Arzu Didem Yalcin

Omalizumab (anti-IgE) therapy in the asthma–COPD overlap syndrome (ACOS) and its effects on circulating cytokine levels

Abstract Context: The term “asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome” (ACOS) has been applied to the condition, in which a person has clinical features of both asthma and COPD. Methods: The patients (N = 10) were presented to our clinic with low lung function, limited reversibility of airway obstruction, hyperinflation, abnormal body composition, dyspnea and episodic wheezing. Based on the clinical and laboratory findings, the patients were diagnosed with ACOS. Patients’ serum IL-2 (sIL-2), sIL-4 sIL-6, sIL-10, sIL-17, sTNF-α and sIFN-γ levels were investigated as an apoptotic marker and a marker for inflammation. Results: Having undergone omalizumab treatment and a long-term (12 months) later, patients had a decreased IgE, fractional exhaled nitric oxide concentrations (FENO), eosinophil, neutrophils, macrophages, eosinophil cationic peptide (ECP) and sIL-4 levels. Conclusion: To our knowledge, this is the first documentation of omalizumab use in ACOS. We demonstrated decreased IL-4, allergic pulmonary symptoms (dyspnea, wheezing, bronchial hyper responsiveness) and migraine attacks in the patients.

Common variable immunodeficiency syndrome with right aortic arch: a case report

BackgroundCommon variable immunodificiency syndrome predominantly affects adults. It is characterized by low production of all the major classes of immunoglobulins. We report a case of common variable immunodeficiency syndrome with right aortic arch. An association of right-sided arch and common variable immunodificiency syndrome has not been previously reported.Case presentationA 41-year-old female patient presented with a history of recurrent pneumonia, sinusitis, otitis media, diarrhoea, cystitis since childhood. Biochemical and immunocytochemical analysis revealed common variable immunodeficiency syndrome and radiological evaluation confirmed right aortic arch and aberrant left subclavian artery.ConclusionCommon variable immunodeficiency syndrome syndrome is a clinical entity that should be kept in mind in patients with recurrent infections of different sites.

High serum soluble CD200 levels in patients with autosomal dominant polycystic kidney disease

This study aims to determine fibroblast growth factor-23 and soluble α-Klotho levels in patients with autosomal dominant polycystic kidney disease. A total of 76 patients with autosomal dominant polycystic kidney disease and 32 healthy volunteers were included in the study. Serum fibroblast growth factor-23 and soluble α-Klotho levels were measured with ELISA kits. Parathyroid hormone, phosphate, calcium, creatinine, 25-hydroxyvitamin D3 levels, urinary protein to creatinine ratio and estimated glomerular filtration rate were also measured or calculated. Patients with autosomal dominant polycystic kidney disease had significantly higher serum parathyroid hormone (p<0.001), fibroblast growth factor-23 (p<0.001), soluble α-Klotho levels (p=0.001) and lower serum 25-hydroxyvitamin D3 levels (p<0.001) as compared with healthy volunteers. Serum fibroblast growth factor-23, soluble α-Klotho and 25-hydroxyvitamin D3 levels were similar in all five chronic kidney disease stages of autosomal dominant polycystic kidney disease (p>0.05). Fibroblast growth factor-23 (r=−0.251, p=0.034) and soluble α-Klotho levels (r=−0.251, p=0.034) were found to be negatively correlated with estimated glomerular filtration rate. This study shows increased fibroblast growth factor-23 levels in patients with autosomal dominant polycystic kidney disease which is in harmony with the general trend in patients with chronic kidney disease of other aetiologies, but, unlike them, also a significant increase in serum soluble α-Klotho levels in patients with autosomal dominant polycystic kidney disease suggesting an aberrant production or a decreased clearance of α-Klotho molecule. Considering the unique increases in erythropoietin levels due to erythropoietin production in renal cysts, we assume, patients with autosomal dominant polycystic kidney disease may potentially have different soluble α-Klotho production/clearance characteristics than the patients with other parenchymal renal diseases.

Unusual case of multicentric mixed‐type Castleman's disease presenting with exfoliative dermatitis

Castlemans disease is a rare disorder that results in the underregulated growth of lymphoid tissue. It may present as benign involvement of one lymph node group or as multicentric disease with systemic symptoms. We here present a patient with Castlemans disease of mixed‐type and multicentric involvement.

