Emin Murat Akbas

Platelet-to-lymphocyte ratio better predicts inflammation than neutrophil-to-lymphocyte ratio in end-stage renal disease patients.

Neutrophil‐to‐lymphocyte ratio (NLR) was introduced as a potential marker to determine inflammation in end‐stage renal disease (ESRD) patients. Recently, platelet‐to‐lymphocyte ratio (PLR) and NLR were found to positively correlated with inflammatory markers including tumor necrosis factor‐α (TNF‐α) and interleukin (IL)‐6 in cardiac and noncardiac patients. Data regarding PLR and its association with inflammation are lacking in hemodialysis (HD) and peritoneal dialysis (PD) patients. Hence, we aimed to determine the relationship between PLR, NLR, and inflammation in ESRD patients. This was a cross‐sectional study involving 62 ESRD patients (29 females, 33 males; mean age, 49.6 ± 14.6 years) receiving PD or HD for ≥6 months in the Dialysis Unit of Necmettin Erbakan University. PLR, NLR, C‐reactive protein, TNF‐α, IL‐6 levels were measured. PLR, NLR, serum high sensitive C‐reactive protein, IL‐6, and TNF‐α levels were significantly higher in PD patients when compared with HD patients. ESRD patients with PLR ≥ 140 had significantly higher NLR, IL‐6, and TNF‐α levels when compared to patients with PLR < 139. In the bivariate correlation analysis, PLR was positively correlated with NLR, IL‐6, and TNF‐α in this population. When we compared the association of PLR and NLR with IL‐6 (r = 0.371, P = 0.003 vs. r = 0.263, P = 0.04, respectively) and TNF‐α (r = 0.334, P = 0.008 vs. r = 0.273, P = 0.032, respectively), PLR was found to be superior to NLR in terms of inflammation in ESRD patients. Simple calculation of PLR can predict inflammation better than NLR in ESRD patients.

The relationship between neutrophil‐to‐lymphocyte ratio and vascular calcification in end‐stage renal disease patients

Chronic inflammation was found to be correlated with coronary (CAC) and thoracic peri‐aortic calcification (TAC) in end‐stage renal disease (ESRD) patients. Neutrophil‐to‐lymphocyte ratio (NLR) was introduced as a potential marker to determine inflammation in cardiac and noncardiac disorders. Data regarding NLR and its association with TAC and CAC are lacking. We aimed to determine the relationship between NLR and vascular calcification in ESRD patients. This was a cross‐sectional study involving 56 ESRD patients (22 females, 34 males; mean age, 49.9 ± 14.2 years) receiving peritoneal dialysis or hemodialysis for ≥6 months in the Dialysis Unit of Necmettin Erbakan University. TAC and CAC scores were measured by using an electrocardiogram‐gated 64‐multidetector computed tomography. NLR was calculated as the ratio of the neutrophils and lymphocytes. There was a statistically significant correlation between NLR, TACS and CACS in ESRD patients (r = 0.43, P = 0.001 and r = 0.30, P = 0.02, respectively). The stepwise linear regression analysis revealed that age, as well as NLR were independent predictors of TACS. However, increased age was the only independent predictor of CACS according to linear regression analysis. Simple calculation of NLR can predict vascular calcification in ESRD patients.

The relationship between atherogenic index of plasma and epicardial adipose tissue in hemodialysis and peritoneal dialysis patients

Abstract Introduction: Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in end-stage renal disease (ESRD) patients. One of the established risk factor in this population is dyslipidemia. We aimed to determine the relationship between atherogenic index of plasma (AIP) and EAT in ESRD patients. Methods: This was a cross-sectional study involving 76 ESRD patients receiving PD or HD for ≥6 months and 42 healthy subjects. EAT was measured by using an electrocardiogram-gated 64-multidetector computed tomography (MDCT). Atherogenic index of plasma was calculated as the logarithmically transformed ratio of the serum trigliseride to HDL-cholesterol. Results: The etiology of ESRD patients was diabetic nephropathy (n = 16), chronic glomerulonephritis (n = 10), hypertensive nephropathy (n = 23), polycystic kidney disease (n = 7), nephrolithiasis (n = 5) and unknown (n = 15). There were no differences with respect to the following variables between ESRD patients and healthy subjects: age; sex; BMI; predialysis levels of DBP; serum levels of albumin, HDL-cholesterol and hemoglobin. However, ESRD patients had higher serum levels of trigliseride, hs-CRP and AIP when compared to healthy subjects. There was a statistically significant relationship between EAT, BMI and AIP in ESRD patients (r = 0.42, p < 0.001 and r = 0.25, p = 0.028, respectively). The stepwise linear regression analysis revealed that age, as well as BMI were independent predictors of EAT. Conclusion: We found a relationship between EAT as defined by MDCT and AIP in ESRD patients. Further clinical and experimental studies are needed.

