Background: Spondyloarthritis refers to a group of chronic inflammatory diseases with unknown etiologies that involve particularly sacroiliac joints and spine but may also affect the remaining joints and entheses and exhibit extra-articular involvement in some patients. Oxytocin is a peptide hormone released from hypothalamus and stored in pituitary gland. It has been known for a while that oxytocin has anti-inflammatory effectsandcan causeareductioninTNF-alpha levels. Objectives: The aim of this study was to investigate the serum levels of oxytocin and its potential association with disease activity, spinal mobility and some other laboratory parameters such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in patients with ankylosing spondylitis (AS) and non-radio-graphic axial spondylitis (nrAxSpA). Methods: Seventy-one patients with nrAxSpA and 38 patients with AS who presented to the Outpatient Clinic of Physical Medicine and Rehabilitation of Dicle University Hospital between March 2017-October 2017 and 67 healthy control subjects were included in this study. All the subjects underwent a thorough physical examination. Disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index, and spinal mobility by Bath Ankylosing Spondylitis Metro-logic Index. Laboratory examinations included complete blood count, ESR, CRP, andoxytocin tests. Results: There was no significant difference in serum levels of oxytocin among the three groups (p= 0.973). However, serum levels of oxytocin correlated negatively with both ESR (r= -0.359, p=0.027) and BASDAI scores (r= -0,448, p=0.005) in patients with AS. On the other hand, serum levels of oxytocin had a negative correlation only with ESR in the patients with nrAxSpA (r= -0.321 p= 0.009). Conclusion: ESR is one of the parameters associated with disease activity in patients with inflammatory rheumatoid diseases. Serum levels of oxytocin correlating negatively with both ESR and BASDAI scores in patients with AS and only with ESR in patients with nrAxSpA suggests that low levels of oxytocin may be associated with increased disease activity. This study lays the foundation for further studies that may aim to investigate how addition of oxytocin to the treatment regimen impact on the disease activity in patients with AS who exhibit particularly low levelsofoxytocin duringactive disease period.

Background Rheumatoid arthritis (RA) is a chronic disease of unknown etiology that is characterized by articular inflammation and deformities and may also present with extra-articular findings. Various cellular and molecular immunological factors are involved in the pathophysiology of RA. Recent studies suggest that neutrophils and alpha-defensins released from the neutrophils assume significant roles in the pathogenesis of RA. Objectives The purpose of this study was to investigate the potential association between serum alpha-defensin levels especially human neutrophil peptides (HNP) 1–3 and disease activity, functional status and radiologic damage as well as some other laboratory parameters such as erythrocyte sedimentation rate (ESH) and C-reactive protein (CRP) in patients with RA. Methods A total of 42 patients with established RA who presented to the Outpatient Clinic of Physical Medicine and Rehabilitation of Dicle University Hospital and 38 healthy control subjects were included in this study. All the subjects underwent a through physical examination. Swollen and tender joints were noted for each patient. Disease activity was assessed by Disease Activity Scale 28 (DAS28). Quality of life was assessed by Rheumatoid Arthritis Quality of Life (RAQoL) Questionnaire and Nottingham Health Profile (NHP). Functional status was assessed by Stanford Health Assessment Questionnaire (HAQ). Laboratory examinations included complete blood count, ESH, CRP, and human neutrophil peptides (HNP) 1–3 tests. Results The patients with an active disease exhibited higher HNP 1–3 levels compared to the patients in remission. At cut off 708 pg/ml, the sensitivity and the specificity of the test for HNP 1–3 were 72% and 70.6%, respectively. Moreover, HNP 1–3 levels correlated significantly with WBC counts as well as with HAQ, NHP total, NHP pain, NHP physical activity and NHP sleep scores. There were no significant differences between the patients and the control subjects in serum HNP 1–3 levels. Conclusions In the present study, serum HNP 1–3 levels correlated significantly with WBC counts as well as with HAQ, NHP total, NHP pain, NHP physical activity, and NHP sleep scores. In addition, the patients with an active disease had significantly higher serum HNP 1–3 levels compared to the patients in remission. In this respect, serum HNP 1–3 can be a useful marker in assessment of disease activity and remission in patients with RA. References Bokarewa MI et al. Intraarticular release and accumulation of defensins and bactericidal/permeability-increasing protein in patients with RA. J Rheumatol 2003, 30:1719–24. Arnett FC et al. ACR 1987 revised criteria for classification of RA. Arthritis Rheum, 1988;31:315–24. Fransen J et al. RA Measures: Disease Activity Score, Disease Activity Score-28, Rapid Assessment of Disease Activity in Rheumatology and RA Disease Activity Index. Arthritis Rheum 2003;49:214–24. De Jong Z et al. Reliability and construct validity of the RAQoL: a rheumatoid arthritis-specific quality of life instrument. Br J Rheumatol 1997;36:878–83. Hunt SM, et al. The NHP: subjective health status and medical consultations. Soc Sci Med. 1981;15:221–9 Bruce B, et al. The Stanford health assessment questionnaire: dimensions and practical applications. Health Qual Life Outcomes 2003;1, 20. Disclosure of Interest None declared

