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    Coronary intervention for acute coronary syndrome in a 51-year-old man with immune thrombocytopenic purpura: A case report
    (BioMed Central Ltd. info@biomedcentral.com, 2014) Bora Demirçelik, Muhammed; Altinsoy, Meltem; Bozduman, Fadime; Güneş, Mahmut Fatih; Çakmak, Muzaffer; Eryonucu, Beyhan
    Introduction. Treatment of the rare cases of patients with chronic idiopathic thrombocytopenic purpura with acute coronary syndrome can be a significant problem. The patient in our case report was treated successfully with percutaneous coronary intervention. Case presentation. A 51-year-old man of Turkish origin who had idiopathic thrombocytopenic purpura was admitted to our hospital with severe chest pain. His electrocardiography was normal on admission but dynamic ischemic changes were observed during follow-up. He underwent immediate coronary angiography. In his angiography, left anterior descending artery stenosis was 90% together with the diagonal ostium. Percutaneous coronary intervention was performed successfully. Bleeding complications were not observed after the procedure. Conclusions: We report the presence of a rare case of chronic idiopathic thrombocytopenic purpura in a patient with acute coronary syndrome. In this situation a serious multidisciplinary approach is required before coronary intervention. © 2014 Demircelik et al.; licensee BioMed Central Ltd. © 2014 Elsevier B.V., All rights reserved.
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    Neutrophil-lymphocyte ratio may be superior to C-reactive protein for predicting the occurrence of postmenopausal osteoporosis
    (Institute of Experimental Endocrinology ueenregu@kramare.savba.sk, 2014) Yilmaz, Hakki; Uyfun, M.; Yılmaz, Tuğba S.; Namuslu, Mehmet; Inan, Osman; Taskin, A.; Çakmak, Muzaffer
    Objective: Recent studies revealed that inflammation plays a critical role in bone remodeling and the pathogenesis of postmenopausal osteoporosis, a major health concern. Neutrophil-lymphocyte ratio (NLR) is a cost-effective marker of inflammation that has been linked with several diseases. This study aimed to compare NLR and C-reactive protein (CRP) levels in osteopenic, osteoporotic, and control subjects and to assess the correlation between NLR levels, CRP, and bone mineral density (BMD) in postmenopausal women. Methods: In this cross-sectional study, the relationship between NLR, CRP, and BMD in 438 women was investigated using uni- and multivariate analyses. BMD (g/cm²) was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine and femur. Complete blood count (CBC), CRP, glucose/lipid metabolism, and established risk factors were determined. Results: In the osteoporotic group, NLR and CRP levels were found to be elevated as compared to the osteopenic and control groups (NLR: 4.68 ± 0.72, 3.17 ± 0.43, 2.01 ± 0.54; CRP: 12.3 ± 4.1, 4.1 ± 2.7, 3.2 ± 2.1, respectively). A negative correlation was present between NLR and the lumbar spine (L2-L4) and femoral neck BMD after adjusting other risk factors. There was no correlation between CRP levels and BMD after adjusting other risk factors. NLR was significantly associated with L2-L4 BMD (ß = -0.653, p<0.001) and femoral neck BMD (ß = -0.178, p<0.001), but CRP level had no association with BMD in a multivariate model. Conclusions: Our data indicate that NLR may be a better predictor than CRP for occurrence of osteoporosis in postmenopausal women. © 2015 Elsevier B.V., All rights reserved.
