Omer Colak

Serum Amyloid A, Procalcitonin, Tumor Necrosis Factor-α, and Interleukin-1β Levels in Neonatal Late-Onset Sepsis

Background. Sepsis is an important cause of mortality in newborns. However, a single reliable marker is not available for the diagnosis of neonatal late-onset sepsis (NLS). The aim of this study is to evaluate the value of serum amyloid A (SAA) and procalcitonin (PCT) in the diagnosis and follow-up of NLS. Methods. 36 septic and healthy newborns were included in the study. However, SAA, PCT, TNF-α, IL-1β, and CRP were serially measured on days 0, 4, and 8 in the patients and once in the controls. Töllners sepsis score (TSS) was calculated for each patient. Results. CRP, PCT, and TNF-α levels in septic neonates at each study day were significantly higher than in the controls (P = .001). SAA and IL-1β levels did not differ from healthy neonates. The sensitivity and specificity were 86.8% and 97.2% for PCT, 83.3% and 80.6% for TNF-α, 75% and 44.4% for SAA on day 0. Conclusion. Present study suggests that CRP seems to be the most helpful indicator and PCT and TNF-α may be useful markers for the early diagnosis of NLS. However, SAA, IL-1β, and TSS are not reliable markers for the diagnosis and follow-up of NLS.

Relation of plasma homocysteine levels to atherosclerotic vascular disease and inflammation markers in type 2 diabetic patients

OBJECTIVE Both hyperhomocysteinemia and increased inflammatory activity are shown to be associated with atherosclerosis. The relation of inflammatory activity to homocysteine (Hcy) levels is not well established. In the present study, we aimed to evaluate the relation of plasma Hcy levels to atherosclerotic vascular disease and inflammatory activity in type 2 diabetic patients. DESIGN AND METHODS In total 90 type 2 diabetic patients were included in the study. Of these patients, 41 had established atherosclerotic vascular disease and 49 had no evidence of atherosclerotic vascular disease. Hcy levels and markers of inflammation, namely C-reactive protein, fibrinogen, erythrocyte sedimentation rate, interleukin-6, and tumor necrosis factor alpha (TNFalpha), were measured. Glucose regulation, C-peptide, lipid parameters, and renal functions were also studied. RESULTS Both Hcy levels and inflammation markers were all significantly elevated in patients with atherosclerotic vascular disease when compared with patients without vascular disease. Reduced renal functions were responsible for the majority of Hcy elevation in patients with vascular disease. Also, renal functions were significantly associated with both Hcy levels and inflammatory markers. There was no correlation between Hcy levels and inflammation markers except for TNFalpha. CONCLUSIONS Inflammatory activity and Hcy levels are increased in type 2 diabetic patients with atherosclerotic vascular disease. Impairment of renal functions is the key factor that affects both Hcy levels and inflammation markers. Inflammation is not involved in the process by which Hcy leads atherosclerosis in type 2 diabetes.

Acute phase reactants and cytokine levels in unilateral community-acquired pneumonia.

Background: Bacterial infection of the lower respiratory tract initiates an acute inflammatory response. Regulation of the inflammatory response in bacterial pneumonia depends on a complex interaction between immune cells and inflammatory cytokines. Objectives: We investigated the initial levels of proinflammatory cytokines and acute phase reactants (APR), e.g. C-reactive protein (CRP), upon presentation of community-acquired pneumonia (CAP) in relation to clinical and laboratory indices of infection. Methods: We prospectively studied 28 consecutive patients with unilateral CAP. Tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6 and IL-8 concentrations were measured by ELISA in both bronchoalveolar lavage (BAL) fluid and serum. Results: The concentrations of IL1-β and IL-6 in BAL fluid were found to be significantly higher in the involved lung than those in either the noninvolved lung (p = 0.008 and p = 0.012, respectively) or serum (p = 0.002 and p = 0.025, respectively). Serum CRP concentrations were increased compared to those in the involved and noninvolved lung in BAL fluid (p = 0.000 and p = 0.000, respectively). In serum and BAL from involved lung, IL-6 concentrations were higher in the systemic inflammatory response syndrome (SIRS) group than in the non-SIRS group (p < 0.05), whereas CRP, TNF-α , IL-1β and IL-8 concentrations showed no difference between SIRS and non-SIRS. There was no significant correlation between the acute physiology and chronic health evaluation II score and the cytokines. Conclusions: Our results indicate that the CRP level is higher in the serum than in the BAL fluid in the lung, and that IL-6 is the most important cytokine for the determination of the severity of the disease.

Breastmilk ghrelin, leptin, and fat levels changing foremilk to hindmilk: is that important for self-control of feeding?

