Minimal Change Nephrotic Syndrome with Acute Kidney Injury after the Administration of Pfizer-BioNTech COVID-19 Vaccine.

Nephrotic syndrome progresses with various metabolic disturbances, such as proteinuria over 3.5 grams in 24 hours, hypoalbuminemia, and hypercoagulability. Patients usually complain about diffuse edema throughout the body, which is secondary to hypoalbuminemia. It has many primary and secondary causes. Patients may require a renal biopsy to confirm the diagnosis. Besides, many secondary causes of nephrotic syndrome should be examined and excluded. Although many vaccines were developed due to the COVID-19, many side effects are still reported because of the Pfizer-BioNTech COVID-19 vaccine (COVID-19 mRNA and BNT162b2), which is widely used in Turkey. This study examines a case of nephrotic syndrome with acute renal injury after Pfizer-BioNTech vaccine.

Aumento da Espessura Médio-intimal Aórtica e sua Relação com Estresse Oxidativo Elevado em Pacientes com Talassemia Menor / Aortic Intima Media Thickness is Increased and Closely Related to Elevated Oxidative Stress Increases in Beta Thalassemia Minor

Resumo Fundamento A espessura médio-intimal (EMI) da artéria aorta abdominal (EMI-A) pode ser um marcador precoce de aterosclerose subclínica e um indicador objetivo de estresse oxidativo em pacientes com talassemia menor. Objetivo Avaliar se as EMIs da artéria aorta e da artéria carótida (EMI-C) se alteram com estresse oxidativo, e examinar a relação entre esses parâmetros em pacientes com talassemia menor. Métodos O estudo incluiu 80 pacientes diagnosticados com talassemia menor, e 50 indivíduos sadios com idade e sexo similares. Após procedimentos de rotina, as amostras de sangue foram coletadas dos grupos de estudo para a medida da homeostase tiol/dissulfeto e da albumina modificada pela isquemia (AMI). As medidas da EMI-C foram realizadas a partir de quatro regiões diferentes (artéria carótida externa direita e esquerda e artéria carótida interna direita e esquerda) por ultrassonografia, e a medida da EMI-A foi realizada por ultrassonografia abdominal. Um valor de p<0,05 foi definido como estatisticamente significativo. Resultados Nos pacientes com talassemia menor, os níveis de tiol nativo e tiol total, e a razão tiol nativo/tiol total foram mais baixos, e os valores de AMI, razão dissulfeto/tiol nativo, e razão dissulfeto/tiol total foram mais altos que no grupo controle. A EMI-A foi significativamente maior no grupo de pacientes com talassemia menor que nos controles (1,46±0,37 vs 1,23±0,22 e p<0,001). Quando os parâmetros associados com EMI-A na análise univariada foram avaliados por regressão linear multivariada, EMI-A apresentou uma relação positiva, e os níveis de tiol nativo e tiol total apresentaram uma forte relação negativa com AMI (p<0,01). Conclusão Nós demonstramos, pela primeira vez, um aumento no estresse oxidativo com a elevação da EMI-A, e valores inalterados da EMI-C em pacientes com talassemia menor.

Abstract Background Abdominal aortic intima media thickness (A-IMT) may be an early marker of subclinical atherosclerosis and an objective indicator of increased oxidative stress in beta-thalassemia minor patients. Objective To evaluate whether aortic and carotid IMTs change with oxidative stress and to assess the relationship between these parameters in beta-thalassemia minor patients. Methods The study included 80 patients diagnosed with beta-thalassemia minor, and 50 healthy individuals with similar age and gender. After routine procedures, blood samples were collected from the study groups for thiol-disulfide hemostasis and ischemia-modified albumin (IMA). C-IMT measurements were performed in four different regions (right and left internal and external carotid artery) by ultrasonography. In addition, A-IMT measurement was performed by abdominal ultrasonography. Statistically significant p value was set as <0.05 for all comparisons. Results In beta-thalassemia minor patients, native thiol, total thiol and native thiol / total thiol ratio were lower, and the IMA, disulfide / native thiol ratio and disulfide / total thiol ratios were higher than in healthy control group. A-IMT measurement was significantly higher in beta-thalassemia minor group than controls (1.46±0.37 vs 1.23±0.22 and p<0.001). When the parameters associated with A-IMT in univariate analysis were evaluated by multivariate linear regression analysis, A-IMT was positively related, and native thiol and total thiol levels were negatively and closely related to IMA (p<0.01). Conclusion We demonstrated, for the first time, that oxidative stress status increased with increased A-IMT, while C-IMT remained unchanged in beta-thalassemia minor patients.

Serum Elabela Levels Are Elevated in Patients with Hyperthyroidism.

