Engin Karakeçe

Overlooked hematological markers of disease activity in rheumatoid arthritis.

The aim of this study was to investigate the relationship between hematological markers and disease activity in patients with rheumatoid arthritis (RA).

Idiopathic Granulomatous Mastitis: An Autoimmune Disease?

Purpose. This study aimed to investigate the autoimmune basis of idiopathic granulomatous mastitis (IGM) by determining the anti-nuclear antibody (ANA) and extractable nuclear antigen (ENA) levels of patients diagnosed with IGM. Material and Methods. Twenty-six IGM patients were evaluated. Serum samples were analyzed for autoantibodies by indirect immunofluorescence (IIF) using a substrate kit that induced fluorescein-conjugated goat antibodies to human immunoglobulin G (IgG). IIF patterns were read at serum dilutions of 1 : 40 and 1 : 100 for ANA positivity. Using the immunoblot technique, the sera of patients were assayed at dilutions of 1 : 40 and 1 : 100 for human autoantibodies of the IgG class to 15 lines of highly purified ENAs. Results. In the IIF studies for ANA, positivity was identified for four different patterns in the 1 : 40 diluted preparations, for three different patients in the 1 : 100 diluted preparations and only one pattern was identified at the 1 : 320 dilution. In the ENA studies, positivity was identified for four different pattern in the 1 : 40 dilution, and only one pattern was identified at the 1 : 100 dilution. Conclusion. This study was not able to support the eventual existence of an autoimmune basis for IGM.

Associations between Demodex species infestation and various types of cancer

Tumor-associated immune system cells secrete protease and cytokines that can inhibit the immune response. In particular, T-cell effector functions could be inhibited, potentially causing an increase in parasitic infestations. Demodex species are common inhabitants of normal hair follicles. Humans are the specific host for two species Demodex folliculorum and D. brevis. The aim of this study was to investigate the incidence and infestation of D. folliculorum and D. brevis in patients with cancer. In the present study, 101 patients with cancer were selected from among patients who were diagnosed and treated for cancer. The cancer patients were divided into four groups according to cancer type. Slides were examined for parasites using light microscopy at magnifications of ×40 and ×100. Infestation was defined as having at least five living parasites/cm2 of skin. The ages of the patients with cancer ranged between 38 and 82 years, with a mean of 65.5±10.1 years. It was determined that 77 of the 101 (76.2%) cancer patients were positive for Demodex species. Infestation was positive in 18 (47.4%) of the 38 cases in the breast cancer group, 7 (29.2%) of the 24 cases in the lung cancer group, 5 (18.5%) of the 27 cases in the gastrointestinal system cancer group, and 2 (16.7%) of the 12 cases in the urogenital system cancer group. Results showed that the rate of Demodex species infestation was higher in patients with breast cancer. Thus, cancer — and particularly breast cancer — is a risk factor for Demodex species infestation.

Comparison of fetuin-A and transforming growth factor beta 1 levels in patients with spondyloarthropathies and rheumatoid arthritis.

We investigated the serum transforming growth factor beta 1 (TGFβ1) and fetuin‐A levels, and determined the relationships between these biomarkers and disease activity, mobility and radiologic progression in patients with spondyloarthropathy (SpA) and rheumatoid arthritis (RA).

Association of doripenem resistance with OXA-type carbapenemases in Acinetobacter baumannii isolates

Objectives: To evaluate the in vitro activity of doripenem in Acinetobacter baumannii (A. baumannii) clinical isolates that possess different OXA-type carbapenemases, and to evaluate the roles of these enzymes in the development of carbapenem resistance. Methods: This retrospective study was conducted with 25 A. baumannii isolates at Sakarya University Training and Research Hospital, Sakarya, Turkey from June to October 2014. Antibiotic susceptibility testing was carried out using the Vitek-2 automated system (bioMérieux, Marcy l’Etoile, France). Minimum inhibitory concentrations (MICs) were determined using Etest strips (bioMérieux, Marcy l’Etoile, France). Quantitative polymerase chain reaction was performed in a Fluorion Instrument (Iontek, Istanbul, Turkey). Results: Isolates were divided into 5 groups based on their susceptibility profiles and OXA-type carbapenemase positivity. Group 2 isolates whose MIC of both meropenem and doripenem are in the range of 4-32 µg/mL were negative for both blaOXA-23 and blaOXA-58. Group 3 isolates whose MIC of meropenem and doripenem is in the range of 4-32 µg/mL, blaOXA-23 is positive, and blaOXA-58 is negative. Group 5 isolates whose MIC of meropenem is >32 µg/mL, and that of doripenem is in the range of 16-32 µg/mL were positive for both blaOXA-23 and blaOXA-58. Conclusion: The blaOXA-23 and blaOXA-58 gene combinations may confer resistance with a much greater MIC of both meropenem and doripenem. However, the presence of blaOXA-58 alone was not correlated with doripenem resistance.

Demodex spp. Infestation in a breast-cancer patient: A case report.

Demodex folliculorum and Demodex brevis are obligatory parasites that live in sebaceous glands and follicles. When immune system becomes suppressed by any reason, patients become vulnerable to obligatory parasites like D. folliculorum and D. brevis. Immune system becomes suppressed in cancer patients who undergo chemotherapy, and as a result these patients become vulnerable to infestations. In our case, a 45 year-old female has been admitted to oncology clinic for a medical treatment of breast cancer. Her systematic physical examination was normal, except redness on her cheeks and forehead. There was no abnormality in biochemical and haematological laboratory values. We have decided to apply chemotherapy of Adriamycin, cyclophosphamide and 5-fluorouracil. Due to the itchy redness on her cheeks and forehead, we had performed an examination for demodex before chemotherapy; and we have identified 20 mites/cm2 on her right and left cheeks, and 15 mites/cm2 on her forehead. When our patient had came our clinic with increasing complaint of itchy rash, after the first course of chemotherapy we have reexamined demodex. The result of microscopic examination revealed large amount of demodex of 50 mites/cm2 on her right and left cheeks and 30 mites/cm2 on her forehead, which were nearly 2.5-times higher than the previous examination. This increase probably was associated with immune suppression of chemotherapy.

