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GIRIS ve AMAC: Uzun donem Methotrexat kullanimi artmis karaciger hasari ve fibrozis riski ile iliskilidir. Leflunomid hastalik modifiye edici bir ilactir. Leflunomid nukleer faktor kappa B aktivasyonunun guclu bir inhibitorudur. Ayni zamanda anti-oksidan aktivitesi de vardir. Bu deneysel calismada Methotrexat'in neden oldugu karaciger toksisitesinde Leflunomid tedavisinin etkinligi arastirilmistir. YONTEM ve GERECLER: 39 rat 4 gruba ayrilmistir. Methotrexat'a bagli karaciger toksisitesi tek doz 20mg/kg Methotrexat'in periton icine injeksiyonu ile olusturulmustur. Ardindan Leflunomid 5 gun boyunca 10 mg/kg dozda verilmistir. Ardindan serum ornekleri ve homojenize karaciger ornekleri toplanmistir. Serum alanin aminotransferaz, alkalin fosfataz, superoxide dismutaz, myeloperoxidaz aktivitesi, glutatyon duzeyleri calisilmis ve histopatolojik degerlendirme yapilmistir. BULGULAR: Leflunomid tedavisi tedavi almayan gruba gore karaciger semikantitatif skalaya bagli histopatolojik degerlendirmede anlamli duzelme saglamistir (Patolojik skor 1.1+0.7 ve 5.1+2, p

Background. Adiponectin is an adipocytes-derived hormone which has been shown to possess insulin-sensitizing, antiatherogenic, and anti-inflammatory properties. In acromegaly, the data on adiponectin is contradictory. The relationship between adiponectin levels and cardiac parameters has not been studied. Objectives. The aim of this study was to find out how adiponectin levels were affected in acromegalic patients and the relationship between adiponectin levels and cardiac parameters. Material and Methods. We included 30 subjects (15 male, 15 female), diagnosed with acromegaly and 30 healthy (10 male, 20 female) subjects. Serum glucose, insulin, GH, IGF-1 and adiponectin levels were obtained and the insulin resistance of the subjects was calculated. Echocardiographic studies of the subjects were performed. Results. We determined that adiponectin levels were significantly higher in the acromegalic group than the control group. In the acromegalic group, there was no statistically significant relation between serum adiponectin and growth hormone (GH), or insulin-like growth factor-1 (IGF-1) levels (p = 0.3, p = 0.1). We demonstrated that cardiac function and structure are affected by acromegaly. IVST, PWT, LVMI, E/A ratio, DT, ET, IVRT, VPR, and LVESV values were increased and the results were statistically significant. In the acromegalic group, adiponectin levels were positively related with left ventricle mass index (LVMI) but this correlation was found to be statistically weak (p = 0.03). In our study, there was a positive correlation between VAI and LVM. We also could not find any correlation between VAI and adiponectin levels. Conclusions. Although insulin resistance and high insulin levels occur in active acromegaly patients, adiponectin levels were higher in our study as a consequence of GH lowering therapies. Our study showed that adiponectin levels may be an indicator of the cardiac involvement acromegaly. However, the usage of serum adiponectin levels in acromegalic patients as an indicator of cardiac involvement should be supported with other, wide, multi-centered studies. © Copyright by Wroclaw Medical University.

Background: The purpose of this study was to determine the influential factors of cognitive function in older adults. Methods: In this study, 377 older adults (mean age: 74.71 +/- 6.15 years) were examined. The Hodkinson Abbreviated Mental Test (HAMT) was used to describe cognitive function of the individuals. The Centers for Disease Control (CDC) Health-Related Quality of Life (HRQOL-4) survey tool was used to measure the quality of life. Possible influential factors of cognitive function were also detected. The following independent variables were included in the logistic regression analysis: age, gender, education level, residency, smoking habit, musculoskeletal pain, medication use, number of unhealthy mental days, number of unhealthy physical days, and activity limitation days. Results: The results indicated that the elderly with cognitive impairment showed low scores in terms of the three parameters of the CDC HRQOL-4. The findings also indicate that the following variables were found to significantly affect cognitive function: (1) age, (2) residency (rest home), (3) smoking (yes or quit), and (4) number of unhealthy mental days. Conclusion: Older adults should be assessed in terms of factors related to cognition, such as age, residency, smoking, and mood in order to plan the most suitable geriatric care. Copyright (C) 2013, Taiwan Society of Geriatric Emergency Si Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.

