Ayla Akbal

Neutrophil-Lymphocyte Ratio Connected to Treatment Options and Inflammation Markers of Ankylosing Spondylitis.

In recent years, white blood cells (WBCs) and their subtypes have been studied in relation to inflammation. The aim of our study was to assess the relationship between neutrophil–lymphocyte ratio (NLR) and ankylosing spondylitis (AS).

The development of dysphagia and dysphonia due to anterior cervical osteophytes

Cervical osteophytes may cause dysphagia by compressing the esophagus and may cause dysphonia by compressing the larynx and inferior laryngeal nerve. The occurrence of dysphagia and dysphonia due to cervical osteophytes has rarely been reported in literature. In this article, a case, in which the multiple cervical osteophytes were found to be the cause of dysphagia and dysphonia, was evaluated by imaging methods and electrophysiological evaluation of swallowing and the case was discussed in the light of relevant literatures.

Evaluation of Platelet Distribution Width and Mean Platelet Volume in Patients With Carotid Artery Stenosis

Platelets contribute to the pathogenesis of atherosclerosis. Platelet activation has been linked with increased mean platelet volume (MPV) and platelet distribution width (PDW). We investigated the association between PDW, MPW, and the degree of carotid artery stenosis (CS). Patients (n = 229) were divided into 3 groups according to the North American Symptomatic Carotid Endarterectomy Trial criteria. Demographic and clinical features were collected retrospectively. Correlation analysis showed a positive association between PDW and the degree of CS. However, there was no significant correlation between CS and MPV. Moreover, we observed that PDW and low-density lipoprotein cholesterol were independent predictors of the degree of CS. This study showed that PDW, not MPV, is related to the degree of CS. Platelet distribution width could be a useful biomarker for CS. Whether targeting PDW will be of clinical benefit remains to be established.

Mean platelet volume and platelet distribution width can be related to bone mineralization

SummaryPlatelets functions are related to bone resorption and formation. The present study aimed at studying the association between platelet function and bone mineralization. We showed that mean platelet volume (MPV) and platelet distribution width (PDW) levels in osteoporosis patients increased. The study also showed that PDW and age independently associated with bone mineralization.IntroductionMPV and PDW are widely used for assessing platelet function. Recently, authors argued that platelet function has an important role in bone mineralization. However, only one study has investigated the relationship between MPV and osteoporosis. We aimed to study the levels of MPV and PDW in postmenopausal osteoporosis.MethodsWe investigated 320 bone mineral density (BMD) measurements between the years 2012 and 2013 retrospectively in our clinic. Eighty patients whom chronic diseases are absent and all laboratory findings are complete enrolled in this study. Patients were divided in three groups as an osteoporosis, osteopenia, and normal BMD group. MPV and PDW levels were investigated in these groups. We performed correlation test and linear regression analysis to determine whether there is a relationship between platelet function markers and BMD measurements.ResultsEighty patients were divided as an osteoporosis, osteopenia, and normal BMD group. MPV levels and PDW levels in the osteoporosis group were lower than the normal BMD group. PDW was positively correlated with femur total T (FTT) score and lumbar 1–4T (L1–4T) scores. Linear regression analysis showed that age and PDW were independently related to FTT and LTT scores.ConclusionPlatelet functions are related to the bone mineralization. PDW and MPV have a significant role in the development of postmenopausal osteoporosis.

Association between mean platelet volume and bone mineral density in patients with ankylosing spondylitis and diagnostic value of diffusion-weighted magnetic resonance imaging.

[Purpose] The aim this study was to assess the relation between bone mineral density (BMD) and mean platelet volume (MPV) in ankylosing spondylitis (AS) patients, and evaluate the diagnostic role of the diffusion-weighted magnetic resonance imaging (MRI). [Subjects and Methods] Fifty patients diagnosed with AS were divided into two groups on the basis of BMD, a normal group (n=30) and an osteopenic (n=20) group. [Results] Duration of disease in the group with a normal BMD was 10.3±7.0 years, while it was 16.7±12.2 years in the osteopenia group. MPV was high in the osteopenia group, while no significant differences were observed between the groups in terms of apparent diffusion coefficient (ADC) and platelet distribution width (PDW). There was a positive correlation between MPV and duration of disease. Correlations between ADC value and the lumbar T score, femoral neck T score, and duration of disease were insignificant. A negative correlation was observed between BMD and disease duration. [Conclusion] Diffusion-weighted imaging provides valuable results in osteoporosis but is not a suitable technique for evaluating BMD in patients with AS because of the local and systemic inflammatory effects in the musculoskeletal system. The common pathophysiology of atherosclerosis and osteoporosis plays an important role in the negative correlation observed between MPV and BMD in patients with AS.

