The rate of MEFV gene mutations in hematolymphoid neoplasms.

The aim of this study was to determine the rate of MEFV gene mutations, the gene responsible for familial Mediterranean fever (FMF), in patients with hematolymphoid neoplasm. The rate of the five most common MEFV gene mutations (M694V, M680I, V726A, M694I and E148Q) was determined in 46 patients with hematolymphoid neoplasm. We found a high frequency of carriers in patients with multiple myeloma (60%) and acute lymphocytic leukaemia (33.3%), whereas patients with chronic lymphocytic leukaemia (9%) and non-Hodgkin lymphoma (5%) had a low mutation carrier rate. There is no MEFV gene mutation in patients with Hodgkin lymphoma. Furthermore, the statistically significant predominance of strong heterozygous mutations such as M694V and M680I in patients with hematolymphoid neoplasm; none had own and/or family history compatible with FMF, is interesting. In conclusion, we found a high frequency of carriers for MEFV gene in patients with multiple myeloma and acute lymphocytic leukaemia. The data of our study may provide some new insights in understanding of individual genetic differences in susceptibility to these neoplasms.

Plasma osteoprotegerin concentrations in type 2 diabetic patients and its association with neuropathy.

BACKGROUND AND AIMS: To investigate the association of plasma osteoprotegerin (OPG) levels with diabetic neuropathy. METHODS: Forty-two diabetic patients (21 female and 21 male) and twenty-four non-diabetic healthy control subjects (12 female and 12 male) were included in the study. All consecutive diabetic patients who came for routine follow-up at our outpatient clinic were invited to participate in this clinical study. We studied EMG and neuropathy symptom score in all study subjects. Fasting plasma glucose, HbA1 C, hs-CRP, OPG levels and lipid profile were measured for each subject. RESULTS: Serum fasting glucose, HbA1c, HOMA-IR, total cholesterol, triglyserid, LDL-Cholesterol, HDL-Cholesterol, lipoprotein (a), apolipoprotein-b, hs-CRP, OPG levels, and neuropathy symptom score were statistically higher in diabetic patients than in healthy control subjects. Plasma OPG levels was statistically higher in diabetic patients than it was in nondiabetic control subjects. However, plasma OPG levels were not significantly different between diabetic patients without neuropathy and healthy control subjects. On the other hand, OPG levels were statistically higher in diabetic patients with neuropathy than in patients without neuropathy. In addition to that serum fasting glucose, HbA1c, hs-CRP, diabetes duration, neuropathy symptom score were statistically higher in diabetic patients with neuropathy than they were in patients without neuropathy. In total group of subjects, plasma OPG levels were correlated significantly with age, diabetes duration, HbA1c, total cholesterol, HDL-cholesterol, lipoprotein (a), apolipoprotein b, hs-CRP. In diabetic patients, plasma OPG correlated significantly with age, diabetes duration, neuropathy symptom score, HbA1c, lipoprotein (a), apolipoprotein b levels. CONCLUSIONS: The major findings of this study were that the plasma OPG concentrations were higher in type 2 diabetic patients than OPG concentrations in healthy control subjects and they were positively correlated with diabetic neuropathy. This finding supports the growing concept that OPG acts as an important regulator in the development of vascular dysfunction in diabetes.

Necrotizing fasciitis: A life-threatening clinical disorder in uncontrolled type 2 diabetic patients.

We presented 23 patients with necrotizing fasciitis (NF), 15 of whom had uncontrolled diabetes mellitus (DM), for risk factors, clinical signs, laboratory findings and prognosis during the period 1998 and 2006 in Istanbul. A hospital incidence of NF was 14.2/100,000 admissions. Other risk factors were obesity in 9 and recent surgical trauma in 10 patients. The mean age of the patients with DM was higher than that of the patients with non-DM (58.6+/-12.8 vs 43.0+/-17.2 years, p=0.028). The most frequently isolated microorganisms from tissue cultures were Escherichia coli, Klebsiella pneumoniae and Group A streptococci. Of the 23 patients, 9 (39%), of whom 8 had DM, died between 2 and 29 days after admission. The mortality rate and length of hospitalization were longer in diabetic patients than in others (p=0.02 and p=0.286, respectively). The mean blood glucose levels and HbA1C were higher in non-survival group than in survival group (195.6+/-41.5 vs 133.7+/-22.1 and 10.6 vs 7.4) (p=0.04, r=0.39 and p=0.03, r=0.50, respectively). In the univariate analysis, the hospitalization time (r=0.72), white blood cell count (r=0.52) and surgical debridement count (r=0.47) were found to be prognostic risk factors. Our results showed that NF is a very serious life-threatening disorder in especially diabetic patients with bad metabolic control.

