Ali Yildiz

The levels of the leptin and adiponectin according to body mass index and their relationship with oxidative parameters

OBJECTIVE Obesity is an important risk factor of atherosclerosis and its prevalence in humans is increasing. Recent studies suggest that the leptin and adiponectin play important roles in obesity, and they are associated with complications of obesity. However, the mechanism of effects has not been outstandingly established. In this study, we studied leptin and adiponectin levels according to body mass index (BMI) and their relationship with oxidative parameters. METHODS A total of 87 healthy individuals with BMI ≤35 kg/m² (n=29, Group 1), BMI=25-35 kg/m² (n=29, Group 2) and BMI =25 kg/m² (n=29, Group 3) were included in the cross-sectional observational study. Leptin, adiponectin levels, total antioxidant capacity (TAC) and total oxidant status (TOS) were measured. Oxidative stress index (OSI) was calculated using TAC and TOS values. Statistical analyses were performed using Chi-Square, Mann-Whitney U, one-way ANOVA, Kruskal-Wallis, Pearson correlation and multiple regression analyses tests. RESULTS Age and gender ratio were similar in the groups. The TAC level was the lowest in group 3 and the highest in group 1. The TOS level was higher in groups 2 and 3 than in group 1 (p =0.05 for both). OSI levels were similar in groups 2 and 3, and it was significantly different from the group 1 (p=0.05). The trend for leptin levels was decreasing and for antiponectin levels was increasing from group 1 to group 3. Except for other parameters, levels of leptin were independently related to the TOS (b=-1.123, 95% CI =-12.734-0.255, p=0.040), OSI (b=1.689, 95% CI=1.105-12.481, p=0.018) and waist circumference (b=-0.592, 95% CI= -0.630-0.134, p=0.003). Adiponectin had no significant relation with these parameters. CONCLUSION Findings of the present study reveal that leptin decreased and adiponectin increased with BMI in healthy people. These data support that these changes may be responsible in the increased TOS and OSI levels.

High aortic pulse-wave velocity may be responsible for elevated red blood cell distribution width in overweight and obese people: a community-based, cross-sectional study.

Summary Background: Obesity and overweight are risk factors for atherosclerosis. Red blood cell distribution width (RDW) is associated with subclinical cardiac diseases. The aim of this study was to investigate the association between RDW and aortic stiffness in overweight or obese subjects. Methods: A total of 101 overweight or obese subjects without overt cardiovascular disorders, and 48 healthy controls were enrolled. RDW, aortic pulse-wave velocity (PWV) and augmentation index 75 (Aix75) were evaluated. The case subjects were divided into two sub-groups according to PWV values; ≥ 10 m/s in group I, and < 10 m/s in group II. Bivariate correlation and multiple regression analyses (stepwise) were performed. Results RDW and PWV were considerably increased in the case groups compared with the controls. RDW was significantly increased in group I compared with group II and the controls [median 12.0 m/s, interquartile range (IQR): 10.5–17.5; median 11.7 m/s, IQR: 10.2–14.2, and median 11.4 m/s, IQR: 9.6–15.5, p < 0.05, respectively]. Resting heart rate and age were higher in group I than group II (81 ± 11 vs 74 ± 12 beats/min and 41 ± 120 vs 36 ± 9 years, respectively, p < 0.05). Regression analyses revealed that while log-RDW, age and resting heart rate were independent predictors for aortic PWV, log-RDW was the most important predictor in the final model. Conclusions: RDW, resting heart rate and age independently predicted arterial stiffness, and RDW may be useful to provide an early recognition of subclinical atherosclerosis in overweight and obese individuals.

Paraoxonase and arylesterase activities in stent restenosis in bare metal stent.