Evaluation of ovarian reserve tests in women with systemic lupus erythematosus.

Impact of systemic lupus erythematosus (SLE) on fertility may be negative, and ovarian function can be also reduced by autoimmune oophoritis. In this article, we evaluated the ovarian reserve of pre‐menopausal women firstly diagnosed with systemic lupus erythematosus (SLE).

Apoptosis, autophagy & endoplasmic reticulum stress in diabetes mellitus

The prevalence of diabetes mellitus (DM) is increasing secondary to increased consumption of food and decreased physical activity worldwide. Hyperglycaemia, insulin resistance and hypertrophy of pancreatic beta cells occur in the early phase of diabetes. However, with the progression of diabetes, dysfunction and loss of beta cells occur in both types 1 and 2 DM. Programmed cell death also named apoptosis is found to be associated with diabetes, and apoptosis of beta cells might be the main mechanism of relative insulin deficiency in DM. Autophagic cell death and apoptosis are not entirely distinct programmed cell death mechanisms and share many of the regulator proteins. These processes can occur in both physiologic and pathologic conditions including DM. Besides these two important pathways, endoplasmic reticulum (ER) also acts as a cell sensor to monitor and maintain cellular homeostasis. ER stress has been found to be associated with autophagy and apoptosis. This review was aimed to describe the interactions between apoptosis, autophagy and ER stress pathways in DM.

Neutrophil-to-lymphocyte ratio as a possible indicator of epicardial adipose tissue in patients undergoing hemodialysis

Introduction Chronic inflammation is a major risk factor in the pathogenesis of cardiovascular disease in end-stage renal disease (ESRD) patients. Epicardial adipose tissue (EAT) is the true visceral fat depot of the heart. The relationship between coronary artery disease and EAT was shown in healthy subjects and ESRD patients. In the present study we aimed to investigate the relationship between EAT and inflammation parameters including neutrophil-to-lymphocyte ratio (NLR) in hemodialysis (HD) patients. Material and methods Forty-three HD patients (25 females, 18 males; mean age: 64.1 ±11.9 years) receiving HD and 30 healthy subjects (15 females, 15 males; mean age: 59.1 ±10.8 years) were enrolled in the study. Epicardial adipose tissue measurements were performed by echocardiography. Results Neutrophil-to-lymphocyte ratio levels were significantly higher in HD patients than in the healthy control group. Hemodialysis patients were separated into two groups according to their median value of NLR (group 1, NLR < 3.07 (n = 21) and group 2, NLR ≥ 3.07 (n = 22)). Group 2 patients had significantly higher EAT, C-reactive protein and ferritin levels, while albumin levels were significantly lower in this group. In the bivariate correlation analysis, EAT was positively correlated with NLR (r = 0.600, p < 0.001) and ferritin (r = 0.485, p = 0.001) levels. Conclusions Neutrophil-to-lymphocyte ratio was found to be an independent predictor of EAT in HD patients (odds ratio = 3.178; p = 0.008). We concluded that this relationship might be attributed to increased inflammation in uremic patients.

Vitamin D and inflammation: evaluation with neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio.

