Savaş Gürsoy

Significance of catechol-O-methyltransferase gene polymorphism in fibromyalgia syndrome

Abstract. Fibromyalgia syndrome (FS) is associated with a neuroendocrinal disorder characterized by abnormal function of the hypothalamic-pituitary-adrenal (HPA) axis, including hyperactive adrenocorticotropic hormone (ACTH) release and adrenal hyporesponsiveness. Catechol-O-methyltransferase (COMT) enzyme inactivates catecholamines and catecholamine-containing drugs. Polymorphism in the gene encodes for the COMT enzyme. For this study, the significance of COMT polymorphism was assessed in FS. There were three polymorphisms of the COMT gene: LL, LH, and HH. The analysis of COMT polymorphism was performed using polymerase chain reaction (PCR). Sixty-one patients with FS and 61 healthy volunteers were included in the study. Although no significant difference was found between LL and LH separately, the LL and LH genotypes together were more highly represented in patients than controls (P=0.024). In addition, HH genotypes in patients were significantly lower than in the control groups (P=0.04). There was no significant difference between COMT polymorphism and psychiatric status of the patients as assessed by several psychiatric tests (P>0.05). In conclusion, COMT polymorphism is of potential pharmacological importance regarding individual differences in the metabolism of catechol drugs and may also be involved in the pathogenesis and treatment of FS through adrenergic mechanisms as well as genetic predisposition to FS.

Association of T102C polymorphism of the 5-HT2A receptor gene with pyschiatric status in fibromyalgia syndrome

Abstract. Serotonin (5-HT) is a key neurotransmitter in the central nervous system. It is suggested that serotonergic dysfunction may be involved in the pathophysiology of fibromyalgia syndrome (FS). In this study, we aimed to investigate T102C polymorphism of the 5-HT2A receptor gene in FS. Fifty-eight patients with FS and 58 unrelated healthy volunteer controls were included in the study. In both groups, the C/C, C/T, and T/T genotypes of the 5-HT gene were represented in 31% (22.4% in controls), 50% (53.4%), and 19% (24.1%), respectively. The 5-HT2A receptor gene polymorphism results were not significantly different between patients and controls (chi squared test, P>0.05). There was a significant correlation between patients with the T/T genotype and the subgroup according to the SCL-90-R test, (analysis of variance, P<0.05). We also saw that patients with the T/T genotype had the lowest pain threshold. Conclusion. T102C polymorphism of the 5-HT2A receptor gene is not associated with the etiology of FS. Our results also indicate that the T/T genotype may be responsible for psychiatric symptoms of FS.

Brucellosis of the spine: evaluation of the clinical, laboratory, and radiological findings of 14 patients

In this study, we aimed to assess the clinical, laboratory and radiological findings of vertebral involvement in brucellosis. Fourteen patients diagnosed with spondylitis and spondylodiscitis due to brucellosis were included in the study. Computed tomography, magnetic resonance imaging, or scintigraphy were used to diagnose the vertebral involvement. The control group consisted of 20 patients with brucellosis but no vertebral involvement. The clinical, laboratory, and radiological findings of both groups were compared. The prevalence of vertebra involvement in brucellosis was found to be 7.5%. Of the 14 study patients, two had thoracic, ten had lumbar, and two had both lumbar and sacral vertebral involvement. The associated pathologies were spondylodiscitis, narrowing in the intervertebral space, inflammation or abscess formation in the paravertebral soft tissue, and osteophyte formation. None of the patients had a collapsed vertebral body, angulation deformity, or inflammation in the epidural space. In conclusion, the possibility of vertebral involvement should be remembered in chronic brucellosis, particularly in elderly patients who present with back pain or tenderness over the spine. A high index of suspicion and clinical, laboratory, and radiological examinations help confirm the diagnosis of vertebral involvement.

Neurotologic manifestations of the fibromyalgia syndrome

The purpose was to assess otologic symptoms, and audiologic and vestibular findings in fibromyalgia (FM) syndrome. Twenty-four female patients with FM syndrome (FMS) were included in the study. The assessments were based on history, physical examination, audiometry, bithermal caloric testing and auditory brainstem response (ABR) testing. Dizziness was the most common complaint of the patients, and was followed by tinnitus, hearing loss and vertigo. Almost 50% of the patients had some sort of otologic symptoms.Dix-Halpike maneuver proved positional rotary vertigo in 5 (20.8%) patients. The audiometry results of 23 patients were normal. None of the patients had abnormal bithermal caloric testing. Although there were a variety of ABR abnormalities, the ABR results of the patients with and without cochleovestibular symptoms were not significantly different (p<0.05). In conclusion, FM patients can complain otologic symptoms even though they do not have any clinically or audiologically detectable ear disease. A neural disintegration or some other events related to neural mediators may be the mechanisms involved in the pathogenesis of otoneurologic as well as systemic manifestations of the disease that possibly leads to abnormal perception of the stimuli coming from internal or external environment.

Plasma nitrite levels, total antioxidant status, total oxidant status, and oxidative stress index in patients with tension-type headache and fibromyalgia

OBJECTIVES Tension-type headache (TTH) and fibromyalgia syndrome (FM) are worldwide seen chronic pain syndromes of unknown etiology. Despite the growing body of data on pathophysiology and generation mechanisms of pain; our knowledge on pain mechanisms in both FM and TTH is yet to be limited. PATIENTS AND METHODS We investigated the plasma nitrite levels, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) in 35 TTH, 33 FM patients and 31 healthy controls. RESULTS The mean plasma nitrite levels and TAS levels were significantly low and OSI was found to be significantly high in TTH and FM groups compared to the control group (p=0.001, p=0.001, p=0.001 and p=0.001, respectively). The mean serum TOS levels were also significantly higher in FM group according to the control group (p=0.034), but there was not a significant difference between TTH and control groups (p=0.066). CONCLUSION These results indicated that; FM and TTH patients revealed higher oxidative stress index and lower total nitrite levels than healthy controls. We conclude that oxidative stress may have a role in the pathophysiological mechanisms of TTH and FM, although, whether it is the cause or the consequence, is not clear.

