Leptospirosis: twelve Turkish patients with the Weil syndrome

Twelve cases of leptospirosis followed by the Infectious Diseases Clinic of the Cukurova University Medical School, Adana, Turkey, between January 1994 and November 1995 are reported. Included are their clinical manifestation, laboratory findings and serotype. Nine men and three women with an average age of 40.4 years were studied. Symptoms, clinical manifestations, laboratory findings and treatment of the disease are evaluated. All of the patients had fever and chills and the following symptoms: nausea and vomiting (91.6%), lower back pain and myalgia (58.3%), headache (50%), epistaxis (16.6%) and confusion (25%). The predominant clinical findings were jaundice (91.6%), hepatomegaly (41.6%), dyspnea (25%), conjunctival suffusion (33%), and nuchal rigidity (33%). Diagnosis was based on dark-field examination of the blood, cerebrospinal fluid and urine specimens. Also, microscopic agglutination tests (MAT) were carried out for serodiagnosis. MAT showed L. inter-rogans serovar icterohaemorrhagiae in 11 cases and L. interrogans serovar grippomosocova in one case. There was cross reaction with L. biflexa patoc in all cases. Agglutinations were tested in the same specimens twice and confirmed in the Microbiology Laboratory of the Etlik Veterinary Research Institute in Ankara. All cases were treated with penicillin and doxycycline. In the end; 83.3% of the patients were cured and 16.6% died due to hepatorenal failure.</p

C-Reactive Protein-to-Albumin Ratio: A Novel Inflammatory Marker and Disease Activity Sign in Early Rheumatoid Arthritis

Abstract Objective A novel inflammation-based score, C-reactive protein (CRP)-to-albumin ratio (CAR), has been shown to have an association with the inflammatory status in several diseases. We aimed to analyse the association between CAR and disease activity in patients with early rheumatoid arthritis (RA) and to determine the cut-off value of CAR in early and established RA. Methods A total of 177 patients with RA and 111 age and gender-matched healthy controls were included in this study. Cases with a disease duration of less than 1 year were classified as early RA. Serum albumin, CRP, erythrocyte sedimentation rate (ESR), Disease Activity Score-28 (DAS-28-ESR), Clinical Disease Activity Index (CDAI) and Health Assessment Questionnaire (HAQ) scores were recorded. Results CAR was 2.44 (0.21–30.83) in the RA group and 0.45 (0.21–10.47) in the control group (p&lt;0.001). Eighty-seven (49.15%) of the RA cases were classified as early RA. The analyses indicated that the ESR, CRP and CAR values were higher in patients with early RA than in those with established RA and controls. CAR was correlated with albumin, CRP, ESH, DAS-28 and HAQ scores in both early RA and established RA groups. The receiver operating characteristic curves revealed a CAR cut-off value of 2.67 (80% sensitivity and 85% specificity) and 1.63 (77% sensitivity and 72% specificity) for the prediction of early and established RA, respectively. Conclusion CAR, a formulated ratio, has been described as a predictor for disease activity in patients with early RA as well as in those with established RA. However, CAR has higher sensitivity and specificity for early RA than for established RA.</jats:p

Evaluation of Arthralgia Induced by Aromatase Inhibitor Therapy

Background: In breast cancer treatment, aromatase inhibitors (AI) and tamoxifen (Tmx) are frequently used. In this study, the relationship between the hormonal therapy and arthralgia in women with breast cancer was studied. Methods: Sixty-four patients of whom 32 taking AI and 32 taking Tmx were included into the study. VAS was used to determine the intensity of pain. Also five options Likert scale was applied to all patients to answer the question &#147;what are your thoughts about the sources of your current pain?&#148;. As laboratory parameters, CBC, BUN creatinine, ALT, AST, alkaline phosphatase, calcium, CRP, ESR, ANA, RF, and estradiol levels of the patients were analyzed. Results: The mean age of the AI group was 52.7 &#177; 8.2 years and in the Tmx group, it was 47.4 &#177; 6.5 years (p0.05, for each). Conclusion: In our study, more frequent and severe arthralgia has been observed in patients under AI treatment when compared to tamoxifen. One of the causes that leads to arthralgia in patients using AI may be low levels of estradiol. [Cukurova Med J 2013; 38(1.000): 78-85