Objectives Benign hypermobility syndrome (BJHS) is a clinical entity that characterized with increased joint mobility rather than range of motion in a joint is alternate according to joints surface neuromuscular tonus and neurogenic controls of joints. Prior investigations suggest that there is a significant correlation between ligament laxity and serum relaxin levels. Sourced from thsee findings, we aimed to investigate the serum levels of relaxin in patients with hypermobility syndrome. Methods 45 female patients with BJHS and 40 healty controls were enrolled to the study. Pregnancy, lactation, usage of oral contraceptive, menstrual cycle disorders, any neurological, rheumatological, musculoskeletal disorders, metabolic or connective tissue diseases were determined as exclusion criters. All patients with BJHS were diagnosed according to the Beighton scoring system. All patients and control subjects’ physical examinations were completed and all finding were noted. Postures of the patients were assessed according to New York Posture Rating Test. Serum relaxin levels both in patients with BJHS and controls were measured and noted. Results Although serum relaxin levels were high in patients with BJHS, this difference was not statistically significant (47.1 ± 59.3, 34.4 ± 23.9; p> 0.05). We did not determine any correlation between serum relaxin levels and Beighton scores or New York Posture Rating Test. The levels of relaxin in patients with pes planus and hyperkyphositiy were higher than the patients without these clinical parameters (p=0,01 and p=0,05 respectively) Conclusions Although these results indicate that relaxin has not a major role in patients with BJHS as a circulating hormone, significantly increased levels of relaxin in patients with hyperkyphosity and pes planus suggests that further investigations are needed in respect with relaxin and its receptors. Disclosure of Interest None Declared

BACKGROUND:The differences in concentrations of biomarkers between heart failure patients with dilated cardiomyopathy (HF-D) and with ischemic cardiomyopathy (HF-I) have yet to be defined. The objectives of this study were to compare the concentrations and correlation of biomarkers of inflammation, extracellular matrix (ECM) turnover and oxidative stress parameters between these populations.PATIENTS AND METHODS:Our study consisted of 36 subjects with HF-D (LVSD = 47.2 ± 7.3 mm, LVDD = 65.1 ± 6.3 mm), 44 subjects with HF-I (LVSD = 38.0 ± 4.4 mm, LVDD = 58.5 ± 6.0 mm) and 38 controls without heart failure. Concentrations of matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, MMP-13, Galectin-3, prolidase, TNF-alpha, and oxidative stress index (OSI) were measured.RESULTS:Serum levels of MMP-2, MMP-9, and prolidase were significantly increased in HF-I group compared to healthy controls (p = 0.039, 0.019, 0.012 respectively), whereas the increases in MMP-1 and MMP-13 were not significant. This significance was stronger in the HF-D group than the HF-I group (p = 0.004, 0.001, 0.002 respectively). TNF-α, a marker of inflammation, was significantly increased in heart failure (p = 0.004) but there was no difference between HF-D and HF-I groups; however, Galectin-3 was significantly increased in the HF-D group compared to the HF-I group (p = 0.005). OSI showed the same response pattern as TNF-α (p = 0.019, 0.002 respectively). There was a positive correlation of MMP-9 levels with prolidase activity (r = 0.612, p: 0.003).CONCLUSIONS:MMPs and Galectin-3 are important in cardiac remodeling; prolidase may share an undefined role in fibrosis in heart failure and may have a role in the diffuse fibrosis of heart failure.