The relationship between left ventricular mass index and insulin sensitivity, postprandial glycaemia, and fasting serum triglyceride and adiponection levels in patients with type 2 diabetes.

The relationship between left ventricular mass index (LVMI) and insulin sensitivity, postprandial glycaemia, fasting serum triglyceride and adiponectin was investigated in 70 patients with type 2 diabetes. Serum fasting insulin, C-peptide, high-sensitivity C-reactive protein (hs-CRP), glycated haemoglobin (HbA1c), postprandial glycaemia, lipids and fasting serum adiponectin levels were measured. Ventricular hypertrophy was assessed at rest by electrocardiography and echocardiography. Insulin sensitivity was assessed using the homeostasis model assessment index (HOMA-IR). LVMI was assessed using the Devereux formula. Study patients had lower than normal HOMA-IR, and higher than normal serum fasting insulin levels and LVMI, and tended to have reduced insulin sensitivity. Pearson's correlation coefficient showed a statistically significant correlation between fasting serum adiponectin and LVMI, fasting serum insulin, HOMA-IR, HbA1c, serum postprandial glucose and hs-CRP. There were no statistically significant correlations between LVMI and serum hs-CRP or HOMA-IR. The results indicate the importance of fasting serum adiponectin in the development of cardiovascular complications, such as increased LVMI.

Relationship between serum soluble E-selectin levels and development of diabetic retinopathy in patients with type 2 diabetes.

OBJECTIVE: To investigate whether diabetic retinopathy is associated with serum soluble E-selectin (ssE-selectin) level in type 2 diabetic patients. MATERIAL AND METHODS: Fifty-six patients with type 2 diabetes classified as Groups A, B, C and D according to grade of retinopathy were enrolled in the study. Sixteen age- and gender-matched healthy control subjects were also enrolled. Levels of ssE-selectin were measured using enzyme-linked immunosorbent assays (ELISAs) in all patients and control subjects. Clinical characteristics and ssE-selectin levels were compared between the groups. RESULTS: There was no statistically significant difference in ssE-selectin levels between diabetic patients and non-diabetic control subjects (p>0.05). There was also no statistically significant difference in levels of ss E-selectin between diabetic subgroups (Groups A, B, C, D) (p>0.05). No correlation was found between ssE-selectin level and HbA1c, or duration of diabetes in the whole group of diabetic patients (r = 0.10, p>0.05 and r = -0.12, p>0.05, respectively). CONCLUSIONS: The study shows that no significant elevation of ssE-selectin occurs in patients with type 2 diabetes in comparison with control subjects. Our results also indicate that there is no statistically significant correlation between ssE-selectin level and the development or grade of diabetic retinopathy.

Effect of the function of polymorphonuclear leukocytes and interleukin-1 beta on wound healing in patients with diabetic foot infections.

OBJECTIVES: This study was carried out prospectively to determine the effect on prognosis of phagocytic activity index (PAI) and intracellular killing activity (IKA) of polymorphonuclear leukocytes (PMNL), and the levels of interleukin-1 beta (IL-1beta) on prognosis in patients with diabetic foot infection (DFI). METHODS: The evaluation of PAI and IKA in PMNL and the levels of IL-1beta were performed at the beginning and in the second and fourth weeks of therapy in all diabetic patients, who were categorized into a healing group (HG) and a non-healing group (NHG) on the basis of therapy results. RESULTS: Sixty-six cases (38 diabetic patients and 28 non-diabetic controls) were included in the study. Full recovery was observed in 23 HG patients, whereas 15 (NHG) patients were unresponsive to treatment and nine patients were subjected to amputation at the end. At the baseline, PAI, IKA and IL-1beta levels in HG were not significantly different compared to those of NHG, but at weeks 2 and 4, PAI and IKA levels were significantly higher and IL-1beta levels were significantly lower than those in NHG. On the other hand, at the baseline, PAI and IKA values in HG were significantly lower and IL-1beta levels were significantly higher in comparison with the controls. However, no significant difference was observed at week 2 or 4. CONCLUSION: Our results suggest that the PMNL functions and IL-1beta regulation deteriorated in patients with DFI, and that such deteriorations might indicate inefficient therapeutic responses in patients with diabetes mellitus.

