Mehmet Ali Eren

Impact of contrast enhanced MRI on lymphocyte DNA damage and serum visfatin level

OBJECTIVESnNephrogenic systemic fibrosis is a novel clinical entity encountered in subjects undergoing contrast enhanced magnetic resonance imaging (MRI). The aim of the present study is to evaluate the impact of contrast enhanced MRI exposure on lymphocyte DNA damage and serum levels of visfatin.nnnDESIGN AND METHODSnTwenty-eight subjects undergoing contrast enhanced hypophysial MRI with omniscan were included in the study. Blood samples were drawn before MRI, after non-contrast MRI and after contrast enhanced MRI from each subject. Lymphocyte DNA damage was analyzed by the alkaline comet assay, whereas serum visfatin level was assessed with enzyme immuno assay.nnnRESULTSnBoth lymphocyte DNA damage and serum visfatin levels were statistically significantly increased in samples withdrawn after contrast enhanced MRI compared to samples withdrawn after non-contrast enhanced MRI and baseline samples (ANOVA p<0.001, for both).nnnCONCLUSIONSnFindings of the present study revealed that the contrast enhanced MRI is associated with increased lymphocyte DNA damage and increased serum visfatin level.

The effects of atorvastatin and rosuvastatin on oxidative stress in diabetic patients.

AIMnDiabetes is associated with abnormalities in lipid profile and increased oxidative stress. Statins are preferred agents in diabetic patients due to their antioxidant and LDL-C lowering effects. This study is designed to compare the effects of atorvastatin and rosuvastatin on low density lipoprotein cholesterol (LDL-C), lipid hydroperoxide (LOOH), total oxidant status (TOS) and total antioxidant capacity (TAC) in diabetic patients with hyperlipidemia.nnnMATERIALS AND METHODSnSixty two patients who have type 2 diabetes mellitus with serum LDL levels more than 100mg/dL were randomly assigned to receive atorvastatin 20mg (n=31) or rosuvastatin 10mg (n=31). Blood tests were performed at the beginning of the study and after three months.nnnRESULTSnThere were no statistically significant differences in the pre- and after treatment levels of the LDL-C between groups. TAC values were increased in both groups and statistically significant in the former group (p=0.007). There was no difference between the change percentages ((after treatment TAC-pretreatment TAC)/pretreatment level) of TAC between two treatment groups. The effects of two drugs on the other oxidative parameters were not significantly different.nnnCONCLUSIONnBoth atorvastatin and rosuvastatin may be helpful in reducing increased oxidative stress in diabetic patients with hyperlipidemia.

The major predictors of amputation and length of stay in diabetic patients with acute foot ulceration.

