Elevated neurofilament light chain (NFL) mRNA levels in prediabetic peripheral neuropathy.

Evidence suggests that peripheral nerve injury occurs during the early stages of disease with mild glycemic dysregulation. Two proteins, neuron-specific enolase (NSE) and neurofilament light chain (NFL), have been examined previously as possible markers of neuronal damage in the pathophysiology of neuropathies. Herein, we aimed to determine the potential value of circulatory NSE and NFL mRNA levels in prediabetic patients and in those with peripheral neuropathy. This prospective clinical study included 45 prediabetic patients and 30 age- and sex-matched controls. All prediabetic patients were assessed with respect to diabetes-related microvascular complications, such as peripheral neuropathy, retinopathy and nephropathy. mRNA levels of NSE and NFL were determined in the blood by real-time polymerase chain reaction. NSE mRNA levels were similar between prediabetic and control groups (p > 0.05), whereas NFL mRNA levels were significantly higher in prediabetics than in controls (p < 0.001). NSE mRNA levels did not significantly differ between prediabetic patients with and without peripheral neuropathy (p > 0.05), while NFL mRNA levels were significantly higher in prediabetics with peripheral neuropathy than in those without (p = 0.038). According to correlation analysis, NFL mRNA levels were positively correlated with the Douleur Neuropathique 4 questionnaire score in prediabetic patients (r = 0.302, p = 0.044). This is the first study to suggest blood NFL mRNA as a surrogate marker for early prediction of prediabetic peripheral neuropathy, while NSE mRNA levels may be of no diagnostic value in prediabetic patients.

A case of thrombotic thrombocytopenic purpura associated with bupropion.

OBJECTIVE: To report a case of bupropion-associated thrombotic thrombocytopenic purpura (TTP) syndrome. CASE SUMMARY: A 55-year-old man was admitted with complaints of diarrhea, acute renal failure, and confusion ~ 54 days after bupropion initiation for smoking cessation. Subsequently he had a tonic-clonic seizure and had to be intubated because of altered consciousness. Laboratory findings were compatible with microangiopathic hemolytic anemia. He was diagnosed as TTP for which the Naranjo adverse drug reaction probability scale indicated a probable relationship with bupropion (a score of 5). He was treated with plasma exchange, systemic corticosteroids, hemodialysis and recovered fully. DISCUSSION: Bupropion is an anti-depressant drug also indicated for smoking cessation. It has widely reported neuropsychiatric and allergic adverse effects; however, TTP associated with bupropion has only been reported once. The clinical course of TTP in this case was compatible with TTP related to acute, immune mediated drug toxicity, which suggests that auto-antibodies might have been responsible. CONCLUSIONS: Given the fact that the clinical condition is compatible with acute, immune-mediated TTP syndrome, we suggest bupropion deserves evaluation for auto-antibody induction. Prescribers should be aware of the possible risk of thrombocytopenia and TTP.

The relationship between the level of glutathione, impairment of glucose metabolism and complications of diabetes mellitus.

OBJECTIVE: To investigate whether there is a difference between the subjects with new-onset type 2 diabetes mellitus (DM), impaired glucose tolerance (IGT) and normal fasting blood glucose levels with respect to the level of glutathione (GSH) and the relationship between the presence of complication of diabetes and the level of GSH. METHODS: Oral Glucose Tolerance Test (OGTT) was performed in IFG patients, with no episode of drug use, who were admitted to hospital. According to the results of the application 30 subjects with type 2 DM, 30 subjects with IGT and 28 subjects with normal blood glucose level were included in the study. Anthropometric measurements and blood pressure values of all subjects were recorded. The biochemical parameters of subjects were studied in the biochemistry laboratory by utilizing Olympus AV-2700. The subjects with diabetic retinopathy and nephropathy were established subsequent to the examination of the retina and 24-hour urine collection test performed to subjects with diagnosis of DM. Levels of GSH in all subjects were measured by enzymatic recycling method. RESULTS: The mean levels of GSH in subjects with DM were significantly reduced compared with IGT or normal subjects (respectively p=0.02 and p<0.001). Besides, lower levels of GSH were acquired in subjects with IGT compared to normal subjects (p<0.001). The mean levels of GSH in subjects with diabetic retinopathy were lower than the subjects with no established diagnosis of diabetic retinopathy (p<0.001). Similarly, lower levels of GSH (p<0.001) were obtained in microalbuminuric subjects than normoalbuminuric subjects. CONCLUSIONS: At the end of the study, we came to the conclusion that GSH deficiency was of great significance in the pathogenesis of Diabetes Mellitus.

Comparison of effects of fibrates in patients with hypertriglyceridemia.

