İlter Helvacı

Unexpectedly low prevalence and unusual characteristics of RLS in Mersin, Turkey

Objective: To determine the prevalence, risk factors, and clinical presentation of restless legs syndrome (RLS) in a Turkish population. Methods: A face-to-face, population-based epidemiologic survey was conducted. Multistep, stratified, cluster, and systematic samplings were used. A total of 3,234 adults were interviewed. Results: Of the 3,234 participants, 103 (3.19%) experienced RLS. This prevalence rate is lower than those of other epidemiologic studies conducted among European and North American populations. RLS was found to be more common among women, cigarette smokers, and individuals residing in high altitudes. The self-reported mental and general health status of patients was worse than in the control subjects. The prevalence of RLS did not differ by age or body mass index. Conclusion: The discrepancy in RLS prevalence studies (including the authors’) suggests that prevalence varies among different races, thus supporting a genetic predisposition.

The Influence of HER2 Genotypes as Molecular Markers on Breast Cancer Outcome

Alterations of the human epidermal growth factor receptor 2 (HER2) protooncogene have been implicated in the carcinogenesis and prognosis of breast cancer. A polymorphism has been identified at codon 655 (ATC/isoleucine to GTC/valine [I655V]) in the transmembrane domain-coding region of this gene, which may be associated with the risk of breast cancer. In this study we aimed to determine whether the risk of breast cancer is associated with the I655V polymorphism of HER2 transmembrane domain-coding region at codon 655. The genomic DNA from breast cancer patients and control subjects underwent analysis by the polymerase chain reaction-fragment length polymorphism. We observed no overall association between HER2 genotype and breast cancer (p = 0.53). However, an elevated positive association was observed for Ile/Val+Val/Val versus Ile/Ile genotypes in women >age 60 years (p = 0.02). Further, other risk factors--namely, the body mass index and family history--were found to be risk factors for developing breast cancer (p = 0.006 and p = 0.00, respectively). In conclusion, results of this study suggest that polymorphisms of the HER2 gene may be important susceptibility biomarkers for breast cancer risk among older women.

Mean Platelet Volume and Related Factors in Patients at Different Stages of Diabetic Nephropathy A Preliminary Study

Introduction: Mean platelet volume (MPV) is an independent cardiovascular disease predictor, and characteristics of MPV in patients with diabetic nephropathy (DN) are not well known. Aim: To determine the MPV levels in patients at different stages of DN. Patients and Methods: The MPV levels were investigated in healthy participants (group 1, n = 157), patients with type 2 diabetes mellitus without complication (group 2, n = 160), diabetic patients with clinical proteinuria (group 3, n = 144), and in patients with chronic kidney disease due to DN (group 4, n = 160). Findings: The MPV level was higher in all diabetic patients than that in normal participants (P < .05). The MPV values had a positive correlation with the serum creatinine and proteinuria, and a negative correlation with the glomerular filtration rate ([GFR] P < .001 for all, r values; .72, and .82, and −.92, respectively). Conclusion: The MPV values were higher in diabetic groups than that in normal participants. Both GFR and proteinuria were the most powerful determinants of MPV.

Serum levels of cancer biomarkers in diabetic and non-diabetic proteinuric patients: a preliminary study

Abstract Background: Cancer biomarkers (CBs) can be used in early detection of several cancers as well as in detection of recurrence and following response to treatment. We aimed to investigate the levels of CBs in proteinuric patients with primary glomerular disease (PGD) and diabetes mellitus, and compare them with healthy controls. Methods: One hundred and two patients with untreated PGD, 62 proteinuric patients with diabetic nephropathy, and 84 healthy controls were enrolled. Levels of cancer antigen 125 (CA 125), cancer antigen 15–3 (CA 15–3), carcinoembriogenic antigen (CEA), α-fetoprotein (AFP), total prostate specific antigen (TPSA), free prostate specific antigen (FPSA) and carbohydrate antigen 19–9 (CA 19–9) were measured. Results: Compared to healthy controls, levels of CA 125, CA 15–3 and CA 19–9 were higher in patients with PGD and diabetic patients (all p<0.05), while levels of TPSA, FPSA, AFP and CEA were lower (all p<0.05). There was no correlation between levels of cancer biomarkers and serum fibrinogen and serum amyloid A protein levels (all p>0.05). Both urinary protein excretion rate and serum albumin levels were correlated with all CBs (all p<0.05). Conclusions: CBs levels seem to be changed in different proteinuric patients. This condition should be kept in mind when evaluating CBs levels in proteinuric patients.

