Selim Nalbant

Albumin, hemoglobin, body mass index, cognitive and functional performance in elderly persons living in nursing homes

The aim of this study is to produce the relation between cognitive and functional performance and some biochemical parameters in elderly population. So, we searched for the correlation between the activities of daily living (ADL), mini-mental state examination (MMSE) and body weight, age, hemoglobin, albumin, serum sodium level of 180 elderly people in five nursing homes. Face-to-face interviews and questionnaires were applied to evaluate ADL. To evaluate the cognitive function we used the MMSE. The average age of 180 people contacted was 71.5+/-5.1 (+/-S.D.), ranging 65-91 years; 112 of them were women (62.2%), 68 were men (37.8%). Of these elderly people, 25% had no medically diagnosed illnesses, whereas 17 of them (9.4%) were bedridden. There was a positive correlation between ADL and hemoglobin, albumin, body weight, cognitive function parameters and a negative one with age and serum sodium. There was a positive correlation between cognitive functions and hemoglobin, body weight, ADL and a negative one with serum sodium. Hemoglobin concentrations indicating anemia were observed in 30% of subjects, 3.9% of them had hyponatremia and 26.7% displayed a hypernatremia. There was a positive correlation between cognitive and physical function scores and hemoglobin, albumin levels in elderly patients. These results suggest that restoration of hemoglobin and albumin levels could improve cognitive and physical functional status in the elderly population.

Accidental Oral Poisoning Caused by Rdx (Cyclonite): A Report of 5 Cases

The explosive RDX (hexogen, cyclonite) is usually used for the production of C-4 explosive. The rare occurrence of accidental and intentional RDX intoxications has been reported during manufacturing process or in wartime. In this article, the authors report 5 cases of accidental oral RDX poisoning. On admission, observed signs and symptoms included repetitive generalized tonic-clonic convulsions, postictal coma, lethargy, confusion, hyperreflexia, postictal amnesia, nausea, vomiting, abdominal tenderness, sinusal tachycardia, dysrhythmia with frequent ventricular premature beats, generalized muscle spasms, and myoclonus. Leukocytosis, mild anemia, methemoglobinemia, elevated levels of blood glucose, serum aspartate transaminase, alanine transaminase, lactic dehydrogenase, creatine phosphokinase, amilase, hypokalemia, metabolic acidosis, proteinuria, glucosuria, and myoglobinuria were also noted. Plasma RDX concentrations were 268 to 969 ng/mL at 3 hours of ingestion. For management, supportive and symptomatic measures were taken. Whole-bowel irrigation might have been an effective therapeutic procedure due to probable slow gastrointestinal absorption of RDX. Three patients who developed severe metabolic acidosis underwent urgent hemodialysis. All patients were discharged 7 to 21 days after admission without any sequelae. Plasma RDX levels were strongly correlated with the clinical and laboratory manifestations. The available toxicological data on this rare accidental poisoning are reviewed in light of the literature.

Relationship between anaemia and cognitive functions in elderly people

BACKGROUND The primary goal of the present study was to investigate the effects of anaemia on the cognitive functions and daily living activities in elderly people. METHODS This sectional study was performed using 180 elderly people. Face-to-face interviews and questionnaires were conducted to evaluate daily activities. To evaluate cognitive functions we used the Folsteins Mini-Mental State Examination (MMSE). RESULTS The mean age of the anaemic group and the nonanaemic group were 76.0+/-11.7 and 72.5+/-15.2 years, respectively. The average haemoglobin level among the anaemic population was 10.4 g/dL compared with 13.6 g/dL among the nonanaemic population; a statistically significant difference. There was more impairment in functional status (Katz ADL) (6.8+/-4.3 vs 9.3+/-3.7) and cognition (MMSE) (17.9+/-6.4 vs 21.7+/-6.7) in anaemic than nonanaemic groups, respectively. Albumin and body mass index were lower and the percentage of two or more comorbidities was higher in anaemic group compared to the nonanaemic group, which was a statistically significant variation. The anaemic group was more dependent in terms of bathing, dressing, toileting and transferring. CONCLUSION In the elderly anaemic group, the dependency for daily activities that require physical effort was higher compared to the nonanaemic group. The MMSE score in the elderly anaemic group was lower than subjects who had normal haemoglobin levels. We conclude that anaemia may impair cognitive functions and some daily living activities in the elderly.

