Role of serum calprotectin in identifying familial Mediterranean fever attacks.

BACKGROUND/AIM: The aim of the study was to evaluate serum calprotectin (CLP) levels in familial Mediterranean fever (FMF) patients and to investigate the utility of CLP in distinguishing patients with attack from patients without attack. MATERIAL AND METHOD: FMF patients, rheumatoid arthritis (RA) patients, and healthy controls were included. Serum calprotectin levels were quantified utilizing the enzyme-linked immunosorbent assay (ELISA) method. Receiver operating characteristic (ROC) curve analysis was used to identify the cut-off value of serum CLP level to differentiate FMF patients with attack from those without. Logistic regression analysis was performed to identify predictors. RESULTS: Significant differences were observed among the three groups concerning white blood cell (WBC), neutrophil, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum CLP levels (p = 0.003, p = 0.004, p < 0.001, p < 0.001, and p = 0.002, respectively). Higher ESR, CRP, and serum CLP levels were observed in FMF patients with attacks than those without (all, p < 0.001). Serum CLP was significantly higher in RA patients than in FMF patients in remission (p < 0.001). ROC analysis identified a threshold CLP concentration in FMF with an attack to be 47.1 pg/mL (83.3% sensitivity, 60.6% specificity, AUC = 0.74, 95% CI = 0.63-0.85, p < 0.001). In univariate logistic regression analysis, CLP (ß = 1.045, 95% CI = 1.017-1.073, p = 0.001) was predictive of FMF patients experiencing an attack. CONCLUSION: Serum CLP proves to be as productive as ESR in illustrating inflammation and demonstrating the existence of attacks in FMF patients.

Comparison of anakinra and tocilizumab in management of severe COVID-19: a retrospective cohort study.

BACKGROUND: Studies regarding effectiveness of anakinra and tocilizumab treatments in coronavirus disease 2019 (COVID-19) have contradictory results. Furthermore, there is scarce comparative data regarding superiority of any agent. To further elucidate any superiority between these two agents, we retrospectively investigated and compared outcomes in hospitalized COVID-19 patients of our inpatient cohort who received anakinra or tocilizumab. METHODS: This study was designed as a single-center, retrospective, cross-sectional cohort study. Hospitalized patients with confirmed diagnosis of COVID-19 who had Brescia-COVID respiratory severity scale score ≥3 and hyperinflammation (defined as elevation of C reactive protein ≥50 g/L or ferritin ≥700 ng/mL) and received anakinra or tocilizumab in addition to standard care were enrolled in the study. Length of hospital stay after initiation of antiinflammatory treatment, need for mechanical ventilation, need for intensive care unit admission, mortality were set as primary outcomes and compared between tocilizumab and anakinra recipients after propensity score matching. RESULTS: One hundred and six patients were placed in each group after propensity score matching. In the anakinra group, relative risk reduction for intensive care unit admission was 50% when compared to the tocilizumab group and the number needed to treat to avert an intensive care unit admission was 3 (95% CI, 2-5). In terms of mortality, a 52% relative risk reduction was observed with anakinra treatment and the number needed to treat to avert an intensive care unit admission was 8 (95% CI, 4-50). Significantly more patients were observed to receive glucocorticoids in the anakinra group. DISCUSSION: Anakinra administration in severe COVID-19 patients was significantly associated with better survival and greater clinical improvement compared to the tocilizumab administration in our study. Increased rate of glucocorticoid use in the anakinra group might have contributed to better outcomes.

Hydroxychloroquine shortened hospital stay and reduced intensive care unit admissions in hospitalized COVID-19 patients.