Introduction Dipyridamole is increasingly used for vasodilatation stress test. Caffeine diminishes its effect. At present, there is still no consensus as to whether and how long caffeine should be interrupted. We hypothesized that caffeine impacts the dypyridamole gated MPS findings in patients with coronary artery disease. Methods Thirty-six patients who had >50% stenosis in at least one vessel on coronary angiography (CAG) were included in our study. Gated MPS with standard dipyridamole stress test was used to assess myocardial perfusion defects and LVEF values before and after caffeine ingestion. Myocardial perfusion images and gated analyses were assessed visually and quantitatively. The results were analyzed by the t test for paired observations. Results The mean serum caffeine levels were significantly higher 1 h after caffeine ingestion (1.10 ± 0.05 mg/L vs. 5.82 ± 1.80 mg/L) (p Conclusions We demonstrated that caffeine may cause attenuation of extent and severity of myocardial perfusion abnormalities during dipyridamole stress gated MPS study. Thus, patients should refrain from caffeine at least 1 day before the test.

Purpose To find out how resistin and leptin levels were affected in patients with acromegaly and whether there is a relation between resistin levels and cardiac parameters. We also aimed to investigate whether resistin and leptin may be a link between insulin resistance and cardiac functions as well as these affected cardiac functions in the patients with acromegaly. Methods We included 30 subjects (15 men and 15 women) who had a diagnosis of acromegaly and 30 healthy (10 men and 20 women) subjects. Serum glucose, insulin, growth hormone, insulinlike growth factor 1 (IGF-1), resistin, and leptin levels were obtained, and insulin resistance of subjects were calculated. Echocardiographic studies of the subjects were performed. Results Resistin levels of the patients with acromegaly were found lower than controls. This difference was statistically significant ( P = 0.001). Leptin levels were lower in the patients with acromegaly than in the controls, but this difference was not statistically significant. Resistin and leptin levels were not correlated with growth hormone, IGF-1, and with insulin-like growth factor binding protein 3 levels. Homeostasis model assessment of insulin resistance was positively correlated with resistin levels. ( P = 0.03; r = 0.531) but not correlated with leptin levels. There was a positive correlation between body mass index and leptin levels in the patients with acromegaly ( P = 0.007; r = 0.482). Interventricular septum thickness, posterior wall thickness, left ventricle mass index, peak early mitral inflow velocity–peak late mitral inflow velocity ratio, deceleration time, ejection time, isovolumetric relaxation time, velocity propagation, and left ventricular end-systolic volume values were significantly greater in the patients with acromegaly. Leptin levels in the acromegalic patients were not correlated with any of them. Conclusions We found biventricular hypertrophy and impairment of diastolic and systolic function in the patients with acromegaly. We conclude that changes in resistin and leptin levels are unlikely to account for the insulin resistance of acromegaly. They do not also seem to be contributing factors of cardiovascular changes in patients with acromegaly.

The aim of this study was to determine balance problems and severity and ratio of postural instability of newly diagnosed, early stage Parkinson’s patients who did not receive any antiparkinson treatment before, to evaluate fall risk clinically and posturographically and to examine the effects of pramipexole on these signs and symptoms. Detailed posturographic assessments which involved central vestibular, visual, peripheric vestibular somatosensory field tests were applied to both patient and control subjects and fall risk was determined. There was not statistically significant difference between patients and control subjects before and after drug therapy in the assesment of fall risk in posturography and there was not any improvement with drug usage in the patient group. However, in the analysis of subsystems separately, only the involvement in central vestibular field was more severe and could appear at all positions in Parkinson’s patients comparing with the control group, and pramipexole was partially effective in improving this disorder. Central vestibular field is the subsystem that should be examined with first priority. Posturography is relatively reliable in defining fall risk and postural instability ratio in Parkinson’s disease. But it should be considered that clinical assessment tools can be more sensitive in the evaluation of balance and postural disorders and in the follow-up of the response to drug therapy.

