Evaluation of monocyte to high-density lipoprotein cholesterol ratio in the manic state of bipolar disorder

Ali Metehan Çalışkan; Yusuf Çokünlü

doi:10.22391/fppc.875674

Research Article

Bipolar bozukluk manik dönemde monosit/yüksek dansiteli lipoprotein kolesterol oranının değerlendirilmesi

Year 2021, Volume: 6 Issue: 2, 81 - 85, 05.05.2021

Ali Metehan Çalışkan , Yusuf Çokünlü

https://doi.org/10.22391/fppc.875674

Cited By: 2

Abstract

Giriş: Bipolar bozukluk, immün/inflamasyon işlevlerindeki anormalliklerle ilişkilendirilmiştir. Monosit/yüksek yoğunluklu lipoprotein (HDL) kolesterol oranı (MHO), kronik inflamasyon belirteçleri olarak kullanılmaktadır. Bu retrospektif çalışmanın amacı, bipolar bozukluğu olan manik hastalarda MHO düzeylerini araştırmaktır.

Yöntem: Çalışmaya bipolar bozukluk manik dönem tanısı ile yatışı yapılan 49’u ilk epizot ve 51’i birden fazla epizot geçiren 100 erkek hasta ve cinsiyet ve yaş açısından hasta grubu ile benzer özellikte 50 sağlıklı birey dahil edildi. Alınan hemogram, biyokimya kanları ve lipid paneli tahlil sonuçlarına göre MHO hesaplanarak kaydedildi. MHO değerlerinin ilk epizot, birden fazla epizot ve sağlıklı kontrol grupları arasında karşılaştırılmasında Kruskal Wallis testi kullanıldı.

Bulgular: Hastalar ve kontroller arasında yaş açısından istatistiksel olarak anlamlı bir fark bulunmazken, birden fazla epizot geçiren hastaların yaş ortalaması ilk epizot hastalardan anlamlı derecede yüksekti. İlk epizot ve birden fazla epizot grubunda MHO değerleri sağlıklı kontrollere göre istatistiksel olarak anlamlı derecede yüksek bulundu. İlk atakta olan hastalar ile birden fazla epizot geçiren hastaların MHO düzeyleri arasında istatistiksel olarak anlamlı bir fark yoktu.

Sonuç: Bu çalışma bipolar bozukluğun manik döneminde inflamasyonu bildiren çalışmaların sonuçlarıyla tutarlıdır ve bu nedenle manik dönemde inflamasyonun varlığına işaret edebilir.