BACKGROUND:Common variable immunodeficiency (CVID) is characterized by hypogammaglobulinemia, defective antibody production, and recurrent upper and lower airway tract infections.OBJECTIVES:To reveal the clinical heterogeneity of this condition, analyze the high frequency of respiratory and gastrointestinal complications despite satisfactory trough immunoglobulin (Ig) G levels, and determine the main difficulties in management and treatment.METHODS:We performed a retrospective analysis of 23 patients (13 male and 10 female) diagnosed with CVID between 2001 and 2008.RESULTS:The median diagnostic delay for females and males was 15 years (range, 1-32 years) and 8 years (range, 1-31 years), respectively. Restrictive, obstructive, and combined pulmonary function defects were determined in 23%, 27%, and 14% of patients, respectively. The most frequent findings on the thoracic computed tomography scan were bronchiectasis, mediastinal lymphadenopathy, fibrosis, ground-glass patterns, mosaic oligemia, peribronchial cuffing, and parenchymal nodules. Giardiasis and duodenal lymphoid hyperplasia were detected in 52% and 42% of the patients, respectively, and Helicobacter pylori in 42%. Vitamin A levels were normal, although beta-carotene and/or vitamin E levels were decreased in patients presenting malabsorption-related symptoms. Malignancy was documented in 3 patients and decreased bone mineral density in 9 patients (3 had osteoporosis and 3 had osteomalacia).CONCLUSION:CVID is a multisystemic disease that should be managed by a multidisciplinary team. Intravenous immunoglobulin therapy and antibiotics do not seem to have a suppressive effect on granulomatous or inflammatory manifestations. More comprehensive studies based not only on peripheral blood but also on immunohistological analysis are necessary to shed light on the pathogenesis of these life-threatening complications.

We report the case of a 28-year-old man who presented palatal itching and genaralized urticaria following ingestion of olive 3 years after being diagnosed with olive pollinosis. The patient did not have a history of food allergy or urticaria. The results of skin prick tests with aeroallergens including latex were positive for house dust mite and olive pollen. The results of prick tests and prick-to-prick tests for olive fruit were positive, as were those of specific immunoglobulin E tests to olive pollen and fruit. The results of prick tests to peach, pear, kiwi, melon, and nut were negative. Nasal provocation with olive pollen gave positive results. An open oral provocation test with olive oil did not cause symptoms. This case is unique in that the patient developed olive fruit allergy in the presence of olive pollinosis, and he did not experience allergic symptoms to fruits other than olive, thus enabling us to define a new pollen-food (olive-olive) syndrome.

The aim of the study was to investigate the relationship of eNOS (4 intron 27bp) polymorphism in clinically classified patients with coronary artery disease (CAD) in Turkish populationPCR and restriction fragment length polymorphism analysis were used to detect the variant of the eNOS gene in 74 patients' with CAD and 20 healthy controls The CAD group was separated into 3 clinical groups depending on angiography criteria and clinical form designation 1st Group Myocardial infarction (MI) (n 20) 2nd Group Unstable Angina Pectoris (UAP) (n 18) 3rd Group Stable Angina Pectoris (SAP) (n 36)When a and b allele frequencies in the CAD and control groups we, e compared no statistically significant difference was found No significant difference was observed in the 4 intron 27 bp variants of the eNOS gene when CAD patients were compared without distinguishing them clinically from the control group When we assessed CAD patients classified according to their clinical form no significant difference was determined in allele frequencies and genotype distribution in the subgroups except for subgroup S4P When we compared SAP patients with the other subgroups and with the control group it was found that there was a significant increase in the ab genotype and the a allele frequency and a decrease in the bb genotype (p < 0 05)In conclusion CAD seemed to develop without any alterations in eNOS (4 intron 27bp) genotype frequency However the 27 bp repeat polymorphism of the eNOS gene in patients with SAP can be considered as SAP which may have a hereditary origin High eNOS gene polymorphism in patients with SAP can be related to the increased risk of possible coronary occurrence in future It was concluded that further studies of the relationship between eNOS gene polymorphism and CAD should take account of the clinical forms of CAD

