A case of Mediterranean spotted fever mimicking severe sepsis.

Mediterranean spotted fever (MSF) is a tick-borne acute endemic infectious disease caused by Rickettsia conorii. While MSF may progress asymptomatically, it may lead to clinical pictures like severe hemorrhagic fever. In this article, we are presenting an MSF case with signs of high fever, headache, nausea, weakness and generalized maculopapular rash. The diagnosis of the female patient who had a history of contact with a tick-infested dog was confirmed with her clinical and laboratory data. The clinical and laboratory findings of the patient who was given doxycycline by 200 mg/day for 7 days were improved in a short time. Rickettsia conorii serology by indirect immunofluorescence assay method confirmed the diagnosis of MSF. In cases of severe sepsis accompanied by high fever and generalized maculopapular rash where the source of the infection cannot be determined in the short term, carefully questioning exposure to ticks by considering the existing geographical, seasonal and endemic environmental factors may be life-saving in terms of early diagnosis and treatment of MSF, which may become fatal even in the absence of eschars (tache noire). The symptomatology of hemorrhagic fever associated with Rickettsia conorii may be confused with that of sepsis in clinical practice.

Association between Metabolic Syndrome and Cancer.

Growing data show the association of metabolic syndrome (MetS) or its components with cancer development and cancer-related mortality. It is suggested that in MetS and cancer association, insulin resistance and insulin-like growth factor 1 system play a key role, especially adipokines secreted from visceral adipocytes, free fatty acids and aromatase activity contribute to this process. It is also reported that MetS has a link with colorectal, breast, endometrial, pancreas, primary liver and, although controversial, prostate cancer. Although every component of MetS is known to have an association with cancer development, it is still debated whether the effects of these components are additive or synergistic. On the other hand, in the association between MetS and cancer, the role of antidiabetic and antihypertensive treatments including thiazolidinedione, insulin, angiotensin receptor blockers is also suggested. The primary approach in MetS-cancer relation is to prevent risk factors. Life style changes including weight loss and a healthy diet are known to decrease cancer risk in normal population. It is postulated that an insulin-sensitizing agent, metformin, has cancer-preventing effects on diabetic patients. This review discusses the relationship between MetS and cancer from different aspects and examines this relationship in some of the cancers suggested to be linked with MetS.

A comparison of brown fat tissue related hormone levels in metabolically healthy and unhealthy individuals with obesity.

PURPOSE: One of the key functions of brown adipose tissue is its positive impact on metabolism. This study aimed to examine the potential involvement of brown fat-related hormones in the development of metabolically healthy obesity. Specifically, we sought to compare the levels of NRG4, FGF21, and irisin between metabolically healthy and unhealthy individuals with obesity. METHODS: Patients with BMI ≥ 30 kg/m2 and aged between 20 and 50 years were included in the study. Among these patients, those who did not have any metabolic syndrome criteria except for increased waist circumference were defined as metabolically healthy obese. Age, gender, BMI, body fat, and muscle mass, matched metabolically healthy and unhealthy obese groups were compared in terms of FGF21, irisin, and NRG4 levels. RESULTS: Metabolically healthy and unhealthy obese groups were similar in terms of age and gender. There was no difference between the two groups in terms of BMI, weight, total body fat, muscle, fat-free mass, distribution of body fat and muscle mass. No statistically significant difference was found between irisin, NRG4, and FGF21 levels between metabolically healthy and unhealthy individuals with obesity. It was found that irisin had a significant inverse correlation with BMI and body fat percentage. CONCLUSION: The present study showed no difference between metabolically healthy and unhealthy obese individuals in terms of irisin, FGF21, and NRG4 levels. The weak association between irisin and BMI and body fat percentage may suggest a potential link between irisin with metabolic health.

Effect of different alpha-receptor antagonists on metabolic parameters: a head-to-head comparison.