Keywords

bipolar bozukluk , HDL kolesterol , inflamasyon , monosit , mani

References

1. Vieta E, Berk M, Schulze TG, Carvalho AF, Suppes T, Calabrese JR, et al. Bipolar disorders. Nat Rev Dis Primers 2018;18008(4):1-16. https://doi.org/10.1038/nrdp.2018.8.
2. Fries GR, Walss-Bass C, Bauer ME, Teixeira AL. Revisiting inflammation in bipolar disorder. Pharmacol Biochem Behav 2019;177:12-9. https://doi.org/10.1016/j.pbb.2018.12.006.
3. Rosenblat JD, Brietzke E, Mansur RB, Maruschak NA, Lee Y, McIntyre RS. Inflammation as a neurobiological substrate of cognitive impairment in bipolar disorder: Evidence, pathophysiology and treatment implications. J Affect Disord 2015;188:149-59. https://doi.org/10.1016/j.jad.2015.08.058.
4. Stertz L, Magalhães PV, Kapczinski F. Is bipolar disorder an inflammatory condition? the relevance of microglial activation. Curr Opin Psychiatry. 2013;26(1):19-26. https://doi.org/10.1097/YCO.0b013e32835aa4b4.
5. Kim YK, Jung HG, Myint AM, Kim H, Park SH. Imbalance between pro-inflammatory and anti-inflammatory cytokines in bipolar disorder. J Affect Disord 2007;104(1-3):91-5. https://doi.org/10.1016/j.jad.2007.02.018.
6. Kupka RW, Breunis MN, Knijff E, Ruwhof C, Nolen WA, Drexhage HA. Immune activation, steroid resistancy and bipolar disorder. Bipolar Disord 2002;4 Supp l:73-4. https://doi.org/10.1034/j.1399-5618.4.s1.29.x.
7. Bai YM, Su TP, Tsai SJ, Wen-Fei C, Li CT, Pei-Chi T, et al. Comparison of inflammatory cytokine levels among type I/type II and manic/hypomanic/euthymic/depressive states of bipolar disorder. J Affect Disord 2014;166:187-92. https://doi.org/10.1016/j.jad.2014.05.009.
8. Barbosa IG, Rocha NP, Assis F, Vieira ÉL, Soares JC, Bauer ME, et al. Monocyte and lymphocyte activation in bipolar disorder: A new piece in the puzzle of immune dysfunction in mood disorders. Int J Neuropsychopharmacol 2014;18(1):pyu021. https://doi.org/10.1093/ijnp/pyu021.
9. Ancuta P, Wang J, Gabuzda D. CD16 + monocytes produce IL-6, CCL2, and matrix metalloproteinase-9 upon interaction with CX3CL1-expressing endothelial cells. J Leukocyte Biol 2006;80(5):1156-64. https://doi.org/10.1189/jlb.0206125.
10. Efe TH, Arslan ED, Ertem AG, Yayla C, Felekoglu MA, Inci S, et al. The prognostic value of the Monocyte/HDL ratio in predicting short-term mortality in patients with acute pulmonary embolism. Kosuyolu Heart J 2016;19:149-53. https://doi.org/10.5578/khj.23104.
11. Kirlioglu SS, Balcioglu YH, Kalelioglu T, Erten E, Karamustafalioglu N. Comparison of the complete blood count-derived inflammatory markers in bipolar patients with manic and mixed episodes. Bratisl Lek Listy 2019;120(3):195-9. https://doi.org/10.4149/BLL_2019_051.
12. Demirbas A, Elmas OF, Atasoy M, Tursen U, Lotti T. Can monocyte to HDL cholesterol ratio and monocyte to lymphocyte ratio be markers for inflammation and oxidative stress in patients with vitiligo? A preliminary study. Arch Dermatol Res 2020:1-8. https://doi.org/10.1007/s00403-020-02129-3.
13. Li N, Ren L, Wang JH, Yan YR, Lin YN, Li QY. Relationship between monocyte to HDL cholesterol ratio and concomitant cardiovascular disease in Chinese Han patients with obstructive sleep apnea. Cardiovasc Diagn Ther 2019;9(4):362-70. https://doi.org/10.21037/cdt.2019.08.02.
14. Mirza E, Oltulu R, Katipoglu Z, Mirza GD, Ozkagnici A. Monocyte/HDL Ratio and Lymphocyte/Monocyte Ratio in patients with pseudoexfoliation syndrome. Ocul Immunol Inflamm 2020;28(1):142-6. https://doi.org/10.1080/09273948.2018.1545913.
15. Beumer W, Gibney SM, Drexhage RC, Pont-Lezica, L., Doorduin, J., Klein, H.C., et al. The immune theory of psychiatric diseases: a key role for activated microglia and circulating monocytes. J Leukoc Biol 2012;92(5):959975. https://doi.org/10.1189/jlb.0212100.
16. Inanli I, Aydin M, Caliskan AM, Eren I. Neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and mean platelet volume as systemic inflammatory markers in different states of bipolar disorder. Nord J Psychiatry 2019;73(6):372-9. https://doi.org/10.1080/08039488.2019.1640789.
17. Ozdin S, Usta MB. A comparison of inflammatory markers in manic and euthymic states of bipolar disorder. Nord J Psychiatry 2021;75(2):124-9. https://doi.org/10.1080/08039488.2020.1807048.
18. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;5(1):2. https://doi.org/10.1186/1755-7682-5-2.
19. Melo MCA, Garcia RF, de Araújo CFC, Abreu RLC, de Bruin PFC, de Bruin VMS. Clinical significance of neutrophil-lymphocyte and platelet-lymphocyte ratios in bipolar patients: An 18-month prospective study. Psychiatry Res 2019;271:8-14. https://doi.org/10.1016/j.psychres.2018.10.077.
20. Katipoglu Z, Mirza E, Oltulu R, Katipoglu B. May Monocyte/HDL Cholesterol Ratio (MHR) and Neutrophil/Lymphocyte Ratio (NLR) be an indicator of inflammation and oxidative stress in patients with keratoconus?. Ocul Immunol Inflamm 2020;28(4):632-6. https://doi.org/10.1080/09273948.2019.1611876.
21. Ayhan MG, Dagistan AA, Tanrikulu CS, Bozdogan SY, Eren I. Increased neutrophil/lymphocyte ratio in suicide attempters. Anatolian J Psychiatry 2019;20:305-12. https://doi.org/10.5455/apd.8099.
22. Yildiz M, Batmaz S, Songur E, Sahin S, Demir O. Simple markers for subclinical inflammation in the different phases of bipolar affective disorder. Arch Clin Psychiatry 2016;43(6):143-6. https://doi.org/10.1590/0101-60830000000101.
23. Kalelioglu T, Akkus M, Karamustafalioglu N, Genc A, Genc ES, Cansiz A, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratios as inflammation markers for bipolar disorder. Psychiatry Res 2015;228(3):925-7. https://doi.org/10.1016/j.psychres.2015.05.110.
24. Mayda H, Ahsen A, Bagcioglu E, Ozturk A, Bahceci B, Soyucok E, Effect of increased neutrophil-to-lymphocyte ratio (NLR) and decreased mean platelet volume (MPV) values on inflammation in acute mania. Neuro Psychiatry Arch 2016;53(4):317-20. https://doi.org/10.5152/npa.2016.10272.
25. Padmos RC, Hillegers MH, Knijff EM, Vonk R, Bouvy A, Staal FJ, et al. A discriminating messenger RNA signature for bipolar disorder formed by an aberrant expression of inflammatory genes in monocytes. Arch Gen Psychiatry 2008;65(4):395-407. https://doi.org/10.1001/archpsyc.65.4.395.
26. Uslu AU, Sekin Y, Tarhan G, Canakci N, Gunduz M, Karagulle M. Evaluation of Monocyte to High-Density Lipoprotein Cholesterol ratio in the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost 2018;24(5):828-33. https://doi.org/10.1177/1076029617741362.
27. Liu H, Zhan F, Wang Y. Evaluation of monocyte-to-high-density lipoprotein cholesterol ratio and monocyte-to-lymphocyte ratio in ischemic stroke. J Int Med Res 2020;48(7):1-12. https://doi.org/10.1177/0300060520933806.
28. Bolayir A, Gokce SF, Cigdem B, Bolayir HA, Yildiz OK, Bolayir E, et al. Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients. Neurol Neurochir Pol 2018;52(2):150-5. https://doi.org/10.1016/j.pjnns.2017.08.011.
29. Murphy AJ, Woollard KJ. High-density lipoprotein: A potent inhibitor of inflammation: Frontiers in research review: Physiological and pathological functions of high-density lipoprotein, Clin. Exp. Pharmacol Physiol 2011;37:710-8. https://doi.org/10.1111/j.1440-1681.2009.05338.x.
30. Kapczinski NS, Mwangi B, Cassidy RM, Librenza-Garcia D, Bermudez MB, Kauer-Sant'anna M, Kapczinski F, Passos IC. Neuroprogression and illness trajectories in bipolar disorder. Expert Rev Neurother 2017;17(3):277-85. https://doi.org/10.1080/14737175.2017.1240615

