Association of obesity with rs1421085 and rs9939609 polymorphisms of FTO gene.

The aim of this study is to investigate the genetic influence of polymorphisms in fat mass and obesity associated (FTO) gene on a sample of obese subjects and controls. Obesity is an epidemic all over the world. Several polymorphisms in the first intron of FTO gene have been associated with common forms of human obesity. In this research rs1421085 and rs9939609 polymorphisms of FTO gene were genotyped in 190 obese patients with a BMI ≥30 kg/m(2) (Body Mass Index) and 97 healthy controls with a BMI of 18.5-24.9. Genotyping of SNPs was performed by real-time polymerase chain reaction. Body composition was established with bioelectric impedance analysis. Waist-to-hip ratio was determined for all participants. There were no significant differences (P > 0.05) between obese cases and controls in terms of genotype frequencies of rs1421085 and rs9939609 polymorphisms in our study. Also there were no significant correlations between genotypes and obesity related (anthropometric-body composition) parameters (P > 0.05).

The relationship between vitamin D and PTH levels and cardiovascular risk in the elderly hypertensives.

INTRODUCTION AND OBJECTIVE: In this study, we aimed to investigate the relationship between vitamin D, parathyroid hormone (PTH) and cardiovascular risk (CVR) in hypertensive patients aged 65 years and over. PATIENTS AND METHODS: This study was performed with 84 hypertensive patients and 68 normotensive control group in Afyon Kocatepe University Faculty of Medicine Hospital. The determined cardiovascular risk degrees and the stages of blood pressure were compared with the levels of 25-(OH) vitamin D and PTH. RESULTS: Mean systolic and diastolic blood pressure (BP) levels of the patients with vitamin D deficiency (VDD) were significantly higher than those without VDD (p<0.001 for both). Mean systolic and diastolic BP levels of the patients with hyperparathyroidism were significantly higher than those without hyperparathyroidism (p=0.012, p=0.036, respectively). CVR was reversely correlated with vitamin D but the correlation with hyperparathyroidism did not reach statistically significant level (r=-0.752, p<0.001) and (r=0.210, p=0.055), respectively. CONCLUSION: These results indicate that the presence of hypertension is associated with VDD, as well as the stage of hypertension contributes to insufficiency, hyperparathyroidism and increased CVR. Clinicians should be aware and perhaps more aggressive for the treatment of HT and VDD in patients over 65 years of age.

The effect of biocompatible peritoneal dialysis solutions on neutrophil to lymphocyte ratio.

INTRODUCTION: Long-term exposure to dialysis solutions is an important contributor to the ongoing inflammatory process in peritoneal dialysis (PD) patients. Some studies have shown amelioration of this adverse effect with biocompatible solutions. We aimed to compare the neutrophil-to-lymphocyte (N/L) ratio in PD patients using biocompatible and standard solutions and to find out the association between N/L ratio and peritonitis indices. MATERIALS AND METHODS: This was a cross-sectional, multicenter study involving 120 prevalent PD patients. Seventy-one patients (59%) were using biocompatible solutions and 49 patients (41%) were using standard solutions. From blood samples, N/L ratio and platelet-to-lymphocyte ratio were calculated and mean platelet volume, erythrocyte sedimentation rate and hs-CRP values were detected. Data regarding the peritonitis rate and time to first peritonitis episode were also recorded. RESULTS: Biocompatible and standard groups were similar regarding age and gender. N/L ratio and hs-CRP levels have been found significantly higher in patients using biocompatible solutions (3.75 ± 1.50 vs. 3.27 ± 1.3, p = 0.04 and 3.2 ± 2.5 vs. 1.8 ± 2.0, p < 0.01, respectively). Peritonitis rates and time to the first peritonitis episode were found similar in patients using both types of solutions (0.23 ± 0.35 vs. 0.27 ± 0.32, p = 0.36 and 32.8 ± 35.8 vs. 21.5 ± 26.9 months, p = 0.16, respectively). DISCUSSION: N/L ratio was significantly higher in biocompatible solution users in parallel to hs-CRP levels, so biocompatible solutions seem to be related with increased inflammation in PD patients. Although we cannot make a certain explanation, we assume that there may be an association between acidity of the peritoneal content and virulence of microorganisms.

