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As a New Inflammatory Marker for Familial Mediterranean Fever: Neutrophil-to-Lymphocyte Ratio

Familial Mediterranean fever (FMF), which is an autosomal recessive disease, is characterised by recurrent febrile episodes in association with peritonitis, pleuritis and arthritis and has ongoing subclinical inflammation during attack-free period. In this study, we aimed to investigate the relationship between FMF with neutrophil-to-lymphocyte ratio (NLR), which is determined in many chronic inflammations as a new potential inflammatory mediator. We included 62 patients and 41 healthy subjects who were similar in terms of age and sex. We found that the NLR values of the patients were significantly higher than those of the control group, and C-reactive protein values were correlated with NLR. Another finding was the NLR values were significantly higher in the FMF patient with M694V mutation than with other mutations. As a result, NLR might be used in the FMF patient as an indicator of the subclinical inflammation, and the FMF patients with M694V mutation should be followed up closely because of increased subclinical inflammation risk.

Neutrophil-to-lymphocyte ratio as a quick and reliable predictive marker to diagnose the severity of diabetic retinopathy.

INTRODUCTION Diabetic retinopathy (DR) is the most common complication and cause of visual impairment in diabetes patients. The pathogenesis is not fully understood, but several studies have suggested that inflammation plays an important role. The neutrophil-to-lymphocyte ratio (NLR) was defined as a novel potential marker to determine inflammation. We aimed to evaluate the relationship between DR and inflammation by using NLR. PATIENTS AND METHODS The study was included 58 patients diagnosed with type 2 diabetes mellitus. Twenty-four of them had DR. The control group was composed of 52 age- and sex-matched healthy subjects. Retinopathy was graded using the International Clinical Diabetic Retinopathy Disease Severity Scale. RESULTS NLR values of the diabetes patients were significantly higher than those of the healthy control group (P<0.001), and NLR levels of the patients with DR were higher than those of the patients without DR (P<0.001). In addition, NLR values were correlated with the presence of DR and DR grades (r=0.466, P<0.001; and r=0.630, P<0.001, respectively). CONCLUSIONS According to our knowledge, this is the first study investigating the relationship between NLR, which is an inflammatory marker, and DR and its severity. Our results suggest that while evaluating diabetes patients in terms of DR, higher NLR values may be a remarkable marker.

Atherogenic index as a predictor of atherosclerosis in subjects with familial Mediterranean fever

BACKGROUND AND OBJECTIVE Numerous inflammatory and innate immune pathways are involved in atherogenesis. We aimed to investigate the atherogenic index and other lipid parameters in individuals with familial Mediterranean fever (FMF), as a predictor of atherosclerosis. MATERIALS AND METHODS A total of 60 patients with FMF and 60 healthy age- and sex-matched controls were included in this study. The patients with acute infection, chronic metabolic and rheumatic diseases, use of drugs other than colchicine and smoking history were excluded. CRP, ESR, total cholesterol, triglycerides, LDL-C, and HDL-C levels of patients and the control group were measured. Atherogenic index (TG/HDL-C) was calculated. RESULTS We found that the atherogenic index values of the patients were significantly higher than those of the control group. HDL-C levels were lower and ESR and TG levels were higher in patients. Total cholesterol, LDL-C and CRP levels did not differ significantly between the two groups. There was no significant difference in the values of total cholesterol, LDL-C, triglycerides (TG), HDL-C, and atherogenic indexes between the groups of patients with and without M694V mutation. CONCLUSIONS Elaboration of clinical models of inflammation-induced atherogenesis may further advance our knowledge of multiple inflammatory pathways implicated in atherogenesis and provide a useful tool for cardiovascular prevention. We believe that the atherogenic index also be used as a preliminary indication of accelerated atherosclerosis in FMF. However, large-scale prospective studies on this issue are needed.

Assessment of the Frequency of Autoantibodies in Chronic Viral Hepatitis.

Objective: To examine the occurrence frequency of auto-antibodies and autoimmune diseases in patients with chronic hepatitis B or C. Methods: A total of 67 patients diagnosed with chronic hepatitis B and 77 patients diagnosed with chronic hepatitis C infection based on HBs Ag, Anti HCV, HBe Ag, Anti HBe Ag, HBV DNA, HCV RNA, liver ultrasound, and liver biopsy results as well as 48 healthy individuals were included in this study. ANA, anti dsDNA, anti LKM, Anti-SMA, AMA, C-ANCA, P-ANCA, anti-SSA, anti-SSB, anti-Scl-70, anti Jo-1, anti-U1snRNP, anti-centromere, anti-Jo-1, anti tpo, and anti tg were studied in all individuals in each study group. Results: ANA positivity was detected in 8 (12%), 15 (19%) and 2 (4%) individuals in HBV, HCV and control groups, respectively. The difference between the groups was significant (P=0.04). Similarly, anti Tg was positive in one subject in HBV group, in 6 subjects (7%) in HCV group, and in one subject among controls, the difference being significant (P=0.04). There were no significant differences between the study groups in the frequency of other auto-antibodies. Conclusion: Similar to studies involving patients who received interferon and/or antiviral agents, an increased frequency of auto-antibodies was also detected in our patient group consisting of interferon and anti-viral naive subjects. The increase in the frequency of auto-antibodies reached statistical significance among individuals with HCV infection. Thus, pre-treatment assessment of auto-antibodies in newly diagnosed cases of chronic hepatitis B or hepatitis C infection may provide beneficial information on the future occurrence of auto-immune responses in these patients.