Serum interleukin 2 levels in patients with rheumatoid arthritis and correlation with insulin sensitivity.

Interleukin 2 (IL-2), a Th1 lymphocyte-derived cytokine, is thought to play an important role in the pathogenesis of type 2 diabetes and rheumatoid arthritis (RA). The aim of our study was to evaluate changes in serum IL-2 levels and their correlation with glucose metabolism abnormalities, such as insulin resistance, in patients with RA. Thirty-six subjects with varying degrees of disease activity and 20 healthy age-, sex- and body mass index-matched control individuals were evaluated. Patients with any causes of peripheral insulin resistance were excluded. After a 12-h overnight fast, fasting insulin levels, homeostatic model assessment-insulin resistance (HOMA-IR) estimated insulin sensitivity, and serum IL-2 levels were significantly higher in all patients with RA than in the control individuals. Fasting insulin, HOMA-IR scores and IL-2 levels were correlated in the RA group. This study showed that patients with RA have altered IL-2 regulation, and that there was a significant correlation between serum IL-2 levels and insulin sensitivity.

Serum interleukin 1 alpha and interleukin 2 levels in patients with schizophrenia.

It has been suggested that altered interleukin (IL) regulation may be involved in the pathogenesis of schizophrenia. In this cross-sectional, case-controlled study, patients with schizophrenia and a control group of healthy subjects, matched by age, sex and body mass index, were evaluated. The levels of IL-1 alpha and IL-2 in blood serum were measured by enzyme-linked immunosorbent assay. The fasting serum IL-2 levels were significantly higher in patients with schizophrenia compared with the control subjects, but there was no difference between the fasting serum levels of IL-1 alpha in patients with schizophrenia and the control subjects. Our results suggest that patients with schizophrenia have altered IL-2, but not IL-1 alpha, regulation.

Comparison of the therapeutic efficacy of 4-methylpyrazole and N-acetylcysteine on acetaminophen (paracetamol) hepatotoxicity in rats.

Obtaining effective analgesia with a minimal erosive effect on gastric mucosal tissue has increased the consumption of acetaminophen (paracetamol), especially among the elderly. However, the hepatotoxic effects of acetaminophen have also increased. We aimed to compare the effects of 4-methylpyrazole (4-MP), N-acetylcysteine (NAC) and their combined use on the hepatotoxicity of acetaminophen in a rat model. Male Wistar Albino rats were divided into six groups. Groups 1-5 received 2,000 mg/kg acetaminophen by gavage while the control group was group 6. Group 2 animals were given NAC (loading dose 140 mg/kg followed by seven doses at 4 h intervals); group 3 received 50 mg/kg 4-MP; group 4 received 200mg/kg 4-MP; and group 5 received NAC as in group 2 plus 200 mg/kg 4-MP. Blood samples were taken for measurements of serum AST and ALT levels. The livers of the rats were removed for microscopic examination and grading of hepatic necrosis. AST and ALT levels in groups 2-5 were lower than that of group 1 (p < 0.001), although no significant difference was noted between groups 2-5 (p > 0.05). Higher levels of ALT were found in group 5 than in group 2 (p < 0.05), and higher levels of AST were found in group 5 than in group 3 (p < 0.01). Median necrosis scores were 3.36 for rats receiving acetaminophen alone (p < 0.001, compared with groups 2-6), 1.45-1.81 for groups 2-5 (p > 0.05, compared with each other), and 0.18 for control rats (p < 0.001, compared with groups 1-5). In conclusion, the administration of 4-MP and/or NAC after 4 h of administering toxic dose of acetaminophen, inhibits hepatotoxicity in rats. There was no difference between the 4-MP and NAC-treated groups as reflected by comparable levels of serum transaminases and the degree of hepatic necrosis. Combining of 4-MP and NAC offers no benefit.

Hospital-acquired infections following the 1999 Marmara earthquake.

