Person: MUMCU, GONCA
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MUMCU
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GONCA
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Publication Metadata only Femoral vein wall thickness measurement: A new diagnostic tool for Behcet's disease(OXFORD UNIV PRESS, 2021) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Ergelen, Rabia; Yildiz, Yasin; Aldag, Mustafa; Yazici, Ayten; Cefle, Ayse; Koc, Ertan; Esen, Bahar Artim; Mumcu, Gonca; Ergun, Tulin; Direskeneli, HanerObjectives. Diagnosing Behcet's disease (BD) is a challenge, especially in countries with a low prevalence. Recently, venous wall thickness (VWT) in lower extremities has been shown to be increased in BD patients. In this study, we aimed to investigate the diagnostic performance of common femoral vein (CFV) thickness measurement in BD and whether it can be used as a diagnostic tool. Methods.. Patients with BD (n=152), ankylosing spondylitis (n=27), systemic vasculitides (n=23), venous insufficiency (n=29), antiphospholipid syndrome (APS; n=43), deep vein thrombosis due to non-inflammatory causes (n=25) and healthy controls (n=51) were included in the study. Bilateral CFV thickness was measured with ultrasonography by a radiologist blinded to cases. Results. Bilateral CFV thickness was significantly increased in BD compared with all control groups (P < 0.001 for all). The area under the receiver operating characteristic curve for bilateral CFV thicknesses in all comparator groups was >0.95 for the cut-off value (0.5 mm). This cut-off value also performed well against all control groups with sensitivity rates >90%. The specificity rate was also >80% in all comparator groups except APS (positive predictive value: 79.2-76.5%, negative predictive value: 92-91.8% for right and left CFV, respectively). Conclusion. Increased CFV thickness is a distinctive feature of BD and is rarely present in healthy and diseased controls, except APS. Our results suggest that CFV thickness measurement with ultrasonography, a non-invasive radiological modality, can be a diagnostic tool for BD with sensitivity and the specificity rates higher than 80% for the cut-off value >= 0.5mm.Publication Metadata only Oral health is a mediator for disease severity in patients with Behcet's disease: A multiple mediation analysis study(WILEY, 2019) AKSOY, AYSUN; Yay, Meral; Celik, Zulal; Aksoy, Aysun; Alibaz-Oner, Fatma; Inanc, Nevsun; Ergun, Tulin; Direskeneli, Haner; Mumcu, GoncaObjectivesThe aim of the study was to examine whether oral health as an infection focus could mediate disease course in patients with Behcet's disease (BD). MethodsIn the study, oral health of 194 BD patients was examined at baseline and follow-up periods. The reasons for last dental visits were recorded as tooth extraction or regular control visits/planned treatments at the end of follow-up period. The Behcet's disease severity score was calculated with higher scores indicating a more severe course. Mediation analysis was carried out to assess the effects of oral health on disease severity score at follow-up period in the study. ResultsDental and periodontal indices were found to be higher at follow-up visit compared to those of baseline (P<0.05). Disease severity score was found to be higher in males (5.32.4) compared to females (4.4 +/- 2.5) in the whole group (P=0.005). Moreover, patients having tooth extraction at their last dental visit and patients with dental caries had a more severe disease course (5.4 +/- 2.4; 5.5 +/- 2.5) compared to others (4.2 +/- 2.3; 4.4 +/- 2.4; P<0.0001). In multiple mediation analysis, disease severity score was a dependent variable and was directly mediated by male gender (B=-0.8822, P=0.0145) and indirectly mediated through the presence of dental caries (B=0.9509 P=0.0110) and need of tooth extraction (B=0.8758, P=0.0128). ConclusionBoth presence of dental caries and need of tooth extraction were observed to be effective mediators for a more severe disease course in BD. Therefore, better oral health should be aimed to eliminate microbial factors, which are a part of pathogenic processes.Publication Metadata only Clinical and immunological effects of azithromycin in Behcet's disease(WILEY, 2005) MUMCU, GONCA; Mumcu, G; Ergun, T; Elbir, Y; Eksioglu-Demiralp, E; Yavuz, S; Atalay, T; Direskeneli, HBACKGROUND: The aim of this study was