Yalçın Kepekçi

The human paraoxonase Gln-Arg192 (Q/R) polymorphism in Turkish patients with coronary artery disease

It has been suggested that a Q/R (Glnl92Arg) polymorphism of paraoxonase (PON) might be associated with the predisposition to coronary artery disease (CAD). Therefore, we studied the human paraoxonase gene (PON1) polymorphism in Turkish patients with CAD by polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP). This polymorphism was determined in 96 CAD patients and in 105 control subjects. The frequencies of the QQ, QR, and RR genotypes were found as 36.5, 52.0, and 11.5% in CAD patients and 48.6, 41.0, and 10.4% in control subjects, respectively. The QR genotype was the most common in the patient group, whereas the QQ genotype was more frequent in individuals without CAD. Frequency of the R allele was higher among CAD patients compared to controls (38.5% versus 31%). However, neither the genotype nor the allele distribution of the Gln92Arg polymorphism of PON1 was statistically significantly different between the two groups (P>0.05). Although both systolic and diastolic blood pressure levels were slightly higher in patients with the QQ genotype, there was no differences in regard to age, sex, serum triglyceride, total cholesterol or high-density lipoprotein cholesterol among CAD patients with different PONI Gln192Arg genotypes. In summary, our results suggest that no association exists between the Gln192Arg polymorphism of paraoxonase and CAD in Turkish patients.

Use of the auditory brainstem response testing in the clinical evaluation of the patients with diabetes mellitus

The objective of the study was to assess whether a relationship exists between the auditory brain stem response (ABR) results and diabetes mellitus with and without complications. In the clinical and audiometry laboratory settings, diabetic patients with and without complications (retinopathy and/or nephropathy) were examined using ABR testing, and the results were interpreted for their applicability in clinical practice. Fifty-nine patients with diabetic retinopathy or nephropathy (study group) and 20 diabetic patients without any known diabetic complication (control group) were assessed with audiometry and ABR testing. ABR revealed that the absolute latencies and interwave intervals of the waves I through V were prolonged significantly in the study group when compared to the control group. The amplitudes of waves I through V were diminished in the study group when compared to the control group, but a statistical significance was present only for wave V amplitude. Quantitative (wave I to wave V amplitude ratio) and qualitative analyses of the ABR waves showed abnormal waveforms in the study and control groups by 55.2 and 27.6%, respectively. There is a brain stem neuropathy in diabetes mellitus which can be assessed with ABR testing. The likelihood of encountering a diabetic complication increases as the ABR results become abnormal.

Angiotensin-converting enzyme gene polymorphism and microvascular complications in Turkish type 2 diabetic patients

The aim of this study was to investigate whether an association exists between the angiotensin converting enzyme (ACE) insertion/deletion (I/D) polymorphism and microvascular complications of type 2 diabetes mellitus in Turkish patients. A total of 239 type 2 diabetic patients and 138 sex and age matched control subjects were included into the study. The I/D polymorphism was determined by polymerase chain reaction (PCR). Nephropathy status was determined according to urinary albumin/creatinine ratio (microg/mg) (<30 normoalbuminuria, 30-300 microalbuminuria, >300 macroalbuminuria) and retinopathy was evaluated by fundoscopic examination and by flourescein fundus angiography. The distribution of ACE I/D polymorphism and allele frequencies in diabetic patients were not significantly different from controls, DD genotype 32.2 versus 37.2%; ID genotype 50.6 versus 47.1%; and II 17.2 versus 15.2%; D allele 57.5 versus 61.2%; I allele 42.5 versus 38.8%. Genotype distribution between normo-, micro- and macroalbuminuric patients did not differ significantly (DD:ID:II (%), normoalbuminuria, 35:46:19; microalbuminuria, 28:55:17; macroalbuminuria, 31:55:14). There was also no difference in genotype distribution between patients with and without retinopathy (DD:ID:II (%), retinopathy positive, 32:51:17; retinopathy negative, 33:49:18). In conclusion, the ACE I/D polymorphism does not seem to be associated with diabetic nephropathy and retinopathy in Turkish type 2 diabetic patients.

Is increased red cell distribution width (RDW) indicating the inflammation in Alzheimer's disease (AD)?

