Factors affecting inadequate response to HBV vaccine in hemodialysis patients: northeast anatolia survey with six hemodialysis centers.

BACKGROUND: In hemodialysis patients Hepatitis B virus (HBV) infection is one of the problems. Because of HBV vaccine response is lower than in the general population, in this study it is aimed to determine the factors that may cause inadequate HBV vaccine response in hemodialysis patients. METHODS: In study, HBsAg, anti-HBs, anti-HBc IgG data belonging to 278 patients were obtained from file and computer records. It was seen that seronegative cases had been given recombinant HBV vaccine. Anti-HBs titers were monitored 1 month after vaccination was completed. According to this, the patients are divided into two groups. Those with anti-HBs < 10 IU/mL were identified as non-responders and with anti-HBs ≥ 10 IU/mL as responders. Factors such as age, serum albumin and urea reduction rate which may affect inadequate response to HBV vaccine were evaluated. As statistical examination, Chi-square test was used for the analysis of the data determined by counting, and logistic regression was used for statistically significant independent variables in chi-square test. p value of < 0.05 was considered statistically significant (Confidence interval: 95%). RESULTS: Out of 278 patients, according to exclusion criteria 81 patients were excluded. 13.2%(26/197) of HBV vaccinated patients had insufficient response. The inadequate response rate to HBV vaccination was found to be higher in patients with age ≥ 65 (p = 0.039), serum albumin < 3.5 g/dL (p = 0.024) and urea reduction rate ≤ 65 (p = 0.028). No statistically significant relationship was found between inadequate response to HBV vaccine and anti-HCV positivity, presence of diabetes mellitus, anemia status, vitamin D therapy and vascular access pathway variability. CONCLUSION: We conclude that relatively high patient age, low albumin level and insufficient urea reduction rate may cause inadequate HBV vaccine response. Taking these factors into consideration may provide a useful insight for an adequate response to vaccination.

Does Treatment of Either Hypothyroidy or Hyperthyroidy Affect Diurnal Blood Pressure.

OBJECTIVE: Thyroid hormone has well recognized effects on the cardiovascular system. The purpose of this study was to define the influence of treatment of either hypothyroidism and hyperthyroidism on the values and circadial variations of arterial blood pressure measured by ambulatory blood pressure monitoring. MATERIAL AND METHODS: The study was carried out on 30 hypothyroidic and 30 hyperthyroidic patients without hypertension and 46 healthy participants. First, all the parameters of the groups, then blood pressure values obtained by ambulatory blood pressure monitoring before and after treatment (thyroid hormone replacement with levothyroxine and antithyroid treatment either with propylthyrouracil or metimazole) were compared. For statistical examinations, Shapiro-Wilk, one-way analysis of variance, Kruskal Wallis, post-hoc Tukey, and Wilcoxon Sign tests were used. RESULTS: In the hypothyroid group, 24-hour mean and diastolic blood pressure, daytime diastolic blood pressure, nighttime mean, systolic and diastolic blood pressures were higher than the control group (P < 0.05). After treatment, 24-hour, daytime and nighttime systolic and diastolic blood pressures diminished. Mean blood pressures diminished only in daytime and nighttime. In the hyperthyroid group, 24-hour average and daytime systolic, mean blood pressures, and all nighttime blood pressure values were higher than the control group (P < 0.05). After treatment, 24-hour and daytime systolic, mean blood pressures, all nighttime pressures diminished (P < 0.05). CONCLUSION: Throughout 24 hours, in hypothyroidic patients especially higher diastolic and in hyperthyroidics especially higher systolic blood pressures were exhibited than euthyroid subjects. After treatment of these diseases, ambulatory blood pressure values decreased. Early control of thyroid dysfunctions may help to protect cardiovascular system from hazardous effects of thyroid dysfunctions and lower mortality and morbidity in these patients.

The relationship of mean platelet volume with retinopathy in type 2 diabetes mellitus.

