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Öğe Beyond expectations: safinamide’s unprecedented neuroprotective impact on acute spinal cord injury(Springer Science and Business Media Deutschland GmbH, 2024) Gökten, Murat; Zırh, Selim; Sezer, Can; Zırh, Elham Bahador; Gökten, Dilara BulutBackground: Traumatic spinal cord injury (SCI) is the most common preventable cause of morbidity. Despite rapid advances in medicine, effective pharmacological treatment against SCI has not yet been confirmed. This study aimed to investigate the possible anti-inflammatory, antiapoptotic, and neuroprotective effects of safinamide after SCI in a rat model. Methods: A total of 40 male Wistar albino rats were randomly divided into four groups. Group 1 underwent only laminectomy. Group 2 underwent SCI after laminectomy. In group 3, SCI was performed after laminectomy, and immediately afterward, intraperitoneal physiological saline solution was administered. In group 4, SCI was performed after laminectomy, and 90 mg/kg of safinamide was given intraperitoneally immediately afterward. Moderate spinal cord damage was induced at the level of thoracic vertebra nine (T9). Neuromotor function tests were performed and levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-1 beta (IL-1β) were measured. In both serum and spinal cord tissue, immunohistochemistry and histopathology studies were also conducted. Results: TNF-α, IL-1β, and IL-6 levels were found to be significantly increased in group 2 and group 3. In group 4, these levels were statistically significantly decreased. Group 4 also exhibited significant improvement in neuromotor function tests compared to the other groups. Histopathologically, it was found that group 4 showed significantly reduced inflammation and apoptosis compared to the other groups. Conclusion: This study revealed that safinamide has neuroprotective effects against SCI due to its anti-inflammatory, antiapoptotic, and antioxidant activities. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany 2024. corrected publication 2024.Öğe Kaşıntı: Spinal Tümörlerin Gözden Kaçan Bir Belirtisi(Sivas Cumhuriyet Üniversitesi, 2024) Gökten, Dilara Bulut; Gokten, Murat; Mercan, RıdvanGiriş Kronik kaşıntı, karmaşık yapısından dolayı sıklıkla ağrıyla ilişkilendirilir. Nöropatik kaşıntı, bugüne kadar hakkında fazla bir şey bilinmeyen, kronik kaşıntının bir şekli olarak tanımlanır. Bu durum çeşitli nörolojik olayların bir sonucu olarak gelişebilir ve somatosensoriyel sinir sistemindeki hasarla ilişkili kısmı, kronik kaşıntı vakalarının yaklaşık %10'unu oluşturur. Siringomiyeli, transvers miyelit, radikülopatiler, torasik omurga kitleleri, beyin tümörleri, felçler ve apseler bugüne kadar nöropatik kaşıntı ile ilişkililendirilmiş durumlar arasındadır. Olgu Bilinen herhangi bir hastalığı olmayan ve düzenli ilaç kullanımı olmayan 65 yaşında kadın hasta, iki yıldır devam eden kaşıntı şikayeti ile başvurdu. Kaşıntı başlangıçta iki taraflı diz altı fleksör yüzeylerinde yaklaşık beş santimetrelik alanda başlamıştı. Fizik muayenede kaşıntının olduğu bölgelerde eritematöz ekskoriye papüller görüldü. Hastanın kan şekeri, karaciğer ve böbrek fonksiyon testleri, tam kan sayımı, eritrosit sedimantasyon hızı, tiroid fonksiyon testleri, idrar tahlili, dışkı parazitolojisi normal idi. Aynı bölgede soğukluk hissi bildiren hasta, olası nöropatik kaşıntının etiyolojisinin araştırılması için beyin cerrahisine yönlendirildi. Hastanın görüntülemesinde spinal tümör saptandı. Beyin cerrahisi tarafından gerçekleştirilen ameliyatta omurga kitlesi çıkarıldı ve hasta, ameliyat sonrası kaşıntılarının tamamen kaybolduğunu bildirdi. Sonuç Ağrının bir çeşidi olarak kaşıntı kavramı çok yeni olmamakla birlikte, merkezi veya periferik sinir sisteminde meydana gelen ve kaşıntının işlenmesinden sorumlu nöronları etkileyen herhangi bir hasar, nöropatik kaşıntıya yol açabilir. Omurilik patolojilerine odaklanacak olursak, spinal korda zarar veren herhangi bir durum, hasarın derecesine bağlı olarak kaşıntıya neden olabilir. Ağrı, sıcak veya soğuk hissi, paroksismal kaşıntının olduğu dermatomal kaşıntı durumlarında ek görüntüleme yöntemleri veya etiyolojiye yönelik araştırmalar yapılmalıdır.Öğe Navigating Rhupus Complexity(Ankara Şehir Hastanesi, 2024) Gökten, Dilara Bulut; Mercan, RıdvanThe term ‘Rhupus,’ introduced by Peter Schur in 1971, describes patients meeting criteria for both rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Rhupus (RhS) is a rare syndrome, and approximately 60 cases have been described in the literature to date. The challenges in diagnosing this disease stem from the lack of well-defined clinical criteria. In this case, we present a 42-year-old female patient with overlap syndrome of RA and SLE (RhS) who developed inflammatory arthritis, swelling in her bilateral wrists, severe malar rash, oral ulcers and alopecia, anemia and thrombocytopenia during follow-up. Upon arrival, the patient’s laboratory values were as follows: erythrocyte sedimentation rate: 61 mm/hour (normal value: 0-20), hemoglobin: 8.3 g/dL (12-16), platelet count: 112.103/μL (150-450.103/μL). The purpose of documenting this case is to share our own experience with a syndrome that is quite rare and has the potential to cause confusion in the daily practice of clinicians.