In this study, medical records of all casualties admitted to our hospital following the Marmara earthquake, which struck northwest Turkey and resulted in the destruction of several towns in the Marmara region, were evaluated retrospectively. The time buried under the rubble, demographic data, type of medical and surgical therapies performed, type of injury and data on infection were analysed. Between 17 August and 25 September 1999, 630 trauma victims were received at our hospital and 532 (84%) of them were hospitalized. The mean age of hospitalized patients (312 males, 220 females) was 32 years (2-90 years). Two hundred and twenty patients were hospitalized for more than 48 h. Forty-one of them (18.6%) had 43 hospital-acquired infection (HAI) episodes, which were mostly wound infections (46.5%). A total of 143 culture specimens was collected and 48 yielded the following potential pathogens: 15 Acinetobacter baumanii (31.2%), nine Staphylococcus aureus (18.7%), seven Pseudomonas aeruginosa (14.6%), six Escherichia coli (12.5%), six Klebsiella pneumoniae (12.5%), two Stenotrophomonas maltophilia (4.2%) and three various Pseudomonas spp. (6.3%). All S. aureus strains were found to be resistant to methicillin in vitro. Two strains of A. baumannii and one P. aeruginosa were found to be resistant to all antimicrobials including carbapenems. Fifty-three victims died (10%) and 36 of those died during the first 48 h because of severe injuries and multi-organ failure. After 48 h of hospitalization, the mortality rate was significantly higher in those patients with HAI (14/41) than those without (3/179) (34.1% vs. 1.7%, P<0.05). In conclusion, trauma is the significant factor associated with HAI and a high incidence of Acinetobacter strains was responsible for HAI in trauma patients.

The effects of valsartan on insulin sensitivity in patients with primary hypertension.

Insulin resistance is an important risk factor of cardiovascular disease. This study was performed to determine the effects of valsartan on insulin sensitivity in patients with primary hypertension. In this study, non-obese subjects with primary hypertension and a reference group of healthy subjects matched by age, sex and body mass index were evaluated; patients with any other causes of peripheral insulin resistance and hyperlipidaemia were excluded. The effect of valsartan on insulin resistance, assessed by homeostasis model assessment (HOMA-IR), fasting serum insulin levels, determined by radioimmunoassay, and fasting blood glucose concentrations, measured by the glucose oxidase method, were evaluated. All obtained data were evaluated by Pearson correlation analysis. Before valsartan treatment, the fasting serum insulin levels were significantly elevated in the 20 hypertensive patients with primary hypertension compared with the 20 subjects in the reference group (19.6 +/- 7.1 versus 8.7 +/- 1.9 microIU/ml). The fasting serum insulin levels correlated with HOMA-IR. Correlation analysis also showed a significant relationship between HOMA-IR and both systolic and diastolic blood pressures (r = 0.71 and r = 0.77, respectively). In our study, we showed that patients with primary hypertension have a decreased insulin sensitivity that was reflected in high serum fasting insulin levels. Anti-hypertensive treatment with valsartan increases insulin sensitivity.

Effects of fluvastatin treatment on insulin sensitivity in patients with hyperlipidaemia.

This study aimed to determine the effects of fluvastatin treatment on insulin sensitivity in patients with hyperlipidaemia. Non-obese, normoglycaemic, normotensive patients with hyperlipidaemia (n = 20) and a reference group of healthy subjects of similar age, sex, and body mass index (n = 20) were evaluated. Patients with other causes of peripheral insulin resistance were excluded. All participants underwent a diagnostic protocol, which included measurements of insulin sensitivity index and other metabolic parameters. Insulin sensitivity was assessed by Homeostasis Model Assessment (HOMA). Serum insulin levels were tested by radioimmunoassay. Patients were treated with fluvastatin 40 mg once daily for 3 months. Before fluvastatin treatment, fasting serum insulin levels were significantly raised in patients with hyperlipidaemia compared with subjects from the reference group (19.1 +/- 13.4 versus 8.1 +/- 3.4 microIU/ml). The fasting serum insulin levels and HOMA-estimated insulin sensitivity were correlated in the whole group. Correlation analysis showed a significant relationship between HOMA-estimated insulin resistance and plasma cholesterol and triglyceride concentrations. Patients with hyperlipidaemia had reduced insulin sensitivity that was reflected by high serum fasting insulin levels. Anti-hyperlipidaemic treatment with fluvastatin increases insulin sensitivity.