The IL4-VNTR P1 allele, IL4-VNTR P2P2 genotype and IL4-VNTR_IL6-174CG P2P1-GG genotype are susceptable with a increased risk in Brucelosis.

In this study, associations between IL-4, IL-6, and macrophage migration inhibitory factor (MIF) polymorphisms and susceptibility to brucellosis were investigated. Consecutive adult patients with no known treatment against brucellosis and who did not have any other autoimmune and/or chronic disorders, were included in this study (n = 120, Group I). Age and sex-matched controls who had no other autoimmune and/or chronic disorders were also included (n = 120, healthy volunteers, Group II). The IL4_P2P2 genotype, IL4_P1 allele, and IL4_variable number of tandem repeats (VNTR)_IL6-174CG compound genotype were found to be more frequent in the patient group than in control subjects. There were significant differences between the patients and controls with respect to the frequencies of the IL4_P2P2 genotype (77.5% versus 87.5%; p = 0.001; OR, 0.36; 95% confidence interval [CI], 0.21-0.62) and the IL4_P1 allele (12.1% versus 6.7%; p = 0.030; OR, 0.92; CI, 1.02-3.64). The IL4-VNTR_IL6-174CG compound genotype was also present at a significantly higher frequency in the patient group than in control subjects (11.7% versus 4.2%; p = 0.027, OR, 3.04; CI, 1.06-8.68). No statistically significant differences in the frequencies of the IL-6-174, MIF-173, IL-4_P1P1, and IL4_P2P1 genotypes were observed between patients and control subjects. The IL4_VNTR P1 allele, P2P2 genotypes, and IL4-VNTR_IL6-174CG P2P1-GG genotypes are common in southern Turkey, and carriers of these polymorphisms are susceptible to brucellosis.

Anti-Ige (Omalizumab) Improved Trombotic Emboli by Elevating Activated Protein C, Protein S, and Antithrombin III in a Case of Prothrombin G20210A Mutation: Long Term Follow-Up

Plasma protein C levels were significantly lower compared to patients without acute rejection at the time of rejection, specifically antibody mediated rejection [1,2]. In a parallel mammer Endothelial Protein C Receptor (EPCR) expression was found higher in tubules and arteries of rejection patients than in control patients [3] and activation of the inflammatory/coagulation cascades has been suggested in the pathogenesis of the rejection.

Cryptococcus as a cause of proliferative glomerulonephritis in an immunodeficient HIV+ patient

This report presents the first proliferative glomerulonephritis (GN) induced by Cryptococcus neoformans in a human immunodeficiency virus (HIV)+ patient. While the patient was on medication against HBV, HIV RNA was found 4.25 × 105 in his blood. Six months later, he experienced headache, visual blurring, nausea, and vomiting and was hospitalised due to possible CMV, TBC, or HIV-related retinopathy and raised creatinine level. Cryptococcus neoformans grew in his blood culture. Albumin was 2.2 at that time. Because of the persistent proteinuria, kidney biopsy was applied. On histological examination, some glomeruli appeared normal, while endocapillary proliferative glomerulonephritis was seen in other glomeruli. Tubules were enlarged with many round yeasts. Mucicarmine stain confirmed peripheral capsule. Immunofluorescence staining with IgG, IgA, IgM, C3, C1q, fibrinogen, kappa, and lambda light chains revealed no deposition. Electron microscopy was not applied. The patient was well with 26 BUN (range 8-20 mg/dl) and 1.70 creatinin (range 0.84-1.25 mg/dl) five months after the biopsy date. The most common secondary immunodeficiency is caused by HIV, and although different forms of renal disease were noted in this population, HIV-associated nephropathy (HIVAN) is the most common cause of renal failure in HIV1+ patients. The term HIVAN is reserved for the typical histopathological form of focal and segmental glomerulosclerosis. Cryptococcal GN was not reported in the glomeruli previously. HIV AIDS Rev 2017; 16: 61-63 DOI: https://doi.org/10.5114/hivar.2017.65222