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Because of the senescence of the immune system, antibody response to the COVID-19 vaccines may differ from older to younger adults. The study aim compares the titers of SARS-CoV-2 IgG antibody of patients ≥60 years who received three doses of CoronaVac vaccine and those who received two doses of CoronaVac+1 dose of Pfizer-BioNTech after 1 month of the last vaccination. Patients ≥60 years who received the CoronaVac vaccine between March 1, 2021, and April 30, 2021, who did not have COVID-19 disease before the first dose of vaccination and were negative for COVID-19 antibodies, whose antibodies were tested before the third dose of vaccination, and who did not have any COVID-19 disease during the follow-up were included. The demographic characteristics and comorbidities of patients were recorded. An immunofluorescence assay (IFA) fast test and a chemiluminescent microparticle immunoassay (Abbott) were used to measure SARS-CoV-2 quantitative antibody levels at the first month after the third-dose vaccine. Totally 81 patients, 41 patients in third dose of the CoronaVac group (female:male 18:23, mean age 69.4 ± 8.5), and 40 patients in third dose of the Pfizer-BioNTech group (female:male 15:25, mean age 69.9 ± 9.1) were included. The patients' comorbidities in the groups were similar. The titers of IgG antibodies to SARS-CoV-2 measured according to both IFA and Abbott Kit at first month the third dose vaccination was significantly higher in the Pfizer-BioNTech group (p ≥ 0.001, p = 0.012, respectively). The results report that the formed immunity in the first month after the two doses of CoronaVac+1 dose Pfizer-BioNTech vaccine was higher than three doses of CoronaVac vaccine in older adults.

Obesity may also develop due to a viral infection caused by adenovirus 36. We aimed to detect the presence of neutralizing antibodies against Ad-36 in adult patients who developed type 2 diabetes due to obesity (BMI ≥ 30 kg/m2).The patient group (PG) was composed of 80 obese people with type 2 diabetes, the patient control group (PCG) was composed of 40 non-obese people with type 2 diabetes, and the healthy control group (HCG) was com-posed of 40 non-obese people without type 1 or type 2 diabetes in this case-control study. The presence of Ad-36 neutralizing antibodies was studied by serum neutralization assay.A significant difference was found between the PG and HCG in terms of Ad-36 antibody positivity (p0.0001) but no significant difference was detected between the PG and the PCG (p0.05). BMI, serum leptin, adiponectin, and triglyceride levels were significantly higher in the PG (p0.05). Conversely, TNF-α and IL-6 levels were significantly lower in the PG (p0.0001). When the two groups were compared, the mean levels of total cho-lesterol and LDL in the PG were found to be high, although not significant (p0.05). In type 2 diabetes patients (n = 120), age, BMI, HDL, LDL, triglyceride, total cholesterol, Ad-36 presence, leptin, adiponectin, TNF-α, and IL-6 parameters were taken as independent variables for logistic regression. While BMIs was found to be significant (odds ration [OR] = 2.358; p = 0.0001, 95% Cl 1.507 - 3.690, Ad-36 presence was found to be a significant (OR = 27.352; p = 0.003, 95% Cl 3.157 - 236.961). Our study showed that BMI and Ad-36 increase type 2 diabetes risk by 2.3 and 27.3-fold in the PG and PCG (type 2 diabetes patients) versus the HCG. There was also a significant difference between PCG and HCG.We suggest that Ad-36 seropositivity is also a risk factor for the development of type 2 diabetes independent of being obese.

In this period when mutant strains are increasing all over the world, studies on how much humoral immunity will protect against the Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) are quite limited. The aim of our study is to investigate the positivity and antibody levels of the COVID-19 reverse transcription polymerase chain reaction (RT-PCR) test, the frequency of SARS-CoV-2 re-infection, and the protective antibody level against re-infection.Patients who were positive for COVID-19 IgG antibody between 1 July and 31 August were included in our study. The COVID-19 RT-PCR test positivity, age, gender and comorbidities of these patients were recorded before this date. The COVID-19 RT-PCR test positivity of these patients was followed from the National COVID-19 Database between September 1, 2020 and February 28, 2021.1665 patients (female: male 683: 982, mean age 40.6±13.4 years). Among all patients, 14 patients had reinfection and the frequency of reinfection was 0.8%. It was observed that the frequency of reinfection was more frequent in patients with PCR negative (Humoral antibodies against SARS-CoV-2 were protective against COVID-19 reinfection, 0.8% of the patients had reinfection and the resultant reinfection was mostly seen in PCR negative patients who were asymptomatic.

Background: Neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), and platelet-lymphocyte ra-tio (PLR) are inflammation markers in inflammatory, cardiovascular, and malignant diseases and are important to assess prognosis. The aim of the study is to show the correlation between the inflammation markers of NLR, LMR, and PLR identified in total blood count of patients with Coronavirus disease 2019 (COVID-19) with the dis-ease severity. Methods: A total of 409 patients attending hospital with clinical symptoms of COVID-19 and with positive quanti-tative reverse transcriptase-polymerase chain reaction (RT-PCR) test were divided into two groups as 61 severe patients and 348 non-severe patients. The levels of inflammation markers NLR, LMR, PLR, and c-reactive pro-tein (CRP) were assessed. Results: The mean age of 409 patients was 49.9 +/- 18.3 years and 48.7% of all patients were female. In the severe patient group, NLR 8.94 +/- 13.24, LMR 2.24 +/- 1.46, and PLR 248 +/- 254 were identified. NLR exhibited the largest area under the curve at 0.698, with the highest specificity (67%) and sensitivity (67.3%) among the other inflam-mation markers such as LMR and PLR. Consistent with the severity of disease in severe COVID-19 patients, NLR, PLR, CRP and other inflammation markers increase, while LMR is observed to reduce. Conclusions: NLR and PLR, calculated with the simple, cheap, and easily accessible hemogram test requested for diagnosis and follow-up of COVID-19 disease, were correlated with the total score for radiological findings and duration of hospitalization, and we observed NLR and LMR may predict disease severity.

