omer; Yilmaz, Neslihan; Alibaz-Oner, Fatma; Yildiz, Fatih; Kalfa, Melike; Kimyon, Gezmis; Kiraz, Sedat; Direskeneli, Haner; Erken, Eren; Aksu, Kenan; Onat, Ahmet Mesut; Gul, Ahmet; Ocal, Lale; Inanc, Murat; Kamali, SevilÖğe Current antiviral practice and course of Hepatitis B virus infection in inflammatory arthritis: a multicentric observational study (A(Aves, 2015) Kalyoncu, Umut; Emmungil, Hakan; Onat, Ahmet Mesut; Yilmaz, Sedat; Kasifoglu, Timuin; Akar, Servet; Inanc, Nevsun; Yildiz, Fatih; Kucuksahin, Orhan; Karadag, Omer; Mercan, Ridvan; Bes, Cemal; Yazisiz, Veli; Yilmazer, Baris; Ozmen, Mustafa; Erten, Sukran; Senel, Soner; Yazici, Ayten; Tascilar, Koray; Kalfa, Melike; Kiraz, Sedat; Kisacik, Bunyamin; Pehlivan, Yavuz; Kilic, Levent; Simsek, Ismail; Cefle, Ayse; Akkoc, Nurullah; Direskeneli, Haner; Erken, Eren; Turgay, Murat; Ozturk, Mehmet Akif; Soy, Mehmet; Aksu, Kenan; Dinc, Ayhan; Ertenli, IhsanObjective: The reactivation of hepatitis B virus (HBV) infection is a well-known event in hepatitis B surface antigen (HbsAg)-positive patients receiving immunosuppressive therapy. The objective of this study was to assess the antiviral practice and course of HBV infection in inflammatory arthritis. Material and Methods: Nineteen rheumatology centers participated in this retrospective study. HbsAg-positive patients who were taking disease-modifying antirheumatic drugs and who were being tested for HBV viral load at a minimum of two different time points were included. The case report form (CRF) consisted of demographic data, rheumatic diseases, treatment profiles, transaminase levels, viral hepatitis serological markers, and HBV viral load. The reactivation of HBV was defined as the abrupt rise in HBV replication by an increase in serum HBV DNA levels in a patient with a previously inactive HBV infection. Results: In total, the data of 101 (female 50.5%) patients were included (76 patients with inactive HBV carriers and 25 patients with chronic HBV infection). The mean age of patients was 44 +/- 12 years, and the mean follow-up duration was 31 +/- 22 months. Of the 101 patients, 70 (69.3%) received antiviral treatment. HBV reactivation was detected in 13 of 76 (17.1%) patients with inactive HBV carriers. HBV reactivation was observed less frequently, not although significantly, in those patients receiving antiviral prophylaxis compared with those not receiving prophylaxis [5/41 (12.2%) vs. 8/33 (24.2%), p=0.17]. Forty-two patients (31 patients had inactive HBV carriers) were using anti-tumor necrosis factor agents. HBV reactivation was detected in 6 of the 31 (19.3%) patients. Twenty-five patients had chronic hepatitis, and five (20%) of them had not received antiviral prophylaxis. HBV viral loads were persistently elevated in 7 (28%) of 25 patients (three patients under and four patients not under antiviral treatment). Conclusion: HBV reactivation was observed in approximately 17% of patients under immunosuppressive treatments. HBV reactivation was more frequently observed in those who did not receive antiviral prophylaxis.Öğe Frequency of Pulmonary Arterial Hypertension Is Not Increased in Takayasu's Arteritis.(Wiley-Blackwell, 2011) Kalfa, Melike; Musayev, Oktay; Emmungil, Hakan; Soysal, Ozgul; Yilmaz, Zevcet; Inal, Vedat; Akar, Servet; Akkoc, Nurullah; Onen, Fatos; Kayikcioglu, Meral; Keser, Gokhan; Aksu, KenanÖğe Frequency of pulmonary hypertension in transthoracic echocardiography screening is not increased in Takayasu arteritis: Experience from a single center in Turkey(2018) Kalfa, Melike; Emmungil, Hakan; Musayev, Oktay; Gündüz, Özgül Soysal; Yılmaz, Zevcet; İnal, Vedat; Akkoç, NurullahObjective: Pulmonary hypertension (PH) may occur in Takayasu arteritis (TA), mostly due to pulmonary arteritis, but also due to left heart disease and/or chronic thromboembolism (CTE). Using transtho- racic echocardiography (TTE), we investigated the frequency of PH caused by pulmonary arteritis. Methods: This cross-sectional study included 70 patients with TA fulfilling the 1990 ACR