Ayse Albayrak

Mean Platelet Volume: A New Predictor in Confirming Acute Appendicitis Diagnosis

Objective: The purpose of this study was to investigate the diagnostic value of mean platelet volume (MPV) in acute appendicitis (AA). Methods: Our study was carried out in 206 healthy control groups and 226 patients who had a preliminary diagnosis of AA. Results: A statistically significant decrease in MPV was noted in patients with AA compared with healthy controls (P < .001). The best MPV level cutoff point for AA was 7.6 fL, with a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 73%, 84%, 84%, and 74%, respectively. Conclusions: As the MPV value is included in the complete blood count (CBC) analysis, it increases the sensitivity and NPVs of white blood cell (WBC) in AA diagnosis without the need for extra analyses, loss of time, or cost increase. Therefore, we believe that the MPV value should also be taken into consideration along with the WBC in every patient with suspected AA.

Sildenafil treatment attenuates lung and kidney injury due to overproduction of oxidant activity in a rat model of sepsis: a biochemical and histopathological study

Sepsis is a systemic inflammatory response to infection and a major cause of morbidity and mortality. Sildenafil (SLD) is a selective and potent inhibitor of cyclic guanosine monophosphate (cGMP)‐specific phosphodiesterase PDE5. We aimed to investigate the protective effects of sildenafil on caecal ligation and puncture (CLP)‐induced sepsis in rats. Four groups of rats were used, each composed of 10 rats: (i) 10u2003mg/kg SLD‐treated CLP group; (ii) 20u2003mg/kg SLD‐treated CLP group; (iii) CLP group; and (iv) sham‐operated control group. A CLP polymicrobial sepsis model was applied to the rats. All groups were killed 16u2003h later, and lung, kidney and blood samples were analysed histopathologically and biochemically. Sildenafil increased glutathione (GSH) and decreased the activation of myeloperoxidase (MPO) and of lipid peroxidase (LPO) and levels of superoxide dismutase (SOD) in the septic rats. We observed a significant decrease in LPO and MPO and a decrease in SOD activity in the sildenafil‐treated CLP rats compared with the sham group. In addition, 20u2003mg/kg sildenafil treatment in the sham‐operated rats improved the biochemical status of lungs and kidneys. Histopathological analysis revealed significant differences in inflammation scores between the sepsis group and the other groups, except the CLPu2003+u2003sildenafil 10u2003mg/kg group. The CLPu2003+u2003sildenafil 20u2003mg/kg group had the lowest inflammation score. Sildenafil treatment decreased the serum tumour necrosis factor (TNF)‐α level when compared to the CLP group. Our results indicate that sildenafil is a highly protective agent in preventing lung and kidney damage caused by CLP‐induced sepsis via maintenance of the oxidant–anti‐oxidant status and decrease in the level of TNF‐α.

Nimesulide is a Selective COX-2 Inhibitory, Atypical Non-Steroidal Anti-Inflammatory Drug

In this review it is shown that nimesulide, a selective cyclooxigenase-2 (COX-2) inhibitor, is different from other selective COX-2 inhibitors and classical non-steroidal anti-inflammatory drugs (NSAIDs). The anti-inflammatory effect mechanism of nimesulide (inhibition of inflammatory mediators) is similar to other classic NSAIDs, but the protective effect of nimesulide on classic NSAID-induced ulcers elucidates the difference between nimesulide and these other drugs. It is known that the selective COX-2 inhibitor nimesulide prevents NSAID-induced ulcers, while celecoxib and rofecoxib, which are more selective to COX-2, failed to prevent these ulcers. Nimesulide produces gastro-protective effects via a completely different mechanism. In addition, while selective COX-2 inhibitors increase the risk for cardiovascular diseases, nimesulide does not exert significant cardiotoxicity. This data suggests that gastrointestinal side effects of classic NSAIDs cannot be related to the COX-1 inhibition alone and also suggest that nimesulide is an atypical NSAID, which is different from both non-selective and selective COX-2 inhibitors.

Is HMGB1 a new indirect marker for revealing fibrosis in chronic hepatitis and a new therapeutic target in treatment

In chronic hepatitis B virus (HBV) infection, inflammation-associated cytokines including proinflammatory cytokines are involved in the development and progression of liver fibrosis. The liver is a source of many cytokines that may influence liver function. High-mobility group box 1 (HMGB1) was identified as an inflammatory cytokine. HMGB1 is present in nuclei of all mammalian cells and is released both through active secretion from various cells and by passive release from necrotic cells. Here we explore the relationship between HMGB1 plasma levels and liver fibrosis. HMGB1 serum levels, HBV-DNA, and ALT values were significantly higher in patients with chronic HBV than in controls. In addition, HMGB1 serum levels were significantly higher in patients with low fibrosis (fibrosis score 1-2) compared to those with high fibrosis (fibrosis score 3-4). In the present study, we have shown that HMGB1 is a noninvasive, repeatable, and convenient marker for distinguishing advanced fibrosis from low fibrosis in chronic HBV patients. We believe that the inhibition of HMGB1 may reduce inflammation, apoptosis, and fibrosis, and may stop the progression of chronic liver disease. Furthermore, we are of the opinion that fibrotic progression in chronic liver patients may be prevented by the inhibition of HMGB1, and that this substance can be a new means of following chronic HBV treatment.

