NLR, MPV and RDW as Biomarkers in Operated and Non-operated Patients with Colorectal Adenocarcinoma

Objective:There is a need for inexpensive, reliable and readily available biomarkers in the early diagnosis and prediction of mortality, morbidity and treatment response in colorectal cancer (CRC). In our study, it was aimed to compare mean platelet volume (MPV), red cell distribution width (RDW) and neutrophil-lymphocyte ratio (NLR) measurements in operated and non-operated patients with the diagnosis of CRC.Method:In our study, we retrospectively reviewed 52 patients (including 26 operated patients and 26 non-operated patients) diagnosed as CRC with colonoscopic biopsy at endoscopy unit of gastroenterology department between 2016 and 2019. We extracted and compared demographic, colonoscopy, clinical, laboratory and surgical data in both groups.Results:In our study, the mean age (60.04 years and 64.19 years, respectively) and gender distribution (female: male, 12: 14 and 11: 15, respectively) were comparable in operated and non-operated patients with CRC. MPV, RDW and NLR measurements were found to be significantly lower in patients who underwent surgery (operated) when compared to non-operated patients (p<0.001, p=0.026 and p<0.001, respectively).Conclusion:There is strong evidence suggesting that inflammation plays a role in the pathogenesis of many disorders including malignancy. In our study, it was found that inflammatory markers, namely MPV, RDW and NLR values, were lower after surgery which removed tumor; thus, inflammation. These biomarkers can be suggestive for early diagnosis in CRC as well as response to surgical treatment

Unusual presentation of peritonitis with persistent clear aspirate: a case report

<p>Abstract</p> <p>Introduction</p> <p>Peritonitis is the most frequent complication of peritoneal dialysis. Diagnosis of peritonitis includes symptoms and signs of peritonitis with a cloudy aspirate of more than 100 WBC/ml, as well as positive cultures. Although sterile peritonitis has been reported in the literature, to the best of our knowledge this is the first report of an unusual presentation of peritonitis without any white blood cells in the peritoneal aspirate despite multiple positive peritoneal cultures.</p> <p>Case presentation</p> <p>An 82-year-old Caucasian man who had been on continuous cycling peritoneal dialysis for 12 years was admitted to our hospital with general malaise, loss of appetite, weight loss and somnolence. He did not describe abdominal pain or fever. Even though his peritoneal fluid was consistently negative for leukocytes and clear, he had peritonitis with different organisms consecutively.</p> <p>Conclusions</p> <p>Our case report shows that any patient on peritoneal dialysis presenting with evidence of infection (fever, peripheral leukocytosis) without an obvious cause should have aspirate cultures done even if the aspirate is clear and abdominal pain is absent. Our case report may change the initial work-up and management of these patients. We believe this report is of interest to general medicine and emergency room physicians as well as nephrologists.</p

The Association between Non-Alcoholic Fatty Liver Disease and Dynapenia in Men Diagnosed with Type 2 Diabetes Mellitus

Background: Dynapenia and non-alcoholic fatty liver disease (NAFLD) are common, especially in the middle and advanced-age diabetic male population. We aimed to examine the clinical features, NAFLD severity, and parameters associated with the presence of dynapenia in type 2 diabetes mellitus (T2DM) cases. Material and Methods: One hundred thirty-five male patients diagnosed with T2DM between 45 and 65 years of age were included. Patients were staged by ultrasonography according to NAFLD status. Results: There were significant differences in muscle strength, upper arm circumference, calf circumference, and up-and-go test scores between the mild-moderate-severe and non-NAFLD groups (p &lt; 0.001 for all). The frequency of dynapenia was lower, and arm and calf circumferences were higher in patients without NAFLD. The muscle strength, upper arm circumference, calf circumference, and up-and-go test scores were significantly lower in the dynapenic group compared to the non-dynapenic group (p &lt; 0.005 for all). The prevalence of dynapenia increased along with the increase in NAFLD stages (p &lt; 0.001). Conclusions: We detected a significant association between NAFLD and dynapenia in middle-aged men with T2DM. As muscle strength decreases, the amount of fat in the liver increases, and as the fat in the liver increases, muscle strength decreases