Evaluation of monocyte to high-density lipoprotein cholesterol ratio in the manic state of bipolar disorder

Year 2021, Volume: 6 Issue: 2, 81 - 85, 05.05.2021

Ali Metehan Çalışkan , Yusuf Çokünlü

https://doi.org/10.22391/fppc.875674

Cited By: 2

Abstract

Introduction: Bipolar disorder has been linked to abnormalities in the immune/inflammatory functions. Monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) is used as chronic inflammation markers. The aim of this retrospective study was to investigate the MHR levels in manic patients with bipolar disorder.

Methods: The study included 100 male patients, 49 of whom were in the first episode and 51 of whom had multiple episodes, hospitalized with a diagnosis of bipolar disorder manic state and 50 healthy individuals with characteristics comparable to the patient group in terms of gender and age. MHR values were calculated on the basis of the obtained hemograms, and the results of the biochemistry blood tests and lipid panel analyses and recorded. Kruskal Wallis test was used to compare the MHR values among the first episode, multiple episodes, and healthy control groups.

Results: There was no statistically significant difference between the patients and controls in terms of age, whereas the mean age of the patients who had multiple episodes was significantly higher than the first episode. MHR values were found to be statistically significantly higher in the first episode and multiple episodes group than healthy controls. There was no statistically significant difference between the MHR levels of the patients, who were in the first episode, and of the patients who had multiple episodes.

Conclusion: This study is consistent with the results of studies reporting inflammation in the manic episode of bipolar disorder and therefore may indicate the presence of inflammation in the manic episode.

