Investigation of the relationship between serum and saliva calprotectin levels and disease activity parameters evaluated clinically and by laboratory parameters in patients with rheumatoid arthritis

Romatoid artrit hastalığının tanısında yol gösterecek yeni biyobelirteçler üzerinde çalışılmakta ve hastalığın erken teşhisi ve tedavisi hedeflenmektedir. Periodontit ve RA'nın benzer patogenetik mekanizmaları gösterilmiştir. Periodontal hastalığı olan RA'lı hastaların hastalık aktiviteleri daha kötü seyretmektedir. Önceki çalışmalar kalprotektinin RA tanısı ve prognozu için değerli bir biyobelirteç olabileceğini göstermektedir. Periodontiti olan hastalarda kalprotektinle hastalık aktivitesi arasındaki ilişki bilinmektedir. Ayrıca kronik periodontiti olan hastalarda tükürük kalprotektin düzeyinin de yüksek olduğu birkaç çalışmada gösterilmiştir. RA tanılı hastalarda tükürükteki kalprotektin düzeyleriyle hastalık aktivitesinin ilişkisini gösteren bir çalışma şu ana dek literatürde bulunmamaktadır. Bu çalışmada amacımız RA tanılı hastalarda serum ve tükürük kalprotektin düzeyleriyle hastalık aktivitesini değerlendirmek, ikincil olarak da bu hastalarda periodontiti değerlendirerek serum ve tükürük kalprotektin düzeylerinin periodontitle ilişkisi olup olmadığını ortaya koymaktır. Medipol Üniversitesi Tıp Fakültesi Romatoloji Bilim Dalı polikliniğine başvuran, 2010 ACR/EULAR sınıflandırma kriterlerine göre RA tanısı almış 76 hasta (K/E: 59/17), hasta kontrol grubu olarak 2016 ACR-EULAR sınıflandırma kriterlerine göre Sjögren sendromu tanısı almış 24 hasta (K/E: 24/0) ve sağlıklı kontrol grubu olarak 40 yetişkin (K/E: 25/15) çalışmaya dahil edildi. Olguların demografik, klinik ve laboratuvar verileri hasta takip formuna kaydedildi ve eş zamanlı olarak kalprotektin için serum ve tükürük örneği alındıktan sonra periodontit muayenesi yapıldı. Gruplar arası analizler Student-T testi, Mann-Whitney U testi; hasta ve doktor kökenli ölçekler arası korelasyonlar Spearman korelasyon testiyle değerlendirildi. RA'lı hastalarda serum kalprotektin değeri, yüksek hastalık aktivitesi olan grupta, düşük hastalık aktivitesi olan gruba göre daha yüksek saptandı [YHA ve DHA: 11,5 (0,78-38,23); 8,3 (1,6-24,4) (p:0,02)]. Ortalama serum kalprotektin değerleri RA grubunda diğer iki gruba göre daha yüksek saptandı ve RA grubuyla SS grubu arasında istatistiksel fark saptanırken, RA grubu ile sağlıklı kontrol grubu arasında istatistiksel fark saptanmadı [RA, SS ve SK sırasıyla: 13,6 (9,8); 8,1 (7,5) ve 10,9 (6,02) (p:0,01)]. RA tanılı hastalarda ortanca tükürük kalprotektin düzeyleri, periodontiti olan hastalarda periodontiti olmayanlara göre daha yüksek saptandı [Periodontit evre I ve Periodontit evre II-IV sırasıyla: 27,3 (1,6-40,74); 31,7 (0,64-75,85) (p:0,04)]. Romatoid artrit hasta grubunda serum kalprotektin değerleri sağlıklı ve hasta kontrol grubuna göre yüksek saptanmış ve hastalık aktivitesiyle korele bulunmuştur. Buna karşılık romatoid artritli hastalarda tükürük kalprotektin değerleri sağlıklı ve hasta kontrol grubuna göre düşük saptanmıştır. Romatoid artritli hastalarda periodontal enflamasyon tükürük kalprotektin değerleri ile korele çıkarken, diğer iki grupta böyle bir ilişki saptanmamıştır. Bu çalışma diğer çalışmalara benzer şekilde serum kalprotektin düzeylerinin hastalık aktivite belirteçleriyle pozitif yönde korele olduğunu göstermiştir.New biomarkers that will guide the diagnosis of rheumatoid arthritis are being studied and early diagnosis and treatment of the disease is aimed. Similar pathogenetic mechanisms of periodontitis and RA have been demonstrated. Disease activities of patients with RA who have periodontal disease tend to be worse. Previous studies suggest that calprotectin may be a valuable biomarker for the diagnosis and prognosis of RA. The relationship between calprotectin and disease activity in patients with periodontitis is known. In addition, several studies have shown that the salivary calprotectin level is high in patients with chronic periodontitis. A study showing the relationship between salivary calprotectin levels and disease activity in patients with RA has not been found in the literature so far. In this study, our aim is to evaluate the disease activity with serum and salivary calprotectin levels in patients with RA, and secondly, to evaluate periodontitis in these patients and to reveal whether serum and salivary calprotectin levels are related to periodontitis. 76 patients diagnosed with RA (Female/Male: 59/17) according to the 2010 ACR/EULAR classification criteria, 24 patients diagnosed with SS (F/M: 24/0) according to the 2016 ACR-EULAR classification criteria as the patient control group, and 40 healthy adults (F/M: 24/0) as healthy control group, who applied to the Medipol University Faculty of Medicine Rheumatology Department outpatient clinic, were included in the study. Demographic, clinical and laboratory data of the cases were recorded in the patient follow-up form, and periodontitis examination was performed after taking serum and saliva samples to measure the calprotectin levels simultaneously. Intergroup analyzes were evaluated with Student-T test and Mann-Whitney U test. The correlations between patient and physician-derived scales were evaluated with the Spearman correlation test. In patients with RA, serum calprotectin value was found to be higher in the group with high disease activity than in the group with low disease activity [HDA and LDA: 11.5 (0.78-38.23); 8.3 (1.6-24.4) (p:0.02)]. Mean serum calprotectin values were found to be higher in the RA group than in the other two groups, and there was a statistical difference between the RA group and the SS group, but no statistical difference was found between the RA group and the healthy control group [RA, SS, and HC, respectively: 13.6 (9.8); 8.1 (7.5) and 10.9 (6.02) (p:0.01)]. Median salivary calprotectin levels in patients with RA were found to be higher in patients with periodontitis than in patients without periodontitis [Periodontitis stage I and Periodontitis stage II-IV, respectively: 27.3 (1.6-40.74); 31.7 (0.64-75.85) (p:0.04)]. Serum calprotectin levels were found to be higher in the rheumatoid arthritis patient group than in the healthy and patient control group, and were correlated with disease activity. On the other hand, salivary calprotectin values in patients with rheumatoid arthritis were found to be lower than those of the healthy and patient control group. While periodontal inflammation was correlated with salivary calprotectin values in patients with rheumatoid arthritis, no such relationship was found in the other two groups. Similar to other studies, this study showed that serum calprotectin levels were positively correlated with disease activity markers

