Tezcan Kaya

Usefulness of the platelet-to-lymphocyte ratio in predicting the severity of carotid artery stenosis in patients undergoing carotid angiography.

Carotid artery stenosis (CAS) is primarily caused by atherosclerotic plaque. Progressive inflammation may contribute to the rupture of an atherosclerotic plaque. The platelet‐to‐lymphocyte ratio (PLR) is a new and simple marker that indicates inflammation. In this study, we aimed to investigate the use of the PLR to determine the severity of CAS. One hundred forty patients were chosen from among patients who underwent carotid angiography in our institution. Symptomatic patients with stenosis >50% in the carotid arteries and asymptomatic patients with stenosis >80% were diagnosed via carotid angiography as having critical stenosis. Patients were classified into two groups. Group 1 included patients who had critical CAS, whereas Group 2 included patients with noncritical CAS, as determined by carotid angiography. Correlations between the PLR and the severity of CAS were analyzed. There were no significant differences in sex and age between the two groups. The PLR was 162.5 ± 84.7 in the noncritical CAS group patients and 94.9 ± 60.3 in the critical CAS group patients (p < 0.0001). The PLR value of 117.1 had 89% sensitivity and 68% specificity for CAS [95% confidence interval, 0.043–0.159; area under the curve, 0.101 ± 0.03)]. In this study, we have shown that PLR values may be associated with critical stenosis in at least one of the carotid arteries. Furthermore, PLR values may be used to predict critical stenosis in the carotid arteries.

Does Vitamin D Deficiency Effect Heart Rate Variability in Low Cardiovascular Risk Population

AIM: This study aimed to evaluate the cardiac autonomic dysfunction and the cardiac arrhythmia risk using heart rate variability parameters in subjects with vitamin D deficiency and low cardiovascular risk. MATERIAL AND METHODS: One hundred five consecutive individuals, 54 patients with low vitamin D status and 51 healthy controls were enrolled in this study. The overall cardiac autonomic tone was quantified by using various heart rate variability parameters included mean RR interval, mean Heart Rate, mean of standard deviations of intervals for 24 hours (SDNN), standard deviation of averages of intervals (SDANN), mean of standard deviation of intervals for 5 minutes (SDNNI), root mean square of difference of successive intervals (rMSSD) and the proportion of intervals differing more than 50 ms (pNN50) values. The 12-lead ECG was recorded from each participant, and QT intervals were measured. RESULTS: Baseline demographic profiles were similar between two groups. The heart rate variability parameters such as mean RR interval, mean HR, SDNN, SDANN, SDNNI, rMSSD and pNN50 (%) values were not significantly different in patients with low vitamin D status compared to control group. The electrocardiography analysis revealed only slight but significant prolongation of corrected QT (QTc) intervals in the control group. CONCLUSION: HRV variables were not significantly altered in patients with vitamin D deficiency in low cardiovascular risk profile group. Further studies evaluating these findings in other cohorts with high cardiovascular risk are required.

Association between the neutrophil-to-lymphocyte ratio, a new marker of systemic inflammation, and restless legs syndrome.

INTRODUCTION Restless legs syndrome (RLS), also known as Willis-Ekbom disease, is characterised by abnormal sensations in the legs as well as dysaesthesia. Although the aetiology of RLS has not yet been determined, it may be associated with systemic inflammation. The neutrophil-to-lymphocyte ratio (NLR) is a new and simple marker indicating systemic inflammation. The present study aimed to investigate the relationship between systemic inflammation and RLS through the use of the NLR. METHODS A total of 75 newly diagnosed patients with RLS and 56 healthy control subjects were included in the study. Baseline NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. The NLRs of the two groups were compared. RESULTS There were no significant differences in gender and age between the two groups. The NLR was 1.96 ± 0.66 in the patient group and 1.67 ± 0.68 in the control group (p = 0.005). Receiver operating characteristic analysis was performed to determine the cut-off value of NLR to predict RLS. The NLR was predictive at 1.58 with a 64% sensitivity and 50% specificity (95% confidence interval 0.55-0.74, area under curve 0.648 ± 0.05). The NLR was found to be statistically higher in patients with RLS and may be used to predict RLS. CONCLUSION The aetiology of RLS remains undetermined. The present study showed that systemic inflammation may play a role in RLS. However, RLS could also be associated with systemic inflammatory diseases. This relationship is supported by high NLR values, which are related to chronic systemic inflammation.

