Person: SEÇKİN GENÇOSMANOĞLU, DİLEK
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SEÇKİN GENÇOSMANOĞLU
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DİLEK
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Publication Metadata only Psoriasis and the liver: problems, causes and course(WILEY, 2017) SEÇKİN GENÇOSMANOĞLU, DİLEK; Tula, Elona; Ergun, Tulin; Seckin, Dilek; Ozgen, Zuleyha; Avsar, ErolBackground/ObjectivesPsoriasis patients have a higher risk of liver abnormalities such as non-alcoholic fatty liver disease (NAFLD), drug-induced hepatitis, alcoholic hepatitis and neutrophilic cholangitis, than the general population. Associated liver disease limits therapeutic options and necessitates careful monitoring. The aim of the study was to identify liver problems in psoriasis patients and to investigate the underlying causes as well as their course. MethodsThe files of 518 psoriasis patients were retrospectively reviewed. Among these, 393 patients with relevant laboratory data were analysed for liver enzymes and their relation to the known risk factors for liver disease (obesity, diabetes mellitus, alcohol consumption, hepatotoxic medications, dyslipidemia, psoriatic arthritis and infectious hepatitis). ResultsAmong 393 patients, 24% and 0.8% developed liver enzyme abnormalities and cirrhosis, respectively. The most common factors associated with pathological liver enzymes were drugs (57%) and NAFLD (22%). Other rare causes were alcoholic hepatitis, viral hepatitis, neutrophilic cholangitis, autoimmune hepatitis and toxic hepatitis due to herbal therapy. Drug-induced liver enzyme abnormalities were reversible whereas in patients with NAFLD transaminases tended to fluctuate. One patient with herbal medicine-related cirrhosis died of sepsis. ConclusionLiver enzyme abnormalities are common in psoriasis patients and are mostly associated with drugs and NAFLD. Although most cases can be managed by avoiding hepatotoxic medications and close follow up, severe consequences like cirrhosis may develop.Publication Open Access Drug eruption: A mimicker of Coronavirus disease-2019 rash(2022-01-01) ERGUN, SAFİYE ATLAS TÜLİN; SEVEN, SEDA; SEÇKİN GENÇOSMANOĞLU, DİLEK; TİGEN, ELİF; AKTAŞ, MERYEM; ERGUN S. A. T., Ergenc I., SEVEN S., SEÇKİN GENÇOSMANOĞLU D., CÖMERT ÖZER E., AKTAŞ M., TİGEN E.Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infections can be associated with several cutaneous lesions, among which maculopapular rash is the most common. A maculopapular rash can also be induced by medications used for Coronavirus disease-2019 (COVID-19) treatment. The distinction between viral rash and drug eruption may be difficult especially in case of several medication use for COVID-19. Thus, this study aimed to describe cutaneous manifestations in six patients with COVID-19 and highlight dues for distinguishing SARS-CoV-2-related rash and drug eruption. Between March and June 2020, 1,492 patients were hospitalized for COVID-19 and treated with hydroxychloroquine in Marmara University Hospital. Among them, six cases were consulted for possible COVID-19-related rash or drug reaction. Hydroxychloroquine was given as monotherapy in one patient. All six patients developed an erythematous, symmetrical, and maculopapular eruption that mainly affected the trunk, axilla, and genitocrural region, 5-21 days after the onset of COVID-19 symptoms. Five patients developed rash in 4-11 days after treatment completion. Pruritus was severe. All were treated with topical corticosteroids and oral antihistamines, which provided partial relief. The resolution of the eruption was typically slow, which took a few weeks. A long period between the COVID-19 symptoms and the eruption, as well as slow recovery, is in favor of drug eruption. The effects of co-existent viral infection, a well-known promoting drug eruption factor, in facilitating adverse drug reaction in patients with COVID-19 needs further observations and research.Publication Metadata only Assessment of left atrial volume and function in patients with psoriasis by using real time three-dimensional echocardiography(SPRINGER WIEN, 2015) ÇİNÇİN, AHMET ALTUĞ; Atas, Halil; Kepez, Alper; Bozbay, Mehmet; Gencosmanoglu, Dilek Seckin; Cincin, Altug; Sunbul, Murat; Bozbay, Ayfer Yildiz; Darvishova, Ramila; Ergun, TulinBackground Left atrial (LA) volume has been identified as a predictor of adverse cardiovascular outcomes, both in the general population and in selected clinical conditions. The