The effects of pentoxifylline on lung inflammation in a rat model of meconium aspiration syndrome

ABSTRACT To examine the effects of pentoxifylline (PTX) on regional pulmonary and systemic inflammation after meconium aspiration, we studied 26 anesthetized and ventilated adult rats for 3 hours. Seventeen rats were instilled with human meconium (1.5 mL/kg, 65 mg/mL) intratracheally. After instillation of meconium, PTX (20 mg/kg, i.a.; n = 9) or saline (n = 8) was given to the subjects. Nine rats that were ventilated and not instilled with meconium served as sham group. Meconium instillation resulted in increased bronchoalveolar lavage (BAL) fluid tumor necrosis factor-α (TNF-α; P = 0.004 and P = 0.002, respectively), protein (P = 0.005 and P = 0.001, respectively) levels, and arterial oxygenation index (OI) in PTX and saline groups. PTX treatment prevented the increase of BAL fluid TNF-α, protein concentrations, and OI in the meconium-instilled lungs but had no statistically significant effect. These results indicate that meconium aspiration induces severe inflammation in the lung. PTX treatment affects the TNF-α production in the lungs and it may attenuate meconium-induced derangements.

Community-acquired hyperkalemia in elderly patients: risk factors and clinical outcomes

Abstract Background: Although the risk and related factors of hyperkalemia developed in the hospital are known in elderly, risk and related factors of community-acquired hyperkalemia (CAH) in this population are not well known. This study was performed to investigate the risk of CAH in elderly and evaluate the related factors and clinical outcomes. Study design, setting and participants, intervention: Patients (aged ≥65 years) with hyperkalemia were screened. Group 1 (young-old); 65–74 years/old, Group 2 (middle-old); 75–84 years/old, Group 3 (oldest-old); ≥85 years/old, and Group 4 (control group); ≥65 years/old (normal serum potassium levels). The relation between CAH and hospital expenses (HE), the number of comorbid diseases (NCD), and all-cause of mortality rates (MR) were evaluated. We also investigated whether drugs, sex, and NCD are risk factors for the development of CAH. Results: There was a positive correlation between serum potassium levels and length of hospital stay, MR, HE, and NCD (p < 0.001). Risk factors for CAH were the use of non-steroidal-anti inflammatory drugs (NSAIDs) (Odds Ratio [OR]: 2.679), spironolactone (OR: 2.530), and angiotensin converting enzyme inhibitors (ACEI) (OR: 2.242), angiotensin receptor blockers (ARB) (OR: 2.679), ≥2 comorbid diseases (OR: 2.221), female gender (OR: 2.112), and renal injury (OR: 5.55). CAH risk was found to be increased 30.03 times when any of ACEI, ARB, NSAIDs, or spironolactone is given to a patient with a renal injury. Conclusion: Use of NSAIDs, ACEI, ARB, spironolactone and increased NCD are all independent risk factors for CAH in the elderly, especially in patients with kidney diseases.

Community-acquired hypernatremia in elderly and very elderly patients admitted to the hospital: Clinical characteristics and outcomes

Summary Background The clinical features, outcome and cost burden of community-acquired hypernatremia (CAH) in elderly and very elderly patients are not well known. Our aim was to investigate the etiologies, reasons for admission, clinical courses, outcomes, complications, and cost assessments of the elderly patients with CAH. Material/Methods We conducted a retrospective study in our tertiary hospital. Elderly and very elderly patients evaluated in the emergency department (ED) from January 1, 2010 to December 31, 2010 (n=4960) were included. Totally, 102 patients older than 65 years and diagnosed with CAH were evaluated. The patients were divided into 2 main groups according to their age: elderly (65–74 years old) (group 1) (n=38), and very elderly (>74 years) (group 2) (n=64). Results Our overall observed prevalence of CAH was 2.0% (n=102, 102/4960). In particular, the prevalences of CAH in group 1 and group 2 were 1.0% (38/3651) and 4.8% (64/1309), respectively (p<0.001). Totally, 62 patients had been treated by renin-angiotensin system (RAS) blockers (ie, ACE-inhibitors). Alzheimer’s disease had been diagnosed in 46.1% of the subjects. The mean Katz scores at the time of admission were 2.4±1.9 and 1.1±1.0 in group 1 and 2, respectively (p<0.001). The mean cost was higher in group 2 than in group 1 (2407.13±734.54 USD, and 2141.12±1387.14 USD, respectively) (p<0.01). The need for intensive care was significantly greater in group 2 as compared to group 1. Conclusions The important determinants of “CAH” in elderly subjects are accompanying Alzheimer’s disease, oral intake impairment, and concomitant treatment with RAS blockers.

