Huriye Balci

Atherosclerosis in Behçet's Syndrome

OBJECTIVES We had the impression and preliminary evidence that atherosclerosis was not much increased in Behçets syndrome (BS). Thus, we evaluated the presence of subclinical atherosclerosis in a sizeable group of patients with BS both with major organ involvement and mucocutaneous disease along with diseased and healthy controls. METHODS We studied 239 (162 M/ 77 F; mean age: 40.7+/-7.0) patients with BS. Seventy-two (32 M/ 40 F) had only mucocutaneous and/or joint disease and 167 (130 M/ 37 F) had major organ involvement. Also 100 (24 M/ 76 F; mean age: 44.7+/-7.1) patients with rheumatoid arthritis (RA), 74 (58 M/ 16 F; mean age: 39.4+/-7.0) patients with ankylosing spondylitis (AS) and 156 (83 M/ 73 F; mean age: 39.2+/-6.6) healthy controls (HC) were studied as the control groups. We used B-mode USG to assess the frequency of plaques and intima-media thickness (IMT) in the carotid and femoral arteries. Traditional atherosclerotic risk factors were also evaluated. Men and women were analyzed separately. RESULTS The frequency of plaques and the mean IMT in the carotid and femoral arteries were similar between patients with BS, AS and HC and also between the 2 subgroups of BS, among both men and women. Only men with RA were found to have significantly increased frequency of carotid artery plaques after adjustment for atherosclerotic risk factors. CONCLUSION Increased atherosclerosis is not a prominent feature of BS, even among those patients with major organ involvement.

Serum N-Terminal pro-BNP Levels Correlate with Symptoms and Echocardiographic Findings in Patients with Mitral Stenosis

This study is designed to evaluate the N‐terminal pro‐BNP (NTproBNP) levels in patients with mitral stenosis (MS) and its possible correlation with clinical and echocardiographic parameters of the disease. The study group consisted of 29 patients with isolated MS (patients with greater mild regurgitation were excluded) and 20 normal control subjects of similar age and gender distribution. Blood samples for NTproBNP were collected at the time of clinical and echocardiographic examination. NTproBNP levels were elevated in patients with MS compared to controls (325 ± 249 pg/dL [19.9–890] versus 43 ± 36 pg/dL [5.76–193.3], P < 0.001). Patients with atrial fibrillation had significantly higher NTproBNP levels compared to those with sinus rhythm (561 ± 281 pg/dL versus 254 ± 194 pg/dL, P = 0.044). MS patients with sinus rhythm also had higher NTproBNP levels compared to controls (254 ± 194 pg/dL versus 43 ± 36 pg/dL, P = 0.00011). NT pro BNP levels correlated to the LA (R = 0.73, P < 0.0001) and RV (R = 0.41, P = 0.042) diameters, mitral valve area (R =−0.45, P = 0.025), mean mitral gradient (R = 0.57, P = 0.003), peak PAP (R = 0.7, P = 0.03), and NYHA functional class (R = 0.61, P = 0.007). In conclusion, serum NTproBNP levels correlate well with echocardiographic findings and functional class in patients with MS and can be used as a marker of disease severity. Additionally, it may have a potential use as an additional noninvasive and relatively cheap method in monitoring disease progression especially in patients with poor echocardiographic windows.

Intima–media thickening in patients with familial Mediterranean fever

OBJECTIVE The aim of this study was to assess the frequency of atherosclerotic plaques and intima-media thickness (IMT) in patients with FMF and suitable controls. METHODS We studied 100 (46 males, 54 females; mean age: 40 +/- 6 years) patients with FMF. Also 94 (15 males, 79 females; mean age: 41 +/- 7 years) patients with SLE and 103 (44 males, 59 females; mean age: 40 +/- 5 years) apparently healthy volunteers were included as the control groups. Subclinical atherosclerosis was assessed by investigating atherosclerotic plaques and measuring IMT from carotid and common femoral arteries using B-mode ultrasonography (USG). Traditional atherosclerotic risk factors were also assessed. RESULTS Both FMF and SLE patients had significantly higher carotid (C-IMT) and femoral artery IMT (F-IMT) compared with healthy controls. This was also true after adjustment for atherosclerotic risk factors. Only patients with SLE were found to have higher frequency of atherosclerotic plaques in the carotid and in the carotid and/or femoral artery. When all atherosclerotic risk factors were adjusted, again only patients with SLE were found to have risk for atherosclerotic plaques. In FMF, whereas the presence of atherosclerotic plaques was only associated significantly with diabetes mellitus; C-IMT was correlated with age, BMI and fasting glucose; and F-IMT with age and BMI. CONCLUSIONS Increased atherosclerosis defined as the presence of plaques was not observed in patients with FMF. The significance of increased C- and F-IMT among patients with FMF must be further assessed.