Do neutrophil-lymphocyte ratio and platelet-lymphocyte ratio have a role in determining mortality in intensive care patients undergoing plasmapheresis? Single-center experience

Introduction: Plasmapheresis is a frequently used procedure that removes the pathogenic components from circulation. We aimed to evaluate the relationship between plasmapheresis, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and mortality in the intensive care unit (ICU) between 2014 and 2021. Methods: Forty-nine patients (27 females and 22 males) were included. Demographic characteristics, laboratory values of the day of admittance to the ICU, APACHE II scores, and length of stay were recorded. Results: The mean age was 52.73 ± 16.93. APACHE II value (p = 0.003; p < 0.01), NLR ratio (p = 0.001; p < 0.01) and PLR ratio (p = 0.001; p < 0.01) of the surviving group were lower than those of the deceased group, which was statistically significant. Conclusion: As high PLR and NLR levels suggest increased mortality in the ICU population, attention should be paid for increased NLR and PLR when plasmapheresis is decided on in the ICU

Rare side effect caused by atezolizumab, an immune checkpoint inhibitor: Cold agglutinin disease

Introduction Immune checkpoint inhibitors are drugs that are included in the guidelines of hematological and solid cancer treatments, give highly effective results and increase T cell functionality. However, these drugs can cause immune-related adverse events resembling autoimmune diseases. Case report A 50-year-old male patient was admitted to an external center with complaints of chest pain and dyspnea. Thoracic CT revealed a 97 x 58 mm mass in the left lung, and a diagnosis of Small Cell Lung Cancer (SCLC) was made by biopsy. The PET/CT performed for staging was also evaluated as extensive stage small cell lung cancer. It was decided to give a combination of atezolizumab and carboplatin-etoposide to the patient. Management and outcome: The patient completed 3 cycles without any problem. Discordance was detected in the hemogram of the patient who came to the control for the assessment of response and had a regression in the imaging. Hemoglobin 9.6 g/dl (N: 14-17.5) hematocrit 14.8% (N: 41-51) were detected in the hemogram. Agglutinins were seen in the peripheral smear performed. Cold agglutinin (+4 positive) and indirect coombs (+3 positive) were found positive. Atezolizumab was stopped and methylprednisolone was started. After 10 days of treatment, discordance improved and methylprednisolone was discontinued by decreasing to half dose every 5 days. Discussion With the increasing use of immune checkpoint inhibitors, the variety of side effects has increased and case reports have increased. After detection of cold agglutinin, IgG, cryoglobulin, mycoplasma pneumonia, hepatitis B, hepatitis C and HIV were found negative in the differential diagnosis, Our case appears to be immune checkpoint inhibitor-related Cold Agglutinin Disease (CAD). It should not be forgotten that immune checkpoint inhibitors, which are widely used, may cause CAD, and hemoglobin-hematocrit discordance should be paid attention to in routine controls