BackgroundVenous thromboembolism is among the common and preventable cardiovascular syndromes. The risk of thromboembolism is increased in elderly and patients with renal failure, and the risk of bleeding due to the use of anticoagulants also increases. Pectoral hematoma due to enoxaparin are presented rarely unlike other bleeding localisation. In this article, 3 cases of pectoral hematoma due to enoxaparin are presented in the light of the literature, especially in this period when the use of anticoagulants is increasing.Case presentationTwo of the 3 cases over the age of 65 were in the intensive care unit, and the other patient received low molecular weight heparin therapy during outpatient follow-up. In these cases enoxaparin use for profilactic and treatment dosages. After anticoagulant using pectoral hematoma was diagnosed by ultrasonography and computed tomography of the thorax in patients. One patient was died from sepsis but in two of other with the discontinuation of the treatment, the size of the hematoma decreased and the treatment change was sufficient.ConclusionLow molecular weight heparins are used in the treatment and prevention of thromboembolism. In elderly and patients with renal failure, care should be taken in terms of pectoral bleeding and other bleeding.

Introduction The use of herbal medicine is common and is increasing globally but it is unknown whether this affects patients’ use of western medicine. The aim of this study was to investigate whether herbal medicine (HM) use may effect medication adherence in Turkish patients with chronic disease attending internal medicine outpatient clinics. Methods Patients prescribed medication by a medical doctor for longer than one year for a chronic disease and with any symptoms were identified from the register of patients attending a general internal medicine outpatient clinic. Medication adherence was measured using the Morisky Medication Adherence Scale (MMAS) score. Patients were questioned about whether they had used any HMs. Results Out of 912 patients examined, 516 patients (51.7% female patients, mean age 52.4) met the inclusion criteria. Use of the HMs was positively correlated with educational status and monthly income and negatively correlated with the MMAS score. Multivariate logistic regression analysis demonstrated that use of herbs and/or herbal products was significantly associated with the MMAS score (OR: 0.85, 95% CI 0.78-0.93, p Conclusion Low medication adherence was found to be independently associated with the use of HMs in this study population. Medication non-adherence is an important public health problem for all departments of medicine. Hospitalizations, drug resistance and disease relapse in patients with chronic diseases could be prevented if medication adherence is achieved

Introduction: This study aimed to assess the correlation between nucleic acid amplification test (real-time reverse transcription-polymerase chain reaction, RT-PCR) positivity of patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19-specific pneumonia diagnosis on thoracic computed tomography (CT), with symptoms, laboratory findings, and clinical progression. Methods: The study included 286 patients (female:male 131:155; mean age, 53.3 ± 17.9 years) who were divided into two groups according to their RT-PCR test results. The symptoms, laboratory examinations, clinical findings, and thoracic CT imaging of the patients were evaluated. Results: While the physical examination, comorbidities, and total CT scores were similar between the groups, taste/smell abnormalities were observed more frequently in the PCR-positive group. The use of moxifloxacin, lopinavir/ritonavir, and tocilizumab was higher in the PCR-positive group (p = 0.016, p < 0.001, and p = 0.002, respectively). The duration of hospitalization, intensive care requirement, and mortality rate of the studied groups did not differ between the groups. Conclusions: Among patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19 on thoracic CT, the symptoms, physical examination, total CT scores, duration of hospitalization, intensive care requirement, and mortality rate were similar between RT-PCR-positive and RT-PCR-negative patients. However, PCR-positive patients appeared to require more specific treatments.

Background: Pneumonia due to Severe Acute Respiratory Syndrome 2 (SARS-CoV-2) is spreading rapidly all over the world and air travel is the leading transmission route of the virus among countries. The aim of the study is to determine the frequency of SARS-CoV-2 Immunoglobulin G (IgG) antibodies in aircrew, to determine occupational exposure, and to understand the spread of immunity in social groups. Method: The study was designed as a cross-sectional retrospective study. SARS-CoV-2 IgG levels were measured in patients who applied to between December 1, 2020 and January 13, 2021. Coronavirus disease-2019 (COVID19) Reverse transcription polymerase chain reaction (RT-PCR) positivity was investigated before December 1, 2020. Results: The patients were divided into three groups according to their jobs such as 313 aircrew; 451 healthcare workers; 4258 other patients. The PCR positivity rate was found to be 39% in the aircrew group, 32% in the healthcare workers and %20 other patient group (p < 0.001). The IgG antibody positivity rate was 46% in the aircrew, 41% in healthcare workers, and 35.3% in the other patient group (p < 0.001).The group with the highest IgG antibody titer is in the aircrew; there was a significant difference between the groups (p < 0.001). Conclusions: In our study, it was observed that aircrew, similar to healthcare workers, are at serious risk against SARS-CoV-2. In this process, it is suggested that the vaccination processes included repeated doses of aircrew should be accelerated and protective measures and equipment should be increased in terms of reinfection.

