Subclinical Hypothyroidism Increases the Requirement of Renal Replacement Therapy After Cardiac Surgery.

BACKGROUND: Subclinical or biochemically diagnosed hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4) levels. Thyroid hormones play a major role in the normal function of the heart and vascular physiology. Atherosclerosis, increased systemic vascular resistance, and decreased arterial compliance are common pathophysiological changes that may occur in hypothyroidism. Acute kidney injury (AKI) is one of the devastating complications after cardiac surgery. Age, diabetes mellitus (DM), preexisting renal dysfunction, hypertension, impaired left ventricular function, and severe arteriosclerosis are the major risk factors for the development of AKI. The purpose of the current study was to analyze the influence of SCH on AKI and the requirement of renal replacement therapy (RRT) after isolated coronary artery bypass graft surgery (CABG). METHODS: We retrospectively reviewed the prospectively collected data of 336 adult patients who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value <1.4 mg/dL) from January 2017 to January 2019. The patients were divided into two groups either having the diagnosis of SCH (Group I, N = 47) or not (Group II, N = 289). SCH was diagnosed based on preoperative serum TSH and FT4 levels. Kidney injury was interpreted, according to RIFLE classification. The effect of SCH on AKI and the need for RRT after CABG was determined using logistic regression analysis and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A P value < .05 was considered statistically significant. RESULTS: Subclinical hypothyroidism was diagnosed in 14% of all patients. Postoperative AKI occurred in 15 patients (31.9%) in Group I, whereas there were 42 patients (14.5%) in Group II. On logistic regression analysis, the presence of SCH was shown to be associated with an increased incidence of postoperative AKI (OR, 0.363; 95% CI, 0.181-0.727; P = .004). RRT was used in 2.97% of patients (seven patients in Group I and three patients in Group II, P < .001). The 30-day mortality was 2.1%. CONCLUSION: The presence of SCH seems to be associated with an increased incidence of AKI and increased requirement for RRT after cardiac surgery.

Melanocortin-4 receptor gene polymorphisms in obese patients.

Obesity is a complex disease caused by both genetics and environmental factors. Melanocortin-4 receptor (MC4R) (MIM 155541) gene polymorphisms were reported to be the cause of monogenic obesity in humans. We studied three polymorphisms (Val50Met, Val103Ile, and Ser58Cys) and a mutation (Asn274Ser) of the MC4R gene in 203 obese patients and in 110 healthy subjects in the Turkish population. A high incidence of Val103Ile and Val50Met polymorphisms as well as the Asn274Ser mutation was found in the obese patients, whereas no significant correlation was found regarding the Ser58Cys polymorphism. We conclude that there is a concordance between the polymorphisms (Val103Ile, Val50Met, Ser58Cys) that were first studied in the Turkish population with obesity.

Diffuse plane xanthomatosis in a patient with Budd-Chiari syndrome and monoclonal gammopathy.

Diffuse plane xanthomas are characterized by the presence of yellowish plaques on the eyelids, neck, upper trunk, buttocks, and flexural folds. Histology shows foamy histiocytes in the dermis. Approximately half of the cases are associated with lymphoproliferative disorders. Budd-Chiari syndrome is an uncommon condition induced by thrombotic or nonthrombotic obstruction of hepatic venous outflow. We present a case of diffuse plane xanthoma in a 62-year-old man who developed normolipemic plane xanthomas coinciding with Budd-Chiari syndrome and monoclonal gammopathy. We review the English-language literature regarding the rare association of xanthomas and Budd-Chiari syndrome.

Risk factors and correlates of snoring and observed apnea.

BACKGROUND AND PURPOSE: Risk factors and correlates of snoring and observed apnea in the population are not well known. This study aimed to assess risk factors and correlates of snoring and observed apnea. METHODS: Parents and grandparents of students from 20 randomly selected primary schools in urban and rural areas of Kirikkale, Turkey were asked about respiratory diseases, psychological distress and sleep-related disorders, using the Respiratory Questionnaire, Hospital Anxiety and Depression (HAD) scale and Sleep Questionnaire, respectively, which were returned by their children. RESULTS: Out of 13,225 parents and grandparents of primary school students 12,270 returned the questionnaires, for an overall response rate of 92.7%. Snoring and the observed apnea were more prevalent among subjects from rural than those from urban areas (52.6% vs. 46.6%, odds ratio (OR): 1.2, p<0.001 and 16.2% vs. 10.1%, OR: 1.7, p<0.001, respectively). Exposure to biomass smoke and smoking were associated with an increased risk of snoring and observed apnea, after adjusting for gender, age, body mass index, income and education in the multivariate linear model. In all subjects, increases in performance ability, daytime sleepiness, psychological distress and dyspnea scores observed in categories indicating increases in snoring intensity and observed apnea frequency constituted a trend but did always not reach statistical significance. Lastly, prevalence of traffic accidents, falling asleep at the wheel and morning headaches increased with the increments of snoring intensity and apnea frequency. CONCLUSIONS: Exposure to biomass smoke in rural areas may account for the higher prevalence of snoring and observed apnea. Snoring intensity and observed apnea frequency may increase prevalence of traffic accidents along with many unfavorable symptoms.

