Improving sleep quality is essential for enhancing soluble Klotho levels in hemodialysis patients.

PURPOSE: Sleep and Klotho seem to share common physiological pathways in aging. However, studies investigating this relationship are very few and none of them was done with a specific patient group. The aim of this study was to investigate the association of sleep quality and soluble Klotho levels in hemodialysis patients. METHODS: 100 hemodialysis patients were included in this study. Soluble Klotho levels were obtained from each patient and Pittsburgh Sleep Quality Index was performed by all patients. Association of soluble Klotho with sleep quality was calculated. RESULTS: Soluble Klotho levels were significantly inversely correlated with total sleep quality score (p < 0.001, r = - 0.444). Among the subscales, soluble Klotho levels were negatively correlated with subjective sleep quality (p < 0.001, r = - 0.365), sleep latency (p = 0.002, r = - 0.312), sleep disturbance (p = 0.002, r = - 0.303) and daytime dysfunction (p = 0.027, r = - 0.221). Patients who had good sleep quality scores were found to have higher soluble Klotho levels [4.15 (0.05-22.68) vs. 1.14 (0.32-17.63), p < 0.001]. In regression analysis, total sleep quality score, subjective sleep quality and age were found to be independent negative factors for soluble Klotho levels. CONCLUSION: In this study, a significant association between sleep quality and soluble Klotho levels was revealed in hemodialysis patients. Improving sleep quality will lead to increased soluble Klotho levels, which may further slow down the aging process in hemodialysis patients.

Evaluation of sirtuin 1 (SIRT1) levels in autosomal dominant polycystic kidney disease.

PURPOSE: Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease and the majority of patients have a PKD-1 or PKD-2 mutation. Sirtuin 1 (SIRT1) has roles in cellular aging, antioxidant activity, cellular proliferation. In an experimental study, inhibition of SIRT1 was found to delay renal cyst development in ADPKD. The purpose of this study is to determine the SIRT1 levels in ADPKD patients. To our knowledge, this is the first study that investigating blood and urine SIRT1 levels in ADPKD patients. METHODS: Sixty-seven patients with ADPKD and 34 control cases with normal renal functions and without renal cysts were included in this study. Serum and urine SIRT1 concentrations were determined by human enzyme-linked immunosorbent assay (ELISA) kit. 24-h urine samples were used for urine SIRT1 measurements. RESULTS: The urine SIRT1 levels were statistically significantly lower in ADPKD patients group (p < 0.001). Although blood SIRT1 levels of ADPKD patients were higher than control cases but there were no statistically significant difference between the groups in terms of blood SIRT1 levels. Urine SIRT1 levels (ß = 2.452, CI 95% 1.419-4.239, p = 0.001) were found an independent factor in multivariate regression analysis for ADPKD. CONCLUSIONS: Urine SIRT1 levels were lower in ADPKD patients than control group. The low urinary SIRT1 levels despite the similar blood SIRT1 levels might be due to the impaired metabolism of SIRT1 in ADPKD patients; this state might has a role in cyst development.

The relationship of soluble klotho level with uremic cardiomyopathy and ecocardiographic parameters in hemodialysis patients.

There are studies reporting that soluble kltho (sKlotho) deficiency plays a role in cardiovascular disease in addition to traditional risk factors such as diabetes, hypertension, anemia, smoking, and excessive volume burden. Our aim in this study was to investigate the relationship of sKlotho with uremic cardiomyopathy and echocardiographic parameters in patients receiving hemodialysis treatment. According to the median value, the sKlotho value was divided into two groups as ≥1.24 and <1.24 ng/ml. Ventricular wall thicknesses, ejection fractions, left atrium, M mode aorta systole, and diastole diameter measurements were taken. The left ventricular mass (LVM) was calculated using the Devereux formula. There were significant differences between the two groups in terms of age, number of patients with diabetes mellitus, comorbidity, dialysis time, sKlotho, phosphorus, parathormone, and albumin parameters. No significant difference was found between the two groups that were separated according to the median sKlotho value, when the echocardiographic parameters of interventricular septum thickness, left ventricular posterior wall thickness, left atrial diameter, left ventricular ejection fraction, and LVM index were compared. In conclusion, sKlotho is not a marker for showing and predicting uremic cardiomyopathy in hemodialysis patients.