The news was reported from the Wuhan region of China about a novel corona virus in the end of 2019. After spreading around the world, a pandemic was declared by the WHO. Depending on the different involvement of the disease, the most common symptoms are fever, cough, and dyspnea. However, some indeterminate symptoms that make diagnosis difficult, such as myalgia and fatigue, can also be seen alone, without the typical clinical picture. We describe a patient with COVID-19 pneumonia, the only complaint of which is myalgia, and the first diagnosis is mild rhabdomyolysis. The patient had no evidence or history other than viral infection that could explain muscle pain and also increased level of muscle enzymes. When mild rhabdomyolysis lack of myoglobinuria and complications was diagnosed, treatment-related rhabdomyolysis was also avoided as no treatment related to COVID-19 was initiated yet. Apart from the typical symptoms leading to the typical diagnosis of COVID-19 at the first admission, SARS-CoV-2 related with rhabdomyolysis should also be kept in mind.

Objective To recognize the period of exaggerated cytokine response in patients with Coronavirus disease 2019 (COVID‐19) pneumonia, and to describe the clinical outcomes of using tocilizumab as a treatment option. Methods The data of 12 adult COVID‐19 pneumonia patients who were followed in the inpatient clinics of Biruni University Medical Faculty Hospital (Istanbul, Turkey) were retrospectively analyzed. Diagnostic tests, laboratory examinations, clinical findings and computed tomography of the thorax imaging results were evaluated. Results A dramatic laboratory and clinical improvement was observed in 83% (10/12) of patients after tocilizumab. In 17% (2/12) of our patients, short‐term ventilator support was required in the intensive care unit. The longest hospital stay was 18 days. However, in the end, all of our patients were discharged home with health. While arterial oxygen saturations (87.58±3.12%) dropped in room air in the pre‐tocilizumab period, post‐tocilizumab they normalized in all patients (94.42±1%). None of them had fever after tocilizumab treatment and the levels of c‐reactive protein (13.08±12.89) were almost within normal limits. Eosinophil values were quite low at the time of diagnosis (10±17.06), but increased significantly post‐tocilizumab (155.33±192.69). Conclusion There is currently no proven treatment for COVID‐19 induced by novel coronavirus SARS‐CoV‐2. Based on our experience with twelve adult COVID‐19 pneumonia patients, we can say that tocilizumab, an IL‐6 inhibitor, is more beneficial in preventing the damage caused by excessive cytokine response in the body if administered at the right time and provides clinical and radiological recovery. This article is protected by copyright. All rights reserved.

Background/aim: The aim of this study was to assess the risk of malnutrition in hospitalized patients with three different tests and to compare these tests in terms of long hospitalization periods and sarcopenia. Materials and methods: Hospitalized patients in an internal medicine clinic were enrolled in this cross-sectional study. Patients were grouped as under 65 years (Group 1 = G1) and over 65 years old (Group 2 = G2). The nutritional status of the patients was evaluated with the Nutritional Risk Screening (NRS) 2002, Universal Malnutrition Screening Tool (MUST), Mini Nutritional Assessment Short Form (MNA-SF), and total Mini Nutritional Assessment (MNA) tests. Diagnosis of sarcopenia was assessed via bioimpedance analysis for muscle mass, a hand-grip strength test, and a "timed get up and go" test. Nutritional tests were compared in terms of sarcopenia and long hospitalization periods with receiver operating characteristic curve analysis. Results: Mean ages were 54 (G1, n = 84) and 76 (G2, n = 112) years old. Sarcopenia was found in 5% in G1 and 33% in G2. The MNA-SF in G1 (area under curve (AUC) = 0.585, P = 0.26; sensitivity 41%, specificity 44%) and the MUST in G2 (AUC = 0.614, P = 0.048; 25%, 86%) were better predictors of prolonged hospitalization. The MNA-SF was associated with sarcopenia in both groups (G1: AUC = 0.716, P = 0.147; 63%, 64% and G2: AUC = 0.762, P < 0.001; 86%, 48%). In addition, the MNA-SF was a better predictor of low lean muscle mass index (AUC = 0.762, P < 0.001; 86%, 48%), low grip strength (AUC = 0.594, P = 0.27; 65%, 50%), and reduced walking speed (AUC = 0.642, P = 0.01; 71%, 47%) in G2. Conclusion: None of the three tests are highly sensitive or specific for predicting sarcopenia. The MNA-SF is a better test to evaluate sarcopenia and/or related parameters than the others, and the MUST is related to prolonged hospitalization in older patients.

