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Öğe A case of granulomatosis with polyangiitis and pyoderma gangrenosum successfully treated with infliximab and rituximab(Wiley, 2014) Donmez, Salim; Pamuk, Omer N.; Gedik, Mustafa; Ak, Recep; Bulut, GulayHere, we present a young male patient who was admitted with alveolar hemorrhage, arthritis and cutaneous lesions, who later developed bilateral orbital involvement and pyoderma gangrenosum (PG). He also had pathergy test positivity. The patient was refractory to conventional immunosuppressive therapy. Therefore, multiple devastating PG lesions and disease activity in granulomatosis with polyangiitis (GPA) were controlled with infliximab. Later, rituximab was used with success to prevent recurrence of symptoms. The relationship of PG with various autoimmune diseases is known; however, PG in GPA has been only rarely reported. Biologic agents might prove to be effective in GPA and PG patients who are refractory to standard immunosuppressive therapy.Öğe Clinical and epidemiologic data on chronic lymphocytic leukemia patients followed up at a tertiary center in Turkey(Taylor & Francis Ltd, 2015) Pamuk, Gulsum Emel; Uyanik, Mehmet Sevki; Aydogdu, Erkan; Ak, Recep; Demir, Ahmet Muzaffer; Harmandar, Orbay[Abstract Not Available]Öğe Clinical characteristics of haematological malignancy patients diagnosed with leukaemia cutis: Experience of a single centre(Wiley, 2015) Pamuk, Gulsum Emel; Ak, Recep; Tasci, Murat; Harmandar, Ferda; Demir, Muzaffer; Arican, OzerBackground/ObjectivesWe evaluated the clinical characteristics of patients with haematological malignancies at our centre who were diagnosed with leukaemia cutis (LC). In addition, we describe the spectrum of other skin lesions, including, secondary skin malignancies and nonspecific benign skin lesions in haematological malignancy patients. MethodsWe defined 58 skin lesions that developed in 54 inpatients hospitalised in the Department of Haematology, Trakya University Medical Faculty, Turkey. All skin lesions that developed in inpatients between 2006 and 2012 had been evaluated by a dermatologist. The patients' clinical features, skin biopsy results and therapies were obtained from hospital files. The diagnosis of LC was based on clinical features and histopathological examinations of the skin biopsy. ResultsThere were 11 patients with LC. Six (54.5%) had acute myeloblastic leukaemia. In nine patients (82%), LC was present at the initial presentation. Secondary skin malignancy was detected in 11 patients (five basal cell carcinoma, four Kaposi's sarcoma, one squamous cell carcinoma, one malignant melanoma); and malignancy was present in two patients (18%) at the initial presentation. Nonspecific benign skin lesions, the most frequent of which were drug eruptions, were determined in 32 of our patients. LC had a significantly higher likelihood of being present at initial presentation than other skin lesions (P<0.01). The median survival in LC patients was quite short (4.5 months). ConclusionsLC was usually diagnosed at the initial presentation of the patient or during the early course of the disease. Having LC was a poor prognostic factor.Öğe Clinical Features and Types of Articular Involvement in Patients with Psoriatic Arthritis(Clinical & Exper Rheumatology, 2014) Donmez, Salim; Pamuk, Omer Nuri; Akker, Mustafa; Ak, Recep[Abstract Not Available]Öğe Clinical features and types of articular involvement in patients with psoriatic arthritis(Springer London Ltd, 2015) Donmez, Salim; Pamuk, Omer Nuri; Akker, Mustafa; Ak, RecepPsoriatic arthritis (PsA) is a psoriasis-associated inflammatory arthritis which causes joint destruction. There are some epidemiologic data about PsA; however, there are no sufficient data from Turkey. Herein, we evaluated the frequency of PsA in the Thrace region of Turkey according to hospital-based data. In addition, we evaluated clinical features and types of joint involvement in PsA patients. We included 172 PsA patients fulfilling CASPAR criteria admitted to the Division of Rheumatology, Trakya University Medical Faculty, between 2003 and 2012. Data from Turkish Statistical Institution was used to calculate the incidence and prevalence of PsA. Patients' demographic features, durations of psoriasis and PsA, number of tender and swollen joints, treatment modalities, laboratory data, and X-ray film findings were recorded from hospital files. The annual incidence of PsA was 2.8/100,000. The mean annual incidence was 3.47/100,000 in females and 2.15/100,000 in males. The overall prevalence of PsA in our region was 27.9/100,000 (95 % confidence interval (CI) 23.7-32.1) in individuals > 16 years. The prevalence of PsA was higher in females than in males (34.7/100,000 vs. 21.5/100,000). Polyarthritis was present in 67 (38.9 %), oligoarthritis in 47 (27.3 %), spondyloarthritis in 39 (22.6 %), and distal interphalangeal (DIP) arthritis in 19 (11.0 %) patients. The duration of psoriasis was significantly longer in polyarticular PsA patients than in DIP and oligoarticular groups (p values = 0.016 and 0.018, respectively). The number of swollen joints correlated with age (r = 0.21, p = 0.006), duration of psoriasis (r = 0.20, p = 0.01), number of tender joints (r = 0.92, p a parts per thousand currency signaEuro parts per thousand 0.001), ESR (r = 0.24, p = 0.001), and CRP (r = 0.17, p = 0.026). The frequency of PsA in Thrace region is similar to that in low-frequency regions. The most frequent type of involvement was polyarticular, and it correlated with the duration of psoriasis and erosive disease.Öğe Cognitive Dysfunction in Chronic Renal Disease: Impact of Dialysis Modality(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2015) Ak, Recep; Ustundag, Sedat; Ustundag, Ayten; Guldiken, Baburhan; Sut, NecdetOBJECTIVE: Cognitive dysfunction (CD) is common among patients with chronic kidney disease (CKD) and contributes to morbidity and mortality. We aimed to explore the factors involved in the development of CD in patients with CKD and to compare cognitive function between hemodialysis (HD) and peritoneal dialysis (PD) patients. MATERIAL and METHODS: We studied 122 patients with different stages of CKD, and divided them into two groups: Predialysis Group: included 60 CKD patients, (28 stage III and 34 stage IV); Dialysis Group: included 60 patients on dialysis therapy, (30 on HD and 30 on PD). Psychometric tests were done all patients. The results were compared with 41 healthy subjects. RESULTS: We found that the CD rate was higher in patients with CKD (24.6%) than controls (0%, p<0.001). The Mini Mental Test score was found to be correlated with age (r=-0.428), hemoglobin (r=0.336), CRP (r=-0.311), and albumin (r=0.336); the Calculation Test score was found to be correlated with LDL cholesterol (r=-0.336); the Praxis Test Score was found to be correlated with duration of CKD (r=-0.204), HDL (r=0.188); and the Visual Memory Test score was found to be correlated with parathormone levels (r=-0.270). We found the CD rate to be higher in patients on HD (50%) than on PD (23.3%, p=0.032). CONCLUSION: Our findings suggest that anemia, malnutrition and inflammation play an important role in the development of CD in our patients, and cognitive functions are better preserved in the PD group than the HD group.Öğe Gastrointestinal symptoms are closely associated with depression in iron deficiency anemia: a comparative study(K Faisal Spec Hosp Res Centre, 2015) Pamuk, Gulsum Emel; Uyanik, Mehmet Sevki; Top, Mehmet Serif; Tapan, Umit; Ak, Recep; Uyanik, VesileBACKGROUND AND OBJECTIVES: Until now, very few studies evaluated the association between gastrointestinal and psychiatric symptoms in iron deficiency anemia (IDA). The study investigated the frequency of functional dyspepsia (FD) in IDA patients and determined its association with depression and somatization. DESIGN AND SETTINGS: The study was conducted at the Hematology Department of Trakya University Medical Faculty, which is a tertiary referral center in northwestern Turkey. It was a case-control study. MATERIALS AND METHODS: A total of 125 consecutive IDA patients and 57 healthy control subjects were included. Patients and controls were questioned about the severity of their gastrointestinal system (GIS)-related symptoms and the presence of constipation and associated symptoms using a visual analog scale. In addition, IDA patients were administered a validated depression scale (Beck Depression Inventory, BDI) and somatization symptoms checklist. RESULTS: IDA patients had more frequent self-reported constipation compared with controls (56% vs 22.8%, P<.001). The mean scores of bloating, dyspepsia, and constipation-related quality of life (QoL) disturbance were significantly higher in the IDA group than in the control group (all P values <=.01). A total of 71 IDA patients were depressed according to the BDI. Depressed IDA patients had higher mean reflux, bloating, halitosis, and dyspepsia-related QoL disturbance scores compared with nondepressed patients (all P values <=.01). Their frequency of self-reported constipation and mean constipation-related QoL disturbance score (P values, .002 and <.001) were also higher. Depressed IDA patients had significantly higher somatization scores compared with others (P=.001). CONCLUSION: An increased frequency of dyspepsia symptoms and constipation-related QoL disturbance were observed in IDA patients. The findings of this study suggested that in IDA patients without red flags in favor of malignancy, physicians should try to uncover any psychiatric factors before undertaking extensive GIS investigation.