criteria, 68 healthy controls, and 67 patients with systemic sclerosis (SSc) fulfilling the 1980 ACR criteria repre- senting the disease control group. Patients with severe left heart disease or CTE were excluded. the ESC-ERS guideline definition was considered for diagnosis of PH. Results: the mean systolic pulmonary artery pressure (SPAP) values in TA, SSc, and healthy control groups were 20.93±6.06, 31.57±12.75, and 18.88±5.39 mmHg, respectively. While the SPAP values were similar between TA and healthy groups, the SPAP values in the SSc group were significantly higher than in other groups. Based on conventional and/or magnetic resonance angiography find- ings, pulmonary arteritis was present in 4 out of 70 TA patients; however, PH was not detected in any patients with TA, including those with pulmonary arteritis. Conclusion: the TTE findings suggested that the frequency of PH was not increased in TA. However, a low frequency of pulmonary arteritis in our series might have affected our results.Öğe Frequency of pulmonary hypertension in transthoracic echocardiography screening is not increased in Takayasu arteritis: Experience from a single center in Turkey(Aves, 2018) Kalfa, Melike; Emmungil, Hakan; Musayev, Oktay; Gunduz, Ozgul Soysal; Yilmaz, Zevcet; Inal, Vedat; Akar, Servet; Akkoc, Nurullah; Onen, Fatcs; Kayikcioglu, Meral; Keser, Gokhan; Aksu, KenanObjective: Pulmonary hypertension (PH) may occur in Takayasu arteritis (TA), mostly due to pulmonary arteritis, but also due to left heart disease and/or chronic thromboembolism (CTE). Using transthoracic echocardiography (TTE), we investigated the frequency of PH caused by pulmonary arteritis. Methods: This cross-sectional study include 70 patients with TA fulfilling the 1990 ACR criteria, 68 healthy controls, and 67 patients with systemic sclerosis (SSc) fulfilling the 1980 ACR criteria representing the disease control group. Patients with severe left heart disease or CTE were excluded. The ESC-ERS guideline definition was considered for diagnosis of PH. Results: The mean systolic pulmonary artery pressure (SPAP) values in TA, SSc, and healthy control groups were 20.93 +/- 606, 31.57 +/- 112.75, and 18.88 +/- 5.39 mmHg, respectively. While the SPAP values were similar between TA and healthy groups, the SPAP values in the SSc group were significantly higher than in other groups. Based on conventional and/or magnetic resonance angiography findings, pulmonary arteritis was present in 4 out of 70 TA patients; however, PH was not detected in any patients with TA, including those with pulmonary arteritis. Conclusion: The TTE findings suggested that the frequency of PH was not increased in TA. However, a low frequency of pulmonary arteritis in our series might have affected our results.Öğe Impaired quality of life, disability and mental health in Takayasu's arteritis(Oxford Univ Press, 2013) Yilmaz, Neslihan; Can, Meryem; Oner, Fatma Alibaz; Kalfa, Melike; Emmungil, Hakan; Karadag, Omer; Yildiz, Fatih; Kimyon, Gezmis; Yilmazer, Baris; Gerdan, Vedat; Bilge, Sule Yasar; Ilhan, Birkan; Cobankara, Veli; Kasifoglu, Timucin; Cefle, Ayse; Kisacik, Bunyamin; Onat, Ahmet Mesut; Akar, Servet; Onen, Fatos; Erken, Eren; Kiraz, Sedat; Aksu, Kenan; Keser, Gokhan; Mumcu, Gonca; Direskeneli, HanerObjective. Patient-reported outcomes (PROs) are increasingly accepted to be among the major tools for outcome assessment in rheumatic disorders. In this study we aimed to assess quality of life (QoL), disability, anxiety and depression in patients with Takayasu's arteritis (TAK). Methods. Patients followed with the diagnosis of TAK (n = 165) and healthy controls (HCs) (n = 109) were enrolled to the study. The 36-item Short Form Health Survey (SF-36) and hospital anxiety and depression scales (HADS) were used to assess QoL and mental status together with HAQ for disability. Results. In SF-36 subscale assessment, all items were observed to be statistically lower in TAK patients; similarly HAQ scores were also higher (P < 0.001) in this group. In mental