Mehmet Rami Helvaci

Protective Effects of N-Acetylcysteine on Cyclosporine-A-Induced Nephrotoxicity

Objectives. Cyclosporine A (CsA) is used for the treatment of autoimmune and inflammatory disorders. However, CsA‐induced nephrotoxicity remains an important clinical problem, and oxidative stress has been implicated as a possible responsible mechanism. We assessed the protective ability of N‐acetylcysteine (NAC), an antioxidant, against CsA-induced nephrotoxicity. Materials and Methods. Wistar albino rats were randomly assigned into four groups. Group 1 rats were treated with sodium chloride as control, group 2 with CsA, group 3 with CsA and NAC, and group 4 with NAC alone. Animals were sacrificed and blood samples were analyzed for blood urea nitrogen (BUN), serum creatinine (Cr), malondialdehyde (MDA) and nitric oxide (NO) levels, and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities. Kidney sections were analyzed for MDA and NO levels and SOD and GSH-Px activities, as well as histopathological changes. Results. Overall, the treatment of rats with CsA alone produced significant increases in NO and MDA levels and significant decreases in SOD and GSH-Px activities in serum and renal samples. Morphological changes, including tubular epithelial atrophy, vacuolizations, and cellular desquamations, were clearly observed in the rats treated with CsA alone. Concurrent NAC administration with CsA improved renal function, as indicated by lower BUN and Cr values. Moreover, NAC significantly reduced MAD and NO levels and increased SOD and GSH-Px activities in serum and renal tissue, as well as provided a histologically proven protection against CsA-induced nephrotoxicity. Conclusion. These results indicate that NAC produces a protective mechanism against CsA-induced nephrotoxicity and suggest a role for oxidative stress in pathogenesis.

Hereditary Behavior of Varicocele

The inheritance of varicoceles and the potential transmission to first-degree relatives has rarely been investigated. In the present study, we examined the first-degree relatives of men with known varicocele to reveal the familial risk for varicocele. Of the patients with clinical varicocele who presented with infertility, testicular pain, or asymmetrical swelling of the scrotum between June 1, 2008 and May 31, 2009, 49 agreed to have their available first-degree relatives contacted for screening of varicoceles (n = 66). A cohort of 100 consecutive men who applied to the department of internal medicine between 2008 and 2009 for checkup procedure without a history of subfertility or a varicocele were used as a control population. Of the 92 first-degree relatives contacted, 66 (71.7%) decided to participate in this study. Of these 66 men, 21 (33.9%) had a palpable varicocele on physical examination. Compared with a control population (12%), the prevalence of palpable varicocele in the first-degree relatives of patients with known varicocele (33.9%) was approximately 3-fold greater (P < .005). Among the first-degree relatives, 4 (21.1%) of 19 fathers and 17 (36.2%) of 47 brothers had palpable varicocele. As a conclusion, a significant increase in varicocele prevalence is present in the first-degree relatives of men with known varicoceles. Patients should be counseled about this increased risk in male relatives of patients.

Clinical Presentation and Laboratory Findings of Organic Phosphorus Poisoning

This study was conducted to evaluate the demographic, causative, and biologic characteristics of patients with organophosphate (OP) poisoning who were admitted to tertiary teaching and research hospitals at 2 different universities. All patients admitted to the emergency departments of Cukurova University Hospital in Adana, Turkey, between 2001 and 2003 and the Hospital of Mustafa Kemal University in Hatay, Turkey, between 2004 and 2006 were included. The study group consisted of subjects with a mean age of 28.5±14.1 y (range, 14–80 y), and the maximum number of cases in the second decade of life; the female-to-male ratio was 2.2:1. In all, 27 of 43 females and 16 of 20 males were married. Most subjects (n=55) had graduated from primary school; 3 were illiterate and 5 were highly educated. A total of 36 (57.1%) subjects belonged to lower socioeconomic groups. Fifty-three patients intended to commit suicide, and 10 cases were accidental. Mean arrival time of subjects to the hospital after poisoning was 9.9±16.1 h (range, 1–96 h); mean Glasgow Coma Scale score was 10.2±2.9 (range, 3–15). A total of 19 subjects were intubated, and 4 died. A total of 59 patients recovered completely. The mortality rate (6.3%) depended on various factors such as OP compound consumed, amount ingested, time interval before hospitalization, and patients’ general health. Chances for recovery were greater when the patient was hospitalized at the earliest indication. In conclusion, OPs especially affected young single females, and most cases were due to attempted suicide. Because OP poisoning is an important cause of morbidity and mortality, therapy should be started immediately to avoid undesirable consequences.