The aim of this study was to evaluate the changes in the ghrelin, leptin, and fat levels in the foremilk and hindmilk and the possible relationship between these levels with the age and growth of term healthy infants. Sixty-two babies were subdivided (according to their nutrition) into breastfed (BF), formula-fed (FF), and BF plus FF (BF + FF) groups. The total and active ghrelin and tryglyceride levels and the total cholesterol levels in the foremilk and hindmilk were studied at the first and second visits (mean of the second and fifth months, respectively). At both visits, the total and active ghrelin and the total cholesterol levels were lower in the hindmilk than in the foremilk. However, the triglyceride levels were higher in the hindmilk than in the foremilk (p < 0.001). The leptin levels were also higher in the hindmilk, but this difference was not statistically significant. At the second visit, the mean total foremilk ghrelin (p < 0.01), leptin (p < 0.05), tryglyceride (p < 0.001), and cholesterol (p < 0.01) levels in the BF group were decreased compared with the levels at the first visit, whereas the active ghrelin levels increased (p < 0.001). At the second visit, we observed a 3.5% increase in the body mass index in BF infants, a 14.6% increase in FF infants, and an 11.8% increase in BF + FF infants (p < 0.01). The foremilk leptin levels were lower in the BF + FF group than in the BF group at both visits. In conclusion, at the first and second visits, the decreased ghrelin and increased tryglyceride and leptin levels in the hindmilk might be associated with the important role of self-control when feeding BF infants. The stable content of formulas might be associated with a lack of self-control during feeding and increased nutrition. Changing the breast milk ghrelin, leptin, and fat levels between the foremilk and hindmilk and between the first and second visits might explain the differences in the weight gain patterns of BF and FF infants.

Coronary risk factors in Turkish schoolchildren: Randomized cross‐sectional study*

Abstract Background: There is a strong association between the extent of atherosclerotic lesions in aorta and coronary arteries and antemortem risk factors in children and young adults. Cardiovascular diseases are the most common cause of death in adults in Turkey. However, the data about the extent of coronary risk factors in Turkish children is very limited. The aim of this cross‐sectional study was to investigate the prevalence of coronary risk factors in Turkish schoolchildren living in Eskişehir, Turkey.

Serological screening for celiac disease in premenopausal women with idiopathic osteoporosis.

The aim of this study was to perform serological testing to screen for celiac disease (CD) among premenopausal women with idiopathic osteoporosis and to investigate the bone turnover in patients who are seropositive for CD. We studied 89 premenopausal women with idiopathic osteoporosis. The serological screening protocol was based on a two-level evaluation. The first level consisted of determining serum level of IgA antigliadin antibodies (AGA). Subjects who were negative for IgA AGA were classified as not having CD, while samples testing positive for IgA AGA underwent a second level of the screening process. For the second level of screening, the serum IgA endomysial antibody (EMA) test was performed. Bone metabolism was evaluated by serum calcium (Ca), phosphorus, alkaline phosphatase, parathyroid hormone (PTH), 25 (OH) vitamin D, osteocalcin (OC), urinary deoxypyridinoline (dPD), and 24-h urinary calcium levels. Of the 89 patients evaluated, 17 were found to have positive IgA AGA tests (19%) and 9 were found to be positive for EMA (10.11%). EMA-positive patients showed lower values of serum Ca (p<0.05) and 25 (OH) vitamin D (p<0.01) and significantly higher values of PTH (p<0.01) compared with the EMA-negative patients. The level of urinary dPD was found to be significantly higher in EMA-positive patients (p<0.05). The results of this study suggest that all patients with idiopathic osteoporosis should be screened for CD by measurement of EMA. Additionally, we believe that serological screening for CD and detection of such patients will allow determination of the most convenient treatment strategies for osteoporosis.

Usefulness of bone markers for detection of bone metastases in lung cancer patients.

OBJECTIVES Lung cancer commonly causes destructive bone metastases. The aim of this study was to compare efficiency of biochemical bone markers in the detection of bone metastases in lung cancer patients. DESIGN AND METHODS We measured serum calcium (Ca), alkaline phosphatase (ALP), bone isoenzyme of alkaline phosphatase (BALP), osteocalcin (OC) and urine deoxypyridinoline crosslinks (DPD) levels in 52 lung cancer patients; 27 patients with the evidence of bone metastases, 25 without metastases in bone when they were first diagnosed. BALP, OC and DPD were measured by specific immunoassays. ALP, Ca and urine creatinine levels were determined by colorimetric methods. RESULTS Ca, ALP, BALP, OC and DPD levels were significantly higher in the patients with bone metastases than those without bone metastases (p < 0.01 for BALP and OC, p < 0.001 for Ca, ALP and DPD). The sensitivity and specificities of all markers as follows: 89%-44% for BALP, 52%-88% for OC, 81%-76% for DPD, respectively. ROC curves were generated separately for BALP, OC and DPD to assess the diagnostic efficiency of markers in a different manner. DPD showed the best curve characteristics among the studied bone markers, followed by the BALP curve. OC curve showed poor characteristics. CONCLUSIONS Our results suggest that the measurement of DPD and BALP may be useful in detecting bone metastases in lung cancer patients. Also it could help in the follow-up of bone metastases from lung cancer since they can be repeated more often than roentgenography and bone scintigraphy, at less cost and with less discomfort to the patients.

