Mustafa Gültepe

FAMILIAL MEDITERRANEAN FEVER. A REVIEW OF THE DISEASE AND CLINICAL AND LABORATORY FINDINGS IN 105 PATIENTS

BACKGROUND The diagnosis of familial Mediterranean fever still remains clinical, since no specific laboratory test exists, other than a molecular genetic test which is not widely available. AIM To evaluate the clinical findings in 105 Turkish patients; to compare these findings with those in the literature; and to make a brief review of the disease. METHODS A total of 105 familial Mediterranean fever patients were evaluated either retrospectively (for those diagnosed before 1997), or prospectively (for those after 1997). A diagnostic criteria set was used in addition to the clinical and laboratory findings that can be seen in familial Mediterranean fever, including the newly described manifestations. Previously selected clinical and laboratory parameters were observed for three consecutive days. RESULTS Of our patients, 88.5% were of Turkish, 3.8% of Armenian and 7. 6% of Jewish origin. Family history was positive in 87 (82.8%) patients. Involved site was peritoneum in 97 (92%), joints in 45 (42.8%) and pleura in 19 (18%). Frequency of myalgia/arthralgia was 24.7%, and skin findings were observed in 16. 1% of patients. Splenomegaly, not related to amyloidosis, was present in 21 (20%) patients. Meningeal, retinal or ovarian/testicular involvement was not observed. CONCLUSION Identification of familial Mediterranean fever gene has led to the application of a molecular genetic test for the diagnosis of Familial Mediterranean Fever. Until genetic methods become widely available, diagnosis will remain clinical. Thus, awareness of various clinical forms and of the correct usage of diagnostic criteria in various patient populations is important.

In vivo inefficiency of pentoxifylline and interferon-alpha on hepatic fibrosis in biliary-obstructed rats: Assessment by tissue collagen content and prolidase activity

Background and Aim: To evaluate the possible antifibrotic effects of two drugs, pentoxifylline (PTX) and interferon (IFN)‐α as well as their combination, on a bile‐duct‐ligated rat hepatic fibrosis model.

The Role of Prolidase Activity in the Diagnosis of Uremic Bone Disease

The derangements in bone metabolism in patients with chronic renal failure (CRF) are summarized as uremic bone disease (UBD). In this study, we planned to determine the serum prolidase to compare it with the other biochemical markers. This study was performed on 44 patients (19 females, 25 males, mean age = 56.8 ± 15.6 years) with end-stage renal disease (ESRD). The patients were divided into three groups according to serum bone alkaline phosphatase (bAP) levels. The patients whose bAP was ≥77 U/L were accepted as having high-turnover UBD (n = 18), the patients whose bAP was ≤50 U/L were accepted as having low-turnover UBD (n = 14), and the patients whose bAP levels were between these two values were accepted as having bone disease with normal turnover (n = 12). The serum prolidase levels did not increase in patients with ESRD. There were no significant differences between the serum prolidase levels of patients according to types of the UBD (p > 0.05). Kidney is the most prolidase-rich tissue of the human body. The serum prolidase activity is low in all patients with ESRD, irrespective of the type of UBD. Therefore, we concluded that prolidase had no value in the diagnosis of UBD.

CagA status in dyspeptic patients with and without peptic ulcer disease in Turkey: association with histopathologic findings.

CagA seropositivity is closely associated with that of vacuolating cytotoxin (VacA). Helicobacter pylori strains positive for both VacA and CagA were reported to be strongly associated with peptic ulcer disease. Different results reporting that cagA gene is not associated with more serious diseases, lowers the importance of CagA protein as a marker. In this study, CagA seropositivity is examined in Turkish peptic ulcer and nonulcer dyspepsia patients; histopathologic scores of CagA (+) and CagA (−) groups were compared.

The effect of Helicobacter pylori eradication on gastric juice and blood ammonia concentrations and on visual evoked potentials in cirrhotics.

