Insulin resistance and cardiovascular risk factors in women with PCOS who have normal glucose tolerance test.

INTRODUCTION: We aimed to determine the insulin resistance in women with PCOS patients who have normal oral glucose tolerance test (OGTT) and to evaluate cardiovascular risk by measuring C-reactive protein (CRP) and carotid intimae-media thickness (CIMT). METHODS: A total of 34 patients and age and body mass matched 20 healthy control subjects were included to this prospective study. Both of patients and control groups were consisted of normal oral glucose tolerance test. Insulin resistance (IR) was estimated using HOMA-IR method. CRP, lipid and hormone levels were measured. CIMT was measured by Carotid Artery B-Mode ultrasonography. RESULTS: There was no significant difference between patients and controls in BMI, and waist circumference, lipid, TSH, LH, FSH, estradiol, and prolactin levels. Serum insulin, testosterone, DHEAS, ferritin levels and HOMA values were significantly higher in patient group. We found that 64.7% (n = 22/34) patients with PCOS had insulin resistance. Both of CIMT and CRP levels were significantly higher in the PCOS patients had BMI over 25 kg/m². CRP levels was significantly higher in the PCOS patients had waist circumference greater than 80 cm. CONCLUSION: We found insulin resistance in the women with PCOS even if OGTT was normal. Our data were similar to literature, the women with PCOS have increased risk of premature atherosclerosis and metabolic syndrome.

Oxidative stress in the adult and pediatric patients with Crimean-Congo haemorrhagic fever.

BACKGROUND & OBJECTIVES: Crimean-Congo haemorrhagic fever (CCHF) can be fatal with bleeding, shock and disseminated intravascular coagulopathy (DIC). Although similar genetic strains have been defined, the causes of the clinical differences between the cases are yet to be found. We aimed to demonstrate the balance between oxidant and antioxidant system in CCHF. METHODS: In this study, the patient group consisted of 72 cases with a positive diagnosis of CCHF according to PCR/ELISA outcome among the patients referred to Cumhuriyet University, Medical Faculty in 2010. A total of 74 volunteers who were not having any viral or metabolic disease, non-smokers and age and sex matched with the patients group were enrolled as the control group. Both in the controls and the patients, individuals aged under 16 yr were defined as group 1 and the individuals aged over 16 yr as group 2. The serum samples were stored at -80°C until the study was carried out. All the samples were simultaneously thawed. In these cases, total antioxidant capacity (TAC), total oxidative status (TOS), oxidative stress index (OSI), lipid peroxide (LPO), paraoxonase (PON) and arylesterase were analyzed with the ELISA method. OSI was calculated. RESULTS: Levels of TOS, OSI and LPO were found significantly higher in CCHF patients in both the groups (p <0.05), whereas levels of TAC, PON1 and arylesterase were lower in CCHF patients compared to the controls, but low level of TAC in the group 1 was not statistically significant. INTERPRETATION & CONCLUSION: Our study demonstrated increased oxidative stress in CCHF patients in both groups 1 and 2. In order to prevent tissue damage which might be developed due to the oxidative stress in CCHF patients, further comprehensive studies should be conducted to define whether the adding antioxidants to the treatment would be helpful or not.

Irritable Bowel Syndrome in Dialysis Patients and Symptom Check List Revised (SCL 90-R) Screening.

OBJECTIVE: Irritable bowel syndrome (IBS) is a frequently seen functional bowel disease. Although not lifethreatening, it impairs quality of life and leads to economic losses. IBS symptoms are widespread in dialysis patients. Psychopathological disorders are known to increase in both IBS and dialysis patients. The purpose of this study was to investigate the prevalence of IBS, IBS-related factors, and psychopathological disorders in patients. MATERIALS AND METHODS: One hundred fifty patients followed-up in hemodialysis (HD) or peritoneal dialysis (PD) programs were included in this prospective study. Patients were divided into groups with and without diagnoses of IBS based on the Rome-III diagnostic criteria. The Symptom Check List Revised (SCL90-R) test was then applied to the patients. Patients with and without IBS were compared according to the scores obtained from the questionnaire. RESULTS: IBS was determined in 59 (39.3%) of the dialysis patients. The prevalence of IBS was significantly higher in women (P = .030). The presence of coronary artery disease (CAD) and use of erythropoietin (EPO) were significantly higher in patients with IBS (P = .029, P = .031). Somatization, obsessive-compulsive disorder, interpersonal sensitivity, depression, anxiety, phobic anxiety, psychoticism, and additional items were also higher in patients with IBS. Subscale scores for somatization, depression, and additional parameters in dialysis patients with IBS were above the threshold values for screening. CONCLUSION: IBS is common in dialysis patients. The presence of CAD or use of EPO were frequently observed in dialysis patients with IBS, and psychopathologies in depression, somatization, and additional subparameters were also higher in these patients.

