[Hepatitis E virus seropositivity in hemodialysis patients in Hatay province, Turkey]. / Hatay'da hemodiyaliz tedavisi alan hastalarda hepatit e virus seropozitifligi.

Hepatitis E virus (HEV) which is mainly transmitted through faecal-oral route, can also be transmitted via parenteral and vertical route. Recent studies suggest zoonotic nature of the virus. The last studies done in Turkey indicate increasing frequency of HEV infection. This study was conducted to determine the rate of anti-HEV seropositivity among patients with terminal stage renal failure undergoing hemodialysis. A total of 92 patients (54 male, 38 female; age range: 22-71 years, mean age: 55 +/- 11 years) who had undergone hemodialysis for a mean period of 66 +/- 18 months, were included to the study. HEV antibodies were analyzed using anti-HEV IgG enzyme immunoassay (ELISA, Dia.Pro Diagnostic Bioprobes, Italy). In order to study the relationship of anti-HEV positivity between hepatitis C virus and hepatitis B virus infections, anti-HCV antibody and HBsAg were also considered. Mean age, duration of hemodialysis, platelet, serum albumin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, blood transfusion history were the other evaluated parameters. Anti-HEV IgG positivity was detected in 19 (20.6%) patients, while 7 (7.6%) had anti-HCV positivity and 4 (4.3%) had HBsAg positivity. No statistically significant relation was determined between anti-HEV IgG positive and negative patients in terms of hemodialysis duration, blood transfusion, other laboratory findings and anti-HCV and HBsAg positivity (p > 0.05). While the anti-HEV seropositivity rate (20.6%) determined in this study was higher than the rates determined in the same group of patients in the western part of the country (10-16%), the rate was similar to the rates reported from the southeastern part (23%) of Turkey. It can be concluded that screening of patients before or during hemodialysis in terms of anti-HEV antibodies, seems to be of crucial importance in order to establish necessary precautions to prevent parenteral and/or nosocomial transmission of HEV.

Protective effects of N-acetylcysteine on cyclosporine-A-induced nephrotoxicity.

OBJECTIVES: Cyclosporine A (CsA) is used for the treatment of autoimmune and inflammatory disorders. However, CsA-induced nephrotoxicity remains an important clinical problem, and oxidative stress has been implicated as a possible responsible mechanism. We assessed the protective ability of N-acetylcysteine (NAC), an antioxidant, against CsA-induced nephrotoxicity. MATERIALS AND METHODS: Wistar albino rats were randomly assigned into four groups. Group 1 rats were treated with sodium chloride as control, group 2 with CsA, group 3 with CsA and NAC, and group 4 with NAC alone. Animals were sacrificed and blood samples were analyzed for blood urea nitrogen (BUN), serum creatinine (Cr), malondialdehyde (MDA) and nitric oxide (NO) levels, and superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities. Kidney sections were analyzed for MDA and NO levels and SOD and GSH-Px activities, as well as histopathological changes. RESULTS: Overall, the treatment of rats with CsA alone produced significant increases in NO and MDA levels and significant decreases in SOD and GSH-Px activities in serum and renal samples. Morphological changes, including tubular epithelial atrophy, vacuolizations, and cellular desquamations, were clearly observed in the rats treated with CsA alone. Concurrent NAC administration with CsA improved renal function, as indicated by lower BUN and Cr values. Moreover, NAC significantly reduced MAD and NO levels and increased SOD and GSH-Px activities in serum and renal tissue, as well as provided a histologically proven protection against CsA-induced nephrotoxicity. CONCLUSION: These results indicate that NAC produces a protective mechanism against CsA-induced nephrotoxicity and suggest a role for oxidative stress in pathogenesis.

Ocular surface disease index for the diagnosis of dry eye syndrome.

