Mehmet Akif Buyukbese

Efficacy and tolerability of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C.

Background and Aim:  Hepatitis C virus (HCV) is prevalent in hemodialysis (HD) patients. These patients experience more side‐effects with antiviral treatment. The aim of the present study was to evaluate the efficacy and tolerability of pegylated interferon (PEG‐IFN) α‐2a in chronic hemodialysis patients with chronic hepatitis C.

Risk factors for ocular surface disorders in patients with diabetes mellitus

OBJECTIVE To evaluate risk factors for ocular surface disorders and tear dysfunction in patients with type 2 diabetes. STUDY DESIGN AND METHODS This prospective case controlled study included 41 patients with type 2 diabetes and 20 healthy subjects as the control group. All subjects underwent routine ophthalmic examination, tear film break-up time (BUT) test, Schirmer test, fluorescein dye test, rose bengal staining test, and a questionnaire for subjective complaints. The relationship of metabolic control of diabetes mellitus, duration of diabetes, severity of diabetic retinopathy, and argon laser photocoagulation (ALP) to tear dysfunction was evaluated. RESULTS Tear film BUT and Schirmer test values were significantly lower in diabetic patients compared with control subjects (P < 0.001). In the diabetic group, significantly more subjects had abnormal fluorescein and rose bengal staining than in the control group (P < 0.001). Abnormal tear function tests were associated with poorer metabolic glucose control, panretinal ALP, and proliferative diabetic retinopathy (P < 0.05), but not with duration of diabetes (P > 0.05). CONCLUSIONS The results of the study indicate that poor metabolic control, panretinal ALP, and proliferative diabetic retinopathy are high risk factors for ocular surface disorders in type 2 diabetes. These patients should be followed more carefully, and should be referred to an ophthalmologist when required.

Clinical and laboratory features of brucellosis in two university hospitals in Southeast Turkey

This prospective study was carried out in two university hospitals between January 2000 and December 2002. The diagnosis of brucellosis was made with compatible clinical findings, positive Brucella agglutination 1/160 titres, and/or the isolation of Brucella species. The patients were followed up without intervention. One hundred and thirty-eight patients with active brucellosis were evaluated. Of the participants, 79 (57.2%) cases were acute, 23 (16.7%) sub-acute and 36 (26.1%) chronic. Brucella melitensis was isolated in the specimens of 24 (26.9%) out of 89 patients. The most frequent symptoms were fever (78.3%), arthralgia (77.5%) and sweating (72.5%). The most common physical findings were fever (40.6%), splenomegaly (36.2%), and hepatomegaly (26.8%). The osteoarticular involvement was found in 64 patients (46.4%). Ten (7.5%) patients had orchiepididymitis. Meningitis, pulmonary involvement, endocarditis, and hepatitis were found in five (3.6%), three (2.1%), two (1.5%) and one (0.7%) patient, respectively. Relative lymphomonocytosis was found in 80 cases (58.8%), anaemia in 46 (33.3%) and leucopoenia in 30 cases (21.7%). Clinical relapse was observed in 14 patients (10.1%).

Levels of Malondialdehyde and Superoxide Dismutase in Subclinical Hyperthyroidism

We aimed to determine whether patients with subclinical hyperthyroidism (SH) are subject to oxidative stress. Twenty-two women and 8 men having endogenous subclinical hyperthyroidism for a duration of at least 6 months, and 21 women and 9 men healthy controls were included in this study. We measured the level of plasma malondialdehyde, as one of the lipid peroxidation markers, and the activity of erythrocyte superoxide dismutase, which is an antioxidant enzyme. The activity of erythrocyte superoxide dismutase and plasma malondialdehyde levels were found to be significantly higher in subjects with subclinical hyperthyroidism than the control group (P < .01). The results of this study suggest that oxidative stress and antioxidative response could be increased in patients having subclinical hyperthyroidism.

Diabetes and Ramadan: Practical Guidelines

Ramadan fasting is one of the five pillars of Islam and is compulsory for all healthy Muslims from puberty onwards. Exemptions exist for people with serious medical conditions, including many with diabetes, but a large number will participate, often against medical advice. Ensuring the optimal care of these patients during Ramadan is crucial. The International Diabetes Federation (IDF) and Diabetes and Ramadan (DAR) International Alliance have come together to deliver comprehensive guidelines on this subject. The key areas covered include epidemiology, the physiology of fasting, risk stratification, nutrition advice and medication adjustment. The IDF-DAR Practical Guidelines should enhance knowledge surrounding the issue of diabetes and Ramadan fasting, thereby empowering healthcare professionals to give the most up-to-date advice and the best possible support to their patients during Ramadan.

Leptin levels in obese women with and without type 2 diabetes mellitus

INTRODUCTION The role of leptin has been more clear in the endocrinology area after the discovery of its secretion from the adipose tissue. The aim of the study is to investigate the leptin levels in obese women in whom type 2 diabetes mellitus were present or absent. MATERIALS AND METHODS Thirty-five obese women with type 2 diabetes mellitus (group 1) and 34 obese women without type 2 diabetes mellitus (group 2) were enrolled in the study. In both groups the body mass index (BMI), waist circumference, and waist-to-hip ratio were measured. Leptin, HbA1c, creatinine and the lipid profile were assessed. RESULTS Leptin was found to be statistically significantly lower in group 1 than in group 2 (40.22 +/- 17.77 ng/ml versus 50.12 +/- 15.51 ng/ml, respectively; p = 0.019). It was well correlated with BMI in group 1 (r = 0.60, p = 0.0001). In group 1 also, correlation of leptin was moderate with creatinine and high-density lipoprotein-cholesterol (r = 0.36, p = 0.037 versus r = 0.37, p = 0.027, respectively), whereas triglyceride had a negative correlation (r = -0.34, p = 0.046). In group 2, the only significant correlation with leptin was BMI (r = 0.41, p = 0.02). Leptin was also significantly lower in 17 subjects with poorly controlled diabetes mellitus than in 18 well-controlled diabetics (33.54 +/- 15.82 ng/ml versus 44.61 +/- 17.54 ng/ml, respectively; p = 0.038). CONCLUSION Since leptin is lower in obese women with diabetes than without diabetes and additionally it is even lower in the poorly controlled diabetes subgroup, we think that further studies a rerequired to make clear the issue for lower leptin levels, whether it is a reason or an outcome.

