Emine Binnetoglu

Platelet/lymphocyte ratio and risk of in-hospital mortality in patients with ST-elevated myocardial infarction.

Background Platelet-to-lymphocyte ratio (PLR) is a new prognostic marker in coronary artery disease. We aimed to evaluate the relationship between PLR and in-hospital mortality in patients with ST-elevated acute myocardial infarction (AMI). Material/Methods The present study included 636 patients with ST-elevated AMI. The study population was divided into tertiles based on their admission PLR. Patients having values in the third tertile was defined as the high PLR group (n=212) and those having values in the lower 2 tertiles were defined as the low PLR group (n=424). Results Risk factors of coronary artery disease and treatments administered during the in-hospital period were similar between the groups. Male patient ratio was found to be lower in the high PLR group (73% vs. 82.8%, p=0.004). In-hospital mortality was increased in the high PLR group when compared to the low PLR group (12.7% vs. 5.9%, p=0.004). The PLR >144 was found to be an independent predictor of in-hospital cardiovascular mortality (HR: 2.16, 95% CI: 1.16–4.0, p=0.014). Conclusions This study showed that PLR is an independent predictor of cardiovascular mortality in patients with ST-elevated AMI.

Increased Platelet Distribution Width Is Associated With Severity of Coronary Artery Disease in Patients With Acute Coronary Syndrome

Platelet activation plays a pivotal role in acute coronary syndrome (ACS). We investigated the relationship between platelet distribution width (PDW) and severity of coronary artery disease (CAD) in patients with ACS. A total of 502 patients with ACS were enrolled. High (n = 151) and low PDW (n = 351) groups were defined as patients having values in the third tertile (>17%) and lower 2 tertiles (≤17%). There were significantly higher Gensini score (44 [10-168] vs 36 [2-132], P < .001), and neutrophil–lymphocyte ratio (3.1 [0.8-12.4] vs 2.5 [0.3-13], P = .012) and baseline platelet counts were significantly lower (220 [61-623] vs 233 [79-644] 103/mm3, P = .022) in the high PDW group. The variables PDW >17%, diabetes mellitus, and myocardial infarction were found to be associated with high Gensini score (odds ratio [OR]: 1.91, 95% confidence interval [CI]: 1.27-2.88, P = .002; OR: 2.85, 95%CI: 1.91-4.25, P < .001; OR: 2.67, 95% CI:1.74-4.1, P < .001, respectively). An increased PDW (>17%) is associated with severity of CAD in patients with ACS.

Pantoprazole-induced thrombocytopenia in patients with upper gastrointestinal bleeding

Abstract Proton pump inhibitors (PPIs) are highly effective drugs for patients suffering from peptic ulcer and gastro-esophageal reflux diseases, but recent studies have indicated possible risks with the long-term use of PPIs, such as osteoporosis, fractures, increased risk of pneumonia, diarrhea, iron and vitamin B12 deficiencies. There are publications written as a case study that indicate thrombocytopenia as side effects of PPIs, but there is no study on this subject. This study aimed to investigate the development of thrombocytopenia in patients with short-term use of PPI-infusion therapy. In this study, the records of the patients were evaluated retrospectively, for the period between January 2012 and January 2013. Thirty-five patients with upper gastrointestinal bleeding were enrolled. Platelet counts were analyzed before treatment, and on the first, second and third day of treatment, respectively. All patients were treated with intravenous pantoprazole. Hemogram values of patients were analyzed before and after PPI infusion treatment. Platelet counts were found to decrease from the first day to the third day of treatment (249 714.29/µl, 197 314.29/µl, 193 941.18/µl, 183 500/µl, respectively). The platelet count decrease was statistically significant (p < 0.001). After cessation of infusion therapy, platelet counts began to rise on the fourth day. Three patients had severe thrombocytopenia on the third day of the treatment. (69 000/µl, 97 000/µl and 49 000/µl respectively). Platelet counts recovered after discontinuation of treatment. In conclusion, this study demonstrates that PPIs may cause thrombocytopenia, and this result should not be ignored. In particular, patients with PPI infusion therapy should be monitored more closely.

