Kazım Şenel

The interrelation of glutathione reductase, catalase, glutathione peroxidase, superoxide dismutase, and glucose-6-phosphate in the pathogenesis of rheumatoid arthritis

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis, a systemic autoimmune disease characterized by chronic inflammation of the synovial joints, ultimately leading to joint destruction and permanent disability, affecting 1% of the world population. Oxidative stress in rheumatoid inflammation, due to the fact that antioxidant systems are impaired in RA and caused by fee radicals, might have an essential role in etiology of RA. This review includes the interrelation of antioxidants against free radicals in RA patients. There is much evidence that antioxidant team that covers glutathione reductase, catalase, glutathione peroxidase, superoxide dismutase, and glucose-6-phopshate destroy reactive oxygen species and other free radicals through enzymatic as well as nonenzymatic means. The change in relative levels of antioxidants vis-à-vis free radical formation and level could be used as indicators for effective and earlier diagnosis of RA.

The effectiveness of gabapentin in patients with chronic radiculopathy

AbstractThis study was carried out to determine the efficacy of gabapentin in patients with radiculopathy. Fifty patients (32 women, 18 men) with lumbosciatalgia secondary to L5 or S1 radiculopathy were evaluated. MRI showed L4-5 and/or L5-S1 bulging and/or protrusion without significant spinal stenosis. Baseline assessments for each patient included a standard neurological examination and radiological investigation. The patients were randomly assigned into two groups: group 1 was treated with oral gabapentin from a total of 900 mg per day up a total of 3600 mg per day divided in 3 doses; group 2 received placebo for the 8-week trial period. In group 1 we observed statistically significant improvement in pain at rest (p < 0.001), motor function (p < 0.01), limitation of spinal flexion (p < 0.001), straight leg raising test (p < 0.001) and sensory function (p < 0.001). Stretch reflexes instead did not significantly change. In group 2 we observed significant improvement in all clinical parameters, muscle st...

Awareness of osteoporotic patients

Osteoporosis has recently been recognized as a major public health problem by some governments and health care providers. Despite significant progress in knowledge about osteoporosis, public awareness is required for effective management if precautions are to be taken. The aim of this study was to evaluate the educational status of osteoporotic individuals, and their awareness about the disease and sources of information. We also aimed to compare the variables between the geographical regions of the country, since significant differences exist in socioeconomic status and lifestyle within the same cultural context. This multicenter study was carried out in eight cities located in six different geographical regions between September 2001 and January 2002. To our knowledge, this is the first multicenter study in Turkey evaluating the relationship between awareness of osteoporotic patients and other variables such as educational level and economic factors. Ten centers took part in this study and consecutive patients with either femoral or lumbar T-scores below −2.5 SD were enrolled into the study group. Bone mineral density was measured using dual energy X-ray absorptiometry (DXA). Patients were interviewed using a questionnaire on past medical history, education, awareness about their disease and risk factors for osteoporosis. A total of 540 women (93.8%) and 36 men (6.3%) were included in the study. Fifty-four percent of patients declared that they were aware of osteoporosis. With regard to sources of information, 56.8% of patients reported physicians as the main source of information. Awareness of the patients was negatively correlated with age (P=0.025, r=−0,94) but positively correlated with education (P=0.0001, r=0.327), level of physical activity (P=0.001, r=143), calcium intake (P=0.005, r=119) and modern clothing style (P=0.0001, r=309). Educational status of the patients was negatively correlated with BMI (P=0.0001, r=−283) and positively correlated with physical activity (P=0.0001, r=268), modern clothing style (P=0.0001, r=600) and smoking (P=0.0001, r=273). Regional comparison of female patients demonstrated that significant differences exist in terms of educational status, clothing style, smoking, level of physical activity, calcium intake, and knowledge about osteoporosis. As a result, education has profound effects on awareness about osteoporosis and many aspects of human behavior, such as calcium intake, physical activity, clothing style and smoking. Significant disparities may be observed between the geographical regions of the same country.

The timing of low dose glucocorticoid therapy in treatment of rheumatoid arthritis

AbstractThe purpose of this study was to determine the effects of low-dose prednisolone in treatment of rheumatoid arthritis (RA) administered in the morning or at night. Thirty patients with active RA were divided randomly into two groups. For 6 months, prednisolone was administered at 02:00 am or 07:30 am. During the treatment, changes observed each month in clinical and laboratory status of patients in both groups were recorded and results were compared both within and between the groups. Significant improvements were observed in both groups in clinical and laboratory findings compared to values before treatment, beginning from first month to sixth month (p 0.05). Lowdose prednisolone therapy in treatment of RA significantly suppresses the activity of disease beginning from the first month. This condition is kept until the sixth month. However, administration of the medication ...

A Multicenter Pilot Study of Burden Among Caregivers of Geriatric Rehabilitation Patients with Neuromusculoskeletal Diseases

Purpose: In this study, we aimed to describe the sociodemographic characteristics of caregivers of patients in a geriatric unit and to clarify the relationship between caregiver burden and specific clinical variables in the patients and the characteristics of the caregivers. Design: Cross-sectional multicenter study. Methods: One hundred twenty-three patients and 123 caregiver dyads, with mean ages of 72.5 ± 7.7 years and 51 ± 14.7 years, respectively, were included. The functional, psychological, and cognitive statuses of the patients were determined, and the sociodemographic characteristics of the caregivers as well as the type and duration of caregiving were recorded. Caregivers completed the Caregiver Burden Inventory (CBI) to measure the perceived burden of care. Most patients were female and generally lived with their family. Findings: Most of the caregivers were family members (90%), female (73.2%), primary school graduates (52.8%), and first-degree relatives (73.1%). The average CBI score was 33, and the highest CBI subscores were for time, developmental, and physical burdens. Caregiver burden correlated with the patient’s ambulatory, psychological, and cognitive status and with the caregiver’s age, gender, income level, and duration of caregiving. Conclusions: We have highlighted the relationship between caregiver and patient characteristics in a cohort of elderly Turkish patients with neurological and musculoskeletal disorders. In particular, we have highlighted the heavy caregiver burden in a developing country. Clinical Relevance: Our results may guide the nurses to understand the requirements of caregivers and to help them find suitable resources that would meet their needs to cope with their burden.

