Mehmet Gundogdu

Trace elements and some extracellular antioxidant proteins levels in serum of patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a chronic progressive autoimmune disorder with a wide spectrum of clinical and immunological abnormalities. In this study, we aimed to investigate the levels of serum zinc (Zn), copper (Cu), magnesium (Mg), manganese (Mn), iron (Fe), ceruloplasmin (Cp), transferrin (Trf), and albumin (Alb) in SLE and whether it is related to the severity of the clinical condition of this chronic disease. Cp and Cu levels were higher, while Trf, Alb, Zn, Mg, Mn, and Fe levels were lower in serum of patients with SLE (n=27) compared with healthy controls (n=20). The mechanisms by which these alterations occur in certain inflammatory conditions need to be elucidated. It is also obscure whether these alterations are a cause or a consequence of the inflammation. As a conclusion, alterations in the levels of the parameters in SLE may not be a reason for, but in fact a consequence of the disease itself.

Levels of soluble E-selectin in patients with active Behçet’s disease

Behçet’s disease is a systemic vasculitis of unknown aetiology. Endothelial cell injury plays an important role in the pathogenesis and immunopathology of Behçet’s disease. E-selectin is expressed by activated endothelial cells. Because the selectin adhesion molecules are shed from activated cells, soluble forms of these proteins can be used as activation markers of endothelium (E-selectin). The pathogenesis of Behçet’s disease (BD) is closely related to endothelial cells, leucocyte functions and immunity. The aim of this study was to investigate circulating E-selectin adhesion molecules, which are known to play a significant part in the immune response especially by regulating interaction of the leucocytes with endothelium in BD. Plasma E-selectin concentrations were evaluated in 23 patients with BD and 20 healthy control subjects. The disease activity was evaluated by clinical manifestations (oral aphthous ulcer, genital ulceration, positive pathergy test, skin lesions, eye involvement, thrombophlebitis and arthritis) and by laboratory investigations [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)]. The patients were newly or previously diagnosed cases not taking any drug for BD. Levels of E-selectin were measured with commercially available sandwich enzyme- linked immunosorbent assay (ELISA) kits using human sE-selectin (cat. no: BMS 205). Plasma E-selectin concentrations of patients and controls were compared with the Mann-Whitney U test. Statistical significance was assigned to p values lower than 0.05. Serum levels (mean±SD) of soluble E-selectin (sE-selectin) were significantly higher in 23 patients with BD than in 20 healthy controls (53.2 ± 18.2 ng/ml vs 33.8 ± 7.5 ng/ml, p < 0.0001). A statistically significant positive correlation was observed between sE-selectin levels and CRP and ESR in patients with BD (r = 0. 78, p < 0.001 and r = 0.56, p < 0.01, respectively). Increases in the E-selectin in BD may be a direct consequence of the leucocyte and endothelium activations observed during the disease process. The noninvasive investigations can be used as biochemical markers for inflammation. This may provide additional information regarding disease activity along with the traditional indices such as ESR and CRP.

Thrombotic Thrombocytopenic Purpura Associated With Brucella Infection

Thrombotic thrombocytopenic purpura (TTP) is characterized by disseminated thrombotic occlusions located in the microcirculation and a syndrome of microangiopathic hemolytic anemia (MAHA), thrombocytopenia, fever, and renal and neurologic abnormalities. Although several factors such as viral and bacterial pathogens, pancreatitis, drugs, collagen-vascular diseases, cancers, and pregnancy have been reported to be associated with TTP, brucellosis is an exceptional cause of this disorder. We represent a 19-year-old woman applying to our outpatient department with the complaints of headache, fever, sweat, malaise, and jaundice. Clinical signs and laboratory findings were consistent with TTP. Brucella agglutination was found to be 1/320 positive. After the administration of therapeutic plasma exchange, all symptoms and laboratory abnormalities improved dramatically. Antibiotic therapy directed to Brucella infection was initiated and no recurrence of TTP was seen.

Thrombotic Thrombocytopenic Purpura in a Patient with Brucella Infection Is Highly Responsive to Combined Plasma Infusion and Antimicrobial Therapy

Objective: To report a case of brucella infection presenting with thrombotic thrombocytopenic purpura (TTP) that responded well to plasma and antimicrobial treatment infusion. Case Presentation and Intervention: A 51-year-old man with moderate confusion, depressed mood and dysarthria was admitted. He was chronically ill, with fever (38.5°C), anemia, jaundice and petechial-purpuric skin lesions. Neurological examination revealed diminished consciousness with a Glasgow coma scale score of 7 and +1 neck rigidity. The hemoglobin and platelet counts were decreased and reticulocyte index, erythrocyte sedimentation rate, as well as serum lactate dehydrogenase and renal dysfunction were elevated. TTP was a possible diagnosis and the patient responded well to plasma infusion and antimicrobial treatment. Conclusion: This report shows that therapy of underlying infection together with plasma infusion may be a successful treatment option for brucellosis-induced TTP.