BACKGROUND/AIM: Patients with diabetes mellitus have an increased risk of developing micro- and macrovascular complications. Retinopathy is one of the most important complications of diabetes whose pathophysiological cause has not yet been determined. One candidate may be platelet volume. In this study we aimed to investigate the association between mean platelet volume and diabetic retinopathy. MATERIALS AND METHODS: Mean platelet volume levels were investigated in type 2 diabetic patients with and without retinopathy, and in healthy participants. After reclassifying our diabetics in terms of the presence or absence of hypertension and hyperlipidemia, we compared their mean platelet volumes. We then checked to see if the mean platelet volume correlated with hemoglobin A1c and body mass index. RESULTS: The mean platelet volume levels were higher in all diabetic patients, and they were highest in diabetics with retinopathy. The mean platelet volume levels were not different in diabetic patients with and without hypertension or hyperlipidemia. Moreover, the mean platelet volume levels did not correlate with hemoglobin A1c or body mass index. CONCLUSION: We think that platelets may play a role in diabetic retinopathy. We can also say that, in diabetic patients, hypertension, hyperlipemia, obesity, and control of diabetes were not related to mean platelet volume.

The relationship of mean platelet volume with microalbuminuriain type 2 diabetic patients.

BACKGROUND/AIM: Activation and size of platelets have been suggested to be involved in the pathogenesis of vascular complications in diabetes mellitus. The purpose of the present study was to investigate the association of mean platelet volume with microalbuminuria in type 2 diabetic patients. MATERIALS AND METHODS: Mean platelet volume levels were investigated in healthy participants and type 2 diabetic patients with and without microalbuminuria. After their mean platelet volume values were compared, correlation of mean platelet volume with sex, duration of diabetes, microalbuminuria, fasting blood glucose, hemoglobin A1c, creatinine clearance, and body mass index was examined. RESULTS: Mean platelet volume levels were higher in all diabetic patients than those in controls. Mean platelet volume levels were highest in diabetics with microalbuminuria. The mean platelet volume levels had a positive correlation with microalbuminuria. CONCLUSION: Mean platelet volume values of diabetic patients were higher than those of nondiabetics, the highest levels being in diabetics with microalbuminuria. Our results suggest that microalbuminuria might be related with mean platelet volume in diabetic patients.

Evaluation of Invasive and Noninvasive Methods for the Diagnosis of Helicobacter Pylori Infection

Objective: The present study was conducted to evaluate invasive and noninvasive diagnostic methods for detection of Helicobacter pylori (H. pylori) in patients admitted with dyspeptic complaints and to compare sensitivities and specificities. Method: Sets of four gastric biopsy specimens were obtained from a total of 126 patients included in the study. The presence of H. pylori was determined by invasive tests including culture, rapid urease test, polymerase chain reaction (PCR) and histopathology. Among noninvasive tests, urea breath test, serological tests and enzyme-linked immunosorbent assay (ELISA) were performed. Results: H. pylori was isolated in 79 (62.7%) gastric biopsy cultures, whereas positivity was concluded for 105 (83.3%) patients by rapid urease test, for 106 (84.1%) by PCR, for 110 (87.3%) by histopathology, for 119 (94.4%) by urea breath test, and for 107 (84.9%) by ELISA. In the present study, the culture findings and histopathological examination findings were accepted as gold standard. According to the gold standard, urea breath test had the highest sensitivity (96.5%) and the lowest specificity (30%), whereas culture and histopathology had the highest specificities (100%). Conclusion: The use of PCR invasively with gastric biopsy samples yielded parallel results with the gold standard. PCR can be recommended for routine use in the diagnosis of H. pylori.

The relation of obesity with serum resistin levels in smoker and nonsmokers.

