Proprotein convertase subtilisin/kexin type 9 is associated with atherosclerosis in patients with Behcet's disease.

OBJECTIVES: The incidence of cardiovascular disease is increased in patients with Behcet's disease (BD). Proprotein convertase subtilisin/kexin type 9 (PCSK9) causes the acceleration of atherosclerosis. We aimed to investigate whether there is a relationship between PCSK9 with carotid artery intima-media thickness (cIMT), a marker of subclinical atherosclerosis, and BD disease activity. METHODS: Fifty-eight patients with BD and 58 age-, gender-, and body mass index (BMI)-matched healthy control subjects were included in the study. The disease activity of the patients was estimated. Individuals' cIMT values were measured, and PCSK9 levels were studied. RESULTS: Patients with BD' cIMT (0.51 ± 0.1 vs 0.41 ± 0.1 mm, p < .001) and PCSK9 (623.2 ± 101.7 ± 10.1 vs 528.3 ± 242.7 ng/ml, p = .007), values were significantly higher than the control group. In stepwise regression analysis, there was an independent relationship between cIMT with PCSK9 (ß = 0.179, p < .050). There was no independent relationship between disease activities with PCSK9. Based on the ROC curve analysis, the PCSK9 optimal cutoff value for cIMT was 595.1 ng/ml, sensitivity 66.7%, specificity 64.7% (AUC = 0.672; 95% CI: 0.530-0.815, p = .040). CONCLUSION: There is a strong independent association between subclinical atherosclerosis and PCSK9 in patients with BD. There may be no independent association between PCSK9 and disease activity.

Coexistence of obstructive sleep apnea syndrome and fibromyalgia.

Introduction: Fibromyalgia is characterized by pain all over the body, whose diagnosis and treatment are not fully understood. Obstructive sleep apnea syndrome (OSAS) is a disease that causes apnea, hypopnea and oxygen desaturation due to collapse in the upper respiratory tract and is characterized by excessive daytime sleepiness, fatigue and lack of attention. Symptoms and signs of OSAS and fibromyalgia are similar. In our study, we aimed to compare the association of fibromyalgia in female OSAS patients in terms of polysomnography and laboratory parameters. Materials and Methods: We aimed to examine the association of fibromyalgia in patients with female OSAS. A total of 190 female OSAS patients were included in the study. The patients were divided into two groups according to the presence of fibromyalgia: 88 (46.3%) patients in the fibromyalgia group and 102 (53.7%) patients in the control group. Statistical Package for the Social Sciences (SPSS) program was used for the evaluation of demographic data, polysomnography parameters and laboratory tests of the patients, and values with p<0.05 were considered statistically significant. Result: Mean age of the patients was 52.1 ± 11.9 years and mean body mass index (BMI) was 35.1 ± 7.2. There was no difference between age and BMI (p= 0.971, p= 0.716, respectively). Periodic leg movements (PLMS) were higher in the fibromyalgia group (p= 0.02). The desaturation index (CT90) was found to be high in the fibromyalgia group (p= 0.043). The minimum SaO2 value was found to be low in the fibromyalgia group (p= 0.022). Sleep latency was found to be higher in the fibromyalgia group (p= 0.031). Hemoglobin and hematocrit values were found to be statistically significantly higher in the fibromyalgia group (p= 0.020, p= 0.027, respectively). Triglyceride level was found to be high in the fibromyalgia group (p= 0.043). Conclusions: We recommend clinical evaluation of female patients with fibromyalgia and we suggest polysomnography, especially in patients with excessive daytime sleepiness. Early diagnosis and treatment of concomitant OSAS will contribute to quality of fibromyalgia patients' life.

[Brachial plexus damage following coronary artery bypass graft surgery]. / Koroner arter baypas greft cerrahisi sonrasi gelisen brakiyal pleksus hasari.

Brachial plexus injury is a complication that can be seen after coronary artery bypass grafting (CABG), especially median sternotomy. Brachial plexus injury was detected by clinical, examination, and electromyography in the presence of pain in the left arm who underwent CABG operation about 3 months ago. Our case was diagnosed early and improved with appropriate treatment. We are of the opinion that early diagnosis and treatment of a rare complication will lead to improvement in quality of life and improvement.

The relationship of serum visfatin levels with clinical parameters, flow-mediated dilation, and carotid intima-media thickness in patients with ankylosing spondylitis

Background/aim: Atherosclerotic heart diseases can occur at an early age in patients with ankylosing spondylitis (AS). Flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT) values are reliable markers for early detection of subclinical atherosclerosis in patients with AS. We aimed to investigate the relationship between visfatin levels and indirect markers of subclinical atherosclerosis and endothelial dysfunction in patients with AS. Materials and methods: Forty-two patients diagnosed with AS and 42 age, sex, and body mass index (BMI)-matched controls were included in the study. Visfatin levels, FMD, and cIMT were measured using appropriate methods. Results: Visfatin levels of the patients were significantly higher than controls (p < 0.001). FMD values in patients with AS were significantly lower (p = 0.007) whereas cIMT were significantly higher than the controls (p = 0.003). There was a negative relationship between FMD with visfatin levels (p = 0.004), BASDAI (p = 0.010), and BASFI (p = 0.007). There was a positive relationship between cIMT with visfatin (p = 0.005), BASDAI (p < 0.001), and BASFI (p < 0.001). There was a positive relationship between visfatin with BASDAI (p < 0.001), and BASFI (p < 0.001). Conclusion: Visfatin levels are increased and associated with impaired FMD and increased cIMT in patients with AS. Increased visfatin levels may be associated with subclinical atherosclerosis in AS.

Assessment of the frequency of tarsal tunnel syndrome in rheumatoid arthritis.

OBJECTIVES: In this study, we aimed to determine the frequency of tarsal tunnel syndrome (TTS) in rheumatoid arthritis (RA) patients. PATIENTS AND METHODS: Thirty RA patients (1 male, 29 females; mean age: 41.9±10.1 years; range, 26 to 65 years) who met the American College Rheumatology (ACR) classification criteria and 20 healthy volunteers (1 male, 19 females; mean age: 39.3±10.8 years; range, 26 to 60 years) without any complaints between August 2006 and October 2007 were included in the study. Demographic characteristics of the study group were assessed and neurological examinations were performed. The Tinel's sign was checked to provoke the TTS symptoms. Disease severity was measured using Visual Analog Scale (VAS), Disease Activity Score-28 (DAS28), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The health-related quality of life and disability status were determined using the Health Assessment Questionnaire (HAQ), Short Form 36 (SF-36), Foot Function Index (FFI), and VAS (0-100 mm). The positional relationship of the foot pain was questioned with VAS. The 100-m walking distance of the patient and control groups were calculated. RESULTS: Bilateral TTS was detected in 10 of the patients (33.3%) with rheumatoid arthritis. No relationship with the TTS disease duration, seropositivity, rheumatoid nodule, joint deformities, corticosteroid use, and DAS28 score were found. In correlation with TTS, foot and ankle joint were the first involved joints at the beginning of RA disease (p<0.005). The Tinel's sign was found to be 45% positive in patients with TTS. The 100-m walking time was significantly longer in RA patients compared to the control group (p<0.0001). CONCLUSION: Tarsal tunnel syndrome is commonly seen in RA and its incidence increases in patients with primary foot involvement. Therefore, caution should be taken against the entrapment neuropathies in these patients, and they should be supported by electrophysiological practices, when the diagnosis is necessary.

A novel marker relationship between carotid intima media thickness and disease activity score-28 in patients with rheumatoid arthritis: Human endothelial cell-specific molecule-1.

Background/aim: Human endothelial cell-specific molecule-1 (endocan) is a marker of vascular endothelial dysfunction that may be used in the evaluation of inflammatory-associated atherosclerotic lesions. Endocan may be a marker for the evaluation of atherosclerosis and disease activity in rheumatoid arthritis (RA) patients. Materials and methods: We included 39 RA patients assessed according to the American College of Rheumatology/European League Against Rheumatology 2010 diagnostic criteria and recruited 30 age- and sex-matching healthy subjects for the control group. Results: Endocan values were 14.11 ± 3.27 for the RA patients and 12.10 ± 2.92 for the controls. The endocan values of the patients were significantly higher than those of the control group (P = 0.009). In the correlation analysis, endocan showed a significantly positive correlation with disease activity score-28 (r = 0.386, P = 0.029) and carotid intima­media thickness (cIMT) (r = 0.419, P = 0.008). Linear regression analysis revealed that there was an independent relationship between endocan and cIMT (P = 0.029). Conclusion: Endocan can be a marker for early atherosclerosis and disease activity in RA patients.