Nejat Demircan

Levels of serum IL-1beta, IL-2, IL-8 and tumor necrosis factor-alpha in patients with unstable angina pectoris.

OBJECTIVES Inflammation is the most important mechanism of plaque disruption playing an essential role in acute coronary syndromes. It is controversial whether the inflammatory mediators are the cause or the result in the development of plaque rupture. Stimulation of interleukins increases adhesion molecules, fibrinogen and plasminogen activator inhibitors,which cause the activation of inflammation and thrombosis. However, the importance of interleukins in acute coronary syndromes has not been clearly defined. We did not find any article concerning relations between the levels of serum interleukin(IL)-1beta, IL-2, IL -8 and tumor necrosis factor (TNF)-alpha in patients with unstable angina pectoris (UAP). So the aim of this study was to determine the levels of serum I -1b, IL-2, IL-8 and TNF-alpha during the early stage of UAP. METHODS AND RESULTS Thirty-seven patients with UAP(12 females and 25 males; mean age, 57.5 +/- 9.7 years) within 6 h of admission and 20 healthy volunteers(eight females and 12 males; mean age, 51.3 +/- 6.3 years) were included in the study. IL-1beta, IL-2, IL-8 and TNF-alpha levels were measured using the enzyme-linked immunosorbent assay method. Patients with acute or chronic inflammation, renal failure or chronic heart failure were excluded from the study. The age, gender and risk factors of the study and control groups were similar. The levels of IL-1beta, IL-8 and TNF-alpha were significantly increased (p < /0.0001, p < /0.001 and p < /0.016, respectively) in patients with UAP. There was no difference of IL-2 levels between the UAP group and controls. CONCLUSION We detected high levels of IL-1beta, IL-8 and TNF-alpha in patients with UAP during early phase. We suggest that proinflammatory cytokines (e.g. IL-1beta,IL-8, TNF-alpha) may play an important role in the development of atherosclerosis and its complications.

Knowledge and attitudes towards complementary and alternative medicine among medical students in Turkey

ObjectiveThis study aims to examine knowledge and attitudes towards Complementary and Alternative Medicine among medical students in Turkey, and find out whether they want to be trained in Complementary and Alternative Medicine (CAM).MethodsA cross-sectional study was carried out between October and December 2010 among medical students. Data were collected from a total of seven medical schools.FindingsThe study included 943 medical students. The most well known methods among the students were herbal treatment (81.2 %), acupuncture (80.8 %), hypnosis (78.8 %), body-based practices including massage (77 %) and meditation (65.2 %), respectively. Acupuncture, aromatherapy, herbal treatment and meditation were better known among female participants compared to males (p < 0.05). Females and first year students, generally had more positive attitudes. A larger proportion of female students compared to male students reported that a doctor should be knowledgeable about CAM (p = 0.001), and this knowledge would be helpful in their future professional lives (p = 0.015). Positive attitudes towards and willingness to receive training declined as the number of years spent in the faculty of medicine increased.ConclusionsMajority of the medical students were familiar with the CAM methods widely used in Turkey, while most of them had positive attitudes towards CAM as well as willingness to receive training on the subject, and they were likely to recommend CAM methods to their patients in their future professional lives. With its gradual scientific development and increasing popularity, there appears a need for a coordinated policy in integrating CAM into the medical curriculum, by taking expectations of and feedback from medical students into consideration in setting educational standards.

Migration of a bullet in the spinal canal

Migration of a bullet within the spinal canal after gunshot injury is rare. We report here the case of a penetrating gunshot injury of the lumbar spine at L3 with migration of the bullet within the spinal canal S2. The patient had marked paraparesis (proximal 1/5, distal 0/5 muscle strength) and anaesthesia at L3 and below, and had a hypocompliant, hyper-reflexive bladder with decreased capacity, and absent anal tonus. We removed osseous fragments in the canal with an L3 laminectomy and extracted the bullet by S2 laminectomy. After surgery, we observed an improvement in paraparesis, an increase in bladder capacity and urinary compliance, and improvement in anal tonus. The appropriate course of action in this type of injury remains unclear, because the number of cases described in the literature is not sufficient to provide a basis on which to make a definitive therapeutic decision. We herein review the literature describing cases in which a bullet in the spinal canal has migrated; we describe the treatment used and the outcomes in these cases.

Effects of three different iron supplementations in term healthy infants after 5 months of life.