INTRODUCTION: Effectiveness of hydroxychloroquine against SARS-CoV-2 has been highly controversial. In our research, we aimed to investigate the effects of hydroxychloroquine on disease outcomes in hospitalized patients with COVID-19. METHODOLOGY: A total of 393 hospitalized patients with COVID-19 were retrospectively assigned to the standard of care therapy group (n = 180) or the standard of care plus hydroxychloroquine group (n = 213). The standard of care therapy comprised favipiravir, low molecular weight heparin, acetylsalicylic acid. Status of oxygenation at baseline and on the seventh day, laboratory tests at baseline and at discharge were recorded. Length of hospital stay, administration of anti-inflammatory treatment, admission to the intensive care unit and 28th day mortality were set as primary endpoints. RESULTS: There were no statistically significant differences between groups in terms of oxygen delivery route and mortality after seven days of treatment (p = 0.592). C-reactive protein levels of the standard of care plus hydroxychloroquine group were significantly lower than that of the standard of care group at discharge (p = 0.034). Patients in the standard of care plus hydroxychloroquine group had shorter hospital stay (p = 0.007). The standard of care plus hydroxychloroquine group was favored over standard of care group in terms of rate of intensive care unit admissions (21.7% vs. 10.8%; relative risk with 95% CI = 0.49 [0.31-0.80], p = 0.003). CONCLUSIONS: Hydroxychloroquine in addition to standard of care was associated with less intensive care unit admissions, early discharge and greater C-reactive protein reduction. There was no difference in 28-day mortality.

Development and validation of nomogram to predict severe illness requiring intensive care follow up in hospitalized COVID-19 cases.

BACKGROUND: Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. METHODS: Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer-Lemeshow Goodness-of-fit test, and calibration curve analysis. RESULTS: Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902-0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899-0.947). Hosmer-Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). CONCLUSION: We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

Which hematological markers have predictive value as early indicators of severe COVID-19 cases in the emergency department?

Background/aim: Coronavirus 2019 disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic infectious disease that causes morbidity and mortality. As a result of high mortality rate among the severe COVID-19 patients, the early detection of the disease stage and early effective interventions are very important in reducing mortality. Hence, it is important to differentiate severe and nonsevere cases from each other. To date, there are no proven diagnostic or prognostic parameters that can be used in this manner. Due to the expensive and not easily accessible tests that are performed for COVID-19, researchers are investigating some parameters that can be easily used. In some recent studies, hematological parameters have been evaluated to see if they can be used as predictive parameters. Materials and methods: In the current study, almost all hematological parameters were used, including the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, mean platelet volume to lymphocyte ratio, mean platelet volume to platelet ratio, plateletcrit, and D-dimer/fibrinogen ratio, neutrophil/lymphocyte/platelet scoring system, and systemic immune-inflammation index. A total of 750 patients, who were admitted to Ankara City Hospital due to COVID-19, were evaluated in this study. The patients were classified into 2 groups according to their diagnosis (confirmed or probable) and into 2 groups according to the stage of the disease (nonsevere or severe). Results: The values of the combinations of inflammatory markers and other hematological parameters in all of the patients with severe COVID-19 were calculated, and the predicted values of these parameters were compared. According to results of the study, nearly all of the hematological parameters could be used as potential diagnostic biomarkers for subsequent analysis, because the area under the curve (AUC) was higher than 0.50, especially for the DFR and NLR, which had the highest AUC among the parameters. Conclusion: Our findings indicate that, the parameters those enhanced from complete blood count, which is a simple laboratory test, can help to identify and classify COVID-19 patients into non-severe to severe groups.

Changing trends in the Turkish maternal deaths, with a focus on direct and indirect causes.

OBJECTIVE: Our aim is to evaluate trends in the direct and indirect causes' distribution using data from National Maternal Mortality Surveillance (2012-2015). STUDY DESIGN: A population-based retrospective review was performed on all pregnancy-associated maternal deaths in Turkey from 2012 to 2015. Causes of death were grouped into direct and indirect maternal deaths and compared in the context of distribution. Maternal mortality rate was reported. Statistics included chi-square test or Fisher's exact test for categorical variables. RESULTS: Between 2012 and 2015 there were 812 maternal deaths. The maternal mortality rate was 15.4 deaths per 100,000 live births in 2012 as compared to 13.7 in 2015. Direct maternal deaths in Turkey declined from 59.5% in 2012 to 45% in 2015 while indirect maternal deaths increased from 45% in 2012 to 55% in 2015 (p = 0.045). The leading direct causes of maternal deaths were postpartum hemorrhage. The major indirect causes of maternal deaths were circulatory system diseases. CONCLUSION: Direct maternal deaths in Turkey appear to be declining. This data will aid the management of maternal deaths.

Maternal mortality due to hemorrhage: population-based study in Turkey.