aim of this study was to evaluate the effect of psoriasis on LA volume and mechanical function. Methods A total of 40 consecutive normotensive psoriasis patients free of any cardiovascular disease and 39 healthy volunteers were included. All participants underwent comprehensive transthoracic echocardiographic examination. LA volume and mechanical function were evaluated using real-time three-dimensional echocardiography (RT3DE). Results There were no significant differences between psoriasis and control groups with regard to conventional echocardiographic parameters. Individuals with psoriasis had a higher incidence of left ventricular diastolic dysfunction (LVDD) than the controls; nine people with psoriasis (23 %) and three control individuals (8 %) had LVDD (p = 0.06). With regard to the parameters obtained from RT3DE, LA maximum, LA minimum, passive stroke volume, and passive emptying fraction were significantly higher; whereas LA active emptying fraction, LA total emptying fraction, LA expansion index, and active stroke volume values were significantly lower in individuals with psoriasis compared with controls. Disease duration and Psoriasis Area of Severity Index (PASI) score correlated with the majority of volume parameters. Conclusion Individuals with psoriasis had higher LA phasic volumes and impaired LA mechanical function compared with healthy controls. LA volume and functional analysis with RT3DE may facilitate recognition of subtle LA dysfunction in patients with psoriasis.Publication Open Access Atypical presentations of eosinophilic fasciitis(MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2016) SALMAN, ANDAÇ; Ergun, Tulin; Seckin, Dilek; Salman, Andac; Ocak, Esra Sarac; Yucelten, Ayse Deniz; Direskeneli, Haner; Demirkesen, Cuyan; Ekinci, Gazanfer; Bayik, MahmutEosinophilic fasciitis is an uncommon connective tissue disease that may mimic and overlap with other sclerosing disorders such as morphea and lichen sclerosus. Herein, we report four patients (two men and two women, aged 16-64 yeas) with eosinophilic fasciitis. There was overlap with both morphea and lichen sclerosus in 2 patients and with morphoea alone in 1 patient. Magnetic resonance imaging (MRI) was used for diagnosis in three patients and for assessing treatment response in one patient. Eosinophilic fasciitis may co-exist with morhoea and lichen sclerosus. In view of the overlapping clinical and histopathological features of these disorders, MRI may be helful in delineating the conditions by detecting involvement of fascia.Publication Open Access Cutaneous leishmaniasis mimicking verrucous carcinoma: A case with an unusual clinical course(WOLTERS KLUWER MEDKNOW PUBLICATIONS, 2015) SALMAN, ANDAÇ; Salman, Andac; Yucelten, Ayse Deniz; Seckin, Dilek; Ergun, Tulin; Demircay, ZeynepPublication Open Access Tumor necrosis factor-alpha inhibitors for the treatment of psoriasis patients with liver cirrhosis: A report of four cases with a literature review(MEDKNOW PUBLICATIONS & MEDIA PVT LTD, 2017) SALMAN, ANDAÇ; Ergun, Tulin; Seckin-Gencosmanoglu, Dilek; Salman, Andac; Qzgen, Zuleyha; Ocak, Esra Sarac; Avsar, Erol; Imeryuz, NesePatients with psoriasis are at an increased risk of developing liver disease due to various factors. The existing data regarding the treatment of psoriasis patients with associated liver cirrhosis is limited. We report four patients of psoriasis with liver cirrhosis who were treated with TNF-alpha inhibitors for a mean duration of 35.4 months. Two patients were treated with etanercept, one with adalimumab and one was treated with both infliximab and etanercept. Three patients tolerated the treatment well without any deterioration of liver disease whereas one died of progressive liver disease. Although large-scale, controlled studies are needed, this case series provides insights regarding the long-term safety of TNF-alpha inhibitors in patients with psoriasis and liver cirrhosis.Publication Metadata only Sistemik antipsoriatik tedavinin depresyonun subjektif ve biyokimyasal göstergelerine etkisi(2019-04-10) ERGUN, SAFİYE ATLAS TÜLİN; PEKER EYÜBOĞLU, İREM; SEÇKİN GENÇOSMANOĞLU, DİLEK; CÖBEK ÜNALAN, GÜLRU PEMRA; AKKİPRİK, MUSTAFA; AKSOY H., ERGUN S. A. T., AKKİPRİK M., PEKER EYÜBOĞLU İ., SEÇKİN GENÇOSMANOĞLU D., CÖBEK ÜNALAN G. P., YÖNEY T. H.GİRİŞ VE AMAÇ: Psoriasis, depresyon riskini arttıran bir hastalıktır. Depresyon patogenezinde kronik inflamatuar süreçlerin, nöron maturasyonunu ve sağ kalımını etkileyen nörotropinleri