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Öğe Characteristics of traumatic spinal cord injuries in south-eastern Anatolia, Turkey: a comparative approach to 10 years' experience(Lippincott Williams & Wilkins, 2005) Gur, A; Kemaloglu, MS; Cevik, R; Sarac, AJ; Nas, K; Kapukaya, A; Sahin, HThe purpose of this study was to determine the demographic and epidemiological characteristics of traumatic spinal cord-injured patients. The hospital records of 539 patients (416 men, 123 women) with spinal cord injuries (SCIs) admitted to four hospitals that were major referral centers for trauma in the south-eastern region of Turkey from 1990 to 1999 were reviewed retrospectively. The patients with SCI were investigated for two periods; the first period covered patients admitted between 1990 and 1994 during which time an influx of people from rural to urban areas occurred and firearm injuries were common. In the second period (1995-1999) the influx of people declined and firearm injuries were reduced. The most common causes of injuries were road traffic accidents (200, 37.12%), followed by falls (172, 31.90%) and bullet wounds (115, 21.34%). In the first period, incomplete paraplegia was encountered more often than in the second period (P < 0.001).Öğe Comparison of biochemical markers of bone remodelling in the assessment of the effects of alendronate and calcitonin on bone in postmenopausal osteoporosis: Preliminary study(Springer-Verlag London Ltd, 2003) Coplan, L; Gur, A; Cevik, R; Nas, K; Sarac, AJ[Abstract Not Available]Öğe Comparison of clinical symptoms, functional and health status in painful knee osteoarthritis by gender and age(Springer London Ltd, 2003) Gur, A; Cevik, R; Nas, K; Sarac, AJ; Cosut, A; Calgan, N[Abstract Not Available]Öğe Comparison of zinc excretion and biochemical markers of bone remodelling in the assessment of the effects of alendronate and calcitonin on bone in postmenopausal osteoporosis(Pergamon-Elsevier Science Ltd, 2005) Gur, A; Colpan, L; Cevik, R; Nas, K; Sarac, AJObjectives: The aim of this study was to determinate the clinical usefulness of urinary bone resorption markers, urinary zinc excretion, and other biochemical markers in postmenopausal women with osteoporosis. We also evaluated the effects of alendronate and calcitonin therapies on biochemical markers of bone remodeling and urinary zinc excretion over a 6-month period. Subjects and methods: The Study design was a randomized placebo controlled study. The patients were randomly assigned to receive alendronate (10 mg/day; 45 patients) or calcitonin (200 IU/day; 45 patients) or placebo (45 patients) for 6 months. All patients received supplemental calcium (1000 mg/day). To assess bone resorption, we measured excretion of cross-linked N-telopeptides of Type I collagen (uNTx); urinary zinc concentrations and standard chemistry determinations were also measured; and osteocalcin (sOC) was measured as a marker of bone formation. All parameters were measured before therapy and again after 1, 3, and 6 months in all groups. Results: A statistically significant decrease Occurred in the levels of sOC, uZn, and uNTx after 3 and 6 months in patients receiving calcitonin therapy (P < 0.05). sOC, uZn, and uNTx levels in the calcitonin group were significantly lower after three and 6 months from both placebo and baseline values of calcitonin group. In the alendronate group, a statistically significant decrease was observed in the levels of uNTx and uZn after 1 month and in the sOC, uZn, and uNTx after 3 and 6 months from both placebo and baseline values of alendronate group (P < 0.05). uNTx, sOC, and uZn decreased about 44%, 36%, and 33%, respectively, in the calcitonin group and about 53%, 5 1%, and 38%, respectively, in the alendronate group below baseline values 6 months after initiating treatment. In the placebo group, there was no significant decrease in sOC, uZn, and uNTx during the Course of the study. Conclusion: Our study suggests that in postmenopausal women with osteoporosis, both alendronate and calcitonin reduce the concentrations of uNTx, uZn, and sOC, the effect of the alendronate dose administered being significantly earlier and more pronounced. Measurement of uNTx, uZn, and sOc might be a useful biochemical method of observing the positive clinical effect following alendronate or calcitonin therapy in postmenopausal women. (C) 2004 The Canadian Society of Clinical Chemists. All rights reserved.