Prevalence of hypertension among high school students in a middle Anatolian province of Turkey.

Hypertension may lead to irreversible damages in vital organs, such as heart, brain, and kidney, and may cause death in children if treatments are not given despite early diagnosis. This cross-sectional epidemiological study was conducted during 1 January-31 March 2004 to investigate the prevalence of hypertension among high school students. The study cohort included 1,041 students of six high schools, who were selected from among 14,789 students of 26 high schools in Sivas province of Turkey, using the cluster-sampling method. A questionnaire was used for collecting information from students on age, gender, smoking, and whether they or their families have any diseases. Blood pressure, height, and weight of the participitants were determined by the research group. Students whose repeated systolic or diastolic blood pressures were higher than the 95th percentile were considered to be hypertensive patients. Hypertension was prevalent among 4.4% (n=45) of the students. There was a significant correlation between prevalence of hypertension and body mass index. No significant correlation was found between prevalence of hypertension and other variables, such as smoking, age, gender, and family history of diabetes. The results suggest that hypertension is an important public-health problem among high school students. The results also showed that the body mass index was an important parameter in hypertension in such a study group. Researchers should consider overweight a causative risk factor for development of hypertension in early-onset groups.

Serum leptin levels and malnutrition in patients with chronic renal failure.

OBJECTIVE: To investigate the correlation between serum leptin levels, body mass index, and triceps skin fold thickness, which are anthropometric measurements, as well as serum albumin levels in patients with chronic renal failure on hemodialysis. METHODS: We studied 75 patients (48 males, 27 females; ages between 18-82) at the Hemodialysis Unit, Cumhuriyet University Medical School; Private Sivas Dialysis Center; Hemodialysis Unit, Sultan Izzettin Keykavus Hospital; and the Hemodialysis Unit, SSK Sivas Hospital between January 2003 and February 2004. Patients were excluded if they had been on dialysis for less than one year, if they were anuric, or if they had been on dialysis with jugular or subclavian catheter and long-term permanent port catheter. Similarly, patients with diabetes mellitus, chronic pulmonary disorders, and hepatic cirrhosis or hepatitis B, hepatitis C carriers as well as those on active tuberculosis therapy were excluded. C-reactive protein was measured in all patients and those with above normal values were excluded. RESULTS: While the mean age for the males was 44.52 +/- 16.53 years (18-77), it was 48.29 +/- 14.32 years (22-82) for the females. The mean triceps skin fold thickness for males was 6 +/- 1.81 mm (3-11.3 mm), and for females, it was 14.07 +/- 8.79 mm (4.3-33.3 mm). The mean body mass index for males was 20.77 +/- 2.61 kg/m2 (14.8-26.6 kg/m2), and for females, it was 25.36 +/- 6.47 kg/m2 (17.3-42.2 kg/m2). The mean serum leptin level for males was 4.61 +/- 4.20 ngr/dl (0.1-18.7 ngr/dl), and for females, it was 52.06 +/- 61.67 ngr/dl (0.6-172.5 ngr/dl). A positive correlation was observed between triceps skin fold thickness and leptin, both in the male group (r=0.478; p<0.05), and in the female group (r=0.876; p<0.05). Body mass index and leptin were also correlated positively both in the male group (r=0.502; p<0.05) and in the female group (r=0.905; p<0.05). No correlation was established between serum albumin levels and leptin. Leptin did not correlate with other measured parameters CONCLUSION: Our study demonstrates that serum leptin levels positively correlated with body mass index and triceps skin fold thickness, which are malnutrition parameters. Therefore, the leptin hormone may be utilized in obtaining preliminary information regarding malnutrition.

