Predictive value of immature granulocyte percentage and neutrophil lymphocyte ratio in terms of prognosis in the course of acute pancreatitis.

AIM: We aimed to investigate the role and importance of immature granulocyte percentage and neutrophil/lymphocyte ratio in the etiology, diagnosis and follow-up of acute pancreatitis (AP) in patients tentatively diagnosed with AP in the emergency department. We evaluated these factors alongside other established markers proven effective in the diagnosis and follow-up of AP. MATERIAL AND METHODS: A total of 139 patients with a tentative diagnosis of acute pancreatitis who were hospitalized and followed up in the gastroenterology clinic in 2021‒2022 were included in the study. In addition, a control group, consisting of 139 individuals admitted to the clinic for various other reasons, was established. The cases were also compared with the control group in terms of NLR, ICG and IG%. RESULTS: There was a significant difference in the NLR, IGC and IG% measurements between the patients in the AP group and the control group. In all three markers, the average values of the patient group were higher than those of the control group. Furthermore, a significant difference in IGC and IG% blood measurements was noted between sub-groups of patients categorized based on the severity of acute pancreatitis, particularly the patients with severe pancreatitis exhibited higher mean IGC and IG% blood measurements compared to those with mild or moderate pancreatitis. CONCLUSION: IGC and IG% values emerged as superior indicators to other acute-phase reactants for detecting inflammation, determining its severity, and establishing prognosis in acute pancreatitis. While the N/L ratio remains an important parameter in acute pancreatitis, our findings indicate that it was not significantly superior to other investigated markers in terms of prognosis (Tab. 5, Ref. 35).

Relation of whole-body metabolic tumor volume and total lesion glycolysis on fluorodeoxyglucose PET/computed tomography with clinical and laboratory parameters in newly diagnosed multiple myeloma.

OBJECTIVE: This study aims to evaluate the relationships of metabolic fluorodeoxyglucose PET/computed tomography (FDG PET/CT) parameters such as whole-body metabolic tumor volume (WB MTV), WB-total lesion glycolysis (TLG), and bone marrow (BM)-mean standard uptake value (SUVmean) with clinical stage and other prognostic biomarkers in newly diagnosed multiple myeloma (MM) patients. METHODS: Patients who underwent pretreatment PET/CT with the diagnosis of MM were evaluated retrospectively. The number of focal lesions, WB MTV, WB TLG, and BM SUVmean values were measured on FDG PET/CT images. Clinical stages and prognostic laboratory parameters were recorded the pretreatment period. RESULTS: WB MTV and WB TLG values were significantly higher in patients with more than three focal lesions on FDG PET/CT scan (all P < 0.001). According to the Revised International Staging System (R-ISS), all WB MTV, WB TLG, and BM SUVmean values are significantly higher in patients with stage 3 disease than in stages 1-2 ( P = 0.027, P = 0.019, P = 0.001, respectively). Serum creatinine level is positively correlated with WB MTV, WB TLG, and BM SUVmean values ( P = 0.020, P = 0.004, P < 0.001, respectively). In addition, the ß2 microglobulin level, an essential biochemical prognostic parameter, was positively correlated with the BM SUVmean value ( P = 0.013). CONCLUSION: The BM SUVmean, WB MTV, and WB TLG values, which reflect FDG avid WB tumor burden, are associated with prognostic biomarkers and R-ISS stage in newly diagnosed MM patients. It contributes to the identification of high-risk patients at the pretreatment staging.

F-18 Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography Findings of Isolated Gastric Tuberculosis mimicking Gastric Cancer and Lymphoma.