assessment, anxiety was found to be more common in TAK patients [90 (54.5%) vs 38 (34.9%), P = 0.001]. Depression also tended to be higher in TAK patients [70 (66.7%) vs 35 (33.3%)], without reaching significance (P = 0.086). Most of the SF-36 subgroup parameters were lower in TAK patients with active disease. Patients having anxiety and depression or with high HAQ scores reported worse SF-36 scores. In multivariate analysis, HADS-A, HADS-D and HAQ were associated with most SF-36 subscales. Conclusion. PROs demonstrate that not only general health but also physical and social functioning with physical role limitations and mental health parameters were impaired in TAK. Our results, especially in active disease, suggest that PROs such as SF-36 can be core domains of disease assessment in TAK, similar to ANCA-associated vasculitides.Öğe The Prevalance of Autoimmune Thyroid Disfunction in Ankylosing Spondylitis(Wiley-Blackwell, 2012) Emmungil, Hakan; Erdogan, Mehmet; Kalfa, Melike; Karabulut, Gonca; Kocanaogullari, Hayriye; Inal, Vedat; Kabasakal, Yasemin; Oksel, Fahrettin; Aksu, Kenan; Keser, GokhanÖğe Right ventricular endomyocardial fibrosis mimicking Ebstein anomaly in a patient with Behcet's disease: case report and review of the literature(Taylor & Francis Ltd, 2014) Buturak, Ali; Saygili, Ozlem; Ulus, Sila; Kalfa, Melike; Karabulut, Hasan; Alhan, Cem; Dagdelen, Sinan; Aksu, KenanBehcet's disease is a multisystemic, chronic inflammatory disorder with diffuse clinical manifestations including the cardiovascular system. Endomyocardial fibrosis is a rarely seen complication of Behcet's disease leading to progressive heart failure. We report a case of right ventricular endomyocardial fibrosis mimicking Ebstein anomaly in a 26-year-old male Turkish patient with Behcet's disease, who had heart failure symptoms. In addition, the previously reported cases of endomyocardial fibrosis complicating Behcet's disease are reviewed in this article.Öğe Segmental arterial mediolysis mimics systemic vasculitis(Aves, 2016) Kalfa, Melike; Kocanaogullari, Hayriye; Karabulut, Gonca; Emmungil, Hakan; Cinar, Celal; Yilmaz, Zevcet; Gucenmez, Sercan; Kabasakal, YaseminSegmental arterial mediolysis (SAM) is a rare, nonarteriosclerotic, noninflammatory vascular disease and mostly affects medium-to-large sized abdominal arteries as well as presents with hemorrhages in the abdominal cavity. We report the case of a patient with SAM of the celiac, right renal, jejunal branch of the superior mesenteric, left gastric, and splenic arteries who was diagnosed by excluding other causes and in whom transcatheter embolization was performed in two different sessions, but he died because of an undefined reason. SAM mimics systemic vasculitis and causes abdominal pain; it should be considered because abdominal hemorrhage or arterial infarction can result in death.Öğe Takayasu arteriti ve behçet hastalığı'nda latent tüberküloz enfeksiyonunun tüberkülin cilt testi ve quantiferon testi ile değerlendirilmesi(Ege Üniversitesi, 2012) Kalfa, Melike; İnal, VedatGünümüzde birçok inflamatuar hastalık tedavisinde kullanılan Tümör Nekrozis Faktör-Ü (TNF-Ü) inhibitörlerinin, artmış tüberküloz (TB) riski ile ilişkili olduğu bilinmektedir. Latent TB enfeksiyonu (LTBE) taramasında uzun yıllardır tüberkülin cilt testi (TCT) kullanılmaktadır. Ancak son yıllarda LTBE'nu saptamada M. tuberculosis için özgül proteinlerin kullanıldığı in vitro interferon-gama (IFN-Þ) yöntemleri (IGRA) kullanılmaktadır. Bu yöntemlerden bir tanesi Quantiferon-TB Gold In-Tube testidir (QTF-IT). Günümüzde tedaviye dirençli Behçet Hastalığı (BH) ve Takayasu arteriti (TA) tedavisinde TNF-Ü inhibitörleri kullanımı söz konusudur. Vaskülitik hasta gruplarında anti-TNF tedavisi öncesi LTBE taramasına yönelik az sayıda çalışma bulunmaktadır. Bu nedenle, bu tez çalışmasında, TNF-Ü inhibitörü tedavi adayı olabilecek BH ve TA hastalarında LTBE'nun, TCT ve QTF-IT testleri ile değerlendirilmesi ve birbirleri ile karşılaştırılması amaçlanmıştır. Bu kesitsel çalışmaya, 1990 