Quality of life after stapler haemorrhoidectomy evaluated by SF-36 questionnaire.

OBJECTIVE: Hemorrhoids are normal elements of the anal canal anatomy and they become symptomatic with potential factors such as gravity or strain. When symptomatic, hemorrhoidal disease can be costly measured in time away from productive activities. The aim of the study was to assess changes in the quality of life of patients after hemorrhoidectomy using Short Form-36. MATERIAL AND METHODS: Thirty patients, 24 male and 6 female (age 28 to 65), who were diagnosed with grade III and IV internal hemorrhoidal disease at the general surgery outpatient clinic and treated with stapled hemorrhoidectomy were enrolled in the study. They filled out Short Form-36 a week before surgery and four weeks after surgery. Post-Hoc tests were evaluated with Bonferroni correction after Kruskal Wallis analysis. Wilcoxon test, Student-t-test and Mann-Whitney U test were used for statistical analysis using SPSS 15. RESULTS: Physical health (Physical functioning, Physical role restriction, Bodily pain) scores were significantly improved after surgery. CONCLUSION: Success of hemorrhoidectomy operations can be evaluated by postoperative recovery, incidence of complications or relapses. Quality of life questionnaires are another method to evaluate the success of the treatment from the patient's perspective.

Ezetimibe therapy and its influence on oxidative stress and fibrinolytic activity.

OBJECTIVE: The effect of ezetimibe on blood lipids, oxidative stress, and fibrinolytic activity in hyperlipidemic patients was investigated after three months of therapy. METHODS: Thirty hyperlipidemic patients were treated for twelve weeks with ezetimibe 10 mg/day. A healthy control group with matching age and gender was also included. Fasting blood glucose, lipid parameters, paraoxonase (PON1), protein carbonyl (PCO), oxidized LDL (oxLDL), 8-isoprostane (ISOPR), total antioxidant capacity (TAC) levels, tissue-type plasminogen activator (tPA), plasminogen activator inhibitor type-1 (PAI-1), and PAI-1/t-PA levels were evaluated. RESULTS: Ezetimibe therapy for twelve weeks led to changes in lipid profile in accordance with the literature. Fibrinolytic activity parameters, PAI-1/tPA and tPA-1 decreased, whereas PAI-1 levels did not change significantly. Antioxidant parameters, serum PON1 activity, and TAC levels increased significantly compared with the basal values. Oxidant parameters, oxLDL, ISOPR, and PCO (which is an indicator of oxidative protein damage) decreased significantly after therapy. CONCLUSIONS: Ezetimibe therapy has beneficial effects on fibrinolytic activity and homeostasis between oxidant and antioxidant activity in hyperlipidemic patients This may be through lowering lipid levels or other mechanisms such as decreasing insulin resistance and the pleiotropic effects of the drug.

Relation of Biochemical Parameters with Flow-mediated Dilatation in Patients with Metabolic Syndrome.

BACKGROUND: Metabolic syndrome (MetS) is one of the high cardiovascular (CV) situations. Endothelial dysfunction, which is a common finding in patients with MetS, is related with increased CV risk. In patients with MetS, the effect of the major CV risk factors, not included in the MetS definition, on endothelial dysfunction is not well known. The aim of this study was to determine the effect of major CV risk factors such as gender, smoking, family history, and biochemical parameters on endothelial dysfunction in patients with MetS. METHODS: The study was performed between December 2010 and August 2014. A total of 55 patients (15 females and 40 males) with MetS and 81 healthy controls (37 females and 44 males) with a body mass index <25 kg/m2 were enrolled in the study. Endothelial dysfunction was measured by flow-mediated dilatation (FMD), oxidative stress parameters; high-sensitivity C-reactive protein (hs-CRP), oxidized low-density lipoprotein (ox-LDL), endothelial nitric oxide synthase (e-NOS), nitric oxide, and cell adhesion markers; von Willebrand factor, and e-selectin. Platelet aggregation (endothelial adenosine diphosphate), total platelet count, and mean platelet volume were additionally analyzed and demographic parameters were explored. Student's t- test, Mann-Whitney U-test, and Chi-square test were used to analyze the results. RESULTS: The fasting blood glucose (z= 3.52, P= 0.001), hs-CRP (z = 3.23, P= 0.004), ox-LDL (z = 2.62, P= 0.013), and e-NOS (z = 2.22, P= 0.026) levels and cardiac risk score (z = 5.23, P< 0.001) were significantly higher in patients with MetS compared with the control group. Smoking was correlated with decreased FMD (χ2 = 9.26, P= 0.002) in MetS patients but not in the control group. CONCLUSIONS: Increased ox-LDL, hs-CRP, and e-NOS are likely to be a result of oxidative stress, a condition in which an imbalance occurs between the production and inactivation of reactive nitrogen and oxygen species. In addition, in patients with MetS, smoking is independently related to endothelial dysfunction.

Endothelial Dysfunction Markers in Low Cardiovascular Risk Individuals: Comparison of Males and Females.