Increasing evidence indicates that inflammation has a substantial role in the pathogenesis and progression of AD. RDW, a measure of heterogeneity in the size of circulating erythrocytes, is associated with inflammatory markers in many numerous diseases. Present study was undertaken to assess the interrelationships between RDW and AD. A total of 197 patients with AD (male/female: 96/101, mean age 76.2 ± 6.9) and 133 patients as controls with normal cognitive function (male/female: 72/61, mean age 71.68 ± 5.3) were enrolled in this cross-sectional study. RDW values of all participants were measured. Mini-Mental State Examination (MMSE) and clock drawing tests were performed for cognitive assessment. DSM-IV and NINCDS-ADRDA criteria were used for diagnosis of AD. The mean RDW values were significantly higher in AD group (13.93 ± 1.1 vs. 13.24 ± 1.2; p<0.001) and also a negative moderate correlation between RDW and MMSE was identified (r: -0.453; p<0.001). After adjusting for confounders, RDW has the strongest association with AD (odd ratio (OR) 1.51, CI=1.10-2.07). In present study RDW levels were significantly increased in patients with AD. Whereas elevated RDW value is usually considered as a novel biomarker of inflammation, the results of our study may support the role of inflammation in pathophysiology of AD. Furthermore the correlation of RDW with poorer cognition status suggests that it may be used as a marker of AD severity.

Is there a link between neutrophil-lymphocyte ratio and microvascular complications in geriatric diabetic patients?

Background: Chronic inflammation plays an important role on development and progression of Type 2 diabetes (T2DM) through immunologic inflammatory mechanisms. Neutrophil to lymphocyte ratio (NLR) is a new, simple and cheap marker of subclinical inflammation. NLR has recently been used as a systemic inflammation marker in chronic diseases as well as a predictor of prognosis in cardiovascular diseases and malignancies. Aim: The objective of the present study was to investigate the relationship between NLR and microvascular complications of diabetes mellitus (DM) in elderly population. Subjects and methods: Two hundred and forty-two patients with DM (145 diabetic patients with complications, 97 diabetic patients without complications) and 218 control subjects were enrolled in this study. NLR and microvascular complications because of DM were evaluated and compared with other inflammatory markers. Results: NLR was higher in the diabetic group (2.21±1.14) than in the controls (2.18±0.76). Furthermore, there was a statistically significant difference between NLR levels in diabetic patients with and without complications (2.46±1.26 vs 2.04±0.51, respectively; p<0.001). The results of the multiple logistic regression analysis depicted that NLR is also an independent predictor for microvascular complications (odds ratio 2.217; 95% confidence interval 1.086–4.526, p=0.029). Receiver operating curve analysis suggested that the optimum NLR cutoff point for microvascular complication was 2.89 with 96.72% specificity, 94.4% positive predictive value. Conclusion: Increased NLR levels may be associated with microvascular complications of DM in the elderly population.

Inverse relationship between neutrophil lymphocyte ratio (NLR) and bone mineral density (BMD) in elderly people.

Osteoporosis is, an age related disorder, influencing elderly people worldwide. The latest data suggests that inflammation plays a critical role in bone remodeling and in pathogenesis of osteoporosis. NLR is a simple, non-invasive and cost-effective marker of inflammation in various malignancies and inflammatory diseases. The objective of the present study was to compare NLR levels in osteopenic, osteoporotic and control subjects and to assess the correlation between NLR levels and BMD. A total of 1635 patients aged 65 years or more were included in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine and femur. Complete blood count (CBC), biomarkers of inflammation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)), glucose/lipid metabolism and established risk factors were determined. In osteoporosis group, NLR levels were found to be elevated as compared to osteopenic and control group (2.54±1.45, 2.37±1.00 and 2.18±0.85, respectively). At multivariate analysis NLR emerged as independent predictor of osteoporosis (OR=1.122; 95%=1.020-1.235, p=0.018) and there was a significant negative correlation between lumbar spine (L2-L4), femoral neck scores and NLR (r=0.348, p<0.001; r=0.264, p=0.004, respectively). Elderly people with osteoporosis have elevated NLR levels, suggesting that inflammation may play an important role in bone remodeling.

The predictive value of auditory brainstem responses for diabetic retinopathy.

OBJECTIVE The purpose was to find out whether there is a relationship between the central nervous system involvement and retinopathy in diabetes mellitus. STUDY DESIGN In a multidisciplinary clinical study, diabetic patients with and without retinopathy were examined utilising auditory brainstem response (ABR) testing, and the results were interpreted from clinical and pathophysiological point of view. PATIENTS AND METHODS Thirty-three diabetic patients with retinopathy (study group) and 20 diabetic patients without retinopathy (control group) were included. Audiometry and ABR testing were made. The results of both groups were compared for ABR parameters. RESULTS Audimetric results of the study and control groups were similar. In the study group, ABR testing revealed prolonged absolute and interpeak latency of the waves. The difference was significant for I-III interval (P<0.01). The amplitudes of the waves were similar in both groups and wave V amplitude was significantly diminished in the study group. Abnormal waveforms were recorded by 40 and 12.5% in the study and control groups, respectively. CONCLUSION Retinopathy is accompanied with lower brainstem disintegration. Microangiopathy is the possible mechanism that is involved in the occurrence of retinopathy and brainstem neuropathy. ABR can help diagnose retinopathy. Better understanding the role of ABR in diagnosis and early detection of retinopathy in diabetic patients needs further study.

