Visfatin Levels May be an Early Marker of Atherosclerosis in Patients with Acromegaly.

The purpose of the study was to compare serum visfatin levels between patients with acromegaly and healthy controls and to evaluate the relationships between visfatin levels and epicardial fat thickness (EFT), carotid intima media thickness (cIMT), and ankle brachial index (ABI). We conducted a cross-sectional case-control study of 54 patients with acromegaly (37 females and 17 males) and 34 healthy controls (22 females and 12 males). Serum visfatin was measured by ELISA. Acromegalic and control participants and those with active or controlled acromegaly were compared with respect to their serum visfatin, clinical and metabolic parameters, EFT, cIMT, and ABI. Linear correlation was used to identify associations between these parameters and visfatin in all participants. Serum visfatin and glycated hemoglobin (HbA1c) were higher in the acromegaly group than in the control group (p<0.001 and p=0.007, respectively). There was no difference in visfatin between the active and controlled acromegaly groups, but HbA1c was higher in the active than the controlled acromegaly group (p<0.04). EFT, cIMT, and ABI were similar between the acromegaly and control groups and between the active and controlled acromegaly groups. Serum visfatin positively correlated with HbA1c, growth hormone (GH), and insulin-like growth factor-1 (IGF-1)/upper limit of normal ratio (r=0.245, p=0.024; r=0.259, p=0.017; and r=0.282, p=0.009, respectively). This study has revealed that a high visfatin level is associated with glycemic dysregulation and higher levels of GH and IGF-1 in acromegalic patients.

Comparison of serum paraoxonase and arylesterase activities between iron deficiency anemia patients and chronic kidney disease patients with anemia.

OBJECTIVE: Altered paraoxonase (PON) and arylesterase (ARE) activities have been shown in anemic chronic kidney disease (CKD) patients and in iron deficiency anemia (IDA) patients. Whether accompanying anemia alone is responsible for this diminished PON and ARE activities in CKD patients or an additive factor for this is not well studied. Therefore, we tried to clarify this issue here. METHODS: A total of 82 subjects that consisted of 19 patients with IDA (group 1), 23 anemic CKD patients (group 2), and 40 age and sex matched healthy subjects (group 3) were enrolled. Carotid intima media thickness (CIMT), serum total thiol (-SH), PON, and ARE activities of the participants were analyzed. RESULTS: Group 2 patients had significantly lowest serum levels of Total -SH, PON and ARE. Further comparison showed that total -SH, PON and ARE levels were lower in group 1 than group 3 (p = 0.0001 in both). Regarding comparison of group 1 and 2, only serum ARE levels were significantly lower in group 2 (p = 0.001). PON activity was not different between group 1 and group 2 whereas ARE activity was lower in group 2 than groups 1 and 3. In addition, correlation analysis showed that CIMT was negatively correlated with PON and ARE. CONCLUSIONS: This markedly decreased ARE activity in CKD patients, which could not be explained by the anemia alone, may have a role in the pathogenesis of increased atherosclerosis in such patients. Still further studies are needed to certain this.

Relationship between monocyte-to-high-density lipoprotein cholesterol ratio and excess weight loss in laparoscopic sleeve gastrectomy.

Aim: The present study evaluates the relationship between the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) and the percentage of excess weight loss (%EWL) in patients undergoing laparoscopic sleeve gastrectomy. Method: This prospective cohort study evaluated 125 patients who underwent laparoscopic sleeve gastrectomy. The MHR before and at 6 months after surgery were compared in patients with <50 and ≥50 %EWL. Results: The MHR was lower in patients with a %EWL of <50 than in patients with a %EWL of ≥50 (p = 0.019). The decrease in the MHR at postoperative 6 months was more remarkable in patients with a %EWL of ≥50 (p < 0.001). Conclusion: The present study suggests that MHR decreased more remarkably at postoperative 6 months in patients with high %EWL, predicting a decrease in cardiovascular risk.

Lay abstract The primary focus of laparoscopic sleeve gastrectomy is to achieve sufficient weight loss to reduce cardiovascular events while minimizing surgical morbidity. The present study found a significant relationship between the percentage of excess weight loss and monocyte-to-high-density lipoprotein cholesterol ratio (MHR), the decrease in MHR being more remarkable with increasing excess weight loss and mostly attributable to the monocyte component. MHR can be used as a marker of atherosclerosis to monitor patients if they have achieved a reduction in cardiovascular risks. Monocyte count can be used as a simple substitute in conditions where MHR is not readily available.

The Relationship between Vitamin D Level and Lower Urinary Tract Symptoms in Women.