PURPOSE: Although it is known that alpha-adrenergic receptor antagonists have positive effects on metabolic parameters such as glucose metabolism, lipid profile, and insulin sensitivity, it is unclear whether this is a class effect. Tamsulosin is reported to have adverse effects on glucose metabolism and insulin resistance, and this may be because of its lack of glycolysis-enhancing effect compared with other alpha-adrenergic receptor antagonists with glycolysis-enhancing effects such as doxazosin, terazosin, and alfuzosin. The aim of this study was to compare the effect of tamsulosin on metabolic parameters with another alpha-1 adrenergic receptor antagonist, doxazosin. METHODS: In this prospective, observational, controlled, 12-week clinical study, a total of 60 male patients aged ≥ 40 years who were first started on tamsulosin (n = 30; 0.4 mg/day, oral; mean age, 59.20 ± 8.97 years) or doxazosin (n = 30; 4 or 8 mg/day, oral; mean age, 58.50 ± 8.93 years) for benign prostatic hyperplasia (BPH) or lower urinary tract symptoms (LUTS) were enrolled. The groups were compared according to the changes in anthropometric and biochemical parameters (glycemia, lipid profile, and insulin sensitivity) at the end of treatment. RESULTS: In intragroup analyses, systolic blood pressure, diastolic blood pressure, total cholesterol, and HbA1c levels decreased significantly in the doxazosin group compared with baseline (p < 0.05 for all), while no significant change was observed in the tamsulosin group. In comparisons between groups, systolic blood pressure, total cholesterol, and low-density lipoprotein cholesterol levels showed a significant decrease in the doxazosin group compared with the tamsulosin group (percent change: - 6.68 ± 13.08 vs. 0.53 ± 11.02, p = 0.025; - 3.63 ± 9.56 vs. 4.02 ± 10.86, p = 0.005; and - 5.62 ± 18.18 vs. 5.24 ± 15.42, p = 0.015, respectively). CONCLUSION: Although these results do not support previous findings that tamsulosin has adverse effects on metabolic parameters, they suggest that doxazosin treatment may be a reason for preference in patients with BPH or LUTS accompanied by metabolic disorder.

Follistatin as a Potential Biomarker for Identifying Metabolically Healthy and Unhealthy Obesity: A Cross-Sectional Study.

Metabolically healthy obesity (MHO) refers to obese individuals with a favorable metabolic profile, without severe metabolic abnormalities. This study aimed to investigate the potential of follistatin, a regulator of metabolic balance, as a biomarker to distinguish between metabolically healthy and unhealthy obesity. This cross-sectional study included 30 metabolically healthy and 32 metabolically unhealthy individuals with obesity. Blood samples were collected to measure the follistatin levels using an enzyme-linked immunosorbent assay (ELISA). While follistatin did not significantly differentiate between metabolically healthy (median 41.84 [IQR, 37.68 to 80.09]) and unhealthy (median 42.44 [IQR, 39.54 to 82.55]) individuals with obesity (p = 0.642), other biochemical markers, such as HDL cholesterol, triglycerides, C-peptide, and AST, showed significant differences between the two groups. Insulin was the most significant predictor of follistatin levels, with a coefficient of 0.903, followed by C-peptide, which exerted a negative influence at -0.624. Quantile regression analysis revealed nuanced associations between the follistatin levels and metabolic parameters in different quantiles. Although follistatin may not serve as a biomarker for identifying MHO and metabolically unhealthy obesity, understanding the underlying mechanisms that contribute to metabolic dysfunction could provide personalized strategies for managing obesity and preventing associated complications.

Prediction of visceral adipose tissue magnitude using a new model based on simple clinical measurements.