Neutrophil to lymphocyte ratio might help prediction of acute myocardial infarction in patients with elevated serum creatinine.

Background and Objective: Diagnostic performance of troponin assays is affected by renal insufficiency. Neutrophil to lymphocyte ratio(NLR) is an independent predictor of acute coronary syndrome. Our objective was to evaluate performance of NLR in diagnosing acute myocardial infarction (AMI) among patients with elevated serum creatinine. Methods: Patients with elevated creatinine levels evaluated for coronary artery disease were included (n=284). Patients were divided into two groups according to having AMI or non-specific chest pain. AMI diagnosis was made based on clinical and laboratory data, including serial EKG and cardiac enzymes, ECHO and coronary angiography. Results: Troponin, neutrophil, and NLR were found to be higher in patients with AMI, compared to patients without AMI (P= 0.001, P= 0.001 and P=0.028, respectively). ROC curve analysis for NLR in diagnosing AMI was significant (AUC: 0.607; P=0.003). Sensitivity, specificity, LR +, LR-, PPV and NPV for NLR>7.4 were found as 42.3%, 74.7%, 1.68%, 0.77%, 77% and 40%, respectively. Logistic regression analysis revealed that patients whose NLR>7.4 were 2.18 times as likely to have AMI. Conclusions: NLR can be used as an independent predictor of AMI in patients with renal insufficiency. This seems to get more important in the era of high sensitivity troponin assays. Our results might also help in early diagnosis of AMI in this high risk population while serial cardiac enzyme results are pending.

Relationship between primary restless legs syndrome and migraine with aura

In this study, the prevalence and characteristics of definite migraine in primary restless legs syndrome (pRLS) patients and matched control patients (CPs) were investigated. We evaluated 63 consecutive adult pRLS patients and 141 age‐ and sex‐matched controls in this case–control study. The diagnosis of migraine and its subtypes were defined based on The International Classification of Headache Disorders‐II. Only those with “definite” migraine were included in the study. The mean age of 63 adult pRLS patients (15 men and 48 women) who participated in the study was 49.4 years. A total of 27 patients (42.9%) had definite migraine. Of these migraineurs, seven (11.1%) were without aura and 20 (31.8%) were with aura. The mean age of the 141 matched CPs was 48.7 years. A total of 32 CPs (22.7%) experienced migraine. Among these 32 migraineurs, 28 (19.9%) were without aura and four (2.8%) were with aura. Migraine and migraine with aura were significantly more common in pRLS patients than in CPs. pRLS patients with migraine were more anxious and experienced a shorter duration of RLS symptoms than pRLS patients without migraine. Migraineurs in the pRLS group tended to have high scores for severity of migraine headache by Visual Analog Scale score and high levels of disability by Migraine Disability Assessment grading than those in the control group. pRLS patients showed a positive association with definite migraine headaches. In contrast to results highlighted in recent studies, we found a strong link between migraine with aura and pRLS.

Severe Hypokalaemia, Hypertension, and Intestinal Perforation in Ectopic Adrenocorticotropic Hormone Syndrome.

Ectopic adrenocorticotropic hormone (ACTH) syndrome is a rare cause of the Cushings syndrome. The occurrence of the ectopic ACTH syndrome presenting with severe hypokalaemia, metabolic alkalosis, and hypertension has been highlighted in case reports. However, presentation with lower gastrointestinal perforation is not known. We report the case of a 70-year-old male patient with severe hypokalaemia, metabolic alkalosis, hypertension, and colonic perforation as manifestations of an ACTH-secreting small cell lung carcinoma. Ectopic ACTH syndrome should be kept in mind as a cause of hypokalaemia, hypertension, and intestinal perforation in patients with lung carcinoma.

Relationships Between Malnutrition, Inflammation, Sleep Quality, and Restless Legs Syndrome in Hemodialysis Patients.