Tumour necrosis factor-α levels in hepatitis B virus-related chronic active hepatitis and liver cirrhosis and its relationship to Knodell and Child-Pugh scores

Although both chronic active hepatitis‐B (CAH‐B) and liver cirrhosis (LC) are characterised by various degrees of inflammation and hepatocyte necrosis, in advanced stage cirrhosis, marked fibrosis develops and inflammation and tissue necrosis diminishes.

Oxidase Activity of Ceruloplasmin and Some Acute Phase Reactant and Trace Element Concentrations in Serum of Patients with Chronic Lymphocytic Leukemia

In the present study, we aimed to investigate the parameters in serum of patients with chronic lymphocytic leukaemia (CLL) and correlate with the cancer stage. The serum concentrations of ceruloplasmin, a-1-acid glycoprotein, albuminumin, transferrin, copper, zinc, manganese, and ceruloplasmin oxidase activity were measured, and compared with those from a healthy control group. The serum from 34 patients with CLL were extracted before chemotherapy. Serum transferrin, albuminumin and Zinc concentrations were lower in patients with CLL while serum a-1-acid glycoprotein, ceruloplasmin, copper concentrations, and ceruloplasmin oxidase activity were higher in CLL patients when compared with the control group. Although serum manganese concentration was lower in CLL groups than in the control group, the difference was not statistically significant. Serum transferrin concentration was lower in the early stage group compared with the advanced stage. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients from the early stage group. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients with advanced stage. In conclusion, increased serum ceruloplasmin oxidase activity, ceruloplasmin, a-1-acid glycoprotein, copper levels and decreased transferrin and albuminumin, unchanged manganese levels are associated with CLL and appear to be a consequence of the disease itself.

Mercury Toxicity: A Family Case Report

Background: Environmental pollution exposes humans to toxic substances. Herein we present 5 family members aged20-54 years that were poisoned by liquid mercury. Case Reports: Case 1 presented to our clinic with cough, fever, and night sweats. The patient had neutropenia, anemia,and pneumonia, rapidly developed acute respiratory distress syndrome (ARDS), and died on day 4 of hospitalization.Her WBC count was 0.4 × 10³ mm-3 (normal range: 4.3-10.3 × 103 mm-3) and Hb was 10.8 g dL–1 (normal range: 11.5-16.0 g dL–1). Case 2 presented with bicytopenia; the leukocyte count was 1.3 × 103 mm-3 (normal range: 4.3-10.3 × 103mm-3) and the PLT count was 88 × 103 mm-3 (normal range: 150-400 × 103 mm-3). Cases 2 and 3 had toxic peripheralneuropathy. The PLT count in case 3 was 123 × 103 mm-3 (normal range: 150-400 × 103 mm-3). Cases 4 and 5 presentedwith fatigue and headache; these 2 patients did not have positive findings, apart from high levels of mercury in theblood. We have written informed consent. Conclusion: We think that heavy metal exposure—although rare—should be considered in patients that present withnumerous symptoms involving multiple systems, including the cardiovascular, respiratory, and neurological systems.The present report is unique in that in describes mercury poisoning in 5 members of the same family.

Acute promyelocytic leukemia, centre, experience, Turkey

Acute promyelocytic leukemia (APL) is a specific type of acute myeloid leukemia (AML) and has distinct hematopathologic, cytogenetic, clinical and molecular features. This study was a retrospective review of 18 adult patients (10 male, 8 female; mean age of 32.17 ± 5.66 (15-61 years) with APL at our department from January 2006 to December 2011. Following induction therapy, 17 patients achieved CR, 1 of 18 patients died of result bleeding within thirty-sixth hours of admission. In two of 18 patients developed RAS. The relapse rate was 27% (5/18). Fourteen of 18 patients (77%) have been followed in remission. APL is a malignancy requiring quick diagnosis, efficient treatment and supportive care system. ATO, one of the important therapy option in the treatment of APL, cannot be obtained easily in developing countries. This may lead to an increase in the mortality rates. The studies should be made with more number of patients and a longer period of time for accurate results.

