Sema Nur Ayyildiz

Evaluation of the Association of Sleep Apnea-Related Systemic Inflammation with CRP, ESR, and Neutrophil-to-Lymphocyte Ratio

Background Obstructive sleep apnea syndrome (OSAS) is characterized by cyclic episodes of hypoxemia and reoxygenation. It has been suggested that OSAS is associated with chronic inflammation within the microvasculature. This low-grade inflammation may play a role in the pathophysiology of OSAS-related comorbidities. Evaluation of the inflammatory markers may predict the degree of the systemic inflammation and this may be a prognostic factor for future adverse events such as cardiovascular risks. Proinflammatory cytokines have been extensively studied in sleep-disordered breathing. Neutrophil-to-lymphocyte ratio is a recently described indicator of systemic inflammation, but it has not been studied in OSAS patients. In this study we aimed to evaluate the easily measurable parameters of systemic inflammation in these patients. We conducted this study to examine the association among OSAS and C- reactive protein, erythrocyte sedimentation rate, and neutrophil-to-lymphocyte ratio. Material/Methods OSAS patients who underwent overnight polysomnography were studied retrospectively. They were divided into 4 groups: control, mild, moderate, and severe OSAS patients. Blood test results and inflammatory markers were compared between the groups. One-way ANOVA and Kruskall-Wallis H test were used for statistical analysis. Results A total of 147 patients were included in the study. No differences in evaluated inflammatory markers were observed among the 4 groups. Conclusions Evaluation of the OSAS-related systemic inflammation is not likely to be possible by CRP, ESR, or neutrophil-to-lymphocyte ratio measurements. These markers do not seem to be associated with the degree of the upper airway obstruction.

Increased Serum Zonulin Levels as an Intestinal Permeability Marker in Autistic Subjects

Objective To evaluate the serum levels of zonulin, which regulates tight junctions between enterocytes and is a physiological modulator controlling intestinal permeability, in patients with autism spectrum disorders (ASDs). Study design Serum zonulin levels were determined in 32 patients with ASD and 33 healthy controls using an enzyme‐linked immunosorbent assay. The severity of ASD symptoms was assessed with the Childhood Autism Rating Scale. Results Serum zonulin levels were significantly higher in the patients with ASD (122.3 ± 98.46 ng/mL) compared with the healthy controls (41.89 ± 45.83 ng/mL). There was a positive correlation between zonulin levels and Childhood Autism Rating Scale score when all subjects were assessed (r = 0.523; P < .001). Conclusions This study suggests that zonulin, which regulates intestinal permeability, plays a role in the development of symptoms of ASD.

PSA, PSA derivatives, proPSA and prostate health index in the diagnosis of prostate cancer.

Currently, prostate- specific antigen (PSA) is the most common oncological marker used for prostate cancer screening. However, high levels of PSA in benign prostatic hyperplasia and prostatitis decrease the specificity of PSA as a cancer marker. To increase the specificity of PSA, PSA derivatives and PSA kinetics have been used. However, these new techniques were not able to increase the diagnostic specificity for prostate cancer. Therefore, the search for new molecules and derivatives of PSA continues. With the aim of increasing the specificity of prostate cancer diagnosis, proPSA and the Prostate Health Index have been introduced. In this review, the roles of PSA, PSA derivatives, proPSA and the Prostate Health Index in Prostate Cancer diagnosis are examined.

Cyanoacrylic tissue glues: Biochemical properties and their usage in urology

Tissue adhesives are being used in medical and cosmetic industries and first aid for a long time. But their everyday usage has not been widespread. Only case report information is available about their usage. Despite good and meaningful results after they were used, there is lack of standard information that gives idea of about in which cases they could be helpful. Nowadays, cyanoacrylates are used in the surgery more frequently. In this review, we wanted to oversee the biochemical properties and the urological utilisation areas of cyanoacrylates.

Evaluation of serum Neuron-specific enolase, S100B, myelin basic protein and glial fibrilliary acidic protein as brain specific proteins in children with autism spectrum disorder

Brain specific‐proteins are not found in other tissues and measurement non‐invasively in the blood may identify structurally and functionally damaged brain regions and identify the severity and prognosis of neuropsychiatric diseases. For this reason, we aimed to evaluate serum brain‐specific protein values as brain damage markers in children with autism spectrum disorder (ASD).