It has long been known that antihyperlipidemic agents categorized as fibrates are capable of reducing triglyceride concentrations, although the superiority of one over another remains questionable. In the present study, investigators compared treatment results from various fibrates. In all, 60 patients aged 54.1+/-12 y with hypertriglyceridemia were included in the study. Patients who had increased values on liver function tests, had been given a diagnosis of hypothyroidism or chronic renal failure, and who needed statin medication were excluded. Patients were divided into 4 groups according to the medication given; treatments consisted of Lipanthyl 1 x 1, Lipofentrade mark 1 x 1, Lopid 1 x 1, and Lopid 2 x 1. Biochemical and hematologic parameters of patients were recorded at the first visit and at the end of the 2-mo treatment period. A total of 18 patients (30%) were given Lipanthyl 1 x 1, 14 (23.3%) received Lipofen 1 x 1, 16 (26.7%) were treated with Lopid 1 x 1, and 12 (20%) were given Lopid 2 x 1. Effects on triglyceride values were assessed in all groups. Lopid 1 x 1 and Lopid 2 x 1 produced significant decreases in triglyceride values. Most adverse effects were reported in the group given Lopid 2 x 1. In the treatment of hypertriglyceridemia, fibrates have similar effects on tolerability and reliability. However, study findings indicated that Lopid 1 x 1 and 2 x 1 treatments have greater efficacy.

Decreased serum vitamin D levels are associated with diabetic peripheral neuropathy in a rural area of Turkey.

Data examining the association between vitamin D and diabetic peripheral neuropathy are limited. This study investigated the serum levels of vitamin D, vitamin D-binding protein (VDBP), and vitamin D receptor (VDR) in diabetics in the Yozgat region of Turkey, and assessed their relationships with diabetic peripheral neuropathy. 69 diabetic patients and 49 age- and sex-matched control subjects were enrolled in this clinical prospective study. All the diabetics underwent conventional sensory and motor nerve conduction studies, and diabetic peripheral neuropathy was confirmed or ruled out according to the electromyography findings and Douleur Neuropathique 4 questions. Serum vitamin D, VDBP and VDR levels were measured using commercial enzyme-linked immunosorbent assay kits. The serum vitamin D levels (p = 0.001) were significantly lower, while the VDR levels (p = 0.003) were higher, in diabetics than in controls. The serum VDBP levels were similar in both groups (p > 0.05). The serum vitamin D levels were significantly lower in diabetics with diabetic peripheral neuropathy than in those without (p = 0.032), whereas the serum VDBP and VDR levels were similar in these two groups (p > 0.05). The lower serum vitamin D levels in diabetics, especially in those with peripheral neuropathy, may suggest a neurotrophic effect of vitamin D.

Graves' disease in a renal transplant.

The occurrence of hyperthyroidism and/or Graves' disease (GD) in transplant recipients receiving immunosuppressive therapy is extremely rare. A 47-year-old man developed GD after renal transplantation while he was under adequate immunosuppressive therapy. To our knowledge, the case presented here is the second case report of GD developed in a renal transplant recipient under adequate immunosuppressive therapy. The patient had undergone a renal transplantation 2 years before, and since then, he had been receiving continuous immunosuppressive therapy with cyclosporine A and prednisone. He presented with 3 months' history of palpitation, excessive sweating, weakness, heat intolerance and weight loss. Thyroid ultrasonography and scan revealed diffusely enlarged thyroid gland without nodules. The finding of elevated serum levels of thyroid hormones and suppressed TSH level subsequently confirmed hyperthyroidism. A diagnosis of GD was made after the demonstration of elevated thyroid autoantibodies. Although the mechanisms involved in transplant rejection and human autoimmunity are thought to be similar, the development of GD in a patient receiving therapeutic immunosupression suggests that different immunologic processes may be involved in GD. Further studies seem to be needed since the pathogenetic mechanisms suggested in the literature so far are not satisfactory to explain the development of GD in transplant patients under adequate immunosuppressive therapy.

Simple renal cyst prevalence in internal medicine department and concomitant diseases.

A total of 684 patients who had not been diagnosed with renal cyst but had undergone abdominal ultrasonography for various reasons were evaluated. Patients with and without renal cyst were classified into two groups and were compared in terms of hypertension (HT), hyperlipidemia (HL), diabetes mellitus (DM) and obesity (body mass index: > or = 30 kg/m2) prevalence. Although 94 patients (13.7%) were established with a renal cyst, 590 patients (86.3%) did not have a renal cyst. The mean age of the patients established with a simple renal cyst was 67.3 +/- 12.1 years (range: 28-82 years); 54 (57.4%) of them were women and 40 (42.6%) were men. Of the patients established with a simple renal cyst, 64 (68.1%) had HT, 40 (42.6%) had DM, 20 (21.3%) had HL, 42 (44.7%) were obese, 18 (19.1%) had nephrolithiasis, and 6 (6.4%) had urinary tract infection. Of the patients without a cyst, 272 (46.1%) had DM, 212 (35.9%) had HT, 122 (20.7%) had HL, and 96 (16.3%) were obese. HT and obesity were significantly higher in patients with a renal cyst when compared with those without a cyst. However, although HL incidence was higher in patients with a cyst, the difference was not significant statistically. HT, HL, and obesity are more prevalent in patients with a renal cyst when compared with patients without. Consequently, patients with a simple renal cyst should be evaluated and followed up in terms of atherosclerotic risk factors.