to evaluate the effects of azithromycin on mucocutaneous manifestations, oral health and immune response in Behcet's disease (BD). METHODS: Eight BD patients with active mucocutaneous symptoms were treated with azithromycin for 4 weeks. Oral health, clinical manifestations and in vitro interleukin (IL)-12, interferon (IFN)-gamma, IL-10 and monocyte chemotactic protein (MCP)-1 responses were evaluated before and after treatment. RESULTS: The number of folliculitic lesions, healing time of oral ulcers and scores of plaque indexes (PLIs) were lower after azithromycin treatment (P < 0.05). Scores of PLIs correlated positively with the healing time of oral ulcers (P = 0.02). Although a trend towards increased stimulated IL-10 responses with azithromycin was observed, no statistically significant difference was found. Stimulated and unstimulated MCP-1, IFN-gamma and IL-12 responses were similar before and after treatment (P > 0.05). CONCLUSION: Azithromycin was observed to be effective in decreasing folliculitic lesions and fastening the healing time of oral ulcers in BD.Publication Metadata only Does illness perception associate with disease symptoms in Behcet's disease?(SPRINGER-VERLAG ITALIA SRL, 2019) ALİBAZ ÖNER, FATMA; Mumcu, Gonca; Yagar, Fedayi; Alibaz-Oner, Fatma; Inanc, Nevsun; Direskeneli, Haner; Ergun, TulinThis study aims to assess the relationship between illness perception and disease course and symptoms in Behcet disease (BD). One hundred ten consecutive BD patients (F/M 50/60, mean age 38.5 +/- 9.88years) and 57 patients with Psoriasis as a disease control group (F/M 28/29, mean age 48.12 +/- 15.52) are included in this cross-sectional study. Illness perception is evaluated using a revised version of the Illness Perception Questionnaire (IPQ-R). In IPQ-R, the identity score reflecting the number of symptoms is higher in BD patients with musculoskeletal involvement than the others (6.77 +/- 2.91 vs. 5.08 +/- 3.3, respectively, p=0.007). The consequences score for musculoskeletal involvement (19.52 +/- 7.03) and timeline (acute/chronic) score for eye involvement (26.67 +/- 4.32) are also higher compared to patients without them (16.37 +/- 5.82 and 22.09 +/- 8.68) (p=0.011 and p=0.038), reflecting negative beliefs about the illness. The score of psychological attribution is higher in patients with psoriasis than BD (p=0.039), whereas the other subgroup scores are lower in patients with psoriasis compared to those of BD (p<0.05). This study provides a patient's perspective in the disease management process of BD using the IPQ-R questionnaire. A patient's own personal beliefs and emotional responses to their symptoms might affect the outcome measures, especially with musculoskeletal symptoms and eye involvement in BD. However, psychological attribution is found to be a prominent issue in psoriasis.Publication Metadata only Oral health related quality of life is affected by disease activity in Behcet's disease(WILEY, 2006) MUMCU, GONCA; Mumcu, G; Inanc, N; Ergun, T; Ikiz, K; Gunes, M; Islek, U; Yavuz, S; Sur, H; Atalay, T; Direskeneli, HOBJECTIVES: This study aimed to investigate oral and general health related quality of life (QoL) in patients with Behcet's Disease (BD) and to assess the performance of Turkish versions of oral health related quality questionnaires. SUBJECTS AND METHODS: Ninety-four BD patients, 24 patients with recurrent aphthous stomatitis (RAS), 113 healthy controls (HC) and 44 dental patients were investigated. QoL was assessed by oral health impact profile-14 (OHIP-14), oral health related quality of life (OHQoL) and short form-36 (SF-36) questionnaires. RESULTS: OHQoL, OHIP-14 and SF-36 subscale scores were significantly worse in patients with BD compared with those in HC (P < 0.05). Both OHIP-14 and OHQoL scores were significantly worse in active patients compared with inactives in BD and RAS (P < 0.05). Scores of SF-36 Role physical, Role emotional and Vitality were also lower in active patients than in inactives in BD (P < 0.05). Scores of OHIP-14 and OHQoL were significantly worse in patients treated with colchicine compared with those treated with immunosuppressives (P < 0.05). CONCLUSIONS: Both oral and general QoL was impaired in BD and associated with disease activity and treatment modalities. Translated Turkish versions of OHIP-14 and OHQoL were also observed to be valid and reliable