Öğe Complementary and alternative medical therapies in fibromyalgia(Bentham Science Publ Ltd, 2006) Sarac, AJ; Gur, AThis article describes the studies that have been performed evaluating complementary or alternative medical (CAM) therapies for efficacy and some adverse events fibromyalgia (FM). There is no permanent cure for FM; therefore, adequate symptom control should be goal of treatment. Clinicians can choose from a variety of pharmacologic and nonpharmacologic modalities. Unfortunately, controlled studies of most current treatments have failed to demonstrate sustained, clinically significant responses. CAM has gained increasing popularity, particularly among individuals with FM for which traditional medicine has generally been ineffective. Some herbal and nutritional supplements (magnesium, S-adenosylmethionine) and massage therapy have the best evidence for effectiveness with FM. Other CAM therapies such as chlorella, biofeedback, relaxation have either been evaluated in only one randomised controlled trials (RCT) with positive results, in multiple RCTs with mixed results (magnet therapies) or have positive results from studies with methodological flaws (homeopathy, botanical oils, balneotherapy, anthocyanidins and dietary modifications). Another CAM therapy such as chiropractic care has neither well-designed studies nor positive results and is not currently recommended for FM treatment. Once CAM therapies have been better evaluated for safety and long-term efficacy in randomised, placebo-controlled trials, they may prove to be beneficial in treatments for FM. It would then be important to assess studies assessing cost-benefit analyses comparing conventional therapies and CAM.Öğe The effect of calcitonin on biochemical markers and zinc excretion in postmenopausal osteoporosis(Elsevier Ireland Ltd, 2005) Colpan, L; Gur, A; Cevik, R; Nas, K; Sarac, AJObjectives: A double-blind randomized, placebo-controlled trial was conducted in women with postmenopausal osteoporosis to evaluate effects on biochemical markers and urinary excretion of zinc (Zn) of calcitonin therapy. Methods: Patients were required to have a bone mineral density (BMD) of 2.5 S.D. or more below the young adult mean either at the postero-anterior lumbar spine or at the femoral neck. Subjects were eligible for our study if they were 50 years or older, with at least 5 years of menopause, and in good general health as determined by medical history and a routine clinical blood analysis. The patients were randomly assigned to receive intranasal salmon calcitonin (200 IU/day; 50 patients) or placebo (50 patients). All patients received supplemental calcium (1000 mg/day). Additionally, 40 age-matched, demographically similar, healthy postmenopausal women were also selected as controls. Measurements of cross-linked N-telopeptides of type I collagen (uNTx), osteocalcin (sOQ, and urinary zinc concentration were done. All parameters were measured before therapy and again after 1, 3 and 6 months. Results: After 3 and 6 months of treatment, a higher decrease of most indices was observed in the calcitonin group. A statistically significant decrease occurred in the levels of sOC, uNTx and uZn after 3 and 6 months in patients receiving calcitonin therapy (P < 0.05). Levels of sOC and uNTx in calcitonin group were significantly different after 3 and 6 months from both placebo and baseline values of calcitonin group (P < 0.05). Levels of sOC, uNTx and uZn decreased about 40, 46 and 37%, respectively, in calcitonin group at 6 months after the start of treatment. Conclusions: Our study suggests that values of uNTx, uZn and sOC were significantly lower in the patient group than those in control group and in postmenopausal women with osteopororsis, calcitonin reduces the concentrations of uNTx, uZn and sOC. (c) 2004 Elsevier Ireland Ltd. All rights reserved.