Fahri Güneş

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.

Evaluation of epicardial fat tissue thickness in patients with Hashimoto thyroiditis.

Hypothyroidism, whether overt or subclinical, has multiple effects on the cardiovascular system. Epicardial fat tissue (EFT) is closely related to cardiovascular disorders and atherosclerosis. Our study aimed to assess EFT thickness and carotid artery intima‐media thickness (CIMT) in patients with Hashimotos thyroiditis (HT) displaying overt and subclinical hypothyroidism (SCH).

Liver Fatty Acid-binding Protein Is A Diagnostic Marker to Detect Liver Injury Due to Chronic Hepatitis C Infection

BACKGROUND AND AIMS Liver fatty acid-binding protein (L-FABP) is a small molecule. The aim of this study was to examine L-FABP levels and to detect its diagnostic value in chronic hepatitis C (CHC). METHODS We studied 22 patients with CHC and 20 healthy control subjects. Patients with persistently elevated serum aminotransferases and positive HCV RNA were included in the study. Patients with CHC underwent percutaneous liver biopsy. Serum level of L-FABP was determined by ELISA method. RESULTS Patients with CHC had significantly increased levels of L-FABP compared to controls. A strong correlation between serum L-FABP concentrations and aspartate aminotransferases, alanine aminotransferases, HCV RNA levels and hepatic inflammation was found. When a cut-off value was 29,000 pg/mL for L-FABP, sensitivity and specificity were 75 and 100%, respectively. Positive and negative predictive values for L-FABP were 100 and 78%, respectively. CONCLUSIONS Serum L-FABP is used as a new diagnostic marker to detect liver injury.

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.

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.

Relationship between red cell distribution width and long-term mortality in patients with non-ST elevation acute coronary syndrome.

Objective: Red cell distribution width (RDW) has been reported to be a predictor of cardiac events in coronary artery disease (CAD). Here, we hypothesized that RDW level on admission would be predictive of adverse outcomes in non-ST elevation acute coronary syndrome (NST-ACS). Methods: In total, 202 patients with NST-ACS (159 males and 43 females) were retrospectively analyzed. The patients were divided into two groups based on the 50th percentile of admission RDW levels. A high RDW group (n=100) was defined as those patients having RDW levels of >14.0. The relationship between RDW and primary endpoint (cardiovascular death), secondary endpoints [(reinfarction, repeat target vessel revascularization-percutaneous/surgical)], and major adverse cardiac events (MACE) were assessed. The median follow-up time was 18 (13-24) months. Results: The patients in the high RDW group were older (62.9 vs. 57.5, p=0.001). Multivessel disease, low-density lipoprotein, creatinine, platelet, CK-MB, troponin I, and RDW were higher (p=0.047, p=0.003, p=0.012, p=0.012, p=0.017, p<0.001, respectively), and gender (male/female), ejection fraction, and hemoglobin levels were lower (p=0.021, p=0.04, p=0.016, respectively) in the high RDW group. Cardiovascular death and MACE were higher in the high RDW group (16% vs. 4.9%, p=0.01, 52% vs. 31.4%, p=0.003, respectively). By multiple regression analysis in 202 patients, age >65 and RDW >14.0% on admission were found to be powerful independent predictors of cardiovascular mortality (OR: 4.5, 95% CI: 1.5-13.1, p=0.005, OR: 3.0, 95% CI: 1.0-8.9, p=0.039, respectively). Conclusion: A high RDW level on admission is associated with increased long-term mortality in patients with NST-ACS.

