Ahmet Ahsen

Neutrophil-to-Lymphocyte Ratio in Chronic Obstructive Pulmonary Disease: A Retrospective Study

Chronic obstructive pulmonary disease (COPD) is a common chronic inflammatory disease of the lung with a high mortality and morbidity rate. Some of the inflammatory markers such as C-reactive protein (CRP), leukocyte count are associated with COPD. In this study, we aimed to evaluate the role of neutrophil-to-lymphocyte ratio (NLR) in COPD patients comparing with the other well-known inflammatory markers. We retrospectively enrolled the laboratory results of 269 COPD patients of which 178 patients at stable period and 91 patients during acute exacerbation and 50 sex- and age- matched healthy controls. We found that NLR values of the stable COPD patients were significantly higher than those of the controls (P < 0.001). During acute exacerbation of the disease there was a further increase compared to stable period (P < 0.001). NLR values were also positively correlated with serum CRP levels and red cell distribution width (RDW) and negatively correlated with mean platelet volume (MPV) in both COPD groups. In conclusion, NLR could be considered as a new inflammatory marker for assessment of inflammation in COPD patients with its quick, cheap, easily measurable property with routine complete blood count analysis.

As a New Inflammatory Marker for Familial Mediterranean Fever: Neutrophil-to-Lymphocyte Ratio

Familial Mediterranean fever (FMF), which is an autosomal recessive disease, is characterised by recurrent febrile episodes in association with peritonitis, pleuritis and arthritis and has ongoing subclinical inflammation during attack-free period. In this study, we aimed to investigate the relationship between FMF with neutrophil-to-lymphocyte ratio (NLR), which is determined in many chronic inflammations as a new potential inflammatory mediator. We included 62 patients and 41 healthy subjects who were similar in terms of age and sex. We found that the NLR values of the patients were significantly higher than those of the control group, and C-reactive protein values were correlated with NLR. Another finding was the NLR values were significantly higher in the FMF patient with M694V mutation than with other mutations. As a result, NLR might be used in the FMF patient as an indicator of the subclinical inflammation, and the FMF patients with M694V mutation should be followed up closely because of increased subclinical inflammation risk.

Neutrophil-to-lymphocyte ratio as a quick and reliable predictive marker to diagnose the severity of diabetic retinopathy.

INTRODUCTION Diabetic retinopathy (DR) is the most common complication and cause of visual impairment in diabetes patients. The pathogenesis is not fully understood, but several studies have suggested that inflammation plays an important role. The neutrophil-to-lymphocyte ratio (NLR) was defined as a novel potential marker to determine inflammation. We aimed to evaluate the relationship between DR and inflammation by using NLR. PATIENTS AND METHODS The study was included 58 patients diagnosed with type 2 diabetes mellitus. Twenty-four of them had DR. The control group was composed of 52 age- and sex-matched healthy subjects. Retinopathy was graded using the International Clinical Diabetic Retinopathy Disease Severity Scale. RESULTS NLR values of the diabetes patients were significantly higher than those of the healthy control group (P<0.001), and NLR levels of the patients with DR were higher than those of the patients without DR (P<0.001). In addition, NLR values were correlated with the presence of DR and DR grades (r=0.466, P<0.001; and r=0.630, P<0.001, respectively). CONCLUSIONS According to our knowledge, this is the first study investigating the relationship between NLR, which is an inflammatory marker, and DR and its severity. Our results suggest that while evaluating diabetes patients in terms of DR, higher NLR values may be a remarkable marker.

Neutrophil-to-lymphocyte ratio as a new, quick, and reliable indicator for predicting diagnosis and prognosis of idiopathic sudden sensorineural hearing loss.

Introduction Idiopathic Sudden sensorineural hearing loss (ISSNHL) is a common otologic emergency. Recently, the cause of ISSNHL, which is still unclear, has been focused on chronic inflammation. Neutrophil-to-lymphocyte ratio (NLR) is a new and quick inflammatory marker, which is being measured routinely in CBC tests without any cost. We aimed to investigate the relationship between ISSNHL and inflammation by using NLR. Materials and Method Forty-seven patients diagnosed with ISSNHL and 45 age- and sex-matched healthy subjects were enrolled in the study. An automated blood cell counter was used for NLR measurements. The hearing assessments of the patients were carried out by an audiometer, and audiometric patterns were assessed initially and after 1 month of the treatment. All the patients were treated with prednisone in the dose of 1 mg/kg per day, with a progressive dose reduction maintained for at least 2 weeks. Then, the patients were divided into 2 groups as “ recovered” and “unrecovered” according to their response to the treatment. Results The mean NLR, neutrophil, and lymphocyte values in patients with ISSNHL were significantly higher than the control group (p < 0.001, p < 0.001, and p = 0.004, respectively). In addition, NLR levels were higher in unrecovered patients compared with the recovered ones (p < 0.001). Conclusion This is the first study investigating the relationship between NLR levels and ISSNHL and its prognosis. While evaluating ISSNHL, determining NLR should not be overlooked as a quick and reliable indicator for predicting the diagnosis and the prognosis of the disease.