Background:The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection associated with coronavirus disease 2019 (COVID-19) causes a 3- to 9-fold higher age-adjusted mortality in African American and Hispanic populations, the major US racial groups affected by sickle cell disease (SCD). The Centers for Disease Control designates SCD as a condition at increased risk for severe COVID-19. An urgent need for repurposing of available and safe therapeutics has been cited for such high-risk populations until vaccines are widely available. L-glutamine (GLN) ameliorates clinical pathology of SCD related to elements of COVID-19. Multiple systemic complications of COVID-19 are increasingly attributed to oxidative damage, a target which GLN regulates. Prescription-grade L-glutamine (PGLG) (Endari®, Emmaus Medical) decreases oxidative stress by increasing the ratio of reduced nicotinamide adenine dinucleotide (NAD) to total NAD, which may increase availability of reduced glutathione. PGLG also decreases red cell endothelial adhesion in patients with SCD. Of note, additional analysis of the phase 3 trial demonstrated a 63% lower occurrence of acute chest syndrome (ACS) in PGLG-treated SCD patients compared to control, which has important relevance in the pandemic. A recent report of two computational screens of FDA-approved therapeutics, directed to protein and chemistry targets and to gene expression changes induced by SARS-CoV-2, predicts glutathione and GLN are highly likely to confer benefit in COVID-19 (Kim, J Translat Med, 2020). Methods:We therefore reviewed reports of multi-system effects of GLN in experimental respiratory distress animal models and in ICU and COVID-19 patients. We focused on contributors to cytokine storm and acute respiratory distress syndrome (ARDS), the leading causes of mortality in COVID-19 (Huang, Lancet, 2020). We also conducted a clinical trial in hospitalized COVID-19 patients on ESPEN-recommended nutrition +/- GLN. Results:In experimental ARDS, sepsis, and endotoxin-induced lung injury, GLN decreases consolidation, pulmonary edema, and neutrophil infiltration and increases lung compliance, oxygen saturation, heat shock protein activation, and survival by 2.5-fold over saline controls (Perng WC, Clin Exp Pharmacol Physiol, 2010; Singleton, Crit Care Med, 2005). Patients with severe COVID-19 have increased proinflammatory cytokines; interleukin 6 (IL-6) levels predict and contribute to severity of COVID-19 (Yuki, Clin Immunol, 2020). GLN modulates inflammatory responses by suppressing C-reactive protein, IL-6, and TNF-α release; it also reduces IL-6 in murine studies (37% decrease,p< 0.05; Chuang, BMC Pulm Med, 2014), which could benefit COVID-19 patients. Myocardial injury occurs in up to 12% of COVID-19 patients directly with viral entry through ACE-2 receptors, microvascular damage, endothelial shedding, and inflammation-mediated damage, which GLN protects against (Shi, Eur Heart J, 2020; Shi, JAMA Cardiol, 2020; Shao, Pak J Med Sci, 2015). Inflammatory states lead to GLN consumption and negative GLN balance (Santos, Amino Acids, 2019). Deficient plasma GLN (< 420 µmol/L) is a defined risk for higher mortality in ICU and COVID-19 patients (Shen, Cell, 2020). Glutathione deficiency contributes to SARS-CoV-2 oxidative lung damage and severe disease (Polonikov, ACS Infect Dis, 2020). In a recent clinical trial, patients were confirmed to have SARS-CoV-2 by RT-PCR, had positive CT scans, and were admitted from a COVID-19 clinic. Both arms received ESPEN-recommended nutrition for COVID-19 alone or with GLN (10 grams, 3 times/day; see Table). Conclusions:GLN and glutathione deficiency contribute to COVID-19 severity, and GLN has salutary biologic actions on reducing lung pathology, mediators of cytokine storm, and myocardial injury in animal models, SCD, and ICU patients. GLN reduces severity in standard risk COVID-19 patientsafterinfection has occurred. These findings, combined with computational prediction of GLN benefit vs. COVID-19, support the hypothesis that PGLG treatmentprior toSARS-CoV-2 infection mayreducethe development of severe COVID-19 in SCD and perhaps other high-risk populations. The data as a whole provides a strong rationale for a controlled clinical trial of PGLG toreducesevere COVID-19 in high-risk SCD patients and improve outcomes if infection occurs. Disclosures Cengiz: Biruni University Medical Faculty:Current Employment;Istanbul University-Cerrahpasa Medical Faculty:Ended employment in the past 24 months.Yavuzer:Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Internal Medicine, Division of Geriatrics:Current Employment.Yavuzer:Biruni University Medical Faculty:Current Employment;Istanbul University-Cerrahpasa Mediacl Faculty:Ended employment in the past 24 months.Tang:Kaiser Permanente:Current Employment.Ward:Emmaus Medical, Inc.:Current Employment.Goodrow:Emmaus Medical, Inc.:Current Employment;Emmaus Life Sciences Shareholder:Current equity holder in publicly-traded company.Ludlum:Emmaus Life Sciences, Inc.:Consultancy, Current equity holder in publicly-traded company.Stark:Emmaus Life Sciences Shareholder:Current equity holder in publicly-traded company;Emmaus Medical, Inc:Current Employment.Perrine:Cetya Inc.:Membership on an entity's Board of Directors or advisory committees;Phoenicia Bioscience:Current Employment, Current equity holder in private company, Membership on an entity's Board of Directors or advisory committees;Phoenicia Therapeutics:Membership on an entity's Board of Directors or advisory committees, Patents & Royalties;Boston University School of Medicine:Current Employment, Patents & Royalties;Viracta Therapeutics:Patents & Royalties.

Objective: Polypharmacy, quite common in elderly patients, is an important issue, resulting in increased morbidity and mortality. This study aimed to examine polypharmacy rates and drug usage chara...

There is considerable evidence that oxidative DNA damage is increased, DNA repair capacity is decreased in patients with Alzheimer's disease. Base excision repair is the major pathway in removal of oxidative DNA damage. 8-oxo-deoxyguanosine DNA glycosylase 1 (OGG1) is the enzyme which is involved in the first step of this repair process. Alterations in DNA repair capacity may be related with polymorphisms in DNA repair genes. In order to investigate the effect of OGG1 Ser326Cys polymorphism on oxidative DNA damage level, OGG1 genotyping was performed, basal and oxidative DNA damage in lymphocytes and 8-OHdG level in plasma were examined in patients with Alzheimer's disease. Basal and oxidative DNA damage and 8-OHdG level were measured by OGG1-modified comet assay and enzyme-linked immunoassay, respectively. OGG1 genotyping was performed by polymerase chain reaction- restriction fragment length polymorphism assay. Basal and oxidative DNA damage and plasma 8-OHdG levels were found to be higher in the Alzheimer's disease group than those in the control group (P 0.001). In the Alzheimer's disease group, the levels of oxidative DNA damage was higher in the patients having OGG1 (Ser326Cys + Cys326Cys) genotype than those in the patients having OGG1 Ser326Ser genotype. It was concluded that oxidative DNA damage is increased in patients with Alzheimer's disease and OGG1 Ser326Cys polymorphism may be responsible for this increase.