PURPOSE: Evaluation of ocular surface disease index (OSDI) questionnaire for the diagnosis of dry eye syndrome. METHODS: Sixty-eight patients admitted to the Ophthalmology Polyclinic of the Dumlupinar University between December 2005 and April 2006 were randomly studied. The OSDI questionnaire was performed before, and the Schirmer and tear film breakup time (TBUT) tests were performed after the routine ophthalmologic examination. RESULTS: There was a significant inverse correlation between the OSDI and TBUT test scores, but no correlation between the Schirmer test scores and OSDI (r = -.296, p = .014, r = -.182, p = .138, respectively). Although there was a significant difference between the low and high OSDI having cases according to the TBUT test scores (p = .043), there was not according to the Schirmer test scores. CONCLUSIONS: The OSDI is a standardized instrument to evaluate symptoms, and can easily be performed and used to support the diagnosis of dry eye syndrome.

Clinical presentation and laboratory findings of organic phosphorus poisoning.

This study was conducted to evaluate the demographic, causative, and biologic characteristics of patients with organophosphate (OP) poisoning who were admitted to tertiary teaching and research hospitals at 2 different universities. All patients admitted to the emergency departments of Cukurova University Hospital in Adana, Turkey, between 2001 and 2003 and the Hospital of Mustafa Kemal University in Hatay, Turkey, between 2004 and 2006 were included. The study group consisted of subjects with a mean age of 28.5+/-14.1 y (range, 14-80 y), and the maximum number of cases in the second decade of life; the female-to-male ratio was 2.2:1. In all, 27 of 43 females and 16 of 20 males were married. Most subjects (n=55) had graduated from primary school; 3 were illiterate and 5 were highly educated. A total of 36 (57.1%) subjects belonged to lower socioeconomic groups. Fifty-three patients intended to commit suicide, and 10 cases were accidental. Mean arrival time of subjects to the hospital after poisoning was 9.9+/-16.1 h (range, 1-96 h); mean Glasgow Coma Scale score was 10.2+/-2.9 (range, 3-15). A total of 19 subjects were intubated, and 4 died. A total of 59 patients recovered completely. The mortality rate (6.3%) depended on various factors such as OP compound consumed, amount ingested, time interval before hospitalization, and patients' general health. Chances for recovery were greater when the patient was hospitalized at the earliest indication. In conclusion, OPs especially affected young single females, and most cases were due to attempted suicide. Because OP poisoning is an important cause of morbidity and mortality, therapy should be started immediately to avoid undesirable consequences.

Ultrasonographic Assessment of the Distal Femoral Cartilage Thickness in Patients with Homozygous Sickle Cell Disease.

OBJECTIVE: To compare the distal femoral cartilage thickness of patients with sickle cell disease (SCD) with those of healthy subjects using ultrasonography. METHODS: The study comprised 30 patients with SCD (16 male, 14 female; mean age, 30.1 years) and 30 age- and sex-matched healthy subjects. Demographic features and medications of the patients were recorded. With the knees held in maximum flexion, the femoral cartilage thickness was measured bilaterally with a 7- to 12-MHz linear probe. Using ultrasonography, 3 midpoint measurements were taken from both knees: lateral femoral condyle (LFC), intercondylar area (ICA), and medial femoral condyle (MFC). RESULTS: Patients with SCD had thinner femoral cartilage thickness values at LFC (P = 0.004), at MFC (P = 0.000), and ICA (P = 0.002) when compared with those of the healthy subjects. Patients with SCD also had lower Hb levels (P = 0.000) levels. Weak positive correlations were determined between Hemoglobin (Hb) levels and ultrasonographic measurements in the SCD group at MFC (r = 0.331, P = 0.010), and ICA (r = 0.289 , P = 0.025 ). Low levels of Hb seem to affect the femoral cartilage thickness. CONCLUSION: These preliminary findings of decreased femoral cartilage thickness in SCD patients should be complemented with future studies. The possibility of early knee joint degeneration and eventual osteoarthritis in SCD should be kept in mind.

Mortal quintet of sickle cell diseases.