Aims: Waist circumference (WC) is a reliable obesity surrogate but may not distinguish between visceral and subcutaneous adipose tissue. Our aim was to develop a novel sex-specific model to estimate the magnitude of visceral adipose tissue measured by computed tomography (CT-VAT). Methods: The model was initially formulated through the integration of anthropometric measurements, laboratory data, and CT-VAT within a study group (n=185), utilizing the Multivariate Adaptive Regression Splines (MARS) methodology. Subsequently, its correlation with CT-VAT was examined in an external validation group (n=50). The accuracy of the new model in estimating increased CT-VAT (>130 cm2) was compared with WC, body mass index (BMI), waist-hip ratio (WHR), visceral adiposity index (VAI), a body shape index (ABSI), lipid accumulation product (LAP), body roundness index (BRI), and metabolic score for visceral fat (METS-VF) in the study group. Additionally, the new model's accuracy in identifying metabolic syndrome was evaluated in our Metabolic Healthiness Discovery Cohort (n=430). Results: The new model comprised WC, gender, BMI, and hip circumference, providing the highest predictive accuracy in estimating increased CT-VAT in men (AUC of 0.96 ± 0.02), outperforming other indices. In women, the AUC was 0.94 ± 0.03, which was significantly higher than that of VAI, WHR, and ABSI but similar to WC, BMI, LAP, BRI, and METS-VF. It's demonstrated high ability for identifying metabolic syndrome with an AUC of 0.76 ± 0.03 (p<0.001). Conclusion: The new model is a valuable indicator of CT-VAT, especially in men, and it exhibits a strong predictive capability for identifying metabolic syndrome.

Is Metabolic Score for Visceral Fat (METS-VF) a Better Index Than Other Adiposity Indices for the Prediction of Visceral Adiposity.

Background: Visceral adiposity is an important risk factor for cardiometabolic diseases. Objective: To determine whether the Metabolic Score for Visceral Fat (METS-VF) is more effective than other adiposity indices in predicting visceral fat area (VFA). Methods: In this single-center and cross-sectional study, we included patients aged 20-50 years, without diabetes and coronary artery disease, who underwent computed tomography (CT) including the third lumbar vertebra. Age, blood pressure, waist circumference (WC), hip circumference, fasting lipids, and glucose were assessed. VFA was measured by cross-sectional examination of CT. The correlation of WC, body mass index (BMI), waist-hip ratio (WHR), lipid accumulation product (LAP), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), and METS-VF with VFA was analyzed by correlation analysis. The cut-off values and area under the curve (AUC) for identifying increased VFA (>130 cm2) were determined. Results: We included 185 individuals with mean age 38.2 ± 8 and female predominance (58.4%). There was a significant positive correlation between all indices and VFA (p<0.001). ROC analysis revealed that METS-VF and WC demonstrated the highest predictive value for identifying increased VFA. In both men (p=0.001) and women (p<0.001), METS-VF (AUC 0.922 and 0.939, respectively) showed a significant superiority over ABSI (AUC 0.702 and 0.658, respectively), and VAI (AUC 0.731 and 0.725, respectively). Additionally, in women, its superiority over WHR (AUC 0.807) was also statistically significant (p=0.003). We identified a METS-VF cut-off point >6.4 in males >6.5 in females and WC cut-off point >88 cm in males (AUC 0.922), >90.5 cm in females (AUC 0.938). Conclusion: METS-VF is strongly associated with visceral adiposity and better to predict increased VFA. However, its superiority over WC, BMI, BRI, and LAP was not significant. The results emphasize that WC is more appealing as screening indicator for visceral adiposity considering its easy use. Clinical Trial Registry Name: Clinicaltrials.gov (http://www.clinicaltrials.gov). Clinical Trial Registry Url: https://clinicaltrials.gov/ct2/show/NCT05648409. Clinical Trial Registry Number: NCT05648409.

Comparison of Initial CT Findings and CO-RADS Stage in COVID-19 Patients with PCR, Inflammation and Coagulation Parameters in Diagnostic and Prognostic Perspectives.

