Mustafa Yurtkuran

The effect of balneotherapy on patients with ankylosing spondylitis

Objective: To compare the effect of balneotherapy on physical activity and quality of life as well as the symptoms of pain and stiffness with exercise alone in ankylosing spondylitis (AS) patients. Methods: A total of 60 patients who had a diagnosis of AS according to the modified New York criteria were included in the study. The patients were randomly assigned to two groups. In Group I (n = 30) the patients received balneotherapy in a therapeutic pool for 30 min once a day for 3 weeks. All patients received instructions on the exercise programme, which they were requested to repeat once a day for 30 min during the study. The patients in this group continued the same exercise programme after the end of the balneotherapy protocol to complete a course of 6 months. In Group II the patients were given the same exercise protocol but did not receive balneotherapy. Patients were evaluated before the start of the study and at 3 weeks and 24 weeks. Evaluation parameters were daily and night pain, morning stiffness, the patients global evaluation and the physicians global evaluation (according to a scoring system of 1 to 5), the Bath Ankylosing Spondilitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Dougados Functional Index (DFI), tragus–wall distance, chest expansion, modified Shober test (MST), fingertip–fibula head distance, and Nottingham Health Profile (NHP). Results: Evaluations were completed in 54 patients in the two groups. Comparison of the groups showed significantly superior results for Group I for parameters of BASDAI, NHP total, pain, physical activity, tiredness and sleep score, patients global evaluation and the physicians global evaluation at 3 weeks, but only for the parameters of patients global evaluation and MST at 24 weeks. Conclusion: Balneotherapy has a supplementary effect on improvement in disease activity and functional parameters in AS patients immediately after the treatment period. However, in the light of our medium‐term evaluation results, we suggest that further research is needed to assess the role of balneotherapy applied for longer durations in AS patients.

Urinary IL-18: a marker of contrast-induced nephropathy following percutaneous coronary intervention?

OBJECTIVES Contrast-induced nephropathy (CIN) is a complication that is underestimated in clinical practice after cardiac catheterization. Recently, the value of interleukin (IL)-18 as a novel biomarker for the detection of acute renal failure has been highlighted. In the present study, we sought to investigate whether urine IL-18 may be an early diagnostic marker of CIN. DESIGN AND METHODS We performed a nested case-control study using a hospital based cohort of all patients (n=157) admitted for elective PCI for stable angina to the Uludag University School of Medicine between February 2007 and June 2007. We identified 15 patients (9.5%) with CIN. Controls were matched with cases at an attempted 2.5:1 ratio by age and gender. Urinary IL-18 values were measured before as well as 24 and 72 h after the PCI. RESULTS No statistically significant differences in urine IL-18 were detected between cases (n=15) and controls (n=36) or between the patient samples obtained before PCI and after the invasive procedure in both study groups. CONCLUSIONS These findings argue against the hypothesis that urine IL-18 may be clinically useful as a biomarker of CIN after radiological procedures requiring intravascular administration of iodinated contrast media. Further studies with larger sample sizes are needed to validate our findings.

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.

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‐1β, 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‐1β−511 TT genotype was higher in the BD group in comparison to the control group. Interestingly, we demonstrated that IL‐1 β +3962 gene polymorphism seems to be associated with the presence of Erythema nodosum in BD patients. Our data suggest that polymorphisms in IL‐1β 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.

Efficacy of a self-management program for osteoporotic subjects.

Alp A, Kanat E, Yurtkuran M: Efficacy of a self-management program for osteoporotic subjects. Am J Phys Med Rehabil 2007;86:633–640. Objective:This study is based on whether the self-management program choices For Better Bone Health is effective to promote behavioral strategies for improving bone health, life quality, pain perception, physical function, and balance in osteoporotic subjects. Design:In this single-blind, randomized controlled study, a total of 50 sedentary women with postmenopausal and idiopathic osteoporosis were selected from the outpatients of Atatürk Balneotherapy and Rehabilitation Center according to their physical activity level and T scores of dual-energy x-ray absorptiometry as the inclusion criteria. Fifty sedentary women with BMD T scores of −2.5 or lower were randomized into two groups (self-management group: group 1; and control group: group 2) and enrolled in a 6-mo study. Participants attended self-management class once a week for 5 wks. Evaluations were done at baseline, at the end of the fifth week, and at the sixth month. Pain-intensity evaluation by Visual Analogue Scale (VAS), life-quality assessments by SF-36, balance testing by Sensitized Romberg Test (SRT), and functional assessment by Timed Sit to Stand test (TSS) and a simple questionnaire were the outcome measures. Results:When the groups were compared by change scores and percentages of change, improvements observed in pain intensity by VAS (P < 0.001), SF-36 Physical Function (P < 0.001), SF-36 Physical Role Limitations (P < 0.001), SF-36 Social Function (P < 0.001), SF-36 Mental Health (P < 0.001), SF-36 Vitality (P < 0.01), SF-36 Pain (P < 0.001), SF-36 General Health Perceptions (P < 0.05), SF-36 Emotional Role Limitations (P < 0.01), SRT eyes open (P < 0.001), SRT eyes closed (P < 0.001), and TSS (P < 0.001) were determined to be superior in group 1 at the end of the sixth month. Seventy-four percent of patients in group 1 engaged in regular physical activities, and 92% of them declared that they understood the purpose and benefits of medications and dietary calcium intake. Fifty-seven percent of them formed personal plans for preventing traumas, whereas 8% of the subjects in group 2 experienced new falls but no fractures. Conclusion:It is determined that the self-management class led to improvements in functional, balance, and life-quality outcomes and to reductions in pain perception.

