Flow cytometric evaluation of T and B lymphocyte percentage in chronic kidney disease

Introduction. T and B lymphocytes play crucial roles in adaptive immunity. These cells are negatively affected in multiple disorders, including chronic kidney disease. The purpose of this study was to compare T and B lymphocyte ratios between patients with chronic kidney disease and healthy controls. Methods. In this study, we evaluated the percentages of patient and donor (healthy control) lymphocytes referred to our laboratory between 2012 and 2014. In total 103 patient-donor couples were tested by the FCXM method. CD3-PerCP and CD19-PE monoclonal antibodies were used in order to differentiate T and B cells, respectively. T and B cell percentages of the participants were statistically compared. Results. The mean age of the investigated patients and donors was 36.3 ± 13.7 and 46.2 ± 12.4 years, respectively. Of the studied patients, 45.6% and 54.3% were female and male, whereas 54.3% and 45.6% of donors were female and male, respectively. In the investigated group, 42 patients were preemptive, 45 subjects were treated with haemodialysis, and 16 individuals were on peritoneal dialysis. T and B lymphocyte percentages in the healthy group were higher than in patients with chronic kidney disease. However, the difference reached statistical significance only for T lymphocytes (p < 0.05). The percentages of total lymphocytes, and T and B lymphocytes in patients treated with haemodialysis were numerically lower than in those on peritoneal dialysis. In addition, we found that patients with chronic kidney disease had lower concentrations of haemoglobin and albumin than healthy controls. Conclusion. This study suggests that patients with advanced chronic kidney disease have lower rates of lymphocytes that healthy controls. This fact may at least partially explain impaired immunity in this setting. However, our findings require confirmation and detailed investigation of underlying mechanisms in further studies.

ACUTE RENAL FAILURE OCCURING RESULT OF FAVISM: CASE REPORT AND REVIEW OF THE LITERATURE

Glukoz 6 Fosfat Dehidrogenaz (G6PD) eksikliği, en sık görülen kalıtsal hastalıklardanbiridir ve X'e bağlı kalıtımsal geçiş gösterir. G6PD enzimi bütün dokularda bulunur.Pentoz Fosfat Yolunun (PFY) ilk basamağını katalize eden bu enzimin eksikliğinde;infeksiyon, bazı ilaçların kullanımı veya bakla yenmesi sonrasında neonatal sarılıkveya akut hemolitik anemi gelişebilir. Özellikle mitokondriyal yapıları olmayaneritrositler için PFY'u NADPH üretimi için tek kaynaktır. G6PD eksikliği olaneritrositlerde NADP'den NADPH'e dönüşüm normal düzeyde olmadığı için oksidatifhasara yatkınlık meydana gelir ve hemoliz oluşur. Oksidatif hasara uğramış olaneritrositlerde, hemolize artmış duyarlılığın nedeni tam bilinmemektedir. G6PD eksikliğinebağlı akut böbrek yetmezliği gelişebilecek olan bir komplikasyondur.Makalemizde fava yeme öyküsü sonrasında hemoliz ve akut böbrek yetmezliği gelişen;takibinde G6PD enzim eksikliği saptadığımız olgumuzu sunduk. Glucose 6 phosphate dehydrogenase enzyme deficiency is the most commonhereditary disease and in hereditary by recessive X linked. G6PD enzyme exists in alltissues. It catalyses the first step of penthose phosphate pathway. In this enzymedeficiency, neonatal jaundice and acute hemolytic anemia may occur after infection,use of some drugs or favism. Especially the erythrocytes that do not acquiremitochondria, penthose phosphate pathway is the only resource for NADPHproduction. Because of the transformation of NADP to NADPH is not normal level inthe erythrocytes with G6PD deficiency, the susceptibility of oxidative damage increasesand hemolyses occurs. In the erythrocytes exposed to oxidative injury, the reason ofincreased sensitivity to hemolysis is not well known. The occurring of acute renalfailure in the adult with G6PD deficiency is a well known complication. We presentedin our case report, a case whom hemolysis and acute renal failure developed afterfavism and the follow ups G6PD enzyme deficiency is determined.