Prevalence of occult hepatitis B and hepatitis C virus infections in Turkish hemodialysis patients.

BACKGROUND AND OBJECTIVE: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important causes of morbidity and mortality in maintenance hemodialysis patients. Although their exact prevalence is not known, HBV and HCV viral infections and occult viral hepatitis are frequent in these patients. This study aimed to determine the prevalence of occult HBV and HCV infections in maintenance hemodialysis patients. MATERIALS AND METHODS: One hundred and eighty-eight end-stage renal disease patients on maintenance hemodialysis (100 male, mean age 49+/-29 [16-80] years, and mean duration of hemodialysis 98+/-66 [12-228] months) were enrolled in this study. Serological markers for HBV and HCV were determined with immunoenzymatic assay (ELISA) by using commercial diagnostic kits (Access and BioRad, Beckman-Coulter). HCV-RNA (Cobas Amplicor HCV kit) and HBV-DNA (Artus GmbH HBV kit) were determined quantitatively by polymerase chain reaction. RESULTS: Among the patients screened, 25 (13.3%) had HBV infection alone and 38 (20.2%) had HCV infection alone, while seven (3.7%) had dual infection of both viruses. Serological markers for occult hepatitis B and occult hepatitis C were positive in five (2.7%) and nine (4.8%) of the patients, respectively. Isolated anti-HBc was positive in 12 (6.4%) of all patients, three (7.9%) of the patients with anti-HCV and two (40%) of the patients with occult hepatitis B. Isolated anti-HBc positivity was more frequent in patients with occult hepatitis B than in those without (40% [2/5] vs. 5.5% [10/183], p=0.002). None of the patients with HCV had occult hepatitis B. CONCLUSIONS: Both occult and non-occult forms of HCV infection are more prevalent than HBV infection in hemodialysis patients. Especially the patients with isolated anti-HBc positivity should be tested for probable occult hepatitis B infection.

Predictive value of grip strength for bone mineral density in males: site specific or systemic?

This study aimed to investigate the predictive role of grip strength on bone mineral density (BMD) of different sites in males. Two hundred thirty-four male patients were included in the study. BMD of lumbar spine, femoral neck, proximal radius-ulna (PRU) and distal radius-ulna (DRU) sites were measured by dual-energy X-ray absorptiometry and grip strength by using a hand dynamometer. Grip strength and BMD values of PRU and DRU at forearms were significantly higher on the dominant sides (P = 0.001, P = 0.001, P = 0.001, respectively). Stepwise linear regression analysis revealed that only the grip strength of the same side was the best predictor of the BMD of the dominant and non-dominant PRU with a ratio of 8.5 and 10.2%, respectively, whereas grip strength of the same side, age and weight were the best predictors of the BMD of the dominant and non-dominant DRU with a ratio of 25 and 24.6%, respectively. There was no predictive value of grip strength for BMD of lumbar spine and femoral neck. In conclusion, grip strength appears to be predictive of site specific rather than systemic BMD.

Perception of dyspnea during exacerbation and histamine-related bronchoconstriction in patients with asthma.