Objective: The aim of this study was to determine the epidemiological characteristics of maternal mortality due to postpartum hemorrhage, and to investigate whether national preventative measures of the Maternal Mortality Program have been successful in Turkey. Design: A population-based cohort study. Setting: Turkish National Maternal Mortality Data collected by the Turkish Ministry of Health. Participants: Women who died due to hemorrhage during pregnancy or after delivery within the initial 42 days, from 2012 to 2015, throughout Turkey (N = 812/146). Main outcome measures: The preventability and problems in each maternal death due to hemorrhage. Results: A total of 779 maternal deaths were identified during the study period. Our estimate of the Maternal Mortality Ratio (MMR) in the 3-year period was 19.7 per 100,000 live births. Of the 779 deaths, the report listed 411 as direct and 285 as indirect deaths. Direct obstetric complications were the leading causes of maternal deaths, the most common of which was maternal cardiovascular diseases (21%) and obstetric hemorrhage (20.6%). Conclusion: Improving data surveillance and implementing national guidelines for the prevention and management of major complications of pregnancy, childbirth, and puerperium is necessary to reduce MMR. The healthcare authorities of Turkey should continue to set a sustainable development goal of ≤70 maternal deaths per 100,000 live births by 2030. We believe our results may provide useful information for other developing countries that are aiming to reduce maternal mortality, as well as mobilize global efforts to improve women's health.

The diagnostic and prognostic value of platelet indices in gastrointestinal bleeding.

BACKGROUND: We aimed to investigate the association between platelet indices [platelet, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW)] and gastrointestinal bleeding (GIB), as well as determine its severity and prognosis. METHOD: 500 patients with GIB who were admitted to hospital between March 2014 and February 2017 and diagnosed with "Gastrointestinal System Bleeding", as well as114 healthy individuals were retrospectively included in the study. Patients' platelet indices were recorded after one week and one month from their files. RESULTS: Platelet, PCT, MPV and PDW levels were determined to be higher in the patients with bleeding, when compared to the control group (p < 0.001). Within the first week, a significant reduction was determined in patients' platelet, PCT, MPV and PDW values compared to the admission values (p < 0.001). In initial-month controls, a significant reduction was determined in the platelet indices compared to the initial-week values (p < 0.001). A significant association between bleeding severity and increased platelet indexes was determined. Increasing age, female gender, the presence of comorbidities, high levels of platelet indexes, low levels of hemoglobin, and albumin values were all found to be associated with a poor prognosis. PCT, MPV, and PDW were determined as being the independent risk factors that predict the odds of GIB, alongside the independent predictors that predict risk of bleeding severity and the prognosis. CONCLUSION: We think that platelet indices may be used in diagnosis of GIB, as well as in predicting bleeding severity and the prognosis.

A view of maternal mortalities in women conceiving through assisted reproductive techniques: A nation-based study of Turkey.

BACKGROUND: Our aim was to evaluate maternal mortality causes among Turkish women giving birth after assisted reproductive techniques (ARTs). METHODS: All maternal deaths following conception with ART pregnancies were identified through the National Maternal Mortality Surveillance System. We analyzed the system data collected between 2007 and 2014. During this period, there were 10,369,064 live births and 1788 maternal deaths resulting from both direct and indirect causes. We identified 28 maternal death cases following ART procedures. The age, gestational age at birth, number of antenatal visits, delivery route, time of death, cause of death, and neonatal outcomes were recorded. Also, any existing delay (phase 1, 2, or 3) and preventability of maternal death were assessed. RESULTS: Hypertensive disorders, pulmonary embolism, and cardiovascular disease were the leading causes of maternal death. Twelve (40%) women were over 35 years of age. Of the deaths, 15 (54%) were attributed to indirect causes. The number of unpreventable maternal deaths was 19 (67.9%), and 9 (36%) were classified as preventable after being assessed by the review commission of maternal mortality. CONCLUSION: Pregnancies conceived with ARTs should undergo a careful assessment of risk factors for hypertensive disorders, pulmonary embolism and cardiovascular diseases. Those women require closer antenatal surveillance because 1/3 of these deaths were preventable.