The Relationship of the Peroxisome Proliferator Activated ReceptorGamma 2 Exon 2 and Exon 6 Gene Polymorphism in Type 2 Diabetic Patients with and without Diabetic Foot Ulcers

We aims investigate Turkish type 2 diabetic patients with/without diabetic foot ulcers and healthy group and examined the contribution of the G/C exon 2 and T/C exon 6 of the PPARgamma gene polymorphism to the development of diabetic foot ulcers. The PPARgamma genotypes were determined prospectively in 50 patients with diabetic foot ulcers and 50 without diabetic foot ulcers and a control group of 50 healthy individuals. Genotyping of the G/C exon 2 and T/C exon 6 of the PPAR-gamma gene polymorphism for all individuals was performed by melting curve analysis of the generated amplicons after real-time online PCR. The genotype exon 2 and exon 6 distribution did not differ between the control group and the type 2 diabetes mellitus patients (with and without diabetic foot) (P&gt;0.05). The frequency of the polymorphic G allele in exon 2 was no similar for the groups (6% and 1%, respectively) (p0.05). The evaluation of exon 2 and exon 6, genotype and haplotype did not show statistically significant difference between the patient diabetic foot and without diabetic foot (p&gt;0.05). The G/C exon 2 and T/C exon 6 of the PPARgamma gene polymorphism is not an independent risk factor for diabetic foot in Turkish type 2 diabetes mellitus patients. Genetic factors in the pathogenesis of diabetic foot may also show any changes in different populations. [Med-Science 2014; 3(4.000): 1582-94

Evaluation of Doxorubicin Cardiomyopathy by Signal Averaged Electrocardiography

BACKGROUND: Signal-averaged electrocardiography detects low-amplitude signals designated as late potentials which are strongly related to myocardial damage. We aimed to search for the possible relation between the myocardial effects of doxorubicin and signal-averaged electrocardiographic parameters. METHODS: Fortyeight patients who received doxorubicin included chemotherapy were enrolled. Signal-averaged electrocardiographic parameters were detected by using 3 parameters; filtered QRS (fQRS), the square root of the voltage obtained during the last 40 milliseconds of the duration of fQRS (RMS40), the duration starting from the last 40 miliseconds of fQRS till the decrease of voltage under 40 microvolts. (HFLA40). Ejection fractions of the patients were measured by echocardiographic evaluation. RESULTS: Median age was 44 (27-70) years. Mean cumulative doxorubicin dosage was 475.56&#177;98.45 mg. Mean values of the measured signal-averaged electrocardiographic parameters were as follows; fQRS: 78.27&#177;10.74 miliseconds, RMS40:115.10&#177;50.23 and HFLA was 21.95&#177;8.39 microvolts . The doses of doxorubicin showed a positive correlation with fQRS (r=0.28, p=0.02) and a negative correlation with RMS40 (r=-.31,p=0.03). There was no correlation between the doxorubicin dosage and the ejection fraction of the patients (r=.18, p=0.22). CONCLUSION: Our results suggested that significant correlations are present between fQRS and RMS40 and cumulative doxorubicin dosages. Therefore, signal-averaged electrocardiographic parameters may be of value for predicting the prognosis of the patients who have received doxorubicin included chemotherapy. [Cukurova Med J 2013; 38(2.000): 241-249

Medicine Science 2014;3(4):1582-94 Peroxisome Proliferator-Activated Receptor-Gamma 2 Gene Polymorphism in diabetic Foot Ulcers Original Investigation The Relationship of the Peroxisome Proliferator Activated Receptor-Gamma 2 Exon 2 and Exon 6 Gene Polymo

Abstract We aims investigate Turkish type 2 diabetic patients with/without diabetic foot ulcers and healthy group and examined the contribution of the Pro12Ala exon 2 and C478T exon 6 of th