Objectives: This study aims to determine whether COVID-19 patients with different initial reverse transcriptase-polymerase chain reaction (RT-PCR), computed tomography (CT) and laboratory findings have different clinical outcomes. Materials and Methods: In this multi-center retrospective cohort study, 895 hospitalized patients with the diagnosis of COVID-19 were included. According to the RT-PCR positivity and presence of CT findings, the patients were divided into four groups. These groups were compared in terms of mortality and need for intensive care unit (ICU). According to the COVID-19 Reporting and Data System (CO-RADS), all patients' CT images were staged. Multivariate binary logistic regression analysis was used to examine the relationship between CO-RADS and predictive inflammation and coagulation parameters. Results: RT-PCR test positivity was 51.5%, the CT finding was 70.7%, and 49.7% of the patients were in the CO-RADS 5 stage. The need for ICU and mortality rates was higher in the group with only CT findings compared to the group with only RT-PCR positivity, (14.9% vs. 4.0%, p < 0.001; 9.3% vs. 3.3%, p > 0.05; respectively). Mortality was 3.27 times higher in patients with CO-RADS 4 compared to those with CO-RADS 1-2. Being in the CO-RADS 4 stage and LDH were discovered to be the most efficient parameters in determining mortality risk. Conclusion: Performing only the RT-PCR test in the initial evaluation of patients in SARS-CoV-2 infection may lead to overlooking groups that are more at risk for severe disease. The use of a chest CT to perform CO-RADS staging would be beneficial in terms of providing both diagnostic and prognostic information.

Apolipoprotein B assessment for evaluating lipid goals.

OBJECTIVE: It is suggested that the apolipoprotein (Apo) B levels are more valuable than LDL cholesterol (LDL-C) levels in assessing cardiovascular risk associated with hyperlipidaemia. However, although non-HDL cholesterol (non-HDL-C) levels are accepted as a secondary objective after achieving LDL-C levels in the guidelines, Apo B has not been recommended as a therapeutic goal yet. The objective of this study was to determine how many of the patients who achieved the LDL-C and non-HDL-C target recommended by the guidelines with a statin therapy achieved the Apo B target. METHODS: The study included a total of 182 consecutive hypercholesterolaemic (119 male, 63 female) patients who were over 18 years of age (mean age: 54.96 +/- 9.27 y) and on statin therapy. Apo B and non-HDL-C levels were determined for the patients who achieved or did not achieve the LDL-C target according to the cardiovascular risk categories defined in the Adult Treatment Panel-III report. Serum Apo B levels were assessed using the nephelometric method. RESULTS: The prevalence of patients who achieved the LDL-C, non-HDL-C and Apo B target was 63.2%, 79.7% and 72.5%, respectively. All of the patients who achieved the LDL-C target also achieved the non-HDL-C target. It was found that 6 of 115 patients (5.2%) who achieved the LDL-C and non-HDL-C target failed to achieve the Apo B target, whereas 23 of 132 patients (17.4%) who achieved the Apo B target failed to achieve the LDL-C target. CONCLUSIONS: These results showed that 95% of patients who received a statin therapy, and achieved LDL-C and non-HDL-C targets also achieved the Apo B target.

Control of hypertension in Turkey--is it improving? The Kocaeli 2 study.

OBJECTIVES: In a previous study conducted in Kocaeli, Turkey, ten years before, a very low rate of hypertension control (6.2%) was reported. This hypertension survey was conducted to determine whether the treatment and control rates of hypertension improved in the same region. STUDY DESIGN: Using a stratified sampling method, 1222 subjects (559 males, 663 females, mean age 44.8+/-13.6 years) living in Kocaeli, aged 25 or over, were included. After administration of a standardized questionnaire, blood pressure was measured in the sitting position from both arms after at least five minutes of resting. The measurement was repeated after 10 minutes on the arm with the higher initial reading. Hypertension was defined as the presence of a mean systolic blood pressure = or >140 mmHg and/or a mean diastolic blood pressure = or >90 mmHg, or a previous diagnosis of hypertension and/or use of antihypertensive drugs. RESULTS: The prevalence of hypertension was 33.6% (37.1% in women, and 29.5% in men, p<0.001). Of the hypertensive subjects, 59.3% were aware of their condition. Hypertension was controlled in 8.7% of the subjects (systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg). CONCLUSION: Our results showed that about one-third of the adult population in Kocaeli had hypertension, with low rates of control and awareness. Since the previous survey, there has been a small improvement in hypertension control rate, but uncontrolled hypertension is still remarkably high in this geographical region. These findings are consistent with the recent Turkish Hypertension Prevalence study (PatenT) reporting a control rate of 8.1%.