The apelinergic system plays an important role in the modulation of the cardiovascular system via the apelin peptide and the apelin receptor (APJ receptor). Apelin and elabela, also known toddler, are peptide ligands for the apelin receptor. These two peptides show similar biological actions, such as vasodilatation, increased myocardial contractility, angiogenesis, and energy metabolism. However, the serum levels of elabela in patients with hyperthyroidism are not well known. The aim of this study was to investigate the changes in serum elabela levels in patients with hyperthyroidism and its association with hypertension. This cross-sectional study included 74 patients with newly diagnosed hyperthyroidism due to Graves' disease and 20 healthy individuals. Serum elabela levels were measured by enzyme-linked immunosorbent assay. The patients were divided into two groups: hyperthyroid patients without hypertension (n = 51) and those with hypertension (n = 23). Basal heart rate, serum glucose and high-sensitive C reactive protein were significantly higher in hyperthyroid patients with and those without hypertension than in healthy controls (p < 0.05 for each). Serum elabela levels were significantly elevated in hyperthyroid patients compared with healthy controls, with higher serum elabela levels found in hyperthyroid patients with hypertension than those without hypertension. Linear regression analysis showed that serum elabela levels were correlated with systolic blood pressure (p < 0.001). In conclusion, serum elabela levels were significantly increased in patients with hyperthyroidism, especially in hyperthyroid patients with hypertension. Elevation in serum elabela levels may contribute to alleviation of cardiovascular complications of hyperthyroidism and hypertension.

CTRP3 is Significantly Decreased in Patients with Primary Hyperparathyroidism and Closely Related with Osteoporosis.

BACKGROUND: Adipokines derived from adipocytes are one of the important factors that act as circulating regulators of bone metabolism. Complement C1q/tumor necrosis factor-related protein-3 (CTRP3), a paralog of adiponectin, is are member of the CTRP superfamily. The aim of this study was to investigate the role of serum CTRP3 in the development of osteoporosis in patients with primary hyperparathyroidism. METHODS: This study included 53 patients with diagnosed primary hyperparathyroidism and 30 healthy controls. Laboratory tests for the diagnosis of primary hyperparathyroidism and serum levels of CTRP3 measured for all patients. Bone mineral density was obtained on lumbar spine 1 and 4 by dual energy X-ray absorptiometry. RESULTS: Serum CTRP3 levels were lower in patients with primary hyperparathyroidism than in the control group (p<0.001). In addition, primary hyperparathyroidism patients are were divided into two groups as, with and without osteoporosis; the levels of CTRP3 were lower in patients with osteoporosis than in patients without osteoporosis (p=0.004). In logistic regression analysis, only CTRP3 levels independently determined the patients to be osteoporosis (p<0.05). According to this analysis, decreased CTRP3 (per 1 ng/mL) levels were found to increase the risk of patients for osteoporosis by 6.9%. When the CTRP3 cut-off values were taken as 30 ng/mL, it determined osteoporosis with 76.4% sensitivity and 73.2% specificity. CTRP3 and urine calcium levels were independently associated with T score in dual energy X-ray absorptiometry. CONCLUSIONS: CTRP3 levels were significantly decreased in patients with primary hyperparathyroidism, and it is also related to osteoporosis.

Relationship Between Morbidity and Mortality and HbA1c Levels in Diabetic Patients Undergoing Major Surgery.

OBJECTIVE: To investigate the relationship between the preoperative HbA1c levels and the complications and mortality rates in the postoperative period in patients with diabetes undergoing a major surgical treatment. STUDY DESIGN: Descriptive study Place and Duration of Study: Deparment of Internal Medicine, Adana Numune Research and Training Hospital, Turkey, from January 2015 to December 2016. METHODOLOGY: Diabetic patients, who underwent major surgery (a large resection) having preoperative HbA1c levels, were considered. A total of 1,013 patients, whose file data were completely accessed, were included in the study. Preoperative HbA1c levels of the patients and complications seen within the first 7 and first 30 days postoperatively were recorded. RESULTS: Fourty-nine (4.8%) of the patients were exitus in the hospital, while 964 (95.2%) of the patients were discharged. Preoperative HbA1c levels of the patients were found to be predictive marker of mortality and complications in the first 7 and 30 days postoperatively (p <0.001). CONCLUSION: HbA1c levels are important in preoperative surgical risk assessment in diabetic patients. Better provision of long-term glycemic control in patients planned elective surgery and have low levels of HbA1c may significantly reduce postoperative mortality and complications.

The evaluation of plasma viscosity and endothelial dysfunction in smoking individuals.