Is Neuregulin-4 a predictive marker of microvascular complications in type 2 diabetes mellitus?

BACKGROUND AND AIMS: Neuregulin-4 (Nrg-4) is a new adipokine released from brown adipose tissue. It plays pivotal role in regulating systemic energy balance, glucose and lipid metabolism and in reducing chronic inflammation. We aimed to investigate the relation between diabetic microvascular complications (DMC) and serum (Nrg-4) levels in patients with type 2 diabetes mellitus. METHODS: Patients with type 2 diabetes mellitus were divided into DMC and diabetic patients without microvascular complications (non-DMC). Nrg-4 levels of the patients were compared. RESULTS: Fifty and 29 patients enrolled to the DMC and non-DMC groups, respectively. Nrg-4 was 1.23 (0.02-5.1) ng/mL and 2.5 (0.21-6.01) ng/mL in DMC and in non-DMC groups, respectively (P < .001). In patients with DMC, FPG was 189.5 (89-446) mg/ dL, whereas it was 128 (95-278) mg/dL in non-DMC diabetic patients (P < .001). HbA1c was also significantly higher in the DMC group than in the non-DMC group (P < .001). Negative correlation was found between Nrg-4 and FPG (r = -0.231, P = .03), HBA1c (r = -0.312, P = .003) and microalbuminuria (r = -0.277, P = .009). Logistic regression analysis showed a 1-unit decrease in Nrg-4 to increase the presence of DMC by 1.9 times. The best cut-off value of Nrg-4 was 1.56 ng/mL with 82.1% sensitivity and 64% specificity, in predicting DMC. CONCLUSION: In patients with diabetes, Nrg-4 levels may be a good predictor of early detection of one or more DMC, as microvascular dysfunction in an organ system is considered to be an initial onset of subclinical systemic damage.

Neuregulin-4 is associated with plasma glucose and increased risk of type 2 diabetes mellitus.

BACKGROUND: Neuregulin-4 is a cytokine with many functions and is primarily produced by fat tissue. AIM OF THE STUDY: The aim of the study was to observe the relationship between serum neuregulin-4 levels and diabetes regulation in type 2 diabetes mellitus (T2DM), and to compare neuregulin-4 levels of diabetic subjects with those in healthy controls. METHODS: Patients with T2DM were included to the study. Healthy subjects were enrolled as controls. Subjects with T2DM with glycated haemoglobin (HbA1c) <7% were classed as well controlled and those with HbA1c >7% were classed as poorly controlled. Neuregulin-4 levels of the study and control groups were compared. RESULTS: The neuregulin-4 levels of the poorly controlled T2DM, well-controlled T2DM and control groups were significantly different (p = 0.005). Neuregulin-4 was significantly correlated with fasting plasma glucose (r = 0.247, p = 0.002) but not with HbA1c. In a regression analysis model, 0.1 point elevation in neuregulin-4 levels increased the rate of existence of T2DM 4.4-fold (odds ratio 4.4, 95% confidence interval 1.26-15.1; p = 0.02). CONCLUSION: Neuregulin-4 is significantly increased in patients with T2DM compared with control subjects, which means that it could be a marker of T2DM. Since neuregulin-4 was correlated with fasting glucose, we suggest that elevated neuregulin-4 could predict poor control in T2DM for short periods when HbA1c is not useful.  Moreover, one unit elevation in neuregulin-4 (0.1 ng/ml) increases the rate of existence of T2DM 4.4-fold, independently from other variables.

