Ayse Kargili

Elevated Concentrations of Soluble Adhesion Molecules and Large Platelets in Diabetic Patients: Are They Markers of Vascular Disease and Diabetic Nephropathy?

P-selectin, E-selectin, and mean platelet volume are markers associated with platelet reactivity that have been demonstrated to be increased in diabetes. We were particularly interested to see if there was a difference in mean platelet volume and selectins between diabetics and nondiabetics, and in diabetics with and without nephropathy, and whether there was a correlation between mean platelet volume and selectins. One hundred and fourteen diabetic patients and 31 healthy controls were investigated. Plasma levels of P-selectin and E-selectin were higher in the diabetic group than in controls (P = .001 and P = .007, respectively) and in diabetic patients with proteinuria than in patients without proteinuria (P = .002 and P = .004, respectively). Protein excretion was lower in patients with low mean platelet volume values (P = .004). In conclusion, elevated platelet volume and high selectin values may play a role in the development of vasculopathies and complications in diabetes mellitus. Further studies are needed to prove these results.

Increased thrombin-activatable fibrinolysis inhibitor antigen levels as a clue for prothrombotic state in polycystic ovary syndrome

Objectives. Our study was undertaken to evaluate the levels of thrombin-activatable fibrinolysis inhibitor (TAFI) antigen and also its relationship with other hemostasis markers in a group of patients affected with polycystic ovary syndrome (PCOS)–under Diane-35 (ethinyl estradiol 0.035 mg/cyproterone acetate 2 mg) treatment or not–as compared with a group of healthy controls. Methods. Forty-two women with PCOS and 30 age-matched healthy controls were involved in the study. Group A were on Diane-35 for at least 6 months; group B did not take any drug; group C served as a control group. Results. TAFI antigen levels of groups A and B were significantly higher than in controls, but no difference was observed between them. All of the other coagulation and fibrinolysis parameters (including prothrombin time, activated partial thromboplastin time, fibrinogen and D-dimer) were comparable between the three groups. Conclusion. The evidence presented herein suggests that women with PCOS have impaired fibrinolysis, as reflected by increased TAFI. This impairment can contribute to the risk of cardiovascular disease in PCOS. Elucidation of the modifiable mechanisms in PCOS can represent an opportunity for preventive therapy of the cardiovascular risks associated with PCOS.

Serum platelet-activating factor acetylhydrolase activity: relationship with metabolic syndrome in women with history of gestational diabetes mellitus

Objective. The aim of this study was to evaluate plasma platelet-activating factor acetylhydrolase (PAF-AH) activity in euglycaemic women with history of gestational diabetes (GDM), and to explore whether this activity is associated with metabolic syndrome (MS) in this group of women. Methods. The cross-sectional study included 36 women with history of GDM and 40 women with history of normal glucose tolerance in pregnancy (control group). Results. Compared to the controls, the GDM group had significantly higher mean values for serum glucose, insulin, HOMA-IR, triglyceride, GGT and plasma PAF-AH activity, and a statistically higher prevalence of MS. Within the GDM group, women diagnosed with MS had significantly higher PAF-AH activity than those without MS (p = 0.002). Conclusion. This is the first study to have shown that plasma PAF-AH activity and GGT levels may be significant for evaluating atherosclerosis risk and metabolic hepatic damage in women with history of GDM.

Migraine, Helicobacter pylori, and Oxidative Stress

Background:  The aim of this study was to ascertain whether oxidative stress is a causative factor of migraine attacks for Helicobacter pylori‐infected migraineurs.

Association of polycystic ovary syndrome and a non-dipping blood pressure pattern in young women

OBJECTIVE The association between polycystic ovarian syndrome and increased cardiovascular disease risk is still a controversial issue. In light of data documenting some common pathways or common end-points, the present study was undertaken to determine whether there is a relationship between sleep blood pressure pattern disturbances and polycystic ovarian syndrome in young women. METHOD The daytime and nighttime ambulatory blood pressures (BPs) were determined for each subject, according to the actual waking and sleeping times recorded in their individual diaries, in this cross-sectional study. RESULTS The study group comprised 168 women (mean age: 25.7±5.5) diagnosed with polycystic ovarian syndrome, while the control group included 52 age- and BMI-matched healthy subjects (mean age: 26.1±5.4). When nocturnal BP declines very little or not at all, with the BP falling less than 10% during sleep compared with waking values, this pattern is classified as a non-dipping BP pattern. However, the non-dipping pattern of BP changes was significantly more common in polycystic ovarian syndrome patients compared to the control group (p<0.01). The prevalence of a non-dipping BP pattern was 43.4% (73 patients) in polycystic ovarian syndrome patients and 3.9% (2 patients) in the control group. CONCLUSION Our cross-sectional study revealed that a non-dipping BP pattern is highly prevalent in polycystic ovarian syndrome patients, even if they are young and non-obese.

