Browsing by Author "Bitik, Berivan"

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Başkent Üniversitesi Ankara Hastanesi’nde romatolojik nedenlerle böbrek nakli yapılan hastaların kısa ve uzun dönem klinik sonuçlarının incelenmesi.
(Başkent Üniversitesi Tıp Fakültesi, 2023) Hatipoğlu, Mesut Buğra; Bitik, Berivan
Giriş ve Amaç: Romatolojik hastalıklar, farklı spektrumlarda böbrek tutulumuna neden olabilirler. Bu spektrum, normal böbrek fonksiyonuna sahip hafif eritrositüri/proteinüri gibi anormalliklerden, hızla ilerleyen böbrek yetmezliğine kadar uzanır. Romatolojik hastalık ilişkili böbrek tutulumunda, etkin tedaviye rağmen son dönem böbrek hastalığı (SDBH) gelişebilmektedir. SDBH, yaşam kalitesini bozan, mortalite ve morbiditeleri artıran ve maliyet yükü fazla olan bir hastalıktır. Renal replasman tedavisi (RRT) seçeneklerinden olan böbrek nakli, diyaliz tedavisine göre avantajlı bir tedavi yöntemidir. Literatürde, romatolojik hastalığı olan bireylerde böbrek nakil sonuçlarını araştıran çalışmalar sınırlı sayıdadır. Bu çalışmada, romatolojik hastalık ilişkili SDBH nedeniyle böbrek nakli yapılan hastaların laboratuvar ve klinik verileri incelenmiştir. Bu spesifik hasta grubunda, nakil sonrası beşinci ve onuncu yılda, romatolojik hastalık dışı nedenlerle nakil yapılan bireylere göre hasta ve allograft sağkalımı açısından farklılık olup olmadığı araştırılmıştır. Nakil sonrası takipte dikkat edilmesi gereken noktalara dikkat çekilmiştir. Gereç ve Yöntem: Ocak 1994-Eylül 2022 tarihleri arasında, Başkent Üniversitesi Ankara Hastanesi’nde böbrek nakli yapılan 18 yaş ve üzerindeki 50 kontrol hastası ve romatolojik nedenlerle böbrek nakli yapılan 18 yaş ve üzerindeki 93 hasta olmak üzere toplamda 143 hastaya ait veriler retrospektif olarak incelenmiştir. Araştırmanın değişkenlerine yönelik hasta bilgileri için, Başkent Üniversitesi Ankara Hastanesi medikal bilgi sistemi “Nucleus MBS” (Monad Yazılım) ve Clinerion Hasta Kayıt Sistemi Platformu kullanılmıştır. İstatistiksel analizler RStudio yazılımı (R Core Team Version 1.4.1106, 2021) programı ile gerçekleştirildi. Çalışmada istatiksel anlamlılık düzeyi olarak p<0,05 değeri kabul edildi. Bulgular ve Tartışma: Araştırmaya böbrek nakli yapılan 20 sistemik lupus eritematozus (SLE), 43 ailevi Akdeniz ateşi (FMF), 9 romatoid artrit (RA), 21 spondiloartrit (SpA), 50 kontrol grubu hastası olmak üzere toplam 143 hasta dahil edilmiştir. SLE grubunda 20 hasta olup hastaların 14’ü(%70) kadın, 6’sı erkekti, ortanca nakil yaşı 26 (22,5-38,5) yıldı. Takip süresince hastalardan 4’ünün (%20) öldüğü görülürken kontrol grubunda ölüm görülmemesi nedeniyle anlamlı olarak SLE grubunda ölüm oranı daha yüksek bulundu (p=0,005). SLE ve kontrol grubu arasında beş yıllık allograft ve hasta sağkalım oranları açısından anlamlı farklılık gözlenmemiştir. Ancak SLE grubunda on yıllık allograft sağkalım oranı (%63,64) kontrol grubuna göre (%92,86) daha düşük olup on yıllık hasta sağkalım oranı da (%73,33) kontrol grubuna göre (%100) daha düşük bulunmuştur (sırasıyla p=0,042; p=0,011). SLE grubunda nakil öncesi daha kısa süre diyalize girmenin sağkalıma yararı görüldü (p=0,038). FMF grubunda 43 hasta olup hastaların 15’i kadın (%34,88) 28’i erkekti (%65,12), ortalama nakil yaşı 31,98±12,03 yıldı. Takip süresince hastalardan 14’ünün (%32,56) öldüğü görülürken kontrol grubunda ölüm görülmemesi nedeniyle FMF grubunda ölüm oranı anlamlı olarak daha yüksek bulundu (p<0,001). Beş ve on yıllık hasta sağkalımları FMF grubunda sırasıyla %87,5 ve %71,43 iken kontrol grubunda %100 olup, FMF grubunda anlamlı derecede daha düşük bulundu (p=0,026; p=0,004). Beş ve on yılık allograft sağkalımlarıysa FMF grubunda sırasıyla %79,49 ve 73,91 iken kontrol grubunda sırasıyla %97,56 ve %92,86 olduğu görüldü (p=0,013; p=0,119). Kardiyak patolojisi AA amiloidoz ile uyumlu olan bir FMF hastasına böbrek nakli sonrasında kalp nakli de yapıldığı görülmüştür. FMF hastalarının beşinde (%11,62) allograftta AA amiloidoz nüksü görüldü. FMF grubunda canlı donörden nakil yapılan hastalarda beşinci yıl allograft sağkalım sonuçlarının daha iyi olduğu bulunmuştur (p=0,028). Daha uzun süre diyalize giren grupta beşinci yıl sonunda allograft kaybı riskinin arttığı görülmüştür (p=0,023). Onuncu yıl allograft sağkalımı açısından karşılaştırıldığında nakil öncesi daha uzun süre diyalize giren grupta allograft