The value of autopsy to determine the cause of maternal deaths in Turkey

Objective: To analyze the value of autopsy reports for determining the cause of maternal deaths in Turkey. Material and Methods: In this descriptive retrospective study, the case files of 992 maternal deaths, except for accidental causes, that occurred in Turkey between 2012 and 2016 were reviewed. An autopsy examination was performed in 177 (17.8%) of the cohort. When the files were reviewed, maternal descriptive data and the cause of maternal mortality according to the autopsy reports were recorded. Results: The mean age at death was 31.5±6.6 years. No exact cause of maternal death was identified after autopsy in 44 (24.9%) of the 177 cases. An exact cause of death could be determined in 133 (75.1%); 34.5% (n=61) were due to direct causes, and 40.7% (n=72) were due to indirect causes. The leading direct causes of maternal deaths were obstetric hemorrhage (13.0%) and obstetric (pulmonary and amniotic fluid) embolism (12.4%). The main cause among the indirect causes was ruptured aortic aneurysm and/or dissection of aorta (8.5%). Among the subjects with no clinical diagnosis based on the clinical course before death (n=96), the exact cause of death could not be determined at autopsy in 19 (19.8%) cases. The exact or possible cause of death was identified at autopsy in 80.3% (n=77) cases with no clinical diagnosis. Among the cases who had antemortem diagnoses based on the clinical course (n=81), the final diagnosis at autopsy was compatible with the clinical diagnosis in 48 (59.3%) subjects. Conclusion: Maternal autopsy examination provides an exact cause of death in most cases and is still a valuable tool for understanding the cause of maternal mortality.

Evaluation of Vitamin B12 Deficiency and Associated Factors in Patients With Systemic Sclerosis.

BACKGROUND/OBJECTIVE: In patients with systemic sclerosis (SSc) gastrointestinal (GI) involvement, nutritional status and medications may lead to cobalamin (Vit B12) deficiency. We aimed to determine the frequency and the potential causes of Vit B12 deficiency in SSc patients. METHODS: We conducted a cross-sectional analysis of 62 SSc patients in a single center in 1 year period. Medical history and physical examination of patients were reevaluated. Data about organ involvements were obtained from hospital file records. The nutritional status of the patients was assessed with Malnutrition Universal Screening Tool (MUST). Vit B12, homocysteine (except in three patients) and Helicobacter Pylori Immunoglobulin G (H. Pylori IgG) levels were measured in all patients. Vit B12 deficiency was considered as serum Vit B12 level <200 pg/mL or being on Vit B12 replacement therapy. Serum Vit B12 levels of the patients were also grouped as low (<200 pg/mL), borderline (200-300 pg/mL) and normal (>300 pg/mL). Plasma homocysteine levels of the patients were classified as elevated (>9 µmol/L) and hyperhomocysteinemia (>15 µmol/L). Mann-Whitney U and Kruskal-Wallis tests were used to compare parameters among the groups. Correlation was tested by Spearman's correlation coefficient. RESULTS: Forty-four (71.0%) patients were defined as Vit B12 deficient; 22 had Vit B12 level <200 pg/mL (four were on Vit B12 replacement therapy) and the remaining 22 had Vit B12 >200 pg/mL and were already on Vit B12 replacement therapy. The percentage of the patients with hyperhomocysteinemia was significantly higher in the group with Vit B12 <200 pg/mL as compared to other groups (P = 0.004) but only 33.3% (7/21) of the patients with Vit B12 <200 pg/mL had hyperhomocysteinemia. There were no statistically significant differences between patients with and without Vit B12 deficiency regarding age, mean disease duration, MUST scores, mean hemoglobin levels, H. Pylori IgG positivity and organ involvements (P > 0.05 for all). CONCLUSIONS: Vit B12 deficiency is frequent in SSc and has multiple causes. All patients should be monitored for Vit B12 deficiency. The homocysteine levels seem unlikely to be helpful for confirmation of Vit B12 deficiency.

Maternal mortality due to hypertensive disorders in pregnancy, childbirth, and the puerperium between 2012 and 2015 in Turkey: A nation-based study.