Atherogenic index as a predictor of atherosclerosis in subjects with familial Mediterranean fever.

BACKGROUND AND OBJECTIVE: Numerous inflammatory and innate immune pathways are involved in atherogenesis. We aimed to investigate the atherogenic index and other lipid parameters in individuals with familial Mediterranean fever (FMF), as a predictor of atherosclerosis. MATERIALS AND METHODS: A total of 60 patients with FMF and 60 healthy age- and sex-matched controls were included in this study. The patients with acute infection, chronic metabolic and rheumatic diseases, use of drugs other than colchicine and smoking history were excluded. CRP, ESR, total cholesterol, triglycerides, LDL-C, and HDL-C levels of patients and the control group were measured. Atherogenic index (TG/HDL-C) was calculated. RESULTS: We found that the atherogenic index values of the patients were significantly higher than those of the control group. HDL-C levels were lower and ESR and TG levels were higher in patients. Total cholesterol, LDL-C and CRP levels did not differ significantly between the two groups. There was no significant difference in the values of total cholesterol, LDL-C, triglycerides (TG), HDL-C, and atherogenic indexes between the groups of patients with and without M694V mutation. CONCLUSIONS: Elaboration of clinical models of inflammation-induced atherogenesis may further advance our knowledge of multiple inflammatory pathways implicated in atherogenesis and provide a useful tool for cardiovascular prevention. We believe that the atherogenic index also be used as a preliminary indication of accelerated atherosclerosis in FMF. However, large-scale prospective studies on this issue are needed.

The role of carnitine in preventing renal damage developed as a result of infrarenal aortic ischemia-reperfusion.

BACKGROUND: This study was designed to use carnitine for preventing deposition of end products of lipid peroxidation in rat models in the prevention of ischemia-reperfusion (IR) damage frequently seen following operations of infrarenal abdominal aorta (AA). METHODS: Forty male rats of Sprague-Dawley type were evenly (n = 8) randomized to five groups: sham laparotomy (SHAM), carnitine control (CC), aortic IR (AIR), AIR + low-dose carnitine (AIR+LDC), and AIR + high-dose carnitine (AIR+HDC). RESULTS: Compared to other groups, serum creatinine levels of AIR group were significantly higher. Also tissue malondialdehyde (MDA) levels of AIR group were significantly higher compared to SHAM, CC, and AIR+HDC groups. In histopathological examination, although tubular necrosis atrophy and tubular degeneration observed in AIR group showed regression with low-dose carnitine, tubular necrosis atrophy, tubular degeneration, glomerular damage, and vascular congestion thrombosis decreased with high-dose carnitine. Total score of histological damage was significantly higher in AIR, AIR+LDC, and AIR+HDC groups compared to SHAM and CC groups. Moreover, total score of histological damage was significantly lower in AIR+HDC group than AIR+LDC group. CONCLUSIONS: In this study, we showed carnitine can partially prevent renal damage in infrarenal AIR models of rats. This result may open new prospects to us in the prevention of renal IR damage during surgery of aorta.

Does Helicobacter pylori-induced inflammation of gastric mucosa determine the severity of symptoms in functional dyspepsia?

