Relationship between homocysteine and non-dipper pattern in patients with type 2 diabetes mellitus.

OBJECTIVE: The rate of reduction of nocturnal blood pressure (NBP) is lesser than normal in patients with type 2 diabetes mellitus (type 2 DM). Hyperhomocysteinemia (HHC) disrupts vascular structure and function, no matter the underlying causes. The risk of development of vascular disease is greater in diabetic patients with hyperhomocysteinemia than in patients with normal homocystein levels. The aim of the study was to investigate whether there are differences of homocystein levels in dipper and non-dippers patients with type 2 DM. SUBJECTS AND METHODS: We compared 50 patien-ts (33 females, 17 males) with type 2 DM and 35 healthy individuals (18 females, 17 males ) in a control group. Ambulatory blood pressure monitoring (ABPM) was performed and homocysteine levels were measured in all patients. RESULTS: We found that the percentage of non-dipper pattern was 72% in patients with type 2 DM and 57% in control group. In diabetic and control individuals, homocystein levels were higher in non-dipper (respectively 13.4 ± 8.1 µmol/L and 11.8 ± 5 µmol/L) than in dipper subjects (respectively, 11.8 ± 5.8 µmol/L and 10.1 ± 4.2 µmol/L), but there was no significant difference between the two groups (respectively, p = 0.545, p = 0.294). CONCLUSION: In both groups, homocystein levels were higher in non-dipper than in dipper participants, but there was no significant difference between the groups. High homocystein levels and the non-dipper pattern increases cardiovascular risk. Therefore, the relationship between nocturnal blood pressure changes and homocystein levels should be investigated in a larger study.

Association of left ventricular diastolic dysfunction with elevated NT-proBNP in type 2 diabetes mellitus patients with preserved ejection fraction: the supplemantary role of tissue doppler imaging parameters and NT-proBNP levels.

BACKGROUND: Early diagnosis of cardiovascular disease in diabetic patients may be important to introduce treatment early. Echocardiography is a method used to show the ventricular functions. A ventricular hormone, BNP is used to identify the changes in the ventricular function in early period. NT-proBNP which is a more stable compound with a longer half-life is used in measurement of BNP. METHODS: Left ventricular diastolic dysfunction (LVDD) was detected and NT-proBNP levels were measured in forty-four asymptomatic patients with ages of 30-70 and type 2 DM and control group consisted of 40 healthy individuals from the same age group. RESULTS: NT-proBNP levels were found as 566.7 ± 738.5 pg/ml in the diabetics with LVDD detected, 166.3 ± 137.1 pg/ml in the diabetics without LVDD and 134.5 ± 77.2 pg/ml in the control group. Levels of NT-proBNP were significantly higher in the group with left ventricular diastolic dysfunction (p<0.05). However, when the levels of NT-proBNP in the diabetic patients without LVDD were compared with the controls, the difference was not significant (p>0.05). NT-proBNP levels were found significantly higher in LVDD group compared to the controls without a difference between the ejection fractions (p<0.05). CONCLUSION: High levels of NT-proBNP was correlated tissue Doppler echocardiography findings in type 2 DM patients with preserved ejection fraction.

[Low L-carnitine levels: can it be a cause of nocturnal blood pressure changes in patients with type 2 diabetes mellitus?]. / Düsük L-karnitin düzeyleri: tip 2 diyabetes mellitus olgularinda noktürnal kan basinci degisikliklerinin bir nedeni olabilir mi?