OBJECTIVE: To analyze maternal deaths in Turkey due to hypertensive disorders. MATERIAL AND METHODS: In this retrospective study 812 maternal deaths were analyzed. Maternal demographic features, presence of antenatal care, medical and obstetric history, mode of delivery, and use emergency antihypertensive therapy were recorded. The delay model for each case was investigated. RESULTS: Hypertensive disorders accounted for 15.5% (n=126) out of all maternal mortality. They were the third most frequent cause among all causes and the 2nd among direct causes of maternal deaths. Sixty-one (48.4%) cases were in severe preeclampsia or pre-existing hypertensive disorder with increased/superimposed proteinuria, 30.1% were in eclampsia, 9.5% cases were diagnosed as hemolysis, elevated liver enzymes, low platelet count syndrome, and 11.1% in pre-existing hypertension complicating pregnancy, childbirth, and puerperium without increased or superimposed proteinuria. The median age was 32 years, 37.3% women were ≥35 years. All deaths except for 2 cases occurred during the postpartum period. Twenty-three percent of deaths occurred in the first 48 hours postpartum, and 51.6% between 8-42 days. Intracranial hemorrhage was the major final cause of death with a rate of 41.3%. With the exception of fifteen patients with intracranial hemorrhage, emergency antihypertensive agents were not implemented in optimal dose and/or duration. A first and/or third delay was identified in 36.5% of cases. CONCLUSION: Approximately one third of maternal death due to hypertensive disorders could be prevented. The importance of acute antihypertensive treatment should be emphasized because of most frequent cause of death was intracranial hemorrhage.

Maternal mortality cases from pulmonary embolism: A nation-wide study in Turkey.

The aim of the study was to evaluate the maternal mortality cases attributed to pulmonary embolism (PE). PE constituted 7.58% of maternal deaths in 2013. Risk factors for PE were present in 15 (88.2%) of the women. Five women (29.4%) were overweight, and 5 (29.4%) were obese. Four women (23.5%) had cardiac diseases. PE occurred in the postpartum period after caesarean delivery in 9 (52.9%) patients. Eleven (64.7%) of the maternal deaths were recognised as preventable. More deaths attributed to PE occurred in the postpartum period (n = 11) than the antepartum period (n = 5). One other maternal mortality case was after therapeutic abortion. Caesarean section, obesity and cardiac diseases were important risk factors. It can be suggested that monitoring all risk factors and timely recognition of related symptoms and signs with initiation of appropriate management have paramount importance for reducing maternal mortality rate related to pulmonary embolism. Increasing awareness of healthcare professionals as well as the public, and continuously reviewing the cases are also important tools for achieving this goal.

Maternal mortality from cardiac disease in Turkey: a population-based study.

OBJECTIVE: Population-based studies on maternal deaths in Turkey are rare. The aim of the present study was to analyze the cardiac causes of all maternal deaths in Turkey between 2007 and 2009. MATERIALS AND METHODS: In this retrospective study, case files of all pregnancy-associated deaths recorded in Turkey between 2007 and 2009 were reviewed. Records for all pregnancy-associated deaths were reviewed by five authors to identify 129 cases in which a cardiac disease seemed to be the reason. For each of the 129 cases, maternal age, gravidity, parity, antenatal care attendance, district of residence, year of death, mode of delivery, perinatal outcome, and clinical history preceding death were recorded. RESULTS: During the study period, 779 maternal deaths were identified. Our estimate of the maternal mortality ratio (MMR) in 3-year period was 19.7 per 100,000 live births. The report lists 779 deaths, 411 direct and 285 indirect. Indirect obstetric causes of maternal death were primarily cardiac disorders and cerebrovascular diseases. Maternal mortality due to cardiac disease was 15.5% in 2007 and 18.4% in 2008. Valvular heart disease was the leading cause of maternal death from cardiac reasons (25.6%). Maternal mortality due to cardiac disease increased with age. CONCLUSION: The main cause of indirect maternal death has been cardiac disease in 3-year period.

The evaluation of diastolic dysfunction with tissue Doppler echocardiography in women with subclinical hypothyroidism and the effect of L-thyroxine treatment on diastolic dysfunction: a pilot study.