Uluslararası Çalışma Grubu kriterlerine göre BH tanısı konulmuş 40, 1990 Amerikan Romatoloji Derneği (ACR) sınıflama kriterlerine göre TA tanısı konulmuş 40 hasta, yaş ve cinsiyet uyumlu 80 sağlıklı kontrol alınmıştır. Tüm olgular LTBE açısından TCT ve QTF-IT testleri ile değerlendirilmiştir. Çalışma sonucunda; hasta grubunda TCT pozitifliği, sağlıklı kontrollere göre anlamlı olarak yüksek saptanmıştır. TCT pozitifliği TA hastalarında %80, BH hastalarında %65 ve sağlıklı grupta %35 olup, TA ve BH hastaları arasında TCT pozitifliği açısından anlamlı fark saptanmamıştır. QTF-IT testi ile değerlendirildiğinde; BH ve TA hastaları arasında ve hasta grubu ile sağlıklı kontroller arasında QTF-IT pozitifliği açısından anlamlı fark saptanmamıştır. BH hastalarında QTF-IT pozitifliği %25, TA hastalarında %35, sağlıklı kontrollerde %21.3 saptanmıştır. TCT-QTF-IT testlerinin uyumu değerlendirildiğinde; tüm gruplar bir arada değerlendirildiğinde, TCT-QTF-IT testleri arasında, test pozitifliği veya negatifliği açısından uyum %53.33, BH hastalarında %60, TA hastalarında %50 ve sağlıklı kontrollerde %65.71 olup; düşük uyum saptanmıştır (m=0.25, 0.30, 0.15, 0.23). Temelde bu uyumsuzluğu Bacillus Calmette-Guerin (BCG) aşılamasına bağlı TCT yanlış pozitifliğinin oluşturduğu düşünülmüştür. Tüm bu bulgular, literatürde diğer inflamatuar hastalıklara yönelik yapılan LTBE taramaları ile uyumlu bulunmuştur. TB enfeksiyonu yaygın olan, BCG aşılaması rutin olarak uygulanan ülkemizde TCT yanlış pozitiflik oranının yüksek olabileceği unutulmamalıdır. Bu nedenle anti-TNF tedavi planlanan hastalarda LTBE taranmasında QTF-IT testi daha doğru sonuçlar verebilir. QTF-IT testi, uygulama kolaylığı, BCG aşılamasından ve tüberküloz dışı mikobakteri (NTM) enfeksiyonlarından etkilenmemesi nedeniyle yanlış pozitiflik oranı daha düşük olabilir ve TB endemik ülkelerde tercih edilebilir. Ancak yine de testin pahalı oluşu, yanlış pozitif ya da negatif sonuçların olabileceği unutulmamalıdır. LTBE tedavisinin sadece TCT ya da QTF-IT test sonuçları ile değil, klinik, öykü ve akciğer grafi bulgularıyla birlikte karar verilmesi gerekmektedir. LTBE saptanmasında altın standart bir yöntem hala bulunmamaktadır. Vaskülit grubu hastalıklarda çalışma sayısı az olduğundan, yeni ve daha geniş çalışmalara ihtiyaç duyulmaktadır.Öğe Therapy resistant idiopathic scleredema: an underlying pathology not always present(2015) Kalfa, Melike; Koçanaoğulları, Hayriye; Zihni, Figen Yargucu; Karabulut, Gonca; Emmungil, Hakan; İnal, VedatScleredema is a rare connective tissue disorder of unknown pathogenesis. Three types of scleredema have been described, based on its association with postinfection, monoclonal gammopathy and diabetes mellitus. We report herein a case of scleredema which the diagnosis didn't get specified. the patient was followed regularly for 13 years and did not respond to various combinations of immunosuppressants and psoralen plus ultraviolet A therapy. Treatment of scleredema is quite difficult and of limited success. At present, there is no proved treatment for this diseaseÖğe Therapy resistant idiopathic scleredema: an underlying pathology not always present(Aves, 2015) Kalfa, Melike; Kocanaogullari, Hayriye; Zihni, Figen Yargucu; Karabulut, Gonca; Emmungil, Hakan; Inal, VedatScleredema is a rare connective tissue disorder of unknown pathogenesis. Three types of scleredema have been described, based on its association with postinfection, monoclonal gammopathy and diabetes mellitus. We report herein a case of scleredema which the diagnosis didn't get specified. The patient was followed regularly for 13 years and did not respond to various combinations of immuno-suppressants and psoralen plus ultraviolet A therapy. Treatment of scleredema is quite difficult and of limited success. At present, there is no proved treatment for this disease.Öğe Thiopurine S-Methyltransferase Levels in Patients with Behcet's Disease.(Wiley-Blackwell, 2012) Emmungil, Hakan; Kalfa, Melike; Durusoy, Raika; Zihni, Figen Yargucu; Keser, Gokhan; Aksu, Kenan