baskılaması suçlanmaktadır. İyi bilinen bir nörotropin olan Brain derived neurostimulatory factor (BDNF), depresyonun moleküler belirteci olarak kullanılabilmektedir. Bu çalışmada, psoriasis hastaları ile hasta ve sağlıklı kontrol gruplarının subjektif ölçeklerle ve laboratuvar belirteçleriyle ölçülecek olan depresyon ve kaygı düzeyleri açısından karşılaştırılması ve psoriasis hastalarına verilen sistemik antipsoriatik tedavinin, depresyonun sübjektif ve biyokimyasal belirteçlerine etkisinin değerlendirilmesi amaçlanmıştır. YÖNTEM: Çalışmaya 18-65 yaş arasında, 31 psoriasis hastası, 31 hasta kontrol ve 31 sağlıklı gönüllü alındı. Her üç gruba ilk vizitte Beck Depresyon Ölçeği (BDÖ) ve Spielberger Sürekli Kaygı Ölçeği (SKÖ) uygulandı, serum BDNF ve serum proBDNF düzeyleri ölçüldü. Çalışma ve hasta kontrol gruplarına Dermatoloji Yaşam Kalite İndeksi (DYKİ) uygulandı. Tüm ölçekler ve laboratuvar testleri 3 aylık tedavi sonunda psoriasis hasta grubunda tekrarlandı. Psoriasis hastalarında hastalık şiddeti, tedavi öncesi ve sonrasında, doktor tarafından Psoriasis Alan Şiddet İndeksi (PAŞİ) ile değerlendirildi BULGULAR: Psoriasis hastalarında depresyon ve kaygı düzeyleri sağlıklı kontrol grubuna göre anlamlı derecede yüksek saptandı. Psoriasis hastalarında yaşam kalitesinin, hasta kontrol grubuna göre daha olumsuz etkilendiği belirlendi. Psoriasis hastalarında, tedavi öncesinde, BDNF ve proBDNF’de kontrollere göre anlamlı bir farklılık saptanmadı. Ancak sistemik antipsoriatik tedavi ile yaşam kalitesinde düzelme ve bununla ilişkili olarak depresyon düzeyinin anlamlı derecede azaldığı belirlendi. Tedavi sonrasında depresyonun laboratuvar belirteçlerinden proBDNF düzeylerinde anlamlı derecede azalma saptanırken, BDNF düzeylerinde değişim gözlenmedi. SONUÇ: Psoriasis, yaşam kalitesindeki etkilenmeye bağlı olarak depresyon ve kaygı düzeylerini arttırmakla birlikte, depresyonun biyokimyasal belirteçleri olan BDNF ve proBDNF düzeylerini etkilememiştir. Ancak, sistemik antipsoriatik tedavi ile depresyonun sübjektif ölçeğinde (BDÖ) iyileşme ve laboratuvar belirteçlerinden proBDNF’de azalma olması, sistemik antipsoriatik tedavinin depresyon riskini azaltabileceğini desteklemektedir. Tedavi sonunda BDNF düzeylerinde değişmenin olmaması, BDNF’nin, depresyonun biyokimyasal belirteci olduğu bilgisiyle çelişmektedir. Bunun olası nedeni, karmaşık bir patogenezi olan psoriasiste, depresyona neden olan nöromediatörlerin ve mekanizmaların farklı olması olabilir.Publication Metadata only Assessment of arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions(SPRINGER, 2015) SEÇKİN GENÇOSMANOĞLU, DİLEK; Sunbul, Murat; Seckin, Dilek; Durmus, Erdal; Ozgen, Zuleyha; Bozbay, Mehmet; Bozbay, Ayfer; Kivrak, Tarik; Oguz, Mustafa; Sari, Ibrahim; Ergun, Tulin; Agirbasli, MehmetArterial stiffness is associated with increased cardiovascular risk. Pulse wave velocity (PWV) and augmentation index (AIx) are non-invasive markers for assessment of arterial stiffness. Increased arterial stiffness is associated with atherosclerosis in patients with psoriasis. Previous studies have shown that high neutrophil-to-lymphocyte ratio (NLR) predicts poor cardiovascular outcome. The aim of this study was to evaluate arterial stiffness and cardiovascular hemodynamics by oscillometric method in psoriasis patients with normal cardiac functions. Fifty consecutive patients with the diagnosis of psoriasis and 50 controls were included in the study. NLR was calculated as the ratio of neutrophil count to lymphocyte count. All patients underwent echocardiographic examination. Measurements of arterial stiffness were carried out using a Mobil-O-Graph arteriograph system. Fifty patients with psoriasis (26 male, mean age 43.3 +/- 13.2 years) and 50 controls (33 male, mean age 45.0 +/- 6.1 years) were included into the study. The distribution of cardiovascular risk factors was similar between the two groups, and NLR was significantly higher in patients with psoriasis (2.74 +/- 1.78 versus 1.82 +/- 0.52, p = 0.002). There was a weak correlation between NLR and PASI score without reaching statistical significance (r = 0.300, p = 0.060). While echocardiographic and hemodynamic parameters were comparable between psoriasis and control groups, heart rate was significantly higher in psoriasis group (81.5 +/- 15.1 and 75.2 +/- 11.8 beats/min, p = 0.021). Psoriasis patients had significantly higher AIx and PWV values as compared to controls (25.8 +/- 13.1 versus 17.4 +/- 12.3 %, p = 0.001 and 