Arsenic exposure associated with decreased bone mineralization in male

Abstract Objective: Arsenic (As) exposure may cause several medical problems. There were a few studies investigated whether it has affected bone tissue in women. However, there was no study in men. The aim of this study was to evaluate associations between bone mineral density (BMD) and As exposure in men subjects. Material and methods: We enrolled in this study 254 subjects who due to chronic As exposure suspected and 82 subjects as a control group. Hair As levels were detected by a hair analysis (Varian AA240Z Zeeman Atomic Absorption Spectrometer, USA). BMD measurements were obtained using dual-energy X-ray absorptiometry instrumentation. We investigated associations between the hair As levels and BMD measurements. Results: The frequency of osteoporosis and osteopenia was found to be 0.8% and 54.5%, respectively, in the As exposure group. The frequency of osteoporosis was found to be 1% and osteopenia was 32.4% in control subjects. There was significant difference between two groups (p < 0.001). Hair As level has a median 1.01 (min: 0.06 and max: 25.71). There were no significant correlation between hair As levels and BMD measurements. Conclusion: According to our observations, As exposure was associated with bone metabolism. Possible cause of osteopenia may be exposure to As. Further investigations are needed to estimate the relationship between As and bone metabolism.

A rarely seen syndrome in rehabilitation of hemiplegia: antiphospholipid antibody-negative Sneddon's syndrome.

Sneddon’s syndrome is a rarely seen disorder and it is characterized by livedo reticularis (LR) and neurologic findings. Some systematic findings may also be seen with neurologic and cutaneous findings. In this case, we aimed to present a 28-year-old female patient with diffuse LR, cardiac valve disease and migraine-type headache who had a right hemiplegic attack.

Aggravated neuromuscular symptoms of mercury exposure from dental amalgam fillings

Dental amalgam fillings are widely used all over the world. However, their mercury content can lead to various side effects and clinical problems. Acute or chronic mercury exposure can cause several side effects on the central nerve system, renal and hepatic functions, immune system, fetal development and it can play a role on exacerbation of neuromuscular diseases. In this case, we will present a patient with vacuolar myopathy whose symptoms were started and aggravated with her dental amalgam fillings.