Öğe The effect of educational level on bone mineral density in postmenopausal women(Elsevier Science Inc, 2003) Gur, A; Sarac, AJ; Nas, K; Cevik, R; Ataoglu, S; Em, S[Abstract Not Available]Öğe Effects of different therapy regimes of low power laser in painful osteoarthritis of the knee: A double-blind and placebo-controlled trial(Springer-Verlag London Ltd, 2003) Gur, A; Cosut, A; Sarac, AJ; Cevik, R; Nas, K[Abstract Not Available]Öğe Effects of low power laser and low dose amitriptyline therapy on clinical symptoms and quality of life in fibromyalgia(Springer Heidelberg, 2002) Gür, A; Karakoc, M; Nas, K; Cevik, R; Sarac, AJ; Ataoglu, SThe purpose of this study was to examine the effectiveness of low power laser (LPL) and low-dose amitriptyline therapy and to investigate effects of these therapy modalities on clinical symptoms and quality of life (QOL) in patients with fibromyalgia (FM). Seventy-five patients with FM were randomly allocated to active gallium-arsenide (Ga-As) laser (25 patients), placebo laser (25 patients), and amitriptyline therapy (25 patients). All groups were evaluated for the improvement in pain, number of tender points, skin fold tenderness, morning stiffness, sleep disturbance, muscular spasm, and fatigue. Depression was evaluated by a psychiatrist according to the Hamilton Depression Rate Scale and DSM IV criteria. Quality of life of the FM patients was assessed according to the Fibromyalgia Impact Questionnaire (FIQ). In the laser group, patients were treated for 3 min at each tender point daily for 2 weeks, except weekends, at each point with approximately 2 J/cm(2) using a Ga-As laser. The same unit was used for the placebo treatment, for which no laser beam was emitted. Patients in the amitriptyline group took 10 mg daily at bedtime throughout the 8 weeks. Significant improvements were indicated in all clinical parameters in the laser group (P = 0.001) and significant improvements were indicated in all clinical parameters except fatigue in the amitriptyline group (P = 0.000), whereas significant improvements were indicated in pain (P = 0.000), tender point number (P = 0.001), muscle spasm (P = 0.000). morning stiffness (P = 0.002), and FIQ score (P = 0.042) in the placebo group. A significant difference was observed in clinical parameters such as pain intensity (P = 0.000) and fatigue (P = 0.000) in favor of the laser group over the other groups, and a significant difference was observed in morning stiffness (P = 0.001), FIQ (P = 0.003), and depression score (P = 0.000) after therapy. A significant difference was observed in morning stiffness (P = 0.001), FIQ (P = 0.003). and depression (P = 0.000) in the amitriptyline group compared to the placebo group after therapy. Additionally, a significant difference was observed in depression score (P = 0.000) in the amitriptyline group in comparison to the laser group after therapy. Our study suggests that both amitriptyline and laser therapies are effective on clinical symptoms and QOL in fibromyalgia and that Ga-As laser therapy is a safe and effective treatment in cases with FM. Additionally, the present study suggests that the Ga-As laser therapy can be used as a monotherapy or as a supplementary treatment to other therapeutic procedures in FM.Öğe Hypothalamic-pituitary-gonadal axis and cortisol in young females with fibromyalgia: The potential roles of depression, fatigue and sleep disturbance in the occurrence of hypocortisolism(B M J Publishing Group, 2003) Gur, A; Cevik, R; Nas, K; Acar, S; Sarac, AJ; Em, S[Abstract Not Available]Öğe Hypothalamic-pituitary-gonadal axis and cortisol in young women with primary fibromyalgia: the potential roles of depression, fatigue, and sleep disturbance in the occurrence of hypocortisolism(Bmj Publishing Group, 2004) Gur, A; Cevik, R; Sarac, AJ; Colpan, L; Em, SObjectives: To investigate abnormalities of the hypothalamic-pituitary-gonadal (HPG) axis and cortisol concentrations in young women with primary fibromyalgia ( FM); and to determine whether depression, fatigue, and sleep disturbance affect these hormones. Methods: Follicle stimulating hormone (FSH), luteinising hormone (LH), oestradiol, progesterone, prolactin, and cortisol concentrations in 63 women with FM were compared with those in 38 matched healthy controls; all subjects aged <35 years. The depression rate was assessed by the Beck Depression Inventory (BDI) and patients with high and low BDI scores were compared. Additionally, patients were divided according to sleep disturbance and fatigue and compared both with healthy controls and within the group. Results: No significant differences in FSH, LH, oestradiol, prolactin, and progesterone levels were found between patients with FM and controls, but cortisol levels were significantly lower in patients than in controls (p < 0.05). Cortisol levels in patients with high BDI scores, fatigue, and sleep disturbance were significantly lower than in controls (p < 0.05). Correlation between cortisol levels and number of tender points in all patients was significant (r = -0.32, p < 0.05). Conclusion: Despite low cortisol concentrations in young women with FM, there is no abnormality in HPG axis hormones. Because fatigue, depression rate, sleep disturbance, and mean age of patients affect cortisol levels, these variables should be taken into account in future investigations.