INTRODUCTION: Tuberculosis (TB) infection is still a challenging health issue, especially in developing countries. Diagnosing extrapulmonary infections, especially isolated organ involvement, is difficult in most cases even with the radiological, endoscopic, and histopathological examinations done for accurate diagnosis. Here we describe a case of isolated gastric TB with specific F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings mimicking gastric cancer/ lymphoma. CASE REPORT: A 20-year-old male patient was admitted to our hospital with abdominal pain in the epigastric region, weight loss, and fever especially at nights for 2 months. Physical examination was normal. Hemoglobin was 9.6 gm/dL; the patient had iron deficiency anemia. Upper gastrointestinal (GI) endoscopy was suggestive of gastric ulcer mimicking malignancy. F-18 FDG PET/CT revealed multiple hypermetabolic malignant lymphadenopathies in the abdomen and diffuse gastric wall thickening as linitis plastica and multiple hypermetabolic peritoneal implants in the omentum. Exploratory laparotomy was done for tissue diagnosis and exploration of the peritoneum for TB infection, lymphoma, and Crohn's disease to make differential diagnosis. Histopathology revealed granulomatous lymphadenitis with granulomas including giant cells, suspecting TB. Patient was put on antituberculosis treatment (ATT). After treatment, the complaints resolved, and he gained weight. Fusion PET/CT exhibited a complete response to ATT with no residual disease. CONCLUSION: According to our knowledge, this is the first report about F-18 FDG PET/CT findings in the diagnosis of isolated gastric TB. F-18 FDG PET/CT may provide help in the diagnosis and follow-up of isolated gastric TB in challenging cases.How to cite this article: Akdogan RA, Rakici H, Güngör S, Bedir R, Akdogan E. F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings of Isolated Gastric Tuberculosis mimicking Gastric Cancer and Lymphoma. Euroasian J Hepato-Gastroenterol 2018;8(1):93-96.

The Effects of Infliximab on Laminin, NFκB, and Anti-TNF Expression through Its Effect on Ischemic Liver Tissue.

The aim of this study was to investigate the possible protective effects of infliximab on expression of laminin, anti-TNF, and NFκB in the rat hepatic cells after ischemia/reperfusion (I/R). A total of 30 male Wistar albino rats were divided into three groups: Control (C), sham I/R (ISC), and I/R+ infliximab (ISC inf); each group comprised 10 animals. C group animals underwent laparotomy without I/R injury. In ISC groups after undergoing laparotomy, 1 hour of superior mesenteric artery ligation was done, which was followed by 1 hour of reperfusion. In the ISC inf group, 3 days before I/R, infliximab (3 mg/kg) was administered intravenously. All animals were killed at the end of reperfusion and hepatic tissue samples were obtained for histopathological and histochemical investigations in all groups. Laminin, anti-TNF, and NFκB immunoreactivity were performed for all groups. ISC caused severe histopathological injury including mucosal erosions, inflammatory cell infiltration, necrosis, hemorrhage, and villous congestion. Infliximab treatment significantly attenuated the severity of intestinal I/R injury and it is shown by laminin, anti-TNF, and NFκB immunoreactivity. Because of its anti-inflammatory and antioxidant effects, infliximab pretreatment may have protective effects on hepatic cells in the experimental intestinal I/R model of rats.

Peripapillary retinal nerve fibre layer thickness in women with iron deficiency anaemia.

OBJECTIVE: To evaluate peripapillary retinal nerve fibre layer (RNFL) thickness in adult women with iron deficiency anaemia and healthy control subjects. METHODS: Women with iron deficiency anaemia and age- and sex-matched healthy control subjects were sequentially recruited and underwent detailed ophthalmic examination, including spectral-domain optical coherence tomography (OCT). Serum haemoglobin (Hb), iron and ferritin concentrations, total iron-binding capacity (TIBC) and mean corpuscular volume were determined. RESULTS: Peripapillary RNFL thicknesses in the nasal and inferior quadrants were significantly smaller in patients (n = 40) than in controls (n = 40). In the patient group, there were significant correlations between inferior quadrant RNFL thickness and Hb, and between nasal quadrant RNFL thickness and serum iron and ferritin concentrations, and TIBC. CONCLUSION: Iron deficiency anaemia reduces RNFL thickness in adult women.

Evaluation of protein tyrosine phosphatase activity in patients with acute leukemia.