Cut-off values for waist circumference in Turkish population: Is there a threshold to predict insulin resistance?

OBJECTIVES: To identify the cut-off values for waist circumference (WC) that may best predict cardiometabolic risk associated with insulin resistance in adult Turkish men and women. STUDY DESIGN: A total of 1,039 non-diabetic subjects (592 females, 447 males; mean age 40.2+/-12.8 years) aged = or >18 years were enrolled. Insulin resistance was assessed with homeostasis model assessment of insulin resistance (HOMA-IR). The subjects were classified into quantiles based on the WC values and quantiles were compared with respect to the HOMA-IR levels. Receiver operating characteristic (ROC) analysis was used to identify the WC cut-off value that would best predict insulin resistance. RESULTS: HOMA-IR values increased in parallel with increasing WC quantiles for both genders (p=0.001). The cut-off values for WC that showed the highest sensitivity and specificity to predict insulin resistance were 93 cm for men (91.6% and 51%, respectively) and 83 cm for women (91.1% and 34.8%, respectively). CONCLUSION: Our results demonstrate that the cut-off values for WC that would best predict cardiometabolic risk associated with insulin resistance are 93 cm for men and 83 cm for women in Turkish adults. However, our findings also raise the question as to whether it is indeed necessary to define a WC cut-off value for the prediction of insulin resistance, because, regardless of the cut-off WC value taken into account, insulin resistance will be overlooked in a significant number of individuals with a WC below this cut-off value.

Gitelman Syndrome Presenting with Hypomagnesemia, Hypokalemia and Hypocalciuria: A Case Report.

Gitelman syndrome is a a rarely seen autosomal recessive renal tubulopathy characterized by inherited hypokalemic metabolic alkalosis with hypomagnesemia and hypocalciuria. The diagnosis of Gitelman syndrome is usually established during adolescence, but is also observed in childhood and even in the adulthood period. In this case report, we presented a 19-year-old male patient who was diagnosed as Gitelman Syndrome and admitted to the hospital with symptoms of muscle weakness, cramps and weakness.

C-peptide concentrations in patients with type 2 diabetes treated with insulin.

AIMS: To determine beta cell reserves of patients with type 2 diabetes who are treated with insulin by using fasting C-peptide concentrations and to investigate the clinical features related to C-peptide concentrations. MATERIALS AND METHODS: Patients with type 2 diabetes, who were using insulin as monotherapy or in combination therapy, were divided into three groups; those with an insufficient beta cell reserve (C-peptide: <0.5 ng/mL), borderline reserve (C-peptide: 0.5-2 ng/mL) and sufficient reserve (C-peptide:> 2 ng/mL). RESULTS: In the 249 patients (mean age, 61.77 ± 9.34 years; 40.6% male), the mean duration of diabetes was 13.9 ± 8.43 years. The mean HbA1c concentrations, fasting glucose and C-peptide concentrations were 8.88 ± 1.87%, 184.29 ± 77.88 mg/dL and 1.95 ± 1.37 ng/mL, respectively. Fifty-seven percent of patients (n = 142) had a borderline beta cell reserve and 37% (n = 92) had high C-peptide concentrations. Only 6% of patients (n = 15) had an insufficient beta cell reserve. C-peptide levels were positively correlated with waist circumference (r: 0.282; p = 0.001), hip circumference (r: 0.251; p = 0.001), body mass index (r: 0.279; p = 0.001), fasting glucose concentrations (r: 0.309; p = 0.001) and triglyceride concentrations (r: 0.358; p = 0.001). CONCLUSION: In this study, almost all patients with type 2 diabetes using insulin were found to have sufficient or borderline beta cell reserves and insulin resistance-related parameters were prominent in those with adequate beta cell reserve. CLINICAL TRIALS NO: NCT04005261.