BACKGROUND: Inflammation induces some structural and biochemical alterations and oxidative damage in gastric tissue. In this study, we aimed to investigate the relationship among the severity of symptoms, oxidative stress, and grading scales of Helicobacter pylori-induced gastric inflammation in functional dyspepsia. METHODS: Thirty-five patients with functional dyspepsia were enrolled in the study. The severity of dyspepsia within the last 6 months was evaluated by Glasgow Dyspepsia Severity Score. In biopsy specimens of gastric mucosa, severity of gastritis was estimated by the revised Sydney Classification System, and oxidative stress parameters were studied. RESULTS: Although there was no statistically significant relationship between symptom scores and degree of chronic inflammation, a tendency for symptoms to be more severe has been observed in low levels of gastritis. Levels of sulfhydryl groups were lower in subjects with high levels of chronic inflammation, and Helicobacter pylori intensity (P < 0.001 and P = 0.02, respectively). Levels of malondialdehyde were higher in subjects with high levels of chronic inflammation (P = 0.04). There was a statistically significant but a weak positive correlation between symptom scores and sulfhydryl levels (P < 0.001, r = 0.323). CONCLUSIONS: In conclusion, there may be an inverse relation between severity of symptoms and level of Helicobacter pylori induced gastric inflammation or oxidative stress in patients with functional dyspepsia.

Increased serum osteoprotegerin levels associated with decreased bone mineral density in familial Mediterranean fever.

Familial Mediterranean fever (FMF) has episodic or subclinical inflammation that may lead to a decrease in bone mineral density (BMD). The aim of this study was to evaluate the effect of FMF on bone metabolism and to investigate the factors that can influence bone metabolism, such as body mass index (BMI), mutations in Mediterranean fever (MEFV) gene, osteoprotegerin (OPG), leptin and inflammatory cytokines, including interleukin (IL)-1beta, IL-6 and tumor necrosis factor-alpha (TNF-alpha). OPG, a soluble protein produced by osteoblasts, favors increased bone mass. Leptin may influence bone metabolism by acting on differentiated osteoblasts, having anabolic effects on bone. Thirty-one FMF patients in attack-free period (12 females and 19 males; mean age 31.4 +/- 9.3 years) and 18 healthy controls (11 females and 7 males; mean age 34.6 +/- 9.5 years) were compared according to the above parameters. BMD (g/cm(2)) and standard deviation scores (Z-score) were measured at the lumbar spine L(1)-L(4) (BMD-L(1-4)) and proximal femur by dual X-ray absorptiometry. Osteopenia is defined as a Z-score between -1 and -2.5 and osteoporosis is equal or below -2.5. FMF patients showed statistically significant reduction in BMD-L(1-4) and Z-score-L(1-4). Moreover, serum OPG concentration was significantly elevated in FMF patients. In contrast, MEFV gene mutations, leptin and the inflammatory cytokines did not differ between the patient and control groups. In conclusion, BMD was decreased and OPG was increased in our FMF patients. The high OPG levels may reflect a preventive mechanism against bone loss; namely, OPG might protect the FMF patients from excessive osteoporosis.

The relationship of amelogenesis imperfecta and nephrocalcinosis syndrome.

AIM: To analyze the prevalence and associated oral findings of nephrocalcinosis in a group of patients affected with amelogenesis imperfecta (AI). The relationship between types of AI and nephrocalcinosis were also evaluated. DESIGN: This study examines patients who were referred to Pediatric Dentistry Department of SDU between the years of 2002-2007 and who, upon clinical and radiological examination, were diagnosed with AI and treated. Patients were offered information about the possibility of nephrocalcinosis syndrome. Patients who agreed to have tests carried out on their renal system were advised to visit the department of nephrology at the clinic. RESULTS: Suspicious radiopacity was observed during renal ultrasonography of a controlled number of patients with hypoplastic type AI. Laboratory results revealed low Ca values (100-300 mg/days) and normal P values (0.4-1.3 g/days). Delayed eruption, gingival hyperplasia, pulp stones and orthodontic problems were also observed in the same patient groups. CONCLUSION: Although renal findings were observed in a few patients, pediatric dentists are the doctors who are the first to have early contact with this patient group. Because of the potential risk of nephrocalcinosis, early diagnosis may offer good prognosis.

Carotid hemodynamic parameters in hemodialysis patients.

