Niacin: Does It affect 8-hydroxy-2-deoxyguanosine levels of the patients having low HDL cholesterol levels?

We aimed to determine whether niacin improve plasma HDL-cholesterol levels by decreasing 8-Hydroxydeoxyguanosine (8-OHdG) as a biomarker of oxidative DNA damage or not. Patients (n=32) with low HDL-cholesterol levels (≤ 40 mg/dl) were included in the study. Lipoprotein profiles (total cholesterol, HDL-C, and total triglycerides) were measured in all patients. LDL-C was calculated as described by Friedewald et al. Before and after 16 week of niacin therapy serum 8-OHdG was measured. There were significant difference between pre and post treatment plasma HDL-C and 8-OHdG levels. We concluded that niacin may raise HDL-C levels. The improvement of plasma HDL-C levels may have a protective effect on endothelial dysfunction. By reducing the level of 8-OHdG, niacin may decrease DNA damage. Thus, niacin therapy may be consider as an alternative to statins or fibrates in patients in whom fail to sufficiently correct low HDL-C levels. [Med-Science 2013; 2(2.000): 618-23

Rates and Risk Factors of Diabetic Foot Reamputations

SUMMARY Aim: The aim of this study is to determine the reamputation rate in patients who had amputation surgery in our hospital with the diagnosis of diabetic foot and to analyze the comorbid factors. Material and Method: Of 131 patients with detailed information in their files 66 patients who had amputation surgery are included in the study. Age, gender, smoking habits, comorbid diseases, number, level, side and time period of amputation surgeries experienced, presence of infection, wound culture growth of microbes, presence of leukocytosis and method of treatment are recorded. Diabetic foot ulcers of the patients are graded with Wagner-Meggit classification depending on the depth of the wound. Wounds are also evaluated in three different pathophysiological groups as neuropathic, neuropathic-ischemic and ischemic. Levels of amputation were digital, ray, transmetatarsal, below-knee transtibial and above-knee transfemoral. Ipsilateral or contralateral reamputations in previosly amputated patients were investigated. Results: Of the 66 patients who experienced amputation or reamputation surgery 45 were males and 21 were females. Mean age was 63,2 ( 26-88 ). 11 patients had reamputation surgery. 7 patients had ipsilateral reamputations at a more proximal level, 2 patients had contralateral side amputations and ipsilateral more proximal level reampuations and 2 patients had contralateral side amputations. Wagner-Meggit classification of the wounds in amputated patients yielded 4 Grade3, 40 Grade4, 11 Grade5 wounds where as 7 Grade4, 4 Grade5 wounds in reampuatated patients. Pathophysiological classification yielded 6 neuropathic, 21 neuroischemic and 28 ischemic wounds in amputation group where as 4 neuroischemic and 7 ischemic wounds in reamputation group. Discussion: Evaluation of diabetes dependent and nondependent comorbid risk factors as well as the physiological capacity of the patients are important as much as selecting accurate level of amputation level with the aid of new diagnostic techniques in decreasing reamputation risk and rates. [Med-Science 2012; 1(4.000): 283-91

Molecular and serological investigations of the Influenza A(H1N1) 2009 pandemic virus in Turkey

Intense research has been conducted on influenza A(H1N1)pdm09 virus to determine the virulence markers. Limited information on characteristics of pandemic virus has become available in Turkey since the pandemic. In this first report from Turkey, we investigated the molecular markers that have been associated with increased virulence and oseltamivir resistance. We also conducted serological studies in people after infection, vaccination, exposure, and no-exposure controls to determine the level of protection against the pandemic H1N1 influenza virus. Thirteen rRT-PCR positive samples were analyzed for presence of mutations that have been associated with host range, virulence, and antiviral resistance: substitution D222G in the HA, E627K in the PB2, and H275Y in the neuraminidase (NA). In addition, 135 serum samples from vaccinated, recovered, asymptomatic contacts, and control individuals were tested using hemagglutination inhibition (HI) assay. D222G was detected in nasal samples from two severe cases. No specified mutations in the PB2 and NA were identified. Additional substitutions, I216V, V321I, E374K, S203T in HA, V655I in PB2, and I163V in NA, were detected. HI testing from vaccinated individuals, recovered patients, asymptomatic contacts, and control individuals showed that 97.9, 99.7, 88.2, and 44.2 % had HI titers a parts per thousand yen40, respectively. Molecular markers promoting influenza A(H1N1)pdm09 to become a pandemic virus are still under investigation. Serological results confirm that younger, un-exposed individuals are at increased risk of pandemic virus infections. Influenza A(H1N1)pdm09 viruses are still in circulation around the globe. Therefore, these viruses need to be monitored closely for development of new markers including antiviral resistance mutations

A Retrospective Analysis of Amputation Rates and Comorbidity in Patients with Diabetic Foot Ulcer