Öğe Hypothalamic-pituitary-gonadal axis hormones and cortisol in both menstrual phases of women with chronic fatigue syndrome and effect of depressive mood on these hormones(Bmc, 2004) Cevik, R; Gur, A; Acar, S; Nas, K; Sarac, AJBackground: Chronic fatigue syndrome (CFS) is a disease which defined as medically unexplained, disabling fatigue of 6 months or more duration and often accompanied by several of a long list of physical complaints. We aimed to investigate abnormalities of hypothalamic- pituitary-gonadal (HPG) axis hormones and cortisol concentrations in premenopausal women with CFS and find out effects of depression rate on these hormones. Methods: We examined follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone and cortisol concentrations in 43 premenopausal women ( mean age: 32.86 +/- 7.11) with CFS and compared matched 35 healthy controls ( mean age: 31.14 +/- 6.19). Patients were divided according to menstrual cycle phases ( follicular and luteal) and compared with matched phase controls. Depression rate was assessed by Beck Depression Inventory (BDI), and patients with high BDI scores were compared to patients with low BDI scores. Results: There were no significant differences in FSH, LH, estradiol and progesterone levels in both of menstrual phases of patients versus controls. Cortisol levels were significantly lower in patients compared to controls. There were no significant differences in all hormone levels in patients with high depression scores versus patients with low depression scores. Conclusion: In spite of high depression rate, low cortisol concentration and normal HPG axis hormones of both menstrual phases are detected in premenopausal women with CFS. There is no differentiation between patients with high and low depression rate in all hormone levels. Depression condition of CFS may be different from classical depression and evaluation of HPG and HPA axis should be performed for understanding of pathophysiology of CFS and planning of treatment.Öğe The influence of duration of breastfeeding on bone mass in postmenopausal women of different age groups(Wiley, 2003) Gur, A; Cevik, R; Nas, K; Sarac, AJ; Ataoglu, S; Karakoc, M; Can, AThis study examines the influence of duration of breastfeeding on bone mineral density (BMD) and investigates the relationship between duration of breastfeeding and bone mass at four sites in postmenopausal women of different ages. A total of 509 postmenopausal women aged 45-86 years were included in the study Patients were divided into three groups: never breastfed (n=67), <96 months (n=157) and greater than or equal to96 months (n=285); they were further classified into two age groups, 40-59 years (n=233) and 60-80 years (n=276). In all patients and in the 40-59 year age group, BMD of the spine was found to be significantly lower in the never-breastfed group, while BMD of the trochanter was significantly lower in the greater than or equal to96 month breastfeeding group. BMD of the spine and femur tended to decrease with longer breastfeeding in all groups, while BMD of the spine and trochanter tended to decrease with longer breastfeeding in the 40-59 year group. Of patients in the 60-80 year group who had never breastfed, spinal BMD was significantly higher than that of the greater than or equal to96 month group, while in the greater than or equal to96 month group trochanter BMD was significantly lower than in other groups. In the never-breastfed group, ward's triangle BMD was significantly higher than that of other groups. There was a significant correlation between duration of breastfeeding and BMD of the spine, neck, trochanter and ward's triangle. The study suggests that duration of breastfeeding has an effect on BMD, and extended breastfeeding leads to lower BMD.