Şeref Demirbaş

Asymmetric Dimethylarginine and Augmentation Index in Newly Diagnosed Patients With Hypertension

Pulse wave velocity (PWV), augmentation index (Aix), and central aortic pressure (CAP) are arterial stiffness markers of endothelial dysfunction (ED). We investigated the relationship between arterial stiffness parameters and asymmetric dimethylarginine (ADMA; a marker of ED), in newly diagnosed patients with hypertension (n = 101; 61 females). These patients were investigated in accordance with the recommendations of hypertension guidelines. Arterial stiffness was measured, and serum ADMA and C-reactive protein (CRP; a marker of inflammation) levels were determined. In both women and men, there was no difference in terms of age, body mass index, systolic and diastolic blood pressures, PWV, CAP and the levels of ADMA, while Aix and CRP levels were significantly higher in women (P = .004, P = .046, respectively). In the whole group, ADMA levels correlated with Aix (Pearson r = .237, P = .024). Our findings provide further evidence of a link between arterial stiffness and ED in newly diagnosed patients with hypertension.

Investigation of the Aortic Pulse Wave Velocity in Patients with Gilbert’s Syndrome

Arterial stiffness is currently the “gold standard” measure of aortic (carotid-femoral) pulse wave velocity (PWV), which is an important independent predictor of risk of developing a cardiovascular event. Gilbert’s syndrome is a congenital disorder characterized by intermittent and non-hemolytic elevation of indirect bilirubin levels due to the deficiency of the enzyme UDP-glucuronyl transferase in the liver and many prospective studies found an inverse relationship between bilirubin levels and cardiovascular events in these patients. We aimed to investigate serum bilirubin levels and arterial stiffness parameters in patients with Gilbert’s syndrome in this study. A total of 53 cases, consisting of 26 patients with a diagnosis of Gilbert’s syndrome and 27 healthy control subjects, were included in the study. Serum bilirubin levels, other routine blood chemistry, and arterial stiffness measurements were recorded. The mean ages of Gilbert’s syndrome and the control group were 31.5 ± 9.7 and 36.8 ± 11.1 years, respectively. PWV measurements were significantly lower in Gilbert syndrome patients (6.68 and 7.3 m/s in patients and controls; respectively) (P < .05). In correlation analysis in Gilbert’s syndrome patients, PWV had a significant correlation with total and indirect bilirubin levels (r = −0.370, P = .009/r = −0.495, P = .003, respectively). Gilbert’s syndrome patients have lower PWV measurements compared to healthy subjects, and the total and indirect bilirubin levels are also associated with PWV measurements. These findings may indicate the decreased atherosclerotic disease incidence in Gilbert’s syndrome patients.

Arterial stiffness and endothelial inflammation in prediabetes and newly diagnosed diabetes patients

OBJECTIVE There is a growing body of data supporting the association between diabetes and microcirculatory disfunction. We aimed to study e-selectin levels, and their associations with serum markers of inflammation and arterial stiffness in prediabetes and newly diagnosed diabetes patients in this study. SUBJECTS AND METHODS Sixty patients (25 females) with a newly established elevated fasting serum glucose [20 impaired fasting glucose (IFG), 20 impaired glucose tolerance (IGT), 20 newly diagnosed diabetes (T2DM)] and 17 healthy controls (13 females) were included in the study. Serum e-selectin and hs-CRP levels, and arterial stiffness parameters of the patients were studied. RESULTS Fasting serum glucose was the most important predictor of serum e-selectin levels. Pulse wave velocity and central aortic pressures were significantly higher in IFG, IGT and T2DM groups, compared to controls (p = 0.001, < 0.001, 0.013 and 0.015, 0.002, 0.009, respectively). The mean arterial pressure did not show any significant association with serum e-selectin and hs-CRP levels (β coefficient: 0.092, p = 0.358; and β coefficient: 0.189, p = 0.362, respectively). CONCLUSION Prediabetes patients have increasing e-selectin levels through the diagnosis of T2DM. E-selectin is associated with serum glucose levels. Prediabetic and newly diagnosed diabetics have higher arterial stiffness measurements. Serum e-selectin may be a good marker of endothelial inflammation and dysfunction increasing in parallel with serum glucose levels, predicting future cardiovascular events.

A case study report of acute renal failure associated with Nigella sativa in a diabetic patient.