Protein tyrosine phosphatases regulate physiological processes including growth, differentiation, metabolism and the cell cycle. Together with tyrosine kinases, they control the phosphorylation state of tyrosine residues of signaling proteins. An increased level of protein phosphorylation results in abnormal proliferation and many cancer types show a mutation or deletion of a protein tyrosine phosphatase gene. In this study we evaluated the protein tyrosine phosphatase activity in acute leukemia patients. Tyrosine phosphatase activity in bone marrow mononuclear cells of acute leukemia patients was measured using a tyrosine phosphatase assay system kit and compared with a control group. We found that tyrosine phosphatase activity in acute leukemia patients was high compared to the controls. According to subgroups of acute leukemia, tyrosine phosphatase activity in the AML-M2 subgroup was high compared to the controls. The effect of increased level of protein tyrosine phosphatase activity on leukemogenesis needs further evaluation. Studies in a large group of patients are needed to emphasize the importance of tyrosine phosphatase activity in acute leukemia patients.

Pregnancy in the setting of asymptomatic non-cirrhotic chronic portal vein thrombosis complicated by pre-eclampsia.

Portal vein thrombosis (PVT) can be chronic or acute in nature; it is characterized by a thrombus formation in the main portal vein and/or its right or left branches. Herein, we present a 36-year-old woman with asymptomatic noncirrhotic chronic PVT who developed preeclampsia in the later stage of pregnancy. This report will emphasize the clinical differential diagnosis, outcome, and management of pregnancies complicated by noncirrhotic PVT.

Voriconazole-induced neuropathy.

BACKGROUND: Fungal infections are common and life threatening among immunosupressive patients. Rare side effects may occur related to the use of voriconazole, which is the drug of choice in invasive aspergillosis. PATIENTS AND METHODS: Neuropathy was determined through clinical and electromyographic findings during the course of voriconazole therapy in 2 patients developing invasive aspergillosis. RESULTS: Since examinations revealed no neuropathy capable of ascription to any other cause and improvement followed the cessation of the drug, this suggested that neuropathy may be linked to voriconazole use. CONCLUSION: Neuropathy may be seen as a side effect during voriconazole treatment. Voriconazole-induced side effects should be borne in mind and patients carefully monitored during its use.

Peripheral blood natural killer cells in Crimean-Congo hemorrhagic fever.

BACKGROUND: The relationship of changes in the peripheral blood lymphocyte subgroups during Crimean-Congo hemorrhagic fever (CCHF) to prognosis has not been reported. OBJECTIVES: To determine peripheral blood lymphocyte subgroups in CCHF patients at the time of diagnosis and relate these to clinical outcome. STUDY DESIGN: Peripheral blood samples were obtained from the patients treated at the Karadeniz Technical University Hospital for CCHF in 2004. Lymphocyte subgroups were analyzed by flow cytometry on these samples and their association with patients' risk group (severe vs. non-severe) and mortality was recorded. RESULTS: There were significantly more peripheral blood natural killer (NK) cells in severe risk CCHF patients than in non-severe risk group CCHF patients. A positive correlation was found between NK cell count and aspartate transferase (AST), alanine transferase (ALT) and activated partial thromboplastin times (aPTT). In addition, NK cell counts were observed to be higher in two patients who died. CONCLUSION: Elevated NK cell counts may be a prognostic marker in CCHF patients.

Change of coagulation parameters after double plateletpheresis.

In the previous studies, some authors reported that automated apheresis leads to a hypercoagulable state. We tried to find out changes in coagulation parameters after double plateletpheresis in this study. Forty-five donors were recruited to the study, and coagulation parameters were assessed before and after double plateletpheresis. After double plateletpheresis, fibrinogen, factor V, factor VIII and factor IX were decreased compared with the values before apheresis. Although serum levels of this coagulation parameters are decreasing, they are still in the normal limits. Therefore, we suggest that double plateletpheresis is a safe procedure for healthy volunteers taking into account these coagulation parameters.

Plasma activity of thrombin activatable fibrinolysis inhibitor in Crimean-Congo hemorrhagic fever.

