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Öğe Cigarette smoking in primary Sjögren's syndrome: Positive association only with ANA positivity(2011) Karabulut G.; Kitapcioglu G.; Inal V.; Kalfa M.; Yargucu F.; Keser G.; Emmungil H.; Gokmen N.M.; Kocanaogullari H.; Aksu K.Smoking 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 Sjögren'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 X 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. © Japan College of Rheumatology 2011.Öğe Effectiveness and tolerability of mirtazapine and amitriptyline in alcoholic patients with co-morbid depressive disorder: A randomized, double-blind study(2008) Altintoprak A.E.; Zorlu N.; Coskunol H.; Akdeniz F.; Kitapcioglu G.Objective: Studies indicate that serotoninergic and noradrenergic pathophysiological mechanisms may underlie both alcohol abuse/dependence and depressive disorder. The purpose of this study was to evaluate and compare the effectiveness and tolerability of two serotonergic and noradrenergic antidepressant drugs-mirtazapine and amitriptyline, for the treatment of patients with alcohol dependence co-morbid with depressive disorder in a randomized, double-blind treatment setting. Methods: Forty-four patients were included in the study. Twenty-four patients were randomized to mirtazapine and twenty to amitriptyline groups. Thirty-six of them completed the study. The 17-item Hamilton Depression Rating Scale (HDRS), the Spielberger State-Trait Anxiety Inventory (STAI) and alcohol craving questionnaire were used at baseline and, at days 7, 14, 28, 42, and 56 to estimate the effectiveness of the antidepressant treatment. Michigan Alcoholism Screening Test (MAST) was used in the assessment of alcohol dependence. The tolerability was assessed with the Udvalg for Kliniske Undersogelser Side Effect Rating Scale (UKU). Results: There was significant improvement in HDRS and alcohol craving scores with both the drugs. However there were no statistical differences between treatment groups. Mirtazapine was tolerated better than amitriptyline treatment. Conclusions: The treatment with either mirtazapine or amitriptyline resulted with the reduction of HDRS and craving scores. The side-effect profile of mirtazapine was relatively favorable in our study. Copyright © 2008 John Wiley & Sons, Ltd.Öğe Endothelial nitric oxide synthase gene Glu298Asp polymorphism is associated with Behçet's disease(2006) Oksel F.; Keser G.; Ozmen M.; Aksu K.; Kitapcioglu G.; Berdeli A.; Doganavsargil E.Objective. The 894 G › T (Glu298Asp) polymorphism in exon 7 of the endothelial nitric oxide synthase (eNOS) gene was previously reported to be associated with Behçet's Disease (BD) susceptibility in Italian origin and Korean patients, but not in a group of unrelated Turkish patients. We analyzed whether this polymorphism is associated with BD, in another group of Turkish patients. Methods. We studied 132 consecutive Turkish BD patients being followed up by Ege University Rheumatology Department and 91 healthy controls. All individuals were genotyped by PCR-RFLP for 894 G › T in exon 7 (Glu298Asp). Results. The frequency of the T allele in BD group (101/264) was significantly higher than in healthy controls (OR 1.88, %95 CI 1.27-2.49, p < 0.001). The frequency of the homozygote (TT) Glu298Asp polymorphism in BD (27/132) was also significantly higher than in healthy controls (5/91) (OR 3.72, %95 CI 3.44-4.0, p < 0.001). However, no association was found between the Glu298Asp polymorphism and clinical parameters in BD. Conclusions. In this study, we found that Glu298Asp polymorphism of the eNOS gene was associated with BD in Turkish patients. © Copyright Clinical and Experimental Rheumatology 2006.Öğe Epidemiology and etiology of breast cancer(Springer New York, 2013) Kitapcioglu G.Breast cancer is the most common cause of cancer death among women worldwide, and breast cancer is by far the most frequent cancer among women, with an estimated 1.38 million new cancer cases diagnosed in 2008 (23% of all cancers), and ranks second overall (10.9% of all cancers). It is now the most common cancer both in developed and developing regions with approximately 690,000 new cases estimated for each region (population ratio 1:4). Incidence rates vary from 19.3 per 100,000 women in Eastern Africa to 89.7 per 100,000 women in Western Europe, and are higher (greater than 80 per 100,000) in the developed regions of the world (except Japan) and lower (less than 40 per 100,000) in most of the developing regions [1]. © Springer Science+Business Media New York 2013.