Cuneyt Muderrisoglu

Can mean platelet volume determine the severity of liver fibrosis or inflammation in patients with chronic hepatitis B

Aims We aimed to determine whether mean platelet volume (MPV) is one of the variables that determine the severity of liver fibrosis and inflammation. Materials and methods Patients with chronic hepatitis B virus (HBV) infection were divided into two groups: patients with fibrosis scores of 0–3 and 4–6 and patients with histologic activity index scores of 0–9 and 10–18 (according to the Ishak Scoring System). The independent variables determining the severity of liver fibrosis and inflammation were investigated. Results Two hundred and thirty-eight patients were included in this retrospective study. The fibrosis scores of 29 patients (12.2%) were higher than 3. The independent variables that determined the severity of the fibrosis score were a high level of serum &ggr;-glutamyl transferase and a low blood platelet count (odds ratio and P values were 1.016 and 0.004 for &ggr;-glutamyl transferase, and 0.986 and 0.002 for blood platelet count). The histologic activity indexes of 38 patients (16%) were higher than 9. The independent variables determining the severity of liver inflammation were serum HBV DNA, &ggr;-glutamyl transferase, and globulin levels and the MPV [odds ratio and P values were, respectively, 0.1001 and 0.046 for HBV DNA (×107); 1.016 and 0.004 for &ggr;-glutamyl transferase; 2.247 and 0.039 for globulin; and 1.488 and 0.004 for the MPV]. The sensitivity, specificity, and positive predictive value and negative predictive value of the model predicting the severity of liver inflammation were 60.5, 83, 40.3, and 91.7%, respectively (area under the receiver-operating characteristic curve=0.775, P=0.0001). Conclusion MPV may provide useful information to predict the degree of liver inflammation along with other markers.

The Impact of Obesity and Insulin Resistance on Iron and Red Blood Cell Parameters: A Single Center, Cross-Sectional Study

Objective: Obesity and iron deficiency (ID) are the 2 most common nutritional disorders worldwide causing significant public health implications. Obesity is characterized by the presence of low-grade inflammation, which may lead to a number of diseases including insulin resistance (IR) and type 2 diabetes. Increased levels of acute-phase proteins such as C-reactive protein (CRP) have been reported in obesity-related inflammation. The aim of this study was to investigate the impact of obesity/IR on iron and red blood cell related parameters. Materials and Methods: A total of 206 patients and 45 control subjects of normal weight were included in this cross-sectional study. Venous blood samples were taken from each patient to measure hemoglobin (Hb), serum iron (Fe), iron-binding capacity (IBC), ferritin, CRP, fasting blood glucose, and fasting insulin. Body mass index (BMI) and waist-to-hip ratio (WHR) were calculated for each patient. IR was determined using the HOMA-IR formula. Results: Subjects were divided into 3 groups according to BMI. There were 152 severely obese (BMI: 42.6±10.1), 54 mildly obese (BMI: 32.4±2.1), and 45 normal-weight (BMI: 24.3±1.3) patients. Hb levels in severely obese patients and normal controls were 12.8±1.3 g/dL and 13.6±1.8 g/dL, respectively. We found decreasing Fe levels with increasing weight (14.9±6.9 µmol/L, 13.6±6.3 µmol/L, and 10.9±4.6 µmol/L for normal controls and mildly and severely obese patients, respectively). Hb levels were slightly lower in patients with higher HOMA-IR values (13.1±1.5 g/dL vs. 13.2±1.2 g/dL; p=0.36). Serum iron levels were significantly higher in the group with low HOMA-IR values (13.6±5.9 µmol/L vs. 11.6±4.9 µmol/L; p=0.008). IBC was found to be similar in both groups (60.2±11.4 µmol/L vs. 61.9±10.7 µmol/L; p=0.23). Ferritin was slightly higher in patients with higher HOMA-IR values (156.1±209.5 pmol/L vs. 145.3±131.5 pmol/L; p=0.62). Conclusion: Elevated BMI and IR are associated with lower Fe and hemoglobin levels. These findings may be explained by the chronic inflammation of obesity and may contribute to obesity-related co-morbidities. People with IR may present with ID without anemia.

The relationship between circulating irisin, retinol binding protein-4, adiponectin and inflammatory mediators in patients with metabolic syndrome

OBJECTIVE We wanted to investigate whether there is a relationship between circulating irisin, retinol binding protein-4 (RBP-4), adiponectin and proinflammatory mediators implicated in the development of insulin resistance (IR) in metabolic syndrome (MetS). SUBJECTS AND METHODS In 180 individuals, including controls and patients with MetS, we measured fasting plasma insulin, high sensitivity C-reactive protein (hsCRP), pentraxin-3 (PTX-3), interleukin-33 (IL-33), irisin, RBP-4, and adiponectin using ELISA kits. RESULTS While fasting plasma hsCRP, PTX-3, IL-33, irisin, RBP-4 concentrations were higher, adiponectin levels were lower in patients with MetS than in controls. A correlation analysis revealed that plasma irisin levels were positively associated with MetS components such as waist circumference and waist-hip ratio, low density lipoprotein (LDL) and markers of systemic inflammation such as PTX-3, hsCRP, uric acid, and RBP-4. Adiponectin levels were negatively associated with waist circumference, waist-hip ratio, PTX-3 and LDL. CONCLUSIONS Although the precise mechanisms are still unclear, irisin, RBP-4, adiponectin and PTX-3 are hallmarks of the MetS, which is related to low-grade inflammation. It is conceivable that irisin and adiponectin might contribute to the development of MetS and may also represent novel MetS components. Future clinical studies are needed to confirm and extend these data.