BACKGROUND: Atherosclerotic vascular disease is a major cause of morbidity and mortality for patients with end-stage renal disease on maintenance hemodialysis. Early atherosclerotic changes of the arterial wall can be evaluated by intima-media thickness (IMT), presence and structure of plaques and parameters of vascular resistance. The aim of the present study has been to investigate the relationship between carotid IMT and pulsatility index (PI) or resistive index (RI) values in hemodialysis patients. METHODS: We studied 36 hemodialysis patients (21 female, 15 male; median age 39.5 years, IQR 33.0-54.7 years) and 38 healthy volunteers (20 women, 18 men; median age 41.0 years IQR 32.5-53.5 years). All subjects underwent ultrasonography of common carotid artery, with determination of IMT, PI and RI. RESULTS: Bilateral and mean carotid IMT were found to be significantly higher in hemodialysis patients than in the control group (P<0.0001). Right and left carotid artery RI values were determined to be lower in hemodialysis patients than in the control group (P=0.007 for both). Similarly, right and left carotid PI values were also determined significantly lower in the hemodialysis group (P=0.005 and P=0.004, respectively). There was a moderate negative correlation between the right carotid IMT and right PI (r=-0.258, P=0.026). CONCLUSIONS: In contrast to previous studies in patients with diabetes, hypertension or cerebrovascular disease, PI and RI values decrease when IMT increases in hemodialysis patients. This finding may be a result of peripheral vasodilatation secondary to anemia in hemodialysis patients.

Comparison of sleep quality between hemodialysis and peritoneal dialysis patients.

AIM: Sleep disorders are common in patients with end-stage renal disease. Although studies have been conducted on the type and frequency of sleep disturbances in hemodialysis and peritoneal dialysis patients, there has been no study comparing the sleep quality between these two groups. Therefore, we aimed to compare sleep quality between hemodialysis and peritoneal dialysis patients. METHODS: A total of 102 patients (52 hemodialysis and 50 peritoneal dialysis) were included in the study. The Pittsburgh sleep quality index (PSQI) was used for the assessment of sleep quality. Two groups were compared for seven components of the PSQI questionnaire and global score as well as for clinical and laboratory findings. We also assessed the independent predictors of sleep quality. RESULTS: There were 51 male and 51 female patients (29 male and 23 female in hemodialysis group versus 22 male and 28 female in peritoneal dialysis group). The mean age was 55.5+/-14.6 years in the hemodialysis and 51.5+/-18.1 years in the peritoneal dialysis group. The median dialysis duration was 36 (77.0) months. The sleep quality was poor in 88.5% of the hemodialysis patients and 78.0% of the peritoneal dialysis patients. However, this difference in sleep quality was not significant between the two groups (P>0.05). There was a significant association between the sleep quality and the age, presence of diabetes mellitus, and serum albumin. Among these variables, only age was found to be an independent predictor of sleep quality. CONCLUSIONS: Hemodialysis and peritoneal dialysis patients had a similar high rate of poor sleep quality. Further studies are necessary to investigate the causes of poor quality of sleep and to investigate methods to improve sleep quality in this population.

The relationship between arteriovenous fistula blood flow rate and pulmonary artery pressure in hemodialysis patients.

PURPOSE: Although there is an increased prevalence of pulmonary hypertension in hemodialysis patients, the relationship between arteriovenous (AV) fistula blood flow and pulmonary hemodynamics is not known. The aim of this study was to evaluate the relationship between blood flow rate of AV fistula and pulmonary artery pressure (PAP) in hemodialysis patients. METHODS: Thirty-two hemodialysis patients were included in this study. Within 1 h of completion of dialysis, blood flow rate of AV fistula and pulmonary hemodynamics were evaluated using Doppler sonography. Pulmonary hypertension was defined as mean PAP > or = 25 mmHg at rest. RESULTS: Mean PAP, median blood flow rate of AV fistula, and mean cardiac index were 22.5 +/- 10.0 mmHg (range 8-39), 978.0 ml/min (interquartile range 762.0-1,584.5) and 3,043.0 +/- 694.3 ml/ min per m2 (range 1,251-4,140), respectively. Mean PAP has a relationship to cardiac index (r = 0.453, P = 0.014). However, there was no correlation between mean PAP and blood flow rate of AV fistula, hemoglobin, calcium-phosphorus (CaxP) product, and parathormone. Pulmonary hypertension was present in 43.7% of patients. Patients with pulmonary hypertension had significantly higher cardiac index (P = 0.036). CONCLUSIONS: We found there was no direct relationship between blood flow rate of AV fistula and PAP. Other factors may play a role in the development of pulmonary hypertension.