SummaryBackgroundDiabetic foot infections are associated with substantial morbidity and mortality. Prediction of diabetic foot ulcer outcome may be helpful for optimizing management strategy. This study aimed to determine the major predictors of amputation and length of stay in diabetic patients with acute foot ulceration.MethodsA total of 55 type 2 diabetic patients with diabetic foot infection were enrolled. The patients were evaluated according to the Infectious Diseases Society of America and International Working Group on the Diabetic Foot criteria and also the Wagner’s classification. Blood samples were taken at the start of hospitalization for the measurement of glucose, hemoglobin A1C (HbA1C), white blood cells (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Length of stay in hospital was recorded.ResultsWBC and CRP were significantly higher in lower-extremity amputation (LEA) group (pxa0=xa00.001 and pxa0=xa00.008, respectively); also, ESR was higher in this group, but there was no statistical significance. Wagner grade and infection severity were significantly higher in the LEA group as compared with the non-LEA group (both p values <xa00.001). Glycemic control parameters (i.e., HbA1C, plasma glucose) were not different in LEA and non-LEA groups. In correlation analyses, amputation rate was negatively correlated (rxa0=xa0−xa00.512, pxa0<xa00.001) with length of stay. WBC, ESR, CRP, Wagner grade, and severity of infection showed positive correlation with length of stay (rxa0=xa00.493, pxa0<xa00.001; rxa0=xa00.271, pxa0=xa00.045; rxa0=xa00.299, pxa0=xa00.027; rxa0=xa00.434, pxa0=xa00.001; and rxa0=xa00.464, pxa0<xa00.001, respectively).ConclusionsBaseline levels of acute-phase reactants, especially CRP, WBC, ESR, and increased Wagner grade, appeared to be helpful in predicting amputation and length of stay in diabetic patients with acute foot ulceration. However, duration of diabetes and glucose control seems to have no effect.ZusammenfassungGrundlagenInfektionen von Fußulzera Ulcera sind bei Diabetikern mit einer beträchtlichen Morbidität und Mortalität verbunden. Eine Vorhersage des Verlaufs des Ulkus kann zur Optimierung der Managementstrategies hilfreich sein. Die vorliegende Studie hatte zum Ziel, die wesentlichsten Prädiktoren für eine Amputation und für die Dauer des Aufenthaltes im Spital zu erheben.MethodikEs wurden insgesamt 55 Patienten mit einem Typ 2 Diabetes mellitus mit einer Infektion im Bereich von Fußulzera in die Studie aufgenommen. Die Patienten wurden entsprechend der diabetischen Fußkriterien der Infectious Diseases Society of America und der International Working Group on the Diabetic Foot criteria, sowie der Klassifikation nach Wagner evaluiert. Am Beginn des Spitalsaufenthaltes wurde Blut zur Messung der Glukose, des HbA1c, der Leukozyten, des C reaktiven Proteins (CRP) und der Blutsenkung (Skg) abgenommen. Die Dauer des Spitalsaufenthaltes wurde registriert.ErgebnisseDie Leukozyten und das CRP waren in der LEA Gruppe (LEA = lower-extremity amputation) signifikant höher (pxa0=xa00,001 beziehungsweise pxa0=xa00,008). Die Skg war in dieser Gruppe zwar auch schneller – allerdings war dieser Unterschied statistisch nicht signifikant.Der Schweregrad der Infektion und die Graduierung nach Wagner waren in der LEA Gruppe signifikant höher als in der Nicht-LEA Gruppe (beide pxa0<xa00,001). Die Parameter der glykämischen Kontrolle (Blutzucker, HbA1c) waren in der LEA und Nicht-LEA Gruppe nicht unterschiedlich. In der Korrelationsanalyse zeigte sich die Rate der Amputationen negativ mit der Dauer des Spitalsaufenthaltes korreliert (rxa0=xa0−xa00,512, pxa0<xa00,001). Leukozyten, Skg, CRP, Wagner Grad und Schweregrad der Infektion waren positiv mit der Dauer des Spitalsaufenthaltes korreliert (rxa0=xa00,493, pxa0<xa00,001; rxa0=xa00,271, pxa0=xa00,045; rxa0=xa00,299, pxa0=xa00,027; rxa0=xa00,434, pxa0=xa00,001 and rxa0=xa00,464, pxa0<xa00,001 respektive).SchlussfolgerungenDie Ausgangswerte von Akutphasenparametern, insbesondere des CRP, der Leukozyten, der Skg und höhere Grade nach Wagner, scheinen in der Vorhersage einer Amputation bzw. der Dauer des Spitalsaufenthaltes hilfreich zu sein. Die Dauer des Diabetes mellitus, beziehungsweise die glykämische Kontrolle scheinen allerdings keine Bedeutung zu haben.

Urotensin-II level and its association with oxidative stress in early diabetic nephropathy

OBJECTIVEnDiabetic nephropathy is the most common cause of end stage renal failure. Early treatment of diabetic nephropathy depends on understanding the underlying mechanisms of the disease. In this study we investigated the role of U-II in early nephropathy and ıts association with oxidative stress, paraoxonase (PON)-1 and arylesterase.nnnRESEARCH DESIGN AND METHODSnTwenty-three diabetic patients with microalbuminuria, 23 diabetic patients with normoalbuminuria and 25 healthy individuals were enrolled in the study. Serum total antioxidant status (TAS), total oxidant status (TOS), PON-1, arylesterase, and urotensin-II (U-II) levels were measured. Oxidative stress index (OSI) percent ratio of TOS to TAS level was accepted as OSI.nnnRESULTSnSerum U-II levels were higher in the microalbuminuric diabetes group compared to the normoalbuminuric diabetic group and the healthy control group (p=0.009 and p=0.0001, respectively). Normoalbuminuric diabetic groups U-II levels were significantly higher compared to those of the healthy control group (p=0.0001). Correlation analysis yielded that plasma U-II levels are negatively correlated to TAS, arylesterase, and PON-1 levels (r=-0.395, p=0.001; r=-0.291, p=0.014; and r=-0.279, p=0.018, respectively) and that they had a positive correlation with OSI levels (r=0.312, p=0.008). These associations were confirmed in the multiple regression analysis. The results of multiple logistic regression analysis showed that oxidative stress is important in the development of microalbuminuria.nnnCONCLUSIONnThe data of this study reveal that increased serum U-II has a role in the development of diabetic nephropathy. This effect of U-II may be related to high levels oxidative stress parameters.