Atherogenic index as a predictor of atherosclerosis in subjects with familial Mediterranean fever

BACKGROUND AND OBJECTIVE Numerous inflammatory and innate immune pathways are involved in atherogenesis. We aimed to investigate the atherogenic index and other lipid parameters in individuals with familial Mediterranean fever (FMF), as a predictor of atherosclerosis. MATERIALS AND METHODS A total of 60 patients with FMF and 60 healthy age- and sex-matched controls were included in this study. The patients with acute infection, chronic metabolic and rheumatic diseases, use of drugs other than colchicine and smoking history were excluded. CRP, ESR, total cholesterol, triglycerides, LDL-C, and HDL-C levels of patients and the control group were measured. Atherogenic index (TG/HDL-C) was calculated. RESULTS We found that the atherogenic index values of the patients were significantly higher than those of the control group. HDL-C levels were lower and ESR and TG levels were higher in patients. Total cholesterol, LDL-C and CRP levels did not differ significantly between the two groups. There was no significant difference in the values of total cholesterol, LDL-C, triglycerides (TG), HDL-C, and atherogenic indexes between the groups of patients with and without M694V mutation. CONCLUSIONS Elaboration of clinical models of inflammation-induced atherogenesis may further advance our knowledge of multiple inflammatory pathways implicated in atherogenesis and provide a useful tool for cardiovascular prevention. We believe that the atherogenic index also be used as a preliminary indication of accelerated atherosclerosis in FMF. However, large-scale prospective studies on this issue are needed.

Assessment of Thyroid Disorders and Autoimmunity in Patients with Rheumatic Diseases

We investigated whether there was a significant increase in thyroid autoimmunity, and disorders in patients with rheumatic diseases (RDs). We enrolled 201 patients with RDs (41 with ankylosing spondylitis, 15 with systemic lupus erythematosus, 80 with rheumatoid arthritis [RA], 65 with familial Mediterranean fever), and 122 healthy controls. Serum levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), C-reactive protein, and thyroid autoantibodies (anti-thyroglobulin and anti-thyroid peroxidase) were measured in all participants. There were no significant differences between the ages of the patients and controls. The mean TSH values of the patients with RDs and the controls were 3.1 ± 2.68 mIU/L and 1.9 ± 0.83 mIU/L, respectively (P = 0.004). The mean fT4 value of the patients with RDs was 1.43 ± 0.67 ng/dL whereas that of the controls was 1.58 ± 0.68 ng/dL (P <0.001). Subclinical hypothyroidism was detected in 24 patients with RDs. Thyroid antibodies were detected in 16 of 201 (8%) patients with RDs. Three of these patients had subclinical hypothyroidism, while the others were euthyroid. Thyroid autoantibodies were significantly higher in patients with RDs (P <0.001). Additionally, thyroid disorders were observed more frequently in patients with RDs than in the healthy controls. Based on our findings, we recommend that thyroid function tests should better be included in the clinical evaluation of patients with RDs.

Protective Effect of Melatonin on Infrarenal Aortic Occlusion: This Effect Is Related to Anti-inflammatory Effect and Antioxidant Effect

Aortic cross-clamping is frequently exerted during surgery of the abdominal aorta (AA). Ischemia–reperfusion (IR) damage, which is observed in the surgery of AA, is a complex situation and is considered not only in lower extremities but also in remote tissues and organs like the lungs, kidneys, heart, and liver [1–6]. IR damage leads to important morbidity and mortality because of its systemic complications [7, 8]. Acute renal dysfunction, which is one of the most important complications following elective surgery of AA, is still a frequently seen condition (15– 22%), but acute kidney injury (AKI) is relatively rare (1.8– 4 %) [9, 10]. Infrarenal clamping of the aorta has been shown to decrease renal blood flow especially in patients who postoperatively developed renal failure [11–13]. This clamping procedure can cause vasoconstriction in renal arteries by forming turbulent flow in the aorta at the level of renal arteries [13]. The mechanisms underlying IR-induced organ damage are likely multifactorial and interdependent, involving hypoxia, inflammatory responses, and free radical damage [14–17]. Two of the most important factors in the pathophysiology of IR injury are reactive oxygen species (ROS) andmassive secretion of systemic inflammatorymediators, which especially increase in the reperfusion phase [18–20]. The endogenous antioxidants which are responsible for protecting against ROS during reperfusion have an important role in decreasing IR injury [18]. Melatonin, the main indolamine produced by the pineal gland, has been demonstrated to be an effective antioxidant and free radical scavenger [21–24]. Additionally, it has also shown an anti-inflammatory effect, which is suppression of proinflammatory cytokines like tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6 [25– 30]. Melatonin has a small size and high lipophilicity; therefore, it crosses biological membranes easily and reaches all sections of the cell [22, 31, 32]. In this study, we aimed to investigate the anti-inflammatory, antioxidant, and protective effects of melatonin in IR damage developing in kidneys following infrarenal aortic occlusion–reperfusion in rat models and in preventing kidneys from this kind of damage.