The cutaneous silent period in diabetes mellitus.

The cutaneous silent period (CSP) may be useful as a method for the evaluation of smaller and unmyelinated fiber dysfunctions. CSP refers to the brief interruption in voluntary contraction that follows strong electrical stimulation of a cutaneous nerve. The aim the present study is to establish whether CSP can be instrumental in the determination of diabetic neuropathy. The nerve conduction studies and CSP evaluations were both used in patients with Diabetes Mellitus and control group. All patients were given clinical neurological examinations for the determination of small-fiber neuropathy (SFN). The CSP values for patients with SFN were compared with values of those without SFN. The nerve conduction velocities had changed unfavorably in diabetic patients. No median nerve CSP reponse could be obtained in two of the diabetic patients. CSP latency (84.6+/-14.0) in diabetics was longer than controls (76.2+/-13.1) (p=0.018). The duration of CSP was similar for the two groups (p=0.46). The CSP latency showed a correlation with routine nerve conduction studies. While the CSP latencies (86.7+/-15.8) of patients who were clinically diagnosed with SFN were similar to the latencies (81.3+/-10.4) of patients without SFN (p=0.606), the duration of CSP (44.6+/-13.7) in patients with SFN was shorter than the duration (55.3+/-12.2) in patients without SFN (p=0.012). These results indicate that even though the CSP does not provide any advantage over routine electrodiagnostic studies in determining diabetic neuropathy, still it may be a useful method for the early detection of diabetic SFN.

The effects of weight loss on normal transaminase levels in obese patients.

BACKGROUND: Obesity is associated with insulin resistance, which is the main pathogenic factor for nonalcoholic fatty liver disease (NAFLD). NAFLD can progress without associated elevations in liver enzymes. Therefore, we investigated the effects of weight loss on normal transaminase levels in obese subjects who are at risk for NAFLD. METHODS: Thirty-seven obese patients with normal ALT levels were evaluated. All patients received an individualized low-calorie diet over at least 6 months. Twenty-two patients who achieved weight loss of at least 5% body weight were identified as the study group and the others as the control group. Transaminases, insulin resistance, and body mass index were compared before and after the intervention. RESULTS: Hepatic steatosis was found in 83.8% of obese patients. ALT was correlated with HOMA-IR in all patients at baseline (r = 0.363, P = 0.027). At the end of the follow-up, mean weight loss achieved in the study and control groups were 9.2% (8.7 +/- 3.0 kg) and 0.3% (0.5 +/- 2.8 kg), respectively. In the study group, HOMA-IR and ALT decreased from 4.0 +/- 1.8 to 2.4 +/- 0.9 and from 21.4 +/- 6.6 IU/L to 16.8 +/- 5.5 IU/L, respectively (P = 0.005 and P = 0.044). CONCLUSIONS: The results demonstrate that weight loss results in a decrease in normal ALT levels as well as insulin resistance. Therefore, the normal range for ALT may need to be reassessed.

[Investigation of hemodialysis patients in terms of the presence of occult hepatitis B]. / Hemodiyaliz hastalarinin gizli hepatit B varligi yönünden arastirilmasi.

