Is there a link between neutrophil-lymphocyte ratio and microvascular complications in geriatric diabetic patients?

BACKGROUND: Chronic inflammation plays an important role on development and progression of Type 2 diabetes (T2DM) through immunologic inflammatory mechanisms. Neutrophil to lymphocyte ratio (NLR) is a new, simple and cheap marker of subclinical inflammation. NLR has recently been used as a systemic inflammation marker in chronic diseases as well as a predictor of prognosis in cardiovascular diseases and malignancies. AIM: The objective of the present study was to investigate the relationship between NLR and microvascular complications of diabetes mellitus (DM) in elderly population. SUBJECTS AND METHODS: Two hundred and forty-two patients with DM (145 diabetic patients with complications, 97 diabetic patients without complications) and 218 control subjects were enrolled in this study. NLR and microvascular complications because of DM were evaluated and compared with other inflammatory markers. RESULTS: NLR was higher in the diabetic group (2.21±1.14) than in the controls (2.18±0.76). Furthermore, there was a statistically significant difference between NLR levels in diabetic patients with and without complications (2.46±1.26 vs 2.04±0.51, respectively; p<0.001). The results of themultiple logistic regression analysis depicted that NLR is also an independent predictor for microvascular complications (odds ratio 2.217; 95%confidence interval 1.086-4.526, p=0.029). Receiver operating curve analysis suggested that the optimum NLR cutoff point for microvascular complication was 2.89 with 96.72% specificity, 94.4% positive predictive value. CONCLUSION: Increased NLR levels may be associated with microvascular complications of DM in the elderly population.

Could platelet indices be new biomarkers for inflammatory bowel diseases?

BACKGROUND AND AIM: Ulcerative colitis (UC) and Crohn's disease (CD) are chronic inflammatory diseases. Many serum biomarkers have been studied for diagnosis and monitoring of disease activity in inflammatory bowel diseases (IBD). Platelets play an important role in inflammation. The aim of the present study is to determine whether platelet indices; mean platelet volume (MPV), platelet distribution width (PDW) and platelet-crit (PCT) would be useful, cheap, non-invasive biomarkers for following up and determining severity of IBD. MATERIALS AND METHODS: The study group consisted of 175 patients with IBD (UC n: 103 and CD n: 72) and the control group included 40 healthy subjects. Disease activity was evaluated both by endoscope and clinically. Platelet indices and inflammatory parameters were measured for all study participants. Patients were checked in both active and remission phase of the diseases. RESULTS: In patients with active UC and CD, there was a statistically significant decrease in MPV, PDW levels and increase in PCT levels when compared to healthy controls. In remission phase of IBD while MPV levels were lower, PDW and PCT levels were higher than control group. Both PDW (r: -0.271 p: 0.032) and PCT (r: 0.295 p: 0.027) had a significant correlation with UC disease activity. There was statistically significant change in all platelet indices during diseases follow-up. CONCLUSIONS: The present report revealed that changes of platelet indices in IBD are noteworthy. They can be added to other inflammatory markers especially to monitor disease from active phase to remission phase.

Association of immune function with bone mineral density and biochemical markers of bone turnover in patients with anklylosing spondylitis.

The lymphocyte-osteoclast interaction has recently been described. The aim of this study was to investigate the possible relationship between ankylosing spondylitis (AS) and bone metabolism. Bone metabolism was evaluated in the blood of 49 patients with AS by means of biochemical markers and bone mineral density (BMD) with a Lunar device. Bone formation markers, bone specific alkaline phosphatase (BALP), osteocalcin (BGP), bone resorption markers, pyridinoline (Pyd), deoxypyridinoline (Dpyd) and lymphocyte surface markers (CD3, CD19, CD4, CD8, CD16+56) were analysed with ELISA and flow-cytometry methods. The patients had significantly lower femoral neck and trochanter BMD than the controls. Dpyd concentrations were negatively correlated to CD3+% and CD3-/CD16+56% cells. Neither mineral nor hormone levels were significantly correlated with absolute T scores of BMD of the hip sites. BALP and BGP were negatively correlated to BMD when expressed as T scores. We conclude that AS is related to accelerated osteoclastic activity. Many lymphokines and growth factors produced by lymphocytes can influence osteoclastogenesis and probably play a role in rheumatologic/inflammatory disorders.

Angiotensin-converting enzyme gene polymorphism and microvascular complications in Turkish type 2 diabetic patients.