Öğe Not every elevating enzyme tells the same story: unpacking creatine kinase and anti-Jo-1 positivity beyond inflammatory myositis(Amaltea Medical Publishing House, 2023) Gökten, Dilara Bulut; Mercan, RıdvanGitelman syndrome (GS) is an autosomal recessive familial disorder characterized by hypokalemia and metabolic alkalosis. Rhabdomyolysis due to hypokalemia is extremely rare. The presentation of GS leading to rhabdomyolysis is extremely rare as well. This case report describes a situation in which GS mimicked inflammatory myositis. A 30-year-old woman presented to the rheumatology outpatient clinic with an inability to walk and severe muscle weakness. Her creatine kinase level was elevated at 9900 U/L and her potassium level was low at 2.6 mmol/L. A myositis panel was ordered on suspicion of inflammatory myositis, and the results showed a positive anti-Jo-1. A muscle biopsy, performed with a presumptive diagnosis of inflammatory myositis, yielded pathology results inconsistent with myositis. Despite persistent low potassium levels during follow-up, potassium replacement was administered. The patient’s clinical condition improved significantly with potassium replacement, leading to a reduction in muscle weakness. © 2023, Amaltea Medical Publishing House. All rights reserved.Öğe Rothmund-Thomson syndrome: Unpacking a rare diagnosis(Amaltea Medical Publishing House, 2024) Gökten, Dilara Bulut; Mercan, RıdvanRothmund-Thomson syndrome (RTS), also known as congenital poikiloderma, is a genodermatosis that appears in infancy and is characterized by poikilodermatous changes in the skin. It is a very rare and complex genetic disorder that can present with a wide range of symptoms and affect multiple systems in the body. The syndrome is inherited in an autosomal recessive manner. A 21-year-old female patient presented to our rheumatology outpatient clinic with swelling of the hands, sclerodactyly, and stiffness of the fingers with preliminary diagnosis of systemic sclerosis. She has had deformities in her feet and hands since the age of one year. Physical examination revealed poikiloderma and extremity deformities. She also had neutropenia in her bloodstream. She was diagnosed with Rothmund Thomson syndrome after genetic test results, prescribed colchicine and followed up regularly every three months. After two years of follow-up, she was diagnosed with ovarian cancer. © 2024, Amaltea Medical Publishing House. All rights reserved.Öğe Salmonella osteomyelitis and retropharyngeal, epidural abscess that developed under biologic therapy(Sociedade Portuguesa de Reumatologia, 2023) Gökten, Dilara Bulut; Akdağ Kaval, Emine Melda; Mercan, RidvanSalmonella is still observed as an infectious agent in developing countries, often causing gastrointestinal infections. Extra-gastrointestinal infections are rare and spinal infections are even rarer. This case report describes a patient with rheumatoid arthritis who is actively receiving biologic therapy, presented with dysphagia, recurrent fevers, back and arm pain, weight loss and weakness and was diagnosed with retropharyngeal and epidural Salmonella infection. © 2023, Sociedade Portuguesa de Reumatologia. All rights reserved.Öğe Tailored Treatments: Utilizing Anti-TNFs for Ankylosing Spondylitis and Essential Thrombocytosis(Sivas Cumhuriyet Üniversitesi, 2025) Gökten, Dilara Bulut; Mercan, RıdvanThrombocytosis is a condition that is often detected incidentally and can be seen both in the course of myeloproliferative diseases (MPD) and as a reactive condition. Ankylosing spondylitis (AS) is a chronic multisystemic inflammatory disease that mainly affects the spine. Mild to moderate thrombocytosis may occur secondary to the course of AS. In the treatment of AS, tumor necrosis factor inhibitor (anti-TNF) treatments are actively used as first-line therapy. The number of cases of MPDs occurring in the course of AS reported in the literature is limited. Although the exact effect of anti-TNF treatment on the MPD process is not fully known, there are publications stating that caution should be exercised in cases of MPD. By this case, we wanted to share our experience of using anti-TNF therapy in a patient diagnosed with ET in the course of AS. The 35-year-old male patient had been diagnosed with AS for 11 years and had been followed up by hematology with the diagnosis of essential thrombocytosis (ET) since 2010. When there was no response to indomethacin and sulfasalazine treatments, the patient was first given etanercept, and after secondary unresponsiveness, infliximab and adalimumab treatments were given. Despite the use of multiple anti-TNFs, no hematological deterioration was detected in terms of ET. Clinical and laboratory responses were also obtained in terms of AS. The patient has been stable and in remission in terms of both AS and ET since 2016.Öğe Understanding Igg4 Related Orbital Disease: A Rheumatologist's Perspective(2024) Gökten, Dilara Bulut; Mercan, RıdvanImmunoglobulin G4-related disease (IgG4-RD) is also known as IgG4-related systemic disease, hyper-IgG4 disease, IgG4-related autoimmune disease. It is a multi-organ, fibro-inflammatory condition with tumefactive lesions of unknown etiology and characteristic histopathological features. It can affect all orbital tissues, including the lacrimal glands and extraocular muscles. A 52-year-old female patient, presented with complaints of swelling above her right eye. After undergoing a contrast-enhanced MRI, she had a biopsy. Consequently, the pathological findings were reported as consistent with IgG4-related sclerosing disease. The patient was initially prescribed corticosteroid therapy, followed by methotrexate and azathioprine treatment, which successfully stabilized her condition. Since the disease can affect almost all organs and systems, it is crucial for clinicians to have knowledge about early diagnosis and employ a multidisciplinary approach in patient management.
