Ali Yaman

The relationship between psychopathology and cognitive functions with cytokines in clinically stable patients with schizophrenia

ABSTRACT OBJECTIVES Inflammation and the cytokine hypotheses have been proposed for schizophrenia. Several proinflammatory and anti-inflammatory cytokines have been studied in drug-naive, first-episode, and/or chronic schizophrenia patients. However, there were limited data on clinical stable outpatients reflecting daily routine. The aim of this study was to compare the serum levels of cytokines, including transforming growth factor-beta (TGF-β), interleukin-6 (IL-6), and tumour necrosis factor-alpha (TNF-α), between clinically stable patients with schizophrenia and healthy controls, as well as to examine the relationship between these inflammation parameters and clinical variables (positive and negative symptom severity and cognitive functions). METHODS Thirty clinically stable outpatients with schizophrenia and 30 healthy controls with similar sex and age were included in this study. Serum IL-6, TGF-β, and TNF-α levels were assessed by enzyme-linked immunosorbent assay (ELISA) and immunoenzyme microplate measurement, respectively. Illness severity was evaluated using the Positive and Negative Syndrome Scale (PANSS), and the cognitive functions of the participants were assessed using a broad neuropsychological test battery. RESULTS The serum levels of IL-6 and TGF-β were significantly higher in patients with schizophrenia compared to healthy controls (p = .048, p = .012). There was no significant difference between groups in terms of TNF-α levels (p = .726). Global impairment of cognitive functions was observed in the patient group compared to healthy controls, and PANSS scores and cognitive functions showed no correlation with cytokine levels (IL-6, TNF-α, and TGF-β). CONCLUSIONS The present study demonstrated an increased inflammatory response in clinically stable patients with schizophrenia compared to healthy controls. However, symptom severity and cognitive functions showed no correlation with cytokine levels. Further research studies are needed to clarify the effects of cytokine levels on schizophrenia symptomatology and etiopathogenesis.

The relationship between heparanase levels, thrombus burden and thromboembolism in patients receiving unfractionated heparin treatment for prosthetic valve thrombosis

INTRODUCTION Procoagulant activity of heparanase has been recently described in several arterial and venous thrombotic disorders. In this study, we aimed to investigate the role of heparanase with regard to thrombus burden, thromboembolism, and treatment success with unfractionated heparin (UFH) in patients with prosthetic valve thrombosis (PVT). METHODS This study enrolled 79 PVT patients who received UFH for PVT and 82 controls. Plasma samples which were collected from patients both at baseline and after the UFH treatment and from controls at baseline only, were tested for heparanase levels by heparanase enzyme-linked immunosorbent assay. RESULTS The PVT group included 18 obstructive and 61 non-obstructive PVT patients who received UFH infusions for a median duration of 15 (7-20) days. The UFH treatment was successful in 37 (46.8%) patients. Baseline heparanase levels were significantly higher in the patient group than in the controls [0.29 (0.21-0.71) vs. 0.25 (0.17-0.33) ng/mL; p = 0.002]. Baseline heparanase levels were significantly higher in obstructive PVT patients. There was a significant increase in heparanase levels after UFH treatment. Post-UFH heparanase levels were higher in patients who experienced treatment failure compared to successfully treated group. Baseline and post-UFH heparanase levels were significantly higher in patients with a thrombus area ≥1 cm2 and with a recent history of thromboembolism. CONCLUSIONS Increased heparanase levels may be one of the esoteric causes for PVT. UFH treatment may trigger an increase in heparanase levels which may affect the treatment success. Increased heparanase levels may be associated with high risk of thromboembolism and increased thrombus burden in PVT patients.

Sequential Measurements of Pentraxin 3 Serum Levels in Patients with Ventilator-Associated Pneumonia: A Nested Case-Control Study

Purpose The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study. VAP diagnosis was established among 28 patients following the 2005 ATS/IDSA guidelines. Results The median PTX3 plasma level was 2.66 ng/mL in VAP adults compared to 0.25 ng/mL in non-VAP adults (p < 0.05). Procalcitonin and CRP levels did not significantly differ. Pentraxin 3, with a 2.56 ng/mL breakpoint, had 85% sensitivity, 86% specificity, 75% positive predictive value, and 92.9% negative predictive value for VAP diagnosis (AUC = 0.78). Conclusions With the suspicion of VAP, a pentraxin 3 plasma breakpoint of 2.56 ng/mL could contribute to the decision of whether to start antibiotics.

