Colchicine modulates oxidative stress in serum and leucocytes from remission patients with Family Mediterranean Fever through regulation of Ca²+ release and the antioxidant system

We investigated the effects of colchicine on oxidative stress and Ca²+ release in serum and polymorphonuclear leucocytes (PMNs) of Familial Mediterranean Fever (FMF) patients with attack, remission and unremission periods. Eighteen FMF patients and six age-matched healthy subjects in four groups were used. The first group was a control. The second group included patients with active FMF. The third and fourth groups were patients with remission and unremission, respectively. Colchicine (1.5 mg/day) was given to the third and fourth groups for 1 month. PMN cells, serum lipid peroxidation and intracellular Ca²+-release levels in the attack and unremission groups were higher than in those in controls, although they were lower in the remission group than in the attack group. Serum vitamin E and β-carotene concentrations were higher in the remission group than in the control and attack groups. However, PMN, serum lipid peroxidation and Ca²+-release levels were further increased in the unremission group compared to the attack group. Glutathione peroxidase, reduced glutathione and vitamin A values in the four groups did not change by FMF and colchicine. In conclusion, we observed that colchicine induced protective effects on oxidative stress by modulating vitamin E, β-carotene and Ca²+-release levels in FMF patients with a remission period.

KNK437, a benzylidene lactam compound, sensitises prostate cancer cells to the apoptotic effect of hyperthermia

Hyperthermia is known to serve as a powerful tool in the treatment of prostate cancer which is commonly diagnosed in men. Quercetin and KNK437, Hsp70 inhibitors, play an important role in blocking thermotolerance in some cancer cells. In the present study we investigated the effects of KNK437 and quercetin on the acquisition of thermotolerance and heat-induced apoptosis. Also, it was examined whether the possible mechanism triggering apoptotic pathway included caspase-3 activation in prostate cancer cells. For this purpose, PC-3 and LNCaP cells were treated with hyperthermia following pretreatment with or without KNK437 or quercetin. Thermotolerance was investigated by colony formation assay in these cells, while Hsp70 mRNA levels were measured by real time RT-PCR. Sandwich ELISA was used for detection of Hsp70 protein levels. Apoptosis was detected by flow cytometric annexin V binding assay and by western blot analysis of procaspase-3 and cleaved poly (ADP-ribose) polymerase levels. In our study, KNK437 and quercetin inhibited thermotolerance in a dose-dependent manner in PC-3 cells. KNK437 and quercetin decreased heat-induced accumulation of Hsp70 mRNA and protein in PC-3 and LNCaP cells. KNK437 and quercetin pretreatment enhanced the apoptotic effect of hyperthermia in both cells. We found that KNK437 was more effective than quercetin in inducing apoptotic cell death, activation of caspase-3, and cleavage of PARP in prostate cancer cells. We suggest that KNK437 is a useful agent for enhancing the efficiency of hyperthermic therapy which has less toxic side-effects in prostate cancer.

Lipid peroxidation and parathyroid hormone influence the cytosolic calcium levels of erythrocytes in peritoneal dialysis patients

BACKGROUND

The aim of this study was to examine the alterations in calcium and lipid peroxidation in red blood cells (RBCs) and serum samples of continuous ambulatory peritoneal dialysis (CAPD) patients. We also investigated the relationship between parathyroid hormone (PTH) and calcium homeostasis in this study.

METHODS

For this purpose, routine blood counts and blood chemistry were analyzed by standard laboratory procedures in serum samples. The concentration of TBARS was measured in erythrocytes and serum samples. RBC calcium was measured by Fura-2AM in a spectrofluorometer.

RESULTS

In CAPD patients, hemoglobin, albumin, and high density lipoprotein cholesterol levels were lower, but glucose, very low density lipoprotein cholesterol, triglyceride, magnesium, PTH, sensitive C-reactive protein, and uric acid levels were higher than the controls. Thiobarbituric acid-reactive substance (TBARS) levels in RBCs and serum samples and cytosolic calcium in RBCs were all found to be significantly increased in CAPD patients compared to control subjects. Multiple regression analysis showed that RBC TBARS and serum PTH were the independent predictors of RBC calcium in our study.