BACKGROUND: Sickle cell diseases (SCDs) are chronic inflammatory processes on capillary level. We tried to understand some possible correlations between stroke and severity of SCDs. METHODS: All patients with SCDs were taken into the study. RESULTS: The study included 343 patients (174 males and 169 females). There were 30 cases (8.7%) with stroke. The mean ages were similar in both groups (32.5 versus 29.1 years in the stroke group and other, respectively, P>0.05). The female ratios were similar in both groups, too (43.3% versus 49.8%, respectively, P>0.05). Prevalences of associated thalassemia minors were also similar in them (73.3% versus 65.1%, respectively, P>0.05). Smoking was higher among the stroke cases, significantly (26.6% versus 13.0%, P<0.05). Mean white blood cell count, hematocrit value, and mean platelet count of the peripheric blood were similar in both groups (P>0.05 for all). On the other hand, although the painful crises per year, tonsilectomy, priapism, ileus, pulmonary hypertension, chronic obstructive pulmonary disease, coronary heart disease, chronic renal disease, rheumatic heart disease, avascular necrosis of bones, cirrhosis, and mortality were all higher in the stroke group, the differences were only significant for acute chest syndrome (ACS), digital clubbing, and leg ulcers (P<0.05 for all), probably due to the small sample size of the stroke group. CONCLUSION: SCDs and smoking are chronic destructive processes on endothelium, and both terminate with early organ failures in life. Probably smoking, digital clubbing, leg ulcers, ACS, and stroke are mortal quintet of the SCDs that may indicate shortened survival in such patients.

Tonsilectomy in sickle cell diseases.

BACKGROUND: We tried to understand whether or not there are lowered prevalences of terminal consequences of sickle cell diseases (SCDs) with tonsilectomy. METHODS: All cases with SCDs were taken into the study. RESULTS: The study included 334 patients (164 females). There were 27 cases with tonsilectomy and 307 cases without. The mean ages, female ratios, and prevalences of associated thalassemia minors and smoking were similar in both groups (P>0.05 for all). Although the white blood cell and platelet counts of peripheric blood were higher in patients without tonsilectomy, the mean hematocrit value was lower in them, but the differences were nonsignificant probably due to the small sample size of the tonsilectomy group (P>0.05 for all). Similarly, although the painful crises per year, digital clubbing, leg ulcers, pulmonary hypertension, chronic obstructive pulmonary disease, rheumatic heart disease, avascular necrosis of bone, cirrhosis, stroke, and mortality were higher in cases without tonsilectomy, the differences were nonsignificant probably due to the same reason again (P>0.05 for all). CONCLUSION: There may be an inverse relationship between prevalence of tonsilectomy and severity of SCDs, and the tonsils may act as chronic inflammatory foci accelerating the chronic endothelial damage all over the body in such patients.

Changes in the cornea related to sickle cell disease: a pilot investigation.

PURPOSE: To investigate corneal structural changes (central corneal thickness, endothelial cell count, and cellular morphology) in patients with sickle cell disease (SCD). METHODS: This prospective study included 56 patients with SCD and 50 age- and sex-matched healthy subjects without any eye disease aside from refractive errors. Endothelial cell density (ECD), percentage of hexagonality, and the coefficient of variation in cell size (CV) were measured using noncontact specular microscopy, and central corneal thickness (CCT) was measured by pachymetry. RESULTS: The mean CCT value was 509.6 ± 20.7 µm in the study group and 520.8 ± 23.6 µm in the control group. The mean ECD, CV, and percentage of hexagonality values in the study group were 2712 ± 335 cells/mm², 34.5 ± 5.3%, and 57.2 ± 6.6%, respectively, and 3030 ± 247 cells/mm², 31.6 ± 5.0%, and 60.4 ± 6.9% in the control group, respectively. Endothelial cell density (p = 0.001), CCT (p = 0.011), CV (p = 0.005), and percentage of hexagonality values (p = 0.018) were significantly different between the study and control groups. CONCLUSIONS: The results of the current study indicate that patients with SCD had considerable morphologic changes in the structure of the cornea when compared to healthy subjects.