Evaluation of the Effect of Storage Temperature on D-dimer Stability, Using Two Different Techniques

Our study designed to assess the stability of D-dimer levels and storage conditions, using two different techniques. This is the frst study to investigate the short-term storage stability of D-dimers in clinical citrated plasma samples containing a range of D-dimer concentrations. This study was performed with 60 samples that were collected randomly patients with suspected thromboembolism.Plasma samples were incubated for eight different time intervals (0 (i.e., fresh samples), 4, 24, 48, 72, 120, 168, and 240h) and at three different temperatures (25+2 °C,4+2 °C, and -20+2 °C) to evaluate the effect of storage conditions on D-dimer stability.Plasma D-dimer concentrations were determined using two different techniques, a fluorescence-based sandwich immunodetection assay (i-CHROMA, Boditech Med Inc., Korea) and an enzyme-linked immunosorbent assay (ELISA) (VIDAS, bioMerieux, France). In accordance with our study, we suggest D-dimer analysis be performed on plasma samples stored for <48h at room temperature. Our findings indicate that i-CHROME and VIDAS D-dimer measurement methods have remarkably high sensitivity and are safe first-line tests that can be utilized to rule out pulmonary emboli in outcome studies multiple freeze-thaw.

Identification of ESM-1 as a new endothelial biomarker in the pathogenesis of rheumatoid arthritis

ABSTRACT The aim of this study was to investigate the use of ESM-1 (endothelial cell-specific molecule-1) as a new biomarker for the pathogenesis of rheumatoid arthritis (RA). The study cohort was divided into four groups according to the DAS28 disease activity score: 16 patients were classified as being in remission (DAS28 < 2.6), 16 patients exhibited low disease activity (DAS28: 2.6–3.2), 20 patients exhibited moderate disease activity (DAS28: 3.2–5.1) and 16 patients exhibited high disease activity (DAS28 > 5.1); 20 healthy subjects were included as a control group. Serum samples were gathered from the patients with documented seropositivity for rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies in order to assess RF IgM and ESM-1. ESM-1 levels were significantly higher in patients with RA than in healthy subjects (p = 0.035). The data presented here strongly indicate ESM-1 as an attractive target for the treatment of inflammation-related diseases, such as RA.

AB0154 Comparison of Fetuin-A and Transforming Growth Factor Beta 1 Levels in Patients with Spondyloarthropathies and Rheumatoid Arthritis

Background New bone formation plays an important role in the progression of inflammatory lesions in inflammatory rheumatic diseases. In recent literature, the question of which molecules to use for estimating new bone formation is a particularly interesting research topic. Fetuin-A and transforming growth factor beta 1 (TGFβ1) have been studied in many diseases, including metabolic, cardiovascular, and neoplastic diseases. Objectives We investigated the serum TGFβ1 and fetuin-A levels, and determined the relationships between these biomarkers and disease activity, mobility, and radiologic progression in patients with SpA and RA. Methods The study included 55 patients with SpA and 38 patients with RA, together with 28 healthy subjects. In AS patients, we assessed disease activity using the Bath AS disease activity index (BASDAI), functional ability using the Bath AS functional index (BASFI), and mobility using the Bath AS metrology index (BASMI), radiologic progression using the Bath Ankylosing Spondylitis Radiology Index (BASRI). Serum feutin-A and TGFβ1 were determined using enzyme-linked immunosorbent assay (ELISA) equipment Results Fetuin-A was significantly higher in the axial SpA and RA groups than in healthy subjects (p<0.01). Serum TGFβ1 and fetuin-A levels were similar in the peripheral SpA group and in healthy subjects. A significant positive correlation was found between the fetuin-A and TGFβ1 levels in the axial SpA, peripheral SpA, and RA groups (r =0.293, p=0.009; r =0.215, p=0.04; r =0.223, p=0.05, respectively). Significant correlations were found between fetuin-A and the BASMI and BASRI values in the axial SpA patients (r =0.244, p=0.031; r =0.416, p<0.001, respectively). There were no correlations of TGFβ1 or fetuin-A levels with CRP, ESR, or all of the clinical parameters in the peripheral SpA and RA patients (p>0.05). Conclusions In conclusion, high levels of fetuin-A and TGFβ1 in patients with axial SpA indicate that fetuin-A could be used as a marker for bone proliferation. We hypothesize that fetuin-A may be one of the possible active steps in new bone formation. The data obtained in the present study will contribute to identifying differences between RA and SpA, and in clarifying the disease process, thereby helping to identify specific therapeutic targets. Disclosure of Interest None declared

Rare Case of Strongyloides stercoralis with Vitamin B12 Deficiency

Strongyloidiyasis is endemic in tropical and subtropical regions, and mostly soil transmitted nematode disease that is seen as sporadic cases in Turkey. As may be asymptomatic in healthy individuals, it may even cause death in immunosuppressive people. We report a case of Strongyloides stercoralis infection in a patient, 29 years old young male was admitted to our institution with diarrhea who has got vitamin B12 deficiency and eosinophilia. The case represents an extremely rare and in our knowledge, it is the first case in Sakarya.