Left ventricular dysfunction in relation with systemic inflammation in chronic obstructive pulmonary disease patients

BACKGROUND/AIMS@#Most important cause of mortality in chronic obstructive pulmonary disease (COPD) patients is known to be cardiovascular disease (CVD). The objective of the present study was to evaluate the echocardiographic parameters in COPD patients with or without pre-diagnosed CVD and to investigate the relationship between echocardiographic parameters and systemic inflammation markers.@*METHODS@#A total of 60 stable COPD patients (23 patients with CVD, group 1; 37 patients without CVD, group 2) and 21 healthy controls (group 3) were included in the study. Six-minute walking test (6MWT), COPD assessment test (CAT), and Body mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index results were recorded. High-sensitivity C-reactive protein (HsCRP), interleukin 8 (IL-8), fetuin-A, Clara cell protein (CCL-16), N-terminal pro-brain natriuretic peptide levels were studied in serum. Parameters of left and right ventricular systolic and diastolic function were measured by echocardiography.@*RESULTS@#Patients with COPD had higher levels of systemic inflammation markers and lower level of inflammation inhibitor fetuin-A. When three groups were compared, group 1 had lower 6MWT result. HsCRP was highest in group 2 while other inflammatory markers were similar in groups 1 and 2. Regarding echocardiographic parameters, left ventricular ejection fraction (LVEF) was lower and left ventricle end-diastolic diameter (LVED), left ventricle end-systolic diameter (LVES) diameters were higher in group 1. The aortic diameter was higher in COPD patients. Fetuin-A was correlated with diameter of aorta and LVES. LVEF, LVED, and LVES were found to be correlated with functional parameters of COPD cases.@*CONCLUSIONS@#In COPD, left ventricular functions are affected as well as right ventricle before prominent clinical findings of cardiac disease and these echocardiographic parameters correlate with functional parameters of COPD patients.

The Evaluation Acute Traumatic Stress Level in Close Relatives of Stroke Patients

OBJECTIVE: Stroke is the second most common cause of death and the leading cause of adult disability. Both stroke patients and their family can therefore experience increased traumatic stress level. METHODS: The participants are close relatives of patients (n=65) who had a first time stroke (CRPWS) hospitalized. A control group (CG) (n=61), who had no history of chronic illness in their family and had at least one traumatic life event experience. The National Institutes of Health Stroke Scale, Modified Rankin Scale, Personal Information Form, Life Events Checklist, Traumatic Stress Symptom Scale, and Multidimensional Scale of Perceived Social Support, were used in the study. RESULTS: We found no significant association between NIHSS and MRS of patients and traumatic stress level of the family member. The traumatic stress level was significantly higher in the CRPWS group than in the CG group. Traumatic stress level was higher in women than men and was not associated with perceived social support in the CRPWS group. CONCLUSION: The traumatic stress level of the relatives was not associated with the clinical features of the stroke patients. In the early phase, after the diagnosis of stroke, psychological support may be important to prevent CRPWS from PTSD.

Routine calcitonin measurement in nodular thyroid disease management: is it worthwhile?

PURPOSE: To evaluate the diagnostic accuracy of routine calcitonin measurement in patients with nodular thyroid disease. METHODS: Consecutive patients with nodular thyroid disease (n = 640) were studied. Serum calcitonin levels were measured under basal conditions, and when basal values were between 10–100 pg/mL, testing was repeated after pentagastrin (PG) stimulation. Patients with previously diagnosed or familial medullary thyroid cancer (MTC) were excluded. Patients were operated on when basal or stimulated calcitonin >100 pg/mL or when other surgical indications were present. RESULTS: Four cases of MTC were identified. MTC was diagnosed in 75% of patients with basal calcitonin >100 pg/mL. One out of 11 patients with basal calcitonin between 10–100 pg/mL was diagnosed with MTC. PG stimulation resulted in elevation in 4 cases, where 1 case was diagnosed with MTC. Positive predictive value for basal calcitonin levels in the preoperative diagnosis of MTC was 5% for values between 10–100 pg/mL and 100% for values >100 pg/mL. Possible reasons for false positivity were papillary thyroid cancer in 17%, renal insufficiency in 8.3%, Hashimoto thyroiditis in 17% and β-blocker use in 33%. Positive predictive value for the PG test (>100 pg/mL) was 25% in the entire series. The cost of adding calcitonin measurement (±PG stimulation) to the preoperative work-up, resulted in €912.68 per MTC patient to detect the disease. CONCLUSION: Basal calcitonin measurement together with PG stimulation in cases of basal calcitonin >10 pg/mL detects MTC in 0.62% of patients with nodular thyroid disease.

