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    Decreased neck muscle strength in patients with the loss of cervical lordosis
    (Elsevier Sci Ltd, 2016) Alpayci, Mahmut; Senkoy, Emre; Delen, Veysel; Sah, Volkan; Yazmalar, Levent; Erden, Metin; Toprak, Murat
    Background: The loss of cervical lordosis is associated with some negative clinical outcomes. No previous study has examined cervical muscle strength, specifically in patients with the loss of cervical lordosis. This study aims to investigate whether there is weakness of the cervical muscles or an imbalance between cervical flexor and extensor muscle strength in patients with the loss of cervical lordosis compared with healthy controls matched by age, gender, body mass index (BMI), and employment status. Methods: Thirty-two patients with the loss of cervical lordosis (23 F, 9 M) and 31 healthy volunteers (23 F, 8 M) were included in the study. Maximal isometric neck extension and flexion strength, and the strength ratio between extension and flexion were used as evaluation parameters. All measurements were conducted by a blinded assessor using a digital force gauge. The participants were positioned on a chair in a neutral cervical position and without the trunk inclined during measurements. Findings: Maximal isometric neck extension and flexion strength values were significantly lower in the patients versus healthy controls (P<0.001 and P = 0.040, respectively). The mean (SD) values of the extension/flexion ratio were 1.21 (0.34) in the patients and 1.46 +/- 0.33 in the controls (P = 0.004). Interpretation: According to our results, patients with the loss of cervical lordosis have reduced neck muscle strength, especially in the extensors. These findings may be beneficial for optimizing cervical exercise prescriptions. (C) 2016 Elsevier Ltd. All rights reserved.
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    Decreased Vertebral Artery Hemodynamics in Patients with Loss of Cervical Lordosis
    (Int Scientific Information, Inc, 2016) Bulut, Mehmet Deniz; Alpayci, Mahmut; Senkoy, Emre; Bora, Aydin; Yazmalar, Levent; Yavuz, Alpaslan; Gulsen, Ismail
    Background: Because loss of cervical lordosis leads to disrupted biomechanics, the natural lordotic curvature is considered to be an ideal posture for the cervical spine. The vertebral arteries proceed in the transverse foramen of each cervical vertebra. Considering that the vertebral arteries travel in close anatomical relationship to the cervical spine, we speculated that the loss of cervical lordosis may affect vertebral artery hemodynamics. The aim of this study was to compare the vertebral artery values between subjects with and without loss of cervical lordosis. Material/Methods: Thirty patients with loss of cervical lordosis and 30 controls matched for age, sex, and body mass index were included in the study. Sixty vertebral arteries in patients with loss of cervical lordosis and 60 in controls without loss of cervical lordosis were evaluated by Doppler ultrasonography. Vertebral artery hemodynamics, including lumen diameter, flow volume, peak systolic velocity, end-diastolic velocity, and resistive index, were measured, and determined values were statistically compared between the patient and the control groups. Results: The means of diameter (p=0.003), flow volume (p=0.002), and peak systolic velocity (p=0.014) in patients were significantly lower as compared to controls. However, there was no significant difference between the 2 groups in terms of the end-diastolic velocity (p=0.276) and resistive index (p=0.536) parameters. Conclusions: The present study revealed a significant association between loss of cervical lordosis and decreased vertebral artery hemodynamics, including diameter, flow volume, and peak systolic velocity. Further studies are required to confirm these findings and to investigate their possible clinical implications.
