Protective effect of melatonin on blood-brain barrier damage caused by Endotoxemia.

OBJECTIVE: Endotoxins, products of Gram-negative bacteria, are the primary cause of blood-brain barrier (BBB) damage. In the present study, we aimed to investigate the possible neuroprotection mechanisms of melatonin on BBB damage induced by endotoxemia. METHODS: Adult, female Sprague-Dawley rats (n = 42) were separated into four random groups as a control group and three treatment groups. Lipopolysaccharide (7,5 mg/kg/day) was administrated for a single dose to generate a 24-hour sepsis model on rats. Melatonin (10 mg/kg/day) was treated a week before sepsis. Afterward, the dissected brain tissues were examined by histopathological, biochemical, and molecular analyses. RESULTS: LPS caused weight loss in the groups. As a result, degenerated neurons with cytoplasmic vacuoles and irregular pyknotic nuclei, pale stained necrotic neurons, and vascular congestion were observed in LPS-exposed rats. However, MEL decreased the number of degenerated neurons in treated groups. MEL treatment increased ZO1 and Occludin immunoreactivity while decreasing TLR4 in brain tissues. MEL effect on protein expression was recorded for ZO1 increase and TLR4 decrease in brain tissue compared to LPS groups. MEL also decreased MDA levels in brain tissue. CONCLUSIONS: MEL recovered the degenerative damage of sepsis by contributing to blood-brain barrier integrity, and by decreasing inflammation, thus the neuroprotective effects of MEL might provide an experimental basis for clinical applications.

In-hospital outcomes of patients undergoing emergent surgical treatment in patients with infective endocarditis.

BACKGROUND: Infective endocarditis is a serious heart disease that may cause several different clinical conditions and can need urgent surgical therapy. In our study, we aimed to evaluate the patients with infective endocarditis undergoing acute surgical treatment results in-hospital mortality. METHODS: A total of 107 consecutive patients with infective endocarditis undergoing acute surgical therapy were included in our retrospective study. The patients were divided into two groups according to the presence of in-hospital mortality as Group 1 without in-hospital mortality (n=89) and Group 2 with in-hospital mortality (n=18). The demographic, laboratory, and clinical parameters were evaluated in both groups. RESULTS: The mean age (50±14; 64±14, P<0.001) and the incidence of chronic renal failure (9 [10.1%]; 8 [44.4%], P=0.001) were higher in Group 2 while the ejection fraction was lower in Group 2 (50.0±9.3; 44.6±12.9, P=0.039). The incidence of positive blood culture was also higher in Group 2 (41 [46.1]; 14 [77.8], P=0.014). Aortic bioprosthesis operation (2 [2.2]; 6 [33.3], P<0.001) and mitral bioprosthesis operation (4 [4.5]; 5 [27.8], P=0.008) were higher in Group 2 as well as the incidence of septic shock was also higher in Group 2 (1 [1.1]; 3 [16.7], P=0.015). In addition, in multivariate logistic regression analyses, advanced age (odds ratio [OR]: 1.068, 95% confidence interval [CI]: 1.009-1.130, P: 0.024) and positive blood culture (OR: 4.436, 95% CI: 1.044-18.848, P: 0.044) were found to be independent predictors of in-hospital mortality. CONCLUSION: Advanced age, lower ejection fraction, high creatinine, positive blood culture, high systolic pulmonary artery pressure, and septic shock predicted in-hospital death in patients who have undergone emergent or urgent surgery due to infective endocarditis.

Biologic treatments in Takayasu's Arteritis: A comparative study of tumor necrosis factor inhibitors and tocilizumab.

OBJECTIVE: To compare the treatment outcomes of TNF inhibitors and tocilizumab (TCZ) in patients with Takayasu arteritis. METHODS: Takayasu arteritis patients who were refractory to conventional immunosuppressive (IS) drugs and received biologic treatment were included in this multicenter retrospective cohort study. Clinical, laboratory and imaging data during follow-up were recorded. Remission, glucocorticoid (GC) sparing effect, drug survival was compared between TNF inhibitor and TCZ treatments. Also, a subgroup matched comparison was performed between groups. RESULTS: One hundred and eleven (F/M: 98/13) patients were enrolled. A total of 173 biologic treatment courses (77 infliximab, 49 TCZ, 33 adalimumab, 9 certolizumab, 3 rituximab, 1 ustekinumab and 1 anakinra) were given. Tocilizumab was chosen in 23 patients and TNF inhibitors were chosen in 88 patients as first-line biologic agent. Complete/partial remission rates between TCZ and TNF inhibitors were similar at 3rd month and at the end of the follow-up. GC dose decrease (≤4 mg) or discontinuation of GCs was achieved in a similar rate in both groups (TNF inhibitors vs TCZ: 78% vs 59%, p = 0.125). Drug survival rate was 56% in TNF inhibitors and 57% in TCZ group (p = 0.22). The use of concomitant conventional ISs did not affect the drug survival (HR =0.78, 95% CI =0.42-1.43, p = 0.42). The match analysis showed similar results between groups in terms of relapse, decrease in GC dose, surgery need and mortality. CONCLUSION: The efficacy and safety outcomes and drug survival rates seem to be similar for TNF inhibitors and tocilizumab in patients with Takayasu arteritis.