TNF-a bloker tedavisi başlanan romatoid artrit hastalarında tedavi öncesi ve tedavi sonrası multiplex laboratuvar yöntemi ile ölçülen sitokin ve kemokin düzeyleri ile klinik seyir ve tedavi yanıtı arasındaki ilişkinin değerlendirilmesi

ÖZETAMAÇRomatoid Artrit (RA) etyolojisi net olarak bilinmeyen, daha çok sinoviyal eklemleritutan ve eklem çevresinde progresif yıkım ile seyreden kronik, inflamatuar, sistemik,otoimmün bir hastalıktır. RA tanısında 1987 ACR ve 2010 yılında yayınlananACR/EULAR tanı kriterleri kullanılmaktadır. Tüm dünyada, ortalama %1 ile en sıkgörülen inflamatuar artrittir. En sık 4. ve 5. dekatlarda olmakla beraber kadınlarda 23kat daha fazla görülür. Hastalığın etyolojisi kesin olarak bilinmemekle birliktegenetik ve çevresel risk faktörleri suçlanmaktadır. RA patogenezinde sinovyumçevresinde ağırlıklı olarak mononükleer hücrelerin birikimi, birçok hücre tipitarafından salınan sitokin ve kemokinlerin aracılığı ile bu hücrelerin sinovyuma akışıve prolifere olmaları, sinovitis oluşumu, ardından eklemi oluşturan kemik vekıkırdak dokuda aşınma ve erozyonlar söz konusudur. RA’nın karakteristikpatolojisininin oluşmasında pro ve antiinflamatuvar sitokinler arasındaki dengeninbozulması önemli bir etkendir. Başta makrofaj kökenli IL-1 ve TNF-α olmak üzere,IL-6, IFN-γ, IL-12, IL-13, IL-15, IL-17, GM-CSF gibi bir çok proinflamatuvarsitokin ve MCP-1,IL-8 ve ENA-78 gibi proinflamatuvar kemokin hastalığınpatogenezinde önemli rol almaktadırlar. RA’da laboratuvar bulguları nonspesifiktir.Klinik belirti ve bulgulara göre konulan tanıyı desteklemede veya hastalığın seyrinideğerlendirmede kullanılabilir. Bu amaçla kullanılan RF, antiCCP antikorları veserum CRP, ESR değerleri tanı ve hastalık aktivitesinde bilgiler vermektedirler ancakyapılan çalışmalarda çoğu laboratuvar tetkiklerinin hastalığın tanısında, seyrinde veprognoz belirteci olarak kullanımlarında duyarlılıklarının ve özgüllüklerininyeterince yüksek olmadığı saptanmıştır. Bu nedenle hastalığın tanısında, seyrinde veprognoz tahmininde bilgi verebilecek moleküller araştırılmaktadır. Bizimçalışmamızın amacını da bu düşünce oluşturmakta olup hastalığın patogenezinde bukadar önemli yer tutan sitokin ve kemokinlerden belirlediğimiz 9 adet sitokin (IL-1β,IL-1ra, IL-6, IL-10, IL-12, IL-13, TNF-α, VEGF, IFN-γ ) ve 1 adet kemokin (MCP-1)multiplex laboratuvar yöntemi ile ölçülmüş ve TNF-α bloker tedavisi öncesinde vetedavi sonrasında 3. ve 6. aylarda ölçülen değerler ile hastalığın seyri arasındailişkiler kurulmaya çalışılmıştır.Anahtar Sözcükler: Romatoid Artrit, TNF-α bloker tedavisi, sitokinler, kemokinler,multiplex, DAS28, hastalık aktivitesi.ABSTRACTOBJECTIVESRheumatoid arthritis (RA) is a chronic, inflammatory, systemic, autoimmune diseasethat primarily affects the synovial joints and causes progressif destruction around thejoint. The diagnosis of RA can be made based on the 1987 ACR and 2010ACR/EULAR diagnostic criteria. %1 of world’s population is diagnosed with RAand thus it is the most common inflammatory arthritis. RA is 2-3 times morecommon in females than in males and it is most frequent in 4th-5th decades. Theethiology of the disease is unknown but there are several genetic and environmentalrisc factors that have been speculated. The pathophysiological chain of events startswith predominantly mononuclear cell clusters around the synovium, this is followedby the secretion of certain cytokines and chemokines from several cell types. Thesedifferent types of cells migrate towards the synovium and proliferate causing asynovitis, followed by the abration and erosion of the bone and cartilage structure.The disturbance of the balance between the pro and anti-inflammatory cytonkinesplays an important role in the typical pathological progress of RA. Abnormalproduction of certain proinflammatory cytokines (IL-6, IFN-γ, IL-12, IL-13, IL-15,IL-17, GM-CSF) and proinflammatory chemokines (MCP-1,IL-8 ve ENA-78 ) takespart in the inflammatory process and among all these factors macrophage originatedIL-1 and TNF-α are known to play the most crucial role. The laboratory findings arenon-specific in RA and they are rather used to support the diagnosis made by theclinical symptoms and findings and to assess the progress of the disease. RF, antiCCPantibodies and serum CRP and sedimentation rates can be usefull in confirmingthe diagnosis and assessing the progress of the disease, never-the-less several studieshave showed that most of the laboratory findings are not sensitive or spesific enoughin determining the diagnosis, progress or the prognosis of the disease. Thereforedifferent molecules that can provide usefull information about the diagnosis,theprogress and the prognoses of the disease have been sought. We have based ourstudy on this idea and chose 9 cytokines (IL-1β, IL-1ra, IL-6, IL-10, IL-12, IL-13,TNF-α, VEGF, IFN-γ ) and 1 chemokine (MCP-1) to evaluate using a multiplexlaboratory technique, we then tried to establish a relationship between the progress ofthe disease and the levels of these molecules before and 3-6 months after the TNF-αblocker treatment.Key Words: Rheumatoid Arthritis, TNF-α blocker treatment, cytokines,chemokines, multiplex, DAS28, disease activit

