Sinan Kirim

Apoptosis and Proliferating Cell Nuclear Antigen in Lupus Nephritis (Class IV) and Membranoproliferative Glomerulonephritis

Background: The role of apoptosis in the pathogenesis of renal diseases has not been clearly established. Proliferating cell nuclear antigen (PCNA) is also a proliferation marker. In this study, we investigated the relationship between clinical course and PCNA apoptosis on baseline renal biopsy in patients with Lupus nephritis (LN) and membranoproliferative glomerulonephritis (MPGN). Methods: Thirty-nine patients with proliferative glomerulonephritis [lupus nephritis (LN)[21] and MPGN[18]] were included in this study. PCNA and apoptosis on renal biopsies were detected by immunohistochemical and terminal deoxynucleotidyl transferase mediated dUTP nick end labelling TUNEL methods, respectively. We calculated the ratios of intraglomerular apoptotic cells and PCNA positive cells per glomeruli, and total numbers of apoptotic tubular cells and PCNA positive tubular cells among the 100 tubular cells, and PCNA positive cell and apoptotic cell on two different tubulointerstitial areas (40 × 10). Results: In LN: Apoptotic indexes of glomerulus and tubulus were 1.08 ± 0.49 and 3.71 ± 1.38, respectively. PCNA positivities were found at 16.76 ± 11.34%, 46.57 ± 22.54%, and 40.28 ± 23.14% on glomerulus, tubulus, and interstitium, respectively. The activity index was 11.23 ± 3.41, and the chronicity index was 3.81 ± 1.99. In MPGN: Apoptotic indexes were found at 0.83 ± 0.25 and 3.55 ± 1.75 on glomerulus and tubulus, respectively. PCNA positivities were found at 21.33 ± 18.42%, 35.5 ± 25.99%, and 34.66 ± 26.84% on glomerulus, tubulus, and interstitium, respectively. In controls, apoptosis was not found. In LN: PCNA positivity on tubulus and interstitium were correlated with the activity index (r = 0.768, p < 0.001, r = 0.721, and p < 0.001, respectively). Glomerular PCNA and apoptosis on interstitium and glomerulus were not correlated with the activity index. The activity index also was not correlated with creatinine clearance and daily proteinuria (p = 0.35 for both). At the end of the first year, patients with recovered or stabilized renal function had higher interstitial and tubular PCNA than others in G1 and G2. Conclusion: It can be said that expression of PCNA on renal biopsy was correlated with activity indexes in LN. PCNA may be a prognostic indicator in MPGN and LN. However, apoptosis does not have a predictive value for MPGN and LN.

Is β-Thalassaemia Minor Associated with Metabolic Disorder?

Objective: To investigate the frequency of metabolic syndrome and its components in subjects with β-thalassaemia minor. Subjects and Methods: A total of 194 subjects, i.e. 92 subjects with β-thalassaemia minor (study group) and 102 subjects without β-thalassaemia minor (control group), were enrolled into this case-control study. Haemoglobin electrophoresis was performed on all patients. The waist circumference and systolic and diastolic blood pressure of the subjects were recorded. Fasting blood glucose and serum lipid levels were measured. Results: Both groups were similar in terms of age and sex (p > 0.05 for each). The percentages of haemoglobin A2 (4.3 ± 0.4 vs. 2.0 ± 0.3) and haemoglobin F (3.38 ± 1.4 vs. 0.26 ± 0.4) and the mean corpuscular volumes (64 ± 4.7 vs. 81.5 ± 9.3) of the groups were statistically different (p < 0.001 for each). The frequency of metabolic syndrome and its components was similar in both groups (p > 0.05 for each). According to correlation analyses, the percentage of haemoglobin A2 correlated with fasting insulin, fasting glucose, systolic blood pressure, high-density lipoprotein, and low-density lipoprotein levels (p < 0.05). Conclusions: No association was found between β-thalassaemia minor and metabolic syndrome despite insulin resistance, which was shown in subjects with β-thalassaemia minor.

Low Serum Phosphorus Level in Massry's Phosphate Depletion Syndrome May Be One of the Causes of Acute Heart Failure.

Hypophosphatemia has been found to be associated with multiple organ dysfunction. In this study we aimed to investigate the association between low serum phosphorus and acute heart failure. A total of 213 subjects, 101 patients with acute heart failure and 112 healthy subjects were included in this case-control study. Serum phosphorus levels, calcium levels, and PTH concentrations were measured. Ejection fraction percentages, pulse rates, systolic and diastolic blood pressures were recorded. The groups were similar in terms of age and gender (p=0.067 and 0.995, respectively). The phosphorus levels and ejection fraction percentages of the patients with heart failure were lower than for the healthy subjects (p<0.001). Frequency of hypophosphatemia was higher in the heart failure group (p<0.001). There was a strong relationship between low serum phosphorus level and acute heart failure (OR 9.85, CI 95% 3.6-26.3, p<0.001). The phosphorus level of patients with acute heart failure was found to be low in this study. Therefore, the phosphorus level should be controlled in patients with acute heart failure and phosphorus supplementation can be a complimentary treatment for these patients.