The presence of hepatitis B virus (HBV) DNA in case of negative HBV surface antigen (HBsAg) in serum is known as "occult hepatitis B". There are many reports indicating that occult HBV infections are more frequently encountered in case of hepatocellular carcinoma, hemodialysis practice and co-infections with hepatitis C virus (HCV). The aim of this study was to investigate the presence of HBV-DNA in HBsAg negative hemodialysis. patients and subjects who had never experienced hemodialysis. A total of 226 HBsAg negative sera were included to the study, of which 153 were from hemodialysis patients (97 male, 56 female; mean age: 41.3 +/- 5.8 years), and 73 were from non-hemodialyzed individuals (46 male, 27 female; mean age: 36.5 +/- 6.9 years) who had serological evidence of previous HBV and HCV infections. Of these 73 subjects, 41 were anti-HCV positive, 22 were "anti-HBc IgG positive alone", seven were anti-HBc IgG and anti-HBs positive, and three were anti-HBc IgG and anti-HBe positive, while 40 of 153 (26.1%) hemodialysis patients were anti-HCV positive. HBV and HCV markers were detected by commercial enzyme immunoassays (bioMerieux, France and Murex, UK, respectively), and HBV-DNA testing was performed by a commercial real-time polymerase chain reaction (PCR; 5700 and 7700 Sequence Detection System, Applied Biosystems, UK) assay. Nineteen (12.4%) of HBsAg-negative hemodialysis patients and five (6.8%) of the non-hemodialyzed subjects were found positive for HBV-DNA (viral loads were > or =10(4) copies/ml, and 10(3)-10(4) copies/ml, repectively). The rates of occult HBV infection in the anti-HCV positive hemodialysis patients and anti-HCV positive non-hemodialyzed subjects were detected as 27.5% (11/40) and 2.4% (1/41), respectively. These rates in the other groups were found as follows; 7.1% (8/113) in the anti-HCV negative hemodialysis patients, 9.1% (2/22) in the "anti-HBc positive alone" subjects, and 20% (2/10) in the subjects positive for anti-HBc+anti-HBs or anti-HBe. The results of this study indicated that the prevalence of HBV viremia (12.4%) in hemodialysis patients being more prominent in those of anti-HCV positive patients (27.5%) should not be overlooked. In conclusion, the hemodialysis patients should be screened by sensitive PCR-based methods for occult HBV infections, even if they were negative for HBsAg, in order to prevent or at least to decrease the transmission risk of HBV infection which is still an important health problem in dialysis units.

[Evaluation of the hemodialysis patient with Pittsburgh sleep quality index]. / Hemodiyaliz hastalarinin Pittsburgh uyku kalite indeksi ile degerlendirilmesi.

Sleep disturbances such as sleep-onset insomnia, frequent awakening, sleep-maintenance insomnia, and restless legs syndrome are extremely common in hemodialysis patient. Those additional problems to their chronic disease appear to have significant negative effects on quality of life and functional health status. This study was intended to evaluate the sleep quality and to identify of hemodialysis patients. Ninety-four patients on hemodialysis (45 females, 49 males) were admitted into this study. "Pittsburgh Sleep Quality Index" was administered to all patients to evaluate their sleep quality. Their mean age and duration of hemodialysis was 49.7 +/- 16.5 years and 31.5 (3-192) month. Sleep quality was determined as poorer (global score >or= 5) in 65 (69.1%) people. Older people and female incidence were significantly higher in patients with poorer sleep quality (p= 0.044 and p= 0.009 respectively). There was no significant difference in other parameter. Sleep quality and related parameters compared. There was not strong but significant relation between poor sleep quality with age, female gender, and hemoglobin (rs= 0.284 p= 0.006, rs= 0.301 p= 0.003 and rs= -0.216 p= 0.037 respectively). Logistic regression analyses showed independent effects of female gender on poor sleep quality. In conclusion, sleep quality had been impaired in patients with chronic hemodialysis, especially in women. Therefore, evaluation of the sleep quality of hemodialysis patients during clinical practice must be taken into consideration. Being able to find out the related factors with sleep disorders, advanced study supported with polysomnography must be done.

Interleukin-18 Binding Protein Pretreatment Attenuates Kidney Injury Induced by Hepatic Ischemia Reperfusion.

