Zeynel Abidin Sayiner

Evaluation of oxidant and antioxidant status and relation with prolidase in systemic sclerosis.

SummaryPurposeSystemic sclerosis (SSc) is a disease characterized by fibrosis of the skin and organs; it is associated with diffuse fibroproliferative microangiopathy and autoimmune background. The studies have shown that the production of excessive free radicals and increased collagen synthesis by the fibroblasts play an important role in the pathophysiology of SSc. Prolidase is an important marker in collagen turnover. We aimed to compare total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and prolidase levels of SSc patients and healthy controls. We also investigated the relationship between prolidase and oxidative stress.MethodsA total of 38 SSc patients and 33 healthy volunteers were included in the study. Serum TAS, TOS, and prolidase activity were evaluated in the groups.ResultsIt was found that the TOS and OSI levels of patients were higher than those in the control group (P = 0.012 and 0.015, respectively), whereas TAS was not significantly different between groups (P = 0.451). Prolidase activity was lower in patients than in controls (P = 0.008). There was a weak correlation between prolidase and OSI in patients. It was found that TAS was lower by marginal significance in the patients with lung and gastrointestinal tract (GT) involvement than the patients without those (P = 0.067 and 0.059, respectively).ConclusionsOur data suggest that oxidative stress is increased in SSc. TAS is decreased in patients with lung and GT involvement. These results support that antioxidant treatment may be useful in SSc, especially in patients with lung and GT involvement. Antioxidant treatment may prevent organ involvement in SSc. TAS may be a marker that predicts the risk of involvement of a specific organ. In addition, prolidase may be a marker of SSc.ZusammenfassungZiel der StudieDie systemische Sklerose (SSc) ist eine Erkrankung, die durch Fibrose der Haut und der Organe gekennzeichnet ist; sie ist vergesellschaftet mit einer diffusen fibroproliferativen Mikroangiopathie und einem autoimmunen Hintergrund. Es konnte in verschiedenen Studien gezeigt werden, dass die überschießende Produktion von freien Radikalen und die gesteigerte Kollagensynthese durch Fibroblasten eine wichtige Rolle in der Pathophysiologie der SSc spielen. Prolidase ist ein wichtiger Marker des Turnovers von Kollagen. Ziel unserer Studie war es, den gesamten oxidativen Status (TOS), den gesamten antioxidativen Status (TAS), den oxidativen Stress Index (OSI) und die Serum-Konzentrationen der Prolidase bei Patienten mit SSc und bei gesunden Kontrollen zu erheben. Außerdem untersuchten wir, ob ein Zusammenhang zwischen Prolidase und oxidativem Stress besteht.Methodik38 Patienten mit SSc und 33 gesunde Freiwillige wurden in die Studie aufgenommen. Serum TAS, TOS und Prolidase-Aktivität wurden in beiden Gruppen erhoben.ErgebnisseDie TOS und OSI waren bei den Patienten höher als bei der Kontrolle (P = 0,012 beziehungsweise 0,015). Die TAS unterschied sich allerdings nicht signifikant zwischen beiden Gruppen (P = 0,451). Die Aktivität der Prolidase war bei den Patienten niedriger als bei den Gesunden (P = 0,008). Bei den Patienten bestand eine schwache Korrelation zwischen Prolidase und dem OSI. Bei den Patienten mit Beteiligung der Lunge und des Gastrointestinaltraktes (GI-Trakt) waren die TAS grenzwertig signifikant niedriger (P = 0,067 beziehungsweise 0,059) als bei den Patienten ohne Befall dieser Organe.SchlußfolgerungenUnsere Ergebnisse lassen vermuten, dass der oxidative Stress bei SSc erhöht ist. TAS ist bei Beteiligung der Lungen und des GI-traktes erniedrigt. Eine antioxidative Behandlung könnte daher bei SSc – vor allem wenn Lungen und GI-Trakt befallen sind, von Nutzen sein. Diese Behandlung könnte der Organbeteiligung vorbeugen. TAS könnte ein Marker sein, der das Risiko des Befalls eines bestimmten Organs vorhersagt. Außerdem könnte die Prolidase ein Marker der SSc sein.