BACKGROUND: Cardiovascular diseases (CVD) account for approximately 50% of the total deaths in Turkey. Most of them are related with atherosclerotic coronary heart disease. Predictive value of endothelial dysfunction markers related with the earliest stage of atherosclerosis has been getting more attention. We hypothesized that differences in endothelial dysfunction biochemical markers among genders would aid to capture proatherogenic activity that was not diagnosed by conventional risk assessment scoring systems. METHODS: We assessed the endothelial dysfuntion markers in 92 Turkish adults who were in the ¼low CV risk group« according to ESC (European Society of Cardiology)-Score Risk Charts. We compared the males and females. RESULTS: We observed higher endothelial dysfunction rates in males, with higher median and mean levels of e-NOS, ox-LDL before and after adjustment for HDL lowness and obesity (P=0.018, P=0.036 for NOS; P=0.000, P=0.004 for ox-LDL, respectively). Men had higher hs-CRP levels than females before adjustment (P=0.021). Decreased e-NOS levels were related with FMD for females before adjustment for confounders (P=0.028). We also found significant correlation between e-NOS and ox-LDL levels both before (r=0.360, P<0.001) and after adjustment (r=0.366, P<0.01) for confounders which pointed out the nitrosative stress. In multivariate regression analyses, after adjusting for other endothelial dysfunction markers which were not included in the ESC-risk scoring system, decreased e-NOS levels were independently asssociated with impaired flow mediated dilatation for females (odds ratio 0.3; P=0.038). CONCLUSIONS: Our results underline the importance of gender in evaluating endothelial dysfunction biochemical markers to assess cardiovascular risk for low CV risk indivuals.

Closer look at white-coat hypertension.

This review aims to clarify novel concepts regarding the clinical and laboratory aspects of white-coat hypertension (WCHT). Recent studies on the clinical and biological implications of WCHT were compared with existing knowledge. Studies were included if the WCHT patients were defined according to the 2013 European Society of Hypertension guidelines, i.e., an office blood pressure (BP) of ≥ 140/90 mmHg, a home BP of ≤ 135/85 mmHg, and a mean 24-h ambulatory BP of ≤ 130/80 mmHg. WCHT studies published since 2000 were selected, although a few studies performed before 2000 were used for comparative purposes. True WCHT was defined as normal ABPM and home BP readings, and partial WCHT was defined as an abnormality in one of these two readings. The reported prevalence of WCHT was 15%-45%. The incidence of WCHT tended to be higher in females and in non-smokers. Compared with normotensive (NT) patients, WCHT was associated with a higher left ventricular mass index, higher lipid levels, impaired fasting glucose, and decreased arterial compliance. The circadian rhythm in WCHT patients was more variable than in NT patient's, with a higher pulse pressure and non-dipping characteristics. Compared with sustained hypertension patients, WCHT patients have a better 10-year prognosis; compared with NT patients, WCHT patients have a similar stroke risk, but receive more frequent drug treatment. There are conflicting results regarding WCHT and markers of endothelial damage, oxidative stress and inflammation, and the data imply that WCHT patients may have a worse prognosis. Nitric oxide levels are lower, and oxidative stress parameters are higher in WCHT patients than in NT patients, whereas the antioxidant capacity is lower in WCHT patients than in NT patients. Clinicians should be aware of the risk factors associated with WCHT and patients should be closely monitored especially to identify target organ damage and metabolic syndrome.

Association of blood lead levels with demographic, reproductive and employment related factors in Turkish women.

OBJECTIVE: The aim of this study is to compare the blood lead levels in employed and unemployed women and associate the difference with sociodemographic and reproductive factors. PARTICIPANTS: Out of a 100 women attending the routine check-up unit of Family Medicine Department for screening of osteoporosis and blood lead levels, 63 post-menopausal participants; 36 unemployed and 27 employed, were included in the study. METHODS: Patients completed a questionnaire regarding their sociodemographics. Their blood chemistry and blood lead levels were determined and bone mineral densities were measured by Dual Energy X-Ray Absorptiometry. In the statistical analysis, Mann-Whitney U test was used to compare means and χ ^{2} was used to compare ratios. Backward logistic regression was used for multivariate analysis. RESULTS: There was no significant difference between the age (57.17 ± 7.46; unemployed, 54.19 ± 5.36; employed). The mean blood lead levels were 25.92 ± 9.31 µ g/dl in the unemployed group and 33.98 ± 13.50 µg/dl in the employed group (p=0.011) adjusted for age. Smoking rate was significantly higher in employed women (p=0.033) whereas the number of births (p=0.032) and duration of breastfeeding (p=0.008) were significantly lower. Although both groups were osteoporotic and post-menopausal, there was no association between osteoporosis and employment while unemployed women had an earlier menopause (p=0.037). CONCLUSIONS: Lead levels are above the accepted threshhold (20 µg/dl) in both groups. Strict environmental and social improvement efforts in both groups are recommended.

Prevalence and characteristics of restless legs syndrome (RLS) in the elderly and the relation of serum ferritin levels with disease severity: hospital-based study from Istanbul, Turkey.

The RLS is an underdiagnosed condition, characterized by unpleasant sensations in the legs. Pathophysiological mechanisms may include iron deficiency as reflected by low serum ferritin levels and dopaminergic system dysfunction. The purpose of our study was to investigate the prevalence and characteristics of RLS in the elderly and the relation of serum ferritin levels with disease severity. Ambulatory 1012 (621 women, 391 men, mean age: 73.51 ± 7.12 years) consecutive patients above 65 years who admitted to our clinic for any reason were evaluated according to the International RLS Study Group (IRLSSG) criteria: 103 patients (74 women, 29 men, mean age: 72.43 ± 6.31) (10.18%) had RLS diagnosis. Only 9 of them had known RLS. The duration of symptoms was 4.80 ± 4.65 years and 27 patients (26.2%) had positive family history. The average of serum ferritin levels was 39.13 ± 23.74 ng/ml and 71 patients (68.9%) had serum ferritin levels ≤ 50 ng/ml. The disease severity was evaluated with IRLSSG rating scale. Patients were classified as severe-very severe group (n=49) and mild-moderate group (n=54). The ferritin levels of severe-very severe disease group were lower than those of mild-moderate disease group (26.01 ± 15.82 ng/ml versus 49.87 ± 23.24 ng/ml, p<0.001). Our data show that RLS is very common in the elderly and the disease is more severe in patients with lower ferritin levels.