Background: Hypertension is an important risk factor for cardiovascular diseases and cognitive function. Blood pressure (BP) variability has been associated with cognitive dysfunction, but data are sparse regarding the relationship between BP variability and cognitive function in geriatric patients with well-controlled BP. Aim: The aim of this study was to demonstrate the relationship between blood pressure variability and cognitive functions in geriatric hypertensive patients with well-controlled BP. Method: We analyzed 435 hypertensive patients (167 male, 74.9 ± 8.3; 268 female, 76.1 ± 8.6) treated at least with one antihypertensive drug. All patients underwent ambulatory BP monitoring and the standardized mini mental test (sMMT). Results: We divided the weighted standard deviation (SD) of systolic BP (SBP) as a measure of BP variability into quartiles. The top quartile group (? 18.5 mmHg) had a significantly lower total sMMT score (23.3 ± 3.2, p < 0.001). According to the results of multivariate logistic regression analysis for sMMT, the SD of 24-h SBP was related to sMMT (p = 0.007, 95% confidence interval - 0.301 [- 0.370 to - 0.049]). Discussion: Although there are some inconsistencies among the studies investigating the relationship between blood pressure variability and cognitive functions in elderly patients, we demonstrated the relationship between increased 24-h blood pressure variability and cognitive functions assessed with sMMT in geriatric population with well-controlled BP. Conclusion: The increased blood pressure variability was associated with poorer cognitive functions in geriatric hypertensive patients with well-controlled blood pressure.

Immune thrombocytopenia (ITP) is the most frequent cause of acquired thrombocytopenia. In adult ITP patients, corticosteroids and intravenous immunoglobulin (IVIg) are used as first-line treatment. The aim of the present study was to investigate retrospectively the demographic and etiologic characteristics of patients with ITP admitted to the emergency room at our hospital. Seventy-five adult patients with ITP were included, and demographic data, bleeding characteristics, etiologic features and responses to treatments were evaluated retrospectively. Fifty-six patients (75 %) were female, and the median age was 43 years. Eighteen patients had a history of ITP, whereas in 57, thrombocytopenia was identified for the first time. During admission, the median platelet count was 5 × 10(9)/L. Cutaneous and/or mucosal bleeding was the most common clinical feature. High-dose dexamethasone was administered in 60 episodes, whereas IVIg and conventional-dose methylprednisolone were used in nine and six episodes, respectively. The overall response rate of the entire cohort following first-line treatments was 67 %, and complete remission was achieved in 31 patients, 19 patients achieved partial remission, and 25 patients were non-responders. In cases with life-threatening bleeding, concomitant infection, post-traumatic bleeding and need for emergency surgery, IVIg can be used as the first line of treatment option in addition to platelet transfusions.

The aim of this clinical study was to evaluate the influence of aging on the levels of lipid peroxidation (quantified as thiobarbituric acid-reactive substances (TBARS) content), lipid hydroperoxide (LOOH), hexanoyl lysine (HEL), 8-iso-prostaglandin F2α (8-iso-PGF2α) and total antioxidant capacity (TAC), and determine their relationships to the demographic and cardiovascular risk factors in elderly hypertensive (HT) patients. This study consisted of four groups: two elderly groups with 30 HT patients (11 males, 19 females) and 30 normotensive healthy volunteers (15 males, 15 females), and two young groups with 30 HT patients (13 males, 17 females) and 30 normotensive healthy volunteers (12 males, 18 females). In the elderly control group, the TBARS, LOOH, HEL and 8-iso-PGF2α levels, and the carotid intima media thickness (CIMT) were significantly higher than in the young control group. The TBARS, LOOH, HEL and 8-iso-PGF2α levels and the CIMT measurements were significantly higher in the elderly HT group than in the young HT group. In addition, the TAC levels were significantly lower in the elderly and young HT groups than in the elderly and young control groups. The CIMT was significantly positively correlated with TBARS (r=0.40, P

TMPRSS6 gene mutations can result in iron deficiency anemia (IDA) and cause an increased iron-regulatory hormone, hepcidin, levels. TMPRSS6 encodes a serine protease, matriptase-2, which functions as negative regulatory protein of hepcidin transcription. Thus, TMPRSS6 variations might be risk factors for IDA. The aim of the study was to investigate the association of rs855791, rs4820268, rs5756506, rs2235324, rs2413450, rs2111833, rs228919, and rs733655 SNPs in TMPRSS6 gene with IDA susceptibility and iron-related clinical parameters. The study consisted of 150 IDA patients and 100 healthy controls. We analyzed the genotype distributions by using Real-Time polymerase chain reaction (Real-Time PCR) technique. We did not find any statistically differences for all SNPs between patients and controls (P > 0.05). In IDA patients, variations rs855791 and rs2413450 were associated with increased RBC (P = 0.03) and TIBC (P = 0.04), respectively. Also, increased of TIBC for rs4820268 (P < 0.05). On the other hand, in control group, rs5756506 was associated with two parameters, Hb (P = 0.02) and Hct (P = 0.03). We did not find markedly hepcidin levels in IDA patients compared to controls (P = 0.32). Our findings suggest that TMPRSS6 variations may not be risk factors for IDA. However, TMPRSS6 polymorphisms are associated with increased many iron-related hematological parameters.