BACKGROUND: The demonstration that adipose tissue produces numerous cytokines increases interest of investigators in their role in the pathogenesis of obesity. Resistin is one of those cytokines. There are conflicing reports as cigarette smoking impairs insulin secretion, augments insulin resistance, or has no effect on glucose metabolism. In our study, we intended to examine the relationship of obesity with resistin levels in smokers and nonsmokers. PATIENTS AND METHODS: The study included 52 male smokers and 34 age matched nonsmoker male control subjects. We classified smoker and nonsmoker groups according to their body mass index as BMI < 27 and ≥27. As well as making physical and anthropometric examinations, fasting plasma glucose and insulin, postprandial plasma glucose, lipid profile, and resistin levels were measured in all male subjects. We compared all parameters in smoker and nonsmokers either having BMI < 27 or ≥27. RESULTS: In both BMI levels, resistin levels were higher in smoker groups than nonsmoker ones (P<0.01 all), we did not find any difference in other parameters. CONCLUSION: in conclusion we may speculate that if someone smokes resistin levels increase.

Relation of resistin with obesity and some cardiovascular risk factors in hypertensive women.

BACKGROUND: Hypertension and obesity are risk factors of cardiovascular disease. The association between C-reactive protein, homocysteine, microalbuminuria and cardiovascular risk have been debated for decades. Resistin is a newly discovered adipocyte derived cytokine. In the current study we planned to investigate the relation of resistin to these probable cardiovascular risk factors and obesity in hypertensive patients. MATERIALS AND METHODS: The study population consisted of 42 non-obese and 42 obese hypertensive females. After making comparisons between C-reactive protein, homocysteine, microalbuminuria and resistin in the two groups, we also sought correlations between all parameters in non-obese and obese groups. RESULTS: In our obese hypertensive group, resistin levels were higher than in the non-obese hypertensive group (p < 0.001), but we did not find any difference in other parameters. We found a positive correlation between resistin and C-reactive protein in both non-obese and obese hypertensive groups (in non-obese hypertensives p < 0.05, and in obese hypertensives p < 0.001). CONCLUSIONS: We showed that in female obese hypertensive patients resistin levels were higher than in the non-obese patients. We also think that resistin may be associated with C-reactive protein levels but not with homocysteine or microalbuminuria in both non-obese and obese hypertensive patients.

Relation of obesity with serum 25 hydroxy vitamin D3 levels in type 2 diabetic patients.

BACKGROUND: Hypovitaminosis D is associated with diabetes mellitus (DM). Aim of our study was to determine the relation of obesity with vitamin D levels in type 2 diabetic patients. MATERIALS AND METHODS: We examined 101 type 2 diabetic patients and made a correlation analysis in all parameters. Then we classified our diabetics according to their body-mass indices and compared their 25 hdroxy vitamin D3 levels. RESULTS: We found negative correlation between 25O HD and body mass index (BMI) (P: <0.001, r: -0.23). When we classified our diabetics according to their body mass indices as normal, overweight and obese, and compared their 25 hydroxy vitamin D3 levels, we determined that in every BMI group 25 hydroxy vitamin D levels were not found to be significantly different. CONCLUSION: These results suggest that at least in a Turkish population with type 2 DM vitamin D levels are low and correlate with BMI, but when vitamin D levels are so low, as obesity worsens vitamin D levels does not lessen.

Relation of resistin levels with C-reactve protein, homocysteine and uric acid in smokers and non-smokers.

BACKGROUND: The association between C-reactive protein, homocysteine, uric acid levels and cardiovascular risk have been debated for decades. Resistin is a newly discovered adipocyte derived cytokine. Smoking besides its effect on atherosclerosis, is shown to alter adipocytokine levels. Bearing in mind, these complex relationship of resistin with smoking, C-reactive protein, homocysteine and uric acid, we planned to investigate the association of resistin and these cardiovascular risk factors in smoker and non-smoker subjects. METHODS: We conducted a cross-sectional randomized study including 52 smoking and 33 non-smoking men. After making comparisons of C-reactive protein, homocysteine, uric acid and resistin between the two groups, we classified the subjects according to their insulin resistance and body mass and made again the comparisons.. RESULTS: Resistin levels were higher in smokers than in non-smokers (p<0.001) and also in insulin resistant than in non-insulin resistant smokers (p<0.05). Resistin levels were indifferent in non-smokers as insulin resistance was concerned and in smoker or non-smokers as body mass index was concerned. As all subjects were grouped based on homeostasis model assesment index and body mass index, neither C-reactive protein nor homocysteine and uric acid levels differred. CONCLUSIONS: We found that smoking may have influence on resistin levels and in smokers, insulin resistance is related to resistin levels, but in smoker and non-smokers body mass may not have any association with resistin. Resistin also may not have a role in C-reactive protein, homocysteine and uric acid levels both in smokers and non-smokers.