Frequency of abdominal obesity and metabolic syndrome in healthcare workers and their awareness levels about these entities.

OBJECTIVES: We investigated the frequency of metabolic syndrome (MetS) and abdominal obesity and evaluated the level of awareness about these two conditions in healthcare workers. STUDY DESIGN: A total of 723 healthcare workers (372 physicians, 247 nurses, 104 other healthcare staff; mean age 32.8+/-8.2 years) from four centers were included. Demographic, anthropometric, and biochemical data were recorded, lifestyle features were inquired, and the levels of awareness about abdominal obesity and MetS were surveyed. The criteria recommended by the Adult Treatment Panel (ATP) III were used for the diagnosis of abdominal obesity and MetS. The presence of MetS was evaluated in 178 subjects. Univariate and multivariate analyses were performed to evaluate the association between lifestyle features and abdominal obesity. RESULTS: The frequency of abdominal obesity was 13.8% and it was significantly higher in males than in females (19.1% vs 10.6%; p=0.002). Metabolic syndrome was diagnosed in 14 participants (7.9%), and there was no significant difference between men and women in this respect (p>0.05). The cut-off values for abdominal obesity and at least three criteria of MetS were correctly listed by 47 participants (6.5%) and 240 participants (33.2%), respectively, with physicians showing significantly higher awareness levels (p=0.001). In multivariate analysis, age =or>40 years and male gender were significantly associated with abdominal obesity. CONCLUSION: Our results demonstrate that only a minority of healthcare workers are cognizant of MetS as a clinical syndrome and the definition of abdominal obesity.

Effects of telmisartan and losartan on insulin resistance in hypertensive patients with metabolic syndrome.

Partial peroxisome proliferator-activated receptor-gamma (PPAR-gamma) agonists are known to decrease insulin resistance. Experimental studies have shown that the angiotensin type 1 receptor blocker (ARB) telmisartan has a PPAR-gamma-activating property, but there does not appear to be a class effect. To test telmisartan's clinical importance, we here investigated its effect on insulin resistance in hypertensive patients with metabolic syndrome (MetS) in comparison with another ARB, losartan. A total of 42 hypertensive MetS patients (29 female, 13 male) were included (mean age: 50+/-9, range: 20-70 years). NCEP-ATP III criteria were used for the diagnosis of MetS. Patients were randomized to receive either telmisartan 80 mg/day (n=21) or losartan 50 mg/day (n=21) for 8 weeks. Biochemical assessments were made at baseline and at the end of the 8 weeks. Insulin resistance was evaluated by using homeostasis model assessment of insulin resistance (HOMA-IR). Both groups had similar reductions in systolic and diastolic pressures (p>0.05). HOMA-IR did not change significantly in either group throughout the study. In the telmisartan group, the mean HOMA-IR at baseline and at the end of the study were 1.9+/-07 and 1.9+/-0.5, respectively. The figures for the losartan group were 1.8+/-0.6 and 1.8+/-0.6, corresponding. In conclusion, in contrast with the reports that telmisartan may decrease insulin resistance by an effect associated with its molecular structure, 8 weeks of telmisartan treatment in the present study had a neutral effect on insulin resistance in hypertensive MetS patients, and similar results were obtained for losartan.

Is metabolic syndrome a condition independent of prediabetes and type 2 diabetes mellitus? A report from Turkey.