Autosplenectomy in severity of sickle cell diseases.

BACKGROUND: We tried to understand whether or not there is an association between prevalence of autosplenectomy and severity of sickle cell diseases (SCDs). METHODS: All SCDs patients with red blood cell (RBC) transfusions of less than 50 units in their lives were put into the first group and 50 units or higher were put into the second group. RESULTS: The study included 316 patients (155 females). There were 224 cases (70.8%) in the first group and 92 cases (29.1%) in the second group (p<0.001). The male ratio was significantly higher in the second group (64.1% versus 45.5%, p<0.001). Although both the white blood cell and platelet counts were higher in the second group, there was a significant difference in platelet counts (p=0.005), and this was probably due to the small sample sizes. Although the prevalence of autosplenectomy was significantly higher in the first group (56.2% versus 45.6%, p<0.05), the mean number of painful crises per year, digital clubbing, chronic obstructive pulmonary disease (COPD), leg ulcers, stroke, chronic renal disease (CRD) and coronary heart disease (CHD) were significantly higher in the second groups (p<0.05 for all). CONCLUSION: In contrast to the lower prevalence of autosplenectomy, the mean number of painful crises per year, digital clubbing, COPD, leg ulcers, stroke, CRD, and CHD were significantly higher in the second group. So there may be an inverse relationship between prevalence of autosplenectomy and severity of SCDs, and spleen may act as a chronic inflammatory focus as a filter of blood for these abnormally hard RBCs.

Left renal atrophy.

BACKGROUND: We tried to understand whether or not there is a higher risk of left renal atrophy in human being. METHODS: All patients applying to the Hematology Service with any underlying complaint were studied. RESULTS: The study included 2,417 cases (1,248 females). The mean ages were 47.3 versus 50.7 years in females and males, respectively (p<0.000). There were 33 cases (1.3%) with the left renal atrophy against five cases (0.2%) with the right (p<0.001). The left renal atrophy cases have splenomegaly (SM) in 51.5%, thalassemia minors (TMs) in 30.3%, sickle cell diseases (SCDs) in 27.2%, myeloproliferative disorders in 18.1%, chronic lymphocytic leukemia in 6.0%, cirrhosis in 6.0%, solid organ malignancies in 6.0%, chronic obstructive pulmonary disease in 3.0%, multiple myeloma in 3.0%, and Waldenström's macroglobulinemia in 3.0%. Similarly, the right renal atrophy cases have SM in 20.0%, TMs in 40.0%, and SCDs in 20.0%. CONCLUSION: Left renal atrophy may be significantly higher than the right side in human being. Aortic pressure induced flow disorders in the left renal vein, structural anomalies of the left renal vein, and possibly the higher arterial pressure of the left kidney due to the shorter distance to the heart as an underlying cause of atherosclerosis may be some of the possible causes. Due to the stronger arterial wall protecting itself from compression and high prevalences of SM and left varicocele in population, SM induced flow disorders of the left renal vein may be the most common cause.

Sickle cell diseases and ileus.

BACKGROUND: We tried to understand whether or not there is an increased incidence of ileus in patients with sickle cell diseases (SCDs). METHODS: All cases with SCDs were taken into the study. RESULTS: The study included 325 patients (160 females). The mean ages were similar in both sexes (29.3 versus 29.8 years in females and males, respectively, p > 0.05). Incidence of ileus was higher in males, significantly (3.6% versus 1.2%, p < 0.01). All of the ileus cases were able to be treated with simple and repeated red blood cell (RBC) transfusions without any surgical procedure. Smoking was higher in males, too (21.8% versus 6.2%, p < 0.001). The mean hematocrit value was also higher in males, significantly (24.4% versus 23.0%, p = 0.016). RBC units transfused, digital clubbing, leg ulcers, pulmonary hypertension, chronic obstructive pulmonary disease, coronary heart disease, and chronic renal disease were all higher in males, too (p < 0.05 for all). On the other hand, although the general mortality, white blood cell and platelet counts of peripheric blood, painful crises per year, rheumatic heart disease, avascular necrosis of bone, cirrhosis, and stroke were all higher in males, the differences were nonsignificant probably due to the small sample sizes of the groups (p > 0.05 for all). CONCLUSION: Although the relatively young mean ages of the patients with SCDs, the very high incidences of ileus are probably due to the strong atherosclerotic and obstructive natures of the two pathologies, and ileus should be treated with simple and repeated RBC transfusions to restore bowel perfusion in such patients.