Background: Most studies regarding natural rubber latex (NRL) allergy have concentrated on the prevalance using skin prick test (SPT) and specific IgE assay. The objective of this study is to examine the target organ (skin, nasal mucosa) responses in patients with positive SPT to NRL using the nasal provacation test (NPT) and glove use test (GUT). Methods: Four thousand four hundred and twenty patients presented to our polyclinic between July 2003 and January 2007 were evaluated. One thousand six hundred and ninety‐nine patients had positive SPT to one or more allergens (NRL and other inhaler allergens). Twenty‐nine patients with positive SPT to NRL comprised the NRL sensitive group (group 1). Thirty‐five randomized patients with positive SPT to an inhaler allergen other than NRL and negative NRL‐specific IgE comprised atopic control group (group 2). Thirty healthy individuals who had no allergic diseases and had negative SPT and NRL‐specific IgE comprised the healthy control group (group 3). Results: The lowest NRL allergen concentration leading to NPT positiveness was 0.05 μg/mL. NPT was negative in groups 2 and 3. NPT was found to have a sensitivity of 96%, specificity of 100%, negative predictive value of 98% and positive predictive value of 100%. GUT was found to have a sensitivity of 81%, specificity of 90%, negative predictive value of 75% and positive predictive value of 93%. Conclusions: Nasal provocation test was successfully used for the first time in the diagnosis of NRL allergy. NPT is a more sensitive method as compared to GUT.

We report newly presenting systemic and local allergic reactions to egg in a 55-year-old woman. The patient did not have a history of egg allergy in childhood or occupational exposure to egg proteins; nor did she report any disease that is known to be related to food allergy. A skin prick test with commercial extracts, prick-to-prick test, CAP radioallergosorbent assay, and a double-blind, placebo-controlled food challenge test were used to prove egg allergy. Because egg allergy mainly affects children and symptoms frequently disappear with age, the late onset in this patient is rare.

Objectives: The aim of this study was to determine the prevalence of primary Sjögren's syndrome (pSS) according to European criteria (1993) and to the US–European Consensus Group (US‐EU) criteria (2002) in adult women in Bornova, Izmir, Turkey. Materials and method: The study was designed as a two‐phase cross‐sectional survey consisting of a baseline questionnaire and collection of blood samples and clinical examination. In the initial phase, positivity for autoantibodies Ro(SS‐A), La(SS‐B), rheumatoid factor (RF), and anti‐nuclear antibodies (ANA) was determined, and in the clinical phase, clinical examination, salivary and ocular tests were performed. Minor salivary gland biopsy was performed for those who had at least three of these five criteria positive. Results: In our sample the prevalence of SS was 1.56% [95% confidence interval (CI) 0.92–2.66] according to the European criteria and 0.72% (95% CI 0.33–1.57) according to the US‐EU criteria. Conclusion: To prevent the loss in diagnosis of pSS, the addition of ANA, RF, and tear break‐up time (BUT) tests to US‐EU criteria would be appropriate.