TNF-a bloker tedavisi başlanan romatoid artrit hastalarında tedavi öncesi ve tedavi sonrası multiplex laboratuvar yöntemi ile ölçülen sitokin ve kemokin düzeyleri ile klinik seyir ve tedavi yanıtı arasındaki ilişkinin değerlendirilmesi

AMAÇ Romatoid Artrit (RA) etyolojisi net olarak bilinmeyen, daha çok sinoviyal eklemleri tutan ve eklem çevresinde progresif yıkım ile seyreden kronik, inflamatuar, sistemik, otoimmün bir hastalıktır. RA tanısında 1987 ACR ve 2010 yılında yayınlanan ACR/EULAR tanı kriterleri kullanılmaktadır. Tüm dünyada, ortalama %1 ile en sık görülen inflamatuar artrittir. En sık 4. ve 5. dekatlarda olmakla beraber kadınlarda 23 kat daha fazla görülür. Hastalığın etyolojisi kesin olarak bilinmemekle birlikte genetik ve çevresel risk faktörleri suçlanmaktadır. RA patogenezinde sinovyum çevresinde ağırlıklı olarak mononükleer hücrelerin birikimi, birçok hücre tipi tarafından salınan sitokin ve kemokinlerin aracılığı ile bu hücrelerin sinovyuma akışı ve prolifere olmaları, sinovitis oluşumu, ardından eklemi oluşturan kemik ve kıkırdak dokuda aşınma ve erozyonlar söz konusudur. RA’nın karakteristik patolojisininin oluşmasında pro ve antiinflamatuvar sitokinler arasındaki dengenin bozulması önemli bir etkendir. Başta makrofaj kökenli IL-1 ve TNF-α olmak üzere, IL-6, IFN-γ, IL-12, IL-13, IL-15, IL-17, GM-CSF gibi bir çok proinflamatuvar sitokin ve MCP-1,IL-8 ve ENA-78 gibi proinflamatuvar kemokin hastalığın patogenezinde önemli rol almaktadırlar. RA’da laboratuvar bulguları nonspesifiktir. Klinik belirti ve bulgulara göre konulan tanıyı desteklemede veya hastalığın seyrini değerlendirmede kullanılabilir. Bu amaçla kullanılan RF, antiCCP antikorları ve serum CRP, ESR değerleri tanı ve hastalık aktivitesinde bilgiler vermektedirler ancak yapılan çalışmalarda çoğu laboratuvar tetkiklerinin hastalığın tanısında, seyrinde ve prognoz belirteci olarak kullanımlarında duyarlılıklarının ve özgüllüklerinin yeterince yüksek olmadığı saptanmıştır. Bu nedenle hastalığın tanısında, seyrinde ve prognoz tahmininde bilgi verebilecek moleküller araştırılmaktadır. Bizim çalışmamızın amacını da bu düşünce oluşturmakta olup hastalığın patogenezinde bu kadar önemli yer tutan sitokin ve kemokinlerden belirlediğimiz 9 adet sitokin (IL-1β, IL-1ra, IL-6, IL-10, IL-12, IL-13, TNF-α, VEGF, IFN-γ ) ve 1 adet kemokin (MCP-1) multiplex laboratuvar yöntemi ile ölçülmüş ve TNF-α bloker tedavisi öncesinde ve tedavi sonrasında 3. ve 6. aylarda ölçülen değerler ile hastalığın seyri arasında ilişkiler kurulmaya çalışılmıştır. Anahtar Sözcükler: Romatoid Artrit, TNF-α bloker tedavisi, sitokinler, kemokinler, multiplex, DAS28, hastalık aktivitesi. ABSTRACT OBJECTIVES Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic, autoimmune disease that primarily affects the synovial joints and causes progressif destruction around the joint. The diagnosis of RA can be made based on the 1987 ACR and 2010 ACR/EULAR diagnostic criteria. %1 of world’s population is diagnosed with RA and thus it is the most common inflammatory arthritis. RA is 2-3 times more common in females than in males and it is most frequent in 4th-5th decades. The ethiology