Neutrophil to lymphocyte ratio as an indicative of diabetic control level in type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes mellitus is associated with chronic low grade inflammation. One of the novel inflammatory markers is hemogram derived neutrophil to lymphocyte ratio (NLR). OBJECTIVE: We aimed to compare NLR levels of diabetic subjects and healthy controls and to observe possible correlation between NLR and HbA1c. METHODS: Medical data of type 2 diabetic subjects admitted to out-patient clinics of our institution between April to July in 2017 were obtained from database and retrospectively analyzed. Control group was chosen from healthy subjects who visited our institution for a routine check-up. Anthropometric measures, laboratory data, including, HbA1c, NLR were recorded. RESULTS: Median NLR of the type 2 DM group 2.44 (1.9) was significantly elevated when compared to healthy controls (1.5 (0.9), (p<0.001). In addition, a Pearson's correlation test revealed that NLR was strongly correlated with age (r=0.26, p=0.008), fasting plasma glucose (r=0.38, p<0.001), and HbA1c (r=0.49, p<0.001). CONCLUSION: Elevated NLR in otherwise healthy subjects may be indicative of underlying impaired glucose metabolism and moreover, NLR should be used as a marker of diabetic control level in addition to HbA1c in type 2 diabetic subjects.

Serum uric acid to HDL-cholesterol ratio is a strong predictor of metabolic syndrome in type 2 diabetes mellitus.

OBJECTIVE: Metabolic syndrome (MS) is a clinical entity that associated with increased risk of type 2 Diabetes Mellitus (DM) and cardiovascular diseases. Serum uric acid levels are correlated MS criteria. We hypothesized whether a uric acid to HDL-cholesterol ratio (UHR) could predict diabetic regulation and presence of MS in type 2 diabetic subjects. METHODS: Admissions of the subjects with type 2 DM to outpatient clinics of our institution were retrospectively analyzed. Study population grouped into well-controlled and poorly controlled diabetics according to the HbA1c level (cut off 7%) and further grouped into type 2 DM with and without MS according to the presence of MS. UHR of study groups compared. RESULTS: A hundred diabetic subjects enrolled. Mean UHR was significantly lower in well-controlled diabetics (9.7 ± 3.7%) compared to poorly controlled subjects (14 ± 5.4%) (p<0.001). Median UHR of diabetics with MS (13 (6-29) %) was greater than that of the diabetics without MS (9 (3-16) %) (p<0.001). UHR greater than 11% has 77% sensitivity and 60% specifity in predicting worse diabetic control (AUC: 0.752, p<0.001) and a UHR greater than 10.6% has 83% sensitivity and 71% specifity in predicting MS (AUC: 0.839, p<0.001). Sensitivity and specifity of UHR in predicting MS were better than most of the sensitivities and specifities of the five criteria of MS. CONCLUSION: We suggest utilization of UHR in diagnosis of MS as a novel criteria. Nevertheless, prospective studies with larger population may make a better scientific evidence in that issue.

Diabetes control could through platelet-to-lymphocyte ratio in hemograms.

OBJECTIVE: Association between type 2 diabetes mellitus and inflammation is well-established. We aimed to study platelet-to-lymphocyte ratio (PLR), a novel inflammatory index derived from hemogram, in diabetic patients in comparison to those in healthy volunteers. METHODS: Medical data of type 2 diabetics that showed up in general outpatient medical clinics of our institution between February 2017 and August 2017 were recorded and analyzed. RESULTS: Median PLR of type 2 diabetic patients was significantly higher than the PLR of healthy controls (p=0.001). Moreover, PLR was significantly and positively correlated with HbA1c (p<0.001, r=0.58), fasting plasma glucose (p<0.001, r=0.49), and c-reactive protein (p=0.003, r=0.30) levels. Type 2 diabetic subjects with proteinuria had significantly higher PLR levels than that of diabetic subjects without proteinuria. CONCLUSION: As an inexpensive and easy to use index, PLR may be useful in predicting the development and control levels of type 2 diabetes mellitus. However, its correlation with HbA1c needs to be validated by larger prospective studies.