Dyes are known to be a causative agent of occupational asthma in workers exposed to them. We have evaluated respiratory symptoms among textile workers. The study population comprised 106 exposed workers and a control (unexposed) group. Data were collected by a questionnaire. PFTs (Pulmonary Function Test) were performed. Among the exposed workers 36.8% defined phlegm. Respiratory symptoms were not significantly different between two groups. The employment duration of the exposed workers with phlegm was longer than those without phlegm (p = 0.027). The mean % predicted of FEF25-75 of the exposed workers was found to be significantly lower than the control (unexposed) group (p = 0.01). Our study suggests that textile dyeing might cause respiratory symptoms in workers. © 2012 by the authors; licensee MDPI, Basel, Switzerland.

Aim: Obstructive sleep apnea syndrome (OSAS) is a common medical problem. Among its sequelae, erectile dysfunction (ED) has been reported. The aim of this study aim was to clarify the association between OSAS and ED., Materials and Methods: The study population consisted of 34 OSAS patients and 13 control patients with simple snoring. Demographics, body mass index (BMI), polysomnography parameters, Epworth Sleepiness Scale (ESS) score, and sexual function situation were noted. All patients underwent urologic examination. The International Index of Erectile Function-5 (IIEF5) was performed to males, and Female Sexual Function Index (FSFI) was performed to females in order to evaluated sexual functions. Patients were grouped as the control group whose apnea-hypopnea index was below 5, and as the study group with respiratory disturbance index RDI= 5. The data were statistically analyzed by using Kruskal Wallis Variance Analysis, Mann Whitney U Test with Bonferroni Correction, Independent Samples t Test and Mann Whitney U Test., Results: ED was found in 24 (70.6%) of 34 patients on the basis of their symptoms. Most of the patients with ED (40%) had severe OSAS. There was a statistically significant relation between Body Mass Index (BMI) and ED (p=0.007). We found ED in 24 patients according to the IIEF-5 score. There was a statistically significant difference in the minimum O2 saturation f. indings between the OSAS patients with and without ED (p=0.044). Respiratory Disturbance Index (RDI) and ESS were higher in the patients with severe ED in comparison to the patients without ED, but the difference wasn't statistically significant (p>0.05)., Conclusion: Sexual functions have been found to be affected in patients with OSAS. Additional studies are needed to ascertain the mechanism of ED in OSAS and the treatment of ED in this group of patients.

The effects of aging and gender on balance performance (BP) among ambulatory adults were investigated in the current work. If there was a relation between the BP and a history of falling, this was also detected. Two hundred and forty ambulatory subjects were divided into two groups depending on their age: (1) 125 middle-aged subjects (50-64 years); (2) 115 elderly subjects (65-75). The functional reach (FR) test, the timed up and go (TUG) test, the sit to stand (STS) test and the step test (ST) were used to evaluate the BP. The fall rate (1-2 in the last year) was 8% for the middle-aged group and was 13.9% for the elderly group. Middle-aged adults had better scores on all tests in comparison to the elderly people. There have been differences found between genders regarding the BP in both groups, except the FR scores in the middle-aged group. The FR distance of the faller subjects was rather low in comparison to non-faller elderly subjects. However, there were no significant differences between the faller and non-faller subjects in both groups regarding other tests' scores. The results of this study indicate that aging affects the BP year by year. The information in this paper can provide normative data to be used as a comparison to clinically obtained information. © 2007 Elsevier Ireland Ltd. All rights reserved.

The aim of this study was to evaluate the prevalence of low back pain (LBP) among school children and the consequences that this problem may have in relation to gender. This study was designed as a cross-sectional 22-question questionnaire-based on LBP completed by a 10- to 18-year-old Turkish sample. The subjects were 624 school children (335 boys and 289 girls) who were attending primary, secondary or high schools in Denizli, Turkey (mean age = 13.91 years, SD = 2.34). Each subject completed the questionnaire under supervision by an investigator during school time. Data were analysed comparing the two genders. Two hundred and ninety-two school children (46.7%) had LBP. Boys were 153 (52.4%) and girls 139 (47.6%). Both boys and girls with LBP reported that LBP did not interfere negatively with their school performance (67.5%) and with daily activities (87.5%). The risk factors should be investigated at early stages of the life. Therefore, a national LBP prevention program should be performed at community level. © 2006 VSP.