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    Efficiency of therapeutic ultrasound on pain, disability, anxiety, depression, sleep and quality of life in patients with subacromial impingement syndrome: A randomized controlled study
    (Ios Press, 2016) Yazmalar, Levent; Sariyildiz, Mustafa Akif; Batmaz, Ibrahim; Alpayci, Mahmut; Burkan, Yahya Kemal; Ozkan, Yasemin; Okcu, Mehmet
    BACKGROUND: Subacromial impingement syndrome (SIS) is characterized by pain and disability of shoulder. Various treatment methods have been used for SIS. OBJECTIVES: The aim of our study was to evaluate efficacy of therapeutic ultrasound (US) on pain, disability, anxiety, depression, sleep quality and quality of life in patients with SIS. METHODS: Patients with SIS were randomly divided into two groups, including the group 1 (continuous US group; 3 MHz, 1.5 W/cm(2), n = 26) and group 2 (sham US group, n = 24). Additionally, transcutaneous electrical nerve stimulation (TENS) + exercise program were added in both groups. Pain and disability of the shoulder were assessed by the Shoulder Pain and Disability Index (SPADI), while anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Quality of life was evalutaed by the Nottingham Health Profile (NHP). Patients were evaluated at baseline and after end of three weeks. RESULTS: Both groups had significantly improvements in terms of SPADI-pain, SPADI-disability, SPADI-total, NHP-pain and NHP-sleep scores after the three weeks interventions. There were significantly improvements in the Group 1 in terms of PSQI-total, and NHP-physical activity. Group 2 had significantly improvements in terms of anxiety-HADS, depression-HADS and NHP-emotional reaction scores. In the inter-group comparison, there were no significantly differences in the change scores were observed in any domains of SPADI scores, anxiety, depression and sleep scores, or any NHP scores. CONCLUSIONS: Our study showed that US does not have any benefits on SIS. TENS + exercise program are not effective on anxiety, depression and fatigue, however TENS + exercise program are effective on pain, disability and sleep disturbance in patients with SIS.
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    Fibromyalgia incidence among patients with hepatitis B infection
    (Wiley, 2016) Yazmalar, Levent; Deveci, Ozcan; Batmaz, Ibrahim; Ipek, Davut; Celepkolu, Tahsin; Alpayci, Mahmut; Hattapoglu, Erkam
    Aim: The purpose of our investigation was to evaluate the incidence of fibromyalgia syndrome (FMS) and identify FMS-related clinical symptoms in hepatitis B virus (HBV) patients. Methods: One hundred and eighteen HBV surface antigen (HbsAg)-positive patients (40 with chronic active hepatitis B, 40 hepatitis B carriers and 38, all of whom had been antiretroviral-treated for at least 3 months) were included in this study. In addition, 60 age- and gender-matched HbsAg-negative healthy controls were included in the study. Results: There was no significant difference in age, gender or body mass index (BMI) between the two groups (P > 0.05). Serum aspartate aminotransferase and alanine aminotransferase levels were significantly higher in HBV patients relative to the control group (P < 0.05). The incidence of FMS, widespread body pain, fatigue, sleep disturbance, anxiety, morning stiffness, arthralgia was significantly greater among HBV patients relative to the control group. Additionally, the mean tender point counts and the visual analog scale values were significantly higher among the HBV patients (P < 0.05). Conclusions: The results of the present study demonstrate that FMS incidence is greater among HBV patients relative to control subjects. However, there were no differences in FMS incidence among the subgroups of HBV diagnoses.