Diabetic regulation of subjects with type 2 diabetes mellitus is associated with serum vitamin D levels.

OBJECTIVE: Vitamin D deficiency is not only associated with bone metabolism but also with diabetes mellitus. We aimed to study the possible association between serum vitamin D concentration and HbA1c level in patients with type 2 diabetes mellitus (T2DM) in this retrospective report. METHODS: Patients with T2DM were enrolled to the study either in regulated or non-regulated T2DM groups, according to HbA1c levels. An HbA1c level of <8% was considered as relatively controlled and others were considered as poorly controlled T2DM. RESULTS: Serum vitamin D levels in poorly controlled T2DM subjects (9.4 (4.9-34) ng/ml) were significantly lower than that of the relatively well regulated T2DM patients (13.5 (3.4-36) ng/ml) (p=0.03). Vitamin D was strongly and inversely correlated with HbA1c levels (r= -0.295, p=0.005). CONCLUSION: Whatever the cause or result of the diabetes mellitus, it is clear that lower vitamin D is strongly associated with worse diabetic regulation in T2DM subjects. Randomized controlled larger studies, which research the relation between diabetic regulation and vitamin D status, are needed to claim whether it could be a therapeutic target in future in diabetic subjects.

Diabetic regulation of subjects with type 2 diabetes mellitus is associated with serum vitamin D levels

SUMMARY OBJECTIVE Vitamin D deficiency is not only associated with bone metabolism but also with diabetes mellitus. We aimed to study the possible association between serum vitamin D concentration and HbA1c level in patients with type 2 diabetes mellitus (T2DM) in this retrospective report. METHODS Patients with T2DM were enrolled to the study either in regulated or non-regulated T2DM groups, according to HbA1c levels. An HbA1c level of <8% was considered as relatively controlled and others were considered as poorly controlled T2DM. RESULTS Serum vitamin D levels in poorly controlled T2DM subjects (9.4 (4.9-34) ng/ml) were significantly lower than that of the relatively well regulated T2DM patients (13.5 (3.4-36) ng/ml) (p=0.03). Vitamin D was strongly and inversely correlated with HbA1c levels (r= -0.295, p=0.005). CONCLUSION Whatever the cause or result of the diabetes mellitus, it is clear that lower vitamin D is strongly associated with worse diabetic regulation in T2DM subjects. Randomized controlled larger studies, which research the relation between diabetic regulation and vitamin D status, are needed to claim whether it could be a therapeutic target in future in diabetic subjects.

RESUMO CONTEXTO E OBJETIVO A deficiência de vitamina D não é apenas associada ao metabolismo ósseo, mas também ao diabetes mellitus. Procurou-se estudar a possível associação entre os níveis de concentração do soro de vitamina D e de HbA1c em pacientes com diabetes mellitus tipo 2 neste relatório retrospectivo. MÉTODOS Os pacientes com diabetes mellitus tipo 2 foram inscritos no estudo em regulada ou não regulada de acordo com os grupos de níveis de HbA1c DM2. HbA1c nível de <8% caracterizava DM2 controlada e HbA1c > 8% DM2 descontrolada. RESULTADOS Os níveis de vitamina D no soro em indivíduos com DM2 mal regulados (9,4 (4,9 a 34) ng/ml) foram significativamente menores do que o do bem regulado em doentes DM2 (13,5 (3,4-36) ng/ml) (p = 0,03). A vitamina D foi forte e inversamente correlacionada com os níveis de HbA1c (p = 0,005). CONCLUSÃO Seja qual for a causa ou o resultado do diabetes mellitus, é claro que níveis baixos de vitamina D são fortemente associados com pior regulação em indivíduos diabéticos com DM2. Maiores estudos randomizados e controlados que pesquisam a relação entre o status de vitamina D e a regulação em diabéticos são necessários para molusco se é, no futuro, poderia ser um alvo terapêutico em indivíduos diabéticos.