Öğe Influence of number of pregnancies on bone mineral density in postmenopausal women of different age groups(Springer Japan Kk, 2003) Gur, A; Nas, K; Cevik, R; Sarac, AJ; Ataoglu, S; Karakoc, MAs data on the relationship between parity and bone mineral density often seem to be controversial, ultimately, a comprehensive research study was thought to be necessary. This study focused on examining the influence of the number of pregnancies on bone mineral density and investigating the relationship between pregnancy and bone mineral density at four sites in postmenopausal women of different age groups. A total of 509 postmenopausal women, varying from 45 to 86 years of age (mean age of 60.85+/-7.53 years) were considered for the study. A standardized interview was employed to obtain information on demographics, lifestyle, and, reproductive and menstrual histories. Patients were separated into four groups according to the number of pregnancies, i.e., nulliparae (52 patients), one to two parity (66 patients), three to five parity (178 patients), and more than five parity (213 patients). The patients were further classified into two age groups, 40-59 years (233 patients) and 60-80 years (276 patients), respectively. The number of pregnancies was found to range from 0 to 17 (with an overall mean of 5.42+/-3.68), with 4.29+/-2.74 (range, 0-16) accounting for live births, while 1.02+/-1.53 (range, 0-14) were abortions. There were no significant differences among the groups with respect to parameters such as, age, body mass index (BMI), age at menarche, age at menopause, and years since menopause (P>0.05) in all of the 509 women and in the 40- to 59- and 60- to 80-year groups. When all the patients were considered, the bone mineral density (BMD) values of the spine and the trochanter for the more-than-five-parity group, were found to be significantly lower than those of the other groups (P<0.05), while the BMD values of the spine and the femur (neck, trochanter) appeared to decrease with increasing parity. In the 40- to 59- year group, the BMD of the spine in both the nulliparae and one-to-two-parity groups was significantly higher than that of the more-than-five-parity group (P<0.05). No significant differences were found among the groups with respect to the BMD values at any femur sites. The nulliparae patients in the 60- to 80-year group exhibited significantly higher trochanter and Ward's BMD values than those of the more-than-five-parity group (P<0.05), whereas in the one-to-two-parity group, spine BMD values appeared to be significantly higher than those of the more-than-five-parity group (p<0.05). Significant correlations were found between the number of pregnancies and BMD values for the spine (r=-0.23; P<0.01), trochanter (r=-0.16; P<0.01), and Ward's triangle (r=-0.14; P<0.05), with no significant correlation for femur neck BMD (r=-0.08; P>0.05) values. In conclusion, the present study suggests that the number of pregnancies has an effect on the BMD values and that this situation shows a variation in different age groups. In addition, our study indicates that there is a significant correlation between the number of pregnancies and the spine, trochanter, and Ward's triangle BMD, but there is no correlation for the femur neck BMD.Öğe Possible pathogenetic role of interleukin-8 and 10 in postmenopausal osteoporosis and changes during calcitonin and alendronate therapy(Elsevier Science Inc, 2003) Gur, A; Cevik, R; Nas, K; Sarac, AJ; Denli, A[Abstract Not Available]Öğe Possible pathogenetic role of new cytokines in postmenopausal osteoporosis and changes during calcitonin plus calcium therapy(Springer-Verlag, 2002) Gür, A; Denli, A; Nas, K; Cevik, R; Karakoc, M; Sarac, AJ; Erdogan, FThe present study was designed to test if the serum cytokines (interleukin, or IL-1beta, -2, -2r, -6, -6r, -8, and -10, and tumor necrosis factor alpha, or TNF-alpha) and osteocalcin levels were different between 50 osteoporotic and 30 postmenopausal nonosteoporotic women and to evaluate the efficacy of calcitonin therapy during 6 months on serum cytokines and osteocalcin levels in postmenopausal osteoporotic women. In our study, serum levels of osteocalcin, TNF-alpha, IL-2, and IL-8 were significantly higher in the patient group (P < 0.05), whereas serum levels of IL-10 and IL-6r were significantly