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Öğe A 12-month course of combination therapy with interferon-alfa and lamivudine in patients with chronic hepatitis delta virus: A single-center, prospective, open-label, uncontrolled study(Excerpta Medica Inc, 2002) Yalcin, K; Degertekin, H; Yildiz, F; Akkus, ZBackground: Chronic hepatitis delta virus (HDV) is a severe and rapidly progressive liver disease for which no therapy has been proved to be effective. Objective: The aim of this study was to investigate the efficacy and tolerability of long-term therapy with a combination of recombinant interferon (IFN)-alfa. and lamivudine. Methods: In this single-center, prospective, open-label, uncontrolled study, patients aged 18 to 60 years with chronic HDV were eligible. Patients were treated with a combination of 10 million units of IFN-alfa-2b subcutaneously 3 times weekly and lamivudine 100 mg once daily for 12 months. The primary outcome measures were biochemical and histologic response at the end of treatment and at least 12 months thereafter. Results: Twelve patients (10 men, 2 women; mean age, 33.9 years [range, 19-49 years]) were enrolled (6 treatment-naive patients, 6 previously treated patients). Normalization or decrease of >50% from baseline in serum alanine aminotransferase (ALT) level occurred in 8 (66.7%) of 12 patients at month 12 of treatment. Of the 12 patients, 10 (83.3%) completed the trial; 1 (8.3%) was withdrawn because of severe leukopenia. and 1 (8.3%) was lost to follow-up. Relapses occurred in 5 of 8 (63.3%) initial responders shortly after the cessation of therapy. In 3 (25%) patients whose ALT levels became normal at the end of the therapy, the complete biochemical responses persisted for up to 3 years (mean, 31 months). The treatment was associated with a marked improvement in histologic activity. Conclusions: In this study, combination therapy with IFN-alfa and lamivudine was well tolerated and reduced hepatic inflammation was found. Further controlled trials are needed to show possible beneficial effects of this model of therapy and to determine the optimal dose and duration of therapy for chronic HDV.Öğe Changes in serum levels of leptin, cytokines and lipoprotein in preeclamptic and normotensive pregnant women(Parthenon Publishing Group, 2004) Koçyigit, Y; Atamer, Y; Atamer, A; Tuzcu, A; Akkus, ZThe aim of this study was to investigate the changes in serum levels of leptin, cytokines and lipoproteins in women with pre-eclampsia and to evaluate their clinical significance in the pathogenesis of pre-eclampsia. We performed a prospective study involving 45 women with pre-eclampsia in the third trimester of pregnancy and 30 normotensive women in the third trimester of pregnancy. Serum level of leptin was measured by enzyme immunoassay using a Cayman chemical kit, Serum levels of tumor necrosis factor (TNF)-alpha, intertleukin (IL)-1beta, soluble IL-2 receptor (sIL-2R), IL-6 and IL-8 were measured by using a nonradioimmunoassay chemiluminescent method. Serum lipid concentrations were measured by an Abbott Aeroset (USA) autoanalyzer. Serum levels of apolipoprotein (Apo)A-I and ApoB were evaluated by nephelometrics assays. Differences between groups were evaluated with Student's unpaired t test and, when a variable was not normally distributed, the Mann-Whitney U test was used. The relationship between the variable was explored by the Pearson correlation test. Serum levels of leptin, TNF-alpha, IL-1beta, sIL-2R, IL-6 and IL-8 in the preeclamptic women were significantly higher than in normotensive women (p < 0.001). In the pre-eclamptic women serum levels of triglycerides, total cholesterol and low-density lipoprotein (LDL)-cholesterol were significantly increased (p < 0.001), while high-density lipoprotein (HDL)-cholesterol and Apo-A were significantly decreased compared to levels in normotensive pregnant women (p < 0.001). No significant differences were noted between the groups in Apo-? (p > 0.05). Serum levels of TNF-? were significantly correlated with the serum levels of IL-6, IL-8, triglycerides, sIL-2R, Apo-A and hematocrit in pre-eclamptic women (r = 0.418, p < 0.05 - r = 0.389, p < 0.01; r = 0.312, p < 0.05; r 0.318, p < 0.05; r 0.340, p < 0.05 and r = 0.41, p < 0,01, respectively). A negative correlation was seen between serum level of leptin and both IL-1? and Apo-A in pre-eclamptic women (r = 0.44, p < 0.05; r = 0.39, p < 0.05, respectively). Serum levels of IL-6 were also signficantly correlated with the serum levels of HDL-cholesterol, LDL-cholesterol and body mass index (BMI) in preeclamptic women (r = 0.40, p < 0.01; r = 0.568, p < 0. 0 1; r 0. 3 0, p < 0. 05, respectively). In addition, serum level of IL-8 were significantly correlated with the serum levels of HDL-cholesterol, total cholesterol and BMI in pre-eclamptic women (r = 0.368, p < 0.05; r = 0.513, p < 0.01 and r = 0.41, p < 0.01, respectively). We found that the pre-eclampsia associated with increases in serum levels of leptin, TNF-?, cytokines, triglycerides, total cholesterol and LDL-cholesterol was associated with a significant reduction in serum levels of HDL-cholesterol and Apo-A. These association may be due to the abnormal lipid metabolism and immune activation involved in the pathogenesis of this disease.