Keywords

bipolar disorder , HDL cholesterol , inflammation , monocyte , mania

References

1. Vieta E, Berk M, Schulze TG, Carvalho AF, Suppes T, Calabrese JR, et al. Bipolar disorders. Nat Rev Dis Primers 2018;18008(4):1-16. https://doi.org/10.1038/nrdp.2018.8.
2. Fries GR, Walss-Bass C, Bauer ME, Teixeira AL. Revisiting inflammation in bipolar disorder. Pharmacol Biochem Behav 2019;177:12-9. https://doi.org/10.1016/j.pbb.2018.12.006.
3. Rosenblat JD, Brietzke E, Mansur RB, Maruschak NA, Lee Y, McIntyre RS. Inflammation as a neurobiological substrate of cognitive impairment in bipolar disorder: Evidence, pathophysiology and treatment implications. J Affect Disord 2015;188:149-59. https://doi.org/10.1016/j.jad.2015.08.058.
4. Stertz L, Magalhães PV, Kapczinski F. Is bipolar disorder an inflammatory condition? the relevance of microglial activation. Curr Opin Psychiatry. 2013;26(1):19-26. https://doi.org/10.1097/YCO.0b013e32835aa4b4.
5. Kim YK, Jung HG, Myint AM, Kim H, Park SH. Imbalance between pro-inflammatory and anti-inflammatory cytokines in bipolar disorder. J Affect Disord 2007;104(1-3):91-5. https://doi.org/10.1016/j.jad.2007.02.018.
6. Kupka RW, Breunis MN, Knijff E, Ruwhof C, Nolen WA, Drexhage HA. Immune activation, steroid resistancy and bipolar disorder. Bipolar Disord 2002;4 Supp l:73-4. https://doi.org/10.1034/j.1399-5618.4.s1.29.x.
7. Bai YM, Su TP, Tsai SJ, Wen-Fei C, Li CT, Pei-Chi T, et al. Comparison of inflammatory cytokine levels among type I/type II and manic/hypomanic/euthymic/depressive states of bipolar disorder. J Affect Disord 2014;166:187-92. https://doi.org/10.1016/j.jad.2014.05.009.
8. Barbosa IG, Rocha NP, Assis F, Vieira ÉL, Soares JC, Bauer ME, et al. Monocyte and lymphocyte activation in bipolar disorder: A new piece in the puzzle of immune dysfunction in mood disorders. Int J Neuropsychopharmacol 2014;18(1):pyu021. https://doi.org/10.1093/ijnp/pyu021.
9. Ancuta P, Wang J, Gabuzda D. CD16 + monocytes produce IL-6, CCL2, and matrix metalloproteinase-9 upon interaction with CX3CL1-expressing endothelial cells. J Leukocyte Biol 2006;80(5):1156-64. https://doi.org/10.1189/jlb.0206125.
10. Efe TH, Arslan ED, Ertem AG, Yayla C, Felekoglu MA, Inci S, et al. The prognostic value of the Monocyte/HDL ratio in predicting short-term mortality in patients with acute pulmonary embolism. Kosuyolu Heart J 2016;19:149-53. https://doi.org/10.5578/khj.23104.
11. Kirlioglu SS, Balcioglu YH, Kalelioglu T, Erten E, Karamustafalioglu N. Comparison of the complete blood count-derived inflammatory markers in bipolar patients with manic and mixed episodes. Bratisl Lek Listy 2019;120(3):195-9. https://doi.org/10.4149/BLL_2019_051.
12. Demirbas A, Elmas OF, Atasoy M, Tursen U, Lotti T. Can monocyte to HDL cholesterol ratio and monocyte to lymphocyte ratio be markers for inflammation and oxidative stress in patients with vitiligo? A preliminary study. Arch Dermatol Res 2020:1-8. https://doi.org/10.1007/s00403-020-02129-3.
13. Li N, Ren L, Wang JH, Yan YR, Lin YN, Li QY. Relationship between monocyte to HDL cholesterol ratio and concomitant cardiovascular disease in Chinese Han patients with obstructive sleep apnea. Cardiovasc Diagn Ther 2019;9(4):362-70. https://doi.org/10.21037/cdt.2019.08.02.
14. Mirza E, Oltulu R, Katipoglu Z, Mirza GD, Ozkagnici A. Monocyte/HDL Ratio and Lymphocyte/Monocyte Ratio in patients with pseudoexfoliation syndrome. Ocul Immunol Inflamm 2020;28(1):142-6. https://doi.org/10.1080/09273948.2018.1545913.
15. Beumer W, Gibney SM, Drexhage RC, Pont-Lezica, L., Doorduin, J., Klein, H.C., et al. The immune theory of psychiatric diseases: a key role for activated microglia and circulating monocytes. J Leukoc Biol 2012;92(5):959975. https://doi.org/10.1189/jlb.0212100.