CONCLUSIONS

Our results confirm that oxidative stress is an important risk factor for CAPD. The results of multiple regression analysis suggest that RBC calcium was affected by both increased levels of TBARS and PTH.

Prognostic impact of 18F-fluoro-deoxyglucose positron emission tomography in untreated mantle cell lymphoma: a retrospective study from the GOELAMS group

PURPOSE

(18)F-fluorodeoxyglucose (FDG) PET is a non-invasive imaging technique recommended for the management of both diffuse large B-cell and Hodgkin's lymphomas. This retrospective study investigated the value of FDG PET for initial staging and its prognostic impact on patients with mantle cell lymphoma (MCL).

METHODS

A total of 44 untreated MCL patients assessed by both conventional evaluations (CE) and FDG PET for initial staging were included. The maximum standardized uptake value (SUV(max)) in the most intense pathological area was recorded for each patient. Disease status after chemotherapy completion was assessed according to the International Workshop Criteria (IWC) for non-Hodgkin's lymphoma (NHL) response and IWC+PET.

RESULTS

FDG PET uptakes at diagnosis were abnormal in all cases. Compared to CT scan, nodal and extranodal sites were only detected by FDG PET. Due to insufficient sensibility for bone marrow (BM) and gastrointestinal (GI) involvement, FDG PET did not modify initial staging. Positive and negative predictive values of IWC+PET for relapse at 1 year were 62.5 and 100%. With a median follow-up of 21 months, only the International Prognostic Index (IPI) and IWC+PET modified both event-free survival (EFS) (p = .02 and .0001, respectively) and overall survival (p = .03 and .05, respectively) duration. When combining IPI and SUV(max) at diagnosis, we were able to identify patients with low (29%; no relapse/progression), intermediate (42%; median EFS: 37 months) and high risk (29%, median EFS: 22 months) (p = .004).

CONCLUSION

In MCL, FDG PET at diagnosis is complementary to CE, but BM and GI biopsies remain mandatory. IWC+PET criteria are highly efficient to identify patients with high risk for early relapse. Combining IPI and SUV(max) may predict patient outcome and warrant further prospective investigations towards designing risk-adapted strategies.

Comparison of lymphomononuclear cell energy metabolism between healthy, impaired glucose intolerance and type 2 diabetes mellitus patients

Diabetes mellitus (DM) is a complex disease that affects many systems. The most important cells of the immune system are lymphomononuclear (LMN) cells. Here, we aimed to evaluate the energy metabolism of LMN cells in patients with diabetes and impaired glucose tolerance. We measured LMN cell energy metabolism in patients with type 2 diabetes mellitus, impaired glucose tolerance (IGT) and healthy subjects. Cells were freshly isolated from peripheral blood and the subgroups were determined by flow cytometric method. Lactate production and glycogen utilization were significantly increased in the LMN cells of patients with type 2 DM and IGT when compared with healthy volunteers. No statistical difference was observed between the patients with type 2 DM and IGT. There was a significant correlation between fasting plasma glucose and lactate production in LMN cells. LMN cells changed their energy pathway in a diabetic state and preferred anaerobic glycolysis. Prediabetic range also affected energy metabolism in LMN cells. This abnormal energy production might cause dysfunction in LMN cells and the immune system in diabetic and prediabetic patients. In conclusion, we concluded that impaired glucose metabolism could change energy metabolism.

Surgical treatment of hepatic hydatid cyst: cysto-jejunostomy by stapling

The appropriate choice of surgical treatment of hepatic hydatidosis depends on the communication between the cyst and the bile ducts. The forms of cavity management and biliary drainage procedures proposed for the case of cysts with bile duct communication vary greatly while the ideal operation is still controversial. Herein, we report partial cystectomy plus cystojejunostomy (with stapler) in a case with hepatic hydatid disease (Fig. 2, Ref. 7).