Effects of anthropometric measurements on renal function.

Although the negative effect of increased body mass index on kidney has been examined, the relation between other anthropometric measurements and kidney functions has not been investigated sufficiently. This study looks at the influence of anthropometric measurements on kidney functions. Forty patients were included in the study. Patients who had increased or normal anthropometric measurements were compared by serum levels of the urea, creatinine, albumin, 24 hr urine creatinine clearance, and urinary albumin excretion rate (UAER). Of all patients, 22 (55%) had an increased body mass index (BMI), 19 (47.5%) had an increased waist circumference (WC), and 24 (60%) had an increased waist-hip ratio (WHR). Subjects with increased BMI, WC, and WHR had significantly higher levels of serum creatinine and UAER than the subjects with normal measurements. The relation between CC and BMI was statistically significant only among the anthropometric measurements (p = 0.026). The ratio of microalbuminuria was 27.3%, 21.1%, and 29.2% in persons with increased BMI, WC, and WHR, respectively. Increases of anthropometric measurements affect kidney functions negatively. However, the influence of BMI on kidney function is more prominent. For this reason; individuals with increased anthropometric measurements should be monitored closely in terms of renal functions additional to cardiovascular risk factors.

Rare case of Alstrom syndrome without obesity and with short stature, diagnosed in adulthood.

Alstrom syndrome is a rare autosomal recessive disorder characterized by retinal degeneration, sensorineural hearing loss, obesity, type 2 diabetes mellitus and chronic nephropathy. It may be associated with acanthosis nigricans, hypergonadotropic hypogonadism, hepatic dysfunction, hepatic steatosis, hyperlipidaemia, dilated cardiomyopathy and short stature. We report a patient with Alstrom syndrome who had hypergonadotropic hypogonadism, hepatic dysfunction, hepatic steatosis and short stature with normal body weight, all of which are seen infrequently with this syndrome.

Relation of thyroid disfunction, thyroid autoantibodies, and renal function.

Fifty-eight patients with thyroid dysfunction were included, comparing 27 healthy subjects to evaluate the relationship between thyroid autoimmunity, thyroid functional status, and renal function. Regardless of clinical status, hypothyroidism was defined as T3-T4upper limit of normal, and hyperthyroidism was defined as T3-T4>normal limits and TSH <0.1 mcU/mL. In all participants, serum antithyroperoxidase level, serum antithyroglobulin level, creatinine clearance (CC), and urinary albumin excretion rate (UAER) in 24-h urine collections were measured. Of 85 persons, 41 patients ages 20 to 71 years (median; 44) had hypothyroidism, 17 patients ages 22 to 56 years (median; 32) had hyperthyroidism, and 27 subjects ages 20 to 67 years (median; 50) were normal. Regarding thyroid autoantibody positiveness, the positive group had a higher UAER than the negative group (30.2 mg/day, 20.8 mg/day, respectively; p=0.05). In hypothyroid patients, UAER was significantly higher than in hyperthyroid patients and control subjects (30.1 mg/day, 11.8 mg/day, 10.5 mg/day, respectively; p<0.001). In the hypothyroid population, with regard to UAER and CC, we could not find a significant difference between the thyroid autoantibody positive and negative groups. In view of CC, hypothyroid patients had significantly lower CC than the hyperthyroid group (79.0 mL/ min, 86.5 mL/min, respectively; p<0.01). A careful control of the renal function in thyroid diseases should be evaluated. Renal dysfunction seems to be secondary to hypothyroidism rather than thyroid autoimmunity.

Retroperitoneal abscess as a late complication following laparoscopic cholecystectomy.

BACKGROUND: Gallstone spillage during laparoscopic cholecystectomy is a relatively common occurrence. These intraperitoneal gallstones are considered to be harmless. Rarely, they may give rise to complications. Surgeons should retrieve spilled stones whenever possible. CASE REPORT: We report the case of a 75-year-old man with retroperitoneal abscess that developed 6 years following laparoscopic cholecystectomy as a late complication. The cavity, though it drained purulent material, was sterile in culture. Gallstones were found in the drain effluent. To our knowledge this is the first case report in English of such a delayed complication caused by spilled gallstones. CONCLUSIONS: Every effort should be made to avoid perforation of the gall bladder during its dissection. Whether the procedure should be converted to open surgery to retrieve all the stones is subject to debate.