Is Neutrophil Lymphocyte Ratio an Indicator for Proteinuria in Chronic Kidney Disease

Recent studies have shown that neutrophil lymphocyte ratio (NLR) is a strong indicator in determining inflammation in cardiac and non‐cardiac diseases. We aimed to evaluate the relationship between proteinuria and NLR in chronic kidney disease (CKD) patients without diabetes mellitus (DM).

The Prognostic Value of Neutrophil-Lymphocyte Ratio in Acute Pancreatitis is Controversial

Dear Editor,IreadwithgreatpleasureandinterestSuppaihandcolleagues’article “The prognostic value of the neutrophil-lymphocyteratio (NLR) in acute pancreatitis: identification of an optimalNLR.” NLR provides a rapid indication of the extent of aninflammatory process. So recently, there are a lot of studiesabout NLR and its relationship with other diseases.In this study, they showed that NLR was increased duringthefirst48hofadmissionofthepatientwithacutepancreatitis(AP), and they suggested NLR as an independent negativeprognostic indicator in AP. But when we examined the study,we could not find any information about the treatment withantibiotics,especiallyinpatientswithsevereacutepancreatitis(SAP).As you well know, broad-spectrum antibiotics with goodtissue penetration are necessary to prevent infection in SAP.Carbapenems, quinolones, and third-generation cephalospo-rins are generally used. Manes et al. compared the earlyantibiotic treatment with the treatment started after the dem-onstrationofpancreaticnecrosis.Atthe end ofthestudy, theysuggested that early antibiotic treatment is associated with asignificant improvement in the prognosis of necrotizing AP.

The importance of education in diabetic foot care of patients with diabetic neuropathy.

OBJECTIVE Our aim is to research the effect of the knowledge and routine gained from the diabetic foot (DF) care education program given to patients with Type 2 Diabetes Mellitus (DM) with diabetic neuropathy. MATERIALS AND METHOD A total of 104 patients with Type 2 DM and diabetic neuropathy participated in a survey to evaluate standards of DF care, and knowledge of and behavior relating to personal care. The difference in knowledge and personal care between the group who had received education on diabetes and the group who had not was researched. RESULTS A total of 42.3% of patients reported receiving education about diabetes. The education for Type 2 DM patients increased the frequency of attending yearly check-ups (p:0.028), and helped develop the habit of having doctors check their feet (p:0.004). When comparing the daily practice of those who had received education about DF care with those who had not, positive effects of education were seen in all questions evaluating foot care, nail care and choice of shoe. The statistical analysis proved that the educated group were significantly better in terms of foot care such as using moisturizer (p:0.002) and using insoles (p:0.042). CONCLUSION Our study reveal that educating diabetic patients about foot care is an effective method to develop their knowledge. However we observed that this education is not provided to all diabetic patients. We believe that every diabetic patient should receive education from the moment of diagnosis and repeated education during check-ups by doctors will increase effectiveness.

The relationship between subclinical cardiovascular disease and lipocalin-2 levels in women with PCOS

OBJECTIVE In this study we aimed to investigate the relationship between lipocalin-2 (LCN2) levels and cardiovascular risk in patients with polycystic ovary syndrome (PCOS). STUDY DESIGN Fifty patients with PCOS and 44 healthy women as controls were enrolled in the study. Laboratory and echocardiographic examinations were performed between the second and fifth days of the menstrual cycle. Serum LCN2 levels were measured with an enzyme-linked immunosorbent assay (ELISA) method. RESULTS Serum LCN2 levels were significantly lower in PCOS patients (75.8 [51.4-131.2] ng/ml vs. 85.3 [56.7-138.5] ng/ml, p=0.038). Carotid intima-media thickness (CIMT) was increased in patients with PCOS compared to controls (0.61±0.13mm vs. 0.50±0.07mm, p=0.001). Aortic strain was lower in patients with PCOS. Aortic stiffness (β index) was significantly increased and distensibility was decreased in PCOS patients compared to control subjects. Serum LCN2 levels and the presence of PCOS were associated with CIMT in Spearman correlation analysis (p=0.05 and p<0.001) in all participants. There was no statistically significant relationship between LCN2 levels and CIMT in patients with PCOS (p=0.238). CONCLUSION In the present study, we found that LCN2 levels were low in women with PCOS. Although our patients with PCOS had elevated cardiac risk, there was no correlation between LCN2 levels and early findings of atherosclerosis.