It has been suggested that metabolic syndrome (MetS) overlaps prediabetes and type 2 diabetes and that it is not necessary to consider it as a separate clinical entity. In the present study, patients with normoglycemia and dysglycemia were compared in terms of MetS frequency and MetS criteria characteristics, in order to test the appropriateness of considering MetS as a condition independent of prediabetes and type 2 diabetes. A total of 1222 (801 females, 401 males, mean age: 51.50 11.73 y) consecutive patients attending Internal Medicine outpatient clinics were included. Cases were assigned into two groups: patients with normoglycemia (fasting plasma glucose <100 mg/dl, n = 555) or dysglycemia (fasting plasma glucose >/=100 mg/dl and/or receiving antidiabetic treatment, n = 667). Groups were compared in terms of MetS frequency and MetS criteria characteristics. A 2-hour oral glucose tolerance test was administered to the normoglycemia group. In addition, patients with MetS were assigned into two groups: patients with normoglycemia and dysglycemia. These two groups were also compared in terms of MetS criteria characteristics. Adult Treatment Panel III criteria were used for the diagnosis of MetS. The overall frequency of MetS was 52.2%. MetS was found in 72.7% of patients with dysglycemia and 27.6% of patients with normoglycemia (p = 0.001). Mean systolic and diastolic blood pressure, waist circumference and triglyceride levels were similar between normoglycemic and dysglycemic MetS patients (p>0.05). Impaired glucose tolerance was higher among normoglycemic MetS patients compared to normoglycemic patients without MetS (13.7% vs. 6.5%, p = 0.006). In conclusion, although MetS is a well known risk factor for type 2 diabetes, our results support that it is a separate entity independent of prediabetes and type 2 diabetes mellitus.

Hepcidin is not a marker of chronic inflammation in atherosclerosis.

OBJECTIVE: To investigate the relationship between atherosclerosis, an inflammatory disease and hepcidin, which is reported as an indicator of inflammation. METHODS: A total of 75 subjects between 40 and 70 years of age were included in the study. The patient group consisted of 40 stable patients who had previously experienced an atherosclerotic event (18 women, 22 men; mean age 56.4+/-7.1 years). There were two control groups. The first control group consisted of 19 healthy subjects (11 women, 8 men; mean age 52.6+/- 7.4 years), while the second group included 16 patients (11 women, 5 men; mean age 56.5+/-9.3 years) with rheumatoid arthritis and anemia (diseased control group). Hepcidin measurement was performed using Hepcidin Prohormone ELISA (Solid Phase Enzyme-Linked Immunosorbent Assay) test kit. RESULTS: Mean serum hepcidin levels were 243.2+/-48.8 ng/ml, 374.5+/-86.4 ng/ml, and 234+/-59.9 ng/ml in the patient group, in diseased controls, and in healthy controls, respectively. Hepcidin levels were higher in diseased controls compared to the patient group and healthy controls (p=0.001). There were no significant differences between the patient group and healthy controls. CONCLUSION: These findings did not support the hypothesis that hepcidin levels could be increased in atherosclerotic cardiovascular diseases as a marker of chronic inflammation.

Urinary kidney injury molecule-1 levels as a marker of early kidney injury in hypertensive patients.