kaybı riskinin arttığı ve preemptif nakil olanların daha iyi sonuçlara sahip olduğu görülmüştür (p=0,015). RA grubunda 9 hasta olup hastaların 4’ü kadın (%44,44) 5’i erkekti. Ortanca nakil yaşı 43 (31-54) yıldı. Takip süresince hastalardan 5’inin (%55,56) öldüğü görülürken kontrol grubunda ölüm görülmemesi nedeniyle RA grubunda ölüm oranı anlamlı olarak daha yüksek bulundu (p<0,001). Beş ve on yıllık hasta sağkalımları RA grubunda sırasıyla %71,43 ve %50,00 iken kontrol grubunda %100 olup RA grubunda anlamlı derecede daha düşük bulundu (p=0,019; p=0,003). SpA grubunda 21 hasta olup hastaların 7’si kadın (%33,33), 14’ü erkekti. Ortalama nakil yaşı 39,65±13,81 yıldı. Takip süresince hastalardan 4’ünün (%19,05) öldüğü görülürken kontrol grubunda ölüm görülmemesi nedeniyle SpA grubunda ölüm oranı anlamlı olarak daha yüksek bulundu (p=0,006). SpA grubunda beş ve on yıllık hasta sağkalımlarının kontrol grubundaki gibi %100 olduğu, beş ve on yılık allograft sağkalım oranlarınınsa SpA grubunda daha düşük olmakla birlikte istatistiksel açıdan kontrol grubuyla benzer olduğu görüldü. Nakil zamanı yüksek düzeyde CRP’ye sahip olmanın, SpA hastalarında mortaliteyi artırdığı görüldü (p=0,027). Akut rejeksiyon gelişen SpA hastalarında takip süresi boyunca allograft kaybı sonucu diyaliz ihtiyacı gelişme riski anlamlı olarak daha yüksek bulundu (p=0,017). Çalışmamızda, SLE hastalarında yapılan böbrek nakillerinde, kontrol grubuna kıyasla ölüm oranının daha fazla, on yıllık allograft ve hasta sağkalım oranının daha düşük olduğu görülmüştür. Ayrıca SLE hastalarında nakil öncesi diyaliz süresinin uzun olmasının hasta sağkalımını olumsuz etkilediği gösterilmiştir. FMF hastalarında, kontrol grubunda yapılan böbrek nakillerine oranla ölüm oranının daha fazla, beş yıllık allograft, beş ve on yıllık hasta sağkalım oranının daha düşük olduğu bulunmuştur. Ayrıca canlı donörden yapılan nakillerde, beşinci yıl allograft sağkalımlarının ve benzer şekilde, nakil öncesi daha kısa süre diyalize giren hastaların beşinci ve onuncu yıl allograft sağkalımlarının daha iyi olduğu görülmüştür. RA ve SPA hastalarında yapılan böbrek nakillerinde, kontrol grubuna kıyasla, ölüm oranının daha fazla olduğu görülmüştür. Ayrıca SpA hastalarında nakil öncesi diyaliz süresinin uzun olmasının beşinci yıl allograft sağkalımını olumsuz etkilediği, akut rejeksiyon gelişen hastalarda allograft kaybı riskinin arttığı, nakil zamanı CRP değerinin yüksek olmasının ise mortaliteyi artırdığı gösterilmiştir. Tüm romatolojik hasta gruplarında, böbrek nakli sonrası en sık ölüm nedeninin enfeksiyon olduğu görülmüştür. Çalışmamızın romatolojik hastalarda böbrek nakli sonuçlarına dair az sayıda yayın olması sebebiyle literatüre önemli katkılar sağlaması beklenmektedir. Bu çalışma ile romatolojik hastalık ilişkili SDBH olan hastalarda, endikasyonu olan durumlarda nakilden kaçınılmaması gerektiği, en iyi RRT şeklinin böbrek nakli olduğu desteklenmiştir. Nakil sonrası gelişebilecek enfeksiyonlar ve erken tedavileri açısından dikkatli olunmalıdır. Nakil döneminde romatolojik hastalık aktivitesinin düşük olmasına dikkat edilmelidir. Nakil sonrasında da romatolojik hastalık nüksü açısından multidisipliner takibe devam edilmelidir.Introduction and Aim: Rheumatological diseases can cause renal involvement in different spectrums. This spectrum ranges from abnormalities such as mild erythrocyturia/proteinuria with normal kidney function to rapidly progressive renal failure. Despite receiving good treatment, end-stage renal disease (ESRD) might arise in renal involvement caused by rheumatic disease. The disease ESRD lowers quality of life, raises mortality and morbidity, and has a large financial impact. Kidney transplantation, which is one of the renal replacement therapy (RRT) options, is an advantageous treatment method compared to dialysis treatment. There aren't many research in the literature looking at kidney transplantation results in people with rheumatological disease. This study analyzed the laboratory and clinical data of patients who received kidney transplantation for ESRD caused by rheumatological diseases. At the five and tenth years following transplantation, it was looked into whether there was a difference in patient and allograft survival in this particular group of patients compared to people who received transplants for non-rheumatic