The primary source of ammonia is the gut. Ammonia can also be generated by the urease activity of Helicobacter pylori in the gastric mucosa. The aim of this study was to investigate the effect of H. pylori eradication on blood and gastric juice ammonia levels and on visual evoked potential (VEP) recordings in cirrhotic patients.

Ghrelin Levels and Postnatal Growth in Healthy Infants 0-3 Months of Age

Objective: The effect of ghrelin on growth of the newborn has long been argued, but not fully clarified. In this study, we aimed to investigate the relationship between ghrelin levels and growth parameters in the first 3 months of life. Methods: The study included 60 babies (27 girls and 33 boys) born at gestational ages between 38-42 weeks. The newborns were divided into three groups according to the Lubchenco curves as: small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA). The relationship between ghrelin levels and growth parameters in the third month was investigated. Results: Ghrelin concentrations were significantly higher in SGA (2.4±2.6 ng/dL) babies than in AGA (1.3±0.9 ng/dL) and LGA (1.0±0.8 ng/dL) babies. The lowest ghrelin levels were in the LGA group. In SGA infants, ghrelin concentrations were inversely correlated with change in weight (r=-0.577; p=0.001), change in length (r=-0.361; p=0.005), and change in head circumference (r=-0.387; p=0.002). Conclusion: The results show that at age 3 months, SGA infants had higher ghrelin levels than AGA and LGA infants. Our findings indicate that ghrelin may be involved in the process of catch-up growth in these infants. Conflict of interest:None declared.

Altered red cell membrane compositions related to functional vitamin B12 deficiency manifested by elevated urine methylmalonic acid concentrations in patients with schizophrenia

Abstract Background Abnormal cell membrane composition and functional cobalamin (vitamin B12) deficiency was reported in schizophrenic individuals. We aimed to investigate the relationship between cobalamin state and cell membrane composition in patients with schizophrenia. Methods Malondialdehyde (MDA), cholesterol, and phospholipid classes in the erythrocyte membranes of 18 schizophrenic and 20 healthy individuals of the same age and sex distribution were determined. Serum vitamin B12, plasma total homocysteine, serum folate, and urine methylmalonic acid (uMMA) concentrations were measured in both groups. Results In the schizophrenic group, uMMA, membrane MDA, membrane cholesterol, membrane phosphatidylinositol concentrations were significantly higher and the membrane phosphatidylserine concentrations were lower than the control group values. In schizophrenic individuals, uMMA concentrations have a significant positive correlation with membrane MDA and a negative correlation with membrane cholesterol concentrations (P < 0.05). The negative correlation of uMMA with membrane cholesterol concentrations may be a biological response to the increased membrane rigidity. Also, a free radical elevation related to the elevated uMMA concentrations in the erythrocyte membrane, might reflect the role of methylmalonic acid (MMA) in membrane damage. Conclusion Our present findings suggest that, functional vitamin B12 deficiency representing itself by MMA elevations in schizophrenic individuals could damage cell membrane.

Reduced urinary excretion of homocysteine could be the reason of elevated plasma homocysteine in patients with psychiatric illnesses

