Mehmet Yuruyen

Circulating miR-21 and eNOS in subclinical atherosclerosis in patients with hypertension

Abstract Objectives: The aim of this study is to evaluate the relationship of miR-21, nitric oxide (NOx) and endothelial nitric oxide synthase (eNOS) with subclinical atherosclerosis in carotid arteries by measuring carotid intima media thickness (CIMT) in patients with hypertension and healthy controls. Design and Methods: A total of 28 hypertensive and 28 healthy controls were enrolled. MiR-21 expression was analyzed by quantitative reverse transcription-PCR and NOx, and eNOS levels were measured by ELISA assay. CIMT was evaluated by ultrasonography and CIMT ≥ 0.8 mm was accepted as increased CIMT (iCIMT). Results: C-reactive protein (CRP) level, plasma miR-21 expression level and CIMT were found to be significantly higher in the hypertension group when compared to the control group (p = 0.009, p = 0.002 and p < 0.001, respectively). NOx and eNOS levels were significantly lower in the hypertension group compared to the control group (p < 0.001, both). MiR-21 level was positively correlated with the clinical systolic blood pressure, clinical diastolic blood pressure, CRP and CIMT. MiR-21 was also negatively correlated with NOx and eNOS. Eighteen patients with hypertension had iCIMT. MiR-21 and CRP levels were significantly higher (p < 0.001 and p = 0.001), whereas NOx and eNOS levels were significantly lower in patients with iCIMT (p < 0.001, both). Conclusion: The decreased levels of NOx and eNOS found in this study indicate the co-existence of endothelial dysfunction and hypertension once more. In the absence of microalbuminuria, the increased miR-21 expression in patients with iCIMT made us conclude that this miRNA might be involved in the early stages of atherosclerotic process in hypertensive patients.

Propylthiouracil-induced lupus-like or vasculitis syndrome

A 27 year old female with Graves’ disease presented with fever, exertional dyspnea and polyarthralgia. Erythema nodosum had occured three months earlier. The patient declared irregular use of propylthiouracil (PTU) for the last 8 months. Neutropenia and microscopic hematuria developed in the second week of admission. Chest X-ray showed inhomogenous pulmonary opacities, left pleural effusion and cardiomegaly. Computed tomography (CT) revealed multiple subpleural nodules, left pleural effusion, pericardial effusion, enlarged mediastinal and axillary lymph nodes. Bronchoalveolar lavage (BAL) cytology demonstrated hemosiderin laden macrophages. Histopathologic examination of the transbronchial biopsy specimen revealed a nonspecific inflammation. Serum was positive for ANA, P-ANCA, MPO-ANCA, PR3-ANCA and negative for anti-ds-DNA, C-ANCA, C3, C4 and anti-histone antibody. All symptoms resolved in two months after PTU withdrawal and starting steroid treatment. The same clinical manifestations recurred when the patient used PTU erronously one month after discharge.This is a case of PTU induced-autoimmune disease in whom the accurate distinction between drug-induced-lupus (DIL) and vasculitis was not possible due to the significant overlap of clinical and laboratory findings causing a significant diagnostic challenge for the chest physician.