Two-year follow-up of thirty-two non-functional benign adrenal incidentalomas

OBJECTIVE

To evaluate the risk of developing endocrine hyperactivity and carcinoma during a period of up to 5 yr in patients with apparently benign and non-functioning adrenal incidentalomas.

PATIENTS AND METHODS

Thirty-two patients (mean age: 57.0+/-8.3 yr) were investigated in a prospective follow-up study for a median time of 24 months. Twenty-eight patients had unilateral and 4 had bilateral masses. Initial average mass diameter was 17.47+/-6.60 mm. All patients were followed up yearly by physical examination, metabolic parameters, hormonal evaluation [morning cortisol after 3-mg dexamethasone suppression, urinary metanephrines, and upright aldosterone/ plasma renin activity (PRA)].

RESULTS

Among the clinical characteristics, 48% of patients were obese, 20% were hypertensive, 13 had Type 2 diabetes and impaired glucose tolerance. During follow-up period no significant change in the functional status was observed and nomalignant transformation occurred. Only 1 patient developed subclinical Cushing's syndrome at the end of the 1st year and referred to surgery. Change in mass size was correlated with homeostasis model assessment of insulin resistance (p=0.002), upright aldosterone/ PRA (p=0.041), cortisol after dexamethasone suppression (p=0.048) and 24-h urinary normetanephrine (p=0.005) levels. Gender, body mass index, glucose metabolism, and blood pressure were not found to be correlated with change in mass size and functional status.

CONCLUSIONS

Due to the extremely low risk of developing malignancy during up to 5 yr of follow-up, conservative approach for the management of adrenal incidentalomas is thought to be appropriate. However, possibility of evolution to hormonal hypersecretion makes long-term follow-up of 2-to-5 yr seems to be obligatory.

[Investigation of the presence of autoantibodies in patients with toxocariasis]

Immunopathologic reactions may occur during toxocariasis due to tissue invasion and destruction by the secretions of larvae containing various enzymes with broad spectrum. The aim of this study was to search for autoantibodies such as anti-nuclear (ANA), anti-mitochondrial (AMA), anti-smooth muscle (ASMA), anti-neutrophil cytoplasmic (ANCA), anti-myeloperoxidase (MPO) and liver-kidney microsomal type 1 (LKM-1) antibodies in patients with toxocariasis, in order to investigate the role of toxocariasis as a trigger factor for autoimmune reactions. Forty patients (22 were male; mean age: 35.6 +/- 10.7 years) diagnosed as toxocariasis by clinical findings (abdominal pain, allergic symptoms and/or eosinophilia, without detection of any other causative agents, and without liver dysfunction, diabetes mellitus, cardiac or renal failure, and autoimmune disease) and in-house ELISA positivity and 32 healthy controls (16 were male; mean age: 40.7 +/- 11.2 years) were included to the study. ANA (screen), dsDNA, SS-A, SS-B, Scl-70, LKM-1, MPO and M2 autoantibodies have been investigated by ELISA (Euroimmun, Germany), while ANCA, AMA and ASMA antibodies by indirect immunofluorescence (IMMCO, NY) methods. Autoantibody positivity was detected in 18 (45%) patients of whom 11 yielded a single type, and 7 yielded > or = 2 types of autoantibodies. This rate was 12.5% for control group (two subjects were positive for ANA-Screen, one for anti-M2 and one for anti-LKM-1). The difference between the total positivity rates in patient and control groups was found statistically significant (chi2 = 5.72, p = 0.004). The most frequent autoantibody type among patients were ASMA (n = 6), followed by anti-dsDNA (n = 5), anti-M2 (n = 5), anti-SS-B (n = 4), anti-LKM-1 (n = 3), anti-SS-A (n = 2), ANCA (n = 2) and anti-MPO (n = 1). Positivity rate for ASMA was found statistically significant in patients' group compared to controls (chi2 = 12.24, p = 0.03), while there was no significant difference between the groups in terms of other autoantibody rates (p> 0.05). These data could be related to the possible release of autoantigens following muscle tissue injury during toxocariasis and/or antigenic mimicry of parasitic products during the infection in which muscle invasion is frequently seen. In conclusion, since autoantibodies are frequently detected in toxocariasis, this situation should be taken into consideration in the presence of autoantibodies.