Angioedema – an unusual serious side effect of risperidone injection

Risperidone is an antipsychotic drug which is predominantly used in the treatment of schizophrenia and schizoaffective disorder. Risperidone has several side effects. The most common side effects are non-serious including drowsiness, increased appetite, fatigue, insomnia, agitation and anxiety. 1 Another important side effect of risperidone is angioedema which rarely occurs. In the previous publications, it was stated that angioedema developed only in three cases. 2 In these cases, angioedema was observed after oral administration of risperidone. 2 We present a case who developed angioedema after parenteral risperidone administration. A 55-year-old woman was admitted to our department with the complaint of periorbital oedema, swelling over the face, dyspnoea and dysphagia. A year ago she was diagnosed with paranoid schizophrenia and was given venlefaxin HCL 75 mg/ day, biperidene HCL 1 mg/day and risperidone 1 mg/day. After a month, she discontinued her medications. A month later, she developed agitation and her hallucinative symptoms. She was taken to a hospital by her family. As the patient refused oral medication, risperidone 25 mg was administered via intramuscular injection. After three days, she developed periorbital oedema and swelling over the face, and had life-threatening diffi culty in breathing and swallowing. Her history revealed no allergic reaction, food allergies or asthma. The physical examination showed no remarkable fi ndings other than periorbital and perioral oedema. The biochemical and haematological screening test (haemogram, renal function tests, liver function tests, electrolytes, ELISA, thyroid function tests and ANA) results were within the normal range. No drugs other than risperidone were administered during that time period. We also observed that Naranjo scale value was 7. This score probably indicated the adverse drug reaction. Risperidone body fl uid concentrations were not measured. Placebo and re-challenge with risperidone were not done. We thought that angioedema was probably caused by risperidone intramuscular injection. Therefore, risperidone was stopped and haloperidol was started. At the same time, feniramin maleat 45.5 mg and methylprednisolone 40 mg were administered via intravenous injection. Dyspnoea and swallowing problem were immediately resolved. Periorbital and perioral oedema disappeared in two weeks. To date, only three cases have been reported in the literature that developed periorbital oedema due to oral risperidone administration. In 1995, Cooney et al. reported the fi rst case of angioedema associated with risperidone. The case was a 30year-old female who developed angioedema in the second week of the treatment with 6 mg of oral risperidone administration. After the dose of risperidone was decreased to 3 mg/day, her symptoms completely resolved. However, when the dose of oral risperidone was again increased to 6 mg/day, angioedema recurred in 3 days. 3 The second case was a 15-year-old boy diagnosed with schizophrenia. He was started on treatment with oral risperidone 1 mg/day and clonazepam 0.5 mg/day. Then, the dose of risperidone was increased to 2 mg/day and that of clonazepam was stopped, and within a week of increasing risperidone, he developed angioedema. 2 The third case who was a 63-year-old female was reported by Kores Plesnicar et al. They stated that the patient developed angioedema on three occasions when exposed to oral risperidone and that the angioedema subsided each time with the discontinuation of risperidone. 4 The previous publications demonstrated that in the fi rst case, only periorbital oedema was associated with intramuscular risperidone. She developed periorbital oedema about two weeks after the intramuscular risperidone injection (37.5 mg). However, angioedema has not been reported on parenteral risperidone application. 5 The mechanism of angioedema has not been clearly defi ned. C1 esterase defi ciency and decreasing complement levels are blamed for angioedema. 2 – 3 The underlying mechanism of the angioedema can be a non-allergic drug reaction caused by delayed (type 4) hypersensitivity. It is commonly seen 48 – 72 h after the fi rst administration of the medication. The route of administration and dose of risperidone can be important factors in developing angioedema. The previous studies reported that angioedema developed after intramuscular and oral applications of risperidone. In all the previous cases, angioedema was reported to develop when the dose of risperidone was increased. As for our case, the patient did not develop angioedema after an oral administration of risperidone, but severe angioedema developed after a high dose of intramuscular risperidone administration. Therefore, high-dose administrations of risperidone seem to be the most important factor in the present case. In conclusion, angioedema is an extremely rare but serious side effect. The patients who need high doses of risperidone and intramuscular risperidone should be carefully monitored in terms of the risk of angioedema. Patients who are to be administered high doses of intramuscular risperidone should be warned about periorbital oedema, swelling over the face, dyspnoea and dysphagia, which could be seen in the first 48 – 72 h after treatment.

Evaluation of possible factors affecting contrast sensitivity function in patients with primary Sjögren’s syndrome

PURPOSE The contrast sensitivity (CS) function in patients with primary Sjögrens syndrome (pSS) may be impaired either frequently as a result of dry eye diseases or rarely as a result of optic neuropathy. In this study, we aimed to evaluate the CS function in pSS patients as well as to assess corneal aberrations and thickness of the peripapillary retinal nerve fiber layer (pRNFL). METHODS Fourteen eyes of 14 pSS patients (pSS group) and 14 eyes of 14 healthy participants (control group) were subjected to assessment of CS at the spatial frequencies of 1.5, 3.0, 6.0, 12, and 18 cycles/degree (cpd) using a functional visual acuity contrast test (FACT); measurement of corneal high-order aberrations (HOAs) in terms of coma-like, spherical-like, and total HOAs using Scheimpflug corneal topography; and measurement of the thickness of both the macular ganglion cell-inner plexiform layer (mGCIPL) and pRNFL in all quadrants using optical coherence tomography. None of the participants were under treatment with artificial tears. RESULTS The results of the CS test did not differ between the 2 groups at all spatial frequencies (p>0.05). In addition, there were no statistically significant differences between the 2 groups in terms of corneal HOAs (p>0.05) and thickness of mGCIPL (p>0.05). However, among all quadrants, only the inferior quadrant of pRNFL in pSS patients was statistically significantly thinner than that in the healthy participants (p=0.04). CONCLUSIONS The CS function in pSS patients can be maintained with normal thickness of both pRNFL and mGCIPL and with lack of increased corneal HOAs, which may be present even in the absence of artificial tear usage.