Vitamin D receptor activation with calcitriol for reducing urinary angiotensinogen in patients with type 2 diabetic chronic kidney disease

Abstract Background Recently, it has been reported that urinary angiotensinogen levels is a specific index of the intrarenal renin-angiotensin-aldosterone system (RAAS) status and it is significantly correlated with urinary albumin:creatinine (Cr) ratio in hypertensive patients. The aim of the present study was to assess the effect of activation of the Vitamin D receptor with calcitriol on albuminuria and urinary angiotensinogen as a novel biomarker of the intra-renal RAAS status in patients with diabetic nephropathy (DN). Methods Ninety-eight patients with type 2 diabetes and albuminuria who were treated with RAAS inhibitors (angiotensin-converting enzyme inhibitor (ACE-i) or angiotensin receptor blocker (ARB)) have participated in this study. Patients were randomized to receive either placebo (n = 50) or 0.25 μg/day calcitriol (n = 48). We have examined urinary albumin:Cr ratio and urinary angiotensinogen:Cr ratio before and 24 weeks later after treatment in both group. Results The mean urinary albumin:Cr ratio and urinary angiotensinogen:Cr ratio were significantly higher in patients with DN than in normal controls (p < 0.001). Urinary angiotensinogen:Cr ratio was significantly, positively correlated with urinary albumin:Cr ratio in both groups (in the placebo group; p = 0.01, r = 0.4236, in calcitriol group; p = 0.01, r = 0.4564). Conclusion These data indicated that administration of Vitamin D receptor activator in combination with RAAS inhibitors had an additional benefit in lowering albuminuria in patients with DN. More pronounced reduction of urinary albumin:Cr ratio that was positively correlated with angiotensinogen:Cr ratio in calcitriol group suggested that Vitamin D receptor activation might blunt albuminuria by reducing urinary angiotensinogen levels reflecting intra-renal RAAS status.

Inflammatory Back Pain in Patients Treated with Isotretinoin

To the Editor: Despite the positive effects of isotretinoin on a number of cancers and severe skin conditions, several disorders of the musculoskeletal system have been reported in patients who are treated with it. Reactive seronegative arthritis and sacroiliitis are very rare side effects1,2,3. We describe 4 cases of inflammatory back pain without sacroiliitis after a month of isotretinoin therapy. We observed that after termination of the isotretinoin therapy, patients’ complaints completely resolved. Musculoskeletal system side effects reported from isotretinoin treatment include skeletal hyperostosis, calcification of tendons and ligaments, premature epiphyseal closure, decreases in bone mineral density, back pain, myalgia and arthralgia, transient pain in the chest, arthritis, tendonitis, other types of bone abnormalities, elevations of creatine phosphokinase, and rare reports of rhabdomyolysis. Musculoskeletal symptoms are common with isotretinoin therapy, but sacroiliitis is a very rare adverse … Address correspondence to Dr. Y. Pehlivan, Gaziantep Universitesi Sahinbey Arastirma Hastanesi, Romatoloji BD, Gaziantep 27310, Turkey. E-mail: drpehlivan{at}hotmail.com

Lu-177 labelled peptide treatment for radioiodine refractory differentiated thyroid carcinoma

Differentiated thyroid carcinoma (DTC) has good prognosis but 5% of the patients already have distant metastasis at the diagnosis. Tumour cells can lose their iodine uptake ability and enter a state of dedifferentiation. Treatment for differentiated thyroid carcinoma that is not suitable for the local surgery and unresponsive to radioactive iodine uptake is not always easy for physicians. We present a case of a 64-year-old man who had total thyroidectomy surgery and central lymph node dissection with diagnosis of multinodular goitre disease. Histopathological evaluation was papillary thyroid cancer with tall cell variant. Treatment using 150 mCi radioiodine was administered to the patient three times but could not effect a cure. We performed Ga-68 labelled DOTATE (synthetic somatostatin analogue peptide). This provided a good outcome. As evident from our case, Lu-177 radionuclide labelled synthetic somatostatin analogue peptides have therapeutic effect on radioiodine refractory DTC, as an alternative treatment modality.

Interferon alpha-induced non-immune thyrotoxicosis treated by plasmapheresis

Interferon-alpha (IFN-α) is an effective drug used for the treatment of chronic hepatitis C. So far its numerous side effects have been reported in the literature. It may be difficult to always put IFN-induced thyroid diseases into a single classic thyroid disease table. There are numerous atypical thyroid diseases due to IFN usage for hepatitis C virus. Herein, we present a case with a rare clinical table such as thyrotoxicosis observed following IFN-α therapy in a patient with euthyroid nodular thyroid without autoimmune thyroiditis findings and the use of therapeutic apheresis method for the treatment of disease.