Emergency room cases of mushroom poisoning.

OBJECTIVE: To describe the pattern of mushroom poisoning in adults. METHODS: We investigated patients presenting at the Emergency Room, Medical School Hospital, Cumhuriyet University, Turkey between 1999 and 2003 with complaints of mushroom poisoning. They were kept under observation in the emergency unit and Anesthesia Department intensive care unit. We evaluated the demographical features of the patients, laboratory data, vital signs, and applied treatment and results. RESULTS: Seventy-eight patients aged between 19-72 (40.27 +/- 16.09) were studied, 52 were females (67%), and 26 were males (33%). It was established that 90% (70) of the patients had picked wild mushrooms, and 67.9% (53) had done so in springtime. Methods of cooking were as follows: 30 patients (38.4%) grilled the mushrooms, 28 patients (35.8%) stir fried, and 20 patients (25.6%) consumed mushrooms uncooked. Onset of symptoms was mostly (43.5%) within the first hour of consumption. The most common (42.3%) symptoms were gastrointestinal complaints. Upon examining laboratory results, 17.9% revealed variations in hematological parameters, impairment in renal functions in 6 patients (7.6%), hematuria in 10 patients (12.8%) and 15.3% had primarily elevated liver enzymes. Seventy-four patients (97%) completely recovered and were discharged. However, 2 patients (2.8%) who consumed raw mushrooms died due to acute hepatic failure. There was a 20-year-old patient at week 31 of her first pregnancy who had consumed uncooked wild mushrooms. She developed gastrointestinal symptoms and mild loss of consciousness within the first half hour. She received quadruple therapy and completely recovered. CONCLUSION: The results of the study indicated that the public, as well as the cultivators, were rather unconcerned and uneducated regarding this issue. Efforts aimed at overcoming this problem will decrease the number of mushroom poisoning cases, will help to save on treatment costs, and more importantly, reduce patient mortality.

Relationship between serum leptin levels and body composition and markers of malnutrition in nondiabetic patients on peritoneal dialysis or hemodialysis.

BACKGROUND: Leptin is a protein hormone secreted by adipocytes, regulating body fat and food intake. It has been reported that serum leptin levels are high in patients with chronic renal failure, and this fact has been associated with malnutrition and body composition changes in patients on hemodialysis. This present study investigated the relationship between plasma leptin concentrations and body composition and markers of malnutrition in nondiabetic patients diagnosed with end-stage chronic renal failure, treated with continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD). METHODS: A total of 152 HD and 32 CAPD patients were enrolled into the study. The body compositions of the patients were established by utilizing a Body Composition Analyzer. Triceps skinfold thickness (TSFT) was measured by using a Harpenden Skinfold Caliper. Serum leptin level was detected by radioimmunoassay in ng/mL through employing a DPC Gambyt-CR gamma counter. Standard laboratory methods were used for measuring the remaining parameters (total protein, albumin, blood urea nitrogen, creatinine, hemoglobin, hematocrit, high-sensitivity C-reactive protein [hsCRP]). RESULTS: No significant difference was observed between the HD and CAPD groups regarding leptin levels. Leptin levels of female patients in both groups were markedly higher when compared with those of men (p = 0.001). Plasma leptin levels in total, as well as for both male and female HD and CAPD patients, significantly correlated positively with age, percent fat, fat mass, body mass index and TSFT (p = 0.001). Serum leptin levels were not found to be correlated with length of time on dialysis, lean body mass, total body water, hsCRP, total protein and albumin levels (p > 0.05). CONCLUSION: The data obtained in this study indicated that serum leptin levels could be instrumental markers in establishing body fat ratio, as well as in determining metabolic and nutritional factors in patients with chronic renal failure.

Association Between the Severity of Nocturnal Hypoxia in Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Damage.