OBJECTIVES: Crimean-Congo hemorrhagic fever (CCHF) is a potentially fatal viral infection. The exact mechanism for hemorrhage remains unknown. Thrombin activatable fibrinolysis inhibitor (TAFI) is a plasma procarboxypeptidase B-like proenzyme and synthesized in the liver, down-regulating fibrinolysis. In this study, we measured the TAFI activity in plasma of patients with CCHF to examine the relationship between hemorrhage and the pathogenesis of CCHF. METHODS: Twenty-one patients and similar number of controls were included in the study. The diagnosis of CCHF was confirmed through detection of IgM by ELISA and/or PCR. TAFI activity was measured in plasma samples. RESULTS: TAFI activity in CCHF patient group was mean 7.2+/-2.3 microg/ml (range: 0.95-10.31 microg/ml) and in the control group was mean 11.7+/-4.1 microg/ml (range: 3.07-23.9 microg/ml). There was a significant decrease of TAFI activity in CCHF patients when compared to controls. A positive correlation between CRP, PT, INR, serum albumin and TAFI activity levels were found. We suggest that the decrease of TAFI activity may be due to liver dysfunction during viral active disease state. CONCLUSIONS: Low TAFI activity may be an attributable factor, leading to imbalance in fibrinolysis, resulting in bleeding complications in CCHF.

The relation of lymphoma and hepatitis B virus/hepatitis C virus infections in the region of East Black Sea, Turkey.

AIM AND BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) are not only hepatotropic, but also lymphotropic viruses. Infections with these viruses induce chronic antigenicity and may stimulate clonal expansion of malignant B-cell neoplasms. Moreover, these viruses can proliferate in lymphatic structures and bone marrow. However, the relationship between lymphomas and HBV/HCV infections is not clear. In our region of the East Black Sea, Turkey (the city of Trabzon), we intended to demonstrate a relation of lymphoma and HBV/HCV infections with a case-controlled study. METHODS: A total of 109 patients diagnosed with lymphoma between 2002-2005 in the Black Sea Technical University Hospital was investigated. Seventy-one patients had a high-grade and 38 patients a low-grade lymphoma. Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies (anti-HCV Ab) were screened. The control group consisted of patients (n = 551) from other departments with diagnoses other than lymphoma. RESULTS: HBsAg was 3.7% and anti-HCV Ab positivity was 2.8% in lymphoma patients, compared with control of 5.3%, 5.1%, respectively. There was no statistically significant difference between two groups (P = 0.7, OR = 0.69, 95% CI, 0.20-2.10; P = 0.4, OR = 0.53, 95% CI, 0.13-1.86, respectively). CONCLUSION: Our findings suggest that the incidence of HBV and HCV infections in lymphoma patients is no different than that of nonlymphoma patients. Therefore, no direct correlation can be deduced between lymphoma and HBV-HCV infections in our East Black Sea region of Turkey.

Erythrocytosis in a patient on hemodialysis for thirteen years.

Most hemodialysis patients exhibit renal anemia mainly due to erythropoietin deficiency as a result of impaired erythropoetin production in the kidney. However, erythrocytosis in patients with renal failure requiring hemodialysis is extremely rare. We report the development of erythrocytosis in a patient with a polycystic kidney disease on hemodialysis for 13 years. She had erythrocytosis with increased serum erythropoietin levels despite severe secondary hyperparathyroidism, which is known to depress erythrocytosis. Since neither renal disease (renal cell carcinoma) nor extrarenal diseases (hypoxia, hepatoma, cerebellar diseases) linked with erythropoietin production could be proven, this case might be one with inappropriate idiopathic erythropoietin production after 13 years of hemodialysis, the longest duration of dialysis in the literature before erythrocytosis was observed.

Crimean-Congo hemorrhagic fever in Turkey.

In 2002 and 2003, a total of 19 persons in Turkey had suspected cases of Crimean-Congo hemorrhagic fever (CCHF) or a similar viral infection. Six serum samples were tested; all six were found positive for immunoglobulin M antibodies against CCHF virus. Two of the samples yielded CCHF virus isolates. Genetic analysis of the virus isolates showed them to be closely related to isolates from former Yugoslavia and southwestern Russia. These cases are the first of CCHF reported from Turkey. Eighteen patients handled livestock, and one was a nurse with probable nosocomial infection. The case-fatality rate was 20% among confirmed CCHF case-patients (1 of 5 patients), and the overall case-fatality rate was 11% (2 of 19 patients). In addition to previously reported symptoms and signs, we report hemophagocytosis in 50% of our patients, which is the first report of this clinical phenomenon associated with CCHF.