Background and objectiveThe serum paraoxonase and arylesterase activities are related to coronary artery diseases. However, there are a few data about the association of paraoxonase and arylesterase activities with in-stent restenosis (ISR). The aim of this study was to evaluate the relationship between paraoxonase and arylesterase activities and ISR in patients with bare metal stent (BMS). Materials and methodsThirty-one patients with normal coronary artery (group 1) and 60 with BMS were enrolled in this observational study. According to the ISR, the patients were classified as group 2, without the ISR (n=29) and group 3, with the ISR (n=31). Serum paraoxonase and arylesterase activities were measured spectrophotometrically. ResultsThe paraoxonase and arylesterase activities were lower in patients with BMS than in the individuals with normal coronary artery (P<0.001 and P=0.001, respectively). The enzyme activities were also higher in patients without ISR than with ISR (both of P<0.001). In bivariate correlation analyses in patients with BMS, ISR shows significant positive correlations with the presence of hypertension and hyperlipidemia, type C lesion, and stent length, but shows negative correlations with type A lesion stent diameter, high-density lipoprotein cholesterol, and paraoxonase and arylesterase activities. In regression analysis, ISR is independently associated with paraoxonase and arylesterase activities (&bgr;=−0.216, P=0.038 and &bgr;=−0.452, P<0.001, respectively), type A lesion (&bgr;=−0.251, P=0.013), and stent diameter (&bgr;=−0.192, P=0.024) in patients with BMS. ConclusionOur study shows that decreased paraoxonase and arylesterase activities play a significant role in ethiopathogenesis ISR in patients with BMS.

Diastolic dysfunction and endothelial dysfunction in systemic lupus erythematosus

amount of cases with normal radionuclide MPI and coronary artery disease might have been included in the present study. Coronary artery disease might lead to both endothelial dysfunction and myocardial diastolic dysfunction [3, 4]. Therefore, impaired FMD and/or myocardial diastolic dysfunction in SLE in the present study might partly be due to coronary artery disease. As a second comment, authors stated in the discussion section that the “left ventricular mass index was not associated with diastolic function despite an association with systolic blood pressure” and “systolic blood pressure may have influenced myocardial diastolic function via other mechanisms, such as microvascular ischemia and aortic stiffness” rather than hypertensive cardiomyopathy. In the present study, nearly 39 % (n = 15) of cases have diastolic dysfunction, whereas 23.7 % (n = 9) of cases were hypertensive without known number of cases with hypertensive cardiomyopathy. In our opinion concluding that the “systolic blood pressure may have influenced myocardial diastolic function via other mechanisms, such as microvascular ischemia and aortic stiffness” rather than hypertensive cardiomyopathy might be cumbersome based on the data of 15 cases with diastolic dysfunction, nine cases with hypertension and unknown number of cases with hypertensive cardiomyopathy, since this study was neither aimed to nor has the power to discriminate the mechanism of diastolic dysfunction with regard to hypertension. Antihypertensive medications (none were noted for nine hypertensive cases) might also influence the association of hypertension with both endothelial dysfunction and diastolic dysfunction [5, 6]. As a last but not least important comment, in Table 3 authors have reported that systolic blood pressure was associated with diastolic function E/e′ on univariate and multivariate linear regression analyses, respectively, with With great interest we have read the recent article of Chin et al. [1] on the association of endothelial function and myocardial diastolic function in women with systemic lupus erythematosus (SLE) and normal radionuclide myocardial perfusion imaging (MPI). In their study, authors revealed normal diastolic function (E/e′ ≤ 8) and definite diastolic dysfunction with E/e′ > 13, respectively, in 61 and 5 % of patients. Authors reported that the brachial artery flow-mediated vasodilatation (FMD%) was associated with E/e′ independent of confounding factors as well. In our opinion, some points of this work are not sufficiently clear. First of all, authors have stated in the “study participants” section that the women with “coronary artery disease, either previous myocardial infarction or cardiac investigations demonstrating myocardial ischemia, infarction or a > 50 % luminal stenosis in a major epicardial vessel” were excluded and study participants underwent pharmacological stress radionuclide MPI to exclude myocardial ischemia. Based on the exclusion criteria and negative radionuclide MPI testing, authors defined the study population as “patients with SLE and no coronary artery disease” at the end of the introduction (last two lines of the first page). However, negative radionuclide MPI does not exclude coronary artery disease. Additionally, negative radionuclide MPI might not exclude significant coronary artery disease due to the well-known limitation of radionuclide MPI: “balanced ischemia” [2]. Therefore, considerable