The Compatibility of Hemoglobin A1c with Oral Glucose Tolerance Test and Fasting Plasma Glucose.

OBJECTIVES: Diabetes mellitus (DM) is a chronic metabolic disease requiring lifelong medical care, and its prevalence is increasing worldwide. Early diagnosis of prediabetes and diabetes is significant in view of the mortality, morbidity and cost associated with them. Because of the difficulties in application and reproducibility of oral glucose tolerance test (OGTT), which is considered to be the gold standard in the diagnosis of DM, more feasible diagnostic tests are needed. This study aims to evaluate the validity of hemoglobin A1c (HbA1c) in predicting prediabetes and diabetes in the Turkish population and to evaluate the compatibility of HbA1c with other diagnostic tests. METHODS: The patients who were admitted to Health Sciences University Sisli Hamidiye Etfal Training and Research Hospital internal diseases and endocrinology outpatient clinics between 01.01.2013 and 30.06.2014 enrolled in this study. The participants were >18 years of age and were not diagnosed with prediabetes or DM earlier. The results of OGTT, fasting plasma glucose (FPG) and HbA1c tests were retrospectively screened, and the correlation of them was analyzed. RESULTS: In this study, 201 participants enrolled. Of these cases, 127 were women and 74 were men. Mean age of the group was 49.3±10.4 years. HbA1c was observed <5.7% in the 15%, 5.7-6.4% in the 60%, and ≥ 6.5% in the 25% of the cases. While FPG was <100 mg/dL in 24% of the participants, it was found to be between 100-126 mg/dL in 71% and ≥126 mg/dL in 5% of the participants. According to the OGTT data, 23% of the cases were healthy, 59% were prediabetic and 18% were diabetic. The sensitivity and specificity of HbA1c were calculated as 50% and 80%, respectively. While the sensitivity of FPG was 17% and specificity was 97%. CONCLUSION: The data obtained from our study show that HbA1c is a more sensitive test compared to FPG in the diagnosis of DM. Prospective studies with broad participation at national and international levels are needed to redefine HbA1c cut-off points for the diagnosis of DM and prediabetes. Thus, it will be possible to revise the diagnostic guidelines accordingly.

Determining INR Awareness of the Patients who Use Warfarin and Rates of Achieving the Target Dosage.

OBJECTIVES: Warfarin is the most frequently used therapy as an oral anticoagulant medication for reducing the risk of thromboembolic complications. However, poor adherence to therapy may cause ineffective INR levels with increased complication risk. In our study, we aimed to show the rates of INR awareness of patients with atrial fibrillation (AF) using warfarin and whether they achieved the targeted INR values. METHODS: In this study, 300 male (60%, n=180) and female (40%, n=120) patients over 18 years of age who applied to warfarin polyclinic and were receiving warfarin treatment due to AF were included. The levels of INR between 2-3 were estimated as effective. Same questionnaire was applied to all patients. RESULTS: Our study showed that 57% of the patients who used warfarin were not in the therapeutic range. We also determined that INR awareness was extremely low in the majority of the patients. In this study, 72.2% of the patients who used warfarin did not know the definition of INR, 68% of the patients did not know the side effects of the medicine, 75.7% of the patients did not know the precautions needed to be taken in daily life and 83.7% of the patients did not know the foods rich in vitamin K. Patients who knew the meaning of INR were more likely have INR levels in the effective range, but these rates were not statistically significant. There was no statistically significant relationship between the educational level, marital status, and INR control frequency of the patients with the achievement of targeted INR levels. CONCLUSION: At the beginning of the warfarin treatment, advantages and disadvantages should be balanced by the doctor. The patient and patient's relatives should be informed directly and comprehensibly about the effects and side effects of the medicine, as well as the interactions, pursuance and precautions need to be taken in daily life. Various modern methods should be enabled for surveillance and the patients who are not in the therapeutic range should be followed closer.