OBJECTIVE: The nocturnal blood pressure (NBP) reduction is less than normal in the patients with type 2 diabetes mellitus (type 2 DM). L-carnitine deficiency may cause changes of NBP by leading to hyperglycemia, insulin resistance and endothelial dysfunction in patients with type-2 DM. The purpose of the study was to investigate whether there is a difference in levels of L-carnitine in dipper and nondippers patients with type 2 DM. METHODS: This is a cross-sectional observational cohort study. We compared the 50 (33 females, 17 males) patients with type 2 DM and the 35 healthy persons (18 females, 17 males) as a control group. In all cases, ambulatory blood pressure monitoring (ABPM) was performed and L-carnitine was measured. The independent samples t test, Chi-square test, Mann-Whitney U test and Pearson correlation analysis were used in the statistical evaluation of data. RESULTS: We found that the percentage of nondipper pattern was 72% in patients with type 2 DM. L-carnitine levels were lower in patients with type 2 DM (52.77 ± 12.34 µmol/L) than those of control group (79.18 ± 10.59 µmol/L), and these differences were statistically significant (p=0.05). L-carnitine levels were lower in nondipper cases (50.02 ± 16.30 µmol/L) than those of dipper cases (53.83 ± 10.50 µmol/L), but these differences were not statistically significant (p=0.125). CONCLUSION: Nondipper pattern is common in patients with type 2 DM. Nondipper pattern is associated with damage of target organ. Therefore, determination of nondipper pattern by ABPM is very important. L-carnitine levels were found to be lower in nondipper patients than in dipper patients with type 2 DM. Although, these differences were statistically nonsignificant, more detailed studies should be performed to determine the frequencies and relationship between nondipper pattern and L-carnitine levels in patients with type-2 DM.

Serum leptin levels and malnutrition in patients with chronic renal failure.

OBJECTIVE: To investigate the correlation between serum leptin levels, body mass index, and triceps skin fold thickness, which are anthropometric measurements, as well as serum albumin levels in patients with chronic renal failure on hemodialysis. METHODS: We studied 75 patients (48 males, 27 females; ages between 18-82) at the Hemodialysis Unit, Cumhuriyet University Medical School; Private Sivas Dialysis Center; Hemodialysis Unit, Sultan Izzettin Keykavus Hospital; and the Hemodialysis Unit, SSK Sivas Hospital between January 2003 and February 2004. Patients were excluded if they had been on dialysis for less than one year, if they were anuric, or if they had been on dialysis with jugular or subclavian catheter and long-term permanent port catheter. Similarly, patients with diabetes mellitus, chronic pulmonary disorders, and hepatic cirrhosis or hepatitis B, hepatitis C carriers as well as those on active tuberculosis therapy were excluded. C-reactive protein was measured in all patients and those with above normal values were excluded. RESULTS: While the mean age for the males was 44.52 +/- 16.53 years (18-77), it was 48.29 +/- 14.32 years (22-82) for the females. The mean triceps skin fold thickness for males was 6 +/- 1.81 mm (3-11.3 mm), and for females, it was 14.07 +/- 8.79 mm (4.3-33.3 mm). The mean body mass index for males was 20.77 +/- 2.61 kg/m2 (14.8-26.6 kg/m2), and for females, it was 25.36 +/- 6.47 kg/m2 (17.3-42.2 kg/m2). The mean serum leptin level for males was 4.61 +/- 4.20 ngr/dl (0.1-18.7 ngr/dl), and for females, it was 52.06 +/- 61.67 ngr/dl (0.6-172.5 ngr/dl). A positive correlation was observed between triceps skin fold thickness and leptin, both in the male group (r=0.478; p<0.05), and in the female group (r=0.876; p<0.05). Body mass index and leptin were also correlated positively both in the male group (r=0.502; p<0.05) and in the female group (r=0.905; p<0.05). No correlation was established between serum albumin levels and leptin. Leptin did not correlate with other measured parameters CONCLUSION: Our study demonstrates that serum leptin levels positively correlated with body mass index and triceps skin fold thickness, which are malnutrition parameters. Therefore, the leptin hormone may be utilized in obtaining preliminary information regarding malnutrition.

Relationship between serum leptin levels and body composition and markers of malnutrition in nondiabetic patients on peritoneal dialysis or hemodialysis.