Mean platelet volume is not associated with coronary slow flow: A retrospective cohort study

Objective: To investigate mean platelet volume (MPV) levels in patients with coronary slow flow (CSF). Methods: 465 stable angina pectoris cases with angiographically normal coronary arteries were recruited [coronary slow flow group (n=76), control group (n=389)] in the observational retrospective cohort study. Clinical, biochemical and demographic variables including MPV were noted and coronary blood flow was assessed with TIMI frame count (TFC). Results: Gender, smoking, height, serum creatinine, uric acid levels, hemoglobin, waist/hip ratio, systolic blood pressure but not MPV were significantly different among groups. Independent predictors of CSF were height (p=.029) and serum uric acid level (p=.045). Gender, height, weight, hip circumference, systolic blood pressure, fasting blood glucose, serum urea, creatinine, uric acid levels, hemoglobin and platelet count were associated with mean TFC whereas independent predictors of mean TIMI frame count were height (p=.010) and serum uric acid level (p=.041). Conclusion: Height and serum uric acid level but not MPV were independent predictors of both CSF and mean TFC.

A morbid coexistence: thrombosed descending thoracic aorta aneurysm and aortic insufficiency with aortic diastolic reverse flow.

A 76-year-old woman presented with difficulty in speech and weakness on right arm and leg. Her medical history was remarkable only for uncontrolled hypertension for a long period. Dysarthria, right central facial paralysis, right hemiparesis and hypoactive deep tendon reflexes were noticed on neurological examination. Moderate degree aortic insufficiency with aortic diastolic reverse flow was detected on transthoracic echocardiography. Thrombosed aortic aneurysm on descending thoracic aorta, and an acute hemorrhagic infarction in the distribution of the left middle cerebral artery were depicted on thorax, and brain computed tomography scans, respectively. Cerebrovascular event was medically managed and whereas conservative management was offered for thrombosed descending thoracic aorta aneurysm.

746 Evaluation of pneumoconiosis in turkey’s annual statistics of occupational diseases between 2006 and 2015

Introduction Republic of Turkey Social Security Institution (SSI) is the institution responsible for statistics of occupational diseases in Turkey by law. We aimed to evaluate proportion of pneumoconiosis in occupational diseases and occupational pulmonary diseases in annual statistics reports of SSI. Methods Annual statistics reports published between 2006–2015 by SSI were evaluated. Diagnoses classified as pneumoconiosis in reports published before 2013 were coal worker’s pneumoconiosis, asbestos or other mineral fibre induced pneumoconiosis, talcosis, silicosis, aluminosis, boxide fibrosis, beriliosis, graphite fibrosis, siderosis, stannosis, and other unclassified pneumoconiosis. Diagnoses classified as pneumoconiosis in reports published starting from 2013 were silicosis and silicotuberculosis, asbestosis, silicatosis, siderosis, and pneumoconiosis induced by hard metal dusts, aluminium, and its compounds. Result Total numbers of cases with occupational diseases varied between 351 and 1208 in annual reports of SSI. Most frequent occupational diseases were pneumoconiosis and diseases induced by lead and its dusts. When occupational diseases listed according to the frequency, rank of pneumoconiosis was 1 or 2 in all of the evaluated years. Total numbers of cases with pneumoconiosis varied between 68–1010. Percentage of pneumoconiosis in all cases with occupational diseases and in cases with occupational pulmonary diseases varied between 19.3%–83.6% and 80.2%–99.3% respectively. Discussion Despite low total numbers of occupational diseases in the annual SSI statistics, pneumoconiosis constitutes the major proportion of occupational diseases in Turkey. This could be a result of directive about dust induced diseases which defines periodical health surveillance for workers with high-risk occupations. Proper application of initial assessment of fitness and health surveillance for workers with current or prior history of risk of pneumoconiosis may increase diagnoses.