Serum uric acid to HDL-cholesterol ratio is a strong predictor of metabolic syndrome in type 2 diabetes mellitus

SUMMARY OBJECTIVE Metabolic syndrome (MS) is a clinical entity that associated with increased risk of type 2 Diabetes Mellitus (DM) and cardiovascular diseases. Serum uric acid levels are correlated MS criteria. We hypothesized whether a uric acid to HDL-cholesterol ratio (UHR) could predict diabetic regulation and presence of MS in type 2 diabetic subjects. METHODS Admissions of the subjects with type 2 DM to outpatient clinics of our institution were retrospectively analyzed. Study population grouped into well-controlled and poorly controlled diabetics according to the HbA1c level (cut off 7%) and further grouped into type 2 DM with and without MS according to the presence of MS. UHR of study groups compared. RESULTS A hundred diabetic subjects enrolled. Mean UHR was significantly lower in well-controlled diabetics (9.7 ± 3.7%) compared to poorly controlled subjects (14 ± 5.4%) (p<0.001). Median UHR of diabetics with MS (13 (6-29) %) was greater than that of the diabetics without MS (9 (3-16) %) (p<0.001). UHR greater than 11% has 77% sensitivity and 60% specifity in predicting worse diabetic control (AUC: 0.752, p<0.001) and a UHR greater than 10.6% has 83% sensitivity and 71% specifity in predicting MS (AUC: 0.839, p<0.001). Sensitivity and specifity of UHR in predicting MS were better than most of the sensitivities and specifities of the five criteria of MS. CONCLUSION We suggest utilization of UHR in diagnosis of MS as a novel criteria. Nevertheless, prospective studies with larger population may make a better scientific evidence in that issue.

RESUMO CONTEXTO E OBJETIVO A síndrome metabólica (SM) é uma entidade clínica associada ao aumento do risco de diabetes mellitus tipo 2 (DM) e doenças cardiovasculares. Os níveis séricos de ácido úrico estão correlacionados com os critérios estabelecidos de EM. Uma vez que DM tipo 2 e MS são distúrbios metabólicos, nós hipotetizamos se uma relação ácido úrico para HDL-colesterol (UHR) poderia predizer a regulação diabética e a presença de MS em diabéticos tipo 2. MÉTODOS As admissões dos sujeitos com DM tipo 2 aos ambulatórios de nossa instituição foram analisadas retrospectivamente. A população do estudo agrupou-se em diabéticos bem controlados e mal controlados, de acordo com o nível de HbA1c (corte de 7%) e posteriormente agrupados em DM tipo 2 com e sem EM de acordo com a presença de EM. UHR dos grupos de estudo comparados. RESULTADOS Um total de 100 indivíduos diabéticos tipo 2 inscritos no estudo. A média UHR foi significativamente menor em diabéticos bem controlados (9,7 ± 3,7%) em comparação com indivíduos com DM tipo 2 mal controlada (14 ± 5,4%) (p < 0,001). A mediana da UAR de diabéticos com EM (13 (6-29)%) foi maior que a dos diabéticos sem SM (9 (3-16)%) (p < 0,001). Um UHR maior que 11% tem 77% de sensibilidade e 60% de especificidade em predizer um pior controle diabético (AUC: 0,762, p < 0,001) e um UHR maior que 10,6% tem 83% de sensibilidade e 71% de especificidade em prever MS (AUC : 0,839, p < 0,001). A sensibilidade e especificidade de UHR em predizer MS foram melhores do que a maioria das sensibilidades e especificidades dos cinco critérios de MS. CONCLUSÃO Sugerimos a utilização da UHR no diagnóstico da SM como um novo critério. No entanto, estudos prospectivos com maior população podem fazer uma melhor evidência científica nessa questão.

