Patients with primary restless legs syndrome have higher prevalence of autonomic dysfunction and irritable bowel syndrome

<p><b>INTRODUCTION</b>Given the limited data on autonomic dysfunction in patients with primary restless legs syndrome (pRLS), we compared autonomic dysfunction and presence of irritable bowel syndrome (IBS) between patients with pRLS and control patients.</p><p><b>METHODS</b>Consecutive adult drug-naïve patients with pRLS, and age- and gender-matched healthy control patients were enrolled in this study. Diagnoses, based on validated self-reported questionnaires, were made using the following guidelines: Rome III classification system for functional gastrointestinal disorders for IBS; Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) for the presence of anxiety and depression, respectively; Pittsburgh Sleep Quality Index (PSQI) for severity of sleep disturbances; and Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) for autonomic dysfunction.</p><p><b>RESULTS</b>There were 88 patients with pRLS (18 male, 70 female) and 128 control patients (40 men, 88 women). The mean age of the pRLS patients and control patients was 50.3 ± 9.3 years and 49.7 ± 8.2 years, respectively. Overall, 41 (46.6%) of the patients with pRLS and 16 (12.5%) of the control patients had IBS. Among patients with pRLS, IBS was significantly more common and the total autonomic SCOPA-AUT scores were higher than those found among control patients. Among pRLS patients with IBS, total autonomic SCOPA-AUT, PSQI, BAI and BDI scores were significantly higher than among pRLS patients without IBS. The presence of IBS did not affect the severity of restless legs syndrome.</p><p><b>CONCLUSION</b>The presence of autonomic nervous system impairment in patients with pRLS and the strong link between IBS and pRLS merit further, more extensive investigation.</p>

relation between serum vitamin D levels and hashimoto thyroiditis in women

Objective: Vitamin D has immunomodulatory effects which suggest a possible association between low serum 25-hydroxyvitamin D [25-OH D[3]] levels and autoimmune thyroid diseases. This study was conducted to investigate such a relation between low serum 25-OH D[3] levels and Hashimoto thyroiditis [HT]

Design: Prospective, case-control study

Setting: Internal Medicine Clinic of Sakarya University, Turkey

Subjects: Serum 25-OH D[3] levels were measured in 498 women presented to the outpatient clinic for routine history and physical examination. Thyroid hormones and antibodies were obtained in all patients. Thyroid ultrasonography was performed in antibody positive patients

Intervention: Blood tests and neck ultrasound

Main outcome measures: Vitamin D levels in Hashimoto Thyroiditis

Results: Serum 25-OH D[3] levels were significantly lower in patients with at least one thyroid antibody positive, compared to thyroid antibody negative patients [P = 0.013]. Serum 25-OH D[3] levels were also lower in antithyroglobine [TgAb] positive patients compared to antibody negative patients [P = 0.010]. There was a statistically significant negative correlation between anti-TgAb and serum 25-OH D[3] levels [P < 0.001]. There was no statistically significant difference in serum 25-OH D[3] levels between anti-thyroid peroxidase positive [TPOAb] patients and antibody negative patients [P = 0.643]

Conclusion: Women with HT thyroiditis have lower vitamin D levels compared to women without HT thyroiditis. We determined that serum 25-OH D[3] insufficiency was 1.7 times more likely to be present in patients with HT. This insufficiency may increase the risk of HT disease

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

<p><b>INTRODUCTION</b>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.</p><p><b>METHODS</b>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.</p><p><b>RESULTS</b>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.</p><p><b>CONCLUSION</b>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.</p>

Echocardiographic evaluation of biventricular function in patients with euthyroid hashimoto's thyroiditis

Objective: The aim of this study was to evaluate the left [LV] and right [RV] ventricular function in euthyroid Hashimoto's thyroiditis [eHT] patients

Subjects and Methods:Forty-five patients diagnosed with eHT and 45 age- and gendermatched control subjects were enrolled in this study. Echocardiographic parameters reflecting RV and LV functions such as chamber dimensions, ejection fraction, fractional shortening, conventional and tissue Doppler-derived early and late filling velocities [E, A, E', A'], isovolumic relaxation [IVRT] and contraction [IVCT] times, ejection time [ET], deceleration time [DT], Tei index, pulmonary acceleration time [PAcT] and tricuspid annular plane systolic excursion [TAPSE] of patients with eHT were compared to those of control subjects using the paired-samples t test or Wilcoxon signedrank test

Results:Regarding the LV function, compared to the controls patients with eHT had a higher LV-Tei index [0.6 +/- 0.2 vs. 0.4 +/- 0.1, p < 0.001], higher DT [p < 0.001] and IVRT [p < 0.001] values, and higher E/E' ratios [p = 0.04]. In contrast, the peak E wave velocity [p = 0.02], E/A ratio [p = 0.01] and ET [p = 0.02] were significantly lower in the eHT group than amongst the controls. The RV, Tei index [0.40 +/- 0.11 vs. 0.28 +/- 0.07, p < 0.001], TAPSE [2.0 +/- 0.3 vs. 2.2 +/- 0.2 mm, p < 0.001], PAcT [124.3 +/- 22.6 vs. 149.4 +/- 18.3 ms, p < 0.001], A' [p = 0.007] and IVCT [p = 0.001] were significantly higher in patients with eHT than the controls. However, the tricuspid E/A ratio [p = 0.01], E' [p = 0.03] and E'/A' ratio [p = 0.001] were significantly lower in the eHT patients than the control group

Conclusions:This study demonstrated that both RV and LV functions were impaired in patients with eHT

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