Management of Chenopodium polyspermum toxicity with plasma exchange and hemodialysis

A 45‐year‐old male patient was admitted to our emergency department complaining of fatigue, headache, mild confusion, nausea, and vomiting. He had had Type 2 diabetes mellitus for 10 years that was managed with insulin injections. Two days before the onset of symptoms, he had consumed the natural herb Chenopodium polyspermum to regulate his blood glucose levels. Upon examination, he was found to be experiencing tenderness in the upper left abdominal area, icteric sclera, and pallor conjunctivas. Laboratory tests revealed that he was anemic and had increased levels of indirect bilirubin, lactic dehydrogenase, and creatinine in blood. Direct and indirect Coombs tests were negative, and fragmented erythrocytes were observed in peripheral blood smears. The best supportive care was provided, and therapeutic plasma exchange (TPE) treatments were administered. TPE was performed five times and hemolytic findings improved. The patient then developed chronic renal failure and was transferred to the dialysis program and discharged. In this article, we present a case with hemolytic and renal toxicity induced by the ingestion of Chenopodium polyspermum that was managed with TPE and hemodialysis. J. Clin. Apheresis 27:278–281, 2012.

Is increased neutrophil lymphocyte ratio remarking the inflammation in sarcopenia

Objectives: Increasing data suggests that chronic inflammation has an essential role on development of muscle dysfunction and progression of sarcopenia in aging population. The aim of the present study was to compare Neutrophil Lymphocyte Ratio (NLR) levels in sarcopenic and non‐sarcopenic individuals and to present the correlation between NLR and other inflammatory markers. Methods: A total of 105 subjects with sarcopenia (male/female: 54/51, mean age 72.8 ± 7.3) and 314 subjects as non‐sarcopenic (male/female: 125/189, mean age 71.44 ± 5.4) were enrolled in this cross‐sectional study. Sarcopenia was diagnosed according to The European Working Group on Sarcopenia in Older People criteria. Comprehensive geriatric assessment was performed to participants. Complete blood count, biomarkers of inflammation (C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR)) of all patients were measured. Results: NLR levels were found to be higher in the sarcopenic group (2.52 ± 1.30 vs 2.21 ± 0.93, p < 0.013, respectively). Compared to non‐sarcopenic participants white blood cell (WBC), ESR and CRP levels were also higher in sarcopenic group. There was a positive correlation between CRP, WBC, total body fat ratio and NLR (r: 0.433, p < 0.001; r: 0.237, p: 0.022; r: 0.339, p < 0.001, respectively). A strong negative correlation was identified between fat free mass and NLR levels in sarcopenic individuals (r: −0.755, p < 0.001). The result of the logistic regression analysis depicted that NLR is an independent predictor for sarcopenia (OR = 1.31; 95% CI = 1.06–1.62, p: 0.013). Conclusion: Increased NLR levels may indicate that inflammation may have a significant role in development of sarcopenia in the elderly population. HighlightsMany various factors and a number of different mechanisms are involved in the pathogenesis of sarcopenia.Chronic, low grade inflammation is believed to play an essential role in this process.Neutrophil lymphocyte ratio (NLR) is a simple and useful marker of chronic inflammation.Increased NLR levels in sarcopenic subjects indicates that inflammation may have a role in development of sarcopenia.

Rare cause of manic period trigger in bipolar mood disorder: testosterone replacement

Hypogonadotropic hypogonadism is a rare congenital disorder characterised by the deficiency and the absence of puberty and infertility. It is caused by the deficient production, secretion or action of gonadotropin-releasing hormone, which is the master hormone regulating the reproductive axis. Gonadotropin-releasing hormone or gonadotropin injections and testosterone replacement therapy are required in the treatment of this disorder. Psychiatric symptoms and disorders may be seen with the use of anabolic androgenic steroids. In this case report, we present a case report in which a patient had behavioural symptoms in childhood and develops bipolar disorder after testosterone replacement therapy. This patient was reached to the remission by increasing the doses of psychiatric drugs without interfering with hormonal therapy. It should be considered that patients receiving testosterone replacement therapy may develop bipolar disorder or trigger mood changes in bipolar mood disease, so behavioural and mood state changes should be closely followed in patients who have bipolar mood disease.

Acute pancreatitis with eruptive xanthoma

Eruptive xanthomas are benign skin lesions caused by localised deposition of lipids in the dermis. Xanthomas can present as early manifestations of systemic disorders, which are typically caused by elevated levels of serum triglycerides and uncontrolled diabetes. Early recognition and treatment of the underlying condition decreases morbidity and mortality. After treatment of the underlying metabolic disorders, lesions mostly disappear without leaving scars. We present a case with multiple yellowish, erythematous papules on the extremities suggestive of eruptive xanthomas admitted to our hospital with acute pancreatitis.