Diabetes control could through platelet-to-lymphocyte ratio in hemograms / O controle diabético poderia ser predicado por Platelet para a relação de linfócitos no hemograma

SUMMARY OBJECTIVE Association between type 2 diabetes mellitus and inflammation is well-established. We aimed to study platelet-to-lymphocyte ratio (PLR), a novel inflammatory index derived from hemogram, in diabetic patients in comparison to those in healthy volunteers. METHODS Medical data of type 2 diabetics that showed up in general outpatient medical clinics of our institution between February 2017 and August 2017 were recorded and analyzed. RESULTS Median PLR of type 2 diabetic patients was significantly higher than the PLR of healthy controls (p=0.001). Moreover, PLR was significantly and positively correlated with HbA1c (p<0.001, r=0.58), fasting plasma glucose (p<0.001, r=0.49), and c-reactive protein (p=0.003, r=0.30) levels. Type 2 diabetic subjects with proteinuria had significantly higher PLR levels than that of diabetic subjects without proteinuria. CONCLUSION As an inexpensive and easy to use index, PLR may be useful in predicting the development and control levels of type 2 diabetes mellitus. However, its correlation with HbA1c needs to be validated by larger prospective studies.

RESUMO OBJETIVO A associação entre diabetes mellitus tipo 2 e inflamação está bem estabelecida. Pretendemos estudar a relação plaquetária com linfócitos (PLR), um novo índice inflamatório derivado do hemograma, em pacientes diabéticos e comparar com aqueles em voluntários saudáveis. MÉTODOS Foram registrados e analisados dados médicos de diabéticos de tipo 2 que apareceram em clínicas ambulatoriais de medicina geral de nossa instituição entre fevereiro de 2017 e agosto de 2017. RESULTADOS A PLR mediana dos pacientes com diabetes tipo 2 foi significativamente maior que a PLR de controles saudáveis (p=0,001). Além disso, a PLR foi correlacionada de forma significativa e positiva com os níveis de glicemia de jejum (p<0,001, r=0,49) e níveis de proteína c-reativa (p=0,003, r=0,30) com HbA1c (p<0,001, r=0,58). Os indivíduos diabéticos de tipo 2 com proteinúria aumentaram significativamente os níveis de PLR do que os indivíduos diabéticos sem proteinúria. CONCLUSÃO Como um índice barato e fácil de usar, a PLR pode ser útil para prever o desenvolvimento e controle do nível de diabetes mellitus tipo 2. No entanto, sua correlação com HbA1c precisa ser validada por estudos prospectivos maiores.

MEAN PLATELET VOLUME: AN OVERLOOKED HERALD OF MALIGNANT THYROID NODULES.

Physicians and surgeons pay much attention to evaluating thyroid nodules due to the malignant potential of these growths. Inflammation has a crucial role in the development of cancer. Increase in the mean platelet volume (MPV) has been described in various inflammatory conditions. Since some of thyroid nodules are malignant, we aimed to compare MPV values between patients with malignant and benign thyroid nodules after precise pathologic diagnosis. We retrospectively analyzed hemograms of patients having undergone thyroid surgery for thyroid nodule between January 2013 and January 2015, and compared them to those recorded in healthy subjects. MPV was higher in the malignant thyroid nodule group than in the benign nodule group (9.1±1 fL vs. 7.8±0.8 fL). The difference was statistically significant (p<0.001). Increased MPV should be considered as an assistive diagnostic tool in differentiating malignant and benign thyroid nodules. However, further prospective studies are required to confirm its usefulness in this population.

Mean Platelet Volume to Lymphocyte Ratio as a Novel Marker for Diabetic Nephropathy.

