Erim Gulcan

Relationship between pregnancy-associated plasma protein-A and lung cancer.

Background:Pregnancy-associated plasma protein-A (PAPP-A) has insulin-like growth factor (IGF)-dependent IGFBP-4 protease activity and plays an important role in amplifying local IGF-1 activity in wound healing, vascular repair, and bone remodeling. We postulated that PAPP-A may contribute to the availability and activity of IGFs, which affect lung cancer. Therefore, we determined the levels of PAPP-A in patients with lung cancer and their possible clinical significance. Methods:The study population consisted of 83 patients with lung cancer and 33 healthy subjects as a control group. Serum PAPP-A levels were determined using an ultrasensitive enzyme-linked immunosorbent assay. Results:The serum PAPP-A levels were higher in patients with lung cancer [median (interquartile range) 10.7 (7.6–14.2) ng/mL] than in the control group [6.2 (5.2–9.8) ng/mL, P < 0.001]. There was a significant negative correlation between the serum PAPP-A levels and Karnofsky performance status (r = −0.330; P < 0.001) and a positive correlation with patient age (r = 0.358; P < 0.001). Conclusion:PAPP-A is a proatherosclerotic metalloproteinase that is also thought to be an inflammatory marker. We found that the serum PAPP-A levels increased in patients with lung cancer and postulated that PAPP-A levels may be a prognostic factor in such cases.

Topical Atorvastatin in the Treatment of Diabetic Wounds

Background:Currently, it is reported that statins may be useful in the treatment of diabetes mellitus foot ulceration. The aim of this study was to evaluate treatment of the wounds in streptozotocin-induced diabetic rats with local atorvastatin. Methods:Two 15 × 15 mm-sized wounds were created in 28 streptozotocin-induced rats. A total of 56 diabetic wounds were studied in 8 groups (n = 7). No treatment was administered in the first and second groups, which lasted for 7 and 14 days, respectively. Third and fourth groups consisted of diabetic rats that were administered 1:1 mixture of lanolin and vaseline therapy for 7 and 14 days, respectively. One percent statin plus 1:1 mixture of lanolin and vaseline was used in the fifth and sixth groups for 7 and 14 days, respectively; and in seventh and eighth groups, 5% statin plus 1:1 mixture of lanolin and vaseline therapy was used for 7 and 14 days, respectively. On the 7th and 14th days, state of the wound healing was observed, and the percent of wound healing was determined by measuring its size and by performing a histopathologic study. The statistical analyses were performed by Mann–Whitney U test, using SPSS 14.0 software. Results:On the 14th day, the rates of wound healing in the first, second, third, and fourth groups were 14%, 40%, 96.59%, and 96.51%, respectively. This ratio was calculated by the formula healing ratio (%) = 100 × (1−wound area/initial wound area). Accordingly, in the multiple comparisons, the rates of wound healing were found to be significantly higher in the diabetic rat groups administered 1% and 5% atorvastatin compared with those administered a mixture of lanolin-vaseline and the untreated group (for comparison each one P < 0.001). Conclusions:Local atorvastatin therapy may be useful for healing the wounds in diabetic rats. Further clinical and experimental studies are needed to confirm these results.

Evaluation of Glucose Tolerance Status in Patients with Asthma Bronchiale

Background. Asthma is characterized by inflammation and airway hyperesponsiveness, which results in episodic airflow obstruction. A relationship between inflammation and insulin resistance (IR) has been previously characterized, and asthma is known to correlate with increasing IR. Thus, we tested whether patients with asthma bronchiale exhibited abnormally low glucose tolerance. The aim of this study was to compare the occurrence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), two precursors of type 2 diabetes mellitus (DM), in patients with asthma bronchiale and paired control patients. Patients and Methods. We examined patients diagnosed with asthma bronchiale. We excluded patients taking any medications other than inhaler broncodilators, patients with a history of other systemic illness, and patients with any diabetic risk factors. Age- and sex-matched healthy volunteers were included as the control group in this study. History, physical examination, and laboratory analyses were performed for both study and control groups. Results. Mean age of the study group was 40.3 ± 7.8 (F/M: 32/19), and mean BMI of the study group was 26.7 ± 2.2. Mean age of the control group was 39.5 ± 6.7 (F/M: 25/15) and mean BMI of the control group was 26.0 ± 2.1. Fasting blood glucose (FBG), Pg2hBG, Plasma insulin, Homeostasis Model Assessment–Insulin Resistance (HOMA IR), IFG, IGT, both IFG and IGT and (LDL) C levels were significantly higher in the asthmatic group, while HDL C levels were significantly higher in the control group. Conclusion. Our results suggest that disturbance of the glucose metabolism caused by inflammation-induced insulin resistance may occur in asthmatic patients and that this phenomenon may increase the risk of diabetes mellitus in these individuals.