Öğe Evaluation of insulin resistance by the homeostasis model assessment in female patients with Primary Sjogren's Syndrome(2011) Karabulut G.; Sarac F.; Kitapcioglu G.; Yilmaz C.; Kabasakal Y.Objective: To evaluate insulin resistance in Primary Sjogren's Syndrome (pSS) using homeostasis model assessment (HOMA) method Design: Cross-sectional study conducted between January 2006 and December 2008 Setting: Ege University Faculty of Medicine, Izmir, Turkey Subjects: Thirty-fivefemalepatientswithpSSfulfillingtheUS-European Consensus Criteria Interventions: A brief clinical history, demographic, anthropometric, clinical and laboratory profileswererecorded Main Outcome Measures: HOMA-IR and serum lipid levels Results: Mean level of HOMA-IR was 1.8 ± 0.7 in patients with pSS. Mean levels of plasma fasting glucose and insulin were 90.6 ± 7.1 mg/dl, 7.8 ± 2.5 microU/l, respectively. A statistically significantdifferencewasdetectedbetweenANA positivity and HOMA-IR values (p = 0.016). Four patients with pSS had high HOMA values (> 2.7) and all these patients had ANA positivity. A statistically significantpositive correlation was detected between HOMA-IR values and HDL-C levels (R = 0,450 p = 0.009). However, a statistically significantdifferencewasdetectedbetweenextraglandularinvolvement and LDL-C (p = 0.01) and total cholesterol levels (p = 0.01). Patients who had no extraglandular involvement had higher levels of total cholesterol and LDL-C levels. Lower triglyceride levels were seen in patients with anti-La antibodies (p = 0.01) but not other antibodies (p > 0.05). Patients with ANA positivity and pSS had lower LDL-C levels (p = 0.009). Conclusion: Autoimmune mechanisms may play a role in insulin resistance in pSS. Metabolic alterations should be taken into account in their management.Öğe Evaluation of quality of life in relation to anxiety and depression in primary Sjögren's syndrome(2010) Inal V.; Kitapcioglu G.; Karabulut G.; Keser G.; Kabasakal Y.The aim of this study was to evaluate health-related quality of life (HR-QOL) in patients with primary Sjögren's syndrome (pSS) using both Short-Form 36 (SF-36) and World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF) questionnaires and to determine the effects of anxiety and depression on HR-QOL using the Hospital Anxiety-Depression Scale (HADS). In this cross-sectional study, 107 female patients with pSS (mean age 54.10 ± 10.2 years), fulfilling US-European Consensus Criteria and 109 female controls (mean age 53.4 ± 10.9 years) were included. Student's t test, Mann-Whitney U test, and analysis of variance (ANOVA) were used for statistical analysis. P values >0.05 were accepted as significant. All domains of the SF-36, with the exception of "Vitality", and all domains of the WHOQOL-BREF with the exception of "Environment", were significantly lower in pSS patients compared with healthy controls. In pSS patients having anxiety according to HADS, the scores of all domains of WHOQOL-BREF were significantly lower, and in patients having depression according to HADS, three of four domains of WHOQOL-BREF were significantly lower compared with the rest of the group. However, the scores of two domains of the SF-36, namely "Role-Physical" and "Role-Emotional" domains, were significantly higher in pSS patients having depression according to HADS. We confirmed the presence of impaired HR-QOL in pSS. Whereas the presence of anxiety and/or depression generally showed a negative affect on HR-QOL, interestingly, depression seemed to improve the scores of "Role- Physical" and "Role-Emotional" domains of the SF-36. This surprising finding might be related to adaptation to changing health. Social support based upon cultural traditions might also have contributed. © 2010 Japan College of Rheumatology.Öğe Fc?RIIa, IIIa and IIIb gene polymorphisms in Behçet's disease: Do they have any clinical implications?(2008) Aksu K.; Kitapcioglu G.; Keser G.; Berdeli A.; Karabulut G.; Kobak S.; Ozmen M.; Inal V.; Kabasakal Y.; Oksel F.; Kocanaogullari H.; Doganavsargil E.Objective. Behçet's disease (BD) is a unique systemic vasculitis involving both arteries and veins of all sizes. Since Fc? receptors (Fc?R) are important in mediating various immune effector functions, Fc?R gene polymorphisms may affect the susceptibility to systemic inflammatory diseases such as BD. The aim of this study was to show the distribution of Fc?RIIa, IIIa ve IIIb receptor gene polymorphisms in BD, and to investigate possible genotype-phenotype relationships. Methods. In this cross-sectional study, Fc?RIIa (H/H131, H/R131, R/R131), IIIa (F/F158, F/V158, V/V158) and IIIb (NA1/NA1, NA1/NA2, NA2/NA2) receptor gene polymorphisms were investigated in 216 unrelated Turkish BD patients (M/F: 130/86) and in 241 healthy subjects, using an allele-specific polymerase chain reaction. Results. The Fc?RIIa R/R131 (p=0.019) and Fc?RIIIa F/F158 genotypes (p=0.001) were found to be significantly more frequent in BD compared with healthy controls, whereas the Fc?RIIIb genotypes were not (p=0.108). Allele analysis showed that the Fc?RIIIa F158 (p=0.001) and Fc?RIIIb NA2 (p=0.016) alleles