Serum endocan levels in multiple sclerosis relapse and remission.

OBJECTIVE: Endocan has been defined as an important marker of inflammatory diseases, vascular and endothelial injury, tumour progression, cell adhesion and angiogenesis. In our study, we compared the serum endocan, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) levels of relapsing-remitting multiple sclerosis (RRMS) patients in remission and in relapse. PATIENTS AND METHODS: This study included 53 RRMS remission patients, 30 RRMS relapse/post-relapse patients and 44 healthy volunteers. Blood samples were collected once from RRMS patients in remission and from the control group, and twice from RRMS relapse patients: once when relapsing and another 1 month after relapse. The endocan, CRP and NLR levels of the RRMS patients measured while in relapse, 1 month after relapse and while in remission were compared to those of the control group. The studied parameters were compared with the disease duration, relapse frequency, Expanded Disability Status Scale (EDSS) score, applied treatment and lesion burden assessed using magnetic resonance imaging (MRI). RESULTS: The endocan, CRP and NLR levels were significantly higher in the RRMS group than in the control group (p < 0.05). The serum endocan levels were found to be significantly higher in the RRMS relapse group than in the post-relapse and control groups (p < 0.05). There were no significant correlations between the disease duration, EDSS score, relapse frequency and lesion burden on MRI and the endocan, CRP and NLR values (p > 0.05). According to the correlation analysis, there was a statistically strong positive relationship between the MRI lesion localisation and the EDSS score, disease duration and relapse frequency (p < 0.001). CONCLUSIONS: Endocan increase is a marker of the endothelial injury that develops secondary to the inflammatory process in MS patients. It can thus be considered a moderately good indicator of relapse.

Serum YKL-40 level is correlated with apnea hypopnea index in patients with obstructive sleep apnea sindrome.

OBJECTIVE: Obstructive sleep apnea syndrome (OSAS) has been associated with elevated biochemical markers of inflammation. Although the exact mechanism is unknown, both sleep deprivation and hypoxemia are believed to be important causative factors. YKL-40, also known as chitinase-like protein, has been shown to be related to various inflammatory conditions including atherosclerosis, diabetes, cancer, and asthma. The present study aimed to evaluate the relationship between YKL-40 levels and the Apnea Hypopnea Index (AHI) in patients with obstructive sleep apnea syndrome. PATIENTS AND METHODS: The study was conducted at the Sleep Unit of the Namik Kemal University Research Center. From January 2013 to December 2013, 120 patients diagnosed with OSAS by polysomnography and 40 subjects without OSAS were recruited. Patients in both groups were matched by age, sex, and body mass index (BMI). They were further divided into groups of mild, moderate and severe OSAS based on their AHI value. Serum YKL-40 concentrations were measured by the enzyme-linked immunosorbent assay (ELISA). RESULTS: OSAS patients showed significantly elevated YKL-40 levels compared to the control group; 102,05 (23.14) pg/ml in the control group vs. 144.81 (65.53) pg/ml in the OSAS group. A Spearman correlation analysis showed that serum YKL-40 levels were significantly and positively correlated with AHI (r = 0.434, p < 0.001) and oxygen desaturation index (r = 0.374, p < 0.001). CONCLUSIONS: The study demonstrated that high serum YKL-40 levels correlated with the severity of OSAS and might serve as a nonspecific biomarker for prediction and progression of the disease.

The role of oxidative stress in the relation between fibromyalgia and obstructive sleep apnea syndrome.

OBJECTIVE: The aim of this study is to examine the involvement of oxidative and antioxidative parameters and to evaluate the relation between fibromyalgia (FMS) and obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Oxidative stress was determined by measuring the levels of malondialdehyde (MDA) and antioxidative parameters (superoxide dismutase [SOD], catalase [CAT], and glutathione peroxidase [GPx]) in 131 randomly selected patients with OSAS. The control group was composed of 129 subjects with no clinical OSAS symptoms. OSAS was diagnosed by polysomnographic tests. All patients underwent overnight polysomnographic recording. The diagnosis of fibromyalgia was made following the diagnostic criteria of the American College of Rheumatology. The FMS patients used visual analog scales (VAS) to evaluate their pain, and they completed the FMS Impact Questionnaire (FIQ). All subjects completed the 36-item Short Form Health Survey (SF-36) and the Beck Depression Inventory (BDI). RESULTS: In the OSAS + FMS group, CAT, SOD, and GDX were found to be statistically significantly lower and MDA was found to be statistically significantly higher than in both the control group and the OSAS group (p = 0.0001). A significant difference was found about gender between the OSAS group and the OSAS+FMS group (p = 0.0001). In the OSAS + FMS group, BDI was found to be statistically significantly higher than in both the control group and the OSAS group (p = 0.0001). In the OSAS + FMS group, SF 36 was found to be statistically significantly higher than in both the control group and the OSAS group (p = 0.0001). No differences were observed between the groups about AHI, minimum O2 saturation, or total sleep time values. About the presence of FMS presence, no differences were detected among the mild, moderate, and severe OSAS groups (p = 0.831). A negative correlation was determined between AHI and VAS and total sleep and sensitive points (p = 0.0001). A negative correlation was shown between CAT and GPX, SOD and apnea/hypopnea index (AHI) (p = 0.0001). A positive correlation was shown between CAT, GPX and SOD (p = 0.0001). A minimum O2 saturation was detected. A positive correlation between MDA and AHI (p = 0.0001), and a negative correlation between MDA and O2 saturation (p = 0.0001) were found. CONCLUSIONS: OSAS and FMS were highly prevalent, which indicated that oxidative stress might play a role in the pathophysiology of both diseases, especially if they co-exist in the same patient.