Cyanocobalamin May be Beneficial in the Treatment of Recurrent Aphthous Ulcers Even When Vitamin B12 Levels Are Normal

Objective:To evaluate the efficacy of cyanocobalamin treatment in patients having recurrent aphthous ulcers (RAUs) with normal or decreased serum vitamin B12 (cobalamin) levels. Methods:Seventy-two patients with RAU were included in the study. In addition to serum cobalamin levels, hemanitic and biochemistrical parameters were measured. Patients with serum cobalamin levels <140 pg/mL were defined as the cobalamin deficient group (CDG) whereas patients with cobalamin levels ≥140 pg/mL were defined as the cobalamin normal group (CNG). The degree of aphthous ulcer healing was determined according to serum cobalamin levels at the first and sixth month after cyanocobalamin treatment protocol. Results:Of the 72 participants, 37 were in the CDG whereas 35 were considered to have normal cobalamin levels. In the first admission the cobalamin levels were 215.8 ± 116.90 pg/mL in CNG and 107.43 ± 29.35 pg/mL in the CDG. The frequency of aphthous ulcers was defined numerically according to monthly occurrence of the lesions. The mean aphthous ulcer frequency in CNG group was 1.9 ± 0.7, whereas it was 2.4 ± 0.9 in the CDG. A significant increase in cobalamin levels was observed after cyanocobalamin treatment in both groups. A significant decrease in aphthous ulcer frequency was also concurrently observed. 96% of the patients showed good response to replacement treatment, 4% of the study population did not respond to the treatment. Conclusion:Cyanocobalamin treatment maybe beneficial for patients with RAU even when serum cobalamin levels are normal. We suggest that higher serum cobalamin levels should be attained in patients with RAU for mucosal protection.

Evaluation of Risk Factors and Seroprevalence of Hepatitis B and C in Diabetic Patients in Kutahya, Turkey

Aim To assess the prevalence of hepatitis B and C viruses among Turkish patients with type 1 and type 2 diabetes mellitus and to determine the risk factors affecting the prevalence in these patient groups. Methods This study included 630 diabetic and 314 nondiabetic patients. Serologic testing for anti-hepatitis C virus (anti-HCV) and HbsAg was done using a third-generation commercial enzyme-linked immunosorbent assay, and samples positive for anti-HCV and HbsAg were confirmed by a polymerase chain reaction assay. Diabetic patients were classified by HbsAg and anti-HCV status and were evaluated according to demographic features, diabetic characteristics and nondiabetic general risk factors, harmful habits, and aminotransferase (alanine aminotransferase and aspartate aminotransferase) levels. Results HbsAg and anti-HCV seropositivity rates were 5.1% and 3.2% in diabetic patients and were 3.8% and 1.3% in control group, respectively. There was no statistically significant difference between the 2 groups with respect to either marker. Shared risk factors for both hepatitis infections were increased aminotransferase levels and history of hospital admission. In addition, long duration of diabetes mellitus, poor diabetic regulation, and insulin treatment usage were found to relate to HbsAg, whereas a history of blood transfusions and surgical procedures were found to associate with anti-HCV seropositivity. Conclusions We determined that hepatitis B virus and hepatitis C virus infections were slightly but not significantly higher in diabetic patients compared with a normal population. If it is considered that different results might be obtained in various countries or even in various regions of same country, it may be concluded that multicenter and comprehensive studies are needed to elucidate true infection rates and to identify other risk factors affecting the prevalence of these infections.