Introduction Association of vitamin D, inflammation and endothelial dysfunction, beside the classic bone metabolism disorders, may explain the pathogenesis of numerous diseases associated with vitamin D deficiency. While large numbers of reports support the relationship of vitamin D with inflammation, several reports fail to confirm this relationship. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are novel and inexpensive markers of inflammation that can be studied in all centers. The goal of this study was to investigate the association between 25-hydroxy vitamin D (25(OH)D) and inflammation with the novel inflammatory markers NLR and PLR. Material and methods This study was performed retrospectively. Results of the simultaneously performed 25(OH)D, parathyroid hormone, albumin, calcium, phosphorus, alkaline phosphatase and creatinine level measurements and complete blood count were recorded. The data of 4120 patients were included in the study. Results Between vitamin D deficient and non-deficient groups there were significant differences in PLR (p < 0.001) and NLR (p = 0.001). Vitamin D had a significant negative correlation with PLR (p < 0.001) and NLR (p < 0.001). Multiple regression analysis indicated that 25(OH)D was independently and negatively correlated with PLR (OR = 0.994, 95% CI 0.991–0.998, p = 0.02). Conclusions Platelet-to-lymphocyte ratio and NLR were significantly associated with 25(OH)D levels, and PLR was found to be an independent predictor of 25(OH)D levels. Our study revealed an inverse association of vitamin D levels and inflammation with these inexpensive and universally available markers.

Bone Marrow Metaplasia in Multinodular Goiter With Primary Hyperparathyroidism

M ultinodular goiter (MNG) constitutes a mixed group of nodular entities. Structural and functional heterogeneity is the most characteristic feature of MNG and may exhibit degenerative alterations such as hemorrhagic and cystic changes, fibrosis, squamous metaplasia and calcification. Rarely, osseous metaplasia, mature bone formation and bone marrow metaplasia have been reported in thyroid tissue. However, according to our literature search, mature bone formation and bone marrow metaplasia in thyroid tissue with primary hyperparathyroidism (PHPT) have not been reported previously. We report a patient with bone marrow metaplasia in the thyroid tissue and PHPT. A 57-year-old white female patient was admitted to the general surgery department for swelling in the neck (over 5 years) and constipation lasting 3 months. On physical examination, a grade 2 goiter was palpated; there was no other pathology in the physical examination. The patient had a history of hyperparathyroidism (parathyroid hormone: 199; normal range: 11–54 pg/mL) and hypercalcemia (Ca: 11.7; normal range: 8.5–10.5 mg/dL). The common blood count and peripheral blood smear were within the normal ranges. The thyroid stimulating hormone and thyroid hormones were also within the normal ranges. On thyroid ultrasonography, a 21 3 14 mm solid nodule in the left lobe of the thyroid in an inferior location, with a peripheral hypoechoic area, was detected. In the middle of the same lobe, there was a calcified nodule (7 mm in diameter), and near the right thyroid lobe in the posteroinferior area, a 15 3 5-mm hypoechogenic lobulated solid nodule, similar to parathyroid adenoma in the sonographic view, was seen. In parathyroid scintigraphy, minimally focused activity retention in the right inferior lobe of the thyroid was detected, which could be a parathyroid adenoma. Because of a prediagnosis of MNG and parathyroid adenoma, a left thyroidectomy and parathyroid adenoma resection of the right inferior location of the right thyroid lobe, by frozen section, was performed. Based on the results of the frozen section, which were similar to the parathyroid adenoma, the operation was ended. On the 1st postoperative day, the patient had a PTH of 18 and Ca of 9.9. In the macroscopic view, a 4 3 3.5 3 2 cm-sized, 12-g weight, claret red–colored, localized, elastic-hard stiffness thyroid tissue was detected. In the cross-sectional view, a 1.5-cm-diameter claret red nodule and, near it, a 0.8-cm-diameter hard calcified region were seen. After decalcification of the tissue, localized degenerated hyalinizing areas and, near them, hypocellular bone marrow and lamellar bone trabeculae were seen (Figures 1 and 2). This was reported as an MNG consisting of bone marrow metaplasia. The frozen section material included parathyroid tissue of 13 0.53 0.4 cm in size, 0.7 g in weight, encapsulated and pink beige color. Using the light microscope, chief cells that compressed the normal parathyroid tissue were seen and described as an adenoma. There was no complaint from the patient during the postoperative follow-up time. Thyroid nodules are a common occurrence in clinical practice. The incidence of thyroid nodules has been on the rise in recent decades, mainly because of the wider use of imaging instruments. The incidence of nodular goiter in the general adult population is 3% to 5% clinically, about 50% discovered at autopsy, whereas it is nearly 100% in the endemic areas. Clinically, most patients are euthyroid and their clinical importance is primarily to exclude a malignancy. Thyroid nodules may undergo a broad spectrum of degenerative changes, such as infarction, hemorrhage or fibrosis, which are associated with calcification or even ossification. Osseous metaplasia, in contrast to calcification, is a rare event in any organ or tissue, and the detection of mature bone formation in a thyroid nodule is extremely rare. Osseous metaplasia could be seen secondary to ischemia, necrosis or inflammation in the tumor or surrounding tissue. Some studies have shown that bone formation might occur as a result of local or systemic inflammation. Additionally, there are studies reporting that hypercalcemia levels are closely associated with bone formation. PHPT is characterized by the autonomous production of PTH, in which there is hypercalcemia or normal to high serum FIGURE 1. Histopathologic view.

