Changes in the inflammatory markers with advancing stages of diabetic nephropathy and the role of pentraxin-3

Background: Immunological and inflammatory mechanisms have been shown to have role in both the development and progression of diabetic nephropathy (DNP). There is need for more specific markers for inflammation as the ones commonly used are influenced by many factors. Pentraxin-3 (PTX-3) seems to be a potential candidate. We aimed in our study to evaluate the changes of PTX-3 levels in different stages of DNP and its relationship with other inflammatory markers.

Methods: This is a cross sectional study in which patients with DNP at different stages were involved. Patient were divided into three groups according to estimated glomerular filtration rate (eGFR), microalbuminuria and proteinuria levels: Group-1: eGFR >60?mL/min and microalbuminuria, Group-2: eGFR >60?mL/min and macroalbuminuria, Group-3: eGFR <60?mL/min and macroalbuminuria. Besides the routine biochemical parameters, levels of PTX-3, high sensitivity C-reactive protein (hsCRP), interleukin (IL)-1 and tumor necrosis factor (TNF)-α was measured. Groups were compared with each other regarding the study parameters and correlation of PTX-3 with other markers was evaluated.

Results: The mean PTX-3 level in Group-2 (0.94?±?0.26?ng/mL) and -3 (1.35?±?1.55?ng/mL) were higher than in Group-1 (0.81?±?0.25?ng/mL) (p?=?0.009 and p?=?0.012). There was a significant correlation of PTX-3 with proteinuria (r?=?0.266, p?=?0.016), microalbuminuria (r?=?0.304, p?=?0.014) and hypoalbuminemia (r?=?0.197, p?=?0.043). PTX-3 was not correlated with other markers of inflammation (IL-1, TNF-α and hsCRP) and diabetic metabolic parameters (hbA1c, C-peptide, insulin and HOMA-IR). PTX-3, IL-1 and TNF-α levels increased with the advancing stage of DNP while hsCRP level did not change.

Conclusion: PTX-3 that increases similar to other markers of inflammation (IL-1, TNF-α) is a better inflammatory marker than hsCRP. Furthermore, there is a relationship between PTX-3 and proteinuria independent from eGFR.     

Behcet’s disease and cardiovascular involvement: our experience of asymptomatic Behcet’s patients

Behcet’s disease is generally defined by oral and genital ulcers and uveitis. It is also known as a recurrent multisystemic and inflammatory disease. It is mostly seen in Mediterranean countries and the Far East.The aetiology of Behcet’s disease is associated with viral, toxic, bacterial and immunological factors. It was defined in 1963 as an auto-immune disease caused by auto-antibodies against the oral mucosa. Vascular involvement is 2–7% and it is usually seen in patients between the ages of 20 and 40 years.Behcet’s disease is a non-specific arterial and venous vasculitis.1-8 Proximal and distal anastomotic aneurysm formation after surgery is not rare one to 12 months postoperatively. Recurrent surgical interventions increase the risk of mortality and morbidity.9,10 Cardiovascular involvement in Behcet’s disease includes pericarditis, coronary arterial disease, cardiomyopathy and valvular dysfunction.11 The aim of this study was to report our experience of cardiovascular involvement with asymptomatic Behcet’s disease.     

Changes in regional cerebral blood flow demonstrated by 99mTc-HMPAO SPECT in euthymic bipolar patients

Single photon emission computed tomography (SPECT) with ^99mTc-HMPAO was used to compare regional cerebral blood flow (rCBF) in patients with bipolar disorder and in healthy controls. The sample of this study consisted of 16 euthymic bipolar patients who met the DSM-IV criteria and 10 healthy control subjects. The mean regional cerebral blood flow values of the bipolar euthymic patients were significantly lower than those of the controls in the bilateral medial-basal temporal, occipital; medial frontal; parietal regions and in the cingulate gyrus; the hypoperfusion in the cingulate had the highest significant P value (.001, Bonferroni correction). No significant differences in rCBF emerged between right and left-brain regions. The most important findings of the current study are the presence of regional cerebral perfusion alterations, particularly in the cingulate gyrus in the euthymic bipolar patients. Our results imply that underlying brain dysfunction may be independent from manic or depressive episodes in bipolar disorder. Because of the small number of subjects, however, this finding should be viewed as preliminary. This study was presented as an oral presentation in the 7th International Congress of Nuclear Oncology and 18th National Congress of The Turkish Society of Nuclear Medicine 13–17 May 2006, Antalya, Turkey and in the International Conference on Mood Disorders 30 March–1 April 2006 Istanbul, Turkey.     