BACKGROUND: Smoking is considered to be one the of risk factors effecting atherosclerosis which is associated the physical forces, biological and chemical stimuli occuring in vessel wall. The aim of this study is analysis of the biomechanical (plasma viscosity) and biochemical effect (nitric oxide, NOx; asymmetric dimethylarginine, ADMA) of smoking on endothelial function. METHODS: One hundred-twenty two individuals were divided into three groups according to their smoking status. Plasma viscosity was measured by Harkness Capillary Viscometer. Plasma NOx level was determined by enzymatic methods using commercial kits. ADMA concentration was determined by Elisa Plasma Assay and and physiologic spirometric and arterial gas parameters and pulmonary blood flow rate (PBFR) were measured. RESULTS: Viscosity variables of former smokers were significantly higher than those of non-smokers (p < 0.001). NOx levels were found to be statistically significantly higher when compared with current smokers and non-smokers (p < 0.001), and former smokers and non-smokers (p < 0.05). There was a higher fibrinogen levels in current smokers (p < 0.05) than smokers. CONCLUSIONS: Smoking increases the plasma viscosity that may lead endothelial damage. Plasma viscosity plays an important role as a biophysical mechanical marker on the behalf of hemodynamics. Biochemical markers, NOx and ADMA may show this damage, however, we observed that plasma viscosity can be consistent with biochemical markers. Thus, plasma viscosity may be useful for diagnosis, treatment and follow-up of the patients.

H. pylori May Not Be Associated with Iron Deficiency Anemia in Patients with Normal Gastrointestinal Tract Endoscopy Results.

Background. The aim of this study was to investigate the association between iron deficiency anemia and H. pylori in patients with normal gastrointestinal tract endoscopy results. Materials and Methods. A total of 117 male patients with normal gastrointestinal tract endoscopy results were included in this retrospective study. The study and control groups included 69 and 48 patients with and without iron deficiency anemia, respectively. The prevalence of H. pylori, the number of RBCs, and the levels of HGB, HTC, MCV, iron, and ferritin were calculated and compared. Results. There was no statistically significant difference found between the groups according to the prevalence of H. pylori (65.2% versus 64.6%, P = 0.896). Additionally, the levels of RBCs, HGB, HTC, MCV, iron, and ferritin in the patients in the study group were lower than those in the control group (P < 0.05). Finally, there was no association between iron deficiency anemia and H. pylori (OR 1.02, Cl 95% 0.47-2.22, and P = 0.943). Conclusion. H. pylori is not associated with iron deficiency anemia in male patients with normal gastrointestinal tract endoscopy results.

Socio-economic status of smokers presenting to the outpatient service: does chronic obstructive pulmonary disease make a difference?

BACKGROUND: Sparse published data are available on the impact of social and personal factors leading to tobacco smoking. Identification of social and economic motives underlying smoking can facilitate the efforts towards control of tobacco smoking. METHODS: A questionnaire was administered to 966 smokers attending the Chest Diseases Out-patient clinic at the Haseki Training and Research Hospital, Istanbul to collect demographic data from the participants. In all of them spirometry was performed. RESULTS: The participants with chronic obstructive pulmonary diseases (COPD) were less benefiting from social security system and they were less educated. Patients with COPD were generally living in cities. In this group the number of divorced patients were more than the other group. CONCLUSIONS: There are many factors causing individuals to initiate smoking. By eliminating these factors, mortality and morbidity rates caused by smoking will decline dramatically. This study aims to draw attention on personal and social factors for smoking.

The efficacy of n-acetylcysteine in preventing contrast-induced nephropathy in type 2 diabetic patients without nephropathy.

BACKGROUND: N-acetylcysteine (NAC) is reported to have potential for prevention of contrast-induced nephropathy(CIN), however, there is not enough data related to its effects on diabetic patients without nephropathy. METHODS: A total of 45 diabetic patients without nephropathy undergoing a computerized tomography (CT) investigation and who would be receiving radio-opaque medication (300 mg iohexaol/100 mL) were enrolled. They were randomized to have either high-dose NAC (1200 mg) plus saline hydration (Group 1, n=25) or only saline hydration (Group 2; n=20). Serum creatinine levels were determined 72 hours post-contrast. CIN was defined as 0.3 mg/dL elevation of creatinine from baseline and/or an increment of 20% over baseline creatinine and/or 20% decrement of estimated GFR. RESULTS: In Group 1, serum creatinine decreased from 0.83 to 0.79 mg/dL, whereas serum creatinine increased from 0.81 to 0.94 mg/dL in Group 2 (not significant for both groups). However there was a significant difference between the creatinine variation of two groups (p=0.031). Furthermore, the groups were analyzed according to overall incidence of CIN. The increase of serum creatinine and decrement of estimated GFR in Group 2 were significantly higher than in Group 1. CONCLUSION: Adding NAC to saline hydration seems more beneficial than saline hydration alone in preventing contrast-induced renal function deterioration in type 2 diabetic patients without nephropathy.