The effects of IL-18BP on mRNA expression of inflammatory cytokines and apoptotic genes in renal injury induced by infrarenal aortic occlusion

BACKGROUND Renal injury is an important complication of infrarenal aortic occlusion (IAO), which is mainly encountered during the postoperative period. Aortic clamping procedure may lead to turbulent blood flow and eventually vasoconstriction at renal arterial level of the abdominal aorta. IL-18BP has well-known antioxidant and anti-inflammatory properties. In this study, we aimed to determine whether IL-18BP has anti-inflammatory, antiapoptotic, antioxidant, and protective effects on acute kidney damage induced by IAO rat model. MATERIALS AND METHODS A total of 30 adult male Wistar-Albino rats were equally and randomly separated to three groups as follows: SHAM laparotomy, ischemia-reperfusion (IR), and IR + IL-18BP. We applied 30-min IAO and 2-h reperfusion. Inflammatory cytokine levels (TNF-α, IL-1β, IL-18, IL-6, and IFN-γ) and oxidative stress parameters (TAS, TOS, and OSI) were measured. In addition to this, urea and creatinine levels, histopathology of kidney, mRNA expression levels of inflammatory cytokines, and apoptotic genes were investigated. RESULTS Urea and creatinine, tissue and serum levels of TNF-α, IL-6, IL-18, IFN-γ, and TOS, and oxidative stress index (OSI) were found significantly lower in IR + IL-18BP group, when compared to the IR group. Moreover, mRNA expression levels of inflammatory cytokines and apoptotic genes were prominently depressed in IR + IL-18BP pre-treatment group in histopathologic examination, there was a significant difference between the IR and other three groups (P < 0.001). These improvements were demonstrated with a total score of histopathologic damage. In our previous studies, we have demonstrated that IL-18BP has antioxidant, inflammatory, and protective effects on liver and spinal cord IR injury. Data established from the present study suggest that IL-18BP may exert anti-inflammatory, antiapoptotic, antioxidant, and protective effects on IAO-induced acute kidney injury in rats, and this would be the first study to be conducted in this field. CONCLUSIONS Data established from the present study suggest that IL-18BP may exert anti-inflammatory, antiapoptotic, antioxidant, and protective effects on IAO-induced acute kidney injury in rats.

Is impaired sleep quality responsible for a nondipping pattern even in normotensive individuals

ObjectiveWe aimed to evaluate the relationship between sleep quality and a dipping–nondipping pattern in normotensive individuals. Materials and methodsOur study was carried out on 100 normotensive individuals; 50 of these individuals had a dipping pattern and 50 had a nondipping pattern, and were chosen from among patients in whom ambulatory blood pressure monitoring was applied before for any reason. All study participants underwent the Pittsburgh Sleep Quality Index survey to evaluate sleep disturbances. ResultsThe overall scores and all the components of the Pittsburgh Sleep Quality Index scores were significantly higher in the nondipper normotensive group compared with the dipper normotensive group. ConclusionIn conclusion, the nondipping blood pressure pattern appears to be associated with poor sleep quality not only in hypertensive patients but also in normotensive healthy individuals. When evaluating patients with poor sleep quality, the possibility that they may have a nondipping pattern even if they are normotensive should be kept in mind.

Interleukin-18 Binding Protein Pretreatment Attenuates Kidney Injury Induced by Hepatic Ischemia Reperfusion ☆ ☆☆ ★

Objective: Acute kidney injury (AKI) is a serious condition that can be induced by liver transplantation, major hepatic resection or prolonged portal vein occlusion. AKI can increase the frequency of postoperative complications. In the current study, we aimed to investigate whether interleukin‐18 binding protein (IL‐18BP) pretreatment has a protective effect against possible kidney injury following liver ischemia‐reperfusion (IR) achieved by Pringle maneuver in an experimental rat model. Materials and Methods: A total of 24 male Wistar albino rats were included in this study. Animals were equally and randomly separated into 3 groups as follows: I, Sham group, II, IR group (1‐hour ischemia and 4‐hour reperfusion) and III, IR + IL‐18BP group (50 &mgr;g/kg IL‐18BP was intraperitoneally administered 30 minutes before surgery). Blood, liver and kidney samples were collected for histopathological and biochemical (hepatic and renal function, nitric oxide, malondialdehyde and glutathione levels) analysis. In addition, proinflammatory cytokines including tumor necrosis factor &agr;, IL‐1&bgr; and IL‐6 levels were measured in kidney tissues. Results: IL‐18BP has improved kidney functions in acute kidney damage, restored structural changes, exhibited anti‐inflammatory effects by decreasing proinflammatory cytokines and regulated the oxidative stress parameters by antioxidant effect. Conclusions: Current study would be the first to evaluate the protective, antioxidant and anti‐inflammatory effects of IL‐18BP on renal damage induced by liver ischemia (1 hour) and reperfusion (4 hours). As a result, we have demonstrated that AKI may develop after hepatic IR with Pringle maneuver and IL‐18BP pretreatment can attenuate this damage. By this way, complications related to liver IR could be minimized and also postoperative hospitalization durations, treatment costs and healing periods could be decreased.