Nuri Karadurmus

Mean platelet volume and its relationship with carotid atherosclerosis in subjects with non-alcoholic fatty liver disease.

Abstract Background. Non-alcoholic fatty liver disease (NAFLD) is linked to an increased risk of cardiovascular disease. Mean platelet volume (MPV), a determinant of platelet activation, is an emerging risk factor for atherothrombosis. Aims. The aim of this study was to investigate the levels of MPV in subjects with NAFLD having no confounding factors for atherosclerosis such as obesity, diabetes mellitus, and hypertension. In addition, the possible relationship between MPV and carotid artery intima media thickness (CIMT), a well known marker of subclinical atherosclerosis, was also studied. Methods. MPV and CIMT levels were measured in 60 biopsy-proven NAFLD subjects and 54 healthy controls. Age and sex were similar between two groups. Results. Body mass index and waist circumference levels were higher in the NAFLD group when compared to the controls. There were no differences between the two groups regarding LDL cholesterol levels, whereas HDL cholesterol levels were lower in the NAFLD group. MPV and CIMT levels were not different between the two groups. According to the correlation analyses, CIMT levels were positively correlated to age in patients with NAFLD. However, no significant correlation was found between MPV and CIMT levels. Conclusions. The results of this study do not show any difference in MPV levels between subjects with NAFLD and controls. These finding suggests that in the absence of other metabolic risk factors, MPV might not be involved in the mechanism(s) of increased cardiovascular risk in NAFLD.

Decreased small dense LDL levels in Gilbert's syndrome.

OBJECTIVE To investigate the role of small dense low density lipoprotein cholesterol (sd-LDL-C) in the mechanism of decreased incidence of cardiovascular disease in Gilberts syndrome (GS). DESIGN AND METHODS sd-LDL-C, ox-LDL, and high sensitive C reactive protein (hs-CRP) levels were investigated in subjects with GS (n=42) and compared to healthy controls (n=52). RESULTS Age, gender and body mass index (BMI) distributions were similar between the two groups. sd-LDL-C, ox-LDL and hs-CRP levels were lower in GS than the healthy controls (p<0.001, p<0.001 and p=0.001, respectively). Unconjugated bilirubin was negatively correlated with sd-LDL-C, ox-LDL and hs-CRP (r=-0.594, p<0.001; r=-0.249, p=0.016 and r=-0.373, p<0.001 respectively). In addition, sd-LDL-C was positively correlated with ox-LDL (r=0.307, p=0.003). CONCLUSIONS The findings of this preliminary study suggest that reduced sd-LDL-C, ox-LDL and hs-CRP levels may have a role in preventing atherosclerosis in subjects with GS.

Adipose tissue 11-beta-Hydroxysteroid Dehydrogenase Type 1 and Hexose-6-Phosphate Dehydrogenase gene expressions are increased in patients with type 2 diabetes mellitus

AIMS We have determined 11-beta-Hydroxysteroid Dehydrogenase Type 1 (HSD11B1) and Hexose-6-Phosphate Dehydrogenase (H6PD) mRNA expression levels in adipose tissues from patients with type 2 diabetes mellitus. METHODS Six non-diabetic and seven diabetic male patients who undergo elective abdominal surgery were included in the study and visceral and subcutaneous adipose tissue samples were obtained. Fresh preadipocyte cultures were administered to low and high glucose medium (11M and 25M) in vitro for 24h and mRNA extractions were performed. HSD11B1 and H6PD gene mRNA expression levels were determined by real-time PCR and compared. Glyceraldehyde-3-phosphate Dehydrogenase (G3PD) mRNA level is used as housekeeping gene expression. RESULTS HSD11B1 mRNA levels were significantly higher in patient with T2DM than controls in both visceral and subcutaneous adipose tissues (3.35+/-0.7 vs. 0.37+/-0.1; P=0.01 and 2.07+/-0.8 vs. 0.11+/-0.05; P=0.01, respectively). H6PD mRNA levels were also significantly higher in patient with T2DM than controls in both visceral and subcutaneous adipose tissues (3.95+/-1.2 vs. 1.95+/-0.8; P=0.050 and 2.23+/-1.1 vs. 0.46+/-0.1; P=0.043, respectively). CONCLUSIONS Failure to down-regulate HSD11B1 activity in patients with type 2 diabetes may contribute to the pathogenesis of T2DM. Subcutaneous and visceral adipose tissues similarly exhibit the same variation in patients with type 2 diabetes mellitus.

Lower leptin levels in young non-obese male smokers than non-smokers.