Background. Subclinical hypothyroidism (SH) predominantly affects women. The necessity of treatment in SH is controversial. Objective. We aimed to investigate the response of diastolic dysfunction to thyroid hormone replacement therapy (THRT) in women. Methods and Results. Twenty-two female subjects with SH and 20 euthyroid female controls were enrolled. Baseline and follow-up biochemical, hormonal, and echocardiographic evaluations were performed. Repeat echocardiograms were performed three months after the achievement of a euthyroid status with THRT. Mean baseline myocardial performance index (MPI) was 0.27 ± 0.08 in the SH group, and 0.22 ± 0.06 in the control group (P = 0.03). MPI did not change significantly after THRT. Pulsed-wave Doppler findings were not different among the groups. However, tissue Doppler-derived mitral annular E' velocities were significantly lower in the SH group. A moderate but significant improvement was observed in E' velocities after THRT (13.2 ± 3.87 versus 14.53 ± 2.75, P = 0.04). We also observed left ventricular concentric remodeling in SH patients which was reversible with THRT. Conclusions. Tissue Doppler echocardiography may be a useful tool for monitoring the response of diastolic dysfunction to thyroid hormone replacement therapy in patients with SH. Our findings suggest that THRT may reverse diastolic dysfunction in women with SH.

Role of endogenous cortisol on Helicobacter pylori colonization.

BACKGROUND AND AIMS: Helicobacter pylori infects the gastric mucosa and can lead to chronic gastritis, gastric ulcer and gastric cancer. Colonization of H. pylori in the gastric mucosa is influenced by a variety of host, bacterial and environmental factors. Host defense mechanisms have been affected by endogenous glucocorticoids. We aimed to investigate the relationship between H. pylori and endogenous glucocorticoid. MATERIALS AND METHODS: Forty cases with endoscopically and histologically proven H. pylori and 26 patients who did not have H. pylori on gastric biopsy samples were enrolled in our study. Cortisol was tested from 24-h collected urine samples. RESULTS: H. pylori (+) and H. pylori (-) groups consisted of 40 (28 women, 12 men; aged 44.85+/-12.52 years) and 26 (22 women, 4 men; aged 52.27+/-15.15 years) patients, respectively. Age and gender were similar in both groups. Body mass index, C-reactive protein and erythrocyte sedimentation rate were not statistically different between the two groups (p>0.05). 24-h urine cortisol amount was lower in patients with H. pylori (+) than H. pylori (-) cases. CONCLUSIONS: Present study demonstrates that patients with gastric H. pylori colonization have significantly lower cortisol levels when compared with H. pylori negative cases. There is a negative correlation between H. pylori colonization and urine cortisol output.

Homocysteine and fibrinogen changes with L-thyroxine in subclinical hypothyroid patients.

The aim of the present study was to evaluate plasma total homocysteine (Hcys) and serum fibrinogen concentrations in subclinical hypothyroid (SH) and overt hypothyroid patients before and after L-thyroxine (LT4) replacement and to compare them in euthyroid subjects. Fifteen SH and 20 hypothyroid premenopausal women were recruited in the study. We measured fasting plasma levels of Hcys and serum levels of free thyroxine (fT4), free triiodothyronine (fT3), thyrotropin (TSH), folate, vitamin B12, fibrinogen, renal functions, and lipid profiles in patients with SH and overt hypothyroid patients before and after LT4 treatment. Eleven healthy women were included in the study as a control group. Pretreatment Hcys levels were similar in SH and control subjects, whereas mean fibrinogen level of SH patients was higher than that of control subjects (p<0.05). Baseline Hcys (p<0.01) and fibrinogen (p<0.001) levels of the overt hypothyroid patients were significantly higher than those of the healthy subjects, and the pretreatment Hcys levels decreased with LT4 treatment (p<0.001). In conclusion, our data support that SH is not associated with hyperhomocysteinemia and Hcys does not appear to contribute to the increased risk for atherosclerotic disease in patients with SH.

[A case of acute pancreatitis due to Weil's disease]. / Weil hastaligina bagli bir akut pankreatit olgusu.

Leptospirosis, the most common vasculitic zoonosis in the world, is characterized with jaundice and acute renal failure. However, pancreatitis is an uncommon complication of leptospirosis. In this report, an acute pancreatitis case due to Weil's disease has been presented. A 31-year-old female patient with high levels of glucose, blood urea nitrogen, creatinine, creatine kinase, bilirubin, amylase and lipase, has been diagnosed to have leptospirosis by the high positive result (1/800) of microscopic agglutination test against Leptospira interrogans serogroup icterohemorrhagiae. The patient has been treated with supportive and symptomatic therapy, and with penicillin G for leptospirosis. Following triple hemodialysis, all the blood biochemistry tests returned to normal on the tenth day of therapy. This case was reported to draw attention to Leptospira infections which should be considered in the differential diagnosis of patients with jaundice and pancreatitis.