Effects of Complement Regulators and Chemokine Receptors in Type 2 Diabetes.

CD55 and CD59 are complement regulatory proteins suggested to be related with progression of diabetes and its complications. The stromal cell-derived factor 1 (SDF-1) and C-X-C chemokine receptor type 4 (CXCR-4) are chemokine proteins. We aimed to investigate the relation of CD55 and CD59 expression levels and polymorphisms of SDF-1 and CXCR-4 with type 2 diabetes mellitus (T2DM) and its complications. Seventy-five T2DM patients and 73 controls were enrolled. Expression levels of CD55 and CD59 were measured by FACS Calibur; qRT-PCR was used to determine SDF-1 and CXCR-4 gene polymorphisms. CD55 and CD59 expressions in patients with nephropathy, retinopathy and cardiovascular disease were significantly lower than controls. Frequency of CXCR-4 T allele carrying was high in patients and created 1.6 fold risk for the disease (p = .07). CXCR-4 a allele carriers had decreased nephropathy; although there was no statistical significance in carrying CXCR-4 T allele, presence of nephropathy was approximately 2 times higher (p = .254). The nephropathy risk increased 10-fold in CXCR-4 TT genotype carriers (p = .02). All SDF-1 CC genotype carriers had retinopathy, so, it was considered that the CC genotype was effective in retinopathy development (p = .031). For the presence of cardiovascular disease, significant difference was observed for SDF-1 genotypes. Increased cardiovascular risk of 5- and 1.9-fold in SDF-1 T (p = .007) and CXCR-4 T (p = .216) allele carriers, respectively, was observed. We suggest that CD55 and CD59 protein levels and SDF-1 and CXCR-4 have predictive importance in process, complications and tendency of T2DM.

Cerebral venous thrombosis after high dose steroid in multiple sclerosis: a case report.

Cerebral venous thrombosis (CVT) is a clinical condition which is caused by the partial or complete occlusion of the dural sinuses and cerebral veins. Cases of associated CVT and multiple sclerosis (MS) have been reported and CVT development has been attributed to the previous lumbar puncture (LP) in majority of these cases. We report a case of 32-year-old woman with no previous history of recent LP, who developed CVT after high dose intravenous methylprednisolone and discuss the possible role of high dose steroids in development of CVT in MS patients.

Cervical vestibular evoked myogenic potentials to air-conducted sound in early amyotrophic lateral sclerosis.

OBJECTIVES: Cervical vestibular evoked myogenic potentials (cVEMPs) provide assessment of lower-brainstem lesions affecting their neuronal pathways. We aimed to determine whether cVEMPs to air-conducted sound (ACS) are also abnormal in patients with early stages of amyotrophic lateral sclerosis (ALS), with or without bulbar involvement. METHODS: cVEMPs were recorded in 22 ALS patients and 23 age- and sex-matched healthy volunteers. Their latencies and amplitudes were compared between the ALS patients and the control group. RESULTS: cVEMPs were obtained in all ALS patients and controls. P(13) and N(23) latencies and P(13)-N(23) amplitudes did not significantly differ between controls and ALS patients, either with or without bulbar involvement. CONCLUSIONS: We postulate that the ACS-cVEMP neural pathway is not affected in patients with early stages of ALS, even with clinical findings of bulbar involvement. Therefore, ACS-cVEMP is not a sensitive diagnostic tool for early detection of brainstem involvement in patients with ALS.

Non-convulsive status epilepticus secondary to valproic acid-induced hyperammonemic encephalopathy.

BACKGROUND: Valproic acid (VPA) may induce hyperammonemic encephalopathy. On the other hand, seizure-inducing effects of antiepileptic drugs (AEDs) may be a paradoxical reaction or a result of AED-induced encephalopathy (commonly induced by VPA). METHODS: We present the case of a 19-year-old male who developed acute mental status changes consistent with encephalopathy evolving into repetitive seizures with oral automatisms induced by relatively small doses of VPA. RESULTS: Although serum hepatic enzymes, such as AST and ALT, were normal, serum ammonia concentration was high, i.e. 70 micromol/l (normal range 9-33 micromol/l). Administration of VPA was discontinued immediately after admission. The patient's condition improved during the second week of hospitalization and ammonium levels returned to normal. CONCLUSION: In conclusion, although uncommon, a possible induction of non-convulsive status epilepticus by valproate-induced hyperammonemic encephalopathy should be taken into account and properly managed by discontinuation of the drug.

Local cold effect on the excitability recovery curve of the sympathetic skin response.

The sympathetic skin response (SSR) is an established technique used to assess the activity of the sympathetic sudomotor pathway, but it is limited in application by the habituation process. The nature of habituation is not clear. In this study we aimed to further understand the role of the peripheral mechanism in the habituation of the SSR. We recorded SSRs to paired stimuli with interstimulus intervals of 1, 2, 3, 4 and 5 seconds on both hands of 15 volunteers simultaneously, while the right hand was cooled to 23-24 degrees C and the left hand was between 32 and 33 degrees C. The amplitude and latency generated by the first stimulus (SSR1) and the second stimulus (SSR2) were measured. While SSR2 first occurred at ISI 2 in 7 subjects and ISI 3 in 8 subjects on the normal side, SSR2 first occurred at ISI 4 in 7 subjects and ISI 3 in 8 subjects on the cooled side. The SSR amplitude recovery percentage, which was obtained by dividing the amplitude of SSR2 by the amplitude of SSR1, was significantly different on the cooled side. No significant differences were found between SSR1 and SSR2 latencies, which were measured at ISI 3, 4 and 5 on the normal side and at ISI 5 on the cooled side. Our findings further support that a peripheral component might be involved in the modification and habituation of the SSR in terms of amplitude, but not of latency.