BACKGROUND: Kidney injury molecule-1 (KIM-1) is a type 1 tubular cell transmembrane protein that is found in high levels in early stages of acute kidney injury and is stated to have predictive value in the early diagnosis of chronic kidney diseases. In this study, the hypothesis was that higher levels of KIM-1 would be detected in hypertensive patients for the early detection of nephropathy. With this goal, urinary KIM-1 levels of hypertensive cases were compared with those of healthy controls, and associations of KIM-1 levels with microalbuminuria and glomerular filtration rate (GFR) were investigated. METHODS: The study included a total of 80 patients aged ≥20 years (55 male, 25 female, mean age: 57.21±9.12 years). The patient group consisted of 40 patients (28 males, 12 females, mean age: 57.58±8.79 years) who had had hypertension for at least 5 years, and the control group consisted of 40 healthy subjects (27 female, 13 male, mean age: 56.85±9.53 years). Groups were compared based on demographic, anthropometric and biochemical data, and urinary KIM-1 levels. Correlation analysis was made to assess the association of KIM-1 levels with microalbuminuria and GFR. Levels of urinary KIM-1 enzyme were measured using linked immunosorbent assay (ELISA). RESULTS: KIM-1 levels were found to be 0.86±0.48 ng/mg creatinine in the patient, and 0.71±0.46 pg/mL in the control groups (P>0.05). A positive correlation was detected between KIM-1 levels and both systolic blood pressure and duration of disease (r=0.308, P=0.032 and r=0.339, P=0.032, respectively). CONCLUSIONS: While not supporting the hypothesis that KIM-1 levels may increase in hypertensive patients as an early indicator of hypertensive nephropathy, these findings suggested that this molecule might be associated with kidney injury in hypertensive nephropathy due to its positive correlation with the duration of hypertension.

Relationship between low levels of high-density lipoprotein cholesterol and metabolic syndrome in Turkish patients.

OBJECTIVE: It is stated that high-density lipoprotein cholesterol (HDL-C) levels are low in Turkish people and that this may be related to genetic factors. Low HDL-C is a parameter of the metabolic syndrome (MetS). In this study, the relationship between low HDL-C levels and MetS has been investigated. METHODS AND RESULTS: A total of 720 successive patients, 20 years or older, were categorized into two groups, as those with low-HDL-C (in men < 40 mg/dl, in women < 50 mg/dl) and those without low-HDL-C levels (in men > or = 40 mg/dl, in women > or = 50 mg/dl). The groups were compared according to the frequency of the MetS and the averages of the MetS criteria other than HDL-C. Moreover, two groups were formed with normal (< 150 mg/dl) and high (> or = 150 mg/dl) triglyceride levels and they have been compared with the average HDL-C levels. The frequency of MetS was 70.8% in the group with low-HDL-C and 24.2% in the group without low HDL-C levels (p < 0.001). The averages of the MetS criteria other than the HDL-C were 2.17 +/- 1.19 in the group with low-HDL-C levels and 1.59 +/- 1.15 in the group without low-HDL-C levels (p < 0.001). Average HDL-C level was 48.90 +/- 13.40 mg/dl in the group with normal triglyceride levels and 44.41 +/- 10.26 mg/dl in the group with high triglyceride levels (p < 0.001). CONCLUSIONS: This study shows that low HDL-C is related to the MetS in our patients, a selected group of a population reported to have a low HDL-C average.

High-density lipoprotein cholesterol in coronary artery disease patients: is it as low as expected?

OBJECTIVE: Epidemiological studies demonstrated that the high-density lipoprotein (HDL) cholesterol levels in Turkish people are lower compared to other populations. In the present study, the HDL cholesterol levels in subjects with or without angiographically documented coronary artery disease (CAD) were compared to assess whether HDL cholesterol levels were as low as expected. METHODS: A total of 420 consecutive patients with age of > or =40 years (160 female, 260 male) undergoing coronary angiography were included in the study. Patients receiving fibric acid derivatives or niacin were excluded. Coronary artery disease group consisted of those patients with any atherosclerotic lesions in coronary angiography, and non-CAD group consisted of patients with no such lesions. RESULTS: Average HDL cholesterol levels were 45.0+/-10.5 mg/dl (44.4+/-10.9 mg/dl in men, 46.5+/-9.6 mg/dl in women) in CAD group, and 47.7+/-9.0 mg/dl (45.5+/-8.4 mg/dl in men, 48.9+/-9.2 mg/dl in women) in non-CAD group (p<0.05). CONCLUSION: Compared to non-CAD patients, patients with CAD had lower HDL cholesterol levels, but in general HDL cholesterol levels were not as low as to be expected from epidemiological studies.