This study aimed to evaluate the role of protein oxidation and DNA damage in the elderly hypertensive (HT) patients. This study consisted of four groups: two elderly groups with 30 HT patients and 30 normotensive healthy volunteers, and two young groups with 30 HT patients and 30 normotensive healthy volunteers. Plasma total thiol (T-SH), advanced oxidation protein products (AOPPs), protein carbonyl (PCO), ischemia modified albumin (IMA), urine 8-hydroxy-2′-deoxyguanosine (8-OHdG), and prooxidant–antioxidant balance (PAB) levels were measured. In the elderly HT group AOPPs, PCO, 8-OHdG, and PAB were significantly higher than the elderly control group. In the young HT group T-SH levels were significantly lower and the other oxidative stress parameters were significantly higher than the young control group. In the elderly control group AOPPs, PCO, IMA, 8-OHdG and PAB were significantly higher than the young control group. T-SH was significantly lower in the elderly control than the young control group. In the elderly HT group, T-SH levels were significantly lower and AOPPs, PCO, IMA, 8-OHdG, and PAB levels were significantly higher than the young HT group. Protein and DNA cell damage occurs by oxidation of free radicals throughout life. Our study supports the view that these radicals may be responsible for the development of hypertension with aging process. Urine 8-OHdG levels can be used as a marker for oxidative DNA damage in the elderly hypertensive patients. Finally, our results suggest that oxidative stress may influence both the development and progression of hypertension and aging.

The aim of this study was to investigate the presence of primary sarcopenia in older patients with normal nutrition and to assess the relationships between the primary sarcopenia with anthropometric measurements.In this prospective clinical cross-sectional study, six-hundred patients who applied to Polyclinic of Geriatrics between dates 2010 and 2011 have been evaluated. The 386 patients who were supposed to have potential secondary sarcopenia were excluded from the study. Age, gender, weight, height, BMI, calf and waist circumference, ongoing medications, additional diseases of the 214 patients included in the study have been surveyed. The sarcopenia criteria of EWSGOP have been applied.Two hundred fourteen cases included in the study were composed of 148 female and 66 male subjects. Mean age was 71.8 ± 2.1 years. Sarcopenia was detected in 105 (49%) subjects while 109 (51%) were normal. Sixty-four female (61%) and 41 (39%) male subjects were sarcopenic. Normal group included 84 female (77%) and 25 male (23%) subjects. Incidence of sarcopenia was found higher in the female patients (p0.001). No statistically significant difference was detected between sarcopenic and normal groups with respect to age, height, weight, calf circumference and evaluation tests. Waist circumference was higher in the sarcopenic group than the normal group (p=0.02). When both groups were analyzed for BMI; 53 (51%) of the 105 sarcopenic patients had BMI over 30 kg/m2 while 29 (27%) and 23 (22%) patients had BMI of 25-30 kg/m2 and below 25 kg/m2, respectively. Incidence of sarcopenia was significantly higher in the group with BMI over 30 kg/m2 when compared with the groups with BMI of 25-30 kg/m2 and below 25 kg/m2 (p=0.01).Sarcopenia that makes older people physically dependent and decreases their quality of life that receive sufficient nutritional support and are also obese should be comprehensively investigated with respect to presence of sarcopenia.

The aim of the current study was to compare oxidative DNA damage, DNA susceptibility to oxidation, and ratio of GSH/GSSG in patients with Alzheimer's disease (AD) treated with acetylcholinesterase inhibitor (AChEI) and combined AChEI+memantine. The study included 67 patients with AD and 42 volunteers as control. DNA damage parameters (strand breaks, oxidized purines, H2O2-induced DNA damage) in lymphocyte DNA and GSH/GSSG ratio in erythrocytes were determined by the comet assay and spectrophotometric assay, respectively. DNA damage was found to be higher, GSH/GSSG ratio was found to be lower in the AD group than those in the control group. DNA strand breaks and H2O2-induced DNA damage were lower in the patients taking AChEI+memantine than those in the patients taking AChEI but no significant difference was determined between the groups for oxidized purines and GSH/GSSG ratio. In conclusion, increased systemic oxidative DNA damage and DNA susceptibility to oxidation may be resulted from diminished GSH/GSSG ratio in AD patients. Although DNA strand breaks and H2O2-induced DNA damage are lower in the AD patients treated with combined AChEI and memantine, this may not indicate protective effect of memantine against DNA oxidation due to similar levels of oxidized purines in the patients treated with AChEI and AChEI+memantine.

As a modifiable risk factor for cardiovascular disease, presence of hypertension (HT) necessitates the awareness of asymptomatic organ damage (AOD). The aim of this study was to measure plasma micro RNA-21 (miR-21) and the parameters that reflect AOD such as carotid intima-media thickness (CIMT), microalbuminuria (MAU) in hypertensive patients compared with healthy controls. In addition, the aim of this study was to evaluate plasma miR-21 levels in HT patients with AOD. This study was designed as a cross-sectional observational study. The study includes 2 groups: 32 patients with HT and 32 healthy controls. First, we compared these 2 groups. Then, to underline the relationship between plasma miR-21 and HT, hypertensive patients were divided into 2 groups: with AOD and without AOD. Sixteen patients with HT had AOD. MiR-21 levels significantly correlated with clinical systolic and diastolic blood pressure, MAU, Creactive protein, and CIMT. CIMT, miR-21, and MAU levels were significantly higher in patients with AOD. Our study showed increased miR-21 levels in HT patients with AOD. Abbreviations: AOD = asymptomatic organ damage, AUC = area under curve, BSA = body surface area, CIMT = carotid intima– media thickness, CrCI = creatinine clearance, CRP = C-reactive protein, D = disease, DBP = diastolic blood pressure, eGFR = estimated glomerular filtration rate, F = female, HDL = high-density lipoprotein, HT = hypertension, IVSTd = interventricular septal diastolic thickness, LDL = low-density lipoprotein, LVDd = left ventricular end-diastolic diameter, LVH = left ventricular hypertrophy, LVM = left ventricular mass, LVPWTd = left ventricular posterior wall diastolic thickness, M = male, MAU = microalbuminuria, miR-21 = micro RNA-21, mRNA = messenger RNA, RNA = ribonucleic acid, ROC = receiver operating characteristic, SBP = systolic blood pressure, T = total.