Psychiatric morbidity among cancer patients and awareness of illness

A significant proportion of cancer patients experience psychiatric morbidity. Potential predictors of psychiatric morbidity include patient disease-related factors and factors relating to the patients environment. The aim of this study was to investigate the prevalence of psychiatric morbidity and the relationship between the clinical or personal factors, especially psychiatric morbidity, and awareness of cancer diagnosis among a group of Turkish cancer patients. A total of 117 cancer patients were assessed using the Structured Clinical Interview for DSM-IV (SCID), the Hospital and Anxiety Depression Scale (HADS) and the General Health Questionnaire (GHQ). Of these patients, 30% had a psychiatric diagnosis. Adjustment disorders comprised most of the psychiatric diagnoses. Awareness of the diagnosis of cancer, history of previous psychiatric disorders, pain and stress factors were correlated with psychiatric morbidity. Of the 117 patients, 64 (54.7%) were unaware of the diagnosis of cancer. Most of the patients (67.9%) who were considered to be aware of the cancer diagnosis stated that they had guessed their illness from the treatment process or drug adverse effects. Psychiatric morbidity was significantly higher in the patients who knew that they had a cancer diagnosis (P=0.03). These findings suggest that the awareness of cancer diagnosis is related to the presence of psychiatric morbidity. In particular, the understanding of the diagnosis indirectly may be stressful to the patient because it arouses suspicion about the cancer and treatment, and consequently can lead to psychiatric disturbance. In Turkey honest disclosure of the true diagnosis is still not common for cancer patients and it seems to be essential to improve this situation.This paper was accepted as a poster presentation at the European Conference of Clinical Oncology (ECCO) Congress held in Copenhagen, 21–25 September 2003.     

The effects of methylene blue on lung injury in septic rats

PURPOSE: We aimed to investigate the effects of methylene blue (MB) on NO production, myeloperoxidase (MPO) activity, antioxidant status and lipid peroxidation in lung injury during different stages of sepsis in rats. MATERIAL AND METHODS: Rats were randomly divided into 4 groups (n = 20): group C, sham operated; group CMB, sham operated and receiving MB (25 mg/kg, i.p.); group S, sepsis; group SMB, sepsis and receiving MB (25 mg/kg, i.p.). Sepsis was induced by cecal ligation and puncture (CLP). The MB dose was administered after CLP. Each group was subdivided into two subgroups (n = 10) which were sacrificed at 9 or 18 h after the surgical procedure. The levels of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-PX) and MPO activity, total nitrite/nitrate and malondialdehyde (MDA) in the lung tissue were measured. Lung injury was graded from 1 (injury to 25% of the field) to 4 (diffuse injury) by the pathologist. RESULTS: In group SMB, while SOD and CAT increased in both early and late sepsis periods, GSH-PX increased significantly only in the early sepsis period when compared with group S. Increase in lung MPO activity after CLP-induced sepsis was prevented by MB administration. MB significantly decreased to nitrite/nitrate and MDA levels both in early and late sepsis periods when compared with group S (p < 0.05). Group S showed a marked increase in neutrophil infiltration into the interstitial space and thickening of the alveolar septa, whereas the alveolar damage score was lower in the SMB group (p < 0.05). CONCLUSION: MB reduced the MPO activity and lipid peroxidation by both decreasing oxidative stress and NO overproduction in the lungs, which resulted in the attenuation of lung injury after CLP-induced sepsis in rats.     

Anterior abdominal wall synovial sarcoma: a rare presentation

Synovial sarcoma usually arises in the extremities and in close proximity to large joints. Primary synovial sarcoma of the anterior abdominal wall is rare. A 17-year-old girl was admitted to the hospital with a palpable abdominal mass, and there was a 9.5 cm x 7.5 cm x 6-cm lobulated, cystic, and semisolid lesion of in the external oblique abdominal muscle shown on the abdominal magnetic resonance image. She was then operated and pathology was consistent with synovial sarcoma. The presence of synovial sarcoma in extraarticular sites such as the abdominal wall argues against an origin from arthrogenous mesenchyme.