Acute chest syndrome in severity of sickle cell diseases.

BACKGROUND: Sickle cell diseases (SCDs) are chronic inflammatory processes on capillary level. We tried to understand whether or not there are some positive correlations between acute chest syndrome (ACS) and severity of SCDs. METHODS: All patients with the SCDs were taken into the study. RESULTS: The study included 337 cases (167 females). There were 15 patients (4.4%) with the ACS. The mean ages were similar in both groups (29.4 versus 29.7 years in the ACS group and other, respectively, P > 0.05). The female ratios were similar in both groups, too (60.0% versus 49.0%, respectively, P > 0.05). Additionally, prevalences of associated thalassemia minors were similar in them (66.6% versus 65.5%, respectively, P > 0.05). Smoking was higher in the ACS group (20.0% versus 13.9%), but the difference was nonsignificant (P > 0.05). Although the mean white blood cell count and hematocrit value of peripheric blood were higher in the ACS group, the mean platelet count was lower in them, but the differences were nonsignificant again (P > 0.05 for all). On the other hand, although the painful crises per year, tonsilectomy, priapism, ileus, digital clubbing, pulmonary hypertension, rheumatic heart disease, cirrhosis, stroke, and mortality were higher in the ACS group, the difference was only significant for the stroke (P < 0.05), probably due to the small sample size of the ACS group. CONCLUSION: SCDs are chronic destructive processes on capillaries iniatiating at birth, and terminate with early organ failures in life. Probably ACS is one of the terminal consequences of the inflammatory processes that may indicate shortened survival in such patients.

The significance of serum transferrin receptor levels in the diagnosis of the coexistence of anemia of chronic disease and iron deficiency anemia.

OBJECTIVE: Iron deficiency anemia is the most common cause of microcytic anemia throughout the world. Ferritin levels are good indicators of iron stores; however, levels may increase irrespective of iron stores in cases of chronic disease. Therefore, it is difficult to diagnose iron deficiency anemia coexisting with anemia of chronic disease. MATERIALS AND METHODS: To determine the level of transferrin receptor in subjects, 30 patients with iron deficiency anemia, 30 patients with anemia of chronic disease and 30 patients with both diseases were included in the study. RESULTS: Mean serum transferrin receptor levels were 5.99±2.98 mg/L in the iron deficiency anemia group, 1.90±1.15 mg/L in the anemia of chronic disease group and 3.07±0.90 mg/L in the combination group. Comparing groups with each other revealed significant differences (p<0.05). CONCLUSION: It is concluded that the assessment of serum transferrin receptor levels is a useful method for the diagnosis of iron deficiency anemia in patients.

Hereditary behavior of varicocele.

The inheritance of varicoceles and the potential transmission to first-degree relatives has rarely been investigated. In the present study, we examined the first-degree relatives of men with known varicocele to reveal the familial risk for varicocele. Of the patients with clinical varicocele who presented with infertility, testicular pain, or asymmetrical swelling of the scrotum between June 1, 2008 and May 31, 2009, 49 agreed to have their available first-degree relatives contacted for screening of varicoceles (n = 66). A cohort of 100 consecutive men who applied to the department of internal medicine between 2008 and 2009 for checkup procedure without a history of subfertility or a varicocele were used as a control population. Of the 92 first-degree relatives contacted, 66 (71.7%) decided to participate in this study. Of these 66 men, 21 (33.9%) had a palpable varicocele on physical examination. Compared with a control population (12%), the prevalence of palpable varicocele in the first-degree relatives of patients with known varicocele (33.9%) was approximately 3-fold greater (P < .005). Among the first-degree relatives, 4 (21.1%) of 19 fathers and 17 (36.2%) of 47 brothers had palpable varicocele. As a conclusion, a significant increase in varicocele prevalence is present in the first-degree relatives of men with known varicoceles. Patients should be counseled about this increased risk in male relatives of patients.