The Relationship between Ghrelin and Copeptin Levels, and Anxiety and Depression Levels in Suicide Attempts

OBJECTIVE: It was aimed to detect acylated ghrelin (AG), unacylated ghrelin (UG) and copeptin levels in patients with suicide attempts and to determine if these biomarkers are risk factors for suicide attempts. METHODS: Serum copeptin, AG and GU levels were screened in 128 patients who were admitted to emergency department with suicide attempts and 59 healthy controls. Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were applied simultaneously, and the data were compared statistically. RESULTS: AG, UG and copeptin levels were higher in the patient group compared with the healthy control group. BAI scores of patients were found to be positively correlated with BDI scores. While there was a significant difference (p=0.0064) between psychiatric and non-psychiatric patients with suicide attempts in terms of BAI scores, there were no differences in BDI scores and levels of biomarkers. We found significantly increased BDI and BAI scores and increased levels of AG, UG and copeptin in psychiatric and non-psychiatric patients compared with healthy individuals. The specificities yielded by receiver operating characteristic curve analysis in patients with suicide attempts were as follows: 91.53% for AG, 72.88% for UG and 94.92% for copeptin. CONCLUSION: Serum levels of AG, UG and copeptin increase with increasing anxiety and depression in patients with suicide attempts. Increased levels of AG, UG and copeptin could be considered a risk factor for suicide attempts.

thrombotic events in polycythemia vera patients may be related to increased oxidative stress

This study was designed to compare the oxidative stress parameters of patients with polycythemia vera [PV] to those of healthy volunteers and to investigate the probable relationship between vascular events and parameters of oxidative status such as total oxidative status [TOS], total antioxidant status, oxidative stress index [OSI] and malondialdehyde [MDA] in PV patients. Thirty-five PV patients [20 males and 15 females] and 20 healthy volunteers [11 males and 9 females] were enrolled. The oxidative status parameters of the patients were measured by spectrophotometric analyses at the time of diagnosis and at 6 months after treatment which consisted of phlebotomy and 100 mg/day acetyl salicylic acid with or without hydroxyurea for the high- and low-risk disease group, respectively. These parameters were compared both to healthy controls and to each other, in order to obtain the values before and after treatment. In addition, during diagnosis, the oxidative status parameters of patients with PV and a history of a vascular event were compared with those of patients with no history of a vascular event. The TOS, OSI and MDA values were significantly higher in the patients than in the control group at the time of diagnosis. At 6 months after phlebotomy and 100 mg/day acetyl salicylic acid therapy, the TOS, OSI and MDA values were significantly lower in the patients when compared to the pretreatment values. The TOS and OSI levels were notably higher in the patients with a vascular-event history than in those without this history. Oxidative stress parameters were increased in PV patients

Relationship between renal stone formation, mitral annular calcification and bone resorption markers

Mitral annular calcification [MAC] is associated with osteoporosis and there is evidence of reduced bone mineral density [BMD] in patients with renal stone formation [RSF]. Therefore, we designed this study to test if RSF was associated with MAC and if this association could be linked to bone resorption. Fifty-nine patients [mean age, 41.5 years] with RSF and 40 healthy subjects [mean age, 44.2 years] underwent screening for MAC and BMD, and measuurements were taken of serum and urine electrolytes, parathyroid hormone, alkaline phosphatase and urine dypyridoline. MAC was diagnosed in 11 [18%] patients with RSF compared with 1 [2.5%] control [P=.01]. Urine phosphorus, magnesium, sodium, potassium and chloride levels were lower [P<.001, P=.02, P<.001, P<.001 and P<.001, respectively], but serum alkaline phosphatase, calcium and potassium levels were higher [P=.008, P=.007 and P=.001, respectively] in patients with RSF versus those without RSF. None of these abnormalities were found in patients or subjects with MAC. Urine pyridoline levels were higher and T-scores were more negative [more osteopenic] in patients and subjects with MAC than in those without MAC [P=.01 and P=.004, respectively]. In a multivariate analysis, only T-scores and urine dipyridoline level were predictive of MAC [P=.03 and P=.04, respectively]. Screening for MAC and bone resorption markers in patients with RSF demonstrated a high incidence of MAC in these patients. The presence of MAC in patients with RSF was associated with bone resorption markers. This seemingly complex interrelationship between RSF, MAC and bone loss needs to be clarified in further studies

role of surface ECG and transthoracic echocardiography for predicting postoperative atrial fibrillation after coronary artery bypass surgery