BACKGROUND: Obstructive sleep apnea (OSA) is a major disease that can cause significant mortality and morbidity. Chronic intermittent hypoxia is a potential causal factor in the progression from fatty liver to nonalcoholic steatohepatitis. OBJECTIVES: This study evaluated the association between the degree of liver steatosis and severity of nocturnal hypoxia. PATIENTS AND METHODS: In this study, between December 2011 and December 2013, patients with ultrasound-diagnosed NAFLD evaluated by standart polysomnography were subsequentally recorded. Patients with alcohol use, viral hepatitis and other chronic liver diseases were excluded. We analyzed polysomnographic parameters, steatosis level and severity of obstructive sleep apnea (OSA) in consideration of body mass index (BMI), biochemical tests and ultrasonographic liver data of 137 subjects. Patients with sleep apnea and AHI scores of < 5, 5 - 14, 15 - 29 and ≥30 are categorized as control, mild, moderate and severe, respectively. RESULTS: One hundred and thirty-seven patients (76 women, 61 men) with a mean age of 55.75 ± 10.13 years who underwent polysomnography were included in the study. Of 118 patients diagnosed with OSA, 19 (16.1%) had mild OSA, 39 (33.1%) moderate OSA and 60 (50.8%) severe OSA. Nineteen cases formed the control group. Apnea/hypopnea index and oxygen desaturation index (ODI) values were significantly higher in moderate and severe non-alcoholic fatty liver disease (NAFLD) compared to the non-NAFLD group. Mean nocturnal SpO2 values were significantly lower in mild NAFLD and severe NAFLD compared to the non-NAFLD group. Lowest O2 saturation (LaSO2) was found low in mild, moderate and severe NAFLD compared to the non-NAFLD group in a statistically significant manner. CONCLUSIONS: We assessed polysomnographic parameters of AHI, ODI, LaSO2 and mean nocturnal SpO2 levels, which are especially important in the association between NAFLD and OSAS. We think that it is necessary to be attentive regarding NAFLD development and progression in patients with OSA whose nocturnal hypoxia is severe.

The relationship between the neutrophil-lymphocyte ratio and disease activity in patients with ulcerative colitis.

Preliminary evidence suggests that a higher neutrophil-lymphocyte ratio (NLR) may be an indicator of active ulcerative colitis (UC). However, it is not clear whether the NLR is a useful and simple indicator of clinical activity in UC after adjusting for the other inflammatory markers. We designed a retrospective study to evaluate the role of the NLR in estimating disease severity in UC patients. The study consisted of 71 patients with UC and 140 age- and sex-matched healthy individuals (control group). The NLR, erythrocyte sedimentation rate, C-reactive protein, and white blood cell count were measured. The NLR values of the active UC group were elevated compared with those of the patients with inactive UC and the controls (2.59 ± 1.47, 2.03 ± 1.07, and 1.98 ± 0.85, respectively; p = 0.005). The receiver operating characteristic revealed that the optimum NLR cut-off point for active UC was 2.39. A multivariable logistic analysis showed that of the parameters studied, C-reactive protein was the only parameter able to significantly discriminate active from inactive UC (B: 0.222; p = 0.017; odds ratio: 1.248; 95% confidence interval: 1.041-1.497).

Sneddon's syndrome: clinical and laboratory analysis of 10 cases.

Sneddon's syndrome is characterized by livedo reticularis and cerebrovascular lesions. We report the cases of women (mean age, 36.2 +/- 8.1 years) diagnosed with Sneddon's syndrome based on the presence of livedo reticularis and characteristic cerebrovascular findings. Seven of these patients had cerebral infarcts on cranial computed tomography scan. Antiphospholipid antibodies were positive in 6 of these cases. Three cases had abnormal levels of antithrombin III. Analyses of chromosome 6 revealed no abnormalities. In 3 of the cases, investigation of the pedigrees revealed autosomal dominant traits. Two cases had epilepsy, and 3 had migraine. One case with migraine also had myasthenia gravis. In addition, we detected inferior altudinal hemianopia in 2 cases, cognitive functional disorder in 3 and depression in 2. Based on these findings, the entire vascular, haematologic, neurologic, and dermatologic systems should be evaluated in patients diagnosed with Sneddon's syndrome.