Increased Arterial Stiffness Measured By Carotid Femoral (Aortic) Pulse Wave Velocity In Patients with Inactive Behçet's Disease.

Introduction Behçet's disease (BD) is a chronic, multisystemic disease characterised by vascular involvement. Acute and chronic inflammatory processes associated with BD may cause endothelial dysfunction, which can then lead to a subsequent increase of arterial stiffness and altered pressure wave reflections. The aim of this study was to evaluate the pulse wave velocity (PWV) measurements in patients with inactive BD and control subjects.Methods We studied 50 patients with inactive BD and 49 healthy control subjects without known cardiovascular disease. Carotid-femoral PWV was determined in all subjects by the same expert research clinician using Complior device (Colson, Paris, France).Results Mean disease duration was 3.23±2.31 years. Patients with BD (mean age 36.04±9.94 years) had significantly higher PWV levels compared to controls (9.57±1.88 vs. 8.47±1.13 m / s; p=0,003). PWV was found to be positively correlated with age, systolic, diastolic, mean blood pressure, waist, and waist / hip ratio.Conclusion In our study we demonstrated that patients with BD exhibit significantly increased arterial stiffness assessed by increased carotid-femoral PWV compared to healthy control subjects.

Adropin and Irisin in Patients with Cardiac Cachexia.

BACKGROUND: Cardiac cachexia is an important predictive factor of the reduction in survival of patients with heart failure with reduced ejection fraction. OBJECTIVES: The aims of the present study were to evaluate adropin and irisin levels in cachectic and non-cachectic subjects and the relationships between the levels of these proteins and clinical and laboratory parameters in patients with HFrEF. METHODS: The clinical records of patients who were admitted to the cardiology outpatient clinic for heart failure with reduced ejection fraction were screened. Cachectic patients were identified and assigned to the study group (n = 44, mean age, 65.4 ± 11.2 y; 61.4% men). Heart failure with reduced ejection fraction patients without weight loss were enrolled as the control group (n = 42, mean age, 61.0 ± 16.5 y; 64.3% men). The serum adropin and irisin levels of all patients were measured. A p-value < 0.05 was considered significant. RESULTS: Serum adropin and irisin levels were significantly higher in the cachexia group than in the controls (Adropin (ng/L); 286.1 (231.3-404.0) vs 213.7 (203.1-251.3); p < 0.001, Irisin (µg/mL); 2.6 (2.2-4.4) vs 2.1 (1.8-2.4); p = 0.001). Serum adropin and irisin levels were positively correlated with brain natriuretic peptide (BNP) levels and New York Heart Association (NYHA) class and negatively correlated with body mass index (BMI) and serum albumin levels (all p values: < 0.001). In a multivariate analysis, adropin was the only independent predictor of cachexia in the heart failure with reduced ejection fraction patients (OR: 1.021; 95% CI: 1.004-1.038; p = 0.017). CONCLUSIONS: The results suggest that adropin and irisin may be novel markers of cardiac cachexia in heart failure with reduced ejection fraction patients. Adropin and irisin are related with the severity of heart failure.

Adropin and Irisin in Patients with Cardiac Cachexia / Adropina e Irisina em Pacientes com Caquexia Cardíaca

Abstract Background: Cardiac cachexia is an important predictive factor of the reduction in survival of patients with heart failure with reduced ejection fraction. Objectives: The aims of the present study were to evaluate adropin and irisin levels in cachectic and non-cachectic subjects and the relationships between the levels of these proteins and clinical and laboratory parameters in patients with HFrEF. Methods: The clinical records of patients who were admitted to the cardiology outpatient clinic for heart failure with reduced ejection fraction were screened. Cachectic patients were identified and assigned to the study group (n = 44, mean age, 65.4 ± 11.2 y; 61.4% men). Heart failure with reduced ejection fraction patients without weight loss were enrolled as the control group (n = 42, mean age, 61.0 ± 16.5 y; 64.3% men). The serum adropin and irisin levels of all patients were measured. A p-value < 0.05 was considered significant. Results: Serum adropin and irisin levels were significantly higher in the cachexia group than in the controls (Adropin (ng/L); 286.1 (231.3-404.0) vs 213.7 (203.1-251.3); p < 0.001, Irisin (µg/mL); 2.6 (2.2-4.4) vs 2.1 (1.8-2.4); p = 0.001). Serum adropin and irisin levels were positively correlated with brain natriuretic peptide (BNP) levels and New York Heart Association (NYHA) class and negatively correlated with body mass index (BMI) and serum albumin levels (all p values: < 0.001). In a multivariate analysis, adropin was the only independent predictor of cachexia in the heart failure with reduced ejection fraction patients (OR: 1.021; 95% CI: 1.004−1.038; p = 0.017). Conclusions: The results suggest that adropin and irisin may be novel markers of cardiac cachexia in heart failure with reduced ejection fraction patients. Adropin and irisin are related with the severity of heart failure.