Increased iron and oxidative stress are separately related to cognitive decline in elderly.

Aim:  The aim of this study is to examine the relation between body iron, oxidative stress and cognitive function in elderly.

High frequency of MEFV gene mutations in patients with myeloid neoplasm

We aimed to investigate the rate of MEFV, the gene mutated in familial Mediterranean fever, mutations in patients with myeloid neoplasm and to determine if known mutations of MEFV cause a tendency for myeloid neoplasms. The frequency of the five most common MEFV gene mutations (M694V, M680I, V726A, E148Q and M694I) was determined in 26 patients with myeloid neoplasm. We identified 1 homozygous (E148Q/E148Q), 1 compound heterozygous (M694V/E148Q) and 5 heterozygous MEFV gene mutations; none had their own and/or family history compatible with familial Mediterranean fever. The mean overall mutation rate was 0.269. We found a high frequency of carriers in patients with myelodysplastic syndrome (66.6%), polycythemia vera (33.3%) and acute myeloid leukemia (28.6%). However, there was no MEFV gene mutation in patients with chronic myeloid leukemia. In conclusion, this study reports for the first time a possibly high prevalence of MEFV gene mutations in patients with myeloid neoplasm, especially myelodysplastic syndrome, polycythemia vera and acute myeloid leukemia. Our findings could open new perspectives for MEFV gene mutations in myeloid neoplasms and its association with tumor promotion. Further research is needed to determine the actual role of MEFV gene mutations in these malignancies.

A case of Weil's syndrome developing steroid resistant immune haemolytic anaemia

Weils syndrome is known in a serious clinical form, but the development of immune haemolytic anaemia related to Leptospira in human beings is a very rare clinical presentation, and we encountered only 1 case report in a literature scan. In this paper we present a case of Weils syndrome in which immune haemolytic anaemia findings, and haemolysis could only be controlled by intravenous immunoglobulin (IvIg) treatment.

Hypersensitivity vasculitis and cytokines.

Abstract Objective. Hypersensitivity vasculitis (HSV) is secondary vasculitis due to an immune response to exogenous substances. Because of the relative rarity of the vasculitides there are no reports on the role cytokines. This report evaluates some of cytokines which might be involved in pathophysiological events of HSV. Material and methods. Patients with HSV (n=20) were classified as active (n=12) ornd inactive (n=8) according to a vasculitis activity index for systemic necrotizing vasculitis (VAI). All the patients were males. A control group was formed from 20 healthy male employees of our department. We performed tests for serum interleukins 6, IL-10, sIL-2 receptor, tumor necrosis factor (TNF) α, C-reactive protein (CRP) levels using enzyme-linked immunosorbent assay and erythrocyte sedimentation rate (ESR). Results. The mean ESR value, CRP, and fibrinogen levels were significantly different in both active and inactive HSV from those in the healthy group; they were also significantly higher in the active than in the inactive group. There was no significant difference between healthy and inactive groups for serum IL-10, IL-6, sIL-2 receptor, and TNFα levels. However, it was also significantly higher for in active HSV patients than in the healthy group. Similar results were obtained comparing active and inactive groups, namely, all cytokine levels were significantly higher for all patients. The most striking finding is the high correlation of ESR (also for CRP, fibrinogen) with serum levels of TNFα and IL-10, but not with IL-6 and IL2R. Conclusions. These data show that serum TNFα and IL-10 levels can be studied in comparison to traditional markers of inflammation such as sedimentation rate or C-reactive protein. This may lead to new approaches to treating or managing HSV.