Intraerythrocyte antioxidant enzyme activities in migraine and tension-type headaches.

BACKGROUND: The pathophysiology of migraine and other headaches is still unknown, and research is mostly done on neurotransmitter, biochemical and vascular mechanisms. The aim of this study was to examine the role of antioxidant enzymes in the pathophysiology of headache in the interictal period of the pain process. METHODS: In this study, glutathione peroxidase, catalase and superoxide dismutase enzyme activities were investigated in 88 cases, which included 11 migraine cases with aura, 17 migraine without aura, 32 chronic type tension headache and 28 control cases. RESULTS: In migraine cases, superoxide dismutase and glutathione peroxidase enzyme activities were statistically lower than in the tension headache and control groups. The differences between tension-type headache and control groups were found statistically insignificant. CONCLUSIONS: Low intraerythrocytes, superoxide dismutase and glutathione peroxidase levels may play an important role in the etiology of migraine.

Effects of the Chemokine Receptor 5 (CCR5)-Delta32 Mutation on Hepatitis C Virus-Specific Immune Responses and Liver Tissue Pathology in HCV Infected Patients.

BACKGROUND: The specific antiviral T cells provide CC chemokine receptor 5 (CCR5) for the immune response during the hepatitis C virus (HCV) infection. Heterogenous and/or homozygous 32 base pair deletion in CCR5 gene (CCR5Δ32 bpdel) leads to reduced protein expression. OBJECTIVES: In the current case control study, we aimed to compare the histopathological findings of liver to the CCR5Δ32 bpdel mutation profiles, expression and some other clinical findings in patients with chronic HCV infection. MATERIALS AND METHODS: Multiple Strip Assay reverse hybridisation and Real Time PCR techniques were used to determine the germline CCR5 mutations and immunohistochemical technique was used to evaluate the gene expression in targer tissue biopsies. RESULTS: Target CCR5 WT/WT, WT/Δ32, and Δ32/Δ32 genotypes were observed in 91.4%, 8.6% and 0.0% for HCV positive patients and 98.3%, 1.7% and 0.0% for control group respectively. The histologic activity index (HAI) was significantly lower (4.0 ± 1.0) in the mutated group than the non-mutated group (5.7 ± 1.0). Decreased fibrosis levels were detected in HCV positive mutated group. CONCLUSIONS: Results showed that CCR5 polymorphism was more frequent in HCV positive patients than in healthy population in Turkish population. Current results also showed that mutated CCR5 signalling pathway due to CCR5-Delta32 may potentially result in subtle reduction of HCV specifity to the drug responses due to the positive impact on liver inflammation, fibrosis levels and liver destruction in HCV infection.

A rare cause of pericardial effusion: giant cell arteritis.

Giant cell arteritis is a granulomatous vasculitis characterized by medium or large sized vessel involvement. Although extracranial branches of the carotid artery are typically involved, involvement of aorta and its major branches can also be seen. Cardiac involvement has been encountered less frequently and pericardial effusion is rarely encountered. In this paper, a case has been presented in which pericardial effusion was determined during the examination and diagnosis was giant cell arteritis.

Prevelance of common YMDD motif mutations in long term treated chronic HBV infections in a Turkish population.

In the current study we aimed to show the common YMDD motif mutations in viral polymerase gene in chronic hepatitis B patients during lamivudine and adefovir therapy. Forty-one serum samples obtained from chronic hepatitis B patients (24 male, 17 female; age range: 34-68 years) were included in the study. HBV-DNA was extracted from the peripheral blood of the patients using an extraction kit (Invisorb, Instant Spin DNA/ RNA Virus Mini Kit, Germany). A line probe assay and direct sequencing analyses (INNO-LIPA HBV DR v2; INNOGENETICS N.V, Ghent, Belgium) were applied to determine target mutations of the viral polymerase gene in positive HBV-DNA samples. A total of 41 mutations located in 21 different codons were detected in the current results. In 17 (41.5%) patients various point mutations were detected leading to lamivudin, adefovir and/ or combined drug resistance. Wild polymerase gene profiles were detected in 24 (58.5%) HBV positive patients of the current cohort. Eight of the 17 samples (19.5%) having rtM204V/I/A missense transition and/or transversion point mutations and resistance to lamivudin. Six of the the mutated samples (14.6%) having rtL180M missense transversion mutation and resistance to combined adefovir and lamivudin. Three of the mutated samples (7.5%) having rtG215H by the double base substituation and resistance to adefovir. Three of the mutated samples (7.5%) having codon rtL181W due to the missense transversion point mutations and showed resistance to combined adefovir and lamivudin. Unreported novel point mutations were detected in the different codons of polymerase gene region in the current HBV positive cohort fromTurkish population. The current results provide evidence that rtL180M and rtM204V/I/A mutations of HBV-DNA may be associated with a poor antiviral response and HBV chronicity during conventional therapy in Turkish patients.