Combined portal, splenic and mesenteric venous thrombosis in inactive ulcerative colitis with heterozygous mutation in MTHFR gene: A rare case of thrombophilia.

Thrombophilia is a rare but potentially catastrophic phenomenon occurring in patients having tendency of thrombosis. It may lead to serious complications. The etiology of thrombophilia is thought to be multifactorial and related to both acquired and inherited factors. Inflammatory bowel disease is an acquired cause of thrombophilia. Thromboembolic events are seen during inflammatory bowel disease, especially during the active period of the disease. In inflammatory bowel disease, thrombus formation in portal, splenic and mesenteric veins are not common. Besides, the association of genetic disorders related to metabolism of homocysteine with inflammatory bowel disease has been evidenced, especially in Crohn disease and rarely in ulcerative colitis. We present a rare case of ulcerative colitis in association with combined portal, splenic and mesenteric vein thrombosis. The patient was recently diagnosed with the disease which was in the inactive period. Interestingly, our patient was also heterozygous for the mutation in methylenetetrahydrofolate reductase (MTHFR) gene.

Plasma soluble intercellular adhesion molecule 1 levels are increased in type 2 diabetic patients with nephropathy.

BACKGROUND/AIM: Intercellular adhesion molecule 1 (ICAM-1) is a mediator in the recruitment of leukocytes in the glomerular cells. The role of ICAM-1 in diabetic complications is still a matter of debate. This study was performed to investigate the relation of plasma soluble ICAM-1 (sICAM-1) to nephropathy in patients with type 2 diabetes mellitus. METHODS: Ninety-three patients (24 males and 69 females) with type 2 diabetes mellitus were included into the study. Fifty patients had nephropathy, and 43 were free from nephropathy. Fifty healthy subjects (14 males and 36 females) served as the control group (group 1). Twenty-five of the diabetic patients had microalbuminuria (group 2), 25 had macroalbuminuria (group 3), and 43 had neither micro- nor macroalbuminuria (group 4). The plasma sICAM-1 levels were measured in blood samples drawn after fasting. RESULTS: The mean plasma sICAM-1 levels were not different in the 93 diabetic patients as compared with the healthy controls (392.7 +/- 119.5 vs. 350.1 +/- 90.2 ng/ml, p > 0.05). The mean sICAM-1 level was significantly higher in the diabetic patients with nephropathy than in those without nephropathy (430.3 +/- 78.2 vs. 368.2 +/- 122.5 ng/ml, p = 0.03) and in the controls (430.3 +/- 78.2 vs. 350.1 +/- 90.2 ng/ml, p = 0.016). The difference in sICAM-1 levels between groups 2 and 3 was not significant (p > 0.05). The plasma sICAM-1 levels were significantly higher in both groups 2 and 3 than in both groups 1 and 4 (434.5 +/- 129.2 vs. 427.2 +/- 113.7 ng/ml and 368.2 +/- 122.5 vs. 350.1 +/- 90.2 ng/ml, respectively). CONCLUSIONS: The plasma sICAM-1 levels in patients with type 2 diabetes mellitus are not significantly different from those in nondiabetic subjects. High levels of sICAM-1 suggest that sICAM-1 may play a role in the development of nephropathy in patients with type 2 diabetes mellitus.