RETINOPATHY CAUSING BLINDNESS IN A PATIENT WİTH DELTA HEPATITIS DURING HIGH DOSE INTERFERON ALFA-2 B TREATMENT: CASE REPORT

İnterferon (İNF) kronik hepatit B, C, metastatik renal karsinom, kutanöz melanom, kaposi sarkomu ve yeni doğanlardaki hemanjiomlarda kullanılan antiviral, antiproliferatif ve immünomodülatuar aktiviteyi düzenleyen bir ilaçtır. İNF alan hastalarda retinopati gelişme insidansı %18-86 arasındadır. Retinopati gelişmesi için başlıca risk faktörleri yüksek doz INF tedavisi, diabetes mellitus ve hipertansiyondur. INF tedavisine bağlı gelişmiş retinopati genellikle iyi seyirlidir, görme kaybı ve diğer göz semptomlarına yol açmaz. Fakat bizim olgumuzda retinopati büyük bir görme kaybına yol açmış ve 3 aylık takip sonrasında düzelmemiştir. Makalemizde 56 yaşında, erkek, delta hepatiti nedeniyle yüksek doz interferon-alfa 2b tedavisi (Haftada 3 gün 10 milyon ünite) sırasında 17. ayda retinopati gelişen hastamızı sunduk. Sonuç olarak; retinopati İNF tedavisi süresince gelişebilen akılda olması gereken bir komplikasyondur. Özellikle, yüksek risk grubundaki hastalar İNF tedavisi öncesinde mevcut olabilecek retinopati açısından değerlendirilmeli ve tedavi süresince retinopati gelişimi riski açısından üç aylık aralıklarla düzenli takip edilmelidir. Interferon (İNF) is an agent that is used in chronic hepatitis B, C, metastatic renal carcinoma, cutaneous melanoma, kaposi sarcoma and hemangiomas of infancy and has antiviral, antiproliferative and immunomodulatory activity. The incidence of retinopathy in the patients associated with interferon therapy is between 18-86%. The main risk factors for developing retinopathy are high dose INF treatment, diabetes mellitus and hypertension. Retinopathy caused by INF treatment has good prognose and does not cause blindness or other symptoms of eye. But in our patient retinopathy caused blindness and did not resolve in the follow ups for 3 months . In our article we presented, a 56 years-old, male patient with delta hepatitis, who has retinopathy that is associated with high dose interferon alfa-2 b treatment (3 x 10.000 Million Ü per week) at seventeeth month of treatment. Finally, retinopathy is a complication that must be considered during treatment with interferon. Especially, high risk patients must be evaluated before interferon therapy for the preexisting retinopathy and should be monitored in every three months for the risk of retinopathy throughout the therapy

Oxidative stres and erytrocyte deformability in patients with active and inactive inflammatory bowel disease <br><br><br><br><br><br><br><br><br><br>