The Effect of Tadalafil on Renal Fibrosis Induced by Ureteral Obstruction

Objective: It has been reported that phosphodiesterase-5 (PDE-5) inhibitors improve kidney function during acute and chronic renal failure. This study aimed to determine the possible therapeutic effects of tadalafil, a specific PDE-5 inhibitor, on renal fibrosis induced by unilateral ureteral obstruction (UUO). Methods: Male Sprague-Dawley rats were used and randomly divided into three groups (n = 6) as sham-operated, UUO and tadalafil-treated (10 mg/72 hours, ig) UUO (UUO+T) groups. Unilateral ureteral obstruction was induced by complete ligation of the left ureter and 14 days after surgery creatinine clearance, urinary cyclic guanosine monophosphate (cGMP), renal alpha-smooth muscle actin (α-sma) and transforming growth factor βeta (TGF-β) levels, as well as histologic changes, were observed in all the animals. Results: Unilateral ureteral obstruction-induced renal fibrosis was confirmed by increased α-sma level, collagen deposition, tubular dilation, inflammatory cell infiltration and necrosis. An increased renal TGF-β level and decreased urinary cGMP level was also observed in obstructed animals in addition to reduced creatinine clearance. Tadalafil treatment, which restored the animals’ urinary cGMP level, significantly attenuated the fibrotic changes and TGF-β increase in their kidneys. Conclusion: This study suggests that tadalafil treatment ameliorates renal fibrosis by reducing TGF-β expression and may have important clinical relevance since tadalafil is currently used clinically to treat erectile dysfunction and pulmonary hypertension.

The effect of trimetazidine on renal oxidative stress in partialand complete ureteral obstructions in a rat model

BACKGROUND/AIM Renal oxidative stress occurs in ureteral obstructions. The purpose of this study was to investigate the effect of the antioxidant and antiischemic agent trimetazidine (TMZ) on oxidative stress following ureteral obstruction. MATERIALS AND METHODS Ten groups were established. Sham groups were checked as controls after 1 and 3 weeks. The other 8 groups had partial or complete ureteral obstruction while receiving or not receiving trimetazidine (TMZ) at 5 mg/kg daily and were evaluated after either 1 week or 3 weeks. Creatinine and cystatin C measurements were performed in the serum. Malondialdehyde, myeloperoxidase, catalase, and glutathione peroxidase activity were measured in renal tissue and serum. RESULTS In the 1-week groups, tissue malondialdehyde, serum myeloperoxidase, and glutathione peroxidase activity increased significantly with obstruction and TMZ use compared to the control group (P < 0.005). In the 3-week TMZ group, cystatin C, tissue malondialdehyde, serum and tissue myeloperoxidase, and tissue glutathione peroxidase differed significantly (P < 0.05). There was no significant difference in all parameters after 3 weeks of partial obstruction (P > 0.05), with only serum malondialdehyde being significantly elevated (P < 0.05). CONCLUSION TMZ did not exhibit a renal oxidative stress-lowering effect in obstruction. It causes mild impairment of renal functions in obstruction. Patients using TMZ must be closely monitored in terms of kidney function in the event of any ureteral obstruction.

Comparison of the effects of continuous versus intermittent enteral feeding on plasma leptin and ghrelin levels in Intensive Care Units

Objetivo: Este ensaio aleatorio prospectivo tem por objetivo verificar se existe uma associacao entre o programa de administracao de nutricao enteral e os hormonios leptina e grelina, os quais funcionam no metabolismo energetico. Metodos: Este estudo incluiu 38 pacientes de Unidades de Terapia Intensiva, com idades entre os 18 e os 85 anos, que receberam nutricao enteral. Os pacientes foram escolhidos aleatoriamente para receberem nutricao enteral utilizando infusao continua (n=19) ou intermitente (n=18). Alem de exames bioquimicos de rotina, foram colhidas amostras de sangue dos pacientes para analises dos niveis de leptina e grelina no 1o, 7o e 14o dias de nutricao enteral. Resultados: Nao houve diferenca estatistica significante entre os grupos em relacao a dados descritivos e variaveis categoricas tais como doencas subjacentes, complicacoes, utilizacao de esteroides e outros (p>0,05). A diminuicao no numero de leucocitos e nos niveis de creatinina e proteina C-reativa com o tempo foi estatisticamente significativa (p=0,010, p=0,026, p<0,001, respetivamente). Nao existiu diferenca com significância estatistica entre os grupos em relacao aos niveis de leptina e grelina (p=0,982 e p=0,054). Embora os niveis de leptina nao mudaram com o tempo, os niveis de grelina de ambos os grupos foram significativamente superiores no 7° e 14° dias quando comparados aos verificados na analise do primeiro dia (p=0,003). Conclusao: Este estudo revelou que os programas de nutricao enteral continua e intermitente foram bem tolerados com pequenas complicacoes apresentadas pelos pacientes em Unidades de Terapia Intensiva. O padrao de administracao de nutricao enteral por si so nao afetou os niveis de leptina e grelina. Estudos controlados aleatorios em coortes maiores sao necessarios para verificar qual programa de administracao de nutricao enteral, intermitente ou a continuo, e mais adaptavel ao padrao de secrecao diurno de hormonios metabolicos.

