Evaluation of Neutrophil-to-Lymphocyte Ratio and Monocyte-to-Lymphocyte Ratio in Gouty Arthritis Attacks

ABSTRACT Objective: To evaluate neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) in patients with gouty arthritis. Methods: Forty-five patients with gout and 45 healthy age and gender matched individuals were included in this study. Clinical and laboratory data of patients during acute gouty arthritis (AGA) attack period, as well as in remission and control group data, were reviewed and recorded from medical files. Patients were divided into two groups as having the arthritis attack and in remission. Results: Neutrophil-to-lymphocyte ratio values were 4.19 ± 3.37 in AGA patients, 2.64 ± 1.74 in patients in remission and 2.07 ± 1.01 in controls. Neutrophil-to-lymphocyte ratio values in AGA were higher than patients in remission and controls, whereas there was no difference between patients in remission and controls (p < 0.0001, p <0.0001, p = 0.453, respectively). Monocyte-to-lymphocyte ratio values were 0.36 ± 0.21 in AGA patients, 0.25 ± 0.15 in patients in remission and 0.22 ± 0.06 in controls. Monocyte-to-lymphocyte ratio was higher in AGA patients than in patients in remission and controls, but there was no difference between patients in remission and healthy individuals (p < 0.0001, p < 0.0001, p = 0.604, respectively). The NLR and MLR values in AGA patients had positive correlations with C-reactive protein, erythrocyte sedimentation rate and leucocyte count. The cut-off value of NLR was 2.18 in receiver operating characteristic (ROC) analysis (73% sensitivity, 63% specificity, AUC = 0.676; p = 0.004). The cut-off value of MLR was 0.22 in ROC analysis (62% sensitivity, 54% specificity, AUC 0.655; p = 0.011). Conclusion: We concluded that MLR and NLR could be used as cheap and useful inflammatory markers predicting arthritis attacks in patients with gout.

Association of soluble ST2 with functional capacity in outpatients with heart failure.

BACKGROUND: Biomarkers play an important role in the risk stratification of patients with heart failure (HF). Recent studies have shown that soluble suppression of tumorigenicity 2 (sST2), a member of the interleukin 1 receptor family, is associated with disease prognosis in acute and chronic HF. In this study we aimed to investigate the relation between sST2 level and functional capacity in outpatients with systolic HF. PATIENTS AND METHODS: This study included 120 HF patients with reduced ejection fraction (HFrEF; EF ≤ 40%). The mean age of patients was 66 ± 11 years. Advanced HF (New York Heart Association [NYHA] functional class III-IV) was observed in 35 patients (29%). RESULTS: sST2 levels were on average higher in patients with NYHA functional classes III and IV than in patients with NYHA functional classes I and II (51 [9-198] vs. 25 ng/ml [9-118], p < 0.001). In a multiple logistic regression model, sST2 level (OR: 1.044, p = 0.004, 95% CI: 1.014-1.075), hemoglobin level (OR: 0.590, p = 0.001, 95% CI: 0.433-0.805), total cholesterol level (OR: 0.977, p = 0.004, 95% CI: 0.962-0.993), and age (OR: 1.066, p = 0.047, 95% CI: 1.001-1.136) were associated with poor functional capacity. In receiver operating characteristic (ROC) curve analysis, the optimal cut-off value of sST2 for predicting poor functional capacity was >42 ng/ml, with 63% sensitivity and 88% specificity (AUC: 0.810, 95% CI: 0.728- 0.875). CONCLUSION: Higher sST2 levels were strongly associated with poor NYHA functional class, independent of cardiac risk factors, in outpatients with HFrEF.

The thioredoxin reductase activity and hypoxia-inducible factor 1 alpha level in anaerobic and aerobic macrophages.