Neural tube defects (NTD) are among the most common congenital abnormalities, with an incidence of 3 per 1000 live births in Turkey. In a study of major congenital abnormalities in the city of Denizli, Turkey, abnormalities of the central nervous system are particularly common (31.1%). The objective of this study was to develop a registry of cases with NTDs in Denizli. Cases that had been diagnosed with NTD between January 2004 and September 2010 in State Hospitals of Central Denizli were retrospectively examined. The diagnoses were established based on the ICD-10 criteria. A total of 250 subjects with NTD were identified, including 123 (49.2%) females and 127 (50.8%) males with a mean age of 13.72 ± 15.62 years (age range 1-81 years). Interestingly, spina bifida constituted a significant percentage of the cases (149 cases; 59.6%). In addition, 10 (4.0%) cases had hydrocephalus plus spina bifida. The second most common diagnosis was microcephaly, which included 70 cases (28.0%). Encephalocele was observed in only 2 cases (0.8%). Development of NTD is influenced by nutrition, socioeconomic factors, and the use of folic acid during the peri-conceptional period. Studies examining the effect of these factors on NTD in Turkey and a review of primary prevention measures are necessary. © FUNPEC-RP.

Oral clefts are one of the most common birth defects in humans. However, few population-based studies of these defects have been carried out in Turkey. Our objective was to determine the registries of cases of cleft lip and palate. All cases of cleft lip and palate referred to central state hospitals in Denizli between January 2000 and May 2010 were investigated retrospectively. Anomalies were determined and classified according to the ICD-10 coding system. A total of 194 cases were identified consisting of 92 females (47.4%), 100 males (51.6%), and 2 subjects of undetermined gender (1%) with an age range of 1 to 65 years. Among the 194 cases, 127 subjects (65.5%) had isolated cleft palate, including 63 females and 64 males; 42 (21.6%) subjects had cleft lip, including 17 females and 25 males; and 25 subjects (12.9%) had cleft lip and palate, including 12 females and 13 males. Studies of oral cleft prevalence are insufficient in Turkey owing to the incompleteness of registries, and the chromosome analysis rate has reached a reasonable level only in recent years. © FUNPEC-RP.

The aim of this study was to evaluate the frequency and characteristics of peripheral nervous system involvement in chronic obstructive pulmonary disease and its relation with proinflammatory cytokines such as TNF-alpha, IL-6, IGF-1 and CRP. Forty chronic obstructive pulmonary disease patients with a mean age 62.8 +/- 5.5 years and 33 healthy controls with a mean age of 61.8 +/- 7.4 were included into this study. All subjects were evaluated with standard motor and sensory nerve conduction studies. Serum TNF-alpha, IL-6, CRP and IGF-1 were measured. The muscle strengths of three muscle groups (knee extensors, shoulder abductors and flexors) were assessed with a hand-held dynamometer. Peripheral neuropathy was detected at 15% of chronic obstructive pulmonary disease patients. Ulnar motor and sensory nerves, left sural nerve distal latencies were found significantly prolonged than healthy volunteers (p = 0.011), peroneal nerve conduction velocities was found lower in patients than in healthy controls (p = 0.021), tibial nerve amplitudes was found lower in patients than healthy controls (p = 0.046). CRP and TNF-alpha were found significantly higher in chronic obstructive pulmonary disease patients and IGF-1 was found significantly lower in chronic obstructive pulmonary disease patients. There was no correlations between proinflammatory cytokines, CRP and electrophysiological findings. Left sural nerve's sensory nerve action potential amplitude was correlated positively with FEV(1)% (r = 0.425; p = 0.009). Muscle strength at the shoulder and knee were significantly reduced in patients with COPD when compared with controls. The frequency of neuropathy was higher in chronic obstructive pulmonary disease when compared with the healthy controls. Chronic obstructive pulmonary disease patients have subclinical peripheral nerve involvements.