The serum copeptin levels in obstructive sleep apnea patients with prehypertensive.

OBJECTIVE: Copeptin is a precursor of AVP, an antidiuretic hormone, plays a pivotal role in the maintenance of cardiovascular homeostasis. Obstructive sleep apnea syndrome (OSAS) is related to cardiovascular disease. We sought to evaluate the serum copeptin levels in newly diagnosed prehypertensive patients with OSAS. PATIENTS AND METHODS: Eighty-four prehypertensive patients were evaluated using polysomnography and were divided into two groups, an OSAS (n = 41) group and a control (n = 43) group. Serum copeptin levels were measured using the ELISA method. RESULTS: Copeptin levels were significantly higher in the OSAS group compared to the control group (146 [93-739] pg/ml vs. 111 [33-253] pg/ml, respectively, p < 0.001). A regression analysis revealed that the apnea hypopnea index (AHI) and the lowest SpO2 were related to serum copeptin levels (unstandardized ß = 1.02 ± 0.40, p = 0.014 and unstandardized ß = -3.1 ± 0.9, p = 0.048 respectively). CONCLUSIONS: According to the results of our study, serum copeptin levels are higher in the prehypertensive patients with OSAS compared to those in the control group. Therefore, in assessing the severity of OSAS, serum copeptin levels can be a candidate for a biochemical marker in addition to polysomnographic findings.

Supraorbital and infraorbital nerve blockade in migraine patients: results of 6-month clinical follow-up.

BACKGROUND: Nerve blockades are used for the treatment of acute migraine episodes in emergency room conditions and beneficial results are obtained from this clinical use. Although this is the case, there are limited numbers of studies investigating the long-term effects of such an approach. PATIENTS AND METHODS: In this investigation, we had 26 patients diagnosed as migraine based on the ICHD II criteria, these were injected with 1% lidocaine at supraorbital and infraorbital nerve localizations and clinical results were evaluated after 6 months of follow-up. All patients received 1.5 ml of 1% lidocaine bilaterally for supraorbital and infraorbital nerves with three day intervals for three times. Clinical evaluation was conducted by recording the number of migraine episodes per month together with migraine disability assessment scale (MIDAS) and visual analog scale (VAS) scores before and six months after the treatment. RESULTS:  Mean age of the patients recruited in the study was 31.1±10.2 years. Disease duration was 8.1±5.4 years, the duration of the headache was 28.4±18.4 hours, mean number of episodes before treatment was 9.9±5.2, mean MIDAS was calculated as 3.2±0.8, and VAS as 9.0±1.0. Six months after the treatment, mean number of attacks was 2.0±3.0, MIDAS was 1.4±0.9 and VAS was 3.5±3.6. There was a statistically significant difference between the results obtained before and after the treatment. CONCLUSIONS:  Injecting 1% of lidocaine to supraorbital and infraorbital nerve for three times prevents the acute migraine episodes effectively during the 6-months of follow-up without having any significant side effects.

Oxidative and antioxidative balance in patients of migraine.

BACKGROUND: Migraine is characterized by multiple attacks of severe headaches often unilateral. The molecular mechanisms of migraine have not yet been clearly defined. Disorders of oxidant-antioxidant balance are observed in a number of acute and chronic diseases of the central nervous system. Oxidative stress is also believed to play a role in the pathogenesis of migraine. To the best of our knowledge, this is the first study investigating oxidant and antioxidant status of patients having migraine without aura (MWoA) and comparing them with those of age and sex matched healthy controls (CG). METHODS: We evaluated the Total Antioxidant Status (TAS) and Total Oxidant Status (TOS) of the plasma and Oxidative Stress Index (OSI) using a recently measurement method developed by Erel. RESULTS: Seventy five patients (55 Female, 20 Male) having MWoA who are free of attacks and 65 healthy volunteers (41 Female, 24 Male) (CG) were enrolled in this research. Mean age of the patients with MWoA and the control group were calculated (30.94 +/- 10.37 vs 31.0 +/- 9.46 years respectively; p > 0.05). Serum TAS levels of patients with MWoA were significantly lower than those of healthy controls (0.72 +/- 0.008 vs. 0.80 +/- 0.179 micromol Trolox equivalent/L; p < 0.001). Conversely, serum TOS values were significantly higher in patients with MWoA than in CG (15.39 +/- 0.770 vs.13.01 +/- 0.471 pmol H2O2 equivalent/L; P < 0.001). The mean values of OSI were greater in patients than in controls (1.75 +/- 0.59 vs. 1.56 +/- 0.57, p < 0.023). Total SH levels were significantly higher in the control group (MWoA: 0.24 +/- 0.005; CONTROLS: 0.28 +/- 0.005, p = 0.001). Furthermore, there was a negative correlation between the levels of Total SH and the duration of the headaches (r: -0.426, p < 0.001). Likewise; there was a positive correlation between OSI and the frequency of the headaches (r: 0.123, p < 0.002). CONCLUSIONS: In this study, we demonstrated that the levels of total antioxidants were decreased and the levels of total oxidants and the oxidative stress index were increased in patients with MWoA. These findings may be an evidence of exposure to potent oxidative stress in MWoA patients. Further investigations are required to clarify the role of oxidative stress in the etiopathogenesis of MWoA.