The aim of this study was to investigate whether an association exists between the angiotensin converting enzyme (ACE) insertion/deletion (I/D) polymorphism and microvascular complications of type 2 diabetes mellitus in Turkish patients. A total of 239 type 2 diabetic patients and 138 sex and age matched control subjects were included into the study. The I/D polymorphism was determined by polymerase chain reaction (PCR). Nephropathy status was determined according to urinary albumin/creatinine ratio (microg/mg) (<30 normoalbuminuria, 30-300 microalbuminuria, >300 macroalbuminuria) and retinopathy was evaluated by fundoscopic examination and by flourescein fundus angiography. The distribution of ACE I/D polymorphism and allele frequencies in diabetic patients were not significantly different from controls, DD genotype 32.2 versus 37.2%; ID genotype 50.6 versus 47.1%; and II 17.2 versus 15.2%; D allele 57.5 versus 61.2%; I allele 42.5 versus 38.8%. Genotype distribution between normo-, micro- and macroalbuminuric patients did not differ significantly (DD:ID:II (%), normoalbuminuria, 35:46:19; microalbuminuria, 28:55:17; macroalbuminuria, 31:55:14). There was also no difference in genotype distribution between patients with and without retinopathy (DD:ID:II (%), retinopathy positive, 32:51:17; retinopathy negative, 33:49:18). In conclusion, the ACE I/D polymorphism does not seem to be associated with diabetic nephropathy and retinopathy in Turkish type 2 diabetic patients.

Wolfram syndrome in a family with variable expression.

Wolfram syndrome is a rare neurodegenerative disorder with autosomal recessive inheritance. The main characteristic features of this disorder are diabetes mellitus and optic atrophy. However, diabetes insipidus, sensorineural deafness, renal tract and neurologic abnormalities are seen in majority of patients. In this study, we describe a family in which two members had the main features of the syndrome while a third sibling had only sensorineural deafness. DNA analysis revealed that the fully affected siblings were homozygote for a pointmutation on chromosome 4p whereas the third sibling with deafness was a heterozygote carrier for the same mutation. The characteristics of disease and phenotypic variations that possibly related to heterozygote carrier state were discussed.

Use of the auditory brainstem response testing in the clinical evaluation of the patients with diabetes mellitus.

The objective of the study was to assess whether a relationship exists between the auditory brain stem response (ABR) results and diabetes mellitus with and without complications. In the clinical and audiometry laboratory settings, diabetic patients with and without complications (retinopathy and/or nephropathy) were examined using ABR testing, and the results were interpreted for their applicability in clinical practice. Fifty-nine patients with diabetic retinopathy or nephropathy (study group) and 20 diabetic patients without any known diabetic complication (control group) were assessed with audiometry and ABR testing. ABR revealed that the absolute latencies and interwave intervals of the waves I through V were prolonged significantly in the study group when compared to the control group. The amplitudes of waves I through V were diminished in the study group when compared to the control group, but a statistical significance was present only for wave V amplitude. Quantitative (wave I to wave V amplitude ratio) and qualitative analyses of the ABR waves showed abnormal waveforms in the study and control groups by 55.2 and 27.6%, respectively. There is a brain stem neuropathy in diabetes mellitus which can be assessed with ABR testing. The likelihood of encountering a diabetic complication increases as the ABR results become abnormal.

The human paraoxonase Gln-Argl92 (Q/R) polymorphism in turkish patients with coronary artery disease.

It has been suggested that a Q/R (Glnl92Arg) polymorphism of paraoxonase (PON) might be associated with the predisposition to coronary artery disease (CAD). Therefore, we studied the human paraoxonase gene (PON1) polymorphism in Turkish patients with CAD by polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP). This polymorphism was determined in 96 CAD patients and in 105 control subjects. The frequencies of the QQ, QR, and RR genotypes were found as 36.5, 52.0, and 11.5% in CAD patients and 48.6, 41.0, and 10.4% in control subjects, respectively. The QR genotype was the most common in the patient group, whereas the QQ genotype was more frequent in individuals without CAD. Frequency of the R allele was higher among CAD patients compared to controls (38.5% versus 31%). However, neither the genotype nor the allele distribution of the Gln92Arg polymorphism of PON1 was statistically significantly different between the two groups (P>0.05). Although both systolic and diastolic blood pressure levels were slightly higher in patients with the QQ genotype, there was no differences in regard to age, sex, serum triglyceride, total cholesterol or high-density lipoprotein cholesterol among CAD patients with different PONI Gln192Arg genotypes. In summary, our results suggest that no association exists between the Gln192Arg polymorphism of paraoxonase and CAD in Turkish patients.

The predictive value of auditory brainstem responses for diabetic retinopathy.