were more frequent in BD than in healthy controls. In BD patients the Fc?RIIIa V/V158 genotype was significantly associated with the presence of arthritis (p=0.002) and with an earlier disease onset (p=0.008), while the Fc?RIIIb NA2/NA2 genotype was significantly associated with disease severity (p=0.02), vascular involvement (p=0.014), and pathergy positivity (p=0.02). Conclusion. We found that the genotype frequencies and allelic distributions of the Fc?RIIa, Fc?RIIIa and Fc?RIIIb gene polymorphisms were significantly different between BD patients and healthy controls. In addition, certain Fc?RIIIa and Fc?RIIIb gene polymorphisms appear to be associated with an early disease onset, disease severity, the presence of arthritis, and vascular involvement in BD. © Copyright Clinical and Experimental Rheumatology 2008.Öğe In vitro fertilization-induced pregnancies predispose to gastroesophageal reflux disease(SAGE Publications Ltd, 2016) Turan I.; Kitapcioglu G.; Goker E.T.; Sahin G.; Bor S.Background: Women conceiving following in vitro fertilization (IVF) likely have a variety of risk factors that predispose them to gastroesophageal reflux disease (GERD) in the future. Objective: We aimed to investigate whether pregnancy through IVF may predispose to subsequent GERD compared with pregnancies without IVF. We also evaluate whether twin IVF pregnancies lead to additional risk for having GERD compared with singleton IVF pregnancies. Methods: A validated reflux questionnaire was administered to 156 women with singleton (n=102) or twin (n=54) IVF birth (IVF group) and 111 women with a naturally conceived singleton birth (control group). All women included in the study were primiparas who had given birth at least 1 year prior to data collection. The diagnosis of GERD was based on the occurrence of typical symptoms (heartburn, regurgitation, or both) at least once a week. Results: The prevalence of GERD was 13.5% and 4.5% in IVF and control groups (p=0.015); in the IVF group, this was slightly higher, but not statistically significant, in women with twin compared with singleton pregnancies (14.8% vs. 12.7%, p=0.749). Logistic regression analysis showed that IVF was strongly associated with subsequent GERD (OR, 3.30; 95% CI 1.20–9.04; p=0.02). Conclusion: The risk of developing GERD at least 1 year after delivery increased following IVF. Long-term follow-up studies are required to determine whether therapy during pregnancy can prevent this risk. © Author(s) 2016.Öğe Increased thickness of the carotid artery intima-media assessed by ultrasonography in Behçet's disease(2005) Keser G.; Aksu K.; Tansel S.; Ozmen M.; Kitapcioglu G.; Kabaroglu C.; Killi R.; Bayindir O.; Doganavsargil E.Objective. Behçet's disease (BD), is a unique systemic vasculitis, which affects almost all types and sizes of blood vessels. Carotid intima-media thickness (IMT) is an endothelial cell dysfunction (ECD) parameter which may also be associated with atherosclerosis. We aimed to search carotid IMT and plaque formation in BD, using high-resolution B-mode Doppler ultrasonography (USG). Methods. We studied 114 BD patients (M/F: 68/46; mean age 38.15±9.44 years; disease duration 121 ± 79 months), being followed up by Ege University, Rheumatology Department. Age and sex-matched, 77 healthy controls, and as the disease control group 46 non-matched SLE patients were also included. Exclusion criteria for all the study participants were hypertension, hyperlipidemia, diabetes mellitus, obesity and history of cardiovascular or cerebrovascular disease. Comparison of the three groups were made by ANOVA and for post-hoc confirmation, Bonferoni test was used. Results. The carotid IMT in BD (mean ±SD, 0.55 ± 0.14 mm) was significantly higher than in healthy controls (0.48 ±0.09 mm) (p = 0.004), but significantly lower than in SLE (0.66 ± 0.24 mm) (p = 0.001). Likewise, plaque frequency in BD (5/114) was significantly higher than in healthy controls (0/77), but significantly lower than in SLE (8/46) (p < 0.001). Conclusion. Despite significantly higher carotid IMT and plaque frequency in BD compared with healthy controls, these parameters in BD were not as marked as in SLE. Less severe carotid artery, abnormalities in BD, may partially explain why cardiovascular morbidity and mortality do not seem to be increased in BD, unlike in SLE. © Copyright Clinical and Experimental Rheumatology 2005.