Amaç: Bu çalışmamızda, İBH olan hastalarda oksidatif stres ve eritrosit deformabilitesinin etkileri araştırılmıştır. Çalışmamızın sonucunda elde edilecek veriler ile, etyopatogenez hakkında yeni bilgiler sağlanması ve nedene yönelik tedavi seçeneklerine de ışık tutması planlanmıştır. Giriş: Son yıllarda, İBH etyopatogenezinin aydınlatılması konusunda yoğun çalışmalar yapılmıştır. Etyopatogenezinde birçok faktör yer almaktadır. Çevresel risk faktörleri, genetik, immünolojik faktörler, mukozal geçirgenliğin artması ve mikroorganizmalar başlıca etyopatogenetik faktörlerdir. Patogenezde üzerinde durulan önemli faktörlerin başında okidatif stres ve mikrovasküler akımda yavaşlama gelmektedir. Artmış oksidatif stresin eritrosit deformabilitesinde azalmaya yol açtığı belirtilmektedir. Ancak İBH olan hastalarda eritrosit deformabilitesi ile ilgili yapılmış çalışma bulunmamaktadır. Mikrovasküler akımdaki yavaşlama ile eritrosit deformabilitesi arasındaki neden-sonuç ilişkisi tam aydınlatılamamıştır. Gereç ve Yöntemler: Çalışmamız Dokuz Eylül Üniversitesi Tıp Fakültesi Gastroenteroloji Bilim Dalı'nda gerçekleşmiştir. 43 aktif İBH, 48 inaktif dönemde İBH olan ve 45 sağlıklı kontrol 3 grup altında toplanarak periferik venöz kanları alınmıştır. İlk alınan kan 2 saat içinde eritrosit deformabilite ölçümünde kullanılmıştır. Geriye kalan kanda eritrosit paketleri ve plazma ayrılarak derin dondurucuda saklanan örneklerde eritrosit paketlerinde MDA, plazma örneklerinde GPO ve sülfidril ölçümleri gerçekleştirilmiştir. Sonuçlar: Toplam 136 kişi 3 alt grupta incelenmiştir. Eritrosit MDA değeri, hem aktif (p=0.03) hem de inaktif İBH (p=0.05) grubunda kontrol grubu ile karşılaştırıldığında anlamlı olarak yüksek saptanmıştır. Plazma GPO değerlerinde, gruplar arasında istatiksel anlamlı fark saptanmamıştır. En düşük plazma TSH değeri aktif İBH grubunda iken en yüksek TSH değeri kontrol grubunda saptanmıştır. Aktif İBH grubunda ki bu düşük değer hem inaktif İBH grubuna (p=0.003) göre hem de kontrol grubuna (p=0.001) göre istatiksel olarak anlamlı bulunmuştur. Ancak inaktif İBH grubundaki düşük değer, kontrol grubu ile karşılaştırıldığında istatiksel olarak anlamlı bulunmamıştır. Eritrosit deformabilitesi değerini gösteren elongasyon indeksi (EI), hem aktif (p Sonuç olarak çalışmamız, İBH olan hastalarda eritrosit deformabilitesinin değerlendirildiği ilk çalışmadır. Çalışmamızda bulunan yüksek eritrosit MDA ve düşük plazma TSH düzeyleri hastalığın patolojisinde oksidatif stresi ortaya koymaktadır. Artmış eritrosit MDA'nın eritrosit deformabilitesinde azalmaya yol açtığı düşünülmüştür. Azalmış eritrosit deformabilitesi ise son zamanlarda üzerinde durulan mikrovasküler iskeminin tetikleyicisi olabilir. Aim: In our study we investigated the effect of oxidative stress and erythrocyte deformability in IBD. The data as a result of our study will give us new information about the etiopathogenesis and as these data about IBD increases they will set light to new treatment choices for the reason. Introduction: In recent years, lots of study are done to light up the etiopathogenesis. There are many factors playing role in the etiopathogenesis. Environmental risk factors, increased mucosal permeability and microorganisms are the major etiopathogenetic factors. Oxidative stress and reduced microvascular flow are important factors in the pathogenesis. The increased oxidative stress reduces the eriytrocyte deformability. But in IBD, there are no studies which evaluate erythrocyte deformability in the literature. The relationship between erythrocyte deformability and reduced-microvascular flow is not clarified exactly. Methods: Our study was performed in Gastroenterology Division of the University of Dokuz Eylül. We divided patients into three subgroupsæ 43 patients with active IBD, 48 patients with inactive IBD and 45 healthy controls. Peripheral venous bloods were taken from each patient. The erytrocyte deformability was measured in two hours. The erythrocyte packages and plasma were separated in the remaining blood and kept in deep freeze. Malonyldialdehyde (MDA) levels were measured in erythrocyte packages. Glutation peroxidase (GPO) and sulfhydryl levels were measured in plasma specimens. Results: Totally 136 people were investigated in three subgroups. Erytrocyte MDA levels in both active and inactive IBD were increased significantly (P=0.005) compared with control groups. Plasma GPO levels did not show statistically significant difference between all groups. While the lowest plasma total sulfhydryl (TSH) levels were found in active group, the highest plasma TSH levels were found in the control group. The decreased plasma TSH levels in active IBD were statistically significant compared with both the inactive IBD (p=0.003) and the control group (p=0.001). But plasma TSH levels in inactive IBD group did not show statistically significant difference when compared with the control group. Elongation index (EI) which shows erytrocyte deformability value in both active (p As a result our study is the first study that evaluates the erythrocyte deformability in IBD. In our study increased erytrocyte MDA levels and decreased plasma TSH levels manifested the role of oxidative stress in the pathogenesis of the disease. It is thought that the increased erythrocyte MDA values cause the reduction in erythrocyte deformability. The reduction of erythrocyte deformability may play a role in triggering the microvascular ischemia