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    The frequency and effect of fibromyalgia in patients with Behcet's disease
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2017) Toprak, Murat; Erden, Metin; Alpayci, Mahmut; Ediz, Levent; Yazmalar, Levent; Hiz, Ozcan; Tekeoglu, Ibrahim
    Objectives: This study aims to investigate the scores of depression, anxiety, sleep and quality of life (QoL), to identify the prevalence of fibromyalgia (FM) in Behcet's disease (BD), and to evaluate whether there is a difference between BD patients with and without FM in these scores. Patients and methods: Between March 2008 and January 2009, 97 patients with BD and 95 age- and sex-matched healthy controls were included in the study. The patients with BD were divided into two groups according to the presence or absence of FM. All participants were evaluated by the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), and Medical Outcomes Study Short Form-36 (SF-36). Results: Compared to the controls, FM prevalence was higher (19.6% vs 3.2%) with increased BDI and BAI scores, while the subscores of SF-36 including physical function, physical role, pain, general health, social function, and emotional role decreased in BD patients (for all p<0.001). All BD patients with FM were females (n=19), while only 46% of BD patients without FM were females (n=36) (p<0.001). In BD patients with FM, compared to female BD patients without FM, the mean age (p=0.017), disease duration (p=0.028), and BDI scores (p=0.017) were significantly higher, while the PSQI scores (p=0.001) and SF-36 subscores, except general health (p=0.114), were significantly lower (for all p<0.05). Conclusion: Our study results suggest that patients with BD have an increased severity of depression and anxiety, higher frequency of FM, and worsened QoL than healthy individuals. In addition, the presence of FM seems to be related with female sex, longer disease duration, older age, depression, sleep disturbance, and poor QoL in BD patients.
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    The relationship between facet joint osteoarthritis and Modic changes of the lumbar spine: a retrospective magnetic resonance imaging study
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2016) Alpayci, Mahmut; Bulut, Mehmet Deniz; Yazmalar, Levent; Yavuz, Alpaslan; Toprak, Murat; Koparan, Ibrahim Halil; Gulsen, Ismail
    Objectives: This study aims to assess the facet joint osteoarthritis in patients with lumbar Modic changes and to investigate the relationship between the Modic types and severity of the facet joint degeneration. Patients and methods: A total of 120 patients (55 males, 65 females; mean age 55.18 +/- 9.47 years; range 40 to 75 years) were included in the study. The patients were divided into four equal groups of 30 patients according to Modic type (No Modic changes, type 1, type 2, type 3). All groups were matched with age, sex, and spinal level. A total of 180 lumbar facet joints of the patients with Modic changes (60 facet joints for each Modic type) and 60 lumbar facet joints of the patients without Modic changes were analyzed. The severity of the facet joint osteoarthritis was assessed. The degree of the facet degeneration was evaluated by using the Pathria grading system with magnetic resonance imaging. Results: Facet joint degeneration increased gradually, as the type of Modic change increased. Compared to the group without Modic changes, all three groups with Modic changes had more degenerative facet joints (all p <= 0.002). The severity of the facet joint degeneration was significantly higher in type 3 versus type 1 Modic changes (p=0.022). Conclusion: Our study results suggest that Modic changes, particularly type 3, are strongly associated with the facet joint osteoarthritis of the lumbar spine. Clinically, facet joint degeneration should be considered in the examination of low back pain inpatients with Modic changes.
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    Serum GDF-15 level in Behcet's disease: relationships between disease activity and clinical parameters
    (Wiley, 2016) Sariyildiz, Mustafa Akif; Yazmalar, Levent; Batmaz, Ibrahim; Alpayci, Mahmut; Burkan, Yahya Kemal; Sula, Bilal; Kaplan, Ibrahim
    Growth differentiation factor-15 (GDF-15), a member of the transforming growth factor-b superfamily of cytokines, plays an important role in cell growth, signal transduction, and apoptosis regulation. The aim of this study was to evaluate serum GDF-15 levels and their relationships with disease-related variables in patients with Behcet's disease (BD). Fortysix patients diagnosed with BD and 30 demographically matched healthy control subjects participated in the study. GDF-15 levels were measured in blood samples from patients and controls. The Behcet's Disease Current Activity Form (BDCAF) was used to evaluate the disease activity of BD. There were no significant differences between the two groups in C-reactive protein (CRP) level, mean erythrocyte sedimentation rate (ESR), age, body mass index, and mean GDF-15 levels (P > 0.05). Serum GDF-15 levels were positively correlated with findings for peripheral arthritis and CRP, and with BDCAF erythema nodosum, BDCAF arthralgia, and BDCAF arthritis scores. Patients with BD were divided into two groups according to the presence of peripheral arthritis; nine subjects (20%) were positive for peripheral arthritis. Serum ESR, CRP, white blood cell counts, and GDF-15 levels were significantly higher in the group that was positive for peripheral arthritis (P < 0.05). GDF-15 may play a role in the progression and pathway of Behcet's joint involvement and erythema nodosum that is independent of classic inflammatory response measures.