Ultrasonographic Assessment of the Distal Femoral Cartilage Thickness in Patients with Homozygous Sickle Cell Disease.

Objective To compare the distal femoral cartilage thickness of patients with sickle cell disease (SCD) with those of healthy subjects using ultrasonography. Methods The study comprised 30 patients with SCD (16 male, 14 female; mean age, 30.1 years) and 30 age- and sex-matched healthy subjects. Demographic features and medications of the patients were recorded. With the knees held in maximum flexion, the femoral cartilage thickness was measured bilaterally with a 7- to 12-MHz linear probe. Using ultrasonography, 3 midpoint measurements were taken from both knees: lateral femoral condyle (LFC), intercondylar area (ICA), and medial femoral condyle (MFC). Results Patients with SCD had thinner femoral cartilage thickness values at LFC (P = 0.004), at MFC (P = 0.000), and ICA (P = 0.002) when compared with those of the healthy subjects. Patients with SCD also had lower Hb levels (P = 0.000) levels. Weak positive correlations were determined between Hemoglobin (Hb) levels and ultrasonographic measurements in the SCD group at MFC (r = 0.331, P = 0.010), and ICA (r = 0.289 , P = 0.025 ). Low levels of Hb seem to affect the femoral cartilage thickness. Conclusion These preliminary findings of decreased femoral cartilage thickness in SCD patients should be complemented with future studies. The possibility of early knee joint degeneration and eventual osteoarthritis in SCD should be kept in mind.

Stroke in Severity of Sickle Cell Diseases

Background: Sickle cell diseases (SCDs) are chronic inflammatory process on capillary level. We tried to understand whether or not there are some positive correlations between stroke and severity of SCDs. Methods: All patients with SCDs were taken into the study. Results: The study included 343 patients (169 females and 174 males). There were 30 cases (8.7%) with stroke. The mean ages were similar in both groups (32.5 versus 29.1 years in the stroke group and other, respectively, p>0.05). The female ratios were similar in both groups, too (43.3% versus 49.8%, respectively, p>0.05). Prevalences of associated thalassemia minors were also similar in them (73.3% versus 65.1%, respectively, p>0.05). Smoking was higher among the stroke cases (26.6% versus 13.0%, p 0.05 for all). On the other hand, although the painful crises per year, tonsilectomy, priapism, ileus, pulmonary hypertension, chronic obstructive pulmonary disease, coronary heart disease, chronic renal disease, rheumatic heart disease, avascular necrosis of bones, cirrhosis, and mortality were all higher in the stroke group, the differences were only significant for digital clubbing, leg ulcers, and acute chest syndrome (p<0.05 for all), probably due to the small sample size of the stroke group. Conclusion: SCDs are chronic destructive process on capillaries iniatiating at birth, and terminate with early organ failures in life. Probably stroke is one of the terminal consequences of the inflammatory process that may indicate shortened survival in such cases.

Changes in the cornea related to sickle cell disease: a pilot investigation.

Purpose To investigate corneal structural changes (central corneal thickness, endothelial cell count, and cellular morphology) in patients with sickle cell disease (SCD). Methods This prospective study included 56 patients with SCD and 50 age- and sex-matched healthy subjects without any eye disease aside from refractive errors. Endothelial cell density (ECD), percentage of hexagonality, and the coefficient of variation in cell size (CV) were measured using noncontact specular microscopy, and central corneal thickness (CCT) was measured by pachymetry. Results The mean CCT value was 509.6 ± 20.7 μm in the study group and 520.8 ± 23.6 μm in the control group. The mean ECD, CV, and percentage of hexagonality values in the study group were 2712 ± 335 cells/mm2, 34.5 ± 5.3%, and 57.2 ± 6.6%, respectively, and 3030 ± 247 cells/mm2, 31.6 ± 5.0%, and 60.4 ± 6.9% in the control group, respectively. Endothelial cell density (p = 0.001), CCT (p = 0.011), CV (p = 0.005), and percentage of hexagonality values (p = 0.018) were significantly different between the study and control groups. Conclusions The results of the current study indicate that patients with SCD had considerable morphologic changes in the structure of the cornea when compared to healthy subjects.