disorders. There were things to keep in mind throughout the post-transplant follow-up. Materials and Method: Retrospective analysis was performed on data from 143 patients between January 1994 and September 2022, including 50 control patients who underwent kidney transplantation at the Başkent University Ankara Hospital and 93 patients who underwent kidney transplantation due to rheumatological diseases. Patients' information on the study's variables was collected using the medical information system "Nucleus MBS" (Monad Software) and the Clinerion Patient Registration System Platform at Baskent University Ankara Hospital. RStudio software (R Core Team Version 1.4.1106, 2021) was used to conduct statistical analyses. p<0.05 was accepted as the statistical significance level. Findings and Discussion: The study comprised 143 patients in total, including 50 control group patients who underwent kidney transplantation, 20 patients with systemic lupus erythematosus (SLE), 43 patients with familial Mediterranean fever (FMF), 9 patients with rheumatoid arthritis (RA), and 21 patients with spondyloarthritis (SpA). The SLE group included 20 patients, 14 of them were female (70%) and 6 were male. The median age of transplant recipient was 26 (22.5-38.5). While it was reported that 4 patients (20%) died during the follow-up period, the mortality rate was determined to be considerably higher in the SLE group because no deaths were noted in the control group (p=0.005). In terms of five-year allograft and patient survival rates, there was no discernible difference between the SLE and control groups. Allograft survival in the SLE group was lower at ten years (63.64%) than in the control group (92.86%), and patient survival was lower at ten years (73.33%) than in the control group (100%). (p=0.042; p=0.011). A shorter period of dialysis before transplantation had a survival benefit in the SLE group (p=0.038). The FMF group included 43 patients, of whom 15 (34.88%) were female and 28 (65.12%) were male. The mean age at transplantation was 31.98±12.03 years. Although 14 patients (32.56%) died during the follow-up period, the mortality rate in the FMF group was considerably greater (p<0.001) than in the control group since no deaths were noted in the control group. Patient survival rates at five and ten years were 87.5% and 71.43%, respectively, in the FMF group, compared to 100% in the control group and substantially lower in the FMF group (p=0.026 and p=0.004, respectively). The FMF group's five and ten year allograft survival rates were 79.49% and 73.91%, respectively, while the control group's rates were 97.56% and 92.86% (p=0.013 and p=0.119). In a patient with FMF whose cardiac pathology was consistent with AA amyloidosis, it was noted that a heart transplant was carried out following a kidney transplant. In five (11.62%) individuals with FMF, AA amyloidosis recurrence was found in the allograft. Patients who received transplants from a living donor were shown to have higher allograft survival results at five years in the FMF group (p=0.028). The group that had dialysis for a longer period of time showed an increase in allograft loss risk at the end of the fifth year (p=0.023). When compared in terms of tenth year allograft survival, it was seen that the risk of allograft loss increased in the group that underwent dialysis for a longer period before transplantation, and those with preemptive transplantation had better results (p=0.015). In the RA group, there were 9 patients; 4 (44.44%) of them were female, and 5 were male. The median age of transplant was 43 (31-54) years. While it was observed that 5 (55.56%) of the patients died during the follow-up period, the mortality rate was determined to be considerably higher in the RA group because there was no death in the control group (p<0.001). In the RA group, patient survival rates at five and ten years were 71.43% and 50%, respectively, compared to 100% in the control group and significantly lower in the RA group (p=0.019; p=0.003). The SpA group consisted of 21 patients, 7 (33.33%) of whom were female, and 14 were male. The mean age at transplantation was 39.65±13.81 years. While it was noted that 4 patients (19.05%) died throughout the follow-up period, the mortality rate in the SpA group was found to be considerably higher since there were no