BACKGROUND: Numerous studies have been performed concerning the perception of dyspnea during changes in airway caliber provoked in the laboratory setting, but studies of asthma exacerbation are scarce. OBJECTIVE: To investigate whether the perception of dyspnea during histamine-induced bronchoconstriction might be used to identify patients with asthma who sense dyspnea poorly during exacerbation. METHODS: The perception of dyspnea in 50 patients (45 female, 5 male) with asthma was evaluated at admission with exacerbation and during a stable period. Perceived intensity of dyspnea was estimated using a modified Borg scale. The perception of dyspnea in the stable period 4 to 6 weeks after exacerbation was measured with the histamine challenge test. Perception parameters were defined as the change in Borg score divided by the change in forced expiratory volume in 1 second (FEV1) as a percentage of the baseline FEV1 (deltaBorg/deltaFEV1) and as the Borg score at 20% decrease (PS20Histamine) or increase (PS20Exacerbation) in FEV1. RESULTS: The perception of dyspnea during asthma exacerbation was unrelated to the perception of dyspnea during histamine-induced bronchoconstriction (for deltaBorg/deltaFEV1, beta = .08, P = .50; for PS20, beta = -.11, P = .40). The kappa value for the agreement of poor perceivers at exacerbation and during the stable period was -0.21 (P = .10). However, the intensity of dyspnea caused by histamine-induced bronchoconstriction was lower than that caused by asthma exacerbation (PS20: 1.6 +/- 1.1 vs 2.8 +/- 2.5, respectively, P = .004; deltaBorg/deltaFEV1: 0.08 +/- 0.05 vs 0.21 +/- 0.28, respectively, P = .001). CONCLUSION: The perception of dyspnea during asthma exacerbation is not correlated with the perception of dyspnea during histamine-induced bronchoconstriction. Therefore, the perception of dyspnea during histamine-induced bronchoconstriction cannot be used to identify the asthmatic patients who perceive dyspnea poorly.

High-resolution computed tomography findings in elderly patients with asthma.

OBJECTIVE: Based on the hypothesis that airway remodelling is related to the duration of asthma, HRCT scanning should show greater abnormalities in the early-onset than the late-onset asthmatics. It was, therefore, intended to assess the presence and the frequency of airway and parenchymal abnormalities with high-resolution computed tomography (HRCT) in elderly asthmatic patients, and to determine whether these abnormalities are related to the duration of asthma. PATIENTS AND METHODS: Sixty-eight clinically stable asthmatic patients aged > or =60 yr were included in this prospective study. The patients were separated into two groups according to the duration of symptoms as late-onset asthma (n=31) with disease duration of <5 yr, and early-onset asthma (n=37) with disease duration of > or =5 yr. All patients were lifelong non-smoker and had been using inhaled beta agonists and inhaled steroids. HRCT-scanning and histamine inhalation test were performed on all patients. RESULTS: In comparison with late-onset asthmatic patients, those with early-onset asthma had significantly higher frequency of emphysema (21.6% versus 0.0%, p=0.006), bronchial dilatation (13.9% versus 0.0%, p=0.03) and bronchial wall thickness (41.7% versus 12.9%, p=0.01). Multiple logistic regression analysis identified that early-onset of disease was an independent risk factor for the presence of irreversible HRCT-scan abnormalities in elderly asthmatics [odds ratio (OR): 9.4 (2.7-32.7), p=0.00001]. CONCLUSION: Present data suggest that HRCT abnormalities in early-onset elderly asthmatics reflect parenchymal and airway changes that become irreversible throughout the long course of the disease.

Negative mood and quality of life in patients with asthma.

The aim of this study was to evaluate the effect of negative mood states at the moment of questionnaire, and other patient and disease characteristics on quality of life (QoL) in patients with asthma. The study groups were composed of 116 stable adult asthmatic patients and 116 age and sex matched healthy subjects. We used Short-Form Health Survey-36 (SF-36) for the assessment of general QoL in all participants, and the Asthma Quality of Life Questionnaire (AQLQ) for the assessment of disease specific QoL in patients with asthma. We evaluated negative mood in all subjects with a questionnaire including six mood subscales in three categories (nervous-anxious, hostile-angry and fearful-panicky). Negative mood scores were not different between asthmatic and comparison groups (p=0.4), but both SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were significantly lower in asthmatic group (p=0.003 and p=0.001, respectively). Multiple linear regression analysis in all study population indicated that both reduced PCS and MCS scores of SF-36 were associated with negative mood score (beta=-0.28, p<0.001 and beta=-0.37, p<0.001, respectively) and with FEV(1)% (beta=0.19, p=0.001 and beta=0.25, p<0.001, respectively) after adjusting for age, female sex, and the presence of asthma. On the other hand, multiple linear regression analysis in patients with asthma revealed that negative mood score and disease severity score were significant predictors for overall score of AQLQ after adjusting for other patient and disease characteristics (beta=-0.17, p=0.008 and beta=-0.64, p<0.001, respectively). The level of negative mood and disease severity in asthmatics significantly impair QoL. Thus, considering that one of the main objectives of health care should be preserving a satisfactory QoL in asthmatics, the presence and seriousness of negative mood and their effects on QoL should be taken into account as part of the clinical evaluation in asthmatics.

Familial Mediterranean fever and ankylosing spondylitis in a patient with juvenile idiopathic arthritis: A case report and review of the literature.