BACKGROUND: Leptin is a protein hormone secreted by adipocytes, regulating body fat and food intake. It has been reported that serum leptin levels are high in patients with chronic renal failure, and this fact has been associated with malnutrition and body composition changes in patients on hemodialysis. This present study investigated the relationship between plasma leptin concentrations and body composition and markers of malnutrition in nondiabetic patients diagnosed with end-stage chronic renal failure, treated with continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD). METHODS: A total of 152 HD and 32 CAPD patients were enrolled into the study. The body compositions of the patients were established by utilizing a Body Composition Analyzer. Triceps skinfold thickness (TSFT) was measured by using a Harpenden Skinfold Caliper. Serum leptin level was detected by radioimmunoassay in ng/mL through employing a DPC Gambyt-CR gamma counter. Standard laboratory methods were used for measuring the remaining parameters (total protein, albumin, blood urea nitrogen, creatinine, hemoglobin, hematocrit, high-sensitivity C-reactive protein [hsCRP]). RESULTS: No significant difference was observed between the HD and CAPD groups regarding leptin levels. Leptin levels of female patients in both groups were markedly higher when compared with those of men (p = 0.001). Plasma leptin levels in total, as well as for both male and female HD and CAPD patients, significantly correlated positively with age, percent fat, fat mass, body mass index and TSFT (p = 0.001). Serum leptin levels were not found to be correlated with length of time on dialysis, lean body mass, total body water, hsCRP, total protein and albumin levels (p > 0.05). CONCLUSION: The data obtained in this study indicated that serum leptin levels could be instrumental markers in establishing body fat ratio, as well as in determining metabolic and nutritional factors in patients with chronic renal failure.

Antibiotic susceptibility patterns of respiratory isolates of Staphylococcus aureus in a Turkish university hospital.

A total of 391 respiratory isolates of Staphylococcus aureus in Sivas (Turkey) were studied between January 1999-2002. The organisms were cultured from the following specimens: throat (43%), sputum (28%), transtracheal/endotracheal aspirates (27%), and bronchial lavage (2%). The isolates were tested against 11 different antibiotics by a disk diffusion method or standardized microdilution technique. Methicillin-resistant isolates constituted 76.9% of all isolates. Most of the methicillin-resistant isolates (95.1%) were isolated from inpatients. The rate of methicillin-resistant isolates in throat, sputum, and tracheal aspirates was 17.2%, 60.1%, and 68.9%, respectively. The resistance of methicillin-resistant isolates in throat to teicoplanin was 3.4%. The methicillin-sensitive isolates were susceptible to most agents tested, while most methicillin-resistant isolates were resistant to these agents. Overall resistance to erythromycin was 61.9%, tetracycline 56.6%, gentamicin 50.7%, ofloxacin 42.0%, rifampin 40.8%, clindamycin 38.9%, chloramphenicol 19.0%, co-trimoxazole 10.2%, and vancomycin 0%.

Retrospective analysis of antibiotic susceptibility patterns of respiratory isolates of Pseudomonas aeruginosa in a Turkish University Hospital.

BACKGROUND: Lower respiratory tract infections due to Pseudomonas aeruginosa have a high mortality rate. Antibacterial activity of various antibiotics against P. aeruginosa isolated from each hospital depends on the variety or amount of antibiotics used in each hospital. METHOD: A total of 249 respiratory isolates of Pseudomonas aeruginosa in Sivas (Turkey) were included between January-1999 and January-2002. Isolates were tested against 14 different antibiotics by a disc diffusion method or standardized microdilution technique. RESULTS: Organisms were cultured from the following specimens: sputum (31.3%), transtracheal/endotracheal aspirates (37.8%), and bronchial lavage (30.9%). Isolates in bronchial lavage were highly susceptible to cefoperazone and aminoglycosides. Resistance to ampicillin/sulbactam was 98.8%, ticarcillin 40.1%, ticarcillin/clavulanic acid 11.2%, piperacillin 21.8%, aztreonam 66.6%, cefotaxim 75.4%, ceftriaxone 84.2%, cefoperazone 39.0%, ceftazidime 50.8%, gentamicin 57.5%, tobramycin 58.4%, amikacin 25.4%, ciprofloxacin 16.1%, and imipenem/cilastatin 21.6%. The term multidrug-resistant P. aeruginosa covered resistance to imipenem, ciprofloxacin, ceftazidime, gentamicin, and piperacillin. 1.2% of isolates were multidrug-resistant. CONCLUSIONS: These findings suggest that amikacin resistance increases progressively in Turkey. Piperacillin and ticarcillin/clavulanate were the most active agents against both imipenem- and ciprofloxacin-resistant isolates in our region.