Hacer Şen

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.

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.

Eosinophilic Colitis: A Rare Cause of Lower Gastrointestinal Bleeding in an Elderly Adult

hyponatremia are common sequelae. Although the prevalence of hypopituitarism in old age is unknown, physicians should consider its possibility when examining for failure to thrive and frailty syndromes. The most commonly assumed explanation for wrinkled skin, lethargy, and incontinence infrequently leads to diagnosis, and pituitary tumors are surprisingly common findings at autopsy. Tumor resection, thyroid replacement, and corticosteroid therapy generally yield good results in elderly adults. Medical therapy is often sufficient in improving symptoms and function. Because cardiovascular mortality is higher in individuals with untreated hypopituitarism than in the rest of the population, treatment may lengthen life. Individuals with physical limitations such as flexion contractures have shown complete reversal. The restoration of quality of life is a meaningful goal making examination for hypopituitarism equally worthwhile.

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.

Evaluation of liver perfusion in diabetic patients using 99mTc-sestamibi

SummaryObjectiveThe liver is an important organ for various aspects of glucose metabolism, including glucose uptake, storage, and synthesis. It is a major organ in the metabolic process with perfusion provided by both the portal vein and hepatic artery. In diabetic patients organ perfusion is reduced and this is linked to atherosclerosis, and as a result complications occur. In this study, we aimed to evaluate liver perfusion by scintigraphic methods in diabetic patients.Design and patientsWe retrospectively investigated 1,100 myocardial perfusion scintigraphies taken between January 2011 and December 2012 at Canakkale Onsekiz Mart University Medical Faculty Nuclear Medicine Department. A total of 66 patients who were diagnosed with diabetes mellitus and had myocardial perfusion scintigraphies were included in the study. The control subjects included 127 patients without diabetes mellitus who were chosen at random. Patients with chronic liver disease were not included in the study. The values from liver regions of interest (liver-ROI) rates and heart regions of interest (heart-ROI) rates were compared between the patients and controls.ResultsPatients were grouped according to the presence of diabetes. In the diabetes mellitus group, the liver-ROI average was lower (p = 0.66) than in the controls. In the control group, the average liver-ROI/heart-ROI ratios were higher than the ratio in the diabetes mellitus group (p = 0.019). Multivariate variance analysis showed that the diabetes mellitus liver-ROI/heart-ROI ratio was independent of other risk factors (p = 0.003; F: 9.6). Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation.ConclusionsThis study shows that liver perfusion in diabetic patients is reduced compared with those without diabetes. Prospective studies with larger patient groups are required.ZusammenfassungZielDie Leber ist aus verschiedenen Gründen (Glukose-Aufnahme, -Speicherung, -Synthese) für den Glu-kosestoffwechsel wichtig. Sie ist ein wesentliches Organ des Stoffwechselprozesses, wobei die Perfusion sowohl durch die Vena portae, als auch durch die Arteria hepatica erfolgt. Bei Diabetikern ist ihre Perfusion als Folge der Atherosklerose vermindert. Dadurch können Komplikationen auftreten. In der vorliegenden Studie war es unser Ziel, bei Diabetikern die Perfusion der Leber mit szintigraphischen Methoden zu erheben.Design der Studie und PatientenWir untersuchten retrospektiv 1100 Myokard-Perfusions-Szintigraphien, die zwischen Januar 2011 und Dezember 2012 an der Abteilung für Nuklearmedizin der Canakkale Onsekiz Mart Universität, Fakultät für Medizin, durchgeführt worden waren. In die Studie wurden 66 Patienten mit der Diagnose Diabetes mellitus, bei denen eine Myokardszintigraphie durchgeführt worden war, aufgenommen. Die Kontrollpersonen bestanden aus 127 zufällig ausgewählten Patienten ohne Diabetes mellitus. Patienten mit chronischer Lebererkrankung wurden in die Studie nicht aufgenommen. Die Werte der bei den Patienten erhobenen Leberregionen von Interesse (Leber – „Regions of Interest“ – ROI), sowie der Herz ROI wurden mit den bei den Kontrollpersonen erhobenen Werten verglichen.ErgebnisseDie Patienten wurden entsprechend dem Vorliegen von Diabetes gruppiert. In der Gruppe mit Diabetes mellitus war die Leber ROI niedriger (p = 0,66) als bei den Kontrollen. Bei der Kontrollgruppe waren die Mittelwerte der Leber ROI/Herz ROI Quotienten höher als bei der Diabetes mellitus Gruppe (p = 0,019). Die Multivarianzanalyse ergab, dass bei den Diabetikern die Leber ROI/Herz ROI Quotienten unabhängig von anderen Risikofaktoren waren (p = 0,003; F: 9,6).SchlussfolgerungenDiese Studie zeigt, dass die Leberperfusion bei Patienten mit Diabetes mellitus im Vergleich zur Leberperfusion bei Patienten ohne Diabetes mellitus vermindert ist. Prospektive Studien mit größeren Patientengruppen sind allerdings zur Bestätigung nötig.

Primer Hiperparatiroidi Nedeniyle Opere Edilen Vakalarda Eşlik Eden Tiroid Patolojilerinin Değerlendirilmesi

Purpose: In this study we aimed to evaluate thyroid pathologies in patients with primaryhyperparathyroidism who underwent surgery for parathyroidectomy.Methods: Patients who underwent parathyroidectomy for primary hyperparathyroidism betweenthe years of 2006-2012 were included in this retrospective study. Before and after surgery,hormonal and biochemical examinations of the patients and results of preoperative imagingstudies were recorded.Results: Of the patients included in the study, 86 were female and 12 were male. Preoperativemean serum calcium level was 12.25 ± 1.48 mg/dL (normal range 8.5-10.1 mg/dL), meanparathyroid hormone (PTH) level was 425.09 ± 440.47 pg/mL (normal range 11-65 pg/mL).The thyroid ultrasound records of 93 patients were available. Of these patients, 26 (28%) hadnormal ultrasound, 18 (19.4%) had solitary nodule, 43 (46.2%) had multinodular goiter and 4(4.3%) had thyroiditis (without nodule) and 2 (% 2.2) had solitary nodule with thyroiditis.Adenoma was detected by ultrasonography in 45.2 % of patients, and by scintigraphy in 72.7of patients. Parathyroidectomy and thyroidectomy were performed at the same time in 54 of 98patients (65.1%). Of these patients Seven (7.1%) had papillary thyroid cancer, 30 (30.6%) hadbenign multinodular goiter, 8 patients (8.2%) had benign solitary nodule, 2 patients (2%) hadlymphocytic thyroiditis, and 7 (7.1%) had normal thyroid tissue.Conclusion: Thyroid diseases are frequently encountered with primary hyperparathyroidism.Therefore, before performing parathyroidectomy with minimally invasive procedure, patientsmust be evaluated for thyroid disorders