The numerical comparison of flow patterns and propulsive performances for the hydromedusae Sarsia tubulosa and Aequorea victoria

The thrust-generating mechanism of a prolate hydromedusa Sarsia tubulosa and an oblate hydromedusa Aequorea victoria was investigated by solving the incompressible Navier–Stokes equations in the swirl-free cylindrical coordinates. The calculations clearly show the vortex dynamics related to the thrust-generating mechanism, which is very important for understanding the underlying propulsion mechanism. The calculations for the prolate jetting hydromedusa S. tubulosa indicate the formation of a single starting vortex ring for each pulse cycle with a relatively high vortex formation number. However, the calculations for the oblate jet-paddling hydromedusa A. victoria indicate shedding of the opposite-signed vortex rings very close to each other and the formation of large induced velocities along the line of interaction as the vortices move away from the hydromedusa in the wake. In addition to this jet propulsion mechanism, the hydromedusa's bell margin acts like a paddle and the highly flexible bell margin deforms in such a way that the low pressure leeward side of the bell margin has a projected area in the direction of motion. This thrust is particularly important during refilling of the subumbrella cavity where the stopping vortex causes significant pressure drag. The swimming performances based on our numerical simulations, such as swimming velocity,thrust, power requirement and efficiency, were computed and support the idea that jet propulsion is very effective for rapid body movement but is energetically costly and less efficient compared with the jet-paddling propulsion mechanism.

Systolic pulmonary artery pressure and echocardiographic measurements in patients with euthyroid Hashimoto's thyroiditis

BACKGROUND

The aim of this study was to investigate systolic pulmonary artery pressure (SPAP) and echocardiographic findings in patients with euthyroid Hashimoto's thyroiditis (HT).

METHODS

Thirty (8 male, 22 female, mean age 47.4+/-10.5 yr) consecutive patients with euthyroid HT and 30 (9 male, 21 female, mean age 46.4+/-10.7 yr) healthy controls were included in the study. Transthoracic echocardiography was performed for all patients and levels of thyroid hormones, thyroid autoantibodies, glucose, insulin, urea, and creatinine were compared.

RESULTS

There were no significant differences in sex, age, body mass index, serum free T4, serum TSH, lipid profiles between patients and controls. Mean SPAP in patients with euthyroid HT were significantly higher than in controls (31.6+/-5.0 vs 25.6+/-4.5 mmHg, p=0.005). Late diastolic transmitral velocity and isovolumic relaxation time were also significantly higher in patients in comparison to controls. In addition, euthyroid HT patients with tricuspid or mitral regurgitation had a higher grade. Correlation between SPAP and antithyroid antibodies and TSH, however, was not significant in this population.

CONCLUSIONS

Pulmonary arterial pressure is higher in patients with euthyroid HT. There may be a relationship between elevated pulmonary arterial pressure and autoimmune thyroid disease independent from thyroid function status. However, further investigations are needed to determine the exact mechanism of association between autoimmune thyroid diseases and pulmonary hypertension.