lower in the patient group (P < 0.05). When analysed separately according to bone turnover, serum levels of IL-10 and IL-6r were significantly lower in the normal-turnover group (P < 0.05), and IL-2, IL-8, and TNF-alpha were significantly higher in the high-turnover group than in the control group (P < 0.05). Statistically significant improvement seemed to happen in the patients receiving calcitonin plus calcium therapy (P < 0.05) concerning levels of serum IL-6r at the 1st month (P < 0.05), IL- 10, IL-2r, IL-6r, and osteocalcin at the 3rd month, and IL-6r and osteocalcin at the end of the 6th month. Our findings demonstrate that calcitonin plus calcium therapy appears to be particularly more effective for patients with high turnover. In addition, our study suggests that IL-10 and IL-6r may have an important role in normal-turnover osteoporosis, while IL-2, IL-8, and TNF-alpha may play an important role in high-turnover postmenopausal osteoporosis.Öğe Relationship between radiological grading and symptoms, functional and health status in painful knee osteoarthritis(Springer London Ltd, 2003) Gur, A; Cevik, R; Nas, K; Sarac, AJ; Cosut, A; Calgan, N[Abstract Not Available]Öğe Sex and thyroid hormone status in women with rheumatoid arthritis(Blackwell Publishing Ltd, 2004) Cevik, R; Em, S; Gur, A; Nas, K; Sarac, AJ; Çolpan, LThere has been considerable interest in the role of hormones in the aetiopathogenesis of rheumatoid arthritis (RA). In this study, we aimed to investigate sex and thyroid hormone conditions according to menopausal state and disease activation in RA women. Fifty-four women with RA were included in the study. Age-matched 28 women with low back pain were used as controls. Sex and thyroid hormones were evaluated in all patients, which included the measurement of estractiol (E-2), progesterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, thyroid-stimulating hormone (TSH), total (T) and free (F) triiodothyronine (T3) and (T) and (F) thyroxine (T4). The RA patients were subdivided according to their pre-menopausal and post-menopausal Status and their disease activation conditions. Mean age was 45.68 (+/-12.5) in women (aged 22-70) with RA;and 42.39 (+/-12.45) in controls (aged 22-62). There were no significant differences in sex hormones, but there were statistically significant higher levels of TT3 and TT4 in whole women with RA compared to controls. Lower concentrations of FSH were detected in active RA patients. There were statistically lower concentrations of LH and higher concentrations of TT3 and TT4 in pre-menopausal RA women, while lower concentrations of FSH were detected in post-menopausal RA women. TT3 and FT3 levels of pre-menopausal RA women were significantly higher than post-menopausal RA women. There were no significant differences for all other hormones studied. In conclusion, sex and thyroid hormones have been influenced in women with RA. Reproductive and menopausal conditions should be taken into consideration when sex and thyroid hormones studies are carried out in RA women.Öğe Traumatic spinal cord injuries in Southeast Turkey: an epidemiological study(Stockton Press, 1997) Karamehmetoglu, SS; Nas, K; Karacan, I; Sarac, AJ; Koyuncu, H; Ataoglu, S; Erdogan, FIn 1994, a retrospective study of new cases of traumatic Spinal Cord Injury (SCI) was conducted in all the hospitals in Southeast Turkey: 75 new traumatic SCI were identified. The estimated annual incidence was 16.9 per million population. The male/female ratio was 5.8/1. The mean age was 31.3, being 31.25 for male patients and 31.36 for female patients. 70.7% of all patients were under the age of 40. The major causes of SCI were falls (37.3%) and gunshot wounds (29.3%), followed by car accidents (25.3%), and stab wounds (1.3%). Thirty one patients (41.3%) were tetraplegic and 44 (58.7%) paraplegic. In tetraplegic patients the commonest level was C5, in those with paraplegia L1. The commonest associated injury was head trauma followed by fractures of the extremity(ies). Severe head trauma, being a major cause of death, may have obscured the actual incidence of SCI. Most of gunshot injured SCI patients were young soldiers fighting against the rebels. As there was no available data for the rebels with SCI, the actual incidence of SCI in Southeast (SE) Turkey should be higher than that found in this study.