6.78 +/- 1.42 versus 6.18 +/- 0.80 m/s, p = 0.011, respectively). AI and PWV were significantly associated with psoriasis when adjusted by heart rate (p = 0.005, odds ratio 1.04, 95 % confidence interval 1.01-1.08 and p = 0.035, odds ratio 1.52, 95 % confidence interval 1.02-2.26, respectively). PWV significantly correlated with blood pressure, lipid levels, and several echocardiographic indices. AIx only correlated with left atrial diameter (r = 291, p = 0.040). Linear regression analysis was performed to find predictors of PWV. Central systolic blood pressure, left atrial diameter, and total cholesterol were independent predictors of PWV. PWV and AIx were significantly higher in patients with psoriasis. Assessment of arterial stiffness parameters may be useful for early detection of cardiovascular deterioration in psoriasis patients with normal cardiac functions. Novel inflammatory biomarkers such as NLR may elucidate the mechanism of vascular dysfunction in such patients.Publication Metadata only The risk of tuberculosis in patients with psoriasis treated with anti-tumor necrosis factor agents(WILEY-BLACKWELL, 2015) SEÇKİN GENÇOSMANOĞLU, DİLEK; Ergun, Tulin; Seckin, Dilek; Bulbul, Emel Baskan; Onsun, Nahide; Ozgen, Zuleyha; Unalan, Pemra; Alpsoy, Erkan; Karakurt, SaitBackgroundTumor necrosis factor-alpha (TNF-) antagonist treatment is associated with 1.6 to 27 times higher risk of tuberculosis (TB). ObjectiveTo find TB incidence of psoriasis patients treated with TNF- antagonists and define risk factors related with this condition in a country with moderately high risk of TB. MethodsThree hundred seventy psoriasis patients treated by anti-TNF agents in four referral centers were included. The data on the characteristics of the patients, TB history, tuberculosis skin test results, anti-TNF agent type and exposure time, localization of TB, and isoniazide prophylaxis state were analyzed. ResultsFour patients (1.08%) developed TB, three pulmonary and one gastrointestinal, 2-23months after initiating anti-TNF agents. Other than the patient with gastrointestinal TB, who was using methotrexate and corticosteroid concomitantly, none had contributing risk factors for TB. Two patients developed pulmonary TB in spite of chemoprophylaxis. Three patients with pulmonary TB completely recovered following antiTB treatment whereas patients with gastroinrestinal TB developed renal failure. LimitationsThe major limitation of the study is the lack of a diseased control group, which enables us to compare the risk of psoriatics with that of patients having other inflammatory diseases. ConclusionTuberculosis is a rare but a severe complication of anti-TNF treatment and may develop in spite of chemoprophylaxis. The risk of TB in psoriasis patients in the present study is comparable to literature mostly based on rheumatology patients.Publication Metadata only The impact of antipsoriatic treatment on serum pro-BDNF, BDNF levels, depression, anxiety scores, and quality of life(WILEY, 2021) SEÇKİN GENÇOSMANOĞLU, DİLEK; Aksoy, Hasan; Ergun, Tulin; Akkiprik, Mustafa; Eyuboglu, Irem Peker; Gencosmanoglu, Dilek Seckin; Unalan, Gulru Pemra Cobek; Yoney, HakanDepression is a comorbidity of psoriasis. Suppression of neurotrophins has been proposed to cause depression. Peripheral brain-derived neurotrophic factor (BDNF) and its precursor, pro-BDNF have been shown to be altered in depression. To compare serum pro-BDNF and BDNF levels, depression, anxiety, and quality of life (QoL) in psoriasis patients, diseased, and healthy controls, to assess impact of 12-week antipsoriatic treatment on abovementioned markers. At baseline, all groups completed Beck Depression Inventory (BDI), Spielberger State-Trait Anxiety Inventory-II (STAI-II) and DLQI; serum BDNF, proBDNF levels were measured. These were repeated after 3-months of treatment in psoriasis patients. Depression and anxiety were significantly higher, QoL was poorer in psoriasis. ProBDNF and proBDNF/BDNF ratios were not different among groups at baseline but significantly decreased after treatment in psoriasis. Depression and QoL improved significantly, BDNF and anxiety scores did not change. Altered pro-BDNF and proBDNF/BDNF ratios may have a role in depression pathogenesis in psoriasis. Antipsoriatic treatment causes improvement in depression, QoL, and reduction of proBDNF and proBDNF/BDNF ratios. Effective disease control may reverse dysregulated neurotrophin pathways and its consequences like depression.