Amyloid Goiter Associated with Amyloidosis Secondary to Rheumatoid Arthritis

Amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues. The most common forms of systemic amyloidosis are primary amyloidosis (PA) of light chains and secondary amyloidosis (SA) caused by chronic inflammatory diseases such as rheumatoid arthritis (RA). Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, clinically significant enlargement of the thyroid owing to amyloid deposition is a rare occurrence. In SA, the deposition of amyloid associated (AA) protein is associated with atrophy of thyroid follicles. The clinical picture of these patients is characterized by rapid, painless thyroid gland enlargement which may be associated with dysphagia, dyspnea, or hoarseness. Thyroid function is not impaired in most cases. Although amyloid goitre secondary to systemic amyloidosis due to chronic inflammatory diseases is relatively common, specifically related to RA is much more uncommon one and it is reported less in the literature. In this report, A 52-old-year female patient with amyloid goiter associated with amyloidosis secondary to rheumatoid arthritis is presented

Inflammatory Markers in Patients Using Domiciliary Non-invasive Mechanical Ventilation: C Reactive Protein, Procalcitonin, Neutrophil Lymphocyte Ratio

Aim: Early identification and treatment of infections in patients using domiciliary non-invasive mechanical ventilation (NIMV) due to chronic respiratory failure (CRF) can reduce hospital admissions. We assessed C-reactive protein (CRP), procalcitonin, and neutrophil lymphocyte ratio (NLR) as indicators of infection/inflammation.Methods: The study was designed as a retrospective, observational, cross-sectional study, and was performed in 2016 in an intensive care unit outpatient clinic in patients using NIMV. Patients who came to the outpatient clinic with dyspnea, increased sputum, increased prothrombin, and who had hemogram, procalcitonin, and serum CRP, NLR, and PLT/MPV levels assessed, were enrolled into the study. Demographic characteristics, co-morbid diseases, respiratory symptoms, hemogram, biochemistry, CRP, and procalcitonin values in stable and acute attack patients were recorded from patient files. The descriptive statistics and CRP, NLR, and procalcitonin values were assessed.Results: During the study period, 49 patients (24 female) with chronic obstructive pulmonary disease (COPD, n = 24), obesity hypoventilation syndrome (OHS, n = 15), or interstitial lung disease, n = 10), and having had three inflammatory markers assessed, were included in the study. Their mean age was 67 (SD ± 12). Stable patients vs. those who had an acute attack was 41 vs. eight, and within 7 days of outpatient admission four patients were hospitalized. CRP, NLR, and PLT/MPV values were similar in patients' who had sputum purulence, and an increase in dyspnea and sputum, but procalcitonin was significantly higher in patients who had an acute attack. Procalcitonin was not correlated with CRP, NLR, and PLT/MPV.Conclusions: Patients with CRF had similar levels of CRP and NLR during a stable and acute attack state. Procalcitonin may be a better marker for therapeutic decisions in advanced chronic inflammatory diseases

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Effects of Urtica dioica Seeds on Oxidative/ Nitrosative Stress Levels and Myeloperoxidase Activity in Muscle Ischemia/Reperfusion Injury

The purpose of this study is to evaluate the preventive effects of Urtica dioica (UD) on muscle ischemia/reperfusion (I/R) injury. A total of 27 male Wistar rats were divided into three groups as the control group (1), I/R + saline group (2), and I/R+UD group (3). Group 1 did not receive any treatment. Group 2 was administered a total of 2mL/kg saline (1mL/kg before ischemia and 1 mL/kg after reperfusion), and group 3 was given a total of 2mL of UD (1mL/kg before ischemia and 1mL/kg after reperfusion) as treatment. Saline and UD were administered via intraesophageal canula once a day for five days. At the end of five days, all the rats were exposed to muscle ischemia for 60 min followed by 60 min of reperfusion of the bilateral hindlimbs induced using a tourniquet. Muscle tissue histopathologies were evaluated by light microscopy. Furthermore, oxidative/nitrosative stress biomarkers such as catalase (CAT), superoxide dismutase (SOD), malondialdehyde (MDA), nitrotyrosine (3-NT), nitric oxide (NO), and myeloperoxidase (MPO) as an inflammatory marker in tissue samples were measured. UD treatment significantly decreased oxidative/nitrosative stress biomarker levels and MPO (p<0.05). We established that UD treatment could alleviate muscle injury induced by muscle I/R in rats by inhibiting the inflammation and oxidative/nitrosative stress

Posaconazole micelles for ocular delivery: in vitro permeation, ocular irritation and antifungal activity studies

