Cagatay Taskapan

Psychiatric disorders and large interdialytic weight gain in patients on chronic haemodialysis

Aims:  Psychiatric disorders have been considered in terms of non‐compliant behaviour and low life quality in haemodialysis patients. The aim of this study is to investigate the potential association of psychiatric disorders with compliance of fluid restriction and nutritional status and to measure the effects of psychiatric disorders on the life quality in chronic renal failure patients on haemodialysis.

Evaluation of autonomic activity in patients with subclinical hypothyroidism

It has been shown that impaired cardiac autonomic activity is closely related with lethal arhythmias. Heart rate variability (HRV), analysis of beat-to-beat variations, is an important and widely used non-invasive method to assess autonomic function. Impaired cardiac autonomic activity and altered sympathovagal balance were previously documented in patients with hypothyroidism. However, the effect of sub-clinical hypothyroidism (SH) on autonomic function has not been studied yet. We aimed to investigate the effect of SH on sympathovagal balance using the HRV method. The study included 31 patients with SH and 28 healthy volunteer controls. Patients with cardiac, metabolic, neurological disease or any other systemic disease that could affect autonomic activity were excluded from the study. HRV time domain and frequency domain parameters were determined over a period of 24 h. All time and frequency domain measures of HRV in patients with SH were not significantly different compared to those of healthy control group (p>0.05). Additionally, we compared SH subgroups (TSH level ≥10 and TSH level <10mU/l) with each other and the controls. A statistically significant difference was observed only in time domain parameters of SD of normal-to-normal intervals (SDNN) and SD of all 5-min mean normal NN intervals (SDANN) between subgroup with TSH level ≥10 and controls (p<0.05, p<0.05, respectively). In correlation analysis with TSH, there was positive relationship between TSH and the root mean square of successive differences between adjacent R-R intervals (rMSSD). These findings indicate that SH may affect cardiac autonomic activity in correlation with TSH levels.

Leptin Levels Increase during Flutamide Therapy in Women with Polycystic Ovary Syndrome

Aim: To evaluate the serum leptin levels and the effects of flutamide treatment on the leptin levels in women with polycystic ovary syndrome (PCOS). Methods: 20 women with PCOS and 20 controls were enrolled in the study. Leptin levels and leptin response to an oral glucose tolerance test were assessed in both groups before and after a 4-week flutamide therapy period. Results: The leptin levels were similar in both groups at baseline. In the PCOS group, leptin levels and area under curve for leptin levels increased significantly after flutamide treatment. Conclusions: Women with PCOS had similar leptin levels to those of controls with similar age and body mass index. Flutamide treatment led to increased leptin levels and leptin responses to oral glucose tolerance tests in PCOS patients. Further studies are needed to gain insights into the clinical consequences of these effects of flutamide.

Diabetic Muscle Infraction : An unusual cause of muscle pain in a diabetic patient on hemodialysis

Diabetic muscle infarction (DMI) is a rare, painful and potentially serious complication in patients with poorly controlled diabetes mellitus and frequently misdiagnosed clinically as abscess, neoplasm, or myositis. A 36-year-old diabetic woman referred to our clinic with severe pain in the left antero-medial thigh. She had a 15-year history of Type 2 diabetes mellitus (DM). She was complicated by diabetic nephropathy and requiring hemodialysis. She had first noticed pain and swelling in her left thigh after a minimal trauma for 2 days prior to presentation. Clinical and laboratory evaluation, and muscle biopsy revealed the diagnosis of muscle infarctions. She did no respond to the conservative therapy. Pain and swelling in her thigh worsened progressively. She underwent surgical debridment and then, her clinical status improved. We describe the characteristic clinical and pathologic findings and the course of the illness with emphasis on the importance of recognition of the syndrome so that unnecessary investigation and overzealous therapy can be avoided.

Maxillary brown tumor and uremic leontiasis ossea in a patient with chronic renal insufficiency.

Findings of renal osteodystrophy in cranial bones are not uncommon and include osteomalacia, osteosclerosis, erosion of the cortical bone, brown tumors and resorption of the lamina dura. However, massive thickening of the cranial vault and facial bones, called uremic leontiasis ossea, have been reported very rare. In the present article, we describe the case of an uncooperative female patient with a brown tumor, involving the left maxillary sinus and massive thickening of the cranial vault and facial bones, secondary to severe secondary hyperparathyroidism during 8 years of regular hemodialysis treatment.