Angioedema – an unusual serious side effect of risperidone injection

Risperidone is an antipsychotic drug which is predominantly used in the treatment of schizophrenia and schizoaffective disorder. Risperidone has several side effects. The most common side effects are non-serious including drowsiness, increased appetite, fatigue, insomnia, agitation and anxiety. 1 Another important side effect of risperidone is angioedema which rarely occurs. In the previous publications, it was stated that angioedema developed only in three cases. 2 In these cases, angioedema was observed after oral administration of risperidone. 2 We present a case who developed angioedema after parenteral risperidone administration. A 55-year-old woman was admitted to our department with the complaint of periorbital oedema, swelling over the face, dyspnoea and dysphagia. A year ago she was diagnosed with paranoid schizophrenia and was given venlefaxin HCL 75 mg/ day, biperidene HCL 1 mg/day and risperidone 1 mg/day. After a month, she discontinued her medications. A month later, she developed agitation and her hallucinative symptoms. She was taken to a hospital by her family. As the patient refused oral medication, risperidone 25 mg was administered via intramuscular injection. After three days, she developed periorbital oedema and swelling over the face, and had life-threatening diffi culty in breathing and swallowing. Her history revealed no allergic reaction, food allergies or asthma. The physical examination showed no remarkable fi ndings other than periorbital and perioral oedema. The biochemical and haematological screening test (haemogram, renal function tests, liver function tests, electrolytes, ELISA, thyroid function tests and ANA) results were within the normal range. No drugs other than risperidone were administered during that time period. We also observed that Naranjo scale value was 7. This score probably indicated the adverse drug reaction. Risperidone body fl uid concentrations were not measured. Placebo and re-challenge with risperidone were not done. We thought that angioedema was probably caused by risperidone intramuscular injection. Therefore, risperidone was stopped and haloperidol was started. At the same time, feniramin maleat 45.5 mg and methylprednisolone 40 mg were administered via intravenous injection. Dyspnoea and swallowing problem were immediately resolved. Periorbital and perioral oedema disappeared in two weeks. To date, only three cases have been reported in the literature that developed periorbital oedema due to oral risperidone administration. In 1995, Cooney et al. reported the fi rst case of angioedema associated with risperidone. The case was a 30year-old female who developed angioedema in the second week of the treatment with 6 mg of oral risperidone administration. After the dose of risperidone was decreased to 3 mg/day, her symptoms completely resolved. However, when the dose of oral risperidone was again increased to 6 mg/day, angioedema recurred in 3 days. 3 The second case was a 15-year-old boy diagnosed with schizophrenia. He was started on treatment with oral risperidone 1 mg/day and clonazepam 0.5 mg/day. Then, the dose of risperidone was increased to 2 mg/day and that of clonazepam was stopped, and within a week of increasing risperidone, he developed angioedema. 2 The third case who was a 63-year-old female was reported by Kores Plesnicar et al. They stated that the patient developed angioedema on three occasions when exposed to oral risperidone and that the angioedema subsided each time with the discontinuation of risperidone. 4 The previous publications demonstrated that in the fi rst case, only periorbital oedema was associated with intramuscular risperidone. She developed periorbital oedema about two weeks after the intramuscular risperidone injection (37.5 mg). However, angioedema has not been reported on parenteral risperidone application. 5 The mechanism of angioedema has not been clearly defi ned. C1 esterase defi ciency and decreasing complement levels are blamed for angioedema. 2 – 3 The underlying mechanism of the angioedema can be a non-allergic drug reaction caused by delayed (type 4) hypersensitivity. It is commonly seen 48 – 72 h after the fi rst administration of the medication. The route of administration and dose of risperidone can be important factors in developing angioedema. The previous studies reported that angioedema developed after intramuscular and oral applications of risperidone. In all the previous cases, angioedema was reported to develop when the dose of risperidone was increased. As for our case, the patient did not develop angioedema after an oral administration of risperidone, but severe angioedema developed after a high dose of intramuscular risperidone administration. Therefore, high-dose administrations of risperidone seem to be the most important factor in the present case. In conclusion, angioedema is an extremely rare but serious side effect. The patients who need high doses of risperidone and intramuscular risperidone should be carefully monitored in terms of the risk of angioedema. Patients who are to be administered high doses of intramuscular risperidone should be warned about periorbital oedema, swelling over the face, dyspnoea and dysphagia, which could be seen in the first 48 – 72 h after treatment.

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.

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.

Aromatase inhibitor treatment for breast cancer: short-term effect on bone health

Aim of this study Aim of this study was to examine the effects of aromatase inhibitors (AIs), which are used in every phase of breast cancer treatment, on the bone mineral density (BMD) of patients with early-stage breast cancer. Material and methods Menopausal female patients who were diagnosed with stages 1–3 breast cancer and who were planned for anastrazole or letrozole as adjuvant therapy were examined. After the patients’ BMD was measured, 45 patients without osteoporosis were included in the study. Six months after AI therapy started, the patients’ BMD was measured again. Results In this study, we tried to show that there was a statistical difference in the BMD of 45 patients before and 6 months after treatment. Among all measurements (femur and lumbar T-scores), the femur Z-score (p = 0.52) was the only score that was not statistically significant. Statistical significance (p < 0.01) was detected in comparative analysis of the other measurements. According to this analysis, a significant loss of BMD was seen even in the first six months after AI treatment was introduced. Conclusions Female patients with breast cancer are at higher risk for bone loss and fractures than healthy women. In this study, we showed the negative effects on BMD of aromatase inhibitor therapy, one of the main contributions to osteoporosis in women with breast cancer. This study is the first to quantify the short-term effect of AI treatment on BMD in postmenopausal women with breast cancer.