Öğe Prevalence of gastroesophageal reflux disease in patients with asthma and chronic obstructive pulmonary disease(Blackwell Publishing, 2010) Bor S.; Kitapcioglu G.; Solak Z.A.; Ertilav M.; Erdinc M.Background and Aim: It is speculated that the prevalence of gastroesophageal reflux disease (GERD) might increase with asthma or chronic obstructive pulmonary disease (COPD). The aim of the present study was to evaluate the prevalence of GERD in patients with asthma and COPD in an area representative of developing countries. Methods: A validated GERD questionnaire was conducted face-to-face with 308 consecutive asthma (240 women) and 133 COPD (35 women) patients in the tertiary referral pulmonary outpatient clinic, and 694 controls from the research area. Detailed histories of patients and pulmonary function tests were also recorded. Results: The prevalence of GERD (heartburn/regurgitation once a week or more) was 25.4%, 17.0%, 19.4% and occasional symptoms (less than weekly) were 21.2%, 16.3% and 27.0% of patients with asthma, COPD and controls, respectively. The prevalence was higher in the asthma group compared with the controls and the COPD group. No significant difference was found between the COPD group and the controls. Heartburn started following pulmonary disease in 24.1% of the asthma group, and 26.4% of the COPD group. The majority of additional symptoms were significantly higher in asthmatics compared with the controls. No difference was found in the consumption of pulmonary medications in asthmatic patients in groups with different symptom frequency. Heartburn was increased 13.8% by the consumption of inhaler medications. Conclusions: These results implicate that the prevalence of GERD in asthma and COPD are lower than in published reports in a tertiary referral center. These differences might be related to the characteristics of developing countries, increased consumption of powerful medications in GERD and pulmonary diseases, or methodological flaws in earlier studies. © 2009 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.Öğe The prevalence of Sjögren's syndrome in adult women(2006) Kabasakal Y.; Kitapcioglu G.; Turk T.; Öder G.; Durusoy R.; Mete N.; Egrilmez S.; Akalin T.Objectives: The aim of this study was to determine the prevalence of primary Sjögren's syndrome (pSS) according to European criteria (1993) and to the US-European Consensus Group (US-EU) criteria (2002) in adult women in Bornova, Izmir, Turkey. Materials and method: The study was designed as a two-phase cross-sectional survey consisting of a baseline questionnaire and collection of blood samples and clinical examination. In the initial phase, positivity for autoantibodies Ro(SS-A), La(SS-B), rheumatoid factor (RF), and anti-nuclear antibodies (ANA) was determined, and in the clinical phase, clinical examination, salivary and ocular tests were performed. Minor salivary gland biopsy was performed for those who had at least three of these five criteria positive. Results: In our sample the prevalence of SS was 1.56% [95% confidence interval (CI) 0.92-2.66] according to the European criteria and 0.72% (95% CI 0.33-1.57) according to the US-EU criteria. Conclusion: To prevent the loss in diagnosis of pSS, the addition of ANA, RF, and tear break-up time (BUT) tests to US-EU criteria would be appropriate. © 2006 Taylor & Francis.Öğe Quality of life and its relation with disease severity in Behçet's disease(2009) Ertam I.; Kitapcioglu G.; Aksu K.; Keser G.; Ozaksar A.; Elbi H.; Unal I.; Alper S.Objective. Since Behçet's disease (BD) is a systemic vasculitis, it may deteriorate the quality of life of the patients. We aimed to investigate the relationship between the disease severity and the quality of life in patients with BD. Methods. We studied 195 BD patients and 195 healthy controls who were matched with regard to age, gender and socio-economic status. Krause score was calculated to assess disease severity, while Short-form-36 (SF-36) and The World Health Organization Quality of Life (WHOQOL-100) were used to evaluate the quality of life in BD. Results. The overall SF-36 and WHOQOL-100 scale scores, as well as their domains were significantly lower in BD patients. In BD patients, "general health", "role-physical", domains of SF-36, and "psychological", "level of independence", "environment", "environmental-public" domains of WHOQOL-100 showed significantly negative linear correlations with Krause scores. In BD patients with arthritis, the scores of "general health", "physical functioning", "role emotional" domains of SF-36, and the scores of "psychological", "level of independence" and "social relations" domains of WHOQOL-100 were significantly worse than without arthritis. The scores of "pain" domain of SF-36 and "level of independence" domain of WHOQOL-100 were significantly worse in BD patients with vascular involvement, while the scores of "mental health" domain of SF-36 and "psychological" domain of WHOQOL-100 were significantly worse in BD patients with eye involvement. Conclusion. Based on the evaluation of SF-36 and WHOQOL-100 scores, quality of life is impaired and related with disease severity in BD. Arthritis, eye involvement and vascular involvement seem to contribute to this impairment. © Copyright Clinical and Experimental Rheumatology 2009.