The Role of 18F-FDG PET/CT in the Evaluation of Gastric Cancer Recurrence

Objective: F-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been widely used for staging, re-staging and for monitoring therapy-induced changes and response to therapy in patients with various types of cancer, but its utilization for gastric cancer has been limited. This study aimed to assess the diagnostic performance of 18F-FDG PET/CT for detecting recurrence in gastric cancer patients with radiologic or clinical suspicion of recurrence and its clinical impact on making decision. Methods: We performed a retrospective review of 130 consecutive patients who underwent PET/CT scans for post-treatment surveillance of gastric cancer between January 2008 and March 2012. The mean time between the initial diagnosis of gastric cancer and PET/CT studies was 44 weeks with a median of 18 weeks. The number and site of positive FDG uptake were analyzed and correlated with the final diagnosis by calculating the diagnostic values. We evaluated the diagnostic accuracy of PET/CT for detecting the recurrence in terms of whether or not histology had been SRC/musinous adenocarcinoma. The changes in the clinical management of patients were also evaluated according to the results of PET/CT. Results: Of all 130 patients, 91 patients were confirmed to have true recurrence. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of PET/CT for diagnosing true recurrence on a per-person basis were 91.2%, 61.5%, 84.6%, 75.0% and 82.3% respectively. Final diagnoses were confirmed histopathologically in 59 (45.4%) of 130 patients and by clinical and radiological follow-up in the remaining 71 (54.6%) patients. In the subgroup with SRC/mucinous adenocarcinoma differentiation of the primary tumor, there was no statistically significant difference in terms of diagnostic accuracy of PET/CT on a per-person basis. In addition, PET/CT results changed the patients’ management in 20 (15%) cases. Conclusions: 18F-FDG PET/CT can provide useful information in discriminating true recurrence in patients with suspected gastric cancer recurrence and may have significant impact on clinical decisions/patient management in a considerable percentage of patients

The Role of 18F-FDG PET/CT in the Evaluation of Gastric Cancer Recurrence

Objective: F-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has been widely used for staging, re-staging and for monitoring therapy-induced changes and response to therapy in patients with various types of cancer, but its utilization for gastric cancer has been limited. This study aimed to assess the diagnostic performance of 18F-FDG PET/CT for detecting recurrence in gastric cancer patients with radiologic or clinical suspicion of recurrence and its clinical impact on making decision. Methods: We performed a retrospective review of 130 consecutive patients who underwent PET/CT scans for post-treatment surveillance of gastric cancer between January 2008 and March 2012. The mean time between the initial diagnosis of gastric cancer and PET/CT studies was 44 weeks with a median of 18 weeks. The number and site of positive FDG uptake were analyzed and correlated with the final diagnosis by calculating the diagnostic values. We evaluated the diagnostic accuracy of PET/CT for detecting the recurrence in terms of whether or not histology had been SRC/musinous adenocarcinoma. The changes in the clinical management of patients were also evaluated according to the results of PET/CT. Results: Of all 130 patients, 91 patients were confirmed to have true recurrence. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of PET/CT for diagnosing true recurrence on a per-person basis were 91.2%, 61.5%, 84.6%, 75.0% and 82.3% respectively. Final diagnoses were confirmed histopathologically in 59 (45.4%) of 130 patients and by clinical and radiological follow-up in the remaining 71 (54.6%) patients. In the subgroup with SRC/mucinous adenocarcinoma differentiation of the primary tumor, there was no statistically significant difference in terms of diagnostic accuracy of PET/CT on a per-person basis. In addition, PET/CT results changed the patients’ management in 20 (15%) cases. Conclusions: 18F-FDG PET/CT can provide useful information in discriminating true recurrence in patients with suspected gastric cancer recurrence and may have significant impact on clinical decisions/patient management in a considerable percentage of patients