The Effects of Diabetes and/or Polymicrobial Sepsis on the Status of Antioxidant Enzymes and Pro-Inflammatory Cytokines on Heart, Liver, and Lung of Ovariectomized Rats

BACKGROUNDnThe rat sepsis model in the present study was used to understand the role of sustained hyperglycemia and ovariectomy, either separately or together, on the response of pro-inflammatory mediators and oxidative response.nnnMATERIALS AND METHODSnPolymicrobial sepsis was induced using cecal ligation and two-hole puncture. Diabetes was induced in the female Wistar albino rats using intraperitoneal administration of aqueous alloxan monohydrate at a single dose of 150 mg/kg body weight. The rats were divided into five groups: sham control: group 1, ovariectomy: group 2, ovariectomy + sepsis: group 3, ovariectomy + diabetes: group 4, and ovariectomy + diabetes + sepsis: group 5.nnnRESULTSnIn lung, heart, and liver tissues, the levels of myeloperoxidase (MPO) and lipid peroxidation (LPO) were higher for the groups 3, 4, and 5 than in control group. In heart and liver tissues, superoxide dismutase (SOD) and catalase (CAT) activities were higher for the groups 3, 4, and 5 than control group. In lung tissue SOD activities were higher for the groups 3, 4, and 5 than in control group. Diabetes + ovariectomy caused a significant increase in serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) in comparison to the sham group. The strongest production of TNF-α and IL-6 in serum was observed in the group 5.nnnCONCLUSIONSnHyperglycemia and ovariectomy (postmenopausal period) severely increased serum cytokines and oxidant levels with the stages of our sepsis model. The lung tissue was most affected by diabetes and ovariectomy under sepsis conditions. Ovariectomy leading to estrogen deficiency results in general changes in metabolism, which are seen in the liver, lungs, and heart with diabetes under sepsis conditions.

Agomelatine: An antidepressant with new potent hepatoprotective effects on paracetamol-induced liver damage in rats

Paracetamol was shown to induce hepatotoxicity or more severe fatal acute hepatic damage. Agomelatine, commonly known as melatonin receptor agonist, is a new antidepressant, which resynchronizes circadian rhythms with subjective and objective improvements in sleep quality and architecture, as melatonin does. In the present study, it was aimed to evaluate the hepatoprotective activity of agomelatine on paracetamol-induced hepatotoxicity and to understand the relationship between the hepatoprotective mechanism of agomelatine and antioxidant system and proinflammatory cytokines. A total of 42 rats were divided into 7 groups as each composed of 6 rats: (1) intact, (2) 40xa0mg/kg agomelatine, (3) 140xa0mg/kg N-acetylcysteine (NAC), (4) 2xa0g/kg paracetamol, (5) 2xa0g/kg paracetamolxa0+xa0140xa0mg/kg NAC, (6) 2xa0g/kg paracetamolxa0+xa020xa0mg/kg agomelatine, and (7) 2xa0g/kg paracetamolxa0+xa040xa0mg/kg agomelatine groups. Paracetamol-induced hepatotoxicity was applied and liver and blood samples were analyzed histopathologically and biochemically. There were statistically significant increases in the activities of aspartate aminotransferase, alanine aminotransferase, levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) and 8-iso-prostane, and decreases in the activity of superoxide dismutase and level of glutathione in the group treated with paracetamol. Administration of agomelatine and NAC separately reversed these changes significantly. In conclusion, agomelatine administration protects liver cells from paracetamol-induced hepatotoxicity via antioxidant activity and reduced proinflammatory cytokines, such as TNF-α and IL-6.

High mobility group box protein-1 (HMGB-1) as a new diagnostic marker in patients with acute appendicitis