Changes in metabolic and cardiovascular risk factors before and after treatment in overt hypothyroidism.

AIM: Overt hypothyroidism is associated with an increased risk for developing cardiovascular disease. We aimed to assess the changes in renal function, serum lipids, vitamin B12, folic acid and homocysteine levels before and after treatment in hypothyroid patients. METHODS: The study included 54 patients (F/M=47/7) with overt hypothyroidism. All patients were assessed for demographic characteristics such as age, gender, body weight, and body mass index. Fasting blood samples were taken from the patients for analysis of chemical parameters including thyroid stimulating hormone (TSH), free thyroxine (fT4), homocysteine, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), folic acid, and vitamin B12 levels before and after L-thyroxine (LT4) treatment. RESULTS: Homocysteine levels in hypothyroidism (9.67 ± 5.24 mmol/l) were significantly higher than in euthyroid state (8.16 ± 3.38 mmol/L, p=0.038). Glomerular filtration rate (GFR) was lower before treatment. Following LT4 replacement, renal functions significantly improved. After achieving the euthyroid state, folic acid levels significantly increased although vitamin B12 levels were not changed. There was a significant reduction in serum lipid levels after LT4 replacement. It was demonstrated that there was a significant negative correlation between GFR and lipids and a positive correlation with homocysteine and lipids at hypothyroid state. After normalization of thyroid functions, the correlations became non-significant. CONCLUSION: The hypothyroidism was associated with increased serum homocysteine, lipids, and creatinine concentrations. The improvement of these parameters with LT4 replacement may be associated with the lower risk for atherosclerotic cardiovascular diseases in the patients with hypothyroidism.

Evaluation of association between atherogenic index of plasma and intima-media thickness of the carotid artery for subclinic atherosclerosis in patients on maintenance hemodialysis.

Incidence of cardiovascular diseases in the patients having chronic kidney disease (CKD) is between 25% and 60%. This increased rate is proposed to be associated with "accelerated atherosclerosis." Increased carotid intima-media thickness (CIMT) is a subclinical atherosclerosis marker. Small-dense low-density lipoprotein particles are a strong risk factor for atherosclerosis. It was shown that atherogenic index of plasma (AIP = log(TG/HDL-c)) is correlated with size of the lipoprotein particles. We investigated the correlation between AIP and CIMT which is a subclinical atherosclerosis marker, in hemodialysis (HD) patients. A total of 62 persons with 31 patients under HD therapy and 31 volunteers were included in the study. In all the participants, CIMT was measured and AIP were calculated. AIP and CIMT values of the participants were compared with blood pressures, lipid profiles and the other risk factors. AIP (0.39 ± 0.32) and CIMT (0.57 ± 0.13) were found significantly higher in the patient group than in the controls (0.04 ± 0.36 and 0.45 ± 0.119, respectively); (P = 0.0001 and 0.0001, respectively). There was a significant correlation between AIP and increased CIMT in the patient group (P = 0.0001, r = 0.430). Among the lipid parameters, the strongest correlation was found between CIMT and AIP. We demonstrated the significant increase of AIP and CIMT in HD patients. A correlation was found between AIP and CIMT. AIP was found to show a correlation with a greater number of risk factors, both classical and CKD specific, than CIMT. These data suggest that AIP might be a method which can be used both in diagnosis of subclinical atherosclerosis and in deceleration processes of its progression.