Visfatin plasma concentrations in patients with hyperthyroidism and hypothyroidism before and after control of thyroid function

Alterations in thyroid function are associated with changes in body weight, metabolism, and low-grade inflammation. In several studies, plasma levels of visfatin were found to be associated with body mass index, diabetes, and metabolic syndrome. In our study we aimed to evaluate visfatin levels according to thyroid dysfunction. The study cohort comprised 56 Hashimoto thyroiditis patients with hypothyroidism (43.94+/-14.27 yr), 56 Graves patients with hyperthyroidism (45.87+/-13.28 yr), and 56 euthyroid healthy subjects (45.23+/-7.11 yr) as a control group. In addition, we evaluated the effect of therapy on plasma visfatin levels in 16 hypothyroid and in 25 hyperthyroid patients. Markedly low visfatin levels were found in hyperthyroid patients [9.44 (8.07- 10.8) ng/ml] compared with the hypothyroid [49.93 (40.72- 59.1) ng/ml] and control groups [38.6 (30.6-46.6) ng/ml] (p<0.001, p<0.001). Plasma visfatin levels in patients with hypothyroidism decreased significantly following treatment [58.58 (10.21-190.7) ng/ml vs 40.00 (10.01-102.6) ng/ml; p=0.001]. Plasma visfatin levels increased significantly after antithyroid therapy in patients with hyperthyroidism [7.86 (1.02-19.23) ng/ml vs 12.63 (3.48-110.9) ng/ml; p<0.001]. There were negative correlations between visfatin levels with free T3 (r=-0.719, p<0.001), and free T4 (r=-0.716, p<0.001) levels. There was a positive correlation between visfatin and TSH levels (r=0.701, p<0.001). There was a negative correlation between delta visfatin levels with delta free T3, delta free T4 (r=-0.686, p<0.001; r=-0.624, p<0.001). Visfatin thus seems to be regulated by thyroid hormones. While the influence of thyroid dysfunction on adipocytokine production and release is still poorly understood, the results of our study suggest that the effects of hyper- and hypothyroidism on various metabolic parameters may be partly mediated by visfatin.

Visfatin plasma concentrations in patients with hyperthyroidism and hypothyroidism before and after control of thyroid function

Alterations in thyroid function are associated with changes in body weight, metabolism, and low-grade inflammation. In several studies, plasma levels of visfatin were found to be associated with body mass index, diabetes, and metabolic syndrome. In our study we aimed to evaluate visfatin levels according to thyroid dysfunction. The study cohort comprised 56 Hashimoto thyroiditis patients with hypothyroidism (43.94+/-14.27 yr), 56 Graves patients with hyperthyroidism (45.87+/-13.28 yr), and 56 euthyroid healthy subjects (45.23+/-7.11 yr) as a control group. In addition, we evaluated the effect of therapy on plasma visfatin levels in 16 hypothyroid and in 25 hyperthyroid patients. Markedly low visfatin levels were found in hyperthyroid patients [9.44 (8.07- 10.8) ng/ml] compared with the hypothyroid [49.93 (40.72- 59.1) ng/ml] and control groups [38.6 (30.6-46.6) ng/ml] (p<0.001, p<0.001). Plasma visfatin levels in patients with hypothyroidism decreased significantly following treatment [58.58 (10.21-190.7) ng/ml vs 40.00 (10.01-102.6) ng/ml; p=0.001]. Plasma visfatin levels increased significantly after antithyroid therapy in patients with hyperthyroidism [7.86 (1.02-19.23) ng/ml vs 12.63 (3.48-110.9) ng/ml; p<0.001]. There were negative correlations between visfatin levels with free T3 (r=-0.719, p<0.001), and free T4 (r=-0.716, p<0.001) levels. There was a positive correlation between visfatin and TSH levels (r=0.701, p<0.001). There was a negative correlation between delta visfatin levels with delta free T3, delta free T4 (r=-0.686, p<0.001; r=-0.624, p<0.001). Visfatin thus seems to be regulated by thyroid hormones. While the influence of thyroid dysfunction on adipocytokine production and release is still poorly understood, the results of our study suggest that the effects of hyper- and hypothyroidism on various metabolic parameters may be partly mediated by visfatin.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey)

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

High prevalence of neuropathy in patients with impaired 60-minute oral glucose tolerance test but normal fasting and 120-minute glucose levels

AIM

The aim of this study was to define the prevalence of neuropathy in patients with impaired 60-min oral glucose tolerance test (OGTT) but normal fasting and 120-min glucose levels and to evaluate risk factors for polyneuropathy and glucose intolerance.