OBJECTIVE: Acute kidney injury (AKI) is a serious condition that can be induced by liver transplantation, major hepatic resection or prolonged portal vein occlusion. AKI can increase the frequency of postoperative complications. In the current study, we aimed to investigate whether interleukin-18 binding protein (IL-18BP) pretreatment has a protective effect against possible kidney injury following liver ischemia-reperfusion (IR) achieved by Pringle maneuver in an experimental rat model. MATERIALS AND METHODS: A total of 24 male Wistar albino rats were included in this study. Animals were equally and randomly separated into 3 groups as follows: I, Sham group, II, IR group (1-hour ischemia and 4-hour reperfusion) and III, IR + IL-18BP group (50µg/kg IL-18BP was intraperitoneally administered 30 minutes before surgery). Blood, liver and kidney samples were collected for histopathological and biochemical (hepatic and renal function, nitric oxide, malondialdehyde and glutathione levels) analysis. In addition, proinflammatory cytokines including tumor necrosis factor α, IL-1ß and IL-6 levels were measured in kidney tissues. RESULTS: IL-18BP has improved kidney functions in acute kidney damage, restored structural changes, exhibited anti-inflammatory effects by decreasing proinflammatory cytokines and regulated the oxidative stress parameters by antioxidant effect. CONCLUSIONS: Current study would be the first to evaluate the protective, antioxidant and anti-inflammatory effects of IL-18BP on renal damage induced by liver ischemia (1 hour) and reperfusion (4 hours). As a result, we have demonstrated that AKI may develop after hepatic IR with Pringle maneuver and IL-18BP pretreatment can attenuate this damage. By this way, complications related to liver IR could be minimized and also postoperative hospitalization durations, treatment costs and healing periods could be decreased.

The relationship between dipping-non-dipping arterial blood pressure pattern and frequency of restless leg syndrome with related factors.

OBJECTIVE: The lack of nocturnal decline in blood pressure (BP) is associated with an increase in cardiovascular events. Restless leg syndrome (RLS) is an uncomfortable feeling in which the patient wants to budge the legs with ache in the legs. RLS also increases the hypertension and cardiovascular risk. In this study, we aimed to evaluate the relationship between dipping and non-dipping blood pressure patterns with RLS and its severity. METHODS: Two hundred patients who had 24-hour ambulatory blood pressure monitoring (ABPM) were enrolled into this cross-sectional study. They were classified by blood pressure pattern as dipping and non-dipping. Then, 100 patients with the dipper pattern and 100 patients with the non-dipper pattern were chosen. A questionnaire for RLS diagnosis that was prepared by the International RLS Study Group was given performed to the patients. RESULTS: RLS symptom score was higher in patients with non-dipping blood pressure patterns (NDBPP), and patients with NDBPP had more severe RLS. Beside this, there were no differences in terms of RLS frequency in dipping and non-dipping blood pressure patterns. CONCLUSION: As a conclusion, dipping and non-dipping blood pressure patterns do not increase RLS risk. But, if patients with NDBPP have RLS, they have more severe RLS. So, we suggest that evaluating a patient with a non-dipping blood pressure pattern, considering RLS, would be helpful to ameliorate the quality of life of the patient.

L-Carnitine Supplementation Reduces Short-Term Neutrophil-Lymphocyte Ratio in Patients Undergoing Coronary Artery Bypass Grafting.