OBJECTIVES: This study was aimed to demonstrate the thioredoxin reductase (TrxR) activities and Hypoxia-Inducible Factor 1 alpha (HIF-1α) levels in macrophage cell line incubated in aerobic and anaerobic settings. BACKGROUND: Pathological situations including inflammatory disorders are associated with the infiltration of phagocyte system cells into damaged tissues. Whenever the environment of tissues converts into hypoxic conditions, phagocytic cells develop an adaptive mechanism in order to fulfill their defense functions. MATERIALS AND METHODS: The macrophage cells were prepared as two replications both for aerobic and anaerobic media. The E. coli bacteria were inoculated onto the some macrophage culture mediums. TrxR and HIF-1α levels of the samples, obtained from all growth cultures, were measured with the ELISA. RESULTS: On the 5th and 6th day, there was a continuous increase in the count of bacteria in the aerobic medium, while a continuous decrease in the count of bacteria in the anaerobic medium.The TrxRand the HIF-1α levels in the groups with anaerobic and aerobic macrophages with or without E. coli bacteria were evaluated. A statistically significant difference was found between these groups in terms of TrxR and HIF-1α levels (p < 0.05). CONCLUSIONS: Increased TrxR and HIF-1α levels were thought to have an effect on the adaptation of the macrophages in the anaerobic environment (Tab. 5, Fig. 2, Ref. 23).

Fibrosis in heart failure subtypes.

BACKGROUND: The differences in concentrations of biomarkers between heart failure patients with dilated cardiomyopathy (HF-D) and with ischemic cardiomyopathy (HF-I) have yet to be defined. The objectives of this study were to compare the concentrations and correlation of biomarkers of inflammation, extracellular matrix (ECM) turnover and oxidative stress parameters between these populations. PATIENTS AND METHODS: Our study consisted of 36 subjects with HF-D (LVSD = 47.2 ± 7.3 mm, LVDD = 65.1 ± 6.3 mm), 44 subjects with HF-I (LVSD = 38.0 ± 4.4 mm, LVDD = 58.5 ± 6.0 mm) and 38 controls without heart failure. Concentrations of matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, MMP-13, Galectin-3, prolidase, TNF-alpha, and oxidative stress index (OSI) were measured. RESULTS: Serum levels of MMP-2, MMP-9, and prolidase were significantly increased in HF-I group compared to healthy controls (p = 0.039, 0.019, 0.012 respectively), whereas the increases in MMP-1 and MMP-13 were not significant. This significance was stronger in the HF-D group than the HF-I group (p = 0.004, 0.001, 0.002 respectively). TNF-α, a marker of inflammation, was significantly increased in heart failure (p = 0.004) but there was no difference between HF-D and HF-I groups; however, Galectin-3 was significantly increased in the HF-D group compared to the HF-I group (p = 0.005). OSI showed the same response pattern as TNF-α (p = 0.019, 0.002 respectively). There was a positive correlation of MMP-9 levels with prolidase activity (r = 0.612, p: 0.003). CONCLUSIONS: MMPs and Galectin-3 are important in cardiac remodeling; prolidase may share an undefined role in fibrosis in heart failure and may have a role in the diffuse fibrosis of heart failure.

Evaluation of adults with acute viral hepatitis a and review of the literature.

AIM: In developing countries HAV infection is very common in the first years of life and it is often asymptomatic. However especially in regions of intermediate endemicity, exposure to the virus may delay and outbreaks of hepatitis A may be encountered in adults. The aim of this study is to evaluate the clinical and laboratory findings and risk factors of adults with acute viral hepatitis A. MATERIALS AND METHODS: In present study we evaluated 203 patient with acute viral hepatitis A, who were admitted to four different hospitals of three cities of Turkey between January 2000-December 2011, retrospectively. The diagnosis of acute viral hepatitis A was performed by laboratory findings and clinically. RESULTS: In a total of 203 patients, 120 (59.1%) patients were male and 83 (40.9%) were female. Mean age of cases with acute viral hepatitis A was 24.7 +11.8 years (ranged 15 to 82 years old). Acute viral hepatitis A were seen in patient who were 15-20 years and 21-30 years old, commonly. Jaundice (74%), fatigue (68%), nausea- vomiting (56%) and dark urine (48%) were the most common symptoms in cases. Prolonged cholestasis (6.8%) was the most common atypical manifestation. Prolonged jaundice was more frequent in the cases with positive HBsAg (P < 0.001). CONCLUSIONS: Acute viral hepatitis A can cause atypical presentations such as prolonged cholestasis, acute kidney injury and fulminant hepatitis. Some precautions such as routine vaccination program, improvement of hygiene conditions and informing people about it, should be taken for reducing of acute viral hepatitis A infection incidence.