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    Serum levels of alpha-1 acid glycoprotein and pentraxin 3 in patients with Behcet's disease and relationship with disease activity
    (Wiley, 2015) Yazmalar, Levent; Batmaz, Ibrahim; Sula, Bilal; Alpayci, Mahmut; Aydin, Fatma; Turkcu, Fatih; Yildiz, Mehmet
    Background To evaluate the relationship between disease activity and levels of alpha 1-acid glycoprotein and pentraxin 3 in patients with Behcet's disease (BD). Methods Forty-eight patients with BD and 29 age-and gender-matched healthy control subjects were included in the study. Serum pentraxin 3 levels were measured using enzyme-linked immunosorbent assay (ng/ml), and alpha 1-acid glycoprotein levels were measured using nephelometry (mg/dl). Disease activity was assessed using the BD Current Activity Form (BDCAF). Results Serum alpha-1 acid glycoprotein levels were significantly higher in patients with BD compared to the control group (P = 0.048). There were no significant differences between two groups in terms of levels of pentraxin 3 (P = 0.697). According to Pearson's analysis, alpha 1-acid levels are significantly positively correlated with erythrocyte sedimentation rate, C-reactive protein, and skin lesions and arthritis of BDCAF scores. Pentraxin 3 levels did not correlate with erythrocyte sedimentation rate, C-reactive protein, or any domains of BDCAF scores. Conclusion The results of the present study demonstrate that serum levels of alpha-1 acid glycoprotein were significantly higher in patients with BD relative to the control group. Alpha-1 acid glycoprotein is greatly associated with skin lesions and arthritis in patients with BD. We did not find high serum levels of PTX3 in patients with BD compared to healthy controls, and pentraxin 3 is not associated with disease activity in BD.
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    Successful Treatment with Etanercept of Rheumatoid Arthritis Occurring in a Patient with Familial Mediterranean Fever
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2014) Alpayci, Mahmut; Yazmalar, Levent
    Familial Mediterranean fever (FMF) is an inherited disorder characterized by lifelong recurrent, self-limiting attacks of fever and systemic inflammation. Rheumatoid arthritis is an erosive, chronic, inflammatory disease that affects mainly the wrists and joints of the hands. Development of rheumatoid arthritis in a patient with FMF is extremely rare. To our knowledge, this condition has been reported only once previously. Here, we present a 31-year-old female patient who developed rheumatoid arthritis during the course of FMF. In the patient, while the FMF was under control with regular use of colchicine, the rheumatoid arthritis was resistant to conventional therapies. Etanercept treatment provided complete remission in our patient.
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    Sunglasses May Play a Role in Depression
    (Yerkure Tanitim & Yayincilik Hizmetleri A S, 2012) Alpayci, Mahmut; Ozdemir, Osman; Erdem, Seyfettin; Bozan, Nazim; Yazmalar, Levent
    Proposed causes of winter depression include decrease in amount of sunlight, inability to suppress melatonin production, and finally disruption of circadian rhythms related to sleep/wake cycle in susceptible individuals. Like seasonal effect of sunlight on mood, the mood is also correlated with sunshine hours. The amount of sunlight reaching the brain from the eyes via retinohypothalamic tract is reduced in sunglass users, because sunglasses screen out 75% to 90% of visible light. In people wearing sunglasses, the antidepressant effect of sunlight may be reduced and circadian rhythms may be distorted, possibly leading to the emergence winter depression. Since the sunlight has antidepressant effect and since sunglasses reduce sunlight exposure, we hypothesized that sunglass use may play a role in depression.