Irritable bowel syndrome and chronic gastritis, hemorrhoid, urolithiasis.

OBJECTIVE: Approximately 10-20% of the general population has irritable bowel syndrome (IBS), and IBS patients usually suffer from chronic gastritis (CG), hemorrhoids (H), and urolithiasis (U). MATERIAL AND METHODS: We randomly chose consecutive patients with upper abdominal discomfort. All possible causes of IBS including celiac sprue, giardiasis, lactose intolerance, and cholelithiasis were investigated. U was diagnosed either by medical history or as a result of laboratory findings. RESULTS: IBS patients (51) and patients without IBS (70) were studied. CG was diagnosed in 78.4% (40) of IBS cases, whereas this ratio was 50.0% (35) in cases without IBS (p<0.001). Similarly, H was detected in 33.3% (17) of IBS cases, but it was only detected in 15.7% (11) of cases without IBS (p<0.05). Additionally, U was detected in 17.6% (9) of IBS cases and in 5.7% (4) of cases without IBS (p<0.05). CONCLUSION: Relationships between IBS and CG, H, and U are significant. IBS is a cascade of many physiologic events that is initiated by infection, inflammation, and psychological disturbances like many stresses, and this eventually terminates with gut dysfunction. Gastric acid is probably not involved in the etiology of IBS, but psychological factors also seem to be important in CG. The significant association between CG and IBS also support this hypothesis. Therefore, we believe CG is one of terminating points of the physiologic cascade of events in IBS. Bearing these associations in mind will be helpful during prevention, treatment, and follow up of these disorders, especially in internal medicine, urology, and general surgery polyclinics and primary health centers.

Treatment of white coat hypertension with metformin.

White coat hypertension (WCH) is most likely a disorder associated with metabolic syndrome. The study was performed at the Internal Medicine Polyclinic of Dumlupinar University on routine check-up patients. WCH cases who were overweight or obese and desiring weight loss were divided into two subgroups according to whether they preferred to achieve weight loss by medication or diet therapy. The study included 324 cases (204 females) with WCH, 45 of whom were in normal weight range. Therefore, 86.1% (279) of cases with WCH were either overweight or obese, and 41.3% (134) of all WCH cases had dyslipidemia. Twenty-five cases (14.7%) stopped metformin therapy due to excessive anorexia. At the end of a 6-month period, there were highly significant differences between the two groups with respect to the prevalences of resolved WCH, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, overweight and obesity, and decreased fasting plasma glucose below 110 mg/dL (P < 0.001 for all). Due to gradually increased prevalences of impaired glucose tolerance, type 2 diabetes mellitus, dyslipidemia, excess body weight, and obesity-like disorders from sustained normotension towards WCH and hypertension (HT) cases, and very high prevalences of excess weight and dyslipidemia in the WCH group, WCH may be an associated disorder of metabolic syndrome rather than just being a predisposing factor of atherosclerosis or HT alone. Thus, the management of WCH should not focus solely on the regulation of blood pressure with antihypertensive medications, but rather on the prevention of future excess weight and various associated disorders, and metformin alone is an effective therapeutic option, most likely due to its powerful inhibitory effect on appetite.

White coat hypertension in definition of metabolic syndrome.