1 Introduction Nigella sativa, known as black seed, has analgesic, anti-inflammatory, antioxidant and anticancer effects [1-3] . It has been shown to reduce the development of kidney failure when given prior to the use of nephrotoxic drugs particularly due to its antioxidant action [4-7] . However, as far as the authors could ascertain, there is no human study in literature showing these effects. Here we present a case of acute renal failure after the use of N. sativa,

Comment on “Cellular and molecular aspects of diabetic nephropathy; the role of VEGF-A”

We read the published article with the title of ‘Cellular and molecular aspects of diabetic nephropathy; the role of VEGF-A’1 with a great interest and we found worth sharing our clinical observations through a case to contribute to the their determination. Katherine Carranza et al.1 have stated that the experimental conditions VEGF-A decreased or after treatment with molecules developed against VEGF, it can be observed various pathologic processes such as glomerular basement membrane damage, proteinuria, acute renal failure and thromboembolic events. Monoclonal antibodies that bind the VEGF has long been used in systemic treatment protocol of solid tumors. Recently, by ophthalmologists, intravitreal administration of anti-VEGF agents seen as the primary treatment method in conditions of agerelated macular degeneration, diabetic retinopathy, retinal vein occlusion.2 Although systemic side effects are well known with the high dose intravenous use in cancer therapy, almost local side effects were reported associated with intraocular anti-VEGF treatment. However, despite the blood retinal barrier, anti-VEGF agents are detectable in systemic circulation after intraocular administration through uveal vessels or by aqueous humor outflow and might constitutes systemic adverse effect like nephropathy by antagonizing to VEGF-dependent pathway in glomeruli.3 We describe a case of nephrotic syndrome that were unable to detect significant findings for etiology in first research. But with detailed history we found that she had received intravitreal anti-VEGF due to diabetic retinopathy 10 days before the occurrence of symptoms. After the exclusion of other possible causes. We thought anti-VEGF agents might be responsible. In the literature, we found only 3 cases associated with renal toxicity of intraocular anti-VEGF therapy.4–6 We would like to remind that even at the small quantities used in the practice of ophthalmology, anti-VEGF agents may able to cause serious systemic effects including nephropathy.

Investigation of the aortic pulse wave velocity in hypertensive and normotensive obese subjects

Arteryel sertliğin halihazırda ’’altın standart’’ ölçümü aortik (karotis-femoral) nabız dalga hızıdır.Obezite genellikle hipertansiyon ve hiperglisemi gibi kardiyovasküler risk faktörleri ile birliktelik gösteren bir hastalıktır. Biz hipertansif ve normotansif obez olgularda, Aortik nabız dalga hızı ve vücut kitle indeksi arasındaki ilişkiyi araştırmayı amaçladık.Kan basıncı ve vücut kitle indeksine göre iki grup olmak üzere toplam 109 olgu alındı. Vücut kitle indeksine göre olgular 30.0-34.9 kg/ m2 olanlar Clas I, ≥35 kg/m2 olanlar Clas II olarak tanımlandı. Sonrasında Clas I ve II grupları kan basıncına göre iki gruba normotansif-Clas I, II ve hipertansif-Clas I, II olarak ayrıldı. Tüm grupta (n:109) nabız dalga hızı, yaş, sistolik kan basıncı ve diyastolik kan basıncı ile korelasyon göstermekteydi (sırasıyla, r=0.229; p=0.017, r=0.301; p=0.001 ve r=0.323; p=0.001). Nabız dalga hızının Clas I ve Clas II grupta vücut kitle indeksi ile korelasyonu yoktu. Bu verilere göre, vücut kitle indeksi 30 kg/ m2 üzerindeki olgularda nabız dalga hızının artması vücut kitle indeksi ile ilişkili değildir, fakat yaş, sistolik ve diyastolik kan basıncı ile ilişkili olabilir.

Tularemia Associated to Drinking Mountain Water Presenting with Lymphadenopathy: a Case Report

Tularemia is a zoonotic disease that can be passed to humans via the consumption of wild animal meat or inadequately cooked contaminated drinking water. There has been an increase in the number of observed cases in recent years. The clinical picture may vary from asymptomatic disease to septic shock. Oropharyngeal type of the disease is the most common clinical form and is associated with pharyngitis, fever and cervical lymphadenopathy (LAP). Here we present a 22-year-old female patient who developed cervical LAP after tonsillopharyngitis and was diagnosed with oropharyngeal tularemia that was determined to be related to drinking mountain water.