To evaluate the roles of surface electrocardiogram ECG and transthoracic echocardiography ECHO for prediction of atrial fibrillation AF after coronary artery bypass grafting CABG. This study was conducted from 2002-2004 at the Cardiovascular Department of Hacettepe University, Ankara, Turkey. Seventy consecutive patients were enrolled in this study that underwent elective CABG. A 12-lead ECG was recorded one day before cardiac surgery and was repeated during the 5 days after CABG. P-wave dispersion PWD was defined as the difference between maximum and minimum P-wave duration. Differences in P-wave duration were compared between the pre- and postoperative 12-lead ECG measurements. Postoperative AF developed in 17 24% cases of 70 patients. The PWD was found to be significantly higher in patients with AF preoperatively 60 +/- 19 versus 47 +/- 13, p=0.003, postoperative first day 56 +/- 12 versus 44 +/- 11, p<0.002 and fifth day 51 +/- 29 versus 41 +/- 11, p<0.001. Patients with AF were significantly older, the mean age of the AF group was 68 +/- 7 years and of the sinus rhythm SR group was 59 +/- 10 years p<0.001. The AF group had left ventricular systolic dysfunction 56 +/- 13% versus 56 +/- 8%, p=0.042, preoperatively; 49 +/- 8% versus 60 +/- 10%, p=0.001, postoperatively and a larger left atrium 46 +/- 5 versus 39 +/- 5 mm, p<0.001, preoperatively and 44 +/- 7 versus 39 +/- 5 mm, p=0.046, postoperatively than the SR group. This prospective study demonstrated that PWD on surface ECG and additional echocardiographic parameters are simple and reliable indexes to predict the development of AF after CABG

role of hepatocyte growth factor in the differentiation of dendritic cells from peripheral blood monocytes

To find out the effects of hepatocyte growth factor [HGF] in the development of dendritic cells [DC] from the peripheral monocytes. The study was carried out in Black Sea Technical University Hospital, Trabzon, Turkey between 2003-2004. Seven different cytokine combinations were employed to assess phenotypical and functional differences of DCs from the peripheral monocytes in serum free culture media. Peripheral monocytes were incubated in media with cytokines for 5 days. The tumor necrosis factor-alpha [TNF-alpha] was added to the cell culture on day 5 and incubated for another 2 days. Surface and co-stimulating molecules on the cells were assessed by flowcytometry. The functional capacity of the DCs was evaluated on day 7 by purified protein derivative loading and subsequent lymphoproliferation test using methyl tetrazolium staining. On the 5th day of incubation DC development was observed in all cytokine groups, but cells were superior in cultures maintained in the presence of interleukin-4 combinations with granulocyte-macrophage colony stimulating factor [GM-CSF] or with GM-CSF+HGF. Moreover, the expression of surface and co-stimulating molecules increased significantly after incubation with TNF-alpha. The effect of PPD loaded-DCs on proliferation of lymphocytes was more striking in HGF containing groups. It was concluded that HGF supplemented cultures exert some additive effects in relation to function of monocyte-derived DCs. But HGF alone does not seem to augment monocyte-derived DC proliferation and maturation significantly

Hodgkin's disease and autoimmune hemolytic anemia: a case report.

To report a case of Hodgkin's disease presenting with immune hemolytic anemia. Clinical Presentation and Intervention: A 47-year-old man was admitted to hospital because of weight loss, fever, and inguinal lymph node adenopathy. Biopsy of the inguinal lymph node revealed mixed-cellularity Hodgkin's disease. Three days after starting combined chemotherapy, the patient showed evidence of autoimmune hemolytic anemia, which responded well to prednisolone. This case shows that clinicians should be aware of the possibility of autoimmune hemolytic anemia in patients with Hodgkin's disease presenting with anemia, and distinguish it from the anemia of chronic disease