Primary sarcopenia in older people with normal nutrition

ObjectiveThe aim of this study was to investigate the presence of primary sarcopenia in older patients with normal nutrition and to assess the relationships between the primary sarcopenia with anthropometric measurements.Design and methodsIn this prospective clinical cross-sectional study, six-hundred patients who applied to Polyclinic of Geriatrics between dates 2010 and 2011 have been evaluated. The 386 patients who were supposed to have potential secondary sarcopenia were excluded from the study. Age, gender, weight, height, BMI, calf and waist circumference, ongoing medications, additional diseases of the 214 patients included in the study have been surveyed. The sarcopenia criteria of EWSGOP have been applied.ResultsTwo hundred fourteen cases included in the study were composed of 148 female and 66 male subjects. Mean age was 71.8 ± 2.1 years. Sarcopenia was detected in 105 subjects while 109 (51%) were normal. Sixty-four female (61%) and 41 (39%) male subjects were sarcopenic. Normal group included 84 female (77%) and 25 male (23%) subjects. Incidence of sarcopenia was found higher in the female patients (p<0.001). No statistically significant difference was detected between sarcopenic and normal groups with respect to age, height, weight, calf circumference and evaluation tests. Waist circumference was higher in the sarcopenic group than the normal group (p=0.02). When both groups were analyzed for BMI; 53 (51%) of the 105 sarcopenic patients had BMI over 30 kg/m2 while 29 (27%) and 23 (22%) patients had BMI of 25–30 kg/m2 and below 25 kg/m2, respectively. Incidence of sarcopenia was significantly higher in the group with BMI over 30 kg/m2 when compared with the groups with BMI of 25–30 kg/m2 and below 25 kg/m2 (p=0.01).ConclusionSarcopenia that makes older people physically dependent and decreases their quality of life that receive sufficient nutritional support and are also obese should be comprehensively investigated with respect to presence of sarcopenia.

Does plasma phoenixin level associate with cognition? Comparison between subjective memory complaint, mild cognitive impairment, and mild Alzheimer's disease

BACKGROUND Alteration in energy expenditure or metabolism is the most accused risk issue for the onset and for the course of neurodegenerative cognitive disorders. Neuropeptides are suggested to be related with learning and memory. Phoenixin (PNX) is the most recently reported neuropeptide and we aimed to compare the plasma level in people with subjective memory complaints, patients with mild cognitive impairment, and mild Alzheimers disease (AD). METHODS Ninety two participants enrolled in the study. After screening tests, all participants were assessed with a neuropsychological battery for further cognitive evaluations. We used ELISA kit to assay the level of Human PNX. RESULTS Patients with AD were significantly older than people in subjective memory complaint group (p = 0.02). There was no significant difference between groups according to gender (p = 0.435). Mean plasma PNX level was not significantly different between groups (p = 0.279). Mean plasma PNX level in MCI group was positively correlated with BMI (r = 0.402 and p = 0.028), serum HDL level (r = 0.454 and p = 0.012), blood systolic pressure (r = 0.428 and p = 0.018) and negatively correlated with logical memory (r=-0.335 and p=0.031). The mean plasma PNX level was positively correlated with immediate recall in subjective memory complaint group (r = 0.417 and p = 0.034). CONCLUSION This study is the first studying the association of plasma PNX level and cognitive complaints or decline. The knowledge about the role, interaction, and physiological functions of PNX is lacking. Lower plasma PNX level might be important in prodromal stages as MCI and the predictive role of PNX should be investigated in further studies.

Acromegaly and aging: A comparative cross-sectional study

OBJECTIVE Cognitive and functional geriatric assessment may change in acromegaly. Herein we aimed to determine at which points geriatric assessment of the cases with acromegaly differs from that of general elderly population. DESIGN In this comparative cross-sectional study, a total of 30 cases with acromegaly (controlled n = 14, uncontrolled n = 16) and 30 gender and body-mass index-matched cases without acromegaly (control group, CG) above 60 years old were included. Cognitive functions were evaluated on the basis of the mini-mental state exam (MMSE). Affective status was determined using the geriatric depression scale. Activities of daily living (ADL) were ranked according to the Barthel index while instrumental activities of daily living (IADL) were graded on the basis of the Lawton scale. Nutritional status was evaluated using the mini-nutritional assessment (MNA). Body composition was measured through bioimpedance analysis. Functional mobility was determined using the Timed Up and Go test (TUG) and muscle strength with the handgrip strength test. RESULTS Scores on the MMSE were significantly lower in the elderly cases with acromegaly than in the cases without acromegaly (p < 0.001). Dementia was more frequent in the acromegaly group than in the CG (p = 0.04). Total MNA scores were significantly lower in cases with acromegaly than in the CG (p = 0.006). More subjects in the acromegaly group (33%) were at greater risk of malnutrition than in the CG (3%) (p = 0.003). There was greater moderate functional impairment based on Barthel ADL in the acromegaly group than in the CG (p = 0.04). CONCLUSION Acromegaly may impair cognitive functions, functional mobility and instrumental daily living activities in the geriatric population. With acromegaly, the risk of malnutrition may also increase.