Öğe Determination of osteoporosis risk factors using a multiple logistic regression model in postmenopausal Turkish women(Saudi Med J, 2005) Akkus, Z; Camdeviren, H; Celik, F; Gur, A; Nas, KObjectives: To determine the risk factors of osteoporosis using a multiple binary logistic regression method and to assess the risk variables for osteoporosis, which is a major and growing health problem in many countries. Methods: We presented a case-control study, consisting of 126 postmenopausal healthy women as control group and 225 postmenopausal osteoporotic women as the case group. The study was carried out in the Department of Physical Medicine and Rehabilitation, Dicle University, Diyarbakir, Turkey between 1999-2002. The data from the 351 participants were collected using a standard questionnaire that contains 43 variables. A multiple logistic regression model was then used to evaluate the data and to find the best regression model. Results: We classified 80.1% (281/351) of the participants using the regression model. Furthermore, the specificity value of the model was 67% (84/126) of the control group while the sensitivity value was 88% (197/225) of the case group. We found the distribution of residual values standardized for final model to be exponential using the Kolmogorow-Smimow test (p=0.193). The receiver operating characteristic curve was found successful to predict patients with risk for osteoporosis. This study suggests that low levels of dietary calcium intake, physical activity, education, and longer duration of menopause are independent predictors of the risk of low bone density in our population. Conclusion: Adequate dietary calcium intake in combination with maintaining a daily physical, activity, increasing educational level, decreasing birth rate, and duration of breast-feeding may contribute to healthy bones and play a role in practical prevention of osteoporosis in Southeast Anatolia. In addition, the findings of the present study indicate that the use of multivariate statistical method as a multiple logistic regression in osteoporosis, which maybe influenced by many variables, is better than univariate statistical evaluation.Öğe Effects of extracorporeal shock-wave lithotripsy on intrarenal resistive index(Taylor & Francis As, 2003) Nazaroglu, H; Akay, AF; Bükte, Y; Sahin, H; Akkus, Z; Bilici, AObjective: This prospective study was performed to determine whether extracorporeal shock-wave lithotripsy (ESWL), widely used for treating renal and ureteral stones, affects the kidney interlobar artery resistive index (RI). Material and Methods: A total of 43 patients (30 with renal and 13 with ureteral stones) underwent color Doppler examination before and 30 min and 3 h after ESWL. Seventeen patients with renal and nine with ureteral stones underwent Doppler examination 2 weeks later. Measurements were made near the stones (nearby region), at least 2 cm from the stones (remote region) and in the contralateral kidney for renal stones, and in the ipsilateral and contralateral kidneys for ureteral stones. Results: In patients with renal stones, the RI was increased 30 min and 3 h after ESWL in the nearby and remote regions, and more markedly in the former. In the contralateral kidney, there was an increase in RI only at 3 h, which was less than that in the ipsilateral kidney. The RI at 2 weeks post-ESWL in the nearby region and contralateral kidney did not differ from the pre-ESWL values. ESWL performed for ureteral stones caused no increase in RI in the ipsilateral kidney. Conclusion: Patients with renal stones had a temporary increase in RI in the hours following ESWL in both the ipsilateral and contralateral kidneys, which was highest in the region near the stones and lowest in the contralateral kidney. Two weeks later, the RI in both areas had returned to pre-ESWL levels.Öğe Expression of E-cadherin in squamous cell carcinomas of the cervix with correlations to clinicopathological features(I R O G Canada, Inc, 2005) Yaldiz, M; Hakverdi, AU; Bayhan, G; Akkus, ZObjective: To evaluate the expression of E-cadherin, a calcium-dependent cell adhesion molecule, in a retrospective analysis of paraffin-embedded tissue specimens of cervical squamous carcinoma and the relationship with histopathological differentiation and lymph node status. Methods: In this study, we investigated by immunohistochemistry E-cadherin expression in ten normal cervical epithelia and 24 cervical invasive squamous carcinomas. Results: Normal cervical squamous epithelium showed strong expression of E-cadherin at the membrane of the cell and intercellular junctions. In 24 tumors immunnostained by E-cadherin antibody, 11 (46%) showed preserved expression and 13 (54%) reduced expression. There was no significant correlation between E-cadherin expression and histological differentiation (p = 0.650, p = 0.294). In the status of lymph node metastasis, reduced expression of E-cadherin was seen in 11/15 (73%) with lymph node metastasis versus 2/9 (22%) without lymph node metastasis. There was a significant inverse correlation between E-cadherin expression and lymph node metastasis (p = 0.032). Conclusion: Reduced E-cadherin expression may be an important factor among a variety of biologic events that occur during the process of metastasis. However, this should be explored by a large scale study.