This study aims to investigate whether preoperative L-carnitine supplementation affects the neutrophil-to-lymphocyte ratio (NLR) in patients undergoing coronary artery bypass grafting surgery. The neutrophil-to-lymphocyte ratio is an inflammatory marker that has proven usefulness for predicting postoperative complications in coronary artery bypass surgery. A lot of studies concerning the role of L-carnitine in the immune system have been performed, contradictory results have been reported on its effects on absolute numbers of WBC subtypes. This randomized, double-blinded, placebo-controlled study was conducted among patients scheduled for coronary artery bypass grafting surgery between June 2012 and December 2013 in our cardiovascular surgery clinic. A total of 60 consecutive patients were randomized and divided into 2 groups. The first group received 2 g of L-carnitine in 1000 mL of 0.9% saline solution infused over 24 hours for each of the 3 preoperative days (L-carnitine group, n = 30), or only 1000 mL of 0.9% saline solution for the same time period (placebo group, n = 30). The basal values of leukocyte, neutrophil, lymphocyte counts, and neutrophil to lymphocyte ratio were similar in the 2 groups. After L-carnitine supplementation (just before surgery), leukocyte and neutrophil counts of the L-carnitine group were significantly lower than those of the placebo group (7.7 ± 1.5 versus 9.7 ± 2.6, P < 0.001 and 4.6 ± 1.3 versus 6.5 ± 2.2, P < 0.001). On postoperative day 1, lymphocyte counts were significantly higher in the L-carnitine group (1.1 ± 0.6 versus 0.8 ± 0.9, P < 0.001). Moreover, the increase in NLR was significantly lower in the L-carnitine group at postoperative day 1 (20.7 ± 13.8 versus 10.8 ± 4.1, P < 0.001). Preoperative L-carnitine supplementation may reduce neutrophil-lymphocyte ratio during the early postoperative period of coronary artery bypass grafting surgery.

Assessment of thyroid disorders and autoimmunity in patients with rheumatic diseases.

We investigated whether there was a significant increase in thyroid autoimmunity, and disorders in patients with rheumatic diseases (RDs). We enrolled 201 patients with RDs (41 with ankylosing spondylitis, 15 with systemic lupus erythematosus, 80 with rheumatoid arthritis [RA], 65 with familial Mediterranean fever), and 122 healthy controls. Serum levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), C-reactive protein, and thyroid autoantibodies (anti-thyroglobulin and anti-thyroid peroxidase) were measured in all participants. There were no significant differences between the ages of the patients and controls. The mean TSH values of the patients with RDs and the controls were 3.1 ± 2.68 mIU/L and 1.9 ± 0.83 mIU/L, respectively (P = 0.004). The mean fT4 value of the patients with RDs was 1.43 ± 0.67 ng/dL whereas that of the controls was 1.58 ± 0.68 ng/dL (P <0.001). Subclinical hypothyroidism was detected in 24 patients with RDs. Thyroid antibodies were detected in 16 of 201 (8%) patients with RDs. Three of these patients had subclinical hypothyroidism, while the others were euthyroid. Thyroid autoantibodies were significantly higher in patients with RDs (P <0.001). Additionally, thyroid disorders were observed more frequently in patients with RDs than in the healthy controls. Based on our findings, we recommend that thyroid function tests should better be included in the clinical evaluation of patients with RDs.

Evaluation of arterial stiffness with plasma GGT levels and pulse wave velocity measurement in patients with FMF.

OBJECTIVE: Pulse wave velocity (PWV) is a non-invasive technique used to evaluate the arterial elasticity, which is an early indicator of atherosclerosis. Lately, gamma glutamyl transferase (GGT) is considered a determiner of arterial stiffness (AS). In this study, we aimed to evaluate the relationship between GGT levels and AS with PWV in patients with Familial Mediterranean fever (FMF). MATERIAL AND METHODS: The study was conducted with 60 patients with FMF and 40 controls. Genetic analysis of the patients were performed. AS was assessed by PWV and, after the measurement of PWV, the presence of AS was determined. RESULTS: Mean PWV values and AS frequency were significantly higher in patients with FMF compared with the control group (p<0.001 and p=0.004, respectively). Mean GGT levels of FMF patients were higher than in the control group but the difference was not statistically different. In the correlation analysis, PWV and AS were positively correlated with FMF (r=0349, p<0.001; r=0.435, p<0.001, respectively). FMF duration and FMF were associated with GGT (r=0.300, p=0.02; r=0199, p=0.047, respectively). CONCLUSION: Increased PWV values in FMF patients may indicate arterial stiffness. These patients may be followed closely with PWV as an early indicator of atherosclerosis. Therefore, the cardiovascular risk can be determined in the early stages of disease and it may be possible to take necessary precautions.