Although white coat hypertension (WCH) is believed to have an effect on health, there is no term defining WCH in metabolic syndrome. Consecutive patients 20 years old or older who underwent a check-up were included. The study included 1068 cases. The prevalences of hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, impaired glucose tolerance (IGT), and WCH were similar to excess weight in that they increased significantly until the seventh decade of life and decreased thereafter significantly (P < 0.05 in most steps). On the other hand, the prevalences of hypertension (HT), diabetes mellitus (DM), and coronary heart disease (CHD) always increased significantly with age without any decrease (P < 0.05 in most steps), indicating their irreversibility in contrast to the reversibility of excess weight, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, IGT, and WCH. Metabolic syndrome is a reversible progression step between health and irreversible final diseases terminating with increased mortality and disabilities. Thus, the definition of metabolic syndrome should include reversible metabolic risk factors such as excess weight (overweight and obesity), hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, IGT, and WCH, instead of irrevesible diseases such as DM, HT, CHD, and stroke that have already developed and require drug therapy. After development of one of the final metabolic diseases, the term metabolic syndrome probably loses most of its significance, since from that point on, nonpharmaceutical approaches such as lifestyle changes, diet, and exercise will provide little benefit to prevent development of the others, most likely due to the cumulative effects of the risk factors on body systems over a long period of time.

What is the relationship between white coat hypertension and dyslipidemia?

The prognostic significance of white coat hypertension (WCH) remains controversial. Consecutive patients (955 cases, 566 females) aged between 15 and 70 years were divided into 3 groups, those with sustained normotension (NT), WCH, and hypertension (HT), and the prevalences of obesity, impaired glucose tolerance (IGT) or type 2 diabetes mellitus (DM), coronary heart disease (CHD), and dyslipidemia were compared among the groups. Although the prevalences of all of the disorders showed significant progression from the sustained NT group towards the WCH and HT groups, the prevalence of dyslipidemia was significantly higher in the WCH group (P < 0.05 for all). Due to the gradually increased prevalences of obesity, IGT or DM, and CHD from the sustained NT group towards the WCH and HT groups and the highest prevalence of dyslipidemia in the WCH group, WCH should preferentially be accepted as an alarming sign of a deterioration in health rather than being a predisposing factor of HT or atherosclerosis alone. The significantly higher prevalence of dyslipidemia in the WCH group than in the HT group may be explained by the increased amount of adipose tissue in the HT cases, since the prevalence of obesity was the highest in the HT group. Thus, the high prevalence of WCH even in early decades may represent increased susceptibility to future weight gain, and dyslipidemia in patients with WCH may be a preliminary sign of obesity. Therefore, the management of WCH should focus on the prevention of dyslipidemia and excess weight gain.

Metformin and parameters of physical health.

BACKGROUND: The prevalence of excess weight, including overweight and obesity, is increasing with a high cost on health in society. METHODS: Consecutive cases with excess weight, aged between 50 and 70 years and desiring weight loss, were divided into two subgroups according to wishes of patients about whether they prefer medication or just a diet. Metformin at a daily dose of 2,550 mg was given to the medication group. RESULTS: As for the very high prevalences, 84.8% (313/369) of cases at or above the age of 50 years were overweight or obese, 67.2% (248/369) of them had white coat hypertension (WCH) or hypertension (HT), 52.5% (194/369) of them had impaired glucose tolerance (IGT) or diabetes mellitus (DM), and 68.8% (254/369) of them had dyslipidemia. Initially 143 cases with excess weight preferred the diet and 162 of them preferred the metformin therapy. But 42 cases (25.9%) stopped the drug because of excessive anorexia. At the end of the six-month period, there were highly significant differences between the two groups according to prevalences of resolved WCH, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, overweight, and obesity and a decreased fasting plasma glucose below 110 mg/dL (p<0.001 for all). CONCLUSION: Due to the very high prevalences of excess weight and probably many associated disorders with the excess weight, including IGT or DM, WCH or HT, and dyslipidemia, above the age of 50 years, and the detected significant benefits of metformin on all of the above parameters, metformin treatment should be initiated in patients with excess weight in their fifties.