OBJECTIVE: To compare mean platelet volume to lymphocyte ratio (MPVLR) of diabetic nephropathy subjects to those diabetics without diabetic nephropathy. STUDY DESIGN: Observational, cross-sectional study. PLACE AND DURATION OF STUDY: Tertiary referral hospital, in Bolu, Turkey, from July to December 2017. METHODOLOGY: Patients with type 2 diabetes mellitus admitted to the Internal Medicine Clinic, were included. Patients were divided into two groups according to the urinary microalbumin/creatinine ratio: diabetic nephropathy and non-nephropathy group. MPVLR was calculated mathematically by division of MPV by lymphocyte count. RESULTS: There were 162 subjects (79 females, 83 males). The MPVLR in patients with diabetic nephropathy and non- nephropathic diabetic groups were 4.1 (2.09-11.84) and 3.4 (1.37-25.56), respectively. The difference was reached statistically significant level (p <0.001). The best cut-off value for MPVLR was 3.66 (AUC=0.733, p <0.001); MPVLR predicted diabetic nephropathy with 71.1% sensitivity and 67.4% specificity, at this level. CONCLUSION: The MPVLR is an easily calculated and efficient index that can be considered a powerful and independent predictor of diabetic nephropathy in diabetic patients. We suggest that, it can be useful adjunct to standard tests in the diagnosis of diabetic nephropathy.

Haemogram Parameters in Vitamin D Deficiency.

OBJECTIVE: To study haemogram derived inflammatory indices, mean platelet volume (MPV), red cell distribution width (RDW), and neutrophil to lymphocyte ratio (NLR) in vitamin D deficient patients and to compare to those subjects with normal vitamin D levels. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Abant Izzet Baysal University Hospital, Bolu, Turkey, from March to May 2017. METHODOLOGY: Patients' data visiting the outpatient clinics of the institution was retrospectively obtained from patients' files and computerised database. Subjects were grouped into normal vitamin D and vitamin D deficiency groups, according to the serum Vitamin D levels. Seasonal threshold value for vitamin D in Bolu region was set as 10 ng/ml. General characteristics and laboratory data of the study population were recorded and compared. RESULTS: Vitamin D deficiency was more common in subjects working inside as compared to those working outside (p=0.02), and in subjects with comorbidities compared to those without comorbidities (p=0.31). Body mass index (BMI), MPV, NLR were significantly higher in vitamin D deficient group as compared to subjects with normal vitamin D levels. A MPV greater than 6.22 has 89% sensitivity and 55% specifity for vitamin D deficiency, and NLR greater than 1.69 has 76% sensitivity and 55% specifity for vitamin D deficiency. CONCLUSION: Elevated MPV and NLR may be the indicator of underlying serious vitamin D deficiency. Physicians should be alert and order a vitamin D assay in patients with elevated MPV or NLR, especially in endemic areas for vitamin D deficiency.

A Case of Secondary Hypertension due to Giant Hydatid Cyst.

Hydatid cyst is a parasitic infection which causes enormous morbidity and mortality worldwide. The pathogenic organism responsible for hydatid cyst is Echinococcus granulosus. Despite the fact that the characteristic cysts of the disease usually occur in liver and lungs, they may also occur in aberrant localisations. Subjects either present with symptoms of infection itself or local complications due to compressive mass effect of the cyst. Here, we report a case of secondary hypertension due to extrinsic compression of the right renal artery by a giant hepatic hydatid cyst. A 78-year woman presented with poorly controlled hypertension. She has been treated for hypertension with an angiotensin converting enzyme inhibitor plus calcium channel blocker for the last 2 years. Imaging studies revealed narrowing of the right renal artery and external compression, caused by a giant hydatid cyst. The giant hydatid cyst was treated by cyst aspiration and alcohol injection. Despite cessation of angiotensin converting enzyme inhibitor plus calcium channel blocker, she remained normotensive on follow-up visits. New onset and resistant hypertension cases in elderly should be carefully evaluated for secondary causes of hypertension, including renovascular conditions. Mass effect of the hydatid cyst disease should be considered in the differential diagnosis.

A Rare Non-Hemolytic Case of Idiopathic Cold Agglutinin Disease.