The relationship between dipping-non-dipping arterial blood pressure pattern and frequency of restless leg syndrome with related factors

Objective: The lack of nocturnal decline in blood pressure (BP) is associated with an increase in cardiovascular events. Restless leg syndrome (RLS) is an uncomfortable feeling in which the patient wants to budge the legs with ache in the legs. RLS also increases the hypertension and cardiovascular risk. In this study, we aimed to evaluate the relationship between dipping and non-dipping blood pressure patterns with RLS and its severity. Methods: Two hundred patients who had 24-hour ambulatory blood pressure monitoring (ABPM) were enrolled into this cross-sectional study. They were classified by blood pressure pattern as dipping and non-dipping. Then, 100 patients with the dipper pattern and 100 patients with the non-dipper pattern were chosen. A questionnaire for RLS diagnosis that was prepared by the International RLS Study Group was given performed to the patients. Results: RLS symptom score was higher in patients with non-dipping blood pressure patterns (NDBPP), and patients with NDBPP had more severe RLS. Beside this, there were no differences in terms of RLS frequency in dipping and non-dipping blood pressure patterns. Conclusion: As a conclusion, dipping and non-dipping blood pressure patterns do not increase RLS risk. But, if patients with NDBPP have RLS, they have more severe RLS. So, we suggest that evaluating a patient with a non-dipping blood pressure pattern, considering RLS, would be helpful to ameliorate the quality of life of the patient

Toxic hepatitis associated with amoxicillin-clavulanic acid in a chronic viral hepatitis B patient: a case report -

Amoxicillin-clavulanic acid (ACA) related hepatotoxicity is among the most common causes of drug-related hepatotoxicity. Cholestatic liver injury is the most common type. Symptoms usually begin 1-4 weeks after ingestion and heal within 8 weeks. Rarely develop fulminant hepatitis and death. In this study, we present a case of a 62-year-old woman who had chronic viral hepatitis B and developed toxic hepatitis after receiving ACA treatment. When ACA was discontinued, the patient’s symptomps improved and her liver enzyme levels reduced to near to the normal range.

Akut Böbrek Yetmezliği Tanısıyla Kliniğimize Yatan Olguların Analizi

Amac: Akut bobrek yetmezligi, bobrek fonksiyonlarinda hizli bir azalmayla karakterize ve yuksek mortalite oranina sahip onemli bir klinik sendromdur. Akut bobrek yetmezliginde mortalite, son yillardaki yogun bakim ve renal replasman tedavilerindeki gelismeye ragmen yuksek kalmaya devam etmektedir. Bu calismada klinigimizde ABY tanisiyla yatan hastalari degerlendirdik.Gerec ve Yontem: Ocak 2011 ve Aralik 2012 arasinda hastanemize Akut bobrek yetmezligi tanisiyla basvuran 145 hastayi retrospektif olarak inceledik. Hastalarin kayitlarindan yasi, Akut bobrek yetmezligi tipi, basvuru sekli, basvurudaki temel bulgulari, etyolojisi, zeminde eslik eden hastaliklar, uygulanan tedavi ve laboratuvar degerleri kaydedildi.Bulgular: Olgularin etiyolojisi incelendiginde en sik nedenler prerenal azotemi (%38,6) ve nefrotoksik ajan kullanimiydi (%30,3). Hastalarin %72,6’si nonoligurik %27,4’u oligurik idi. Olgularin %65,5’ine medikal tedavi uygulanirken %34,5’ine medikal tedaviye ek olarak hemodiyaliz tedavisi uygulandi. Hastalarin %86,9’u tedavi sonucu iyilesirken, %13,1’i kaybedildi. Olen hastalarin %63,2’si medikal tedaviye ek olarak hemodiyaliz tedavisi alirken %36,8’i sadece medikal tedavi almisti. Oligurik hastalarin %67,5’i medikal tedavi ve hemodiyaliz, %32,5’i sadece medikal tedavi alirken nonoligurik hastalarin %21,9’u medikal tedavi ve hemodiyaliz, %78,1’i sadece medikal tedavi aldi.Sonuc: Akut bobrek yetmezligi etiyolojisinde 40 yil oncesine gore medikal nedenler on plana cikmaktadir. Ayrica oligoa