Diyabetik sıçanlarda karaciğer fibrozisi üzerine levetirasetam etkisi

Objectives: In our study we investigated the possible effects of levetiracetam (LEV) on hepatic fibrosis in streptozotocin (STZ) induced diabetic rats with histopathology, real-time elastography imaging technique. We also aimed to investigate the effects of LEV on oxidative stress markers. Materials and methods: Diabetes was induced by intraperitoneal (i.p.) single dose injection of STZ (60 mg/kg). Twenty-one rats were randomly divided into three groups; control group, STZ group treated with 1 mL/kg/day saline (STZ+SP), and STZ group treated with 600 mg/kg/day LEV was administrated by i.p. for four weeks. All rats underwent a real-time elastography (strain-elasticity %). The liver sections are examined by histopathologically (liver fibrosis score). In addition, malondialdehyde, total antioxidant capacity, and glutathione levels were measured in plasma. Results: Treatment with LEV significantly decreased liver fibrosis score and increased strain measurement % on the real-time elastography in diabetic rats. In addition, treatment with LEV significantly increased total antioxidant capacity, glutathione and malondialdehyde levels decreased in plasma of diabetic rats. Conclusion: Levetiracetam has potential as a treatment for diabetic liver injury and hepatic fibrosis and can be a good candidate among new treatment options. In addition, real-time elastography is reliable imaging non-invasive technique for detecting hepatic fibrosis.Amaç: Bu çalışmada, streptozotocin (STZ) ile indüklenmiş diyabetik sıçanlardaki hepatik fibrozis üzerine levetirasetamın (LEV) pozitif etkilerinin histopatolojik ve gerçek zamanlı elastografik görüntüleme tekniği ile incelenmesi amaçlandı. Yine bu çalışmada LEV’nin oksidatif stres belirteçleri üzerine etkisi araştırıldı. Gereç ve yöntemler: Diyabetik model, tek doz intraperitoneal (i.p.) STZ (60 mg/kg) enjeksiyonu ile yapıldı. Yirmi bir sıçan rastgele olarak üç gruba ayrıldı; kontrol grubu, STZ uygulaması yapılıp 1 mL/kg/gün salin verilen grup (STZ+SP) ve STZ uygulanıp dört hafta boyunca 600 mg/kg/gün i.p LEV uygulanan grup. Tüm sıçanlar gerçek zamanlı elastografik yöntem ile incelendi (gerilme-elastikiyet yüzdesi). Karaciğerden alınan kesitler histopatolojik olarak değerlendirildi (karaciğer fibroz skoru). Bunlara ek olarak, plazmadan malondialdehit, total antioksidant kapasite ve glutatyon seviyeleri ölçüldü. Bulgular: Levetirasetam ile tedavi edilen diyabetik sıçanlarda karaciğer fibroz skorlamasında anlamlı bir azalma ve gerçek zamanlı elastografik gerilim-elastikiyet yüzdesinde artış saptandı. Bununla birlikte LEV tedavisinde diyabetik sıçanlarda total antioksidant kapasitesinin arttığı, glutatyon ve malondialdehitin plazma seviyelerinin azaldığı görüldü. Sonuç: Levetirasetam, diyabetik karaciğer hasarı ve karaciğer fibrozisi için yeni tedavi seçenekleri arasında iyi bir aday olabilir. Buna ek olarak gerçek zamanlı elastografi, hepatik fibrozisin tespitinde non-invazif ve güvenilir bir görüntüleme bir tekniğidir

Is there any effect of lower extremity deep vein thrombosis which proven by Doppler ultrasonography on cancer recurrence in patients with stage III colon cancer? A study of the Turkish Descriptive Oncological Researches Group

İstanbul Bilim Üniversitesi, Tıp Fakültesi.This study aimed to determine the predictive value of lower extremity deep vein thrombosis (LE-DVT) on first cancer recurrence in patients with stage III colon cancer. A total of 113 eligible patients with stage III colon cancer were divided into two groups according to whether they had LE-DVT. LE-DVT was detected in 29 (26 %) patients. Presence of recurrence with distant metastasis had a significant positive correlation with baseline platelet count, baseline mean platelet volume, and the presence of lower extremity deep vein thrombosis. It was concluded that the relation between disease progression and the presence of LE-DVT in stage III colon cancer is independent of other study variables (P = 0.031; OR = 4.27; 95 % CI 1.89–6.71). We hypothesized that the presence of LE-DVT in patients with stage III colon cancer may predict to early cancer recurrence with distant metastasis