Aortoiliac occlusive disease is a frequently encountered occlusive arterial disease. Different surgical approaches to the infrarenal abdominal aorta have been reported. We retrospectively studied the postoperative outcomes of patients who were treated for aortoiliac occlusive disease via a retroperitoneal versus a transperitoneal surgical approach.From January 2005 through May 2009, 47 patients underwent surgery at our hospital for the correction of aortoiliac occlusive disease: 30 via a paramedian incision and retroperitoneal approach, and 17 via a midline sternotomy and transperitoneal approach. In the retroperitoneal group, the surgical procedures involved iliofemoral bypass in 15 patients, aortofemoral bypass in 12, aortoiliac bypass in 2, and aortobifemoral bypass in 1. All 17 patients in the transperitoneal group underwent aortobifemoral bypass. The preoperative characteristics and perioperative data of the patients were analyzed. We believe that the retroperitoneal aortoiliac approach with a paramedian incision may be considered as a surgical option for aortoiliac revascularization.

Objective: To determine the proportion of adolescent births in Van, Turkey, and to identify characteristics and related outcomes. Methods: Mothers who gave birth at three maternity centers in Van, Turkey, were chosen randomly and were invited to complete a face-to-face questionnaire. Participants were asked for demographic information and pregnancy history. Pregnancy outcomes were obtained from the birth records. Results: Of 1872 mothers who completed the questionnaires, 211 (11.3%) were younger than 19 years. Adolescent mothers showed significantly more inappropriate education for age (82.5% vs 70.1; P < 0.001) and were married to less educated partners (76.3% vs 59.4%; P < 0.001) following unofficial matrimonies (25.6% vs 10.7%; P < 0.001) than older mothers. There were no differences between the age groups in rates of arranged marriages with relatives, income, and household structure. Adolescent mothers reported higher rates of intimate partner violence (17.1% vs 10.8%; P = 0.008) and inadequate prenatal care use (28.4% vs 17.6%; P < 0.001) compared with older mothers. Adolescent births were associated with an increased risk for preterm delivery (P < 0.001) and low birth weight (P < 0.001). Conclusions: Cultural factors rather than economic factors seem to be related to early age at marriage and adolescent childbearing, which are associated with poor birth outcomes. © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

For the study 1000 families were interviewed during 1996 in the city of Denizli, which is situated in Western Anatolia and has a population of 79 211 families. The overall rate of consanguinity was 11.7%, with a mean inbreeding coefficient of 0.00873. The principal type of consanguineous marriage recorded was between first cousins, which accounted for 49.6% of all unions. For both sexes, a significant negative association was observed between consanguinity and mean age at marriage and level of education.

Oxygen therapy, which is ordered frequently for patients with chronic pulmonary disease, remains a cornerstone of modern medical practice. This study was conducted to compare the efficiency and comfort of a binasal cannula versus a face mask during oxygen therapy. Sixty hypoxemic patients participated in this randomized controlled study. While each patient was hypoxemic, arterial blood gas analysis was performed before oxygen supplementation was begun. Arterial oxygen saturation was continuously monitored during oxygen therapy with a face ask or a binasal cannula. Subjects were allowed to return to their oxygen saturation level in room air before the device for oxygen treatment was changed. The same procedure was then repeated with the other device. Patient comfort was evaluated through the use of a questionnaire that was completed after each treatment period. The mean age±standard deviation was 62±13 y. No statistically significant difference was noted in oxygen saturation levels achieved with the 2 devices. The binasal cannula reached target oxygen levels (P=.007) more quickly than the face mask. The binasal cannula was reported to be significantly more comfortable (P=.0001), and had significantly fewer reports of dyspnea and restlessness, and was less of a nuisance (P=.019, P=.0001, and P=.0001, respectively). The binasal cannula was preferred for oxygen therapy by 71% of study patients. Although the efficiency of the 2 devices did not differ remarkably, Transmission and reproduction of this material in whole or part without prior written approval are prohibited. the binasal cannula was regarded as a more comfortable and time-saving device for delivery of oxygen therapy to hypoxic patients.

