Şeref Yüksel

The cutaneous silent period in diabetes mellitus

The cutaneous silent period (CSP) may be useful as a method for the evaluation of smaller and unmyelinated fiber dysfunctions. CSP refers to the brief interruption in voluntary contraction that follows strong electrical stimulation of a cutaneous nerve. The aim the present study is to establish whether CSP can be instrumental in the determination of diabetic neuropathy. The nerve conduction studies and CSP evaluations were both used in patients with Diabetes Mellitus and control group. All patients were given clinical neurological examinations for the determination of small-fiber neuropathy (SFN). The CSP values for patients with SFN were compared with values of those without SFN. The nerve conduction velocities had changed unfavorably in diabetic patients. No median nerve CSP reponse could be obtained in two of the diabetic patients. CSP latency (84.6+/-14.0) in diabetics was longer than controls (76.2+/-13.1) (p=0.018). The duration of CSP was similar for the two groups (p=0.46). The CSP latency showed a correlation with routine nerve conduction studies. While the CSP latencies (86.7+/-15.8) of patients who were clinically diagnosed with SFN were similar to the latencies (81.3+/-10.4) of patients without SFN (p=0.606), the duration of CSP (44.6+/-13.7) in patients with SFN was shorter than the duration (55.3+/-12.2) in patients without SFN (p=0.012). These results indicate that even though the CSP does not provide any advantage over routine electrodiagnostic studies in determining diabetic neuropathy, still it may be a useful method for the early detection of diabetic SFN.

The relationship between dipping-non-dipping arterial blood pressure pattern and frequency of restless leg syndrome with related factors

Objective: The lack of nocturnal decline in blood pressure (BP) is associated with an increase in cardiovascular events. Restless leg syndrome (RLS) is an uncomfortable feeling in which the patient wants to budge the legs with ache in the legs. RLS also increases the hypertension and cardiovascular risk. In this study, we aimed to evaluate the relationship between dipping and non-dipping blood pressure patterns with RLS and its severity. Methods: Two hundred patients who had 24-hour ambulatory blood pressure monitoring (ABPM) were enrolled into this cross-sectional study. They were classified by blood pressure pattern as dipping and non-dipping. Then, 100 patients with the dipper pattern and 100 patients with the non-dipper pattern were chosen. A questionnaire for RLS diagnosis that was prepared by the International RLS Study Group was given performed to the patients. Results: RLS symptom score was higher in patients with non-dipping blood pressure patterns (NDBPP), and patients with NDBPP had more severe RLS. Beside this, there were no differences in terms of RLS frequency in dipping and non-dipping blood pressure patterns. Conclusion: As a conclusion, dipping and non-dipping blood pressure patterns do not increase RLS risk. But, if patients with NDBPP have RLS, they have more severe RLS. So, we suggest that evaluating a patient with a non-dipping blood pressure pattern, considering RLS, would be helpful to ameliorate the quality of life of the patient

Akut Böbrek Yetmezliği Tanısıyla Kliniğimize Yatan Olguların Analizi

Amac: Akut bobrek yetmezligi, bobrek fonksiyonlarinda hizli bir azalmayla karakterize ve yuksek mortalite oranina sahip onemli bir klinik sendromdur. Akut bobrek yetmezliginde mortalite, son yillardaki yogun bakim ve renal replasman tedavilerindeki gelismeye ragmen yuksek kalmaya devam etmektedir. Bu calismada klinigimizde ABY tanisiyla yatan hastalari degerlendirdik.Gerec ve Yontem: Ocak 2011 ve Aralik 2012 arasinda hastanemize Akut bobrek yetmezligi tanisiyla basvuran 145 hastayi retrospektif olarak inceledik. Hastalarin kayitlarindan yasi, Akut bobrek yetmezligi tipi, basvuru sekli, basvurudaki temel bulgulari, etyolojisi, zeminde eslik eden hastaliklar, uygulanan tedavi ve laboratuvar degerleri kaydedildi.Bulgular: Olgularin etiyolojisi incelendiginde en sik nedenler prerenal azotemi (%38,6) ve nefrotoksik ajan kullanimiydi (%30,3). Hastalarin %72,6’si nonoligurik %27,4’u oligurik idi. Olgularin %65,5’ine medikal tedavi uygulanirken %34,5’ine medikal tedaviye ek olarak hemodiyaliz tedavisi uygulandi. Hastalarin %86,9’u tedavi sonucu iyilesirken, %13,1’i kaybedildi. Olen hastalarin %63,2’si medikal tedaviye ek olarak hemodiyaliz tedavisi alirken %36,8’i sadece medikal tedavi almisti. Oligurik hastalarin %67,5’i medikal tedavi ve hemodiyaliz, %32,5’i sadece medikal tedavi alirken nonoligurik hastalarin %21,9’u medikal tedavi ve hemodiyaliz, %78,1’i sadece medikal tedavi aldi.Sonuc: Akut bobrek yetmezligi etiyolojisinde 40 yil oncesine gore medikal nedenler on plana cikmaktadir. Ayrica oligoa

L-Carnitine Supplementation Reduces Short-Term Neutrophil-Lymphocyte Ratio in Patients Undergoing Coronary Artery Bypass Grafting.

This study aims to investigate whether preoperative L-carnitine supplementation affects the neutrophil-to-lymphocyte ratio (NLR) in patients undergoing coronary artery bypass grafting surgery. The neutrophil-to-lymphocyte ratio is an inflammatory marker that has proven usefulness for predicting postoperative complications in coronary artery bypass surgery. A lot of studies concerning the role of L-carnitine in the immune system have been performed, contradictory results have been reported on its effects on absolute numbers of WBC subtypes. This randomized, double-blinded, placebo-controlled study was conducted among patients scheduled for coronary artery bypass grafting surgery between June 2012 and December 2013 in our cardiovascular surgery clinic. A total of 60 consecutive patients were randomized and divided into 2 groups. The first group received 2 g of L-carnitine in 1000 mL of 0.9% saline solution infused over 24 hours for each of the 3 preoperative days (L-carnitine group, n = 30), or only 1000 mL of 0.9% saline solution for the same time period (placebo group, n = 30). The basal values of leukocyte, neutrophil, lymphocyte counts, and neutrophil to lymphocyte ratio were similar in the 2 groups. After L-carnitine supplementation (just before surgery), leukocyte and neutrophil counts of the L-carnitine group were significantly lower than those of the placebo group (7.7 ± 1.5 versus 9.7 ± 2.6, P < 0.001 and 4.6 ± 1.3 versus 6.5 ± 2.2, P < 0.001). On postoperative day 1, lymphocyte counts were significantly higher in the L-carnitine group (1.1 ± 0.6 versus 0.8 ± 0.9, P < 0.001). Moreover, the increase in NLR was significantly lower in the L-carnitine group at postoperative day 1 (20.7 ± 13.8 versus 10.8 ± 4.1, P < 0.001). Preoperative L-carnitine supplementation may reduce neutrophil-lymphocyte ratio during the early postoperative period of coronary artery bypass grafting surgery.