Copeptin in Severe Mitral Regurgitation Caused by Degenerative Mitral Disease

Introduction: Copeptin is known to be increased in cardiac heart failure. The role of copeptin in patients with severe mitral regurgitation has not been assessed in patients with preserved ejection fraction. The objective of this study is to evaluate the role of severe mitral regurgitation caused by degenerative mitral disease in copeptin release. Patients and Methods: 39 patients with degenerative mitral regurgitation (DMR group) and 30 control subjects (control group) were included in the study. The clinical and echocardiographic findings were recorded. Blood samples were obtained in 15 min before echocardiographic examination for determination of plasma copeptin. Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle-tracking imaging. Results: There was no statistical difference among copeptin levels of all groups (median values are for DMR:10.7 (9.0-17.1); control group:13.2 (10.6-20.7; p= 0.42). GCSTR and GLSTR were significantly lower in the DMR group (-19.2 ± 5.5 vs. -23.8 ± 5.3; p= 0.002 and -17.1 ± 4.3 vs. -19.9 ± 2.4 p= 0.002 respectively). LAV (83.7 ± 38.8 vs. 34.1 ± 7.5 p= 0.0001), E/e’ (9.6 ± 4.0 vs. 6.0 ± 1.4; p= 0.0001), and E/A (1.79 ± 0.5 vs. 0.9 ± 0.24 p= 0.0001) ratios were significantly higher in the DMR group. Conclusion: Our study demonstrated that there is no significant change in serum copeptin concentrations in severe mitral regurgitation due to degenerative mitral disease. This can be attached to the filling changes of left atrium, atrial stretch receptors, and increased stroke volume.

Severe mitral regurgitation is associated with increased copeptin levels in heart failure with reduced ejection fraction

BACKGROUND AND AIM The objective of this study was to assess the potential role of mitral regurgitation (MR) in the release of copeptin in heart failure patients with reduced ejection fraction (HFrEF). METHODS The study included 63 patients of whom 33 had functional mild MR (Group 1) and 30 had functional severe MR (Group 2). The functional class of both groups was New York Heart Association (NYHA) Class III. Blood samples for the determination of plasma copeptin and B-type natriuretic peptide (BNP) levels were obtained on the same day with the echo-cardiographic examination. Standard echocardiographic studies were performed. RESULTS Copeptin and BNP levels showed a substantial agreement in the whole study group (Kappa level: 0.607, p < 0.0001). Also, copeptin and BNP showed a strong correlation and were both increased and significantly higher in Group 2 than in Group 1 (p < 0.001 and p < 0.05, respectively). Left ventricular global longitudinal strain and left ventricular ejection fraction values were similar in both groups. The study population were divided into two subgroups on the basis of copeptin median level (6.4 ng/mL), and the prevalence of severe MR was significantly higher in the above-median-copeptin subgroup. A linear regression analysis showed that the presence of severe MR was the only independent predictor of high circulating plasma copeptin level (OR 7.5, 95% CI 2.8-12.1; p = 0.002). CONCLUSIONS Severe MR is an independent predictor of elevated plasma copeptin level in HFREF irrespective of systolic function.

The effect of different protease inhibitors on stability of parathyroid hormone, insulin, and prolactin levels under different lag times and storage conditions until analysis

Proteolytic cleavage through proteases affects peptide hormone levels, which is of particular significance when the time interval between sampling and analysis is prolonged. We evaluated the stability of parathyroid hormone, insulin, and prolactin molecules (i) with different protease inhibitors such as K2EDTA, aprotinin, and protease inhibitor cocktail (PIC), (ii) with different lag times (6‐72 hours), and (iii) under different storage temperatures (4°C vs room temperature [RT]) until analysis.