Evaluation of the Future Atherosclerotic Heart Disease with Oxidative Stress and Carotid Artery Intima Media Thickness in Gestational Diabetes Mellitus

Background and objective. In this study our aim was to evaluate paraoxonase (PON1) activity and free sulfhydryl groups (–SH) as antioxidative parameters and lipid hydroperoxide (LOOH) as oxidative parameter in the serum of women with gestational diabetes mellitus (GDM) and determine their relation with the degree of subclinical atherosclerosis. Material and methods. Serum samples from 39 pregnant women complicated with GDM and 40 healthy pregnant women were collected for the analysis of oxidative markers. Common carotid artery intima media thickness (CIMT) was measured for both groups to assess future atherosclerotic heart disease risk. PON1 activity and –SH were measured spectrophotometrically. LOOH levels were measured by ferrous oxidation with a xylenol orange assay. Results. CIMT and LOOH levels were significantly higher (p = 0.01, p < 0.001, respectively) in GDM group compared to controls, whereas PON1 and –SH levels were significantly lower (p < 0.001 for both). CIMT values were significantly correlated with body mass index (BMI), 50 g oral glucose tolerance test (OGTT), and mean arterial blood pressure (MABP) (p = 0.003, p = 0.02, and p = 0.03, respectively). However, there was no correlation between CIMT and oxidative markers. Conclusions. Increased levels of LOOH and decreased levels of PON1 and –SH showed disturbance of antioxidative mechanisms in GDM. These changes were associated with increased BMI and MABP which may be relevant to GDM pathophysiology. Furthermore, increased CIMT values in GDM compared to healthy controls designate increased risk of future atherosclerotic heart disease.

Evaluation of oxidative stress parameters and metabolic activities of nurses working day and night shifts

The aim of this study was to evaluate the oxidative stress and metabolic activities of nurses working day and night shifts. Intensive care unit (ICU) (n=70) and ordinary service (OS) nurses (n=70) were enrolled in the study. Just before and the end of the shifts, blood samples were obtained to measure the participants oxidative stress parameters. Metabolic activities were analyzed using the SenseWear Armband. Oxidative stress parameters were increased at the end of the shifts for all OS and ICU nurses compared to the beginning of the shifts. Compared to the OS nurses, the ICU nurses TAS, TOS, and OSI levels were not significantly different at the end of the day and night shifts. The metabolic activities of the OS and ICU nurses were found to be similar. As a result, the OS and ICU nurses oxidative stress parameters and metabolic activities were not different, and all of the nurses experienced similar effects from both the day and night shifts.The aim of this study was to evaluate the oxidative stress and metabolic activities of nurses working day and night shifts. Intensive care unit (ICU) (n=70) and ordinary service (OS) nurses (n=70) were enrolled in the study. Just before and the end of the shifts, blood samples were obtained to measure the participants oxidative stress parameters. Metabolic activities were analyzed using the SenseWear Armband. Oxidative stress parameters were increased at the end of the shifts for all OS and ICU nurses compared to the beginning of the shifts. Compared to the OS nurses, the ICU nurses TAS, TOS, and OSI levels were not significantly different at the end of the day and night shifts. The metabolic activities of the OS and ICU nurses were found to be similar. As a result, the OS and ICU nurses oxidative stress parameters and metabolic activities were not different, and all of the nurses experienced similar effects from both the day and night shifts.

Association of serum amyloid A with subclinical atherosclerosis in women with gestational diabetes

The aim of our study was to evaluate serum amyloid A (SAA), an acute phase reactant, and carotid intima-media thickness (CIMT) as a valid predictor of atherosclerosis in women with gestational diabetes mellitus (GDM). Serum samples from 39 pregnant women with GDM and 25 healthy pregnant women were collected for the analysis of SAA. CIMT was measured in both groups to evaluate future atherosclerotic heart disease risk. The SAA level was measured with ELISA. The mean arterial blood pressure (MABP), CIMT and SAA levels were significantly higher in women with GDM compared with healthy pregnant controls (p = 0.033, p = 0.001 and p = 0.004, respectively). There were significant correlations between SAA and age, BMI, MABP, 50-g oral glucose tolerance test (OGTT), and A1c (p = 0.048, p = 0.037, p = 0.035, p = 0.042 and p = 0.048, respectively) and between CIMT and BMI, MABP, and 50-g OGTT, (p = 0.001, p = 0.004 and p < 0.001, respectively) in correlation analysis. Furthermore, there was a correlation between SAA and CIMT (p = 0.048). Increased SAA and CIMT values in GDM compared with healthy controls might indicate an increased risk of subclinical atherosclerosis and future atherosclerotic heart disease and the importance of inflammation in this process. These changes were associated with obesity, hypertension and glucose intolerance-related factors (BMI, MABP, and 50-g OGTT), which may be relevant to GDM pathophysiology.