METHODS

The hospital files of 320 patients (56.5+/-11.9 years, 73.1% female), who had both electrodiagnostic test for sensory symptoms (nerve conduction studies and needle electromyography) and OGTT in maximum 6 months apart, were studied in this retrospective design study. Serum glucose levels at fasting and 0-, 30-, 60-, 90- and 120-min of OGTT and some biochemical parameters were recorded.

RESULTS

Fifteen percent of patients had diabetes mellitus (DM) and 10.9% and 5.6% had impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Twenty-one patients (6.6%) had only impaired 60-min blood glucose levels. Polyneuropathy was found in 44.4%, 28.5%, and 50.0% of patients with IGT, IFG and DM respectively. The prevalence of polyneuropathy was significantly higher in patients with impaired 60-min than OGTT normal subjects (52.4% vs 21.7% p=0.003). Fasting blood glucose, HDL, LDL and TSH levels, age, glucose intolerance low serum folic acid and significantly increased polyneuropathy risk. Age, weight, body mass index, high fasting, 30, 60-, 90-, 120-min serum glucose, insulin and HgA1c levels were risk factors for glucose intolerance.

CONCLUSION

Since the prevalence of neuropathy in patients with impaired 60-min glucose levels is high, it would be valuable to look at 60-min glucose levels to detect abnormal glucose metabolism and the neuropathy earlier in the course.

Dieulafoy lesion in the stomach

Dieulafoy disease is an uncommon cause of gastrointestinal system bleeding. Although the exact cause is not known, it is characterized by bleeding from abnormal submucosal vessels. There are many methods for diagnosis and treatment. In this case, a patient with a long-time undiagnosed stomach Dieulafoy lesion had a surgical resection. During the postoperative period the patient was discharged without any complication.

Acute effects of orlistat on postprandial serum leptin levels in nondiabetic obese patients

AIM

Leptin is likely to be involved in the homeostasis of body weight. This study aimed to examine the acute effects of orlistat on postprandial serum glucose, insulin, and leptin levels before any effect on body weight occurred.

METHODS

Thirty-four nondiabetic, obese patients were enrolled in this study (body mass index, 35.7+/-3.8 kg/m(2)). Patients were randomly assigned to two groups, one receiving orlistat (120 mg, single dose), and the other received a placebo. A single dose was given before a standard 600-kcal mixed meal containing 60% carbohydrates, 25% lipids, and 15% protein. Blood samples were collected basally before the test meal and then hourly for five hours. Graphic tendencies, peak values, time needed to reach the peak values, and area under the curve values were compared between groups.

RESULTS

There were no differences in sex distribution, mean age, anthropometric measurements, and basal glucose, insulin, and leptin levels between the orlistat and placebo groups. Hourly serum glucose and insulin changes were similar between groups, peak levels of insulin occurred in the first hour in control group, although peak levels of insulin did not occur until the second hour in patients in the orlistat group. Also, serum leptin levels had a more horizontal and delayed increase after a mixed meal in patients in the orlistat group than they did in patients in the placebo group. There were no statistically significant differences between the groups.

CONCLUSION

One dose of 120 mg orlistat made no changes in postprandial serum glucose, insulin, and leptin levels, although leptin-level increases were smaller in patients receiving orlistat.