[Estimate of the artery responsible for acute inferior myocardial infarct attack using arterial electrocardiograph tracings]. / Akut inferior miyokard infarktüsünde infarktan sorumlu arteri elektrokardiyografik olarak tahmin edebilme.

OBJECTIVE: The aim of the study was to determine IRA (infarct-related artery) by analysis of the initial ECG (electrocardiogram) in patients with acute inferior wall myocardial infarction. METHODS: Forty patients (36 male, 4 female) admitted to coronary care unit with the diagnosis of acute inferior wall myocardial infarction were included in the study. The mean age of patients was 62.2 year (29-85 years). The coronary angiography was performed in all patients at the first week of admission. To determine the relationship between IRA and R/S ratio, ST segment depression in lead aVL, statistical analysis was performed. RESULTS: IRA was the right coronary artery (RCA) in 20 cases, circumflex artery (Cx) in 15 cases, RCA + Cx in 5 cases. R/S ratio was bigger than one in patients with Cx lesion and R/S ratio was smaller than one in patients with RCA lesion. The degree of the ST segment depression was equal or smaller than 2 mm in patients with Cx lesion and greater than 2 mm in patients with RCA lesion (p < 0.05). There was no correlation between IRA and precordial reciprocal electrocardiographic changes. Diagnosis of right ventricular infarction was established in 75% of patients with RCA lesion, 26% of patients with Cx lesion and 100% of patients with RCA + Cx lesions. CONCLUSION: We concluded that it was possible to predict IRA after examining the initial ECG changes such as R/S ratio, ST segment depression. This prediction can shorten the time required to perform primary percutaneous transluminal coronary angioplasty. Non-invasive prediction of IRA was useful for suggestion of clinical course in patients with high complication risk, such as patients with RCA lesion.

Comparison of the effects of hypertonic saline and crystalloid infusions on haemodynamic parameters during haemorrhagic shock in dogs.

Haemorrhagic shock, a leading cause of mortality, frequently accompanies cardiac interventions. The administration of small volumes of hypertonic saline solutions and crystalloid solutions may reduce the severity and duration of shock, and result in a decrease in adverse outcomes. Under general anaesthesia, hypotension was induced in 12 healthy dogs. After 30 min, dogs received either hypertonic saline solution or lactated Ringer's solution for fluid, resuscitation. In both groups, decreases in haemodynamic variables were observed during the shock period. Following resuscitation, increases in haemodynamic variables were observed. This increase lasted longer in dogs receiving hypertonic saline. In both groups, haematocrit and oxygen content values decreased after resuscitation and lactate levels increased. During resuscitation, lactate levels decreased. Sodium and osmolarity increased with resuscitation, then subsequently decreased. In conclusion, in a model of haemorrhagic shock, the administration of hypertonic saline solutions provides haemodynamic stability and tissue oxygenation more rapidly.

[Seroprevalence of human T-cell lymphotropic virus type I in Curaçao and predictive variables for that infection]. / Seroprevalentie van humaan T-cellymfotroop virus type I op Curaçao en voorspellende variabelen voor die infectie.

OBJECTIVE: To determine the seroprevalence of human T-cell leukaemia virus (HTLV) type I and predictive variables in Curaçao. DESIGN: Descriptive. SETTING: St. Elisabeth Hospital, Curaçao. METHODS: A total of 2531 sera were randomly collected from a total population of approximately 145,000 over a period of three months (of seven the sex was not known). An initial ELISA test was performed to detect anti-HTLV-I antibodies. If this test was positive an ELISA re-test (in duplicate) was performed. If one of these re-tests was found positive a western blot confirmation test was performed. The association with age, sex, social class and history of syphilis were analysed with multiple logistic regression models and adjusted for confounding. RESULTS: The estimated prevalence of HTLV-I was 1.9% (49/2524). No significant sex differences were observed (odds ratio (OR): 1.13; 95% confidence interval (95% CI): 0.62-2.05). Increasing age (p for trend = 0.0003) and lower social class (OR: 1.86; 95% CI: 1.03-3.38) were important predictive factors for HTLV-I infection. Members of the lower social classes and persons 50 years or older were at relatively high risk (OR: 3.91; 95% CI: 2.21-6.94). CONCLUSION: HTLV-I infection is endemic in the island of Curaçao, as in other Caribbean islands. The estimated prevalence is 1.9%. Age and lower social class were important predictive factors for HTLV-I infection.