Comparison of diagnostic accuracy of Doppler USG and contrast-enhanced magnetic resonance angiography and selective renal arteriography in patients with atherosclerotic renal artery stenosis

Background There are many systemic complications of conventional selective renal arteriography (SRA), such as contrast-mediated nephropathy. Contrast-enhanced magnetic resonance angiography (CE-MRA) and renal artery Doppler ultrasonography (DUSG) have been used increasingly for renal artery stenosis (RAS). The aim of this study was to evaluate the accuracy of CE-MRA and DUSG as used for diagnosis of RAS. Material/Methods We divided 130 consecutive patients investigated for resistant hypertension into 2 groups based on age: group 1 was patients <60 years old and group 2 was patients >60 year. DUSG, CE-MRA, and SRA were performed in group 1 and group 2 patients. Results Seventy-two patients (24 males [M], 48 females [F]) in group 1, and 58 patients (26 M, 32 F) in group 2 were included in the study. In the evaluation of clinically significant renal artery stenosis with DUSG, in group 1 the overall sensitivity was 83.33% and overall specificity was 81.82%, and in group 2 they were 69.23% and 0%, respectively, when compared with SRA. In the evaluation of clinically significant renal artery stenosis with CE-MRA, the overall sensitivity and specificity were 92.31% and 36.36%, respectively, in group 1 and 100.00% and 73.33%, respectively in group 2, when compared with SRA. Conclusions CE-MRA is an accurate, non-invasive method for the diagnosis of RAS in patients above 60 years of age and DUSG may be the choice of diagnostic method for RAS in patients under 60 years of age.

Is the red cell distribution width strong predictor for treatment response in primary glomerulonephritides

Abstract Background: Novel biomarkers are needed to predict the response to treatment in patients with nephrotic syndrome (NS) due to primary glomerulonephritides (PGN). We aimed to test the predictive value of red blood cell distribution width (RDW) for estimation of response to therapy in adult patients with NS. Study design, setting & participants, and intervention: We performed a prospective study including 176 patients with NS due to PGN. Patients were divided into three groups according to their response to the treatment. Group 1 was composed of patients with complete remission whereas group 2 was composed of patients with partial remission and group 3 was composed of patients who were resistant to the treatment. Results: The highest baseline mean RDW value was found in group 3 patients (17.8 ± 1.8) whereas the lowest in group 1 (13.4 ± 0.7) before treatment (p < 0.05). We found a significant decrease in RDW value after an effective treatment in groups 1 and group 2 (p < 0.05). However, there was no significant change in RDW values after treatment in group 3 (p > 0.05). Most of the patient with complete remission had base-line RDW level ≤ 14% (n = 45, 90%) (p < 0.001, Kendal Tau: −0.86), and most of the patients who were resistant to the treatment had base-line RDW level p > 15% (n = 68, 86.1%) (p < 0.001, Kendal Tau: −0.87). Conclusion: Our results suggest that pre-treatment RDW value is a promising novel biomarker for predicting response to the treatment in adult patients with NS due to PGN.

Stapler Esophageal Closure During Total Laryngectomy

Abstract Mechanical esophageal closure with stapler during total laryngectomy has been used by various authors to decrease the surgical time and pharyngocutaneous fistula (PCF) rates. In a few of the studies, surgical site infection (SSI) rates are mentioned and none of the studies emphasize the effect of decreased surgical time on postoperative cardiovascular and cerebrovascular complications. In this study, the authors compared the PCF rates, SSI rates, operation times between 30 mechanical stapler and 40 manual esophageal closure during total laryngectomy for laryngeal cancer patients. National Nasocomial Infections Surveillance system (NNISS) scores were recorded and compared between groups. Total laryngectomy and total operation times were lower in the stapler group patients (P < 0.001 for total laryngectomy time, P = 0.024 for total operation time). There were lower rates of pharyngocutaneous fistula (P = 0.032), surgical site infection (P = 0.019), and NNISS scores (P = 0.009) in the stapler group. There was no statistically significant difference between groups regarding postoperative systemic complications (P = 0.451). In conclusion, stapler esophageal closure decreases operation time, PCF, SSI rates, and NNISS scores but not the systemic complication rates. Comorbid illnesses and prolonged surgical time are risk factors for postoperative systemic complications in total laryngectomy patients, but patients with additional illnesses must not encourage the surgeon to use stapler for decreasing postoperative systemic complications.