Background The objective of this study was to measure associations of circulating interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) levels with anthropometric and abdominal fat distribution in overweight or obese postmenopausal women. Methods One hundred eight overweight or obese postmenopausal were evaluated. Demographic and anthropometric measurements were done. Serum IL-6, TNF-α, glucose, and insulin levels were measured. Insulin resistance was calculated by using homeostasis model assessment-insulin resistance (HOMA-IR). The assessment of abdominal fat distribution was performed by ultrasonography. Statistical analysis was made with Pearson and partial correlation analysis. Results There was a positive correlation between serum IL-6 and TNF-α ( r = .19; p = .047). IL-6 was positively correlated with body mass index (BMI) ( r = .43; p = .0001), waist circumference ( r = .41; p = .0001), and visceral fat layer ( r = .33; p = .0001) measurements and HOMA-IR index ( r = .31, p = .001). A positive relationship between HOMA-IR and visceral fat layer thickness was observed ( r = .320; p = .0001). TNF-α was positively associated with BMI but not with any measures of central obesity. When adjustment for BMI was performed, there were no significant relationships between the studied parameters. Conclusions There are no significant correlations between abdominal fat distributions measured by ultrasonography and circulating IL-6 and TNF-α levels. BMI may have a stronger association with circulating inflammatory cytokine concentrations than with different measures of central obesity in overweight or obese postmenopausal women.

Ankylosing spondylitis (AS) primarily affects the spine and axial skeleton. Major extra‐articular manifestations include cardiovascular and pulmonary involvement, uveitis, enteric mucosal lesions, ...

The purpose of this study was to evaluate Denizli midwives' self-reported knowledge of genetic diseases and genetic counseling. Data was collected on forms that obtained information about midwives approaches to basic genetics, genetic disorders, and genetic counseling (response rate = 70.1%). The highest response rate of midwives describing themselves as "knowledgeable" about basic genetic information was for mitosis and meiosis with 4.8%, about genetic disorders was for phenylketonuria with 61.1%, and about genetic counseling was for recommending ultrasonography during pregnancy with 98.1%. The source for basic genetics information for 56.4% of participants was in their school level classes. None of the midwives felt that they had sufficient knowledge about genetic counseling or screening and 76.4% would like to attend an educational course. Even though the midwives have recognized their knowledge deficit they occasionally give genetic counseling. As a result of this study a genetics course is planned for midwives so they can actively participate in the prevention and early diagnosis of genetic diseases. © 2006 National Society of Genetic Counselors, Inc.

The purpose of this study was to determine relationship between balance performance and pain in lower body among healthy adults. Two hundred and forty volunteer subjects (125 middle aged and 115 elderly people) aged 50 years and above participated. The average age was 61.52 ± 8.22 years (range 50-75 years). The functional reach test (FRT) was used to measure balance ability. The visual analog scale (VAS) was used to measure pain intensity. Subjects were also asked to indicate sites they experienced pain in their lower body (e.g., low back, hip, knee, ankle, toes). Falls history was also recorded. The elderly people had a lower FRT score as compared to the middle-aged adults (p < 0.001). Knee, low back, and hip pain were most common in both groups. The elderly people reported more frequency of falls than the middle-aged adults. The score of the FRT was higher among men (20.67 ± 7.16 cm) than among women (18.77 ± 6.59 cm). In both groups; the women had a higher VAS score than those of matched the men. Although the middle-aged adults had higher and better scores than the elderly people, the data showed that the middle-aged adults are also at risk and should be prepared properly for healthy aging. © 2006 Elsevier Ireland Ltd. All rights reserved.

Background Aerobic exercise enhances endothelium-dependent vasodilation in healthy individuals. It is thought that exercise increases nitric oxide (NO) production and decreases NO inactivation, leading to an increase in NO bioavailability. Angiotensin II and NO have important roles in maintaining vascular tone. There are polymorphisms of the angiotensin converting enzyme (ACE) gene and the presence of the deletion (D) allele has been associated with higher concentrations of circulating and tissue ACE. In this study, the relationship between endothelial function and ACE gene polymorphisms was investigated in athletes and sedentary subjects. Methods and Results The study group comprised 56 endurance athletes and 46 sedentary subjects who underwent brachial artery ultrasonographic examination. ACE insertion (I) and D allele frequencies were analyzed in all patients. Baseline brachial artery diameter and resting blood flow were similar in athletes and controls (p>0.05). The flow-mediated dilation (FMD) was 8.48±3.65% in athletes and 5.16±2.5% in controls (p=0.0001). FMD was significantly different between ACE genotypes in the athletes (p