Relationship between vitamin D and lung function, physical performance and balance on patients with stage I-III chronic obstructive pulmonary disease

OBJECTIVES vitamin D is important for muscle function and it affects different aspects of muscle metabolism. This study aim to determine whether serum 25(OH) D levels are related to lung functions, physical performance and balance in patients with chronic obstructive pulmonary disease (COPD). METHODS in 90 patients with COPD and 57 healthy controls lung function tests, physical performance tests (time up and go, gait velocity test, sit-to-stand test, isometric strength, isokinetic strength), static (functional reach test) and dynamic (time up and go) balance tests and the association of 25(OH)D levels with lung functions, physical performance and balance were evaluated. RESULTS the COPD patients had significantly more deficit in physical function and balance parameters, and in dynamic balance test (p<0.005). Isokinetic knee muscle strength (flexor and extensor) in COPD patients was significantly lower than in the controls (p<0.05); FEV1 (p=0.008), FVC (p=0.02), FEV1/FVC (p=0.04), TLC (p=0.01) were lower in COPD patients with vitamin D deficiency [25(OH) D less than 15 ng/mL] than in COPD patients without vitamin D deficiency. Hand grip test (p=0.000) and isokinetic knee muscle strength (flexor and extensor) (p<0.05) were also lower in COPD patients with vitamin D deficiency. Vitamin D deficiency was more pronounced in patients with stage III COPD (p<0.05). CONCLUSION patients with COPD had worst physical functioning, poor balance and less muscle strength. Severe disturbed lung and peripheral muscle functions are more pronounced in COPD patients with vitamin D deficiency.

Serum Pentraxin 3 and hs-CRP Levels in Children with Severe Pulmonary Hypertension.

BACKGROUND Pulmonary arterial hypertension secondary to untreated left-to-right shunt defects leads to increased pulmonary blood flow, endothelial dysfunction, increased pulmonary vascular resistance, vascular remodelling, neointimal and plexiform lesions. Some recent studies have shown that inflammation has an important role in the pathophysiology of pulmonary arterial hypertension. AIMS The aim of this study is to evaluate serum pentraxin 3 and high sensitive (hs)-C reactive protein (hs-CRP) levels in children with severe pulmonary arterial hypertension (PAH) secondary to untreated congenital heart defects and evaluate the role of inflammation in pulmonary hypertension. STUDY DESIGN Cross sectional study. METHODS After ethics committee approval and receiving consent from parents, there were 31 children were selected for the study with severe PAH, mostly with a left-to-right shunt, who had been assessed by cardiac catheterisation and were taking specific pulmonary vasodilators. The control group consisted of 39 age and gender matched healthy children. After recording data about all the patients including age, gender, weight, haemodynamic studies and vasodilator testing, a physical examination was done for all subjects. Blood was taken from patients and the control group using peripheral veins to analyse serum Pentraxin 3, N-terminal pro-Brain Natriuretic Peptide (NT-ProBNP) and hs-CRP levels. Serum Pentraxin-3 levels were measured by enzyme linked immunosorbent assay (ELISA) and expressed as ng/mL. Serum hs-CRP levels were measured with an immunonephelometric method and expressed as mg/dL. The serum concentration of NT-proBNP was determined by a chemiluminescent immunumetric assay and expressed as pg/mL. RESULTS Serum Pentraxin- 3 levels were determined to be 1.28±2.12 (0.12-11.43) in the PAH group (group 1) and 0.40±0.72 (0.07-3.45) in group 2. There was a statistically significant difference between the two groups (p<0.01). Serum hs-CRP levels were measured as 2.92±2.12 (0.32-14.7) mg/dL in group 1 and 0.35±0.16 (0.07-3.45) mg/dL in group 2. The hs-CRP level was increased in the PAH group to a significant degree (p<0.01). CONCLUSION Our study showed that pentraxin 3 and hs-CRP levels were increased significantly in the PAH group. We consider that inflammation plays an important role in severe pulmonary hypertension and progressive pulmonary arterial hypertension in children with PAH.

Association of folic acid receptor α in maternal serum with neural tube defects

Abstract Objective: To evaluate whether serum folic receptor α levels are changed in women whose previous pregnancies were complicated with neural tube defects (NTDs). Methods: This was a case–control study that included 41 women as the control group who had previously had at least one healthy pregnancy and 37 women as the study group who had a previous pregnancy complicated with NTDs. Blood samples were obtained from all of the participants six weeks after the termination of pregnancy or delivery of a baby. Serum folate receptor α concentrations were analyzed using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. Results: The mean concentrations of serum folate receptor α were significantly lower in the NTD cases compared to those in the control group (p = 0.02). There was no significant difference in mean serum folate titers between the NTD cases and the control group (p = 0.07). Conclusion: Low serum folic acid receptor α levels in the current study did not appear to be a regulatory marker of maternal folate homeostasis per se but rather a factor that contributed to the development of NTDs.