The aim of this study was to investigate the effects of different doses of iron on haematological status of breastfed infants. One hundred and thirteen infants were randomized into four groups at 5 months of age. Iron supplementation was given at doses of 1 mg/kg/day, 2 mg/kg/day, and 2 mg/kg/every other day in the first three study groups, respectively, and the last group received placebo. The hematological values, except hemoglobin, were higher in the group supplemented with iron at a dose of 2 mg/kg/day, and ferritin values were statistically higher in the group supplemented with iron at a dose of 2 mg/kg/every other day than in the group supplemented with iron at a dose of 1 mg/kg/day. We suggest that intermittent iron supplementation is more effective than a daily regimen in equal dosages.

Effect of hyperthyroidism and propylthiouracil treatment on liver biochemical tests

Liver biochemical test (LBT) changes can be commonly observed in hyperthyroid patients. Those kinds of changes could also be observed because of propylthiouracil (PTU) therapy. We prospectively evaluated LBT changes because of PTU use for 1 year in patients who had been diagnosed with hyperthyroidism first. We studied 64 patients who had been diagnosed with hyperthyroidism. These patients took at least 1‐year PTU treatment. We analysed LBT at diagnosis and after 2 and 12 months of treatment with PTU. Prior to PTU treatment, 30 (46.8%) of the 64 patients had at least one LBT abnormality. We observed at least one LBT abnormality in 11 (32%) patients after 2 months and nine (26%) patients after 12 months of treatment with PTU in 34 patients whose CBT were normal before treatment. We did not observe any deterioration in clinical picture and bilirubin levels. Elevated serum LBT during the pretreatment and PTU treatment period is common and usually transient and asymptomatic. PTU could be used for long times by lowering the dose and close follow‐up in patients who have elevated LBT during the pretreatment and after PTU treatment period.

Helicobacter pylori Eradication Lowers Serum Asymmetric Dimethylarginine Levels

Introduction. Microbial pathogens, one of them is Helicobacter pylori (H. pylori), have frequently been implicated in the atherogenesis. Endothelium-derived nitric oxide (NO) is synthesized from L-arginine by nitric oxide synthase (NOS) and plays a pivotal role in the regulation of vascular tone. Asymmetric dimethylarginine (ADMA) is the most potent endogenous NOS inhibitor. Elevated levels of ADMA have been reported in many circumstances associated with a high cardiovascular risk. The aim of the present study was to investigate whether the eradication of H. pylori infection affects serum ADMA levels. Materials and Methods. Forty-two H. pylori-positive patients were enrolled in the study. Triple therapy for 14 days were given to all patients. Serum ADMA levels were measured at baseline and 2 months after therapy. Results. Eradication was achieved in 34 (81%) patients. The mean serum ADMA levels before and after therapy were 1, 77 ± 0, 30 and 1, 67 ± 0, 29 ng/mL in the group with H. pylori eradicated and 1, 63 ± 0, 28 and 1, 56 ± 0, 32 ng/mL in the noneradicated, respectively. We detected statistically significant decreased serum ADMA levels after therapy in H. pylori eradicated group. Conclusion. These findings have indicated that eradication of H. pylori infection may decrease the risk of atherosclerosis and cardiovascular events.

Positive correlation of CRP and fibrinogen levels as cardiovascular risk factors in early stage of continuous ambulatory peritoneal dialysis patients.

We aimed to study the relationship between the C-reactive protein (CRP), albumin, and fibrinogen as cardiovascular risk factors in continuous ambulatory peritoneal dialysis (CAPD) patients, in the early stage of their therapy. The study included 21 CAPD patients as the study group (SG) and age- and sex-matched 21 healthy patients as the control group (CG). History and physical exam data were obtained for all cases, and demographic baseline characteristics were taken. Twelve-hour fasting serum levels of glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, total protein, albumin, hemoglobin, CRP, and fibrinogen were obtained. There was no statistically significant difference between the SG and CG in baseline characteristics, including age, sex, body mass index (BMI), smoking, and family history of cardiovascular disease. However, diabetes mellitus (DM) and hypertension (HTN) were significantly more common among the study group. The average total protein, albumin, and hemoglobin levels were significantly lower, and the CRP and fibrinogen levels were significantly higher (p < 0.001) in the SG. A positive correlation was seen (r = 0.443, p < 0.05) among CRP and fibrinogen levels in SG. There was no correlation among the other parameters in SG. For CG, there was no correlation seen for any studied parameters. When patients with and without cardiovascular disease (CVD) were compared, no correlation was seen between CRP and other parameters. A positive correlation of CRP and fibrinogen levels as cardiovascular risk factors was shown in early stage of CAPD patients. The CAPD patients with elevated levels of CRP and fibrinogen should receive close follow-up for cardiovascular disease prevention.