Mean platelet volume in chronic viral hepatitis.

Bahadır Ceylan, Muzaffer Fincancı, Cem Yardımcı, Gülhan Eren, Ümit Tözalgan, Cüneyt Müderrisoğlu and Esra Paşaoğlu, Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Bezmialem Vakıf University, Ministry of Health, Istanbul Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Ministry of Health, Istanbul Training and Research Hospital, Department of Internal Diseases and Ministry of Health, Istanbul Training and Research Hospital, Department of Pathology, Istanbul, Turkey

Association of Plasma Pentraxin-3 Levels with Retinopathy and Systemic Factors in Diabetic Patients

BACKGROUND Diabetic retinopathy (DR) is mainly caused by metabolic factors, vascular inflammation, and endothelial dysfunction. We aimed to evaluate the relationship of DR with inflammatory and biochemical alterations in type 2 diabetics. METHODS A total of 89 diabetic patients with retinopathy [(DR (+) (n = 30)], without retinopathy [(DR (-) (n = 32)], and 27 control subjects were involved in the study. Demographic properties, biochemical values, ophtalmologic evaluation, C-reactive protein (CRP), and pentraxin-3 (PTX-3) levels were recorded. RESULTS There was significant difference between controls, DR (-) and DR (+) groups with regard to serum PTX-3 levels. Control group had the lowest and DR (+) group revealed the highest PTX-3 levels. Severity of retinopathy was not related with CRP or PTX-3 levels. Duration of diabetes was longer, systolic blood pressure (SBP) and urinary albumin-creatinine ratio (UACR) were significantly higher in DR (+) subjects than DR (-) subjects. Multivariate analysis revealed that PTX-3 level and SBP were the variables that had a significant effect on DR (P = 0.002, OR = 1.61, and P = 0.021, OR = 1.06, respectively). CONCLUSIONS Plasma PTX-3 levels may be a valuable predictor of DR-like factors such as duration of diabetes, hypertension, and UACR. Although inflammation has an important role in DR, we think that biomarkers reflecting inflammation is not sufficient to predict development and progression of DR; but follow up with PTX-3 levels along with ophthalmological evaluation may be useful. A single determination may not reflect the variations over time, so repeat measures may provide knowledge if PTX-3 is just a biomarker or has a causal role.

Role of Uric Acid in Determining Cardiovascular Risk

Yöntemler: Çalışma hastanemiz nefroloji ve dahiliye polikliniklerine 01.01.2013 ve 31.03.2013 tarihleri arasında başvuran ya da bu servislerde yatarak tedavi gören toplam 285 hastayı kapsamaktadır. Hastaların geriye dönük olarak en son kreatinin, total protein, albümin, ürik asit, total kolesterol, düşük dansiteli lipoprotein (LDL), yüksek dansiteli lipoprotein (HDL) düzeyleri, plazma trigliserit düzeyleri, glukoz, HbA1c, spot idrarda protein/kreatinin oranı ve/veya 24 saatlik idrarda kantitatif protein düzeyi ölçümleri değerleri çalışmaya alınmıştır.

In Patients with Type-2 Diabetes, Diabetes Regulation, Hba1c, Duration of Diabetes, BMI, Dyslipidemia, and Microalbuminuria Compared with Macrovascular Complications

