Fetuin-A is related to syndesmophytes in patients with ankylosing spondylitis: a case control study

OBJECTIVES: New bone formation is one of the hallmark characteristics of ankylosing spondylitis, which is thereby associated with syndesmophytes. Fetuin-A is a molecule that is abundantly found in calcified tissues and it shows high affinity for calcium phosphate minerals and related compounds. Considering the role of fetuin-A in the regulation of calcified matrix metabolism, we compared the fetuin-A levels in ankylosing spondylitis patients with syndesmophytes with those in patients without syndesmophytes and in healthy controls. We also studied other biomarkers that are thought to be related to syndesmophytes. METHODS: Ninety-four patients (49 patients without syndesmophytes, 67.3% male, 40.7±8.7 years; 45 patients with syndesmophytes, 71.1% M, 43.9±9.9 years) and 68 healthy controls (44.2±10.6 years and 70.6% male) were included in this study. Syndesmophytes were assessed on the lateral radiographs of the cervical and lumbar spine. The serum levels of fetuin-A, dickkopf-1, sclerostin, IL-6, high-sensitivity C-reactive protein and bone morphogenetic protein-7 were measured with an enzyme-linked immunosorbent assay. RESULTS: Patients with syndesmophytes had significantly higher levels of fetuin-A compared with patients without syndesmophytes and controls (1.16±0.13, 1.05±0.09 and 1.08±0.13 mg/ml, respectively). However, fetuin-A was not different between the patients without syndesmophytes and controls. Bone morphogenetic protein-7 was significantly lower; dickkopf-1 was significantly higher in patients with ankylosing spondylitis compared with controls. The sclerostin concentrations were not different between the groups. In regression analysis, fetuin-A was an independent, significant predictor of syndesmophytes. CONCLUSION: Our results suggest that fetuin-A may a role in the pathogenesis of bony proliferation in ankylosing spondylitis

Impaired Renal Function in Outpatients with Acute Carbon Monoxide Poisoning

Objective: The study aims to investigate the incidence of early stage kidney disease in outpatients with acute carbon monoxide poisoning (CMP) and to assess whether the Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EPI) values of these patients had any impact on the time taken for their discharge

Cenozoic collisional tectonics and origin of Pb-Zn-F mineralization in the Bitlis Massif, SE Turkey

Hasbey Pb-Zn-F mineralization in the Bitlis Massif, south of Lake Van, lies within the Neotethyan suture of the Alpine orogenic belt. Mineralization occurs in two different lithologies and locations: Type-I is present in dolostone fractures and faults as veins and veinlets, whereas Type-II occupies a fault zone between black marbles and calcschists. Sphalerite and argentiferous galena are the main ore minerals in both types. The dominant gangue minerals are quartz and dolomite in Type-I ore and calcite, quartz, and green-white fluorite in Type-II. Analysed fluid inclusion data from sphalerite, fluorite, and quartz indicate that high-temperature (>500 degrees C) mineralization was initiated from low-salinity fluids (4.3 wt.% NaCl equiv.). As temperatures dropped from 400 degrees C to 160 degrees C, the salinity of solutions increased and appreciable CO2 was contributed to the fluid system. In the absence of immiscibility, assemblages of fluid inclusions containing CO2 indicate that the solutions were homogeneous during entrapment and that mineralization took place under pressure conditions between 5 and 2 kb

A case of massive dystrophic cardiac calcinosis with increased bone resorption markers: A novel pathophysiologic link?

We report a 72-year-old man who presented to our emergency room with congestive heart failure that was resistant to initial medical therapy. He had suffered from anterior myocardial infarction 20 years prior. Echocardiography and computed tomography revealed marked cardiac calcification including myocardium, chordal structures, mitral annulus, and aortic valve. Neither chronic renal insufficiency nor hypercalcemia were present in our patient. Bone resorption markers were increased and bone mineral density was consistent with severe osteoporosis. We suggested a novel mechanism, that increased bone resorption may lead to accumulation of calcium into avascular tissues in the heart (ie, chordal structures, mitral annulus, aortic valve, and fibronecrotic myocardium) especially in the setting of high left ventricular end-diastolic pressure. Dystrophic cardiac calcinosis, an age-related cardiomyopathy, is associated with elevated bone resorption markers and it may cause alterations in cellular calcium hemostasis with initiation of deleterious events leading to aggravate dilated and restrictive cardiomyopathy and may result in intractable congestive heart failure. The implication of this case report needs to be reemphasized

A rare foreign body into the male penile urethra

A wide variety of urethral foreign bodies have been described in the literature. In adults, this is commonly caused by the insertion of objects used for masturbation, and is often associated with a mental disorder as in our case described herein. We report a 28-year-old man, hospitalized for self-insertion of a pen into the urethra. The pen was removed successfully by surgery

Serum levels of NT-ProBNP as an early cardiac marker of carbon monoxide poisoning