741 Evaluation of the relationship between smoking and pneumoconiosis: a review of the literature

Introduction Pneumoconiosis is a condition that results in fibrosis in the lung tissue due to accumulation of inorganic dusts in the lung. Smoking and exposure to inorganic dusts affect respiratory functions separately. However, the combined effect may be much more increased than either exposure alone. In this review, we aimed to evaluate the relationship between smoking and dust exposure and their effects on pulmonary function tests (PFT). Methods Studies have been conducted between 1961 and 2016 on the relationship between smoking and dust exposure, and their effects on PFT were evaluated. Result All 4 researches evaluated were performed in coal workers. In 1961, Ashford, et al evaluated 4014 coal workers in 3 coal mines of Scotland. Statistically significant increase in respiratory symptom frequency and decrease in forced expiratory volume in 1 s (FEV1) were found in smokers compared to non-smokers. In 1980, Oger, et al investigated 465 coal workers with diagnosis of pneumoconiosis. Airflow obstruction was detected in 74.1% of smokers and 26.3% of non-smokers. In 1988, William, et al included 3380 coal workers to their study in the United Kingdom and found that smokers had higher respiratory symptoms and more FEV1 reductions. In China, Quink, et al included 376 coal workers to their study published in 2016. Of those, 200 (53.1%) were smokers. Cigarette smoking and exposure to dust impaired respiratory functions more than exposure alone and it has been determined that as the exposure time increases, the abnormality increases in the PFT. No significant difference was found between the non-smoking coal workers and the non-smoking control group. Discussion Results of researches supporting combined effects of smoking and dust exposure reveal the requirement of minimization of dust exposure and cessation of smoking. Further studies could be performed to elucidate relationship between smoking and other types of dust exposures in terms of respiratory symptoms and dust exposure.

Attitudes and behaviors of family physicians regarding occupational diseases

ABSTRACT Objectives: The incidence of occupational diseases (ODs) is below expectations. The approaches of family physicians are very important. In this study, we aimed to evaluate attitudes and behaviors of family physicians about ODs. Methods: The questionnaire was first sent to family physicians via e-mail. Of 3663 responders, 3090 replies were included to study. Results: 44.1% of them stated they obtained detailed occupational history. In logistic regression analysis, physicians who obtained detailed occupational history, discussed their patients health with an occupational physician, had education about ODs and those who stated that they wanted to receive training in ODs were more likely to refer their patient. Conclusion: In this study, it was determined that those who received education on ODs and those who have worked as workplace physician obtained occupational history, knew occupational diseases hospitals and wanted to receive further education.

The Mersin Greenhouse Workers Study. Surveillance of Work-related Skin, Respiratory, and Musculoskeletal Diseases

Background: Skin, respiratory, and musculoskeletal diseases in greenhouse workers are frequently observed due to exposure to plant products and pesticides in enclosed conditions and ergonomic risks. Current studies on occupational health risks of greenhouse workers in Turkey are insufficient. Objectives: The aim of the present study was to assess work-related skin, respiratory, and musculoskeletal diseases in greenhouse workers in the Erdemli province, Mersin, an area with a workforce predominantly active as greenhouse workers. Methods: The study population consists of adult greenhouse workers, who visited their family physician between June 12–14, 2017 and were diagnosed with dermatological, respiratory, and musculoskeletal diseases. Immediately after this consultation, occupational physicians conducted face-to-face interviews, asking questions about sociodemographic features and occupational factors including current and previous work, current exposures and relation of current symptoms with work. Results: In total, 423 workers with 555 diagnoses were included in the study. Percentages of diagnoses were 30.1%, 21.6% and 48.3%, for skin, respiratory and musculoskeletal diseases respectively. Nearly half of participants had taken an absence from work due to those diseases. Mean age of onset for greenhouse working was 15.5 years. Almost all participants (96.2%) reported contact with chemicals, and usage of respiratory protection was low (17.3%). Pesticides were regarded as a risk factor by nearly two-thirds of workers with skin or respiratory system disorders. Participants’ answers to questions regarding the relationship between their diseases and their work was positive for more than half of patients and patients with skin and respiratory diseases. Nearly half of the patients with musculoskeletal diseases attributed their complaints to physical overload at work. Conclusions: We found evidence of work-relatedness in almost half of the 555 greenhouse workers with dermatological, respiratory and musculoskeletal diseases. These findings are helpful in creating an awareness program. There is a need for a more detailed assessment of the cases and the related working conditions to start a tailored prevention program.