Abstract Diabetic foot ulcers cause elongated hospitalisations with high treatment costs and high rates of lower extremity amputations resulting with increased morbidity and decreased quality of life. The aim of this study was to determine amputation rate in patients admitted to our hospital with the diagnosis of diabetic foot and the most common risk factors in patients with diabetic foot ulcers. 131 patients admitted to outpatient clinics of Izmir Katip Celebi University Ataturk Training and Research Hospital between January 2011 and December 2011 with the diagnosis of diabetic foot ulcer were retrospectively analyzed. Of these 96 were males and 35 were females. Age, gender, smoking and alcohol habits, comorbid diseases, presence of infection, growth of microorganism in medium, presence of leukocytes, hypertension, method of treatment and regimes of antibiotics are recorded. Mean age was 61,1 ( 26-90). Patients are divided into two groups according to treatment protocols, first group was consist of debriated and medicaly treated patients, while the second group covered amputated patients. 66 were amputated and the rest 65 had debridement-wound care and antibiotherapy after they were evaluated in the diabetic foot council of our hospital. Rate of amputation was 50 %. 36 of the amputated patients had major and the others had minor amputations. Most common comorbidities that related and nonrelated to diabetes were peripheral arterial disease ( 102 out of 131; 77% ) and hypertension ( 50 out of 131; 38% ); respectively. Grading of diabetic ulcers according to Wagner-Meggit classification yielded that most commonly seen wounds were grade 4 in the amputation group and grade 2 in the debridement group. According to pathophysiological classification most common cause were ischemic wounds in both groups. Compared to the literature, our amputation rates are higher. This issue can be attributed to high rates of comorbid factors, higher age and irregular follow-up. Key words: diabetic foot, amputation, comorbidity [Med-Science 2012; 1(4.000): 331-40

Influenza Surveillance in Nine Consecutive Seasons, 2003-2012: Results from National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Turkey

Influenza is a public health problem that affects 5-20% of the world population annually causing high morbidity and mortality especially in risk groups. In addition to determining prevention and treatment strategies with vaccines and antivirals, surveillance data plays an important role in combat against influenza. Surveillance provides valuable data on characteristics of influenza activity, on types, sub-types, antigenic properties and antiviral resistance profile of circulating viruses in a given region. The first influenza surveillance was initiated as a pilot study in 2003 by now named National Influenza Reference Laboratory, Istanbul Faculty of Medicine. Surveillance was launced at national level by Ministry of Health in 2004 and two National Influenza Laboratories, one in Istanbul and the other in Ankara, have been conducting surveillance in Turkey. Surveillance data obtained for nine consequtive years, 2003-2012, by National Influenza Reference Laboratory in Istanbul Faculty of Medicine have been summarized in this report. During 2003-2012 influenza surveillance seasons, a total of 11.077 nasal swabs collected in viral trantport medium were sent to the National Influenza Reference Laboratory, Istanbul for analysis. Immun-capture ELISA followed by MDCK cell culture was used for detection of influenza viruses before 2009 and real-time RT-PCR was used thereafter. Antigenic characterizations were done by hemagglutination inhibition assay with the reactives supplied by World Health Organization. Analysis of the results showed that influenza B viruses have entered the circulation in 2005-2006 seasons, and have contributed to the epidemics at increasing rates every year except in the 2009 pandemic season. Influenza B Victoria and Yamagata lineages were cocirculating for two seasons. For other seasons either lineage was in circulation. Antigenic characterization revealed that circulating B viruses matched the vaccine composition either partially or totally for only three seasons. Influenza A(H1N1) and A(H3N2) subtypes were in circulation since the beginning of the surveillance in 20032004 season either alone or in cocirculation. After the 2009 pandemic, A(H1N1) viruses were replaced by A(H1N1)pdm09. A(H1N1) and A(H1N1)pdm09 viruses matched the vaccine composition for all seasons. However, A(H3N2) viruses matched the vaccine composition in only three out of eight seasons. Analysis of the data revealed that, (a) influenza season has extended in Turkey and it lasts through May; (b) influenza peaks in different age groups depending on the season; (c) every year a different influenza type and subtype dominates the season; (d) influenza B has been circulating with increasing rate especially in the past six seasons. Influenza surveillance provides valuable data that can guide policy makers in developing programmes to prevent and reduce influenza burden. Therefore, addition of hospital based surveillance to general practice based sentinel surveillance will take influenza surveillance one step ahead in meeting the need for collecting data on severe influenza cases which will allow assesment of burden of influenza more reliably

Sensitivity of rapid influenza antigen tests in the diagnosis of pandemic (H1N1)2009 compared with the standard rRT-PCR technique during the 2009 pandemic in Turkey

The real-time reverse transcription polymerase chain reaction (rRT-PCR) technique has been used as the reference technique for the diagnosis of pandemic (H1N1)2009 virus infections. However, rapid influenza diagnostics tests (RIDTs) have been considered in the diagnosis of pandemic (H1N1)2009 by some healthcare institutions in Turkey due to their ease of use and generation of fast results. Nevertheless, their low sensitivity has caused concern during the control of the pandemic. This study aimed to determine the sensitivity of 4 different rapid tests available on the market in Turkey in the diagnosis of pandemic (H1N1)2009 infections compared to the reference rRT-PCR technique. One hundred and four patient samples that tested positive and 88 samples that tested negative for pandemic (H1N1)2009 by rRT-PCR were tested with RIDTs available on the market. The sensitivity of the rapid tests ranged from 31.7% to 50% depending on the brand of RIDT. Specificity ranged from 97.7% to 100%. Currently available RIDTs are not sensitive enough and could lead physicians to delay the treatment of patients, adversely affecting control efforts to mitigate the pandemic. Therefore, these tests should only be used for screening, and negative results should not rule out influenza. More sensitive and rapid point-of-care techniques are needed to meet the demands of point-of-care testing

The effects of blood transfusion on renal functions in orthopaedic surgery

Objective: The effects of perioperative blood transfusion on renal functions have been studied in various studies. In this study, we investigated the effects of blood transfusion on postoperative kidney functions in patients who underwent orthopaedic surgeries