Restless legs syndrome (RLS) is a common neurologic sensorimotor disorder. It is also seen in hemodialysis patients in whom the mechanism is not thoroughly understood. The aim of this study was to evaluate the association between malnutrition‐inflammation score (MIS), sleep quality, and RLS in chronic hemodialysis patients. This cross‐sectional study included 232 adult stable chronic hemodialysis patients (mean age 60.9 ± 14.1 years, 56.5% male). RLS frequency, MIS, Pittsburgh Sleep Quality Index (PSQI), laboratory data of patients as well as severity of RLS were evaluated. Thirty‐seven patients (15.9%) were diagnosed with RLS. Mean MIS of patients with or without RLS were similar. PSQI of patients with RLS was significantly higher than patients without RLS (P = 0.002). There was a significant positive correlation between RLS severity and PSQI (r = 0.445, P = 0.006). A significant positive correlation was also found between PSQI and MIS in patients with RLS (r = 0.419, P = 0.010). RLS severity was positively correlated with some inflammatory parameters such as white blood cell count and C‐reactive protein (r = 0.427, P = 0.008 and r = 0.418 P = 0.010). PSQI was found as an independent significant predictor of RLS (odds ratio [OR] = 1.15 (1.06–1.25), P = 0.001) in multivariate logistic regression analysis. Our study revealed that there was no significant relationship between RLS and MIS in chronic hemodialysis patients. However, RLS severity is correlated with inflammatory parameters. Also, sleep quality in chronic hemodialysis patients with RLS is negatively associated with MIS.

A Very Rare Presentation of Multiple Myeloma: Unilateral Raccoon Eye

Multiple myeloma (MM), the second most common hematological malignancy, is caused by the accumulation of monoclonal plasma cells in bone marrow. It accounts for 10–15% of deaths from hematological malignancies and approximately 2% of deaths from cancer. The median age at presentation is 70 years old. The diagnosis is incidental in 30% of cases. MM is often discovered through routine blood screening with a large gap between the total protein and the albumin levels. Two thirds of patients complain of bone pain, especially lower back pain. MM could be diagnosed after a pathologic fracture occurs in one third of patients. Presentation with symptoms related to hyperviscosity, hypercalcemia and bleeding tendency could also be observed. A rare presentation of MM is peri-orbital ecchymotic lesion (raccoon eye). Here, we report a 64 years old, male patient presented with unilateral raccoon eye and high erythrocyte sedimentation rate (ESR) to internal medicine outpatient. The patient was referred to hematology outpatient and was diagnosed with multiple myeloma.

Effects of Glucose Control on Hematological Indices in Patients with Diabetes Mellitus

Abstract Aim: We aimed to investigate the effects of diabetes treatment modalities on haematological parameters and leukocyte formula in patients with type 2 diabetes mellitus. Materials and Methods: The study included 102 patients with type 2 diabetes, out of which 51 receiving insulin treatment and 51 receiving oral antidiabetics (OAD). Hemogram data of insulin and OAD treated groups were compared. Results HbA1c levels were 11.12 ± 2.09 mg/dl in insulin group and 7.94 ± 2.1 mg/dl in OAD group p=0.001. Platelet counts were 27866.67 ± 77693 109/L before treatment and 258941.18 ± 69068.2 109/L in OAD group at six months, p: 0.015 whereas; 293011.76 ± 73711.21 109/L before treatment and 289492.86 ± 82631.49 109/L in insulin group at six months p: 0.821. Monocyte counts were 0.47 ± 0.12 109/L before the treatment and 0.57 ± 0.12 109/L in mix insulin therapy subgroup at six months, p:0.004; monocyte percentage was % 6.11 ± 1.74 before the treatment and %7.51 ± 2.57 in mix insulin subgroup at six months p:0.039; Basophiles counts were 0.1 ± 0.02 109/L before treatment and 0.09 ± 0.04 109/L in intensive insulin therapy subgroup at six months, p: 0.005; Lymphocyte and basophils counts were significantly decreased at six months insulin treatment as compared to the pretreatment values. Conclusion: This study showed that, glucose control effects; blood indices HbA1C, basophiles, eosinophils, platelets and lymphocytes counts.

Association between neutrophil-to-lymphocyte ratio and nutritional status in geriatric patients

Neutrophil‐to‐lymphocyte ratio (NLR) and presence of malnutrition have been found to be associated with mortality and morbidity in various clinical conditions. We investigated the association between NLR and nutritional status in geriatric patients.