Decreased levels of serum fibroblast growth factor-2 in children with autism spectrum disorder

The neurodevelopment and functioning of the central nervous system, and especially the cerebral cortex, have basic importance to understand neuropsychiatric disorders like autism. Fibroblast growth factor-2 (FGF-2) plays a very important role in the development and functioning of the cortex. FGF-2 is related to developmental processes in the central nervous system such as neurogenesis, migration, differentiation and survival. This study researched the serum FGF-2 levels in children with autism spectrum disorder (ASD). With this aim, 60 ASD children and 40 healthy controls were compared. We applied a sociodemographic form and the Childhood Autism Rating Scale (CARS) to each subject with their family to assess the severity of autism. Additionally, all subjects had routine laboratory tests performed. Serum samples were studied with ELISA. The results found that serum FGF-2 levels were statistically significantly low in the patient group compared to the healthy control group (p value 0.003). Additionally there was a statistically significant negative correlation identified between serum FGF-2 levels and CARS score for all subjects (r = -0.300; p = 0.02). In conclusion, FGF-2 may contribute to the etiopathogenesis of ASD.

PSA request analysis: how should this be interpreted? What may be overlooked / PSA istem analizi: Nasıl yorumlanmalı? Gözden kaçanlar nelerdir?

Abstract Objective: Prostate specific antigen is widely used for the diagnosis, treatment, and follow-up of prostate cancer. However, despite being organ-specific, PSA is not specific to cancer. As some patients with elevated PSA level have normal biopsy results and some others with low PSA levels have cancer diagnosed in biopsy examination, PSA creates diagnostic uncertainty both for clinicians and patients. Moreover, different PSA results received for the same subject at separate time points as well as smalllarge fluctuations in PSA levels perturb both sides. In a setting where there are so many unknowns we have PSA in our hands without any restrictions for ordering it. This study analyzed PSA orders, patient traffic, and economic burden within a 6-year period. Methods: The number of PSA tests and patient outcomes at a training and research hospital between October 2006 and May 2013 were evaluated. Results: Of 12107 tPSA orders, 73.6% were ordered by the urology clinic and 26.4% orders were made from other outpatient clinics. When patients at follow-up for prostate cancer are excluded because their tPSAs have to be more commonly checked, we detected that 28.22% of tests were ordered at intervals of less than 1 year. The average tPSA testing frequency was 91.84±1.21 days (0-330). The number of patients younger than 40 years who were tested for tPSA was 287. Of these, 25.43% were ordered by the urology clinic and the remaining by other medical branches. Conclusion: A state of chaos surrounds PSA order and interpretation. Neither patients nor physicians are aware of PSA-related outcomes. Therefore, each hospital should hold sessions on PSA testing and inform physicians about them. Furthermore, a detailed public education should be provided and seminars should be organized at the national level. Özet Amaç: Gunumuzde prostat kanserinin tanı, tedavi ve takiplerinde yaygın olarak prostatik spesifik antijen (PSA) kullanılmaktadır. Fakat PSA organ spesifik olmasına rağmen kanser spesifik değildir. PSA duzeyi yuksek olanlarda prostat biyopsi sonucunun normal gelmesi, diğer taraftan PSA duzeyi duşuk hastalarda biyopsi sonucu kanser gelmesinden dolayı PSA hem klinisyende hem de hastada sıkıntı yaratmaktadır. Aynı zamanda aynı kişide PSA’da farklı sonucların cıkması ve PSA’da kucuk-buyuk değişimler her iki tarafı da huzursuz etmektedir. Bu calışmada; hicbir istem kısıtlaması olmayan PSA istemleri analiz edilmiştir. Metod: Ekim 2006-Mayıs 2013 tarihleri arasındaki PSA istemleri değerlendirildi. Bulgular: 7100 kişiye 12107 adet tPSA, 5053 kişiye 7852 adet serbest PSA (sPSA) olcumu yapılmıştı. 12107 tPSA isteğinin %73.6’sı uroloji, %26.4’sı diğer kliniklerden yapılmıştı. Prostat kanseri nedeniyle takip edilen hastalarda tPSA’nın daha sık bakılması gerektiğinden bu hastalar değerlendirme dışı bırakıldığında, %28.22 oranında bir yıldan kısa aralıklarla bakıldığını tespit ettik. tPSA bakılma sıklığı ortalama 91.84 ±1.21 gun (0-330) olarak hesaplandı. Urolojide test istenen ve PSA>4.0 ng/ml uzerinde olan hasta sayısı 347 idi. Ancak, 77 hastaya biyopsi yapılmıştı ve 23 hastada prostat kanseri saptanmıştı (%29.8). Diğer hastalar hakkında hicbir bilgi bulunamadı. 40 yaş altında tPSA bakılan hasta sayısı 287 idi. 40 yaş altı tPSA istemlerinin %25.43’u uroloji kliniğinden geri kalanlar ise diğer branşlardan istenmişti. Sonuç: PSA isteminde ve yorumlanmasında bir kaos ortamı soz konusudur. PSA sonuclarından ne hastaların ne de doktorların haberi bulunmaktadır. Bu nedenle her hastanede PSA ile ilgili oturumlar duzenlenmeli, doktorlar bu konuda bilgilendirilmelidir. Ayrıca ulusal duzeyde topluma detaylı eğitimler verilmeli ve seminerler duzenlenmelidir.