Evaluation of oxidative status with exhaled breath 8-isoprostane levels in patients with hyperthyroidism.

INTRODUCTION: Studies conducted so far on the effect of hyperthyroidism on oxidative stress (OS) have employed blood and urine samples. Exhaled Breath Condensate (EBC) is a non-invasive technique used to take sample from lungs to determine many biological indications. The aim of the present study was determine the possibility of using 8- isoprostane levels in EBC as an indicator of OS in hyperthyroid patients. METHODS: The present study was performed on 42 patients with hyperthyroidism and 42 healthy control subjects. Hyperthyroid patients included patients with newly diagnosed Graves' disease, toxic multinodular goiter and toxic adenoma. Exhaled breath condensates were collected from patients in each group using a condensing device. 8- isoprostane levels as an indicator of OS in EBC were detected via immunoassay method. RESULTS: Hyperthyroid patients and control groups had 8-isoprostane levels of 6.08±6.31 and 1.56±0.88 pg/ml, respectively. The difference between patient and control groups was statistically significant (p<0.001). Of the hyperthyroid patients, eleven had Graves', 21 multinodular goiter, and 10 toxic adenoma diagnosis. There were no significant differences among patients of different diagnoses for 8-isoprostane levels (p=0.541). No significant correlations were found between 8-isoprostane and free thyroxine (fT4) or thyroid stimulating hormone (TSH) levels. CONCLUSION: In the present study, 8-isoprostane levels in EBC of hyperthyroid patients were found to be significantly higher than that in healthy control group. This study is important in that it is the first to evaluate the effects on respiratory system of elevated OS of hyperthyroidism in EBC.

Relationship between homocysteine and non-dipper pattern in patients with type 2 diabetes mellitus.

OBJECTIVE: The rate of reduction of nocturnal blood pressure (NBP) is lesser than normal in patients with type 2 diabetes mellitus (type 2 DM). Hyperhomocysteinemia (HHC) disrupts vascular structure and function, no matter the underlying causes. The risk of development of vascular disease is greater in diabetic patients with hyperhomocysteinemia than in patients with normal homocystein levels. The aim of the study was to investigate whether there are differences of homocystein levels in dipper and non-dippers patients with type 2 DM. SUBJECTS AND METHODS: We compared 50 patien-ts (33 females, 17 males) with type 2 DM and 35 healthy individuals (18 females, 17 males ) in a control group. Ambulatory blood pressure monitoring (ABPM) was performed and homocysteine levels were measured in all patients. RESULTS: We found that the percentage of non-dipper pattern was 72% in patients with type 2 DM and 57% in control group. In diabetic and control individuals, homocystein levels were higher in non-dipper (respectively 13.4 ± 8.1 µmol/L and 11.8 ± 5 µmol/L) than in dipper subjects (respectively, 11.8 ± 5.8 µmol/L and 10.1 ± 4.2 µmol/L), but there was no significant difference between the two groups (respectively, p = 0.545, p = 0.294). CONCLUSION: In both groups, homocystein levels were higher in non-dipper than in dipper participants, but there was no significant difference between the groups. High homocystein levels and the non-dipper pattern increases cardiovascular risk. Therefore, the relationship between nocturnal blood pressure changes and homocystein levels should be investigated in a larger study.

Ischemic skin necrosis following terlipressin therapy: report of two cases and review of the literature.

Terlipressin is a synthetic vasopressin analogue that is used in the treatment of bleeding esophageal varices and hepatorenal syndrome in patients with cirrhosis. Hepatorenal syndrome is a form of renal failure seen in patients with cirrhosis, with fatal outcomes. Ischemic adverse effects related to terlipressin are rarely observed. Herein, two cases who developed ischemic skin necrosis due to terlipressin usage are presented. Terlipressin therapy was started in two cirrhotic patients with presumptive hepatorenal syndrome. During the therapy, ecchymotic and necrotic changes were observed on the scrotal regions of both patients. Skin lesions were relieved after terlipressin therapy. Biopsy results were consistent with ischemia. Even if seen rarely, possible emergence of ischemic complications must be considered.