Circadian rhythm of blood pressure in patients with benign prostatic hyperplasia

Objective. Nocturia, a common and bothersome symptom of benign prostatic hyperplasia (BPH), may cause sleep disturbances. Patients with nocturia may have difficulty returning to their normal sleep after repeated episodes of waking and voiding. Therefore, nocturia may have an impact on the circadian rhythm of blood pressure (BP). The association between nocturia and the circadian rhythm of BP was investigated in this study. Material and methods. A total of 100 male patients who had been diagnosed with BPH and 53 healthy male subjects were included in the study. Nocturnal urinary frequency was assessed by means of a questionnaire and recorded in both groups. Ambulatory BP monitoring was performed in all patients over a 24-h period. Results. Patient characteristics and laboratory parameters were similar in both groups. Seventy-five patients (75%) in the BPH group and 20 subjects (37.7%) in the control group were non-dippers, i.e. they did not have a normal nocturnal fall in BP, and this difference was statistically significant (p=0.001). Eighty-nine patients in the BPH group and 13 in the control group had nocturia. Seventy-one patients (79.8%) with nocturia were non-dippers and the difference compared to the patients without nocturia in the BPH group was significant (p=0.003), whereas four patients with nocturia (30.8%) were non-dippers in the control group. Conclusions. Our findings indicate that non-dipping was more prevalent in elderly men with BPH and nocturia. BPH and nocturia may be etiological factors in the pathogenesis of non-dipping, which is an indicator of early cardiovascular disease. Further studies must focus on this relationship and, especially, on whether treatment of nocturia and BPH helps to treat non-dipping or not.

A forgotten but important risk factor for severe hyponatremia: myxedema coma

Hypothyroidism is one of the most prevalent endocrine diseases. It can lead to a variety of clinical situations, including congestive heart failure, ileus, hypothermia, electrolyte disturbances and coma.1 Hyponatremia, on the other hand, is the most common electrolyte abnormality encountered in clinical practice.2 Herein, we report a case of myxedema coma with severe hyponatremia.

Rheumatologic disease with peripheral eosinophilia.

Eosinophilia is not common in connective tissue diseases, so the frequency and clinical importance of eosinophilia in rheumatologic disease are not known. The purpose of the present review was to explore its prevalance in rheumatologic disease together with a MEDLINE database search.

The association between serum asymmetric dimethyl arginine levels and a history of gestational diabetes among healthy women.

In recent years, asymmetric dimethyl arginine (ADMA) has emerged as an early marker and/or mediator of endothelial dysfunction and it has been proved to be a novel, independent risk factor of cardiovascular and metabolic diseases. Our aim in this study was to compare the ADMA concentrations among patients with a history of gestational diabetes mellitus (GDM) with controls. Thirty women with a history of GDM and 40 age-matched and BMI-matched healthy controls were enrolled in this study. ADMA concentrations, fasting blood glucose levels, 75-g oral glucose tolerance test (OGTT) second hour plasma glucose levels, and insulin levels were compared between two groups. The fasting blood glucose levels were also significantly higher in patients with GDM history. Although second hour values of 75-g OGTT were higher in patients with GDM history, the difference between groups was not statistically significant. However, the insulin and homeostatic model assessment insulin resistance levels were statistically significantly higher in patients with a history of GDM. The concentrations of ADMA were found to be statistically higher in patients with a history of GDM (0.45 ± 0.11 vs. 0.31 ± 0.13 &mgr;mol/l, respectively; P = 0.01). This study shows that women who had a history of GDM are under risk for cardiovascular diseases, although they seem to be healthy and have normal blood biochemical levels, because of elevated serum ADMA levels. Clinicians should be aware of this increased cardiovascular disease risk among patients with a history of GDM.

Levels of thrombin activatable fibrinolysis inhibitor in gestational diabetes mellitus

Abstract Thrombin-activatable fibrinolysis inhibitor (TAFI) is a procarboxypeptidase, which is synthesised in liver and activated by thrombin and the thrombin–thrombomodulin complex. TAFI suppresses fibrinolysis by removing carboxy–terminal lysine residues from partially degraded fibrin. In this study we aimed to assess the circulating levels of TAFI antigen, ‘a fibrinolytic parameter’ in women with gestational diabetes (GDM). Thirty-four pregnant women with GDM and 50 pregnant women with normal glucose tolerance were included in the study. Plasma TAFI antigen levels were significantly higher in pregnant women with GDM when compared with controls. Increased TAFI levels may contribute to the decreased fibrinolytic potency, causing a thrombophilic state. GDM is regarded as a specific form of diabetes, and it could in addition be a predictor of type 2 diabetes mellitus in the future and the risk of complications due to hypercoagulability increases in this disease. Increased TAFI levels may also have a role in increased risk of hypercoagulability.