Serum prolidase activity in diabetic foot ulcers

Impaired wound healing is an important problem in diabetes mellitus; however, its pathogenesis remains unclear. We aimed to evaluate serum prolidase activity (SPA), an important marker of collagen turnover, in subjects with and without diabetic foot ulcers as compared with healthy controls. Twenty-seven patients with diabetic foot ulcers (foot ulcer group), 27 patients without diabetic foot ulcers (diabetic control group) and 27 healthy controls were enrolled. The study groups had similar age, sex distribution and body mass index. Metabolic and inflammatory parameters as well as SPA were determined. The diabetic foot ulcer group had significantly higher SPA (both pxa0<xa00.001) when compared with the diabetic and the healthy control groups. SPA showed a positive correlation with high-sensitive C-reactive protein and a negative correlation with high-density lipoprotein cholesterol levels (rxa0=xa00.313, pxa0=xa00.021 and rxa0=xa0−0.233, pxa0=xa00.036, respectively). No correlation was detected between SPA and glycaemic parameters. SPA appears to be higher in patients with diabetic foot ulcers when compared with patients without diabetic foot ulcers and healthy controls. The underlying mechanisms of elevated SPA and its clinical significance in predicting the natural course of wound healing in diabetic foot ulcers needs to be further evaluation.

The Impact of Carvedilol and Metoprolol on Serum Lipid Concentrations and Symptoms in Patients with Hyperthyroidism

Background. Hyperthyroidism is associated with unpleasant symptoms and hypertension due to increased adrenergic tone. Therefore, beta-blockers are often used in hyperthyroid patients. While some beta-blockers (such as propronolol and metoprolol) may have unwanted effects on lipid profile, carvedilol, a new alpha- and beta-blocker, has been suggested to have some metabolic advantages with respect to lipid profiles in hypertensive patients. However, this has not been shown in hyperthyroid patients. Objective. We aimed to compare the effects of two beta-blockers (metoprolol and carvedilol) on the lipid profiles of hyperthyroid patients with hypertension. Methods. Thirty patients with hyperthyroidism and hypertension were randomly assigned to receive either carvedilol (n = 15) or metoprolol (n = 15). Thyroid-stimulating hormone (TSH), free T3, free T4, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride, and total cholesterol levels were measured before and following 3 months of treatment. Results. Systolic and diastolic blood pressure, heart rate, TSH, and free T4 improved significantly in both treatment groups. There were no statistically significant changes in the lipid parameters in either of the two treatment groups; however, triglyceride levels slightly decreased with carvedilol treatment. There were also no differences between the two groups in terms of the typical symptoms of hyperthyroidism. Conclusion. Carvedilol might be a preferred agent to treat hyperthyroid patients who have hypertension and dyslipidemia. This is likely due to the possible beneficial effect of carvedilol on lipid parameters, especially on triglyceride levels.

High Serum Concentration of Interleukin-18 in Diabetic Patients with Foot Ulcers

BACKGROUNDnIt is well known that interleukin-18 (IL-18) plays a key role in the inflammatory process. However, there are limited data on the role IL-18 plays with diabetic foot ulcers, an acute and complex inflammatory situation. Therefore, we aimed to evaluate serum IL-18 levels of diabetic patients with foot ulcers.nnnMETHODSnTwenty diabetic patients with acute foot ulcers, 21 diabetic patients without a history of foot ulcers, and 21 healthy volunteers were enrolled in our study. Circulating levels of IL-18, and other biochemical markers are parameters of inflammation and were measured in all three groups.nnnRESULTSnDiabetic patients both with and without foot ulcers had high IL-18 concentrations (P < 0.001 and P = 0.020, respectively) when compared with the nondiabetic volunteers. Those with foot ulcers had higher levels of IL-18 level (P < 0.001), high-sensitivity C-reactive protein (hsCRP) (P = 0.001), and erythrocyte sedimentation rate (ESR) (P < 0.001) than those without foot ulcers.nnnCONCLUSIONSnWe found that serum IL-18 concentrations were elevated in diabetic patients with acute diabetic foot ulcers. However, these findings do not indicate whether the IL-18 elevation is a cause or a result of the diabetic foot ulceration. Further studies are needed to show the role of IL-18 in the course of these ulcers.