Serum insulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels in patients with chronic hepatitis B / Kronik hepatit B hastalarında serum insülin benzeri büyüme faktörü 1 (IGF-1) ve insülin benzeri büyüme faktörü bağlayıcı protein 3 (IGFBP-3) düzeyleri

Abstract Objective: Decreased serum insulin-like growth factor-1 (IGF-1) and insulin like growth factor binding protein-3 (IGFBP-3) levels have been found in patients with chronic liver disease of different etiologies, but these factors have not been studied extensively in patients with hepatitis B virus (HBV)-induced chronic liver disease. Methods: We have investigated serum IGF-1 and IGFBP-3 levels in 40 patients with chronic HBV and 40 patients with HBV-induced cirrhosis. According to Child-Pugh classification cirrhotic patients were divided into three groups. Forty age-and sex-matched healthy subjects served as controls. IGF-1 and IGFBP-3 levels were measured by immunochemiluminescence. The results were compared with those for serum albumin, total bilirubin, transaminase activity, and with prothrombin time. Results: IGF-1 and IGFBP-3 levels were significantly lower in patients with cirrhosis than in those with chronic HBV and in controls (p<0.001). In chronic HBV patients, IGFBP-3 levels were significantly lower than in controls (p=0.013). IGF-1 and IGFBP-3 levels were significantly lower in cirrhotic patients with Child-Pugh stage B and Child-Pugh stage C compared with Child-Pugh stage A (for IGF-1 p=0.037 and p<0.001, for IGFBP-3 p=0.036 and p<0.001, respectively). In patients with Child-Pugh stage C significantly IGF-1 levels were lower than in patients with Child-Pugh stage B (p=0.003). IGF-1 and IGFBP-3 levels were positively correlated with serum albumin concentrations and negatively correlated with serum total bilirubin and prothrombin time concentrations in cirrhotic patients. IGF-1 and IGFBP-3 levels in chronic HBV patients were negatively correlated with serum transaminases. Conclusion: We conclude that serum levels of IGF-1 and IGFBP-3 may be useful markers for liver dysfunction in patients with HBV-induced chronic liver disease. Özet Amaç: Farklı etyolojilere bağlı kronik karaciğer hastalığı olan hastalarda serum insülin benzeri büyüme faktörü 1 (IGF-1) ve insülin benzeri büyüme faktörü bağlayıcı protein 3 (IGFBP-3) düzeyleri düşük bulunmuştur, fakat bu parametreler hepatit B virüsüne (HBV) bağlı kronik karaciğer hastalığı olan hastalarda geniş capta calışılmamıştır. Metod: Bu çalışmada kronik HBV’li 40 hasta ve HBV’ye bağlı sirozu olan 40 hasta calışmaya dahil edildi. Child- Pugh sınıflandırmasına göre sirozlu hastalar üç gruba ayrıldı. Yaş ve cinsiyet uyumlu 40 sağlıklı birey kontrol grubu olarak kullanıldı. IGF-1 ve IGFBP-3 düzeyleri immünokemilüminesans yöntemle ölçüldü. Sonuçlar serum albümini, total bilirübin, transaminaz aktiviteleri ve protrombin zamanı ile karşılaştırıldı. Bulgular: IGF-1 ve IGFBP-3 düzeyleri sirozlu hastalarda kronik HBV’li ve kontrollere göre belirgin olarak düşüktü (p<0.001). Kronik HBV’li hastalarda IGFBP-3 duzeyleri kontrollere göre belirgin olarak düşüktü (p=0.013). Serum IGF-1 ve IGFBP-3 düzeyleri siroz hastalarında Child-Pugh B ve Child-Pugh C gruplarında Child-Pugh A grubuna göre belirgin olarak düşüktü (sırasıyla IGF-1 için p=0.037 ve p<0.001; IGFBP-3 için p=0.036 ve p<0.001). Serum IGF-1 düzeyleri Child-Pugh C grubunda Child-Pugh B grubuna göre belirgin olarak düşüktü (p=0.003). Siroz hastalarında IGF-1 ve IGFBP-3 duzeyleri serum albümin konsantrasyonu ile pozitif, protrombin zamanı ve serum total bilirübin konsantrasyonu ile negatif korelasyon göstermekteydi. Kronik HBV’li hastalarda IGF 1 ve IGFBP-3 düzeyleri serum transaminazlarıyla ise negatif korelasyon göstermekteydi. Sonuç: HBV’ye bağlı kronik karaciğer hastalığı olan hastalarda IGF-1 ve IGFBP-3 karaciğer bozukluğunu değerlendirmekte yararlı belirtecler olabilir.

Have You Ever Seen a 21-mmol/L Serum K+ Concentration?

A blood sample from an 82-year-old man with non-Hodgkin lymphoma was analyzed. His chemistry results are shown in Table 1. The serum hemolysis index was negative. View this table: Table 1. Chemistry results. 1. What can cause spurious gross hyperkalemia? 2. What is the most likely type of preanalytical error involved in …