Relationship of the total atrial conduction time to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus

OBJECTIVES: The aim of our study was to evaluate the total atrial conduction time and its relationship to subclinical atherosclerosis, inflammation and echocardiographic parameters in patients with type 2 diabetes mellitus. METHODS: A total of 132 patients with type 2 diabetes mellitus (mean age 54.5±9.6 years; 57.6% male) and 80 age- and gender-matched controls were evaluated. The total atrial conduction time was measured by tissue-Doppler imaging and the carotid intima-media thickness was measured by B-mode ultrasonography. RESULTS: The total atrial conduction time was significantly longer in the patients with type 2 diabetes mellitus than in the control group (131.7±23.6 vs. 113.1±21.3, p<0.001). The patients with type 2 diabetes mellitus had significantly increased carotid intima-media thicknesses, neutrophil to lymphocyte ratios and high-sensitivity C-reactive protein levels than those of the controls. The total atrial conduction time was positively correlated with the high-sensitivity C-reactive protein level, neutrophil to lymphocyte ratio, carotid intima-media thickness and left atrial volume index and negatively correlated with the early diastolic velocity (Em), Em/late diastolic velocity (Am) ratio and global peak left atrial longitudinal strain. A multiple logistic regression analysis demonstrated that the neutrophil to lymphocyte ratio, carotid intima-media thickness and global peak left atrial longitudinal strain were independent predictors of the total atrial conduction time. CONCLUSIONS: We suggest that subclinical atherosclerosis and inflammation may represent a mechanism related to prolonged total atrial conduction time and that prolonged total atrial conduction time and impaired left atrial myocardial deformation may be represent early subclinical cardiac involvement in patients with type 2 diabetes mellitus.

Endoskopi yapılan hastalarda Helicobacter pylori sıklığı ve yerleşim yerinin yaş ve cinsiyete göre dağılımı

Objective: The aim of this study was to define the distribu tion of the incidence and location of Helicobacter pylori in terms of the age and gender in the gastritis patients undergone endoscopy. Methods: Endoscopy and pathology reports of 1,405 patients who undergone biopsy of upper gastrointestinal system endoscopy were retrospectively examined. The frequency and location of Helicobacter pylori infection were evaluated according to the locations, gender and age groups. Based on the Sydney classification, the patients were scored as none (-), low (+), medium (++) and high (+++). Results: A total of 1405 patients (58.6% females, 41.4% males) who had both antrum and corpus biopsies were included. Mean age was 48.58±16.96 (15-94) years. The Helicobacter pylori positivity was significantly higher in males than in the female patients (p=0.012). Helicobacter pylori positivity both in corpus and antrum was 1,101 (78.4%), Helicobacter pylori was negative in 304 (21.6%) patients. Although, females had higher positivity rate, no significant difference was found between the age and gender groups. In 1,064 patients (75.7%) Helicobacter pylori was positive while it was found as negative in 341 (24.3%) biopsies taken from the antrum. While in 572 (40.7%) of the biopsy outcomes taken from the corpus Helicobacter pylori was found as positive, it was found as negative in 833 (59.3%). No statistically significant differences were found between the age groups in terms of the positivity of Helicobacter pylori both in antrum and in corpus. Conclusion: In our study, the frequency of the Helicobacter pylori positivity was 78.4%. This can be accepted as a serious public health problem in terms of the associated diseases.