Assessment of low-density lipoprotein oxidation, paraoxonase activity, and arterial distensibility in epileptic children who were treated with anti-epileptic drugs

OBJECTIVE Studies show that anti-epileptic drugs increase oxidative stress. Thus, low-density lipoprotein oxidation increases and atherogenesis is induced. Paraoxonase-associated high-density lipoprotein protects low-density lipoprotein and high-density lipoprotein oxidation. The effects of anti-epileptic drugs on paraoxonase activity has not been investigated yet. The aim of this study is to investigate the effect of anti-epileptic drugs on paraoxonase activity, lipid profiles, folat, vitamin B12, homocysteine, thyroid hormones, apolipoprotein A-1, total anti-oxidant capacity, malondialdehyd, nitric oxide, and oxidised low-density lipoprotein. The association with carotid-femoral pulse wave velocity and current biochemical parameters had been searched for assessing the effects of anti-epileptic drugs on the vascular system. PATIENTS AND METHODS We recruited 59 epileptic patients treated with anti-epileptic drugs and 23 controls (group IV) at least 6 months ago. The epileptic group was divided into three groups by receiving anti-epileptic drugs as follows: group I: carbamazepine, group II: valproic acid, and group III: carbamazepine and valproic acid. Arterial distensibility was assessed with the Complior device. RESULTS There was no difference between the current biochemical parameters in epileptic children. Serum-free T4 was decreased, when compared with group IV. Thyroid-stimulating hormone was increased in group II, compared with group IV. The carotid-femoral pulse wave velocity was increased in group III, compared with group IV. The carotid-femoral pulse wave velocity was correlated with thyroid-stimulating hormone and valproic acid levels. CONCLUSIONS Anti-epileptic drugs may induce atherogenesis by affecting the thyroid hormones. According to the current data, the effects of thyroid hormones on vascular system may be independent of other biochemical markers. Epileptic patients using anti-epileptic drugs must be followed closely for arterial stiffness, and also for the development and progression of atherosclerosis.

Serum Lipid Hydroperoxide Levels and Paraoxonase Activity in Patients With Lung, Breast, and Colorectal Cancer

The objectives of this article are to investigate the serum lipid hydroperoxide (LOOH) levels and paraoxonase‐1 (PON1) and arylesterase (ARE) activity in patients with lung, breast, and colorectal cancer.

Ezetimibe therapy and its influence on oxidative stress and fibrinolytic activity.

Objective: The effect of ezetimibe on blood lipids, oxidative stress, and fibrinolytic activity in hyperlipidemic patients was investigated after three months of therapy. Methods: Thirty hyperlipidemic patients were treated for twelve weeks with ezetimibe 10 mg/day. A healthy control group with matching age and gender was also included. Fasting blood glucose, lipid parameters, paraoxonase (PON1), protein carbonyl (PCO), oxidized LDL (oxLDL), 8-isoprostane (ISOPR), total antioxidant capacity (TAC) levels, tissue-type plasminogen activator (tPA), plasminogen activator inhibitor type-1 (PAI-1), and PAI-1/t-PA levels were evaluated. Results: Ezetimibe therapy for twelve weeks led to changes in lipid profile in accordance with the literature. Fibrinolytic activity parameters, PAI-1/tPA and tPA-1 decreased, whereas PAI-1 levels did not change significantly. Antioxidant parameters, serum PON1 activity, and TAC levels increased significantly compared with the basal values. Oxidant parameters, oxLDL, ISOPR, and PCO (which is an indicator of oxidative protein damage) decreased significantly after therapy. Conclusions: Ezetimibe therapy has beneficial effects on fibrinolytic activity and homeostasis between oxidant and antioxidant activity in hyperlipidemic patients This may be through lowering lipid levels or other mechanisms such as decreasing insulin resistance and the pleiotropic effects of the drug.

Serum paraoxonase activity and oxidative DNA damage in patients with laryngeal squamous cell carcinoma.

Objectives: To determine the possible role of oxidants and antioxidants in the pathogenesis of in laryngeal squamous cell carcinoma. Design and Setting: Our study involved patients with newly diagnosed laryngeal cancer (n = 29) and same age- and sex-matched healthy individuals (n = 21). Serum malondialdehyde (MDA) and paraoxonase (PON1) levels were measured by colorimetric methods and 8-hydroxy-2&vprime;-deoxyguanosine (8-OH-dG) was measured using enzyme-linked immunosorbent assay in fasting blood samples of participants. Results: The levels of 8-OH-dG (control, 4.61 ± 1.27 ng/mL; patient, 11.70 ± 2.44 ng/mL; P < 0.001) and MDA (control, 4.16 ± 1.02 nmol/mL; patient, 8.74 ± 1.65 nmol/mL; P < 0.001) were significantly higher, and those of PON1 (control, 170.86 ± 72.46 U/mL; patient, 80.44 ± 29.81 U/mL; P < 0.001) were significantly lower in patients. There were no statistically significant differences in the 8-OH-dG, MDA levels, and PON1 activity in relation to T (tumor) staging of differentiation and different smoking/drinking status. There was a statistically significant difference in MDA levels (10.24 ± 0.64 nmol/mL) only in stage II laryngeal cancer. There were a statistically significant positive correlation between serum MDA and 8-OH-dG (r = 0.887, P < 0.001), a statistically significant negative correlation between serum MDA and serum PON1 (r = −0.477, P < 0.01), and a statistically significant negative correlation between serum 8-OH-dG and serum PON1 in patients (r = −0.420, P < 0.05). Conclusions: We conclude that, in patients with laryngeal squamous cell carcinoma, the oxidant/antioxidant balance was impaired in favor of lipid peroxidation and DNA damage.