Since the effect of smoking on plasma leptin has been divergent in clinical trials, which might have occurred due to selection of heterogeneous study populations, we investigated whether there is such an association in a group of healthy, non-obese, young male adults. A total of 54 smokers (mean age: 21.18±1.62; body mass index (BMI): 19.60±0.85) and 26 non-smokers (mean age 21.69±3.0; BMI: 21.59±1.39) with similar daily physical activities and diet and without any documented disease were enrolled, and their plasma leptin levels were determined for the comparison between the two groups. The mean BMI and plasma leptin of smokers were significantly lower than in non-smokers. Plasma leptin in the smokers group correlated inversely with BMI and the amount of daily smoking. Below BMI 20 kg/m2 and between 20.0 and 20.9 kg/m2 the plasma leptin levels in smokers were significantly lower when compared to non-smokers. Plasma leptin is decreased in healthy, young non-obese male smokers independently of the amount of body fat. High amount of smoking is associated with lower serum leptin as well.

Vitamin B12 and folic acid levels as therapeutic target in preserving bone mineral density (BMD) of older men

The knowledge about vitamin B(12) and folic acid levels in preserving bone mass in older men is limited. In this retrospective study, we aimed to find out whether levels of vitamin B(12) and folic acid are related to BMD in older men. Two hundred and sixty-nine older men were included in the study. Forty-two (15.6%) of them had osteoporotic, 150 (55.8%) had osteopenic, and 77 (28.6%) had normal BMD. Vitamin B(12) and folic acid levels were categorized as indicating normal, borderline, or low vitamin statuses. Femur neck densities showed statistically significant differences in subjects having low, borderline, and normal vitamin B(12), respectively. There were no significant differences between the three tertiles of vitamin B(12) in femur total, trochanteric, and intertrochanteric densities. After adjustment for age, body mass index (BMI), alcohol, smoking, and exercise with analysis of covariance, the difference was still statistically significant between two groups for femur neck density (p=0.011). No significant difference was observed between the groups of folic acid in any femur sites. We found that the normal level of vitamin B(12) in older men may be related to a decrease of femur neck bone loss.

The Effect of Short-Term Hypobaric Hypoxic Exposure on Intraocular Pressure

Purpose: To evaluate the effect of short-term hypobaric hypoxic conditions (STHC) on intraocular pressure (IOP) in healthy subjects. Methods: The study group was comprised of 30 healthy participants (60 eyes) with a mean age of 24.8 years. IOP was measured with a Tono-Pen XL tonometer at ground level (792 m above sea level, prehypoxic) during hypobaric hypoxic exposure (equivalent to 9144 m) and at ground level again after this exposure (post-hypoxic). For each condition, the mean of 3 consecutive measurements of IOP was calculated. In each condition, central corneal thickness was also measured. Results: IOP in the hypobaric hypoxic condition (18.23 ± 2.84 mmHg) was significantly greater than IOP in both the prehypoxic condition (16.52 ± 2.84 mmHg) (p < 0.001) and the post-hypoxic condition (17.02 ± 2.52 mmHg) (p < 0.01). When corrected for hypoxia-related changes in CCT, IOP under hypobaric hypoxic conditions was still greater than IOP in both the prehypoxic and post-hypoxic conditions. There was no significant difference between IOP levels in the prehypoxic and post-hypoxic conditions (p > 0.05). Conclusion: STHC caused a significant increase in IOP in healthy participants. But this significant increase in IOP cannot be solely explained by a CCT-related overestimation error due to the increase in CCT. Individuals with IOP-related disorders such as glaucoma should be cautious when facing potential exposure to hypobaric hypoxic conditions.

Detrimental Effects of N-Acetylcysteine Plus Desferoxamine Combination in an Experimental Nephrotic Syndrome Model

The aim of this study was to evaluate the effects of N-acetylcysteine (NAC) and desferoxamine (DFO) administered alone or in combination together in rats with doxorubicin (DOX)-induced nephrotic syndrome, by monitoring oxidative stress parameters and trace elements in renal tissue and erythrocytes. Fifty-four male Sprague-Dawley rats were included the study. Equal volume of isotonic saline was injected to control rats. After DOX administration, the animals were divided into four experimental groups: (a) rats given only DOX; (b) rats treated with NAC; (c) rats treated with DFO; (d) rats treated with NAC plus DFO. The combination of N-acetylcysteine and DFO has no beneficial effect on reducing proteinuria in experimentally nephrotic rats, although both of these agents ameliorate the condition when administered separately. It seems likely that detrimental effects of NAC plus DFO could be secondary to its effects on erythrocyte selenium levels demonstrated here. Consequently, the results may propose caution to the use of antioxidant therapeutic strategies such as NAC plus DFO against nephropathy.