Association Between Serum Vitamin B12 Levels and the Degree of Steatosis in Patients With Nonalcoholic Fatty Liver Disease

Purpose A relationship between liver diseases and serum vitamin B12 levels was observed in previous reports. The purpose of this study was to determine if a similar relationship existed between vitamin B12 and nonalcoholic fatty liver disease (NAFLD), a common chronic liver disorder. Materials and Methods A total of 45 consecutive patients with NAFLD formed the NAFLD group, whereas 30 healthy controls (HC) formed the HC group. The subjects in all of the groups were of similar age and body mass index (BMI). A fatty liver is described in 3 ultrasonographic grades. Fasting blood samples were obtained, and serum vitamin B12 levels were measured. In addition, liver enzymes including aspartate aminotransferase, alanine aminotransferase (ALT), and alkaline phosphatase, and folic acid and other serum parameters were evaluated. The Mann-Whitney U test, χ2 test, and Spearman correlation analysis were used to compare the vitamin B12 levels and other serum parameters in both groups. Results The mean ± SD age and BMI of the NAFLD were 47.2 ± 11.2 and 28.8 ± 3.5. The mean ± SD age and BMI of the HC were 47.1 ± 8.8 and 27.7 ± 2.9, respectively. The serum aspartate aminotransferase and ALT levels of the patients with NAFLD were statistically higher compared with those of the controls (P = 0.001). The levels of vitamin B12 and folate were statistically lower in the NAFLD patients compared with those of the controls (P < 0.05). We found that there was a reduction of vitamin B12 levels, especially in grade 2 to grade 3 hepatosteatosis. In addition, in the Spearman correlation analysis between the vitamin B12 levels and ALT, the grade of fatty liver and the liver dimension were found to have an important negative correlation. Conclusion The serum vitamin B12 levels were significantly lower in the patients with NAFLD than in those of the control group; however, these still remain in the reference range. Consequently, low vitamin B12 levels may be associated with NAFLD especially in grade 2 to grade 3 hepatosteatosis.

The predictive value of CRP levels on future severe renal disease in overweight and obese subjects without diabetes mellitus and hypertension.

Background:Obesity and related disorders have a high prevalence all over the world. Increased C-reactive protein (CRP) value in obese individuals and its potential adverse effects have been reported. Here we have investigated the relationship between CRP levels and renal functions in nondiabetic, nonhypertensive, overweight, and obese individuals. The aim of this study was to evaluate the predictive value of CRP levels on future severe renal disease. Methods:One hundred sixty individuals were included in the study. They were grouped as normal weight, overweight, and obese. Anthropometric measurements, renal function tests, and serum hsCRP values were obtained. Mean values were compared and correlation analysis was performed. Results:Significant differences were detected between the groups according to body mass index, waist circumference (WC), and body fat percentage. There was a significant difference with respect to creatinine clearance (CC). Difference in the mean urinary albumin excretion (UAE) was significant between normal-weight and overweight subjects. There was a linear increase in serum CRP values in parallel to the increase in body weight; mean values were significant between groups. A positive correlation was detected between CC and body mass index and WC, and there were significant correlations between CRP and anthropometric measurements, CC and UAE. Conclusions:This study showed that increased CRP levels in nondiabetic, nonhypertensive, overweight, and obese individuals could possibly associated with impaired renal functions that might be originating from endothelial dysfunction. Determination of cutoff levels of CRP, as in cardiovascular diseases, may be useful for early estimation and prevention of renal diseases.

Does decreased mean platelet volume predict inflammation in chronic renal failure, dialysis, and transplanted patients?