OBJECTIVES: In the literature, the effects of vitamin D on lower urinary tract symptoms (LUTS) have been investigated. Conflicting results have been reported in these studies conducted. LUTS is more common in women. In this study, we aimed to evaluate the relationship between vitamin D and LUTS in female patients using the uroflowmetric method. METHODS: This retrospective cohort study included 186 female patients who were admitted with LUTS. Demographic characteristics, medical history, calcium (Ca) and vitamin D, including laboratory studies and uroflowmetry results, as maximum urine flow rate (Qmax), average urine flow rate (Qav) and voided volume (V) were recorded. Patients were divided into two groups according to age (18-50 and ≥51) and vitamin D levels (<20 and ≥20). Laboratory parameters and uroflowmetry results were compared between groups. RESULTS: Mean age was 56.85±12.95 years. Mean vitamin D level was 21.19±13.93 ng/mL (2.5-83.5). Mean Qmax value was 35.41±12.63, whereas the mean Qav was 19.13±9.89, and the mean V was 446.60±165.08 mL. Vitamin D levels differed according to age groups (p=0.044). No significant difference was observed between groups according to Qmax, Qav and V values (p>0.05). No significant correlation was detected between vitamin D level and Qmax, Qav and V values. However, a negative correlation was detected between serum Ca level and V values (p=0.042) in the low vitamin D group. CONCLUSION: There was no direct relationship between vitamin D levels and LUTS in respect to uroflowmetry. However, we determined that Ca levels affect the uroflowmetry parameter in patients with low vitamin D levels. There is a need for further studies emphasizing serum Ca levels in addition to vitamin D levels in patients with LUTS.

Atelectasis in Bariatric Surgery: Review Analysis and Key Practical Recommendations.

Obesity is a condition that affects multiple organ systems, particularly the cardiovascular and respiratory system. In recent years, bariatric surgery has been reported to be the gold standard in the treatment of morbid obesity. Body mass index alone is insufficient to predict risks related to anaesthesia and surgery. Obesity contributes to significant postoperative atelectasis and is considered an independent risk factor for postoperative atelectasis owing to decreased functional residual capacity. The treatment and reversibility of atelectasis developed in obese patients undergoing bariatric surgery are challenging. Therefore, an optimisation of pulmonary functions before surgery, lung-sparing ventilation during the perioperative period, awareness of potential postoperative complications and knowledge about preventive measures and therapeutic approaches have become increasingly important in bariatric surgery. The aim of this review was to aid clinicians in the management of atelectasis in patients undergoing bariatric surgery during the perioperative and postoperative period.

Thiamin and folic acid deficiency accompanied by resistant electrolyte imbalance in the re-feeding syndrome in an elderly patient.

INTRODUCTION: Re-feeding Syndrome (RS) is a deadly complication, which can be encountered during "refeeding" of malnourished patients. In these patients, thiamin deficiency may develop and "risk awareness" is the most significant factor in the management of these patients. In this case report, the treatment is presented of an elderly patient who was diagnosed with RS and followed-up in the intensive care unit (ICU) due to resistant fluidelectrolyte imbalance. CASE: An 87-year-old elderly woman was admitted to the hospital due to aspiration pneumonia. On day 4, during parenteral nutrition (30 kcal/kg/day), severe electrolyte imbalance developed. Total parenteral nutrition (TPN) was stopped, and enteral feeding together with potassium (90 mmol/day, i.v.) were started. During follow-up, plasma potassium values remained less than 3 mmol/L. Despite replacement therapy, hypoalbuminemia, hypomagnesemia, hypocalcemia, and hypophosphatemia persisted. Considering the parenteral nutrition (30 kcal/kg/day) during the hospitalization period, a diagnosis of RS was made. On day 10, thiamin (200 mg/day, i.v.) and folic acid (5 mg/day) were added, and the patient subsequently responded to electrolyte replacement treatment. The patient was discharged on day26 with a home-care plan. CONCLUSION: In patients with malnutrition, thiamin replacement should be given before starting nutrition to prevent RS. Energy intake should be 10kcal/kg/day at the start, and be gradually increased between days 4-10. Hemodynamic-laboratory parameters should be closely monitored. All these measures may be life-saving for patients at high risk.

Serum galactomannan levels in the diagnosis of invasive aspergillosis.

BACKGROUND/AIMS: In this study, the sensitivity-specificity of galactomannan-enzyme immunoassay (GM-EIA) with a cut-off value of 0.5 for a single, two, or three consecutive positivity in the diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients with hematological malignancy was investigated. METHODS: IPA was classified as "proven," "probable," or "possible" as described in the guidelines prepared by the European Organization for Research and Treatment of Cancer and Mycoses Study Group." Serum samples were collected from the patients twice a week throughout their hospitalization. A total of 1,385 serum samples, with an average of 8.3 samples per episode, were examined. RESULTS: Based on the 165 febrile episodes in 106 patients, 80 (48.5%) were classified as IPA (4 proven, 11 probable, 65 possible) and 85 (51.5%) as non-IPA. The sensitivity/ specificity was 100%/27.1% for a single proven/probable IPA with the cut of value of GM-EIA ≥ 0.5, 86.7%/71.8% for two consecutive positive results, and 73.3%/85.9% for three consecutive positive results. CONCLUSIONS: With the galactomannan levels measured twice a week, consecutive sensitivity decreased and specificity increased. Therefore, an increase may be obtained in sensitivity-specificity by more frequent monitoring of GM-EIA starting from the first day of positivity is detected.