16. Inanli I, Aydin M, Caliskan AM, Eren I. Neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, and mean platelet volume as systemic inflammatory markers in different states of bipolar disorder. Nord J Psychiatry 2019;73(6):372-9. https://doi.org/10.1080/08039488.2019.1640789.
17. Ozdin S, Usta MB. A comparison of inflammatory markers in manic and euthymic states of bipolar disorder. Nord J Psychiatry 2021;75(2):124-9. https://doi.org/10.1080/08039488.2020.1807048.
18. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;5(1):2. https://doi.org/10.1186/1755-7682-5-2.
19. Melo MCA, Garcia RF, de Araújo CFC, Abreu RLC, de Bruin PFC, de Bruin VMS. Clinical significance of neutrophil-lymphocyte and platelet-lymphocyte ratios in bipolar patients: An 18-month prospective study. Psychiatry Res 2019;271:8-14. https://doi.org/10.1016/j.psychres.2018.10.077.
20. Katipoglu Z, Mirza E, Oltulu R, Katipoglu B. May Monocyte/HDL Cholesterol Ratio (MHR) and Neutrophil/Lymphocyte Ratio (NLR) be an indicator of inflammation and oxidative stress in patients with keratoconus?. Ocul Immunol Inflamm 2020;28(4):632-6. https://doi.org/10.1080/09273948.2019.1611876.
21. Ayhan MG, Dagistan AA, Tanrikulu CS, Bozdogan SY, Eren I. Increased neutrophil/lymphocyte ratio in suicide attempters. Anatolian J Psychiatry 2019;20:305-12. https://doi.org/10.5455/apd.8099.
22. Yildiz M, Batmaz S, Songur E, Sahin S, Demir O. Simple markers for subclinical inflammation in the different phases of bipolar affective disorder. Arch Clin Psychiatry 2016;43(6):143-6. https://doi.org/10.1590/0101-60830000000101.
23. Kalelioglu T, Akkus M, Karamustafalioglu N, Genc A, Genc ES, Cansiz A, et al. Neutrophil-lymphocyte and platelet-lymphocyte ratios as inflammation markers for bipolar disorder. Psychiatry Res 2015;228(3):925-7. https://doi.org/10.1016/j.psychres.2015.05.110.
24. Mayda H, Ahsen A, Bagcioglu E, Ozturk A, Bahceci B, Soyucok E, Effect of increased neutrophil-to-lymphocyte ratio (NLR) and decreased mean platelet volume (MPV) values on inflammation in acute mania. Neuro Psychiatry Arch 2016;53(4):317-20. https://doi.org/10.5152/npa.2016.10272.
25. Padmos RC, Hillegers MH, Knijff EM, Vonk R, Bouvy A, Staal FJ, et al. A discriminating messenger RNA signature for bipolar disorder formed by an aberrant expression of inflammatory genes in monocytes. Arch Gen Psychiatry 2008;65(4):395-407. https://doi.org/10.1001/archpsyc.65.4.395.
26. Uslu AU, Sekin Y, Tarhan G, Canakci N, Gunduz M, Karagulle M. Evaluation of Monocyte to High-Density Lipoprotein Cholesterol ratio in the presence and severity of metabolic syndrome. Clin Appl Thromb Hemost 2018;24(5):828-33. https://doi.org/10.1177/1076029617741362.
27. Liu H, Zhan F, Wang Y. Evaluation of monocyte-to-high-density lipoprotein cholesterol ratio and monocyte-to-lymphocyte ratio in ischemic stroke. J Int Med Res 2020;48(7):1-12. https://doi.org/10.1177/0300060520933806.
28. Bolayir A, Gokce SF, Cigdem B, Bolayir HA, Yildiz OK, Bolayir E, et al. Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients. Neurol Neurochir Pol 2018;52(2):150-5. https://doi.org/10.1016/j.pjnns.2017.08.011.
29. Murphy AJ, Woollard KJ. High-density lipoprotein: A potent inhibitor of inflammation: Frontiers in research review: Physiological and pathological functions of high-density lipoprotein, Clin. Exp. Pharmacol Physiol 2011;37:710-8. https://doi.org/10.1111/j.1440-1681.2009.05338.x.
30. Kapczinski NS, Mwangi B, Cassidy RM, Librenza-Garcia D, Bermudez MB, Kauer-Sant'anna M, Kapczinski F, Passos IC. Neuroprogression and illness trajectories in bipolar disorder. Expert Rev Neurother 2017;17(3):277-85. https://doi.org/10.1080/14737175.2017.1240615