questionnaires for further studies.Publication Metadata only The assessment of oral health-related quality of life by factor analysis in patients with Behcet's disease and recurrent aphthous stomatitis(WILEY, 2007) MUMCU, GONCA; Mumcu, G.; Hayran, O.; Ozalp, D. O.; Inanc, N.; Yavuz, S.; Ergun, T.; Direskeneli, H.BACKGROUND: The aim of the study was to test multidimensional properties of oral health impact profile-14 (OHIP-14) in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS) patients with active oral ulcers. METHODS: Ninety-six BD patients, 28 patients with RAS and 117 healthy controls (HC) were included in this study. In patients with active oral ulcers, the frequency and healing time of ulcers were recorded. Multidimensional properties of OHIP-14 were examined by factor analysis. RESULTS: Factor analysis revealed three subscales and explained 66.49% of overall variance in these patients with active oral ulcers. The score of Subscale 1 was positively correlated with the recurrence of oral ulcers per month (P = 0.037). Subscale 3 scores of the patients treated with colchicine were worse than those treated with immunosuppressives (P = 0.035). CONCLUSIONS: The factor structure of OHIP-14 was found to be reliable and sensitive to clinical parameters and treatment modalities in active patients.Publication Metadata only Venous vessel wall thickness in lower extremity is increased in male patients with Behcet's disease(SPRINGER LONDON LTD, 2019) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Ergelen, Rabia; Mutis, Aydan; Erturk, Zeynep; Asadov, Ruslan; Mumcu, Gonca; Ergun, Tulin; Direskeneli, HanerVascular involvement, especially in young males, is seen in up to 40% of the patients with Behcet's disease (BD) and is a major cause of mortality and morbidity. In this study, we investigated vessel wall thickness (VWT) and dilatation in lower extremity veins with Doppler ultrasound (US) in male BD patients. Sixty-one male patients with BD, 37 healthy male controls (HC) and 27 male patients, with ankylosing spondylitis (AS), were included in the study. Venous Doppler US was performed by an experienced radiologist blinded to cases. Bilateral common femoral vein (CFV) wall thickness and great/small saphenous vein (SV) dilatations were assessed. All venous measurements were significantly higher in BD compared to AS and HC (p<0.001 for all). Both right and left extremity CFV thicknesses had a high area under the ROC curve (>0.8). Cut-off values for right and left CFV thicknesses for BD was 0.49 and 0.48mm, respectively. High sensitivity and specificities are observed for both measurements (right CFV: sensitivity 81%, specificity 78.4%; left CFV: sensitivity 82.8%, specificity 81.1%). We found increased CFV thickness in BD patients independent of vascular involvement. As a similar change was not observed in controls, increased CFV thickness may be a specific sign of venous inflammation in BD. Our acceptable sensitivity and specificity values of CFV measurements suggest that assessment of femoral vein thickness with US may be a candidate diagnostic tool, especially in young males suspected of BD.Publication Metadata only Th17-Inducing Conditions Lead to in vitro Activation of Both Th17 and Th1 Responses in Behcet's Disease(TAYLOR & FRANCIS INC, 2017) ALİBAZ ÖNER, FATMA; Deniz, Rabia; Tulunay-Virlan, Aysin; Ozdemir, Filiz Ture; Unal, Ali Ugur; Ozen, Gulsen; Alibaz-Oner, Fatma; Aydin-Tatli, Imren; Mumcu, Gonca; Ergun, Tulin; Direskeneli, HanerObjectives: Interleukin-17 (IL-17) has been associated with the pathogenesis of various autoimmune/inflammatory diseases. The aim of this study was to investigate the expression of Th17-related immunity in an innate immunity-dominated vasculitis, namely Behcet's disease (BD). Methods: Peripheral blood mononuclear cells from 37 patients (age: 38.59.8years) with BD, and 25 healthy controls (HC) (age: 39.19.3years), were cultured in Th17-inducing conditions (IL-6, Phytohemagglutinin (PHA), IL-1, and IL-23) for 6days. Cultured cells were stained with CD4, CD8, CD3, TCR gamma/delta, CD19, interferon- (IFN-), and IL-17 antibodies to determine the intracellular cytokine secretion by flow cytometry. Results: IL-17 expression by CD8+ and + T cells was higher in BD compared to HC (p=0.004, p=0.003, respectively). No differences were observed between the groups in the IL-17 production by B cells. Under Th17-inducing