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.

Alarming Consequences of the Sickle Cell Diseases

Background: We tried to understand whether or not there are some alarming consequences of sickle cell diseases (SCDs). Methods: All patients with SCDs were included. Results: The study included 434 patients (212 females) with similar ages in males and females (30.8 versus 30.3 years, respectively, p>0.05). Smoking (23.8% versus 6.1%) and alcohol (4.9% versus 0.4%) were higher in males (p<0.001 for both). Disseminated teeth losses (5.4% versus 1.4%, p<0.001), transfused units of red blood cell (48.1 versus 28.5, p=0.000), chronic obstructive pulmonary disease (25.2% versus 7.0%, p<0.001), ileus (7.2% versus 1.4%, p<0.001), cirrhosis (8.1% versus 1.8%, p<0.001), leg ulcers (19.8% versus 7.0%, p<0.001), digital clubbing (14.8% versus 6.6%, p<0.001), coronary heart disease (CHD) (18.0% versus 13.2%, p<0.05), chronic renal disease (CRD) (9.9% versus 6.1%, p<0.05), and stroke (12.1% versus 7.5%, p<0.05) were also higher in males. There were 31 mortality cases (17 males) with similar ages in males and females (30.2 versus 33.3 years, respectively, p>0.05). Mean ages of leg ulcers (35.3 years), digital clubbing (35.4 years), CHD (35.7 years), deep venous thrombosis (DVT) and/or varices and/or telangiectasias (37.0 years), cirrhosis (37.0 years), CRD (39.4 years), and benign prostatic hyperplasia (BPH) (41.5 years) were higher in SCDs. Conclusion: SCDs are severe inflammatory processes on vascular endothelium at the capillary level, terminating with an accelerated atherosclerosis induced end-organ failures and a shortened survival in both genders. Leg ulcers, digital clubbing, CHD, DVT and/or varices and/or telangiectasias, cirrhosis, CRD, and BPH may be the alarming consequences of SCDs indicating an advanced disease.

Mental Health May Not Have a Chronic Low-Grade Inflammatory Background on Vascular Endothelium

Methods: We studied consecutive patients between the ages of 15 and 70 years to be able to see possible consequences of underand excess weight on mental health and to avoid debility induced weight loss in elder individuals. Patients with devastating illnesses and a history of eating disorders were excluded to avoid their possible effects on weight. History of medications for depression and current need for a psychiatric consultation for any cause according to the general physical examination findings of the Same Internist were detected.

Cholelithiasis May Also Be a Consequence of Metabolic Syndrome

Background: We tried to understand whether or not there is a significant relationship between cholelithiasis and parameters of the metabolic syndrome. Methods: The study was performed in Internal Medicine Polyclinics on routine check up patients. All cases with cholelithiasis or already performed cholecystectomy for cholelithiasis were put into the first group and age and sex-matched control cases were put into the second group. Results: One hundred and fourty-four cases either with cholelithiasis or already performed cholecystectomy for cholelithiasis were detected among 3.437 cases, totally (4.1%). One hundred and sixteen (80.1%) of them were female with a mean age of 53.6 years. Obesity was significantly higher (54.8% versus 43.7%, p<0.01) and normal weight was significantly lower (7.6% versus 18.0%, p<0.01) in the cholelithiasis group, and the mean body mass indexes (BMI) were 31.0 versus 28.9 kg/m2 in them, respectively (p<0.01). Probably parallel to the higher mean BMI, prevalences of hypertension (26.3% versus 13.1%, p<0.001) and hypertriglyceridemia (25.0% versus 18.0%, p<0.05) were also higher in the cholelithiasis group, significantly. On the other hand, hyperbetalipoproteinemia was significantly lower in the cholelithiasis group with unknown reasons (9.7% versus 18.0%, p<0.05). Conclusions: Cholelithiasis is a common pathology in society and nearly four-fold more frequent in women, particularly in their fifties. There are significant relationships between cholelithiasis and parameters of the metabolic syndrome including female predominance, elder age, BMI, obesity, hypertension, and hypertriglyceridemia. On the other hand, the significantly lower prevalence of hyperbetalipoproteinemia in the cholelithiasis patients should be researched with further studies.