Inflammatory prognostic markers in endometrial carcinoma: Systemic immune-inflammation index and prognostic nutritional index (2020-01-20)
Objective: Systemic inflammatory response markers have prognostic significance in many cancer types. Although the prognostic values of neutrophil/lymphocyte (NLR), and platelet/lymphocyte ratios (PLR) have been shown in patients with Endometrial Cancer (EC) there is no information in the literature about systemic immune-inflammation index (SII) and prognostic nutritional index (PNI). In our study, we aimed to reveal the prognostic role of SII and PNI in EC.
Material and Methods: Medical data for 101 patients with EC were reviewed retrospectively. NLR, PLR, SII and PNI values were dichotomized based on receiver operating characteristic (ROC) curve analysis (cut-off values: 3.3; 177; 1035.9, and 38, respectively). At the time of diagnosis concentrations of these four serum inflammatory markers were analyzed to determine their potential association with clinicopathologic characteristics and to assess their prognostic values via the Kaplan-Meier method and multivariate Cox regression analysis.
Results: Patients with higher NLR, PLR, SII, and lower PNI values had shorter progression-free survival (PFS) and overall survival (OS) times. Higher NLR, SII, and lower PNI, were associated with FIGO stages, lymph node involvement, lymphovascular invasion, and cervical stromal invasion while additionally NLR and PNI were associated with worse ECOG performance scores (2-3) and myometrial invasion. In univariate analyses, all these four variables were prognostic for both OS and PFS, whereas in multivariate analyzes only NLR, SII and PNI were found to be independent factors for OS and PFS.
Conclusion: For the first time in the literature SII and PNI were determined to be independent prognostic factors for both OS and PFS in EC.
Retrospective analysis of clinical, pathological characteristics and prognosis of the patients with endometrial stromal sarcomas (2020-01-21)
Objective: Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor of the uterus.Literature has limited data about the