The effect of smoking on bone metabolism: maternal and cord blood bone marker levels

BACKGROUND To clarify the effect of smoking on bone metabolism in the fetus, we measured osteocalcin (OC), bone isoenzyme of alkaline phosphatase (BALP), procollagen type 1 C-terminal propeptide (PICP) in maternal serum and umbilical cord blood. METHODS 15 active smoker, 14 passive smoker, 15 nonsmoker women and their newborn were included in this study. OC, BALP, PICP were determined by enzyme immunoassay. RESULTS Of the bone markers tested only OC was different in the serum of the three groups of women. Infants of smoker women have significantly lower umbilical cord blood OC levels than those of infants from both passive smoker and nonsmoker women.(25.6 +/- 6.6, 35.8 +/- 10.4, 37.2 +/- 16.1 ng/mL respectively, p < 0.05). Infants of smoker women have significantly lower umbilical cord blood BALP levels than those of infants from nonsmoker women. (46 +/- 12, 57 +/- 15 U/L p < 0.05). All bone markers except total ALP were significantly higher in umbilical cord blood as compared to maternal blood levels (p < 0.001 for all). CONCLUSION High umbilical cord blood bone marker levels may reflect the altered bone metabolism of fetus. Moreover, chronic hypoxia due to smoking may cause the suppression of bone matrix synthesis or placental synthesis as reflected by low OC and BALP levels in umbilical cord blood of infants from smoker women.

Protective Role of Melatonin and Coenzyme Q10 in Ochratoxin A Toxicity in Rat Liver and Kidney

Melatonin (MEL) and coenzyme Q10 (CoQ10) both display antioxidant and free radical scavenger properties. In the present study, the effect of MEL and CoQ10 on the oxidative stress and fibrosis induced by ochratoxin A (OTA) administration in rats was investigated. Rats were divided into five equal groups, each consisting of seven rats: (1) controls; (2) OTA-treated rats (289 μg/kg/day); (3) OTA+MEL–treated rats (289 μg/kg/day OTA + 10 mg/kg/day MEL); and (4) OTA+CoQ10–treated rats (289 μg/kg/day OTA +1 mg/100 g/day body weight (bw) CoQ10). After 4 weeks of treatment, the level of malondialdehyde (MDA), glutathione peroxidase (GPx), and hydroxyproline (Hyp) were measured in the homogenates of liver and kidney. In the OTA-treated group, the levels of MDA and Hyp in both liver and kidney were significantly increased when compared with the levels of control, whereas GPx activities decreased. In OTA+MEL–treated rats, the levels of MDA and Hyp in both liver and kidney were significantly decreased when compared with the levels of OTA-treated rats; however; GPX activities increased. In the OTA+CoQ10–treated group, the levels of MDA and Hyp were decreased when compared with the levels of OTA-treated rats, whereas GPx activities increased. In the OTA+CoQ 10–treated group, the levels of MDA, Hyp, and GPx were not significantly changed in kidney when compared with OTA-treated group. MEL has a protective effect against OTA toxicity through an inhibition of the oxidative damage and fibrosis both liver and kidney. Although CoQ10 has protective effect against OTA toxicity in liver tissue, it has no effect in kidney tissue.

Effects of the anti-ICAM-1 monoclonal antibody, allopurinol, and methylene blue on intestinal reperfusion injury

PURPOSE The aim of this study was to evaluate the effect of allopurinol, methylene blue, and a monoclonal antibody to the adhesion molecule ICAM-1 in intestinal ischemia and reperfusion injury. METHODS The rats were divided into 5 groups. CG (n = 8) was untreated controls, SISG (n = 11) received sterile isotonic saline solution, ICAMG (n = 12) received a monoclonal antibody to rat ICAM-1, ALLOG (n = 12) received allopurinol, and MBG (n = 14) received methylene blue. Intestinal ischemia was performed for 60 minutes followed by 60 minutes of reperfusion. The agents were injected 10 minutes before the reperfusion to animals. After 60 minutes of reperfusion, the plasma samples for myeloperoxidase (MPO) activity, tumor necrosis factor alpha (TNF-alpha) and uric acid levels, and the intestinal biopsies of ileum and jejunum for histopathologic examination were taken. RESULTS The mucosal damage was attenuated, and TNF-alpha level significantly decreased in ALLOG and ICAMG compared with SISG. The MPO activity was the lowest in ICAMG, and uric acid level was significantly decreased in ALLOG compared with the other groups. Methylene blue decreased TNF-alpha response to reperfusion injury but significantly increased the grade of the mucosal damage and the MPO activity. CONCLUSIONS This study shows that prereperfusion application of allopurinol and monoclonal antibody to the adhesion molecule ICAM-1 may attenuate the damage caused by intestinal ischemia and reperfusion, but the different time-points for application, the effects observed in the different ischemia and reperfusion durations, and the long-term results also should be investigated in the same experimental model before the final conclusion. Methylene blue was not effective to prevent or attenuate the intestinal tissue injury, but because this was the first study examining the effect of methylene blue on intestinal reperfusion injury, further studies with the different doses, ischemic duration, and application times will be needed.