OBJECTIVE: The purpose was to find out whether there is a relationship between the central nervous system involvement and retinopathy in diabetes mellitus. STUDY DESIGN: In a multidisciplinary clinical study, diabetic patients with and without retinopathy were examined utilising auditory brainstem response (ABR) testing, and the results were interpreted from clinical and pathophysiological point of view. PATIENTS AND METHODS: Thirty-three diabetic patients with retinopathy (study group) and 20 diabetic patients without retinopathy (control group) were included. Audiometry and ABR testing were made. The results of both groups were compared for ABR parameters. RESULTS: Audimetric results of the study and control groups were similar. In the study group, ABR testing revealed prolonged absolute and interpeak latency of the waves. The difference was significant for I-III interval (P<0.01). The amplitudes of the waves were similar in both groups and wave V amplitude was significantly diminished in the study group. Abnormal waveforms were recorded by 40 and 12.5% in the study and control groups, respectively. CONCLUSION: Retinopathy is accompanied with lower brainstem disintegration. Microangiopathy is the possible mechanism that is involved in the occurrence of retinopathy and brainstem neuropathy. ABR can help diagnose retinopathy. Better understanding the role of ABR in diagnosis and early detection of retinopathy in diabetic patients needs further study.

Fixed drug eruption in hands caused by omeprazole.

OBJECTIVE: Omeprazole is one of the most widely prescribed gastric antisecretory drugs. It is generally well tolerated and significant adverse reactions occur rarely. The objective of this report is to describe a case of fixed drug eruption that occurred during omeprazole treatment. CASE REPORT: A 37-year-old white female patient admitted with epigastric pain and heartburn symptoms. An upper gastrointestinal endoscopy revealed reflux esophagitis and the patient was given 20 mg b.i.d. omeprazole. She developed dark-red coloration on her hands, at the fourth day of treatment, which has been defined as fixed drug eruption. These lesions were attributed to treatment and recurred soon after a rechallenge with omeprazole. CONCLUSION: Fixed drug eruption is associated with many drugs but this is the first such report with omeprazole. We suggest being aware of such reactions during omeprazole usage.

Relation of plasma lipoprotein(a) with myocardial viability and left ventricular performance in survivors of myocardial infarction.

Previous studies have reported that high serum lipoprotein(a) levels may be responsible for total occlusion of the infarct-related artery via inhibition of intrinsic fibrinolysis during acute myocardial infarction. We evaluated whether this would result in a greater extent of myocardial necrosis and impaired left ventricular function in patients with high lipoprotein(a) levels. Sixty-eight patients with prior myocardial infarction, who were not receiving thrombolytic therapy underwent coronary angiography and stress-redistribution-reinjection Tl-201 scintigraphy. Antegrade TIMI flow in the infarct-related artery was lower (1.54 +/- 1.14 vs 2.15 +/- 1.05; p = 0.03) and the collateral index was higher (1.3 +/- 1.0 vs 0.8 +/- 0.9; p = 0.07) in patients with high lipoprotein(a) levels (> 30 mg/dl) compared to those with low lipoprotein(a) levels (< or = 30 mg/dl). Regional wall motion score index was lower (0.8 +/- 0.8 vs 1.4 +/- 0.5; p = 0.008) and global ejection fraction was higher (46 +/- 10% vs 40 +/- 11%; p = 0.03) in patients with low lipoprotein(a) levels. On SPECT images, the number of non-viable defects was higher in patients with high lipoprotein(a) levels (4.0 +/- 2.5 vs 1.9 +/- 1.3; p = 0.0002), whereas the number of viable defects was higher in those with low lipoprotein(a) levels (2.5 +/- 1.8 vs 1.5 +/- 1.3; p = 0.02). We conclude that high lipoprotein(a) levels may prolong the occlusion of infarct-related artery during acute myocardial infarction and lead to a greater extent of myocardial necrosis and impaired left ventricular function.

Does the eradication of Helicobacter pylori cure duodenal ulcer disease in communities with a high prevalence rate? Comparison with long-term acid suppression.

The long-term effect of Helicobacter pylori eradication on the natural history of duodenal ulcer has been investigated and compared with long-term acid suppression treatment in an endemic community for infection. Seventy-three patients with endoscopically verified H. pylori positive active duodenal ulcer disease were included in this prospective study. Patients were divided into two groups. Group A patients (n = 39) were given an omeprazole-based triple eradication regimen, while group B patients (n = 34) were given omeprazole alone followed by long-term famotidine 20 mg daily as maintenance treatment. A control endoscopy was performed at the third month of treatment. The bacterium was eradicated in 32 (82%) of group A patients. All patients were followed up for two years and an endoscopy performed at the end of each year. H. pylori recurred in 13 patients and the reinfection rate was 44.8% over two years. Duodenal ulcer recurred in seven of these patients at two years (24.1%). There was a close association between H. pylori reinfection and ulcer relapse. Group B patients remained H. pylori positive during the study and the ulcer recurred in five of these patients (6.6%) despite continuous famotidine treatment. There was no statistically significant difference in ulcer relapse rate between the groups. These results suggested that H. pylori eradication is not an absolute solution for duodenal ulcer disease in high endemic regions and continuous maintenance treatment with H2-receptor antagonists is still an alternative approach in some chronic recurrent cases.