What are the probable predictors of urinary incontinence during pregnancy

Objectives. The frequency, predisposing factors and impact of urinary incontinence (UI) on quality of life (QoL) during pregnancy were investigated. Materials and Method. A preliminary cross-sectional survey was studied among pregnant women between January and July of 2014. A total of 132 pregnant women were recruited using a questionnaire form for sociodemographic features, the Turkish version of the International Consultation on Incontinence-Short Form (ICIQ-SF), for the characteristics of UI and Wagner’s Quality of Life scale to assess impact on QoL. p < 0.05 was set significant. Results.Urinary incontinence was present in 56 out of 132 pregnant women (42.4%, UI-present group): mean age, 26.7 ± 5.4y(p = 0.780); median height, 160 cm (min–max: 153–176, p = 0.037); median BMI, 28.7 kg/m2(min–max: 22.4–50.0, p = 0.881); urine leakage occurred per week once (n = 18, 32.1%), twice or thrice (n = 8, 14.3%); per day few times (n = 14, 25%), once (n = 5, 8.9%) and always (n = 8, 14.3%) with mainly a small amount of urine leakage (n = 33, 58.9%) or a moderate (n = 4, 7.1%). There were statistically significant relationships between QoL scores and frequency of UI (p = 0.002) or amount of leakage (p = 0.002). Impact on QoL scores ranged from mild (n = 33, 58.9%), moderate (n = 4, 7.1%) to severe (n = 4, 7.1%) levels in daily life. UI impacted the daily life activities of women by making them less likely to undertake activities outside their homes (23.2%), by affecting their working performance and friendships (8.9%), their daily home activities (7.1%), their general health status (12.5%), their sexual relations (12.5%), by making them more nervous or anxious (10.7%) and by the need to wear pads or protectors (25%). ANOVA, Tukey, and Tamhane tests as the minimal important difference model yielded significant relevance between statistical analyses and clinical outcomes by using standard deviations (p = 0.001, 0.001 and 0.005 respectively). The following features favored the occurence of UI: Age (OR = 0.845, 95% CI [0.268–2.669]), being a housewife (OR = 1.800, 95% CI [0.850–3.810]), anemia (OR = 0.939, 95% CI [0.464–1.901]), parity (OR = 0.519, 95% CI [0.325–0.829]), miscarriage (OR = 1.219, 95% CI [0.588–2.825]) and living in rural areas (OR = 1.800, 95% CI [0.887–3.653]). Height (p = 0, 037), educational status (0.016), miscarriage (0.002), parity (0.006) and place of living (0.020) were significant factors. Conclusions.Many pregnant women are suffering from UI, which warrants a significant public health consideration in the region. Age, height, being a housewife or graduation level higher than primary school, living in rural, parity, miscarriage, and anemia were the factors in favor of the onset of UI. The authors plan a health promotion program in the region according to the results in order to provide information to health caregivers, especially family physicians, and to educate women about the predictors of UI and pelvic floor exercises for primary prevention and secondary relief of UI during and after pregnancy and provide some hygienic supplies to the poor in this aspect.

Are the women with Sjögren's Syndrome satisfied with their sexual activity?

OBJECTIVE Females with Sjögrens Syndrome (SS) often experience vaginal dryness and dyspareunia, along with glandular and extraglandular symptoms. We aimed to evaluate sexual function and life quality in women with SS. METHODS Forty-six premenopausal women with SS and 47 age-matched controls were studied. Age, duration of the disease, medications, and comorbid diseases were noted. Participants completed 36-Item Short Form Health Survey (SF-36) and Female Sexual Function Index (FSFI). Patients were asked about vaginal discharge and itching in the last month, and if they informed their rheumatologists about any sexual problems. Gynecologic examinations were performed and vaginal smears were taken on each participant. RESULTS The median total scores of FSFI were significantly lower in the SS group than the controls [17.12 (2.4-27.8) and 27.4 (16.9-36.0), respectively, p<0.001]. In the SS group, 37 (80.4%) and in the control group 18 (38.3%) of patients were sexually dissatisfied (p<0.001). Vaginal dryness and lubricant use were significantly increased in patients with SS compared to controls (p<0.001). Life quality scores were significantly lower in patients with SS than the controls (p<0.001). Vaginal dryness was negatively correlated with FSFI total (r=-0.312, p=0.035) and subscores except desire and arousal. Physical functioning, role physical and role emotional scores were positively correlated with total FSFI scores (r=0.449, p=0.002, r=0.371, p=0.011, r=0.299, p=0.043, respectively). CONCLUSIONS Women with SS experience less satisfaction with sexual activity, which can be affected by age, vaginal dryness, physical pain, and impaired function due to the disease. Therefore, rheumatologists should pay attention to these symptoms and management.