No evidence for an association between the Glu298Asp polymorphism of the endothelial nitric oxide synthase gene and fibromyalgia syndrome

The objective of this study was to analyze the genotype distributions and allele frequencies for the Glu298Asp (G894T) polymorphism of the eNOS gene and the serum nitric oxide level among the patients with fibromyalgia syndrome (FS). Ninety-six fibromyalgia patients and 79 unrelated healthy volunteer controls were included in the study. All patients and controls were females. Genomic DNA from 96 patients meeting the American College of Rheumatology 1990 criteria for FS and 79 healthy controls was analyzed by polymerase chain reaction. A polymerase chain reaction–restriction fragment-length polymorphism analysis of eNOS gene polymorphism was performed, and the results of the patients with FS and healthy controls were compared. Ozone-based chemiluminescence assay with Sievers NO Analyzer was used to measure the serum nitric oxide levels. Neither the frequencies of the Glu298Asp genotypes nor the serum nitric oxide levels showed a significant difference between the groups. These results suggested that FS of the Turkish population seemed to develop without any alterations in eNOS Glu298Asp genotype frequency and the serum nitric oxide level.

The relation between genitourinary prolapse and joint hypermobility in Turkish women

ObjectiveIn this cross-sectional study, we compared frequency of hypermobility syndrome in pelvic organ prolapse (POP) patients and normal healthy Turkish women.MethodsSixty-five women who had diagnosed as POP and ward to surgery and 52 healthy women with similar age group were included into this study.ResultsIt was found that subjects with POP had a significantly higher prevalence of joint hypermobility (53.8%) when compared with normal individuals (9.6%). No significant correlation was demonstrated between Beighton scores and incontinence, exercises pattern and hormone replacement therapy.ConclusionWe concluded that joint laxity is associated with POP but not with urinary incontinence in Turkish women.

Hand deformity in rheumatoid arthritis and its impact on the quality of life

Abstract Objective: For the purpose of this study, we assessed the frequency of hand deformities in rheumatoid arthritis (RA) as well as the impact of these deformities on the quality of life of the patients. Method: A group of 87 consecutive patients who had been admitted to the Department of Physical Medicine and Rehabilitation of our University Hospital between 2000 and 2002 were included in the study. 66 (76%) were females and, 21 (24%) were males with definite or classical RA. Patients who had undergone articular surgery or had warm and swollen joints were excluded. A protocol was designed to record age, dominant hand, duration of disease, and results of the physical examination. Hand disability was assessed by using a special hand disability index, which was composed by seven items. Result: There was hand deformity in 71 (81.5%) patients. The most common hand deformity was flexor tenosynovitis (64.5%). The other deformities were ulnar deviation (39.5%), boutonniere deformity (29.5%) and swan neck de...

Serum Vitamin D Level and its Relation with Clinical Parameters in Fibromyalgia as a Neuropathic Pain

The aim of this article is to examine the role of vitamin D on severity of pain in patients with fibromyalgia. Eighty premenopausal female fibromyalgia patients and 90 healthy controls were included in the study. The demographic characteristics of all subjects, including age, and body mass index, were recorded. The number of tender points was recorded, and the intensity of pain of the subjects was measured by Visual Analogue Scale (VAS). Fibromyalgia Impact Questionnaire (FIQ) was used to evaluate disease severity. The mean age was 44.86 ± 2.4 and 41.48 ± 4.1 years for the patient and control groups, respectively (p=0.08). The mean levels of vitamin D in patient and control groups were determined as 19.9 ± 4.5 and 32.97 ± 13.31 ng/ML, respectively (p<0.001). Apart from BMD in lumbar spine and femur which were significantly lower in the patients compared with healthy women. Vitamin D levels were negatively correlated with VAS (r=-0.653; p=0.001) and FIQ total scores in the fibromyalgia group (r=-0.344; p=0.030). Furthermore, the mean value of LANSS was 16.5 ± 0.4 in patient group. In conclusion, the study confirmed high prevalence of hypovitaminosis D and osteoporosis in patients with FMS than in controls. Furthermore, vitamin D was closely related with pain and disease severity.

Efficacy of transdermal fentanyl in patients with mechanic neck or back pain

Study population included 50 subjects who were consecutively recruited from Gaziantep University Department of Physical Medicine and Rehabilitation among patients referred for screening of mechanic low back or neck pain. They were diagnosed as cervical or lumbar disc herniation according to their clinical and radiological findings. The demographical features, medications, duration of each medications, concomitant diseases, routine test results were recorded. The severity of pain, health related quality of life was evaluated by Visual Analogue Scale (VAS), Short Form 36 (SF 36) in respectively. Transdermal fentanyl was applied as 12 μg/h patch after the first evaluation. Mean age of patients with low back pain and neck pain was measured as 43.6±10.5 and 48.7±10.6 years, respectively. There were no significant differences between two patients group in respect to age, gender, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) levels (p>0.05). There were significant healing in mean scores of role emotional, physical functioning, role physical, bodily pain subscales of SF 36 after treatment in cervical disc herniation group (p