deaths noted in the control group (p=0.006). Five and ten year patient survival rates in the SpA group were 100% as in the control group, and five and ten year allograft survival rates were lower in the SpA group but statistically similar to the control group. A high CRP level at the time of transplantation was found to increase mortality in SpA patients (p=0.027). SpA patients who experienced acute rejection were shown to have a considerably increased probability of needing dialysis as a result of allograft loss during the observation period (p=0.017). In our study, it was observed that the mortality rate was higher and the ten-year allograft and patient survival rates were lower in kidney transplants performed in SLE patients compared to the control group. In addition, it has been shown that the long duration of dialysis before transplantation in SLE patients has a negative effect on patient survival. In FMF patients, the mortality rate was higher and the five year allograft, five and ten year patient survival rates were lower compared to kidney transplants performed in the control group. It has also been observed that transplants from living donors have better fifth-year allograft survival and similarly, patients who were on dialysis for a shorter period before transplantation have better fifth and tenth year allograft survival. It was observed that the mortality rate was higher in kidney transplants performed in RA and SPA patients compared to the control group. In addition, it has been shown that a long duration of dialysis before transplantation negatively affects fifth year allograft survival in SPA patients, the risk of allograft loss increases in patients with acute rejection, and a high CRP value at the time of transplantation increases mortality. In all rheumatologic patient groups, infection has been shown to be the most common cause of death after kidney transplantation. Our study is expected to make a significant contribution to the literature since there are few publications on the outcomes of kidney transplantation in rheumatologic patients.This study supports that transplantation should not be avoided in patients with rheumatologic disease-related ESRD when indicated, and that kidney transplantation is the best form of RRT. Care should be taken in terms of infections that may develop after transplantation and their early treatment. Rheumatologic disease activity should be kept low during the transplantation period. Multidisciplinary follow-up should be continued in terms of rheumatologic disease recurrence after transplantation.
Clinical characteristics of avascular necrosis in patients with Behcet disease: a case series and literature review
(2019) Atas, Nuh; Bitik, Berivan; Varan, Ozkan; Babaoglu, Hakan; Tufan, Abdurrahman; Haznedaroglu, Seminur; Goker, Berna; Ozturk, Mehmet Akif; 30560445
Avascular necrosis (AVN), also known as osteonecrosis, is characterized by death of the osteocytes due to inadequate blood supply caused by various mechanisms. The hip is the most common affected joint followed by knee. Incidence of AVN in rheumatic diseases is variable and high corticosteroid (CS) therapy is a known major risk factor for development of AVN. Data on the AVN in Behcet disease (BD) are limited. The purpose of this study is to examine the clinical and treatment characteristics of BD patients with diagnosis of AVN. Retrospective medical records of 337 BD patients were reviewed. Nine BD patients with AVN were detected. The clinical data of these patients with AVN have been reviewed. All patients had MRI of the symptomatic joints compatible with AVN. All of the nine patients who were diagnosed with AVN were male. Median duration of BD was 7years. Median time between diagnosis of BD and detection of AVN was 3years (1-16years). Multiple joints were involved in seven patients. Six patients had bilateral knee AVN. Six patients had vascular BD. The median time interval between initial CS dose and AVN development was 24months (range=2-100). The median highest daily CS dose was 64mg/day (range=32-80) and median cumulative CS dose prior to AVN was 18g. All of patients had intravenous pulse steroids. CS treatment, smoking and vascular involvement may predispose to AVN in patients with BD. According to this cohort, AVN in BD frequently tended to be in the knee joint and bilateral.