Background: Arthritis is an important and sometimes life-threatening complication in patients with common variable immunodeficiency (CVID).Objective: To describe a patient with CVID and arthritis due to Chlamydia pneumoniae, which is usually regarded as a respiratory tract pathogen and has not previously been detected in the synovial fluid by cell culture technique.Methods: Routine bacteriologic, virologic, mycologic, and tuberculosis cultures were performed. The patient's synovial fluid was examined for fastidious organisms that might be causative pathogens of arthritis, such as chlamydiae, and special cell culture methods were used. Serologic tests were performed to determine viral and bacteriologic etiology.Results: The patient had a history of recurrent respiratory tract infections, and the latest exacerbation was followed by arthritis. Cytologic examination of the fluid yielded abundant lymphocytes. Chlamydia pneumoniae was detected in synovial fluid specimens by cell culture technique. Her nasopharyngeal swab and sputum culture specimens were also positive for this pathogen. She was diagnosed as having arthritis caused by C pneumoniae and was given antibiotherapy.Conclusion: Chlamydia pneumoniae should be kept in mind as a causative pathogen in patients with CVID and arthritis, especially when effusion fluid is full of lymphocytes rather than polymorphonuclear cells and no organism is grown on routine cultures.

In the present study, we analyzed the relationship between cigarette smoke exposure and several markers of oxidative status, plasma thiobarbituric acid reactive substances, erythrocyte glutathione peroxidase, superoxide dismutase and catalase in a group of students. Of the 105 men enrolled into the study, 35 had never smoked and not exposed to cigarette smoke at all. Thirty five had smoked at least 15 cigarettes per day for at least five years (active smokers) and 35 had been exposed to cigarette smoke at indoor environment at least 2 cigarette/day on ≥5d/wk for > 6 months (passive smokers). The urine cotinine level was used as a smoking marker. Erythrocyte SOD activity and plasma TBARs were significantly higher in active and passive smokers than in non-smokers (p < 0.05). However, erythrocyte GSH-Px and CAT were significanly lower in active smokers than in non smokers (p < 0.05). Serum vitamin C and E levels were significantly lower in active and passive smokers than in nonsmokers (p < 0.05). For active and passive smokers, there were significant possitive correlations between urine cotinine levels and plasma TBARs levels (r = 0.60, p < 0.01, r = 0.43, p < 0.05) and a negative correlation between urine cotinine levels and plasma vitamin C (r = -0.48, p < 0.05, r = -0.59, p < 0.01). In conclusion, during both passive and active smoking, oxidative stress was clearly exacerbated and the dynamic balance between oxidation and antioxidation was seriously disrupted, which was closely related to many disorders or diseases in active and passive smokers.

Background: Patients with allergic rhinitis and bronchial hyperresponsiveness (BHR) may be at higher risk of developing asthma.Objective: To investigate whether reactivity to aeroallergens in skin prick testing (SPT) and serum eosinophil cationic protein levels can be used to predict BHR in allergic rhinitis patients.Methods: Fifty-nine consecutive patients with allergic rhinitis underwent SPTs using grass, tree, weed, parietaria, Alternaria, Aspergillus, miles, and cat and dog dander extracts. Methacholine challenge tests were performed using spirometry.Results: Methacholine-induced BHR was detected in 23 patients (39%). Of 59 patients, 14 had 1 positive SPT response, 35 had 2 to 4 positive responses, and 10 had more than 4 positive responses. There was a significant inverse correlation between methacholine provocation concentration that caused a decrease in forced expiratory Volume in 1 second of 20% (PC20) and the number of positive SPT responses (r = -0.28; P =.03). The BHR-positive patients had a mean of 4 positive SPT responses, whereas BHR-negative patients had a mean of 2.6 (P =.04). Nine BHR-positive patients (39%) and only 1 BHR-negative patient (3%) had more than 4 positive SPT responses (P <.001). There was no correlation between serum eosinophil cationic protein levels and methacholine PC,, doses. There was a strong association between hyperresponsiveness to methacholine and both cat and dog dander sensitivity (P <.001 and P =.001, respectively).Conclusions: Allergic rhinitis patients with SPT responses to a higher number of allergens are more likely to have BHR. Whether the number of positive SPT responses correlates with the risk of developing asthma in allergic rhinitis patients remains to be determined.