Effect of VKORC1-1639 G>A polymorphism on warfarin response in east of Turkey / Türkiye’nin doğusunda warfarin yanıtı üzerine VKORC1-1639 G>A polimorfizminin etkisi

Abstract Objective: The aim of the present study was to investigate whether the VKORC1 -1639 G>A polymorphisms could determine differences in the warfarin dose required to maintain a therapeutic INR in patients living in east of Turkish. Methods: A total of 80 patients (45 female and 35 male) aged between 17 and 85 years (mean age 58.96±16.59 years) using warfarin for at least one month and presenting at Atatürk University Medical Faculty Outpatient Clinic between May 2009 and May 2010 were included in the study. Patients underwent genotype investigations and carrier forms of VKORC1 -1639 variants; homozygous (AA), heterozygous (GA) and wild types (GG) were determined. Results: In AA and GA groups, daily warfarin maintenance doses were statistically significant lower than in GG (p=0.010 and p=0.016, respectively). There was no significant difference between AA and GA groups regarding to warfarin dose (p>0.05). INR values were higher in GA and AA groups than in GG group and differences were statistically significant (p=0.014 and p=0.016, respectively). Also there was no difference between GA and AA gropus in terms of INR. Conclusion: In conclusion, our study verified the interindividual variability in warfarin maintenance dose due to VKORC1-1639 G>A polymorphism in patients living in east of Turkish. In order to avoid serious bleeding events in warfarin therapy, prescription of warfarin should be done on an individual basis with consideration for the patient’s genetic background. Özet Amaç: Çalışmanın amacı Türkiye’nin doğusunda yaşayan hastalarda, tedavi edici INR seviyesine ulaşmak için gerekli warfarin dozunun VKORC1 -1639 G>A polimorfizmine göre değişiklik gösterip göstermediğini tespit etmekti. Metod: Çalışma kapsamına Atatürk Üniversitesi Tıp Fakültesi İç Hastalıkları Polikliniği’ne Mayıs 2009 ve Mayıs 2010 yılları arasında yaşları 17-85 arasında olan (ortalama yaş 58.96±16.59 yıl) ve en az bir ay süre ile warfarin kullanan, 45’i kadın ve 35’i erkek, toplam 80 hasta alındı. VKORC1 -1639 G>A polimorfizmi için genetik araştırma yapıldı ve bu genin varyantları; homozigot (AA), heterozigot (GA) ve wild tip (GG) olması açısından değerlendirildi. Bulgular: Günlük warfarin idame dozu, AA ve GA grubunda GG grubundan istatistiksel olarak anlamlı düşüktü (sırasıyla p=0.004 ve p=0.017). AA ve GA grubu arasında warfarin dozu açısından anlamlı farklılık yoktu (p>0.05). GA ve AA gruplarında, INR değerleri GG grubuna göre daha yüksekti ve farklılıklar istatistiki olarak anlamlı idi (sırası ile p=0.014 ve p=0.016). Ayrıca INR değeri açısından GA ve AA grupları arasında farklılık yoktu. Sonuç: Sonuç olarak çalışmamız; Türkiye’nin doğusunda yaşayan hastalarda, VKORC1-1639 G>A polimorfizmi nedeni ile warfarin idame dozları arasında bireysel farklılık olduğunu doğruladı. Warfarin tedavisine bağlı oluşan şiddetli kanamaları önlemek için tedaviye başlamadan önce hastanın genetik yapısına göre kişiye özel warfarin dozunu belirlemek gerekir.

Atherosclerotic Effects of Smoking and Excess Weight

Background: Metabolic syndrome is a systemic atherosclerotic cascade terminating with multi-organ failures. Methods: Consecutive patients with Coronary Heart Disease (CHD) were studied. Results: Study included 1,620 females and 1,240 males. Prevalences of CHD were similar in both sexes (3.8% versus 4.4%, respectively, p>0.05). Mean ages of CHD cases were 61.5 versus 63.5 years in both sexes, respectively (p>0.05). Smoking and Chronic Obstructive Pulmonary Disease (COPD) were higher in males with CHD (54.5% versus 9.6%, p 0.05 for both) probably due to small sample sizes of the groups. Whereas low density lipoprotein cholesterol (LDL-C) and triglyceride (TG) were higher in females with CHD, significantly (132.6 versus 115.6 mg/dL, p=0.008 and 250.3 versus 150.1 mg/dL, p=0.002, respectively). Similarly, hypertension (HT) and diabetes mellitus (DM) were also higher in females with CHD, significantly (58.0% versus 30.9%, p<0.001 and 51.6% versus 38.1%, p<0.05, respectively). Conclusion: Metabolic syndrome is a systemic atherosclerotic process exaggerated by some metabolic disorders. Smoking and excess weight may be the major triggering causes of the syndrome, and they come with similar degree of clinical severity in front. Smoking and COPD were higher in males with CHD against the higher BMI, WCH, LDL-C, TG, HT, and DM in females, resulting with similar prevalences of CHD in both sexes.