Long-Term Results of Kidney Transplantation in Patients with Familial Mediterranean Fever
(2023) Bitik, Berivan; Hatipoglu, Bugra; Sayin, Burak; Kanbur, Aysenur Yalcintas; Bursa, Nurbanu; Oygur, Cagdas Sahap; Ozdemir, Handan; Colak, Turan; Haberal, Mehmet; Yucel, Ahmet Eftal; 0000-0001-5803-915X; 0000-0002-7528-3557; 0000-0002-3462-7632; 0000-0002-0168-2993; 36544375; AAI-9195-2021; X-8540-2019; AAJ-8097-2021
IntroductionLong-term kidney transplantation (KT) results in patients with familial Mediterranean fever (FMF)-related amyloidosis are not well studied. This study reviewed the long-term survival outcomes of FMF patients who underwent KT. MethodsWe compared the outcomes of 31 patients who underwent (KT) for biopsy-proven amyloidosis secondary to FMF with 31 control patients (five with diabetes mellitus and 26 with nondiabetic kidney disease) undergoing KT between 1994 and 2021 at Baskent University Hospital. All data were recorded retrospectively from patients' files. Results: The median age (quartile deviationQD) at the time of KT in the FMF and control group were 31 (6.7) and 33 (11), respectively. The median follow-up period (QD) after KT was 108 (57) months in the FMF and 132 (72) months in the control group. In the FMF group, graft and patient survivals were 71% and 84% at 5 years and 45% and 48% at 10 years, respectively. In the control group, graft and patient survivals were 79% and 100% at 5 years and 63% and 71% at 10 years, respectively. Patient survival in the FMF group at 5 years was significantly lower than in the control group (p = .045). There was no statistically significant difference between the FMF and control groups in terms of graft and patient survival, and serum creatinine levels at 10 years. All patients were given triple immunosuppressive treatment with cyclosporine, mycophenolate mofetil, and prednisolone. Three patients received anakinra and one received canakinumab in addition to colchicine treatment. One FMF patient also underwent heart transplantation due to AA amyloidosis. Of the FMF patients, 11 died during follow-up. ConclusionWe have found that the long-term outcome of KT in patients with FMF amyloidosis is numerically worse but not statistically different from the control group. However, short- and long-term complications still need to be resolved.
Luteolin Modulates Glyco-Lipo-Oxidative Protein Modifications and Inhibits Inflammatory Cytokine Release in Human Osteoarthritic Articular Chondrocytes: Comparison with Colchicine
(2018) Goker, Berna; Elmazoglu, Zubeyir; Bitik, Berivan; Aytekin, Cem Nuri; Karasu, Cimen; 0000-0003-4527-8834; 0000-0001-5803-915X; H-6022-2019; AAI-9195-2021
Radiographic Ischial Enthesopathy in Patients with Psoriatic Arthritis
(2022) Bitik, Berivan; Dalgic, Gunay Sahin; Kanbur, Aysenur Yalcintas; Ok, Mehtap Akcil; Yucel, Ahmet Eftal; https://orcid.org/0000-0001-5803-915X; AAI-9195-2021
Background To investigate the prevalence of radiographic ischial entheseal lesions in patients with psoriatic arthritis (PsA) compared to patients with rheumatoid arthritis (RA). Patients and Methods Thirty-eight patients with PsA and 46 patients with RA were included. Anteroposterior radiographs of the pelvis and lateral foot were evaluated for entheseal lesions. The following entheseal sites were reviewed: os ischium, bilateral Achilles tendon and inferior calcaneus. Abnormalities such as cortical erosions and enthesophytes (irregular bony proliferation) were recorded. Results The frequency of enthesopathic changes in the ischial region was found to be statistically significantly higher in PsA patients compared with RA patients (50 and 28.3%, respectively, p=0.04). Enthesopathic changes of the calcaneus and Achilles tendon also occurred more frequently in PsA patients than in RA patients. Conclusion Radiographic entheseal lesions in the ischial region are more prevalent in PsA patients compared with RA patients with symptoms in that region. Furthermore, such enthesopathic changes in the ischium are observed as frequently as changes in the Achilles tendon. These findings regarding structural entheseal lesions in the pelvic region contribute to the knowledge of entheseal involvement in PsA.
S-ALLYL-L-CYSTEINE ATTENUATES INFLAMMATION RELATED OXIDATIVE STRESS PARAMETERS AND INCREASES ADHESION CAPACITY OF PRIMARY HUMAN OSTEOARTHRITIC ARTICULAR CHONDROCYTES
(2019) Elmazoglu, Zubeyir; Bek, Zehra Aydin; Goker, Berna; Bitik, Berivan; Aktekin, Cem Nuri; Tezcan, Mehmet Engin; Karasu, Cimen