OBJECTIVES Although increased plasma total homocysteine (tHcy) concentrations were reported in psychiatric diseases, currently the reasons of elevated tHcy levels were not clearly understood. In this study we aimed to investigate the contribution of renal clearance of homocysteine on plasma tHcy load in patients with depression and first episode psychosis. DESIGN AND METHODS Thirty depression, 14 first episode psychosis patients and 34 healthy individuals (control group) were involved in the study. In patients and control groups, plasma and urine tHcy levels, urine methylmalonic acid (uMMA), serum vitamin B12 and folate concentrations were measured. RESULTS Although there was not any difference between depression, psychosis and control groups with respect to mean (SD) values of vitamin B12 (289(131), 230 (72) and 249(79) pg/mL, respectively) and folate (6.4(4.0), 5.3(2.3) and 5.7(2.3) ng/mL, respectively), plasma tHcy levels of depression and psychosis group were higher than the control values (16.3(6.2), 15.5(4.3) and 9.9(2.1) micromol/L, respectively). Urine tHcy values of patient groups were significantly lower than those in the control group (14.5(7.6), 15.8(6.8) and 29.6(16.9) micromol/g creatinine, respectively). There were elevated uMMA levels in depression and psychosis groups compared with control group (4.9(2.4), 6.6(3.2) and 2.8(1.2) mmol/mol creatinine, respectively). There were a significant and negative correlation between urinary tHcy and plasma tHcy levels (r=-0.258 and p=0.011). CONCLUSION In conclusion, reduced urinary tHcy levels in psychiatric patients could be one of the reasons of plasma tHcy elevations with normal folate and vitamin B12 levels. Altered renal handling mechanisms of homocysteine may lead to elevated plasma tHcy levels by reduced clearance of homocysteine via glomerular filtration.

The Presence of Prolidase Activity in Amniotic Fluid and Its Evaluation as a Maturity Test

Prolidase (EC: 3.4.13.9) catalyses the hydrolysis of the peptide bond involving the imino nitrogen of proline or hydroxyproline. Because of the high proportion of imino acids in collagen, this enzyme plays an important role in its degradation. Since collagen turnover rate is expected to be high during fetal growth, the level of prolidase activity may reflect the degree of fetal maturation. In this study, amniotic fluid prolidase I activity was measured in term and preterm pregnancies. Lecithin concentration, which has been widely used for predicting fetal lung maturity, was also measured. Prolidase I activity was positively correlated with lecithin levels (n = 30; r = 0.42; p < 0.02), and also with birth weight of the babies (n = 30; r = 0.52; p < 0.01) in the term-mature group. Dysmature babies had significantly lower prolidase I activity in the amniotic fluid which was thought to be indicative of growth retardation.

Prolidase activity in serum and pleural fluids in patients with tuberculous pleural effussion

OBJECTIVES Pleural tuberculosis, which is present in around 4% of all tuberculosis cases may resolve spontaneously or associated with progressive disease and a high recurrence rate. Recently upon exposed to cytokines and bacterial products, mesothelium has been shown to produce collagen that may be involved in pleural inflammatory responses. Prolidase is involved in the final stage of degradation in collagen catabolism. In this study we aimed to evaluate pleural fluid and serum prolidase activities in patients with tuberculous (TB) pleurisy and compared with those in non-tuberculous (non-TB) pleural effusions. DESIGN AND METHODS 21 patients with tuberculous (TB) pleurisy (11 F/10 M), ages 35-52 (median 44) and 22 patients (10 F/12 M), ages 41-63 (median 52) with non-tuberculous pleurisy included as non-tuberculous (non-TB) pleurisy group consecutively referred to our pulmonary clinic for evaluation. Serum and pleural prolidase activities in 21 TB and 22 non-TB pleurisy patients were analyzed by photometric method. RESULTS Prolidase enzyme activities in serum and pleural fluids of TB group (1072+/-171 and 1392+/-215 U/L, respectively) were significantly higher than those values in non-TB group (787+/-144 and 943+/-174 U/L, respectively). Prolidase activities in pleural fluid were significantly higher than those in serum in both groups. There was a significant positive correlation between pleural and serum prolidase activities in TB group (r=0.579 and p=0.006) and in non-TB group (r=0.858 and p<0.001). In Receiver Operating Characteristic (ROC) analysis, sensitivity and specificity values were 86% and 82% for a cut-off value of 1130 U/L for pleural prolidase activity and were 81% and 82% for a cut-off value of 952 U/L for serum prolidase activity, respectively. CONCLUSION In conclusion, there is an elevated pleural fluid and serum prolidase enzyme activity in patients with TB pleurisy compared with non-TB pleurisy group. The higher enzyme activities in TB group might reflect increased collagen turnover in those patients.