BACKGROUND: Cold agglutinin disease is a very rare condition associated with agglutination of erythrocytes in cold environment usually due to IgM type antibodies. Other than hemolytic anemias, it may interfere with routine hemogram tests due to miscalculation of red blood cell count (RBC) and other hemogram parameters calculated with involvement of RBC. Awareness of the condition is important to overcome laboratory errors. METHODS: We studied a peripheral blood smear and repeated the hemogram test at 37°C to establish the diagnosis of cold agglutinin disease. RESULTS: Initial hemogram test results of the fifty-eight year-old man was as follows: RBC: 1.34 M/µL, hemoglobin (Hb): 12.4 g/dL, hematocrit (Htc): 11.8%, mean corpuscular hemoglobin (MCH): 92.4 pg, and mean corpuscular hemoglobin concentration (MCHC): 105 gr/dL. Despite the standard indirect Coombs test being negative, repeated tests at room temperature was 4+. We suspected cold agglutinin disease and repeated the hemogram test using the Bain-Marie method at 37°C and the test results showed RBC: 3.4 M/µL, hemoglobin: 12.6 g/dL, hematocrit: 30.2%, MCH: 31.7 pg, and MCHC: 41.8 g/dL. CONCLUSIONS: Inappropriate hemogram results may be a sign of underlying cold agglutinin disease. Hemolytic anemia not always accompanies the disease; however, cold exposure may trigger erythrocyte agglutination in vitro and may cause erratic laboratory results.

Analysis of the Factors Related to the Blood Pressure Control in Hypertension.

OBJECTIVE: To determine the factors associated with blood pressure control and comparing anthropometric and clinical parameters of subjects with well-controlled hypertension to those with poorly controlled blood pressure. STUDY DESIGN: Observational cross-sectional study. PLACE AND DURATION OF STUDY: Abant Izzet Baysal University Hospital, Bolu, Turkey, from January to June 2016. METHODOLOGY: Medical data obtained and recorded from computerised database and case files of our clinic. Subjects with mean blood pressure above target levels were defined as poorly controlled and others were as well-controlled hypertension group according to JNC VIII. RESULTS: Out of 342 subjects, only 116 (33.9%) were aware of normal blood pressure range. The number of patients who had a blood pressure on goal in the group and knew the normal range of blood pressure was significantly higher than the patients in group who did not know the normal range of blood pressure. Body mass index and waist circumference were both significantly higher in poorly controlled compared to well-controlled hypertensive subjects. Treatment compliance was significantly associated with better control of hypertension. CONCLUSION: Striking results of present study indicate that lower body mass index and lesser waist circumference along with treatment compliance and awareness of normal blood pressure ranges are important factors that affect reaching treatment targets in hypertensive subjects.

Elevated neutrophil-to-lymphocyte ratio in the diagnosis of Hashimoto's thyroiditis

Summary Objective: Hashimoto's thyroiditis (HT) is an autoimmune inflammatory disorder. The purpose of this study was to determine the neutrophil-to-lymphocyte ratio (NLR), a novel marker of inflammation, in patients with HT and to compare these values with those from healthy subjects. Method: A total of 154 participants were included in the study, 90 HT patients and 64 healthy volunteers. Retrospectively, demographic and laboratory data of the subjects were obtained from our institution's database. Patients with active infection, diabetes mellitus, malignancy, other chronic inflammatory diseases, hematologic disorders and patients on aspirin or steroid treatment were excluded from the study. Values for complete blood count (CBC) and serum laboratory parameters of HT patients were the baseline values obtained at the time of HT diagnosis. Control subjects consisted of healthy volunteers who visited our institution for a routine check-up. Results: Age, gender and CBC parameters were not different between the HT group and the control group; however, the NLR of HT group (2.1 [1.3-5.8]) was significantly higher than the control group (1.9 [0.6-3.3]), p=0.04. Conclusion: Increased NLR may be useful as an indicator of the presence of HT, especially in complicated cases. NLR is inexpensive and easy to determine. Larger, prospective studies are required to determine its usefulness in assessing diagnostic potential and treatment outcomes in HT patients.