Neutrophil and platelet to lymphocyte ratios in people with subjective, mild cognitive impairment and early Alzheimer's disease: Inflammation in cognitive impairment

The most common cause of dementia in the elderly is Alzheimer’s disease (AD). Studies have suggested that amyloid β leads to neuroinflammation by promoting synthesis of cytokines and pro-inflammatory mediators, and in turn, chemokines and cytokines induce the production of amyloid β. Mild cognitive impairment (MCI) is an intermediate state between normal ageing and dementia. Subjective cognitive decline (SCD) is also considered an early stage of subsequent cognitive impairment, and it carries a risk of developing into dementia. Neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) are useful and cost-effective biomarkers that show peripheral systemic inflammation. In this study we aimed to explore the role of inflammation in subjects with mild AD, MCI, and SCD via the new potential inflammation markers of NLR and PLR. The study was conducted in the geriatrics and geriatric psychiatry outpatient clinics of the Medical School of Cerrahpasa between 1 January and 31 October 2015. All patients provided written informed consent before clinical assessment. The local ethics committee of Cerrahpasa Medical School approved the study. In the screening phase, after an unstructured interview conducted according to the Diagnostic and Statistical Manual of Mental Disorder, 4th edition (text revision), patients were assessed by the Mini-Mental State Examination, Clinical Dementia Rating Scale, Geriatric Depression Scale, and Hachinski Ischemic Scale. Statistical analyses were performed using SPSS version 16 for Windows (IBM SPSS Inc, Chicago, IL, USA). Significance was set at a P-value <0.05. The study sample consisted of 31 patients with mild AD, 30 with MCI, 31 with SCD, and 31 healthy controls. Sociodemographic characteristics of the groups are shown in Table 1. The NLR value was 2.38 0.81 for AD patients, 2.48 1.19 for MCI patients, 2.24 1.11 for SCD patients, and 1.85 0.80 for healthy controls. NLR was significantly higher in the AD and MCI groups when compared with control group (P = 0.006, P = 0.030, respectively). Pairwise comparisons between AD and MCI groups, AD and SCD groups, and MCI and SCD groups showed no significant difference in NLR (P = 0.757, P = 0.245, P = 0.381, respectively). PLR levels were lowest in the healthy controls (110.29 39.28) and had a rising tendency in AD (124.26 45.41), SCD (124.74 39.60), and MCI subjects (139.61 65.01). NLR, PLR, lymphocyte, neutrophil, and platelet levels are shown in Table 2. In our cross-sectional study, NLR was significantly higher in the AD and MCI groups than in the control group. Strikingly, the same significant difference was not observed between the SCD and control groups. Differences in PLR levels were insignificant among the four groups. The role of NLR in AD patients was first investigated by Kuyumcu et al., who found NLR to be significantly higher in AD patients than in controls. This study also proposed that NLR was a strong independent variable for predicting AD. A study by Rembach et al. evaluated the longitudinal status of NLR in AD, MCI, and healthy controls at baseline and at 18, 36, and 54 months; it reported that the increase in NLR is a function of age and weakly correlates with neocortical amyloid accumulation. In this longitudinal study, Rembach et al. observed that NLR did not significantly differ (except for 18 months) between AD patients and healthy controls after adjustment for age, sex and Apolipoprotein E (APOEε4) allele status. Although inflammation markers have been found to be associated with MCI, a recent meta-

Alexithymia in people with subjective cognitive decline, mild cognitive impairment, and mild Alzheimer’s disease