Resumo Fundamento: A caquexia cardíaca é um importante preditor de redução de sobrevida em pacientes com insuficiência cardíaca com fração de ejeção reduzida (ICFER). O objetivo deste estudo foi avaliar os níveis de adropina e irisina em pacientes com ICFER caquéticos e não caquéticos, assim como a relação entre os níveis dessas proteínas e os parâmetros clínicos e laboratoriais nesses pacientes. Objetivos: Os objetivos do presente estudo foram avaliar os níveis de adropina e irisina em indivíduos caquéticos e não caquéticos e as relações entre os níveis dessas proteínas e os parâmetros clínicos e laboratoriais em pacientes com ICFEN. Métodos: Os prontuários de pacientes atendidos no ambulatório de cardiologia para ICFER foram triados. Aqueles com ICFER caquéticos foram identificados e constituíram o grupo de estudo (n = 44; idade média, 65,4 ± 11,2 anos; 61,4% de homens). Aqueles com ICFER e sem perda de peso foram arrolados como grupo controle (n = 42; idade média, 61,0 ± 16,5 anos; 64,3% de homens). Os níveis séricos de adropina e irisina de todos os pacientes foram medidos. Considerou-se significativo um p-valor < 0,05. Resultados: Os níveis séricos de adropina e irisina foram significativamente mais altos nos pacientes caquéticos do que nos controles [adropina (ng/l): 286,1 (231,3-404,0) vs 213,7 (203,1-251,3); p < 0,001; irisina (µg/ml): 2,6 (2,2-4,4) vs 2,1 (1,8-2,4); p = 0,001]. Os níveis séricos de adropina e irisina correlacionaram-se positivamente com os níveis de peptídeo natriurético cerebral (BNP) e a classe funcional da New York Heart Association (NYHA), e negativamente com o índice de massa corporal (IMC) e os níveis séricos de albumina (todos os p-valores: < 0,001). Na análise multivariada, a adropina foi o único preditor independente de caquexia nos pacientes com ICFER (OR: 1,021; IC 95%: 1,004−1,038; p = 0,017). Conclusões: Os resultados sugerem que a adropina e a irisina possam ser novos marcadores de caquexia cardíaca em pacientes com ICFER. Adropina e irisina estão relacionadas com a gravidade da insuficiência cardíaca.

Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients.

OBJECTIVE: It is reported that eating disorders and depression are more common in patients with type 2 diabetes mellitus (T2DM). In this study, we aimed to determine the prevalence of binge eating disorder (BED) in T2DM patients and examine the correlation of BED with level of depression and glycemic control. METHOD: One hundred fifty-two T2DM patients aged between 18 and 75 years (81 females, 71 males) were evaluated via a Structured Clinical Interview for DSM-IV Axis I Disorder, Clinical Version in terms of eating disorders. Disordered eating attitudes were determined using the Eating Attitudes Test (EAT) and level of depression was determined using the Beck Depression Scale. Patients who have BED and patients who do not were compared in terms of age, gender, body mass index, glycosylated hemoglobin (HbA1c) levels, depression and EAT scores. RESULTS: Eight of the patients included in the study (5.26%) were diagnosed with BED. In patients diagnosed with BED, depression and EAT scores were significantly high (P<.05). A positive correlation was found between EAT scores and depression scores (r = +0.196, P<.05). No significant difference was found in HbA1c levels between patients with BED and those without (P<.05). CONCLUSIONS: T2DM patients should be examined in terms of the presence of BED and disordered eating attitudes. Psychiatric treatments should be organized for patients diagnosed with BED by taking into consideration comorbid depression.

Thoracic primitive neuroectodermal tumor: an unusual case and literature review.

We describe herein a rare case of a primary primitive neuroectodermal tumor (PNET) in the mediastinum of a 75-year-old man. Grossly, the tumor was located in the left upper anterior mediastinum. Transcutaneous fine-needle biopsy (TCNB) revealed small round-cell proliferation. The expression immunohistochemical analysis was confirmed the diagnosis of PNET. He was successfully treated with chemotherapy and is alive with no sign of recurrence for 17 months after the diagnosis.