The relationship between functional disability and depression in patients with rheumatoid arthritis and ankylosing spondylitis

AbstractThis study was performed to investigate the relationship between functional disability and depression in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Twenty-three patients with RA, twenty-seven patients with AS and thirty-five healthy individuals were included. Morning stiffness duration, patients pain evaluation, Stanford health assessment questionnaire (HAQ), Beck depression inventory (BDI), serum C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were evaluated in the RA group. Also, morning stiffness duration, pain levels, Bath ankylosing spondylitis functional index (BASFI), BDI, CRP and ESR levels were measured in the AS group. Significant positive correlations between BDI scores and age, disease duration, pain and HAQ scores were found in the RA group (p < 0.01, p < 0.05, p < 0.05, p < 0.001, respectively). Also, there were similar correlations between BDI scores and disease duration, pain and BASFI scores in the AS group (p < 0.05, p < 0.0...

Decreased percentage of CD4 and CD8 lymphocytes in the synovial fluid of patients with rheumatoid arthritis

AbstractThe purpose of this study was to determine peripheral blood (PB) and synovial fluid (SF) CD4 and CD8 cells in 18 patients with active rheumatoid arthritis (RA). Flow cytometry techniques were used to analyze and compare distribution of lymphocyte subpopulations in PB and SF samples. The lymphocytes of PB from 20 normal subjects served as the control group. The mean percentages of CD4 and CD8 in SF were significantly lower than in PB of the patients and controls (p 0.05). The mean CD4/CD8 ratio was significantly lower in SF of patients than in PB of both patient and control groups (p 0.05). No correlations were found between the mean CD4/CD8 ratio and erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) or Ritchie Articular Index (RAI). T...

Relapsing polychondritis: inflamed joints and ears.

BACKGROUND Relapsing polychondritis (RP) is an episodic and progressive inflammatory disease of the cartilaginous structures, including elastic cartilage of the ear and nose, hyaline cartilage of the peripheral joints, fibrocartilage at axial sites, and cartilage of the tracheo-bronchial tree. The spectrum of its presentations may vary from intermittent mild episodes of chondritis to occasional organ involvement or even life-threatening manifestations. CASE REPORT We presented a 64 year-old male patient with bilaterally knee arthritis and discoloration of pinna. CONCLUSION There is lack of awareness about this disease due to its rarity. With this case presentation, our goal was to draw attention to this disease, which could be delayed for the diagnosis.

Agreement of Turkish Physiatrists with the Assessment in Spondyloarthritis International Society and the European League Against Rheumatism Recommendations for the Management of Ankylosing Spondylitis and Rheumatoid Arthritis

Background: New developments in the field of targeted therapies or biologic agents led more effective management of ankylosing spondylitis (AS) and rheumatoid arthritis (RA). Recommendations for the management of rheumatic diseases propose to reduce inappropriate use of medications, minimize variations among countries, and enable cost-effective use of health care resources. Objective: The aim this study was to evaluate conceptual agreement of ASsessment in SpondyloArthritis International Society (ASAS) and the EUropean League Against Rheumatism (EULAR) recommendations for the management of AS and EULAR recommendations for RA and to assess the rate of application among Turkish physiatrists in daily clinical practice. Methods: An online survey link has been sent to 1756 Turkish physiatrists with e-mails asking to rate agreement on 11-item ASAS/EULAR AS recommendations and 15-item EULAR RA recommendations with synthetic and biological disease-modifying anti-rheumatic drugs. Also barriers and difficulties for using biologic agents were assessed. Results: Three hundred nine physiatrists (17.5%) completed the survey. The conceptual agreement with both recommendations was very high (Level of agreement; mean 8.35±0.82 and 8.90± 0.67 for RA and AS recommendations, respectively), and the self-declared application of overall recommendations in the clinical practice was also high for both RA and AS (72.42% and 75.71%, respectively). Conclusion: Turkish physiatrists are in good conceptual agreement with the evidence-based recommendations for the management of AS and RA. These efforts may serve to disseminate the knowledge and increase the current awareness among physicians who serve to these patients and also implementation of these recommendations is expected to increase as well.

The profile of soluble adhesion molecules in patients with Behcet's disease: a possible association with disease activity

AbstractOur objective was to evaluate the profile of circulating soluble adhesion molecules and whether changes in these molecule levels are related to disease activity in patients with Behcets disease (BD). A sandwich enzyme-linked immunosorbent assay (ELISA) was used to measure levels of soluble (s) intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), sE-selectin, sL-selectin and sP-selectin in sera from 20 consecutive patients with active BD and in sera from 20 age and sex matched healthy controls. At the active stage, slCAM-1, sVCAM-1, and sE-selectin levels were significantly higher in active patients than in healthy controls (p < 0.01, p < 0.001, p < 0.001, respectively). All active patients were treated with different therapeutic medications. When patients achieved clinical remission, sICAM-1, sVCAM-1 and sE-selectin levels were significantly decreased compared with those in active patients (p < 0.05, p < 0.01, p < 0.001, respectively). No statistically signifi...