Ocular surface disorders and tear function changes in patients with chronic renal failure

BACKGROUND Ocular surface changes, mainly squamous metaplasia of the conjunctival epithelium and corneoconjunctival calcification of unknown etiology, may develop in patients with chronic renal failure undergoing hemodialysis. An association between squamous metaplasia and corneoconjunctival calcification has been suggested. The purpose of this study was to investigate the relation between ocular surface disorders and tear function changes in patients with chronic renal failure undergoing hemodialysis. METHODS In this prospective case-control study, 42 patients with chronic renal failure and 20 age- and sex-matched control subjects underwent full ophthalmologic examination, tear function tests (including Schirmers test, tear film break-up time [BUT] test and rose bengal staining) and impression cytology to determine the degree of conjunctival squamous metaplasia. They also responded to a questionnaire regarding subjective ocular complaints. Corneoconjunctival calcification was graded on a scale of 0 to 5 according to the system proposed by Porter and Crombie. Impression cytology samples were graded on scale of 0 to 3 according to the Nelson classification. The relation between ocular surface disorders and tear function changes was evaluated. RESULTS Of the 42 patients, 12 (28%) had grade 0 calcification, 10 (24%) had grade 1, 14 (33%) had grade 2, and 6 (14%) had grade 3 or higher. Four patients (10%) had grade 0 squamous metaplasia, 22 (52%) had grade 1, 12 (28%) had grade 2, and 4 (10%) had grade 3. The difference between the patient and control subjects in squamous metaplasia grades and corneoconjunctival calcification grades was statistically significant (p < 0.001 and p = 0.022 respectively). Abnormal tear film BUT (p = 0.002) and abnormal rose bengal staining (p = 0.023) were significantly more frequent in the patient group than in the control group. The grade of conjunctival squamous metaplasia was correlated with abnormal rose bengal staining (tau = 0.79, p < 0.001) and with the existence of subjective ocular complaints (tau = 0.32, p = 0.026). There was no correlation between corneoconjunctival calcification and tear function changes. INTERPRETATION Abnormal rose bengal staining and the presence of subjective ocular complaints may be used as follow-up criteria for ocular surface disorders in patients with chronic renal failure regularly undergoing hemodialysis.

High-sensitivity C-reactive protein in patients with metabolic syndrome

,!High-sensitivity C-reactive protein (CRP) has been shown to predict cardiovascular disease. Metabolic syndrome has been found to play a critical role in the development of cardiovascular disease. The purpose of this report is to assess the relationship between CRP and the metabolic syndrome. A total of 50 patients with metabolic syndrome and 40 healthy persons were included in the study. Plasma concentrations of CRP were measured by means of particle-enhanced immunonephelometry with the Behring nephelometer using N Latex CRP mono reagent. CRP levels were higher in patients with metabolic syndrome than control group (10.6 ±5.4 mg/L vs 3.5 ±0.8 mg/L, p<0.001). In partial correlation, plasma CRP positively correlated with body mass index (p<0.001), waist circumference (p<0.001), waist-to-hip ratio (p<0.01), total cholesterol (p<0.001), LDL-cholesterol (p=0.033), triglyceride (p=0.023), and fasting blood glucose (p=0.043) in patients with metabolic syndrome. HDL-cholesterol did not significantly correlate with CRP (p>0.05). In multiple regression analysis, body mass index (p<0.01), waist circumference (p<0.01), and fasting blood glucose (p<0.01) showed independent correlations with plasma CRP. CRP levels were found higher in patients with metabolic syndrome. These results suggest that abdominal obesity is the critical correlates of elevated plasma CRP levels found in patients with metabolic syndrome. These patients carrying high risk for cardiovascular events must be followed closely.

Impression Cytology Changes and Corneoconjunctival Calcification in Patients with Chronic Renal Failure

OBJECTIVE To evaluate the relationship between corneoconjunctival calcification and conjunctival squamous metaplasia in patients with chronic renal failure (CRP). STUDY DESIGN We studied impression cytology in 45 CRF patients on regular hemodialysis and 30 age- and sex-matched controls. Specimens were obtainedfrom the temporal bulbar conjunctiva using cellulose acetate filter paper. The samples were fixed in a mixture of 70% ethyl alcohol, 37% formaldehyde and glacial acetic acid and then stained with a combination of periodic acid- Schiff and Gills modified Papanicolaou stain and graded by a masked observer. Corneoconjunctival calcification was graded by the Porter-Crombie classification. RESULTS Of 45 study patients, 4 (9%) disclosed grade 0, 23 (51%) grade 1, 14 (31%) grade 2 and 4 grade 3 (9%) impression cytology changes. There was a statistically significant difference between the patient and control groups (p < 0.001). Calcium deposits were more frequent and extensive in CRF patients than in controls (p = 0.01). There was no correlation between impression cytology and calcium deposit grades (p = 0.128). However the presence of conjunctival inflammation correlated with the existence of extensive squamous metaplasia (p < 0.001). CONCLUSION The severity of conjunctival changes in CRF patients on regular hemodialysis are not related to calcium deposition but to acute conjunctival inflammation.