BackgroundBehavioral and psychological symptoms are widely accepted as accelerator factors in progression to dementia. Although alexithymia is closely related to normal aging process and poor neurocognitive performance, alexithymia has not been included in these symptoms yet.AimsHere, we aimed to investigate alexithymia features in people with prominent clinical memory complaints.MethodsThe participants (n = 82) were classified into three groups as: subjective cognitive decline (n = 30), mild cognitive impairment (n = 27), and mild Alzheimer’s disease (n = 25) after Mini-Mental State Examination, Clinical Dementia Rating Scale, neuropsychological test battery, Geriatric Depression Scale, and Hachinski Ischemic Scale. All participants were assessed with 20-item Toronto Alexithymia Scale.ResultsThe patients with mild Alzheimer’s disease and mild cognitive impairment have significantly greater alexithymia features than individuals with subjective cognitive decline in Toronto Alexithymia Scale (p < 0.05 for all). The alexithymia features in patients with mild Alzheimer’s disease and mild cognitive impairment did not significantly differ (p > 0.05, for all).DiscussionPeople who have objective cognitive decline seem to have more alexithymia features than people with subjective cognitive decline. Moreover, alexithymia features seem to be similar in people mild Alzheimer’s disease and in mild cognitive impairment.ConclusionAlexithymia might be an important searching domain of behavioral–psychological symptoms in people with cognitive problems beyond aging.

Hyperostosis frontalis interna presenting as depression and parkinsonism in an older woman.

Dear Editor, Hyperostosis frontalis interna (HFI) is a well-described entity from ancient times that occurs in 24% of women and 5.2% of men. Although meaningful association between HFI and neurological disorders has not been proven, HFI frequently accounts for neuropsychiatric symptoms including frontal executive dysfunctions, epilepsy, cognitive impairments, parkinsonism, and frontal headache. Here, we present an HFI case involving a woman with symptoms of depression and parkinsonism.

Reliability and Validity of Rowland Universal Dementia Assessment Scale in Turkish Population

Background: The aim is to validate Turkish version Rowland Universal Dementia Assessment Scale (RUDAS). Methods: One hundred forty patients (>65 years) were included. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition -V was used in all patients. Rowland Universal Dementia Assessment Scale was applied for 2 days. Results were compared with Mini-Mental State Examination; reliability, validity, and statistical values were determined. Results: Time validity was verified. Mini-mental state examination was correlated 45.3% in control and 73% in dementia group. Factor weights varied between 0.44 and 0.81; factor construct was verified as 6-item scoring. When 25 was cutoff point, sensitivity was 92.86% and specificity was 92.86%. Content validity index was found to be 100% by 7 specialists. Cronbach α (0.692) and test–retest reliability (intraclass correlation = 0.987) were determined. Conclusion: Rowland Universal Dementia Assessment Scale (Turkish) is validated and verified as reliable. Test could be applied for 5 minutes approximately; results are not affected by educational status, immigrant status, and language used; however, age and gender have significant effect on results.

Applied botulinum neurotoxin injection in a patient with dementia to reduce hypersalivation

1 Grupper M, Kravtsov A, Potasman I. Emphysematous cystitis: Illustrative case report and review of the literature. Medicine (Baltimore) 2007; 86: 47–53. 2 Thomas AA, Lane BR, Thomas AZ et al. Emphysematous cystitis: a review of 135 cases. BJU Int 2007; 100: 17–20. 3 Eken A, Alma E. Emphysematous cystitis: the role of CT imaging and appropriate treatment. Can Urol Assoc J 2013; 7: 754–756. 4 Asada S, Kawasaki T. Images in clinical medicin. Emphysematous cystitis. N Engl J Med 2003; 349: 258. 5 Datta A, Seminario O. Emphysematous cystitis presenting with subcutaneous emphysema. Urology 1978; 12: 701–703. 6 Sadek AR, Blake H, Mehta A. Emphysematous cystitis with clinical subcutaneous emphysema. Int J Emerg Med 2011; 13: 26. 7 Sayhan MB, Aygun A. Lower abdominal pain in an immunocompromised diabetes mellitus patient. Turk J Emerg Med 2016; 15: 190–191.