Öğe Is iron-deficiency anemia associated with migraine? Is there a role for anxiety and depression?(Springer Wien, 2016) Pamuk, Gulsum Emel; Top, Mehmet Serif; Uyanik, Mehmet Sevki; Koker, Hilal; Akker, Mustafa; Ak, Recep; Yurekli, Omer AtalayIn this study, we determined the frequency of migraine headache in iron-deficiency anemia (IDA) patients and whether it was related to anxiety, depression, and somatization. We included 127 consecutive IDA patients into the study. All patients were asked validated questions about headache and migraine face-to-face. They were administered validated questionnaires for anxiety-depression The Hospital Anxiety and Depression Scale and somatization. The quality of life (QoL) disturbance associated with headache was marked on a 0-10 VAS. Of all IDA patients, 79.5 % defined headache at any time of their life. In addition, 36.2 % of all IDA patients defined the criteria for migraine. IDA patients with migraine were more frequently smokers and had significantly lower hemoglobin and mean corpuscular volume values (p values < 0.05). The IDA group with migraine had significantly higher mean anxiety score (p = 0.046) and headache-related QoL disturbance score (p = 0.021) than the IDA group without migraine. Migraine patients with aura had lower hemoglobin values (p = 0.02), higher depression scores (p = 0.005), and higher migraine-related QoL disturbance scores than others. IDA patients have a high frequency of migraine headache. The presence of anxiety and depression have great influence on the presence of migraine in IDA patients.Öğe Kronik böbrek hastalarında kognitif fonksiyonların değerlendirilmesi(Trakya Üniversitesi Tıp Fakültesi, 2012) Ak, Recep; Üstündağ, SedatKronik böbrek hastalığı sürecinde kognitif fonksiyon bozukluğu gelişiminin ki artmış mortalite hızına önemli katkı sağladığı öne sürülmüştür. Çalışmamızda 41 sağlıklı birey ile karşılaştırmalı olarak 62'si diyaliz aşamasına gelmemiş (28'i evre 3, 34'ü evre 4) 60'ı diyaliz tedavisi olan (30'u hemodiyaliz, 30'u periton diyalizi uygulanan) toplam 122 kronik böbrek hastalığı olgusunda kognitif fonksiyon bozukluğunun yaygınlığını ve gelişiminde etkili faktörleri araştırdık. Özetle, yaş, cinsiyet, sigara içim süresi ve oranı, vücut kitle indeksi, sistolik ve diyastolik kan basıncı düzeyleri açısından sağlıklı gönüllülerden oluşan kontrol grubu ile benzer özellikler gösteren hasta grubumuzda belirgin kognitif fonksiyon bozukluğu gelişmiş olduğunu saptadık. Hastalarımızdaki kognitif fonksiyon bozukluğunun böbrek hastalığının erken evresinden itibaren geliştiğini, diyaliz tedavisi gören olgularda kognitif fonksiyon bozukluğu olan hastalarını oranının üçte bir oranına ulaştığını gözlemledik. Ayrıca, periton diyalizi uygulanan hastalarda kognitif fonksiyonların hemodiyaliz uygulanan hastalara göre daha iyi korunmuş olduğunu gördük. Hastalarımızdaki kognitif fonksiyon bozukluğunun hemoglobin düşüklüğü, malnutrisyon, inflamasyon, hiperparatiroidi ve üremik toksin düzeylerinin yüksekliği ile ilişkili olduğunu saptadık. Bulgularımız, kronik böbrek hastalarında yaşam kalitesi ve mortalite riski ile yakından ilişkili olan kognitif fonksiyon bozukluğu gelişiminin erken tanınması ve gelişiminde etkili kontrol altına alınabilmesi durumunda azaltılabileceğini düşündürmektedir.Öğe Kronik Böbrek Hastalığında Bilişsel Fonksiyon Bozukluğu: Diyaliz Modalitesinin Etkisi(2015) Ak, Recep; Üstündağ, Sedat; Üstündağ, Ayten; Güldiken, Babürhan Feyzullah; Süt, Necdetamaç: Kronik böbrek hastalığı (KBH) olanlarda, morbidite ve mortalite artışına yol açan bilişsel fonksiyon bozukluğu (BD)'na sık rastlanır. çalışmamızda, KBH olgularında BD gelişimine etkili faktörleri araştırmayı, hemodiyaliz (HD) ve periton diyalizi (HD) uygulamalarının BD gelişimine etkisini incelemeyi amaçladık.GEREÇ ve YÖNTEMLER: Henüz diyaliz aşamasına gelmemiş 62 (Prediyaliz Grubu; 28'i evre III, 34'ü evre IV) hasta ile diyaliz tedavisi uygulanmakta olan 60 (Diyaliz Grubu; 30'u HD, 30'u PD) hastadan oluşan toplam 122 KBH'lı olgu grubumuzda ve 41 sağlıklı bireyde bilişsel fonksiyonları karşılaştırmalı olarak inceledik bulGular: KBH'lı olgularımızda BD gelişme oranının (%24,6), sağlıklı olgulara göre (%0) çok yüksek olduğunu bulduk (p<0,001). Mini Mental Test puanının hasta yaşı (r=-0,428), hemoglobin (r=0,336), CRP (r=-0,311), albümin (r=0,336); Hesaplama Testi puanının LDL kolesterol (r=-0,336); Praksis Testi puanının hastalık süresi (r=-0,204), HDL (r=0,188); Görsel Hafıza Testi puanının parathormon düzeyi ile (r=-0,270) ilişkili olduğunu saptadık. HD uygulanmakta olan hastalarımızda BD yaygınlığının (%50), PD grubuna göre (%23,3) daha yüksek olduğunu (p=0,032) gözledik.sonuç: Bulgularımız, anemi, malnütrisyon, inflamasyon varlığının hastalarımızdaki BD gelişiminde önemli rol oynadığını ve PD uygulanan hastalarda bilişsel fonksiyonların HD uygulananlara göre daha iyi korunduğunu göstermektedır