Objective: The present study compared the unfavorable effects of protein oxidation and deoxyribonucleic acid damage on patients with white coat hypertension (WCH), sustained hypertension (HT), and normotensives. Methods: Participants were allocated into 3 groups: 40 healthy controls, 36 patients with WCH, and 40 patients with sustained HT. Patients with risk factors for atherosclerosis, endocrine diseases, alcoholism, or masked hypertension were excluded. Plasma level of protein carbonyl (PCO), ischemia modified albumin (IMA), total thiol (T-SH), prooxidant-antioxidant balance (PAB), advanced protein oxidation products (AOPPs), and urinary level of 8-hydroxy-2’-deoxyguanosine (8-OHdG) were measured and relationship between these oxidative stress parameters and WCH and sustained HT was analyzed. Results: Ambulatory 24-hour, daytime and night-time systolic and diastolic blood pressure readings of sustained HT group were significantly higher than those of WCH and control groups (p

The aims of this study are to determine the incidence and risk factors of thrombosis and bleeding in polycythemia vera (PV) patients and to research the effects of these risk factors on survival. The medical records of 155 PV patients were analyzed retrospectively. Patients were divided into groups according to whether or not thrombosis had developed in follow-up, and according to whether or not bleeding had occurred during follow-up. The mean age at diagnosis was 53 years, and the mean follow-up period was 66 months. The percentage of cases in which thrombosis events had occurred before diagnosis and during follow-up were 26 and 28 %, respectively. Comparisons of disease duration and average thrombosis risk score between groups with or without thrombosis drew statistically significant results. A patient’s history of thrombosis and thrombocytosis at first visit was found to have a significant effect on thrombosis recurrence. The major bleeding rate was 8 %. Post-PV myelofibrosis was an independent risk factor for bleeding. The major cause of death among the patients in this study was primary thrombosis. The most important causes of mortality among PV patients are thrombosis, and the most prominent risk factors for thrombosis development are disease duration and high thrombosis risk scores. Thrombocytosis in patients with a history of thrombosis may cause thrombosis recurrence during the follow-up period.

Summary Background Although Legionella pneumophila serogroup 1 is the common disease causing serogroup, rare serogroups can also may cause legionellosis. A 54-year-old male patient (index case) reported that he had been on a religious trip (for visiting, tomb of Ali, which is important for Shias) to Iraq with a large group (50 shia pilgrims from Kars city of Turkey) two weeks prior to admission. Due to civil war, the hotel where the patient stayed in Iraq lacked proper hygiene. A large number of people in the travel group were experiencing the same symptoms. Other five cases were 2 males (ages; 50, 45) and 3 females including the wife of the index case (ages; 50, 28, 27). Method The detection of L. pneumophila IgG and IgM was performed by anti-L. pneumophila Indirect Immunofluorescent IgM, IgG kit. Legionella 1 biochip/verification BIOCHIP slides were used for serogrouping in Euroimmun AG, Leubeck, Germany. Results In index case, L. pneumophila IgM was positive with a titer of 1/32 titer. IgG was negative with a 1/100 titer. Another case (28 year old female), had clinical symptoms identical to the index case. L. pneumophila IgM and IgG were positive with titers of 1/64 and 1/100, respectively. These two cases were diagnosed with Legionnaires' disease caused by L. pneumophila serogroup 12 (index case) and female (28-year-old) by serogroup 11. The other 4 cases were diagnosed with possible Pontiac fever caused by L. pneumophila serogroups 14 (wife of the index case), 4, and 6 whereas the serogroup of L. pneumophila detected in 27 years old female case could not be identified. Conclusion A major limitation of this work is the absence of genotyping and the serogroup difference between index case and his wife who shared the same hotel. We suggest that this serogroup difference may be caused by (for men and women) sitting separately in Islamic rules. On the other hand, the movement of people in the context of mutual visits between countries or neighboring countries for tourism-related (i.e., for religious events or visits to holy sites) or immigration-related reasons, may cause some epidemic diseases. This study reemphasized that not only L. pneumophila serogroup 1, but other rare serogroups might cause also legionellosis which may increase in frequency and cause regional epidemics. We propose that increased financial resources for improving the hygiene conditions and performing routine legionella surveillance studies in touristic hotels would be useful measures for legionellosis prevention and control.

Hypertension is an important risk factor for dementia as much as the morbidity and mortality of cardiovascular disease. Sustained hypertension is also more related to that risk. The aim of the study was to determine the relationship between 24-h ambulatory blood pressure monitoring (ABPM) and cognitive functions in elderly hypertensive patients without comorbid diseases which may deteriorate cognitive functions. Ninety-one patients (21 male, 72.5 ± 8.1;70 female, 71.7 ± 7.7) above 60 years old previously diagnosed as hypertensive (HT) have been included to this study. The ABPM was performed after standardized mini mental test (sMMT) and geriatric depression scale (GDS) has been examined. The patients were divided into the groups as dipper/nondipper and regulated/nonregulated. The sMMT scores of the groups were compared. There was no statistical difference in average sMMT scores and distribution of mini mental groups between the dipper and nondipper groups. Hypertension regulation and mini mental measurements of the studied groups were moderately suggestive in the same direction (r = 0.333, p = 0.001). There is an association between tension regulation and cognitive functions in elderly patients who have primary HT, but no relationship have been found between being nondipper and low cognitive function. Our results suggested that this study is critically important by means of revealing that the studies which are perceived distinctly about HT and cognitive functions need further evaluation with subgroup analyses in selected patient groups.