The association of familial Mediterranean fever (FMF) with juvenile idiopathic arthritis (JIA) or ankylosing spondylitis (AS), most commonly with negative HLA-B27 antigen, was described in several previous reports, although the pathogenic mechanism of this association still remains unknown. Herein we report an uncommon association of FMF with HLA-B27 positive AS as an occasional coincidence in a patient who had been diagnosed as having JIA 23 years previously.

Association of asthma-related symptoms with snoring and apnea and effect on health-related quality of life.

OBJECTIVES: This study aimed to investigate the association of asthma-related symptoms with snoring and apnea, and to assess their effects on health-related quality of life (HRQL). DESIGN: Population-based cross-sectional study. SUBJECTS AND METHODS: A total of 10,224 parents and grandparents of students from 14 randomly selected primary schools in city center were asked to answer questionnaires sent by their children. All subjects were questioned for asthma-related symptoms, sleep-related disorders (snoring and apnea), and for HRQL using the Respiratory Questionnaire, Sleep and Health Questionnaire, and Short Form-12 (SF-12) Health Survey, respectively. RESULTS: The overall response rate to questionnaires was 97.7%, and all analysis was performed on 7,469 subjects (3,920 women and 3,549 men) who provided sufficient responses to questions. There were 2,713 subjects who reported asthma-related symptoms. The snoring and the observed apnea were more prevalent in subjects with asthma-related symptoms (54.0% vs 41.4%; odds ratio [OR], 1.7; 95% confidence interval [CI], 1.5 to 1.8; p < 0.001) than those without asthma-related symptoms (16.7% vs 7.0%; OR, 2.7; 95% CI, 2.3 to 3.1; p < 0.001), respectively. Asthma-related symptoms were found to be associated with snoring (OR, 1.5; 95% CI, 1.3 to 1.6; p < 0.001) and observed apnea (OR, 2.2; 95% CI, 1.8 to 2.5; p < 0.001) after adjusting for gender, age, body mass index, income, education, and smoking. Also, HRQL was found to be adversely affected by asthma-related symptoms, snoring, and observed apnea (beta = - 0.26, p < 0.001; beta = - 0.07, p < 0.001; and beta = - 0.08, p < 0.001, respectively, for SF-12 overall score) after adjusting for other confounding factors. CONCLUSION: Present data suggest that there is a link between the sleep-related breathing disorders and asthma-related symptoms. Moreover, the presence of snoring and observed apnea in individuals with asthma-related symptoms causes further impairment in HRQL. The effects on HRQL of coexistence of these three disorders should be supported by clinical studies.

Evaluation of gallbladder motility in patients with irritable bowel syndrome.

BACKGROUND: Abnormalities involving smooth muscle function in different systems of the body have been reported in irritable bowel syndrome (IBS). There are a few studies on gallbladder function in this disorder with conflicting results. OBJECTIVES: To investigate the motility of gallbladder in patients with IBS. PATIENTS AND METHODS: Forty-eight patients (15 male and 33 female) with IBS and 48 healthy volunteers (15 male and 33 female) were included into the study. Thirty-four patients (70.8%) had constipation predominant and 14 patients (29.2%) had diarrhoea predominant type of IBS. Fasting and postprandial gallbladder volumes were studied using real time ultrasonography and ejection fraction (EF) of gallbladder was calculated. RESULTS: While fasting gallbladder volume (FGV) was similar between IBS and control groups (18.0 +/- 4.0 ml vs. 17.8 +/- 4.9 ml, p >0.05), postprandial gallbladder volume (PGV) was lower in IBS group than in the control group (5.5 +/- 1.4 ml vs. 6.2 +/- 1.9 ml, p = 0.03). Accordingly, the mean EF of gallbladders was found to be higher in IBS group than in the control group (69.1% vs. 64.1%, p = 0.0001). There were no difference in FGV, PGV and EF of gallbladders between constipation predominant and diarrhoea predominant IBS patients (p >0.05). CONCLUSION: The results of this study indicated that IBS patients have increased emptying of gallbladder compared to healthy subjects.

Can lansoprazole, amoxicillin, and clarithromycin combination still be used as a first-line therapy for eradication of helicobacter pylori?