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    Role of interlekin-35 as a biomarker in patients with newly diagnosed hashimoto’s thyroiditis
    (Institute of Experimental Endocrinology macvetrev@fvm.ukim.edu.mk, 2016) Yilmaz, Hakki; Çakmak, Muzaffer; Ceydilek, Bilge; Demir, Canan; Aktas, Aynur
    Objective. Interleukin-35 (IL-35), an interleukin-12 (IL-12) cytokine family member, is shown to be a potent immunosuppressive and anti-inflammatory cytokine. Inducible regulatory T cells (Tregs) produce IL-35 that mediates the immune inhibitory function of Tregs. Growing evidence revealed that upregulation of IL-35 expression may play a critical role in the prevention of autoimmune diseases in various experimental autoimmunity models and vice versa. Hashimoto’s thyroiditis (HT) is considered to be a Treg cell-related autoimmune disease with loss of self-tolerance. Methods. One hundred-twenty eight subjects, newly diagnosed hypothyroid HT patients [56 overt (Group 1), 72 subclinical hypothyroid (Group 2)] and 38 healthy controls (Group 3) were enrolled in the study. The levels of serum IL-35 were determined by enzyme-linked immunosor-bent assay (ELISA). Results. Serum IL-35 levels were lower in the HT group when compared with subclinical HT group [304.5 (834.6) pg/ml vs. 636.1 (1542.0) pg/ml, p=0.004] and control cases [304.5 (834.6) pg/ml vs. 1064.7 (2526.8) pg/ml, p<0.001]. Serum IL-35 levels were inversely associated with thyroid stimulating hormone (TSH; rs=–0.396, p<0.001) and anti-thyroid peroxidase antibodies (TPOAb; rs=–0.571, p<0.001) in whole group. Serum IL-35 were negatively associated with TSH (rs=–0.264, p=0.003) and TPOAb (rs=–0.735, p<0.001) in patients with Hashimoto’s thyroiditis (Group 1 + Group 2). Conclusion. The results suggest that IL-35 may play a role in the pathogenesis of HT. © 2020 Elsevier B.V., All rights reserved.
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    Subclinical hypothyroidism in combination with vitamin D deficiency increases the risk of impaired left ventricular diastolic function
    (Institute of Experimental Endocrinology peter.golla@degruyter.com, 2015) Yilmaz, Hakki; Çakmak, Muzaffer; Darçın, Tahir; Inan, Osman; Gürel, Özgül Malçok; Bilgiç, Mukadder Ayşe; Bavbek, Nüket
    Objective. Subclinical hypothyroidism and vitamin D deficiency are common. The diastolic function of patients with both subclinical hypothyroidism and vitamin D deficiency remains unknown. This study aimed to investigate diastolic dysfunction in patients with both subclinical hypothyroidism and vitamin D deficiency. Subjects and Methods. This study included 254 patients. All patients underwent standard Doppler echocardiography. Patients who had risk factors for diastolic dysfunction or had used L-thyroxine and vitamin D within the previous 3 months were excluded. Vitamin D deficiency was defined as a 25-OH-vitamin D level lower than 20 ng/ml, and vitamin D sufficiency was defined as a 25-OHvitamin D level ?30 ng/ml. Subclinical hypothyroidism was defined as a TSH level of 4.5-10 mU/l when the free T4 concentration was normal. Results. The patients were divided into 4 groups. Group 1 (n=71) included patients with subclinical hypothyroidism and vitamin D deficiency; Group 2 (n=66) included patients with subclinical hypothyroidism and vitamin D sufficiency; Group 3 (n=65) included euthyroid patients with vitamin D deficiency; and Group 4 (n=52) included euthyroid patients with vitamin D sufficiency. LAVI (31.3±3.2, 28.7±3.0, 28.4±3.4, and 27.9±3.9; p<0.001) and E/E’ values (11.2±2.7, 8.9±2.7, 9.1±2.9, 8.8±2.5; p<0.001) were significantly higher in Group 1 than in Groups 2, 3 and 4. E’ values were significantly lower in Group 1 than in Groups 2, 3 and 4. Conclusion. The coexistence of subclinical hypothyroidism with vitamin D deficiency can lead to further deterioration in the LV diastolic function via the regulation of intracellular calcium and induction of inflammatory activity. Therefore, close follow-up of the diastolic functions of these patients could be beneficial. © 2018 Elsevier B.V., All rights reserved.