BackgroundThe aim of this prospective study was therefore to evaluate the diagnostic value of preoperative serum High Mobility Group Box Protein-1 (HMGB-1) levels in patients with Acute Appendicitis (AA) who show normal white blood cell count (WBC) counts.MethodOur study was carried out from October 2010 through November 2010 and included 20 healthy control group participants and 60 patients who presented at the emergency department of Erzurum Training and Research Hospital in Turkey with acute abdominal pain complaints, who were pathologically diagnosed with AA after laparotomy, and who agreed to participate in the study.ResultsOf the 60 patients who underwent appendectomies, 36 were male and 24 were female, and of the healthy group, 12 were male and 8 female. The age averages of the patients in Groups 1, 2 and 3 were, respectively, 31.3+15.4, 34.0+16.3 and 31.0+13.1 years. The WBC averages of Groups 1, 2 and 3 were, respectively, 7.41+2.02 (x109/L), 15.71+2.85 (x109/L) and 8.51+1.84 (x109/L). The HMGB-1 levels for Groups 1 (healthy persons), 2 (AA patients with high WBC counts ) and 3 (AA patients with normal WBC counts) were, respectively, 21.71 ± 11.36, 37.28+13.37 and 36.5 ± 17.73 ng/ml. The average HMGB-1 level of the patients with AA was 36.92 ± 15.43 ng/ml while the average HMGB-1 value of the healthy group was 21.71 ± 11.36 ng/ml.ConclusionThe significantly higher levels of HMGB-1 in AA patients compared to healthy persons infer that HMGB-1 might be useful in the diagnosis of AA. Use of HMGB-1, especially in patients with normal WBC counts, will reduce the number of unnecessary explorations.

Liver alveolar echinococcosis metastasized to the breast.

Background: Alveolar echinococcosis (AE) is a potentially fatal and chronically progressive infestation produced by the multivesicular metacestode of Echinococcus multilocularis, which most commonly affects the liver, lungs, and brain. Case Report: We present a case of AE in which an alveolar cyst, as a result of exophytic growth, adhered to intraabdominal and pelvic organs and metastasized to the breast. Exploration showed that the exophytic cyst in the liver filled the entire abdominal cavity, reaching to the uterus and bladder, and was adherent to the neighboring tissues and organs. This cystic lesion was totally excised, as was the 7 × 6 cm cystic lesion in the right breast. Conclusions: The liver is the most common site for echinococcal cysts of the pastoral strains (> 65%), followed by the lungs (25%); the cyst is seen less frequently in the spleen, kidneys, heart, bone, and central nervous system. AE must be considered in areas where liver cysts are endemic and in the presence of a liver cyst, and the organs where a metastasis is possible must be thoroughly investigated. Furthermore, in these areas, when cystic disorders of the breast are present, AE should not be discounted among possible definitive diagnoses.

Aliskiren – a promising strategy for ovarian ischemia/reperfusion injury protection in rats via RAAS

Abstract The aim of this study was to evaluate the effects of aliskiren, direct renin inhibitor, as an antioxidant and tissue protective agent and evaluate the molecular, biochemical, and histopathological changes in experimentalu2009ischemiau2009andu2009ischemia/reperfusion injury in rat ovaries. Forty-eight female rats were randomly divided into eight groups: in Group 1, only sham operation was performed. Group 2 received 100u2009mg/kg aliskiren and sham operated. In Group 3, 3u2009h-period of bilateral ovarianu2009ischemiau2009was applied. Group 4 received a 3-h period ofu2009ischemiau2009followed by 3u2009h of reperfusion. Groups 5 and 6 received 50 and 100u2009mg/kg, respectively, of aliskiren and bilateral ovarianu2009ischemiau2009was applied (after a 3-h period of ischemia, both ovaries were surgically removed). To Groups 7 and 8, 50 and 100u2009mg/kg of aliskiren were administered, respectively, and the induction ofu2009ischemia was performed. At the end of a 3-h period ofu2009ischemia, bilateral vascular clips were removed, and 3u2009h of reperfusion continued. After the experiments, IL-1β, IL-6, TNF-α, and iNOS mRNA expressions and SOD, GSH, MDA, renin, and angiotensin-II levels were determined and histopathological changes were examined in rat ovaries. Aliskiren treatment normalized excessive changes in cytokine and oxidative stress markers in both ischemia and ischemia/reperfusion injury. Histopathologically, treatment with aliskiren ameliorated the development ofu2009ischemiau2009and/or ischemia/reperfusion tissue injury. This study concluded that aliskiren treatment is effective in reversing ischemia and/or ischemia/reperfusion induced ovary damage via the improvement of oxidative stress, reduction of inflammation, and suppression of the renin-angiotensin aldosterone system.

A case of bacillary angiomatosis developed at a burn site.

Bacillary Angiomatosis (BA) is frequently seen in patients with human immunodeficiency virus (HIV)-induced immunodeficiency. Our patient was a case that developed granuloma-like lesions in the area of a burn, 8 days after being burnt on the upper right arm by scalding water. No indication of immune deficiency was observed and no history of direct contact with cats was evident. By the sixth day of the patients admission to our clinic, some of the lesions had reached a diameter of 2.5 cm. An excision biopsy was carried out from the lesions present on the patient. Electron microscopy revealed solitary bacilli located close to the capillary wall. Oral erythromycin treatment was implemented at 250 mg, 4 times a day for 2.5 months. Within this period of treatment, the lesions regressed completely, and a complete cure was achieved. This case demonstrates that BA must be considered in the differential diagnosis of both HIV-infected and immunocompetent patients.