Investigation of oral selegiline and rasagiline administration on QT interval in conscious rabbits.

Rasagiline (RSG) and selegiline (SEL) are potent selective monoamine oxidase-B inhibitors and used in the treatment of Parkinson's disease. Selegiline is metabolized in vivo to I-methamphetamine and I-amphetamine which effect cardiovascular system. Therefore, the aim of this study was to evaluate and to compare the effects of long-term use of these drugs on QT interval in conscious rabbits. The study involved 17 New Zealand rabbits of both sexes, aged between 7 and 14 months. Control group (CG, n = 6) was orally given isotonic saline solution at dose of 0.5 cc/per rabbit. The SEL group (SG, n = 6) received 5 mg/per rabbit SEL orally twice daily (09:00 am and 09:00 pm) for 14 days. The RSG group (RG, n = 5) was orally given of RSG at 1 mg/per rabbit daily for 14 days. Electrocardiographic records were taken before the experiment (baseline) and at 1st, 7th, and 14th days of experiment by direct writing electrocardiograph for two groups. Heart rate (HR), QT and QTc values were determined from ECG records. HR did not significantly differ in both treatment groups through the experimental period when compared to baseline values. The significant prolongation of QT and QTc values were observed at 7th, and 14th day (p < 0.01) in SG and 1st day of experiment in RG (p < 0.05) as compared to baseline values. In conclusion, the results obtained suggest a statistically significant effect of SEL on QTc prolongation when compared to RAS. QTc prolongations should be taken into account in Parkinson's disease where autonomic system is involved.

Effects of therapeutic doses of Pregabalin on QTc interval in conscious rabbits.

Pregabalin (PRG) is a new antiepileptic drug that has been used as supportive therapy for partial seizures in patients. Although many neuro-psychiatric and non-cardiac drugs are known to prolong ventricular repolarization as manifested by QTc prolongation on ECG of which provokes torsades de pointes, there is limited data available regarding the characteristics of QT interval in conscious laboratory animals after PRG administration. For that purpose, effects of different therapeutic doses of oral PRG administration on Heart Rate (HR), QT and QTc values in rabbits were evaluated at a predefined time interval in this research. The study involved 28 New Zealand rabbits of both sexes, aged between 8 and 12 months. Animals were divided into four equal groups. Rabbits in control group (CG) received saline 0.5 ml/per animal orally. Group I, II and III were orally given single dose of PRG at 1.25 mg/kg, 2.5 mg/kg and 5 mg/kg, respectively. ECG records were taken before experiment (baseline) and at 1st, 2nd, 4th, and 6th hour (h) of experiment by direct writing electrocardiograph. HR, QT and QTc values were determined from ECG records. Heart rates increased in all groups when compared to baseline values. The increases were evident at 4th h in group II (p < 0.001), at 2nd h (p < 0.05) and 4th h (p < 0.001) in group III compared with CG. After application of PRG, QTc began to prolong at 1st h through the 4th of experiment and then turned to baseline values at 6th h of the experiment. The QTc values obtained at 2nd h in Group II and III (p < 0.05) and 4th h (p < 0.001) of application in group III were significantly different from CG. Changes obtained in HR, QT and QTc values in PRG treated rabbits were time and dose dependent (p < 0.001). Increase in HR and QTc prolongation determined in PRG given rabbits may implied that clinicians should take care of these changes when using this drug and further studies are required to fully understand the mechanism involved.

"Stepping-sticks" and "seat-sticks": new types of tools used by wild chimpanzees (Pan troglodytes) in Sierra Leone.

In Tenkere, Sierra Leone, a community of wild chimpanzees (Pan troglodytes verus) spent long hours eating the fruits and flowers of the Kapok (Ceiba pentandra) tree. The branches of this species are covered in sharp thorns which make movement in their high canopies problematic for the chimpanzees. In an apparent attempt to increase their mobility and to ease the discomfort of lengthy bouts of eating in these trees, some of the Tenkere chimpanzees have been observed using stick tools as foot ("stepping-sticks") and body ("seat-sticks") protection against the painful thorns. This form of tool-using is culturally unique to the Tenkere chimpanzees, as at other sites where these apes have been observed eating parts of kapok trees, there are no published records of this tool technology. In three of the stepping-stick tool use incidents, the chimpanzee used the tool(s), held between their greater and lesser toes, in locomotion. This form of tool use is the first recorded case of habitually used tools that can be justifiably categorized as being "worn" by any known wild population of Pan troglodytes.