of the disease is unknown but there are several genetic and environmental risc factors that have been speculated. The pathophysiological chain of events starts with predominantly mononuclear cell clusters around the synovium, this is followed by the secretion of certain cytokines and chemokines from several cell types. These different types of cells migrate towards the synovium and proliferate causing a synovitis, followed by the abration and erosion of the bone and cartilage structure. The disturbance of the balance between the pro and anti-inflammatory cytonkines plays an important role in the typical pathological progress of RA. Abnormal production of certain proinflammatory cytokines (IL-6, IFN-γ, IL-12, IL-13, IL-15, IL-17, GM-CSF) and proinflammatory chemokines (MCP-1,IL-8 ve ENA-78 ) takes part in the inflammatory process and among all these factors macrophage originated IL-1 and TNF-α are known to play the most crucial role. The laboratory findings are non-specific in RA and they are rather used to support the diagnosis made by the clinical symptoms and findings and to assess the progress of the disease. RF, antiCCP antibodies and serum CRP and sedimentation rates can be usefull in confirming the diagnosis and assessing the progress of the disease, never-the-less several studies have showed that most of the laboratory findings are not sensitive or spesific enough in determining the diagnosis, progress or the prognosis of the disease. Therefore different molecules that can provide usefull information about the diagnosis,the progress and the prognoses of the disease have been sought. We have based our study on this idea and chose 9 cytokines (IL-1β, IL-1ra, IL-6, IL-10, IL-12, IL-13, TNF-α, VEGF, IFN-γ ) and 1 chemokine (MCP-1) to evaluate using a multiplex laboratory technique, we then tried to establish a relationship between the progress of the disease and the levels of these molecules before and 3-6 months after the TNF-α blocker treatment. Key Words: Rheumatoid Arthritis, TNF-α blocker treatment, cytokines, chemokines, multiplex, DAS28, disease activit

The Association between Non-Alcoholic Fatty Liver Disease and Dynapenia in Men Diagnosed with Type 2 Diabetes Mellitus

Background: Dynapenia and non-alcoholic fatty liver disease (NAFLD) are common, especially in the middle and advanced-age diabetic male population. We aimed to examine the clinical features, NAFLD severity, and parameters associated with the presence of dynapenia in type 2 diabetes mellitus (T2DM) cases. Material and Methods: One hundred thirty-five male patients diagnosed with T2DM between 45 and 65 years of age were included. Patients were staged by ultrasonography according to NAFLD status. Results: There were significant differences in muscle strength, upper arm circumference, calf circumference, and up-and-go test scores between the mild-moderate-severe and non-NAFLD groups (p p p Conclusions: We detected a significant association between NAFLD and dynapenia in middle-aged men with T2DM. As muscle strength decreases, the amount of fat in the liver increases, and as the fat in the liver increases, muscle strength decreases