Posaconazole (PSC) is a triazole group anti-fungal agent with the widest spectrum. Although there is no commercially available ocular dosage form, its diluted oral suspension preparation (Noxafil (R)) is used as off-label in topical treatment of severe keratitis and sclerokeratitis in the clinic. However, ocular bioavailability of PSC suspension form is extremely low due to its highly lipophilic character. Thus, there is a clinical need to improve its ocular bioavailability and to develop novel delivery system for the treatment of ocular fungal infections. Herein, we studied ex vivo permeation, penetration, anti-fungal activity, and Hen's Egg Test-Chorioallantoic Membrane (HET-CAM) toxicity tests in order to assess ocular targeting of PSC micelles, which were optimized in our previous study. The results indicated that micellar carrier system increased the permeability of PSC to eye tissues. Micelles showed higher affinity to ocular tissues than that of commercial oral suspension of PSC (Noxafil (R)). In vitro anti-fungal activity data also confirmed the efficacy of PSC loaded micellar formulations against Candida. albicans strains. The relative safety of the optimized micelles on the ocular tissue was shown with the HET-CAM toxicity test. In conclusion, micellar systems could be a promising strategy for the effective and safe delivery of PSC in the treatment of ocular fungal infections

Is There an Increased Arterial Stiffness in Patients with Primary Sjogren's Syndrome?

WOS: 000371398300006PubMed ID: 26935363Objective Primary Sjogren's syndrome (pSS) is a common chronic autoimmune disease that primarily affects the salivary and lacrimal glands. Arterial stiffness is one of the earliest detectable manifestations of adverse structural and functional changes within the vessel wall. The aim of this study was to evaluate the relationship between arterial stiffness and pSS. Methods In this study, 75 female patients with pSS who fulfilled the American European Consensus Criteria for Sjogren's syndrome, were included. A total of 68 age-, sex-and body mass index-matched subjects were recruited as the control population. Arterial stiffness was assessed by measurement of the carotid-femoral pulse wave velocity (PWV). Results The mean age of the patients was 54.0 +/- 9.3 years and the median duration of the disease was 10 years. Compared with the control subjects, patients with pSS had a higher mean PWV (8.2 +/- 1.5 m/s vs. 7.5 +/- 1.4 m/s; p=0.01). Correlation analysis showed that the PWV was positively correlated with age, body mass index, serum cholesterol, low-density lipoprotein (LDL) and C-reactive protein levels, blood pressure, mean arterial pressure (MAP), pulse pressure and left ventricular mass index. A multiple linear regression analysis revealed that arterial stiffness was associated with age, MAP and LDL levels in pSS patients. Conclusion Although patients with pSS appear to have increased arterial stiffness, risk factors associated with arterial stiffness in these patients are similar to the general population. However, we cannot exclude the possibility that a higher PWV in pSS patients is caused, not by pSS itself, but by the use of steroids, hypertension and dyslipidemia

Serum NOX1 and Raftlin as new potential biomarkers of Major Depressive Disorder: A study in treatment-naive first episode patients

Introduction: Biological factors are known to be important in understanding the pathogenesis of Major Depressive Disorder (MDD). Oxidative stress and neuroinflammation pathways are likely to play a critical role here. Methods: We undertook a study to investigate two novel biomarkers - serum NADPH oxidase 1 (NOX1) and Raftlin levels - in treatment-naive, smoking-free first episode patients with MDD compared to healthy controls (HCs) matched for age, sex and body mass index. Results: We found increased NOX1 and Raftlin levels in MDD patients compared to HCs. Both parameters showed very good diagnostic performance in the MDD group. In addition, we found a significant positive correlation between depression severity (HAM–D) scores and both biomarker levels in the patient group. Conclusion: To the best of our knowledge, this is the first human study to evaluate serum NOX1 and Raftlin levels in depression. NOX1, an important source of reactive oxygen species (ROS), and Raftlin, which may play a role in the inflammatory process, represent novel potential biomarkers of MDD. These findings support the implication of oxidative stress and inflammatory processes in patients with MDD, and indicate that the deteriorated ROS-antioxidant balance can be regulated via NOX1 in patients with depression.Kemal Akalp ; Serkan Cagla

Relationship of Renal Function, Glomerular Uftrastructure and Slit Pore Count in Chronic Puromrcin Aminonuckoside Nephrosis

Background and Design: In order to create massive proteinuria, puromycin-amin o nucleoside (PAN) is one of the most used models. Podocyte injury causes proteinuria. PAN rats' glomeruli show alterations like minimal change disease in humans, but the mechanism of PAN is not yet understood in total. We aimed to evaluate and show the relationship of renal function and the changes of the ultrastructu-re of the glomeruli, including the number of slit pores in puromycin-aminonucleoside induced chronic nephrosis