Insulin-like growth factor-1 is essential to the increased mortality caused by excess growth hormone: a case of thyroid cancer and non-Hodgkin's lymphoma in a patient with pituitary acromegaly

The effects of growth hormone are mediated in part by stimulating the production of insulin-like growth factor-1. Insulin-like growth factor-1 has significant effects on cell proliferation and differentiation, it is a potent mitogen, and it is a powerful inhibitor of programmed cell death (apoptosis). Insulin-like growth factor-1 also has a well-established role in the transformation of normal cells to malignant cells. Case reports on a possible association between elevated growth hormone and cancer risk in a variety of patient groups have been published. Here, we describe clinical and laboratory findings for a patient with acromegaly who first developed thyroid cancer, and then, in the follow up period, probably due to poorly controlled insulin-like growth factor-1 levels, developed a large cell non-Hodgkin's lymphoma. A search revealed that a case with these peculiarities had not previously been reported.

Risk factors of morbidity and mortality in patients with perforated peptic ulcer

PURPOSE

Peptic ulcer perforation is a serious problem that leads to high complication and mortality rates. The aim of this prospective clinical study was to evaluate complications and possible risk factors for peri-operative morbidity and mortality in patients with perforated peptic ulcer (PPU).

MATERIAL AND METHODS

Ninety-seven patients hospitalized for PPU at the Department of Surgery, Vakif Gureba Training and Research Hospital, between March 1998 and December 2004 were analysed.

RESULTS

The mean age of patients was 38.6 years. Ten patients had 19 co-morbidities. The mean hospitalisation time was 7.1 days. Twenty-one complications in 15 patients occurred. Overall morbidity and mortality rates were 15.5% and 5.2% respectively. Multivariate logistic regression analysis of 97 patients revealed that age (p < 0.006) and late admission (p < 0.001) were linked to morbidity. The mortality rate tended to be associated with advanced age, therapeutic delay and co-morbidities.

CONCLUSIONS

Increased patients' age and the therapeutic delay, predicted outcome after surgical treatment of PPU. Morbidity and mortality could be reduced by avoiding delays in diagnosis and treatment, especially in older patients, and by instituting proper treatment of any coexisting medical illness.

The effect of depression on quality of life of patients with type II diabetes mellitus

Diabetes mellitus (DM) is a frequently encountered metabolic disease with chronic features and involves numerous complications throughout its course, which causes severe restriction and disability in an individual's life. It has been reported that the incidence of depression is higher in diabetic patients and that diabetes is one of the risk factors in the development of depression. It has also been reported that co-morbid psychiatric disorders cause further deterioration in the quality of life in diabetic patients. The aim of this study was to investigate the effects of depression on the quality of life in type II DM patients. Sixty patients (30 females and 30 males) with current major depressive episode diagnosed according to DSM-IV criteria, and 48 type II DM patients (30 females and 18 males) without a major depressive episode (non-depressed group) were included in the study. All patients were evaluated with a semi-structured interview form to assess the clinical features of DM, Hamilton Rating Scale for Anxiety (HRSA), Hamilton Rating Scale for Depression (HRSD), and the Turkish version of The World Health Organization Quality of Life Assessment-Brief (WHOQOL-BREF). The HRSD and HRSA scores in the depressed group were 24.87+/-4.83 and 21.07+/-5.44, respectively, whereas those in the non-depressed group were 7.83+/-3.92 and 6.88+/-3.43, respectively. The physical health, psychological health, social relationship, environmental and social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores were found significantly lower in the depressed group than the non-depressed group. There were significant negative correlations between HRSD and HRSA scores and physical health, psychological health, social relationship, environmental and social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores. Furthermore, there were significant negative correlations between the HbA1c level and physical health, social relationship, environmental domain, social pressure domain, general health-related quality of life, overall quality of life, and WHOQOL-BREF total scores. However, there was a significant positive correlation between the level of education and physical health, psychological health, social relationship, environmental social pressure domain, overall quality of life, and WHOQOL-BREF total scores. There were significant negative correlations between social relationship domain score, and age and duration of illness. Our study demonstrates that the presence of depression in type II DM further deteriorates the quality of life of the patients. Since treating depression would have a beneficial effect on the quality of life, clinicians should carefully assess for depression associated with type II DM.