Öğe Expressions of p53, proliferating cell nuclear antigen, and Ki-67 in gestational trophoblastic diseases(I R O G Canada, Inc, 2002) Uzunlar, AK; Yilmaz, F; Bayhan, G; Akkus, ZObjective: This study was done to determine whether the expressions of p53, PCNA. and Ki-67 could differentiate spontaneous abortions with hydropic changes from gestational trophoblastic diseases. Materials and Methods: Twenty partial hydatidiforin moles, 21 complete hydatidiform moles. nine invasive hydatidiform moles. three choriocarcinomas and 19 first trimester hydropic spontaneous abortions were evaluated by means of immunohistochemical methods with antibodies to p53, PCNA. and Ki-67 in this study. Results: The Ki-67, PCNA, and p53 immunoreactivity was significantly higher in the gestational trophoblastic disease group than in the spontaneous abortion group with hydropic changes. None of the three parameters provided reliable discrimination among gestational trophoblastic disease subgroups. Conclusion: Our findings Suggest that expressions of Ki-67, proliferating cell nuclear antigen and p53 can be used to differentiate between spontaneous abortion with hydropic changes and gestational trophoblastic disease when all three markers are used together.Öğe Intermaxillary Bolton tooth size discrepancies among different malocclusion groups(E H Angle Education Research Foundation, Inc, 2006) Basaran, G; Selek, M; Hamamci, O; Akkus, ZThe orthodontic finishing phase is recognized for the many details necessary to accomplish an excellent result. A high percentage of finishing-phase difficulties arise because of tooth size imbalances that could have been discovered and considered during the initial diagnosis and treatment planning. The aim of our study was to determine whether there is a prevalent tendency for intermaxillary tooth size discrepancies among different malocclusion groups. This study involved 60 subjects who served as the normal occlusion group and 300 patients divided into five malocclusion groups (ie, Class I, Class II, Class II division I, Class II division 2, and Class III). Tooth size measurements were performed on the models of the normal occlusion group and the pretreatment models of the patients. The tooth size ratios and the one-way analysis of variance test showed no sexual dimorphism for these ratios in each of five groups, so the sexes were combined for each group. Then, these ratios were compared among different malocclusion groups. The results showed no significant difference between subcategories of malocclusion, so these groups were combined as Class I, Class II, and Class III. No significant difference was found for all the ratios between the groups.Öğe Potential atherogenic roles of lipids, lipoprotein(a) and lipid peroxidation in preeclampsia(Taylor & Francis Ltd, 2005) Bayhan, GH; Koçyigit, Y; Atamer, A; Atamer, Y; Akkus, ZAims. To evaluate changes in lipid profile, serum levels of malondialdehyde (MDA) and lipoprotein(a) (Lp(a)) and placental MDA in preeclamptic women, and to evaluate the atherogenic role of these changes in the pathophysiology of preeclampsia. Method. A cross-sectional study was performed in 20 normal pregnant women, 25 women with mild preeclampsia and 28 women with severe preeclampsia in the third trimester. MDA, which is the endproduct of lipid peroxidation, was measured in placental tissue by the thiobarbituric acid (TBA) method of Ohkawa and colleagues and in serum by the TBA method of Asakawa and Matsushita. Serum lipid levels were measured by with an autoanalyzer, serum apolipoprotein (Apo) A-I and Apo B were measured by nephelometric assay and serum Lp(a) level using a nephelometric agglutination assay method. In preeclamptic and normal pregnant women, multiple comparisons between groups were performed by one-way analysis of variance supplemented with Tukey's HSD post hoc test. The association between placental and serum concentrations among groups was analyzed using the Pearson correlation test. Results. Serum levels of MDA, Lp(a), total cholesterol, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and placental MDA were significantly higher, and high-density lipoprotein cholesterol (HDL-C) and Apo A-I levels were significantly lower, in severely preeclamptic and mildly preeclamptic women than in the normal pregnant women, but no difference was observed in Apo B among groups. Serum level of Lp(a) was positively correlated with body mass index in severely preeclamptic women (r = 0.489:, p = 0.008). A significant positive correlation was also found between serum level of MDA and systolic blood pressure in women with severe preeclampsia (r = 0.375, p = 0.049). Conclusions. Our findings suggest that high Lp(a), lipid peroxidation, LDL-C and TG, and low HDL-C and Apo A-I levels, are important risk factors for atherosclerosis among preeclamptic women.