Abstract Objectives: Increased platelet activation contributes to cardiovascular mortality in chronic kidney disease patients (CKD). Larger platelets are more active and this increased activity had been suggested as a predictive biomarker for cardiovascular disease. In this study, we aimed to evaluate mean platelet volume (MPV) as an inflammatory marker in a broadened group of CKD patients. Our study is unique in literature as it covers all types of CKD including renal replacement therapies. Materials and methods: 200 patients (50 renal transplanted, 50 hemodialysis, 50 peritoneal dialysis, 50 chronic renal failure stages 3–4) were investigated who were between 18 and 76 years of age. The collected data included demographic properties, platelet count, MPV, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and hemoglobin. All of the patients had at least 12 month of therapy of either renal replacement modality. Results: The mean CRP value was detected statistically significantly higher in hemodialysis (HD) patients compared to the resting three groups of patients (p < 0.01). Mean CRP level was detected significantly higher in the pre-dialysis group compared to transplanted and peritoneal dialysis (PD) patients (p < 0.01). There is no statistically significant difference detected among the mean MPV values of all patient groups (p > 0.05). Conclusions: ESR and CRP were significantly increased in hemodialysis patients compared to the other groups. We did not detect a significant difference among MPV between the groups. ESR was detected lowest in transplanted patients. Transplantation is coming forward as the favorable choice of renal replacement therapy which decreases inflammation.

Topical effects of nebivolol on wounds in diabetic rats

OBJECTIVE Recently, it has reported that nebivolol might be useful in the treatment of diabetes mellitus foot ulcers. The aim of this study was to examine treatment of the wounds in streptozotocin-induced diabetic rats with topical nebivolol. METHODS Two 15 × 15 mm-sized wounds were created in 56 streptozotocin-induced rats. A total of 56 diabetic wounds were studied in eight groups (n=7). No treatment was administered to the first and second groups. The third and fourth groups consisted of diabetic rats that were administered 1:1 mixture of lanolin and vaseline for 7 and 14 days, respectively. Five percent nebivolol plus 1:1 mixture of lanolin and vaseline was administered to rats in the fifth and sixth groups for 7 and 14 days, respectively, and 10% nebivolol plus 1:1 mixture of lanolin and vaseline was administered to rats in the seventh and eighth groups for 7 and 14 days, respectively. On days 7 and 14, wound healing was observed, and the percent of wound healing was determined by measuring its size and histopathologic examination. The ratio was calculated by the formula, healing ratio (%)=100 ×(1-wound area/initial wound area). Statistical analysis was performed by ANOVA with Tukeys HSD test and Mann-Whitney U test, using SPSS 15.0 software. RESULTS On days 7 and 14, rates of wound healing in the fifth, sixth, seventh, and eighth groups were 57.42%, 89.16%, 60.80%, and 91.80%, respectively. Multiple comparison showed that rates of wound healing were significantly higher in rats administered 5% and 10% nebivolol than those in rats administered a mixture of lanolin and vaseline and in the untreated group (P<0.05). CONCLUSION Topical nebivolol therapy may be useful for wound healing in diabetic rats. Further studies are needed to support these data.

Evaluation of platelet activation, coagulation, and fibrinolytic activation in patients with symptomatic lacunar stroke.

Background:It is unclear whether hemostasis plays a role in the pathogenesis of ischemic stroke subtypes. Objective:We aimed to investigate the possible relationship between different hemostatic markers and lacunar stroke. Results:The study consisted of 30 patients with symptomatic lacunar stroke and 30 healthy age-matched healthy individuals. We analyzed the values of “Mean Platelet Volume,” d-dimer, “soluble p-selectin,” “Plasminogen Activator Inhibitor Type-1” (PAI-1), “Thrombin-Activatable Fibrinolysis Inhibitor” (TAFI), and “Platelet Factor 4” (PF4) in patients with lacunar infarct and compared these values to those of control individuals. There were significant differences for d-dimer, mean platelet volume, thrombin-activatable fibrinolysis inhibitor, and platelet factor 4 values in symptomatic lacunar stroke group compared with the control group (P < 0.01). Conclusions:Different hemostatic factors may play a role in the pathogenesis of lacunar stroke. Evaluating the role of hemostatic factors on different types of strokes may help us identify new therapeutic strategies and different prognostic stratifications for ischemic stroke.