Increased telomerase activity in major depressive disorder with melancholic features: Possible role of pro-inflammatory cytokines and the brain-derived neurotrophic factor

The biological mechanisms responsible for depression symptoms are not yet understood. For this reason, it is important to reveal the etiopathogenetic mechanisms in this disease. This study aims to compare the levels of pro-inflammatory cytokines, Brain-Derived Neurotrophic Factor (BDNF), and telomerase activity in patients with major depressive disorder (MDD) and healthy controls. Plasma BDNF, interleukin-6 (IL-6), IL-1beta, and Tumor Necrosis Factor-alpha (TNF-alpha) levels, and telomerase activity were measured in 39 patients with major depression and 39 healthy controls matched with patients in terms of age, gender, and education year. Plasma concentration of BDNF, IL-6 levels, and telomerase activity was significantly different between patients with MDD and healthy controls. Correlation analysis showed a positive trend between plasma BDNF levels and plasma IL-6 levels in patients with MDD with melancholic features. Furthermore, the path analysis results showed that the telomerase activity was indirectly affected by gender, IL-1β, IL-6, BDNF, and BMI, via the severity of depression and anxiety and MDD status as the mediators. Further studies are needed to examine the molecular mechanism of the telomerase activity and the role of BDNF and pro-inflammatory cytokines in the telomerase activation in MDD

The modified glasgow prognostic score (MGPS) and the mortality prediction MODEL II (MPM II) CAN predict mortality in patients with breast cancer admitted to intensive care: A retrospective cohort study

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Increased frequency of occurrence of bendopnea is associated with poor outcomes in heart failure outpatients

Background Relationship between the frequency of occurrence of bendopnea during the daily life of heart failure (HF) outpatients and clinical outcomes has never been evaluated before. Methods Turkish Research Team-Heart Failure (TREAT-HF) is a network between HF centres, which undertakes multicentric observational studies in HF. Herein, the data including stable 573 HF patients with reduced ejection fraction out of seven HF centres were presented. A questionnaire was filled by the patients, with the question 'Do you experience shortness of breath while tying your shoelace?', assessing the presence and frequency of bendopnea. Results To the question related to bendopnea, 48% of the patients answered 'yes, every time', 31% answered 'yes, sometimes', and 21% answered 'No'. Patients were followed for an average of 24 +/- 14 months, and the patients who answered 'yes, every time' and 'yes, sometimes' to the bendopnea question were found having increased risk for both HF-related hospitalisations (HR:3.2,p < .001- HR:2.8,p = .005) and composite outcome consisting of 'HF-related hospitalisations and all-cause death in the multi-variate analysis (HR:3.1,p < .001- HR:3.0,p < .001). Kaplan Meier analysis for HF-related hospitalisation, all-cause death, and the composite of these were provided for these three groups, yielding significant and graded divergence curves with the best prognosis in 'no' group, with the moderate prognosis in 'sometimes' group, and with the worst prognosis in the 'every time' group. Conclusion For the first time in the literature, our study shows that the increased frequency of bendopnea occurrence in daily life is associated with poor outcomes in HF outpatients

Ischemia-modified albumin levels in patients with acute decompensated heart failure treated with dobutamine or levosimendan: IMA-HF study

Objective: Ischemia-modified albumin (IMA) is a sensitive biomarker of myocardial ischemia. However, data on IMA levels in acute heart failure (HF) are still lacking. In this study, we aimed to evaluate serum IMA levels in acute decompensated HF and the effects of dobutamine and levosimendan treatments on IMA levels

Ischemia-modified albumin levels in patients with acute decompensated heart failure treated with dobutamine or levosimendan: IMA-HF study

Objective: Ischemia-modified albumin (IMA) is a sensitive biomarker of myocardial ischemia. However, data on IMA levels in acute heart failure (HF) are still lacking. In this study, we aimed to evaluate serum IMA levels in acute decompensated HF and the effects of dobutamine and levosimendan treatments on IMA levels