The utility of tumor markers CA 125, CA 15-3, and CA 19-9 in assessing the response to therapy in pulmonary and pleural tuberculosis

Aim: Both of the diagnosis and treatment evaluation are time-consuming conditions in patients with pulmonary and pleural tuberculosis. The aim of this study was to establish the validity of tumor markers CA 125, CA 15-3, and CA 19-9 in the diagnosis of pulmonary and pleural TB and to verify the success of the treatment protocol. Patients and methods: The levels of tumor markers CA 125, CA 15-3, and CA 19-9 were measured before and after treatment in 67 TB patients, 54 of whom had pulmonary TB and 13 of whom had pleural TB. All values were compared with the results of a healthy control group of 44 subjects. Results: CA 125 and CA 15-3 levels were significantly high when compared with those of the healthy control group and there was a significant decrease in both tumor marker levels after treatment in patients with pulmonary TB (P < 0.001 and P < 0.004, respectively). However, the difference found in CA 19-9 levels before and after treatment in patients with pulmonary TB was not statistically significant (P < 0.08). When the CA 125, CA 15-3, and CA 19-9 values of the pulmonary TB group before treatment were compared with that of the healthy control group, the results were statistically significant in all parameters except CA 19-9 (P < 0.001, P < 0.001, and P < 0.09 for CA 125, CA 15-3, and CA 19-9, respectively). In the patients with pleural TB, CA 125, CA 15-3, and CA 19-9 values did not change significantly after treatment. Conclusion: The authors suggest that CA 125 and CA 15-3 tumor markers may be important for verification of the success of treatment protocol in pulmonary TB, as the differences found for these tumor markers between the pre- and the posttreatment periods are statistically significant.

Rivastigmine Associated Hyponatremia in an Older Patient with Alzheimer's Disease

To the Editor: Electrolyte disturbances in subjects receiving rivastigmine are rare. We report a case of hyponatremia caused by rivastigmine in an older adults with Alzheimer’s disease (AD). Ms. Z was an 86-year-old, frail woman treated with daily rivastigmine patch with a dosage titration regimen up to 10 cm/d for AD. Her serum sodium level was 144.8 mEq/L (reference range 135–145 mEq/L). She was taking no medications other than rivastigmine. Two months later, she was hospitalized for confusion and lethargy. Her sodium level was 117 mEq/L. After treatment for hyponatremia, her serum sodium level improved to 135 mEq/L, and her symptoms abated. Urinary tract infection and nausea were assumed as reasons for hyponatremia. Rivastigmine patch 10 cm daily was continued after she was discharged from the hospital. After 4 months, she again presented with complaints of a 5-day history of worsening confusion and lethargy and increasing fatigue and loss of appetite. Her serum sodium level had fallen to 121 mEq/L. Her other laboratory findings were as follows: serum glucose, 80 mg/dL; serum creatinine concentration, 0.88 mg/dL; blood urea nitrogen concentration, 10.5 mg/dL; serum potassium, 3.5 mEq/L; erythrocyte sedimentation rate, 10 mm/h; serum osmolality, 250.8 mOsm/kg; urine osmolality, 405.6 mOsm/kg; and urine sodium 27 mmol/d. Complete blood count, liver enzymes, and thyroid function tests were within reference range. Other laboratory data did not show abnormalities. Her relatives denied she took medications other than the rivastigmine patch. On examination, she was afebrile, with a temperature of 36.61C. Her body mass index was 18.4 kg/ m. Her blood pressure was 110/60 mmHg, and heart rate was 72 beats/min. She was disoriented and not alert. Her physical examination was unremarkable otherwise. A brain computed tomography scan did not show any pathological condition. After this extensive examination, hyponatremia was attributed to the rivastigmine patch, so it was stopped, and hypertonic saline (3%) was administered (1 mL/kg per hour) for 3 hours, followed by fluid restriction. Her sodium level improved to 136 mEq/L by the day of discharge, and her symptoms disappeared. Dementia was managed with donepezil 5 mg/d, later increased to 10 mg/d. One month after rivastigmine patch discontinuation, her serum sodium level was 142 mEq/L. No further episodes of hyponatremia occurred over 6 months of follow-up.

Comparison of lymphomononuclear cell energy metabolism between healthy, impaired glucose intolerance and type 2 diabetes mellitus patients

Diabetes mellitus (DM) is a complex disease that affects many systems. The most important cells of the immune system are lymphomononuclear (LMN) cells. Here, we aimed to evaluate the energy metabolism of LMN cells in patients with diabetes and impaired glucose tolerance. We measured LMN cell energy metabolism in patients with type 2 diabetes mellitus, impaired glucose tolerance (IGT) and healthy subjects. Cells were freshly isolated from peripheral blood and the subgroups were determined by flow cytometric method. Lactate production and glycogen utilization were significantly increased in the LMN cells of patients with type 2 DM and IGT when compared with healthy volunteers. No statistical difference was observed between the patients with type 2 DM and IGT. There was a significant correlation between fasting plasma glucose and lactate production in LMN cells. LMN cells changed their energy pathway in a diabetic state and preferred anaerobic glycolysis. Prediabetic range also affected energy metabolism in LMN cells. This abnormal energy production might cause dysfunction in LMN cells and the immune system in diabetic and prediabetic patients. In conclusion, we concluded that impaired glucose metabolism could change energy metabolism.