Evaluation of Epicardial Fat Tissue Thickness in Patients with Primary Hyperparathyroidism

OBJECTIVE Primary hyperparathyroidism (pHPT) affects the cardiovascular system, and epicardial fat tissue (EFT) thickness is closely associated with cardiovascular diseases and atherosclerosis. Despite this, the association between EFT thickness and pHPT has not been studied in a clinical setting. This study aimed to assess EFT thickness in patients with pHPT. METHODS The study included 38 patients with pHPT and 40 healthy controls. EFT thickness, carotid intima-media thickness (CIMT), serum levels of parathormone (PTH) and calcium, and blood chemistry profiles were determined in all subjects. Correlation and regression analyses were performed with EFT thickness and CIMT as dependent variables and age; systolic and diastolic blood pressure; body mass index (BMI); presence of diabetes mellitus; and free plasma glucose (FPG), PTH, and serum calcium (Ca) levels as independent variables. RESULTS Both the mean EFT thickness and the mean CIMT were significantly greater in the pHPT group than the control group (P < .001 for both). Correlation analysis showed that EFT thickness was significantly correlated with CIMT, age, systolic blood pressure, and PTH and serum Ca levels. Furthermore, the regression analysis revealed that EFT thickness retained its independent and positive association with FPG and serum Ca levels. CONCLUSIONS The results of this study indicate that EFT thickness may be a useful marker of early atherosclerosis in patients with pHPT. Furthermore, the increase in EFT thickness appears to be due to hypercalcemia.

An Unusual Initial Presentation of Sjögren's Syndrome: Severe Hypokalemic Paralysis Secondary to Distal Renal Tubular Acidosis.

Sjögrens syndrome is mainly affects the exocrine glands. Patients usually complain of persistent dryness of the mouth and eyes. However, nonexocrine organs such as the kidneys are often affected in these patients. Distal renal tubular acidosis (dRTA) and interstitiel nephritis are common in Sjögrens syndrome. Nonetheless, severe hypokalemia and paralysis secondary to dRTA are unusual initial manifestation of Sjögrens syndrome. Here, we describe a case of a 48 year old women admitted to the emergency setting with severe hypokalemic paralysis and diagnosed Sjögrens syndrome.

Number of metabolic syndrome risk parameters associated with TAFIa/ai antigen levels.

Thrombin activatable fibrinolysis inhibitor (TAFI) is an important procoagulant factor. Patients with metabolic syndrome (MetS) also have an elevated procoagulant status. However, TAFI and its association with MetS are still not well known. We aimed to investigate TAFI in type 2 diabetes mellitus patients with MetS. We enrolled a total of 55 patients who had MetS (n = 30) and 25 healthy controls. MetS was diagnosed using National Cholesterol Education Program Adult Treatment Panel III criteria. We measured activated and inactivated TAFI (TAFIa/ai) antigen in plasma samples using a commercially available ELISA kit (Imubind TAFIa/ai antigen ELISA; American Diagnostica Inc., Stamford, Connecticut, USA). TAFIa/ai levels were then evaluated for links to MetS parameters. Mean TAFIa/ai levels were 156.6 ± 66.9 ng/dl in patients with MetS and 104.1 ± 60.3 ng/dl in the control group (P = 0.005). None of the MetS parameters, including blood pressure, fasting plasma glucose, waist circumference, triglycerides or high-density lipoprotein cholesterol (HDL-C) levels were correlated with TAFIa/ai levels. However, TAFIa/ai level had a strong correlation with the number of metabolic risk components, which increased proportionally when MetS parameters were over three. When there were increased numbers of MetS risk components, we detected a rise in TAFIa/ai levels. TAFIa/ai levels could be an indicator of atherosclerotic tendency in patients with MetS.