Acute carbon monoxide (CO) poisoning may cause cardiotoxicity. The natriuretic peptides, including atrial natriuretic peptide, brain natriuretic peptide (BNP), N-BNP, and NT-proBNP (N-terminal pro brain natriuretic peptide), are endogenous cardiac hormones that may be secreted upon myocardial stress. The aim of this study was to assess the plasma NT-proBNP level in acute CO poisoning and to compare it with healthy control. After approval by the ethical committee, 15 healthy controls and 15 patients admitted to the Gaziantep University Hospital (Gaziantep, Turkey) between January 2005 and July 2005 with the diagnosis of carbon monoxide poisoning were studied. Echocardiography was performed to all patients. Serum NT-proBNP, creatine kinase (CK), creatine kinase-MB (CK-MB), and troponin-T were also analyzed, along with the carboxyhemoglobin (COHb) level. The correlation between serum NT-proBNP and COHb level was investigated. Electrocardiography (ECG) was performed to all patients and healthy controls, and the results were compared. Differences in troponin, CK, and CK-MB levels were not statistically significant between groups (p > 0.05). The level of NT-proBNP and COHb were found to be increased in the study group. There was a positive correlation between the COHb and the NT-proBNP (r = 0.829, p < 0.01), and between the COHb and the CK (r = 0.394, p < 0.01). There was no difference between groups in other parameters, all of which were within normal range. Thus, in this sudy we showed that the plasma NT-proBNP level may contribute to the early diagnosis of cardiotoxicity in patients with carbon monoxide poisoning. Copyright © Taylor and Francis LLC

Cardiac damage secondary to occupational exposure to tin vapor

Tin is commonly used as a coating on copper kitchen appliances, and "tinsmithing" as a trade is common in many non-Western countries, where cooking utensils are re-tinned when the cooking surface wears thin. Tinsmiths, or "tinkers," are commonly exposed to the following fumes during their work: stannic [tin(IV)] oxide, ammonium chloride, and hydrochloric acid. In this study we assessed workers from tinsmith workshops of our province for signs, symptoms, and laboratory evidence of cardiac end-organ damage. Between June 2002 and March 2003, researchers went to the main tinsmith workshop area of our province to interview tinsmiths in their workplaces and to gather addresses of their "traveling tinker" colleagues, who work with portable equipment. All workers were interviewed and underwent a complete physical examination, blood testing for lipid parameters, and echocardiography. Twenty-six tin workers (mean age 49 ± 10 y) and 25 control patients (convenience sample of hospital employees) were included in the study. Tobacco use, incidence of hypertension, and serum lipid parameters were not significantly different between the two groups (p < .05). The differences in myocardial performance index, systolic function, and mitral flow A velocity were also nonsignificant. However, the mitral inflow E velocity in the tinsmiths was significantly less than in controls (0.71 ± 0.1 vs. 0.95 ± 0.1 m/s, p < .001). The mitral deceleration time was also much longer in the tinsmith group (216 ± 71 ms vs. 143 ± 14 ms, p < .001). Eleven of the tinkers (23%) were found to have aortic valve sclerosis (severe in one, moderate in another, mild in the other nine), but aortic valve sclerosis was found in none of the control subjects. One tinsmith was found to have three-vessel coronary disease on angiogram. Another tinker with "myocarditis" in the past, and slow flow on angiography, had normalization of his cardiac tests after refraining from tin exposure for 6 mo. Thus, occupational exposure to heavy tin fumes is associated with left ventricle diastolic dysfunction and sclerosis of the aortic valve. Tin workers should minimize their exposure to tin fumes, and physicians should monitor tinsmiths closely for signs of heart disease. Copyright © Taylor and Francis LLC

An analysis of 682 adult poisonings in central Anatolia of Turkey

We defined patient demographics, type of the poisoning, distribution according to month, route and reason for exposure, mortality causes and rates from 682 poisonings admitted to University Hospital in Kayseri, Turkey to evaluate whether they follow the pattern of other countries. Poisoning were drugs (54.5 %), inhalational poisonings including carbon monoxide (13.7%), food (12.4%), alcohol (7%), pesticides (5.4 %) and corrosives (2.1%). In drug ingestions, psychoactive drugs most common; psychoactive, analgesic, and anti-inflammatory drugs were most frequent agents in multiple drug poisonings. Drugs were the most used poison while pesticides, mushrooms, methanol and carbon monoxide caused more deaths. The mortality rate was 2%

Oral deltamethrin ingestion due in a suicide attempt

Deltamethrin intoxication is uncommon throughout the world. The toxicity of insecticides containing pyrethroids is considered relatively lower than that of other insecticides such as compounds containing orga-nophosphate. Acute deltamethrin poisoning due to oral ingestions is relatively rare. This report describes a case of a 32-year-old woman admitted to the emergency department (ED) with irritability, muscle cramps, discomfort, sensation of burning, loss of sensation in her feet and arms and dyspnea due to deltamethrin ingestion. Deltamethrin intoxication should be considered as a differential diagnosis in patients presented to ED with nonspecific neurological symptoms. The supportive treatment in acute phase of intoxication is critical in the management of these patients since higher doses of deltamethrin ingestion may cause severe symptoms