Do Ramadan Fasting Restrictions Alter Eating Behaviours in Obese Women

Ramadan fasting can be considered as a kind of dietary restriction. Eating restriction is a risk factor for later development of eating disorders. The purpose of this study is to evaluate whether Ramadan fasting changes the eating behaviours of obese women. Our sample consisted of 34 obese women who fasted during the Ramadan month. The data were collected by using Questionnaire Form, Eating Attitude Test (EAT) and Bulimic Investigatory Test, Edinburgh (BITE). No statistically significant differences were found between the scores of EAT, BITE, BMI, which were administered within the weeks before and after Ramadan. According to our results, Ramadan fasting restrictions do not seem to change the eating behaviours of obese women.

Absorbable and Nonabsorbable Sutures for Tracheal Anastomoses in Dogs

Tracheal anastomosis was performed in 3 groups of 6 mongrel dogs each (mean age, 4 months; mean weight, 7 kg) to compare synthetic sutures. The interrupted technique was used for all anastomoses and they were evaluated by rigid bronchoscopy in the 3rd postoperative week. While suture absorption was observed in the Vicryl group, it was not visible in the Ethibond and polydioxanone groups. Dogs were sacrificed between 26 and 76 days (mean, 44 days) postoperatively. No stenosis was observed in any group. Histological evaluation of the epithelium showed a statistically significant difference in epithelization between Vicryl and Ethibond, and between polydioxanone and Ethibond. There was no difference between Vicryl and polydioxanone. These results suggest that absorbable suture material is superior for tension-free anastomoses.

Is there a link between functional ability and serum natural antioxidants in elderly

Ageing is an unavoidable complex biological process that is defined as a decline in intrinsic physiological and biochemical functions of the major systems, leading to an increase in the risk of disease and mortality [1]. It is assumed that with ageing, mitochondrial functions decline progressively and cause accumulation of reactive oxygen species (ROS) [2]. Oxidative stress, caused by imbalance between ROS and antioxidants, is responsible for various age-related diseases such as arteriosclerosis, malignancies and neurodegenerative diseases. Serum uric acid, albumin, and bilirubin are strong natural hydrophilic antioxidants, while gamma glutamyl transferase (cGT) is a marker of oxidative stress in body. Functional ability is one of the main components of successful ageing; in this context, activity of daily living (ADL) and instrumental activities of daily living (IADL) reflect the functional status of elderly people. We hypothesized that there may be an association between functional ability and natural serum oxidants and antioxidants. The patients with end stage renal disease, malignant disease, severe liver failure, neurodegenerative diseases such as Alzheimer’s disease and Parkinson were excluded from the study. A total of 1,418 elderly persons (48 % men) with a mean age of 69.4 were evaluated by comprehensive geriatric assessment. The age range of the men and women was 63–84 and 64–87, respectively. Functional status was measured by using the Barthel index [3] for basic ADL, while the Lawton–Brody index [4] was used for IADL. Laboratory tests including uric acid, albumin, bilirubin and cGT were performed by a hospital autoanalyzer. Spearman correlation analysis revealed a significant positive relationship between ADL and IADL scores with serum natural antioxidants as summarized in Table 1. In addition, a negative, weak correlation was found between ADL and IADL scores with serum cGT levels as oxidative stress marker (Table 1). We have also measured serum uric acid, albumin, bilirubin and cGT levels of a middle-aged group including 331 persons (51 % men) with a mean age 41.3 (29–51). In comparison with elderly group, serum bilirubin and albumin levels were significantly higher in middle-aged group (P = 0.03 and P \ 0.01). There was no difference in the levels of serum uric acid and cGT between two groups. There is a growing body of evidence linking oxidative stress and ageing. In this regard, two recent studies demonstrated that serum natural antioxidants were lower in elderly patients with Alzheimer’s disease and osteoporosis [5, 6]. Uric acid is a strong, endogenously produced watersoluble antioxidant and can scavenge numerous oxidants including superoxide, hydroxyl radical and peroxynitrite [7]. Emerging data indicate that bilirubin, end product of heme metabolism, has more potent antioxidant effect than other antioxidants, including a-tocopherol, superoxide dismutase and catalase [8]. Moreover, bilirubin also has immunomodulatory functions [9]. The main antioxidant role of albumin could be linked to its physiological properties including inhibition of lipid peroxidation and scavenging of oxygenand carbon-centered free radicals [10]. On the other hand, cGT is a prominent oxidative stress marker and cGT-induced glutathione cleavage results in the production of the superoxide anion and hydrogen peroxide [11]. Furthermore, serum free radicals were found to be higher in patients with diabetes mellitus, coronary heart Z. A. Ozturk (&) Y. Kepekci Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Gaziantep University, Sahinbey, 27100 Gaziantep, Turkey e-mail: zaodr79@yahoo.com