Prognostic value of mean platelet volume in patients with upper gastrointestinal bleeding

This study included patients with upper gastrointestinal hemorrhage who were treated in intensive care unit of GATA Haydarpasa Training Hospital, Division of Internal Medicine during 1 year. Medical and demographic data of the patients were recorded. These patients were followed for 3 months after being discharged from the intensive care unit. Of the 50 patients in the study, 18 were female (36%), 32 were male (64%). The mean age was 47±2 years, and the ages ranged between 17 and 89 years. We did not find any statistically significant results in our evaluation of the relationship between the mean platelet volume and the number of transfusions, endoscopic findings, and prognosis after 3 months of follow-up.

Increased Circulating Asymmetric Dimethylarginine (ADMA) Levels in the Active Stage of Behçet’s Syndrome

There is little evidence in the literature about circulating asymmetric dimethylarginine (ADMA) levels in Behcet’s syndrome (BS). The aim of the present study was 1. to measure the levels of ADMA in male patients with BS, 2. to compare ADMA levels with healthy volunteers, and 3. to evaluate whether there is any difference between patients both with/without thrombosis and in active/inactive stage. In patients with BS, CRP levels were higher than controls. The mean ADMA and C-reactive protein (CRP) levels were significantly higher in active stage patients and patients with thrombosis than in patients during the inactive stage and without thrombosis. In conclusion, we did not find any significant difference in ADMA levels between patients with BS and healthy controls. Serum ADMA concentrations, however, were higher in active patients and patients with thrombosis than in patients during the inactive stage and patients without thrombosis.

Dissection of the Thoracic Aorta in a Patient with Autosomal Dominant Polycystic Kidney Disease

Internal Medicine,Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey.Autosomal dominant polycystic kidney disease(ADPKD) is a systemic illness with a number of extra-renal manifestations. A 61-year-old male patient withknown ADPKD was admitted to the emergency roomof our hospital in May 2003 with severe chest painradiating to his neck and back, and a sense ofbreathlessness. There was no history of trauma.On admission, he was hypotensive (90/50 mmHg)and his heart rate was 110 beats/min. He had a mid-systolic murmur, which was most marked at the leftsternal edge. His peripheral pulses were weak. Bilater-al basal crepitations were found on pulmonaryexamination. Abdominal examination was normalexcept for large palpable polycystic kidneys. He hadno focal neurologic signs. Laboratory examinationshowed no significant abnormalities except for raisedserum urea (121 mg/dL) and creatinine (4.1 mg/dL).An electrocardiogram showed depression of ST seg-ments in the anterior leads. Emergency computerizedtomography scanning of the thorax and abdomen de-monstrated dissection and intramural thrombus withinthe descending thoracic aorta and bilateral polycystickidneys (Panels A and B).He was transferred immediately for aortic surgery.During the operation, a type II thoracic aortic dissectionwas observed. His recovery was complicated by theexpansion of the dissection and he died on the thirdpostoperative day.Numerous cardiovascular abnormalities have beenreported in ADPKD patients, including heart valvelesion, cerebral aneurysm, splenic artery aneurysm,aortic root dilatation, abdominal aortic aneurysm,thoracic aortic dissection, and cervical artery dissection[1–3]. The prevalence of intracranial aneurysm andrupture are five-fold higher in ADPKD patients than inthe general population [4]. However, the prevalence ofextracerebral aneurysms is not clear. One autopsy seriesdescribed aortic dissection as being seven times morecommon in patients with ADPKD than in the generalpopulation [2]. Spontaneous artery dissection wasreported as a major complication in five unrelatedADPKD patients. All underwent spontaneous dissect-ion and none had phenotype of elastic tissue disorderor thoracic aortic dissection. Torra et al, in their case-control study, found a similar distribution of aorticdiameters in 139 ADPKD patients and their 149unaffected relatives [5]. The case reported by Paynteret al appears to be very similar to our case [3]. Arterialdissection may belong to the spectrum of extrarenalmanifestations of ADPKD. The association of ADPKD