conditions, production of IFN- by CD4+, CD8+, and + T cells was also higher in BD compared to HC (p<0.05 in all). Conclusion: Our results suggest that under Th17-stimulating conditions, T cells express both IL-17 and IFN- in BD. More prominent IL-17 and IFN- production by all lymphocyte subsets in BD might be associated with the increased innate responses, early tissue neutrophil infiltrations and late adaptive immunity in BD.Publication Metadata only Unmet need in Behcet's disease: most patients in routine follow-up continue to have oral ulcers(SPRINGER LONDON LTD, 2014) ALİBAZ ÖNER, FATMA; Alibaz-Oner, Fatma; Mumcu, Gonca; Kubilay, Zeynep; Ozen, Gulsen; Celik, Gulce; Karadeniz, Asli; Can, Meryem; Oner, Sibel Yilmaz; Inanc, Nevsun; Atagunduz, Pamir; Ergun, Tulin; Direskeneli, HanerThe clinical course of Behcet's disease (BD) as a multisystemic disorder with a remitting-relapsing nature is insufficiently explored. As complete remission should be aimed in all inflammatory diseases, we investigated the frequency of complete remission in patients with BD followed in long-term, routine practice. In this retrospective study, 258 patients with BD who were regularly followed in outpatient clinics were assessed. The demographic and clinical data for active organ manifestations and treatment protocols were evaluated, and complete remission for this study was defined as no sign of any disease manifestation in the current visit and the preceding month. Two hundred fifty-eight patients with BD (F/M 130/128, mean age 41.1 +/- 11.5 years) were included to the study. Mucocutaneous disease was present in 48.4 % (n = 125). Mean visit number was 6.8 +/- 2.7, and mean follow-up duration was 45.8 +/- 36.5 months. Patients were clinically active in 67.2 % (n = 1,182) of the total visits (n = 1,757), which increased to 75.6 % (68.1-90.3) when the month preceding the visit was also included. The most common active manifestation was oral ulcers (39.4-63.2 %) followed by other mucocutaneous manifestations and musculoskeletal involvement. When multivariate analysis was performed, oral ulcers, which are the main cause of the clinical activity, negatively correlated with immunosuppressive treatments (beta = -0.356, p < 0.000) and age (beta = -0.183, p = 0.04). It is fairly difficult to achieve complete remission in BD with current therapeutic regimens. The reluctance of the clinician to be aggressive for some BD manifestations with low morbidity, such as mucocutaneous lesions and arthritis, might be influencing the continuous, low-disease activity state, especially due to oral ulcers, in BD patients.Publication Metadata only A composite index for determining the impact of oral ulcer activity in Behcet's disease and recurrent aphthous stomatitis(WILEY-BLACKWELL PUBLISHING, INC, 2009) MUMCU, GONCA; Mumcu, G.; Sur, H.; Inanc, N.; Karacayli, U.; Cimilli, H.; Sisman, N.; Ergun, T.; Direskeneli, H.Background: Although number, frequency and healing time of oral ulcers and pain are generally used for clinical practice and studies in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS), no standardized activity index is currently present to monitor clinical manifestations associated with oral ulcers. The aim of this study was to develop a standardized composite index (CI) to assess oral ulcer activity in BD and RAS. Methods: In this cross-sectional study, 121 patients with BD and 45 patients with RAS were included. Sixty-five percentage of BD and 68.9% of RAS patients were in active stage during the previous 3 months. The developed CI included the presence of oral ulcers, ulcer-related pain and functional status and was evaluated in patients with both active and inactive disease for content validity. Results: Composite index score was observed to be higher in active patients with RAS (6.94 +/- 2.19) compared with active BD patients (6.01 +/- 2.04) (P = 0.04). The number of oral ulcers and healing time of oral ulcers were significantly higher in RAS compared with BD (P = 0.018, P = 0.001 respectively). CI score correlated with the number of oral ulcers in both BD and RAS (P = 0.000, P = 0.002 respectively). CI score was '0' for inactive patients without oral ulcer in BD and RAS. Conclusions: The presented CI as an oral ulcer activity index seems to be a reliable and suitable tool for evaluating the clinical impact and disease-specific problems in BD and RAS.