BACKGROUND/AIMS: To determine H. pylori eradication rate with lansoprazole-amoxicillin-clarithromycin treatment regimen, which is the most frequently used as first-line therapy, in the Kirikkale region. METHODS: One hundred and five patients (44 male, 61 female) with H. pylori infection were included in the study. Patients were divided into two groups based on the endoscopic findings: non-ulcer dyspepsia (n=84, 31 male, 53 female) and acute gastric or duodenal ulcer (n=21, 13 male, 8 female) groups. The diagnosis of H. pylori infection was confirmed if both the urease test and histological examination, which were performed on endoscopic biopsies, were positive. Lansoprazole 30 mg, amoxicillin 1 g, and clarithromycin 500 mg were given twice daily for 14 days to all patients. Endoscopic biopsies were repeated for the evaluation of eradication three months after the treatment. RESULTS: Ninety-six patients completed the study. Eradication rates were found to be 45.8% (44 of 96) in all patients, 42.1% (32 of 76 patients) in the non-ulcer dyspepsia group and 60% (12 of 20 patients) in the gastric or duodenal ulcer group for per protocol analysis, and the difference between non-ulcer dyspepsia and gastric or duodenal ulcer groups was not statistically significant (p=0.208). CONCLUSIONS: Lansoprazole-amoxicillin-clarithromycin treatment regimen, the most frequently preferred regimen in H. pylori eradication, is ineffective in our region. The low eradication rates observed with lansoprazole-amoxicillin-clarithromycin, at least in our region, bring into question its use as a first-line therapy. The use of alternative treatment protocols or antibiotic susceptibility test before the treatment may be helpful in achieving successful eradication with first-line therapy.

Urinary neopterin levels in the different stages of pregnancy.

BACKGROUND/AIMS: Neopterin is a biochemical marker of activated cell-mediated immune response which increases in pathological conditions associated with cellular immune activation as well as in pregnancy where cellular immune response is predominant. The aim of this study was to determine the urinary neopterin level in each trimester of pregnancy and to determine if it can be used as a marker. METHODS: 104 healthy pregnant women (mean age 22.10 +/- 4.39 years; 36 in the first, 30 in the second and 38 in the third trimester) and 16 non-pregnant healthy women (mean age 20.94 +/- 4.48 year) were included. RESULTS: The mean urinary neopterin concentration of all pregnant women was higher than that of non-pregnant women (166.4 +/- 31.7 and 103.1 +/- 27.5 micromol/mol creatinine respectively, p < 0.01). The mean urinary neopterin levels in each trimester and non-pregnant women were 139.8 +/- 49.6, 131 +/- 40.2, 227.9 +/- 86.5 and 103.1 +/- 27.5 micromol/mol creatinine, respectively. Urinary neopterin levels were not significantly different between non-pregnant, first and second trimester groups, but were significantly higher in the third trimester than each of these groups (p < 0.05, p < 0.01 and p < 0.01 respectively). CONCLUSION: Urinary neopterin levels increase significantly in the third trimester probably due to more predominated cellular immunity. The pathologies causing cellular immune activation, especially in the first two trimesters can be predicted with urinary neopterin levels.

Remission criteria for the follow-up of patients with acromegaly.

OBJECTIVE: The aim was to evaluate the validity of current remission criteria in acromegaly, a random GH level of <2.5 microg/l, a glucose-suppressed GH level of <1 microg/l and a normal IGF-I level. DESIGN: In forty-one patients treated for acromegaly (23 males and 18 females, 20-69 years) and 94 healthy subjects (50 males and 44 females, 20-78 years), basal GH and IGF-I levels and nadir GH levels after 75 g oral glucose were evaluated in decade blocks; these were assayed by sensitive immunoradiometric assays. RESULTS: Basal GH levels varied widely from 0.022 to 10.4 in healthy subjects and were >2.5 microg/l in 19%. The mean post-glucose GH nadir was 0.067+/-0.009 microg/l (range 0.003-0.4 microg/l) and the upper limit of the GH nadir was 0.26 microg/l (means+2 S.D.) in healthy subjects. Thirty-five patients with acromegaly had high-for-age IGF-I levels in relation to our healthy subjects. In this group, 15 (42.9%) patients had basal GH levels of <2.5 microg/l, 14 (40%) patients had nadir GH levels of <1 microg/l, and three (8.6%) patients had GH suppression to <0.26 microg/l which was defined as normal GH suppression in our healthy subjects. Only six patients with acromegaly had normal-for-age IGF-I levels and all of these patients had basal GH levels of <2.5 microg/l and all but one had nadir GH levels of <0.26 microg/l. CONCLUSIONS: A basal or random GH level of <2.5 microg/l is not a reliable criterion for remission in acromegaly and the currently accepted normal upper limit of 1 microg/l for post-glucose GH suppression is too high. Post-glucose nadir GH levels, measured with sensitive assays, can be <1.0 microg/l in 40% and basal GH levels can be <2.5 microg/l in 43% of the active acromegalic patients. IGF-I levels appeared to correlate better with a nadir GH cut-off of 0.26 microg/l rather than 1 microg/l in the determination of disease activity.