Effects of Hyaluronic Acid–Carboxymethylcellulose Antiadhesion Barrier on Ischemic Colonic Anastomosis

AbstractPURPOSE: Intraperitoneal adhesions may help the healing of marginally viable bowel ends. If adhesion formation is prevented by various methods, the integrity of ischemic bowel anastomosis may be compromised. Thus, we decided to study the effects of hyaluronic acid–carboxymethylcellulose, an antiadhesion barrier, on ischemic bowel anastomosis. METHODS: Thirty Wistar-Albino rats were divided into three groups. In Group A (control), a well-perfused distal colonic segment was transected, and free ends were anastomosed. In Group B, an ischemic colonic segment was prepared, then divided and anastomosed. In Group C, after completion of ischemic colonic anastomosis, hyaluronic acid–carboxymethylcellulose film was wrapped around the anastomosis. In all groups, rats were killed on the seventh day. Intraperitoneal adhesions were graded by adhesion score, and healing of the anastomosis was assessed by measurement of bursting pressure and hydroxyproline levels in the anastomotic tissue. RESULTS: A statistically significant difference was found between hydroxyproline levels of the control group and the ischemic group (P = 0.02). HP level was also significantly higher in the hyaluronic acid–carboxymethylcellulose group than in the ischemic group (P = 0.01). There was no difference in hydroxyproline levels between the control and hyaluronic acid–carboxymethylcellulose groups. Compared with the control group, bursting pressure was lower in the ischemic group (P = 0.02). Hyaluronic acid–carboxymethylcellulose wrapping increased the bursting pressure significantly (P < 0.001). However, there was no difference in bursting pressure between the control group and the hyaluronic acid–carboxymethylcellulose group (P = 0.13). A marked increase in the adhesion score was observed in the ischemic group (P = 0.01). The difference between adhesion scores of the hyaluronic acid–carboxymethylcellulose and ischemic groups was not found to be significant, although the adhesion score in the hyaluronic acid–carboxymethylcellulose group was lower (P = 0.16). There was no difference in adhesion score between the control and hyaluronic acid–carboxymethylcellulose groups. CONCLUSIONS: Application of hyaluronic acid–carboxymethylcellulose in ischemic colonic anastomosis did not compromise anastomotic integrity. The adverse effect of ischemia on healing of colonic anastomosis was counteracted by hyaluronic acid–carboxymethylcellulose.

The relationships of leptin, adiponectin levels and paraoxonase activity with metabolic and cardiovascular risk factors in females treated with psychiatric drugs.

OBJECTIVES The aim of this study was to investigate serum leptin, adiponectin and paraoxonase1 levels in adult females receiving pharmacotherapy for various psychiatric disorders. METHODS The study group consisted of 32 obese females (mean age 40.53 ± 11.00 years, mean body mass index 35.44 ± 5.33 kg/m2) who were receiving treatment for psychiatric disorders, and the control group included 22 obese females (mean age 35.95 ± 9.16 years, mean body mass index 30.78 ± 3.33 kg/m2) who were free of psychiatric disorders. Analyses were performed using a bioelectrical impedance device. Fasting blood samples were obtained for complete blood count and various biochemical tests, including determination of leptin, adiponectin and paraoxonase1 activity. RESULTS Body mass index, waist and hip circumference, body fat percentage, fasting blood glucose, insulin, glycosylated hemoglobin, homeostasis model assesment of insulin resistance, alanine transaminase, aspartate tarnsaminase, and leptin levels were significantly higher in the study group than in controls. Although body weight was positively correlated with leptin levels in both groups, body weight was negatively correlated with adiponectin levels in the control group and positively correlated with adiponectin levels in the study group. In the study group, body mass index and hip circumference correlated positively with leptin levels, hip circumference correlated positively with adiponectin levels, and waist to hip ratio correlated positively with paraoxonase levels. In the control group, body mass index as well as waist and hip circumferences were positively correlated with leptin levels. Weight, body mass index, and hip circumference were also negatively correlated with the adiponectin/leptin ratio in the control group. CONCLUSION This study indicates a higher risk for obesity-related disorders, particularly metabolic syndrome, diabetes and cardiovascular disease, in patients treated with psychiatric drugs.

Hereditary Thrombophilia, Anti‐Beta2 Glycoprotein 1 IgM, and Anti‐Annexin V Antibodies in Recurrent Pregnancy Loss

Citation Karata S, Aydin Y, Ocer F, Buyru A, Balci H. Hereditary Thrombophilia, anti‐beta2 glycoprotein 1 IgM, and anti‐annexin V antibodies in recurrent pregnancy loss. Am J Reprod Immunol 2012; 67: 251–255