Effects of acute organophosphate poisoning on thyroid hormones in rats

The aim of this study was to investigate the effects of organophosphate poisoning on thyroid hormones. In this study, male Wistar albino rats weighing 200-225 g were used. The rats were divided into 4 groups. Group 1 (n = 10) was administered 30 mg/kg lethal dose of methamidophos, whereas group 2 (n = 7) was treated with physiologic NaCl (SP). Group 3 (n = 10) was treated with 30 mg/kg of methamidophos. When cholinergic symptoms developed among the rats in group 3, they were treated with 40 mg/kg pralidoxime intraperitoneally (IP) and administered atropine IP until the cholinergic symptoms disappeared. Group 4 (n = 7) was treated with SP. After the cholinergic symptoms appeared among the rats in group 1, intracardiac blood samples were taken. In group 3, blood samples were taken after the cholinergic symptoms had disappeared. Then triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), and plasma choline esterase (PCE) levels were studied by RIA. The Kruskal-Wallis test and Mann-Whitney U test were used for comparison between groups. Bonferroni correction was applied when multiple comparisons were made. T3, T4, and TSH levels decreased in group 1 compared with group 2 (P < 0.01). When the results between groups 3 and 4 were compared, it was found that the T3 and T4 levels in group 3 decreased while the decreases in T3 levels were statistically significant (P < 0.01). When comparing the results of groups 1 and 3, the T4 level was lower in group 1 and the T3 level was higher in group 3 (P < 0.01). The TSH level increased in group 3 after treatment (P < 0.01). Thyroid hormones were affected after acute organophosphate poisoning. Hypothyroidism and sick euthyroid syndrome was observed during poisoning and after treatment. In serious poisoning, there may be a poor prognosis, but more extensive studies will illuminate the issue in depth.

Insulin resistance in patients with hypothyroidism or hyperthyroidism without hepatosteatosis

without hepatosteatosis SO Keskek, S Kirim, M Tasdemir, D Tuzun, G Ortoglu, T Saler Numune Education and Training Hospital, Department of Internal Medicine, Adana, Turkey Introduction: Insulin resistance, refers to decreased response of tissues to insulin, primarily associated with type 2 diabetes and glucose intolerance. Several results were obtained in previous studies about the relation between insulin resistance and thyroid dysfunction. In these studies hepatosteatosis was not an exclusion criteria despite insulin resistance has a key role in the development of it. In this study we aimed to investigate insulin resistance in patients with hypothyroidism or hyperthyroidism without hepatosteatosis. Design: A total of 340 patients without hepatosteatosis were included. These patients were further divided into two study subgroups and a control group: 106 subjects with hypothyroidism, 104 with hyperthyroidism and 130 with normal thyroid function in the control group. The institution review board of hospital approved the study. We measured serum TSH, free T4, free T3 concentrations, blood glucose and insulin levels, serum lipid levels, hepatic transaminases and homeostasis model assessment of insulin resistance (HOMA IR). Insulin resistance was calculated according to HOMA index and compared between the groups. SPSS 19.0 package program (SPSS Inc., Chicago, Illinois) was used for statistical analysis. Ki square and ANOVA tests were used for comparing groups. Results: Average age of 340 patients was 41.2 ± 10.9 years. Male/female ratio was 52:288. Frequencies of insulin resistance in hypothyroidism, hyperthyroidism or normal thyroid function were 17%, 20% and 24% (P=0.673), respectively. HOMA-IR indexes were 1.85±1.18, 1.96±1.54, 2.09±1.79 respectively. The difference was not statistically significant (P = 0.589) (Table 1). Conclusion: In this study, we did not found insulin resistance in patients with hypothyroidism or hyperthyroidism. We concluded that insulin resistance could be associated with comorbidities in patients with thyroid dysfunction in previous studies. In our opinion, hepatosteatosis should be evaluated as a comorbidity in such patients.

Insulin resistance in patients with thyroid dysfunction and hepatosteatosis

SO Keskek, S Kirim, R Kaya, D Tuzun, G Ortoglu, T Saler Numune Education and Training Hospital, Department of Internal Medicine, Adana, Turkey Introduction: Hepatosteatosis is one of the results of insulin resistance. Thyroid dysfunctions effect on insulin sensitivity. The aim of this study was to evaluate insulin resistance in patients with hepatosteatosis and either hypothyroidism or hyperthyroidism. Design: A total of 407 patients with hepatosteatosis were included. These patients were further divided into two study subgroups and a control group: 102 subjects with hypothyroidism, 103 with hyperthyroidism and 202 with normal thyroid function in the control group. The institution review board of hospital approved the study. Serum TSH, free T4, free T3 concentrations, blood glucose and insulin levels, serum lipid levels, hepatic transaminases and homeostasis model assessment of insulin resistance (HOMA IR) were measured. Insulin resistance was calculated according to HOMA index and compared between the groups. IBM statistics 20.0 for Windows was used for statistical analysis. Ki square and ANOVA tests were used for comparing groups. Results: Average age was 50.8 ± 14.1 years. Male/female ratio was 141:266. Frequencies of insulin resistance in patients with hepatosteatotis and either hypothyroidism, hyperthyroidism, or normal thyroid function were 43%, 40% and 48% (P, nonsignificant), respectively. HOMA-IR indices were not statistically different between groups (P = 0.104) (Table 1). Conclusions: Hypothyroidism and hyperthyroidism are not correlated to insulin resistance in patients with hepatosteatosis. We decided that patients with hepatosteatosis already have insulin resistance despite different associated comorbidities. Similar studies in literature did not emphasize on hepatosteatosis in such cases.