An association has been described between inflammation and the progression of hypertension (HT) and is shown with several biochemical parameters. Our aim was to examine the distribution of the serum procalcitonin (PCT), pentraxin (PTX)-3 and interleukin (IL)-33 levels and their relationship with carotid intima-media thickness (CIMT) in subjects with white coat HT (WCH), HT and normotension (NT) groups. Thirty-three patients with HT, 33 patients with WCH and 33 healthy subjects were enrolled in this study. PCT, PTX-3 and C-reactive protein (CRP) levels significantly increased in the HT group compared with the NT group. In addition, PCT and CRP levels were significantly higher in the WCH group than in the NT group. CIMT measurements were significantly higher in the WCH and HT groups than in the NT group. In the HT and WCH groups, there were significant positive correlations between PTX-3, PCT and CRP. In the WCH group, PTX-3 and PCT levels were significantly positively correlated with CIMT. PCT had area under the curve value of 0.817 which demonstrates its sufficiency to distinguish WCH from NT individuals. Our results suggest that in subjects with WCH and HT, which are characterized by increased cardiovascular risk, PTX-3 and PCT levels in the HT group and PCT levels in the WCH group are significantly and consistently higher than normotensives. Systemic inflammation moderately occurs in the WCH and HT groups. PCT monitoring may be a useful biomarker in inflammation related to atherosclerosis and early stage HT.

We thank the Research Fund of Istanbul University. This work was supported by grants from the Research Fund of Istanbul University (Project Number: 40447)., Objectives: The aim of this study is to evaluate the relationship of miR-21, nitric oxide (NOx) and endothelial nitric oxide synthase (eNOS) with subclinical atherosclerosis in carotid arteries by measuring carotid intima media thickness (CIMT) in patients with hypertension and healthy controls. Design and Methods: A total of 28 hypertensive and 28 healthy controls were enrolled. MiR-21 expression was analyzed by quantitative reverse transcription-PCR and NOx, and eNOS levels were measured by ELISA assay. CIMT was evaluated by ultrasonography and CIMT0.8mm was accepted as increased CIMT (iCIMT). Results: C-reactive protein (CRP) level, plasma miR-21 expression level and CIMT were found to be significantly higher in the hypertension group when compared to the control group (p=0.009, p=0.002 and p, Istanbul University [40447]

The aims of this study included an examination of soluble lectin-like oxidized low-density lipoprotein (LDL) receptor-1 (sLOX-1) levels in hypertensive (HT) patients. Another aim examined sLOX-1 associations with oxidized LDL (oxLDL), nitric oxide synthase (eNOS) and nitric oxide (NOx). A final aim was to compare these parameters between HT patients, white-coat hypertensive (WCH) patients and healthy controls. The three groups, HT, WCH and controls, were comprised of 35 patients each. sLOX-1 and oxLDL levels were significantly increased in WCH and HT patients compared with controls. The eNOS activation was significantly lower in HT than in the control group. sLOX-1 and oxLDL levels were significantly negatively correlated with eNOS levels in the WCH and HT groups. Carotid intima-media thickness (CIMT) measurements were significantly higher in the WCH and HT groups compared with controls. There was a significant positive correlation between CIMT and sLOX-1 and oxLDL; however, there was a negative correlation with eNOS in WCH. Regression analysis revealed that sLOX-1 was the variable that had a significant effect on blood pressure (P

This work was supported by grants from the Research Fund of Istanbul University (project number: 40447)., White coat hypertension (WCH) is a high cardiovascular risk condition, and a fundamental understanding of the cause and pathophysiology of the disorder is still lacking. Recent studies demonstrated that microRNAs (miRNAs) are involved in hypertension; however, the roles of miRNAs in WCH are not known. The expressions of selected 10 miRNAs were investigated independently in plasma samples from 30 hypertension (HT) patients, 30 WCH patients, and 30 normotensive (NT) subjects. MiR-21, miR-122, miR-637, and let-7e expression levels were significantly upregulated in the HT group compared with the NT groups (P = 0.017, P = 0.022, P = 0.048, and P = 0.013, respectively). MiR-122 and miR-637 expressions were also significantly upregulated in the WCH group compared with the NT group (P = 0.048 and P = 0.039, respectively). MiR-296-5p expression level was significantly down-regulated in HT patients and upregulated in the WCH patients compared with the NT group (P = 0.049 and P = 0.039, respectively). Additionally, the ambulatory 24-hour and daytime systolic and diastolic blood pressures were negatively correlated with miR-2965p. MiR-296 and miR-637 had area under the curve (AUC) values of 0.778 and 0.774, respectively, which demonstrates their sufficiency to distinguish WCH from NT individuals. MiR-296 and miR-637 had AUC values of 0.868 and 0.680, respectively, which shows their potential to distinguish WCH from HT individuals. We report for the first time a plasma miRNA profile for WCH patients and demonstrate a novel link between miRNA and WCH. These findings may reveal crucial insights into the development of WCH., Istanbul University [40447]