Bulgular: Bir çok çalışmada glisemi kontrolünün komplikasyon sıklığını azalttığı gösterilmiştir. Çalışmamızda da çıkan en önemli sonuçlardan biri glisemik kontrolün makrovasküler komplikasyonlar üzerindeki olumlu etkisiydi. HbA1c düzeyi 8 ve üstünde olan olgularda hipertansiyon ve koroner arter hastalığı sıklığını, HbA1c %8’in altında olan olgulara göre anlamlı derecede daha fazla bulduk. Diyabet süresi ile makrovasküler komplikasyon gelişimi arasında ilişki bilinmektedir. Glisemik maruziyetin süresinin bu süreçte ana neden olduğu düşünülmektedir. Çalışmamızda diyabet süresi 5 yıl üzerinde olan olgularda 5 yıl ve altı olan olgulara göre makrovasküler komplikasyon sıklığı anlamlı derecede yüksek saptandı. Hipertansiyon ve koroner arter hastalığı gelişimiyle diyabet süresinin istatiksel olarak anlamlı derecede paralel olduğu görüldü. Diyabet yaşı 5 yıl üzerinde olanlarda periferik arter hastalığı ve serebrovasküler hastalık sıklığı yüksek saptanırken istatistiksel olarak anlamlı saptanmadı. Obezite tip 2 diyabet gelişimi için önemli risk faktörlerinden olup kardiyovasküler hastalıklar açısından bağımsız bir risk faktörüdür. Bizim çalışmamızda BMI ve bel çevresi grupları ile komplikasyonlar arasında anlamlı ilişki saptanmadı. Lipid düzeyleri ile makrovasküler komplikasyonlar arasındaki ilişki birçok çalışmada gösterilmiştir. LDL kolesterol yüksekliği, HDL kolesterol düşüklüğü, trigliserid yüksekliği ateromatöz süreci hızlandırmaktadır. Çalışmamızda total kolesterol, LDL ve HDL kolesterol grupları arasında anlamlı bir farklılık saptanamamıştır. Yalnızca trigliserid düzeyi yüksekliği ile hipertansiyon arasında anlamlı ilişki saptanmıştır. Mikroalbuminüri diyabetli hastalarda kardiyovasküler hastalık için risk faktörleri kompleks sendromunun önemli bir komponenti ve yaygın endotel hasarının göstergesi olarak düşünülmektedir ve diyabetli hastalarda nefropatiye yol açmaktadır. Mikroalbümin tip 2 diyabette kan basıncı ve sigara gibi diğer faktörlerden bağımsız bir risk faktörüdür. Bizim çalışmamızda da makrove mikroalbuminüri ile hipertansiyon ve koroner arter hastalığı arasında anlamlı derecede ilişki gözlendi.

Plasma asymmetric dimethylarginine and nitric oxide levels on early prognosis in patients with myocardial infarction

SUMMARY Objectives: It is unclear whether abnormalities of nitric oxide (NO) are related to hemodynamic dysfunction and mortality in patients after acute myocardial infarction (MI). We investigated the relationship of plasma asymmetric dimethylarginine (ADMA) and NO levels with early prognosis in patients with MI. Methods: Fifty-nine patients (9 females, 50 males, aged 32-75) hospitalized in the Coronary Care Unit were included in the study. Blood samples were obtained on the first day of admission for routine hematological and biochemical tests and for plasma ADMA and NO levels. NO was determined as the concentration of nitrate plus nitrite (NO metabolites) spectrophotometrically at 430 nm using the Griess reaction. ADMA concentrations were determined by competitive ELISA assay. One month after MI, echocardiography was performed on 56 patients who survived, and left ventricular ejection fraction (LVEF) was investigated as a prognostic marker of cardiac function. Results: There was no correlation between ADMA and NO levels with age, gender, smoking, localization of the infarction, history of hypertension, coronary heart disease or diabetes mellitus, and the levels of total cholesterol, triglyceride, lactate dehydrogenase, white blood cells, and Creactive protein. Plasma ADMA concentrations were negatively correlated with NO levels (r=-0.72) and creatine kinase -MB levels (r=-0.37). LVEF had no correlation with ADMA or NO levels (p>0.05). Conclusion: In previous studies, decreased NO and high levels of ADMA were proposed as independent risk factors for coronary artery disease. Although MI patients had higher ADMA levels, they showed no correlation with left

A Comparison of Insulin Resistance Between Hemodialysis and Peritoneal Dialysis Patients

Gereç ve Yöntem: Çalışmamıza, S.B. İstanbul Eğitim ve Araştırma Hastanesi İç Hastalıkları Kliniği ve Nefroloji Polikliniğinde takip ve tedavisi devam eden, 20-70 yaş arasında, 51’i hemodiyaliz, 46’sı periton diyalizi uygulanan 97 hasta alındı. Hastalar hemodiyaliz grubu ve periton diyalizi grubu olarak iki gruba ayrılarak insülin dirençleri Homeostatic Model Assessment (HOMA) ile karşılaştırıldı.

The Variables Identified in the Development of Exacerbation Hepatitis in Chronic HBV Infection Responding to Treatment

Gereç ve Yöntem: Bu çalışma hepatit B virüs (HBV) enfeksiyonlu olguların verilerini değerlendiren geriye dönük kesitsel bir çalışmadır. Hasta dosyalarından olguların boy, kilo, cinsiyet, yaş, alkol kullanım durumu, tedavi öncesi HBV DNA ve ALT düzeyi, Knodell skorlama sistemine göre ölçülen histopatolojik aktivite indeksi ve fibroz skoru, tedavi süresi, tedaviye biyokimyasal ve virolojik yanıt süresi, HBeAg durumu, kullanılan tedavi türü ve alevlenme hepatiti gelişip gelişmediği öğrenildi. Hastalar alevlenme hepatiti olan ve olmayanlar olarak iki gruba ayrıldı. İki grup değerlendirmeye alınan değişkenler açısından karşılaştırıldı.