There are 30 citations in total.

Details

Primary Language	English
Subjects	Psychiatry
Journal Section	Original Research
Authors	Ali Metehan Çalışkan 0000-0002-7347-7200 Yusuf Çokünlü 0000-0002-6170-8614
Publication Date	May 5, 2021
Submission Date	February 7, 2021
Acceptance Date	April 21, 2021
Published in Issue	Year 2021 Volume: 6 Issue: 2

Cite

APA	Çalışkan, A. M., & Çokünlü, Y. (2021). Evaluation of monocyte to high-density lipoprotein cholesterol ratio in the manic state of bipolar disorder. Family Practice and Palliative Care, 6(2), 81-85. https://doi.org/10.22391/fppc.875674
AMA	Çalışkan AM, Çokünlü Y. Evaluation of monocyte to high-density lipoprotein cholesterol ratio in the manic state of bipolar disorder. Fam Pract Palliat Care. May 2021;6(2):81-85. doi:10.22391/fppc.875674
Chicago	Çalışkan, Ali Metehan, and Yusuf Çokünlü. “Evaluation of Monocyte to High-Density Lipoprotein Cholesterol Ratio in the Manic State of Bipolar Disorder”. Family Practice and Palliative Care 6, no. 2 (May 2021): 81-85. https://doi.org/10.22391/fppc.875674.
EndNote	Çalışkan AM, Çokünlü Y (May 1, 2021) Evaluation of monocyte to high-density lipoprotein cholesterol ratio in the manic state of bipolar disorder. Family Practice and Palliative Care 6 2 81–85.
IEEE	A. M. Çalışkan and Y. Çokünlü, “Evaluation of monocyte to high-density lipoprotein cholesterol ratio in the manic state of bipolar disorder”, Fam Pract Palliat Care, vol. 6, no. 2, pp. 81–85, 2021, doi: 10.22391/fppc.875674.
ISNAD	Çalışkan, Ali Metehan - Çokünlü, Yusuf. “Evaluation of Monocyte to High-Density Lipoprotein Cholesterol Ratio in the Manic State of Bipolar Disorder”. Family Practice and Palliative Care 6/2 (May2021), 81-85. https://doi.org/10.22391/fppc.875674.
JAMA	Çalışkan AM, Çokünlü Y. Evaluation of monocyte to high-density lipoprotein cholesterol ratio in the manic state of bipolar disorder. Fam Pract Palliat Care. 2021;6:81–85.
MLA	Çalışkan, Ali Metehan and Yusuf Çokünlü. “Evaluation of Monocyte to High-Density Lipoprotein Cholesterol Ratio in the Manic State of Bipolar Disorder”. Family Practice and Palliative Care, vol. 6, no. 2, 2021, pp. 81-85, doi:10.22391/fppc.875674.
Vancouver	Çalışkan AM, Çokünlü Y. Evaluation of monocyte to high-density lipoprotein cholesterol ratio in the manic state of bipolar disorder. Fam Pract Palliat Care. 2021;6(2):81-5.