Angiotensin-II receptor antagonist losartan reduces microalbuminuria in hypertensive renal transplant recipients

In recent years, it has been demonstrated that losartan lowers macroproteinuria in diabetic or non‐diabetic renal transplant recipients (RTx) similar to angiotensin converting enzyme (ACE) inhibitors. Microalbuminuria (MAU) may reflect subclinical hyperfiltration damage of the glomerulus. It could be a marker of kidney dysfunction in renal transplantation. The aim of the study was to assess the efficacy of losartan in hypertensive RTx with MAU. This study was conducted in 17 (M/F: 4/13) stable RTx. No change was made in the medical treatment of the patients. All cases received 50 mg/day losartan therapy for 12 wk. Renal functions and MAU were determined 12 and 6 wk and just before the treatment as well as sixth and twelfth week of the treatment in all patients. Losartan satisfactorily lowered systemic blood pressure. A significant reduction in MAU was observed from 103 ± 53 μg/min at the beginning to 59 ± 25 μg/min in the sixth week and 47 ± 24 μg/min in the twelfth week (p=0.0007 and 0.0005, respectively). From the sixth week of the treatment, the therapy significantly decreased hemoglobin, hematocrit and erythrocyte levels but did not change mean leukocyte and platelet counts, urea, creatinine levels and creatinine clearances. No serious side‐effect was observed during the study.

Efficacy of losartan in patients with primary focal segmental glomerulosclerosis resistant to immunosuppressive treatment

Abstract. Usta M, Ersoy A, Dilek K, Özdemir B, Yavuz M, Güllülü M, Yurtkuran M (Uludağ University Medical School, Bursa, Turkey). Efficacy of losartan in patients with primary focal segmental glomerulosclerosis resistant to immunosuppressive treatment. J Intern Med 2003; 253: 329–334.

Changes of plasma free choline and choline-containing compounds’ concentrations and choline loss during hemodialysis in ESRD patients

OBJECTIVES This study was undertaken to determine the changes in plasma free choline and choline-containing compounds in end stage renal disease (ESRD) and to determine if they were lost into the dialysate during hemodialysis. DESIGN AND METHODS Plasma and dialysate free choline, phosphocholine and phospholipid-, phosphatidylcholine-, sphingomyelin-bound choline were measured before, during and after hemodialysis. RESULTS Plasma free and bound choline concentrations (mean +/- standard error of the mean) were 12.9 +/- 0.6 and 2697 +/- 57 microM or 37.3 +/- 0.9 and 2792 +/- 98 microM in controls or in ESRD patients, respectively. Free choline concentrations were correlated (r = 0.598; p < 0.001) with the time the patients were subjected to hemodialysis. Plasma free choline and phosphocholine concentrations are decreased by a total of -8.1 +/- 0.6 micromol/L and -88 +/- 8 micromol/L, respectively; phospholipid-, phosphatidylcholine- and sphingomyelin-bound choline are increased, during hemodialysis. Patients lost about 350 micromoles of choline into the dialysate during hemodialysis. CONCLUSION Plasma free choline concentrations are elevated in ESRD, and a considerable amount of choline is lost into the hemodialysate.

Prevalence of hepatitis C virus antibody in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a disease of unknown aetiology characterised by impaired immune regulation and production of polyclonal autoantibodies. It is reported in the medical literature that in patients with chronic hepatitis resulting from hepatitis C virus (HCV) more autoantibodies such as antinuclear antibodies, anti-ds DNA, antiphospholipid antibody, antithyroglobulin antibody, rheumatoid factor, cryoglobulinaemia, and anti-GOR (an HCV induced, host derived epitope) are seen than in patients with other causes of hepatitis virus.1-3 There have also been reports on HCV associated with several immunological …

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.