[Two cases of visceral leishmaniasis from Kahramanmaras, Turkey]. / Kahramanmaras'da saptanan iki viseral leysmanyazis olgusu.

Turkey is an endemic area for cutaneous leishmaniasis (CL) according to the data of World Health Organization. CL is more widely distributed in Sanliurfa region (located at south-eastern part of Anatolia) of Turkey, while visceral leishmaniasis (VL) is reported sporadically from all parts of Turkey, especially in pediatric cases. However VL has not been reported from our region yet. Here we report two cases of VL from Kahramanmaras region (located at eastern part of South Anatolia), one of which was a 57-year-old immuncompromised patient and the other was a 18-year-old immunocompetent patient. The common symptoms of the patients were high fever, hepatosplenomegaly and pancytopenia. The diagnosis of both patients was made by demonstration of the amastigotes of parasite in Giemsa-stained smears prepared from bone marrow aspiration samples, and isolation of promastigotes from cultures in NNN medium. The isolates were identified as Leishmania donovani with PCR and sequencing methods. Both of the patients were treated successfully with liposomal amphotericin B, resulting in complete cure. In conclusion, cases with fever of unknown origin, hepatosplenomegaly, pancytopenia and hypergammaglobulinemia should be considered in terms of VL especially in Kahramanmaras region.

Mean platelet volume seems to be a valuable marker in patients with systemic sclerosis.

The predictors for the development of cardiovascular diseases and peripheral arterial diseases in patients with systemic sclerosis (SSc) were not clearly established, and there is no specific study conducted to investigate the mean platelet volume (MPV) levels in SSc patients. Therefore, this study evaluates the MPV levels in SSc and possible relationship between SSc, its clinical features and activity/severity scores, and MPV. In total, 76 SSc patients (67 women and 9 men, mean age 50.44 ± 13.21 years) diagnosed according to the classification criteria of the American College of Rheumatology and 45 healthy volunteers were enrolled into study. Data relating to anamnesis, physical examination, MPV, erythrocyte sedimentation rate, C-reactive protein levels, electrocardiography, echocardiography, high-resolution computerized tomography findings, complaints, and treatment processes were recorded into the database. Of the total cases, 17 had (22.3 %) cardiac involvement, 45 had gastrointestinal involvement (59.2 %), 47 had (61.8 %) lung involvement, 31 (32 %) had finger flexion deformity, and 27 (35.5 %) had digital ulcers at the fingertips. The mean MPV levels of SSc patients were significantly higher than those of the control group (p = 0.008). The mean MPV levels of SSc patients with cardiac involvement, digital ulcers, and gangrene presence were significantly high, and lower in Ilomedin-receiving patients than in the Ilomedin naives (p < 0.05). A negative relationship was discovered between the mean MPV levels, Valentini score, and Disease Severity Index of the patients with systemic sclerosis (p = 0.006, r = -0.310; p = 0.047, r = -0.229). MPV levels were significantly elevated in SSc patients and they were negatively correlated with disease activity scores. Increased MPV levels would be a predictive marker in the diagnosis of macrovascular and microvascular disease involvement in SSc patients.

Inverse relationship between neutrophil lymphocyte ratio (NLR) and bone mineral density (BMD) in elderly people.

Osteoporosis is, an age related disorder, influencing elderly people worldwide. The latest data suggests that inflammation plays a critical role in bone remodeling and in pathogenesis of osteoporosis. NLR is a simple, non-invasive and cost-effective marker of inflammation in various malignancies and inflammatory diseases. The objective of the present study was to compare NLR levels in osteopenic, osteoporotic and control subjects and to assess the correlation between NLR levels and BMD. A total of 1635 patients aged 65 years or more were included in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine and femur. Complete blood count (CBC), biomarkers of inflammation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)), glucose/lipid metabolism and established risk factors were determined. In osteoporosis group, NLR levels were found to be elevated as compared to osteopenic and control group (2.54±1.45, 2.37±1.00 and 2.18±0.85, respectively). At multivariate analysis NLR emerged as independent predictor of osteoporosis (OR=1.122; 95%=1.020-1.235, p=0.018) and there was a significant negative correlation between lumbar spine (L2-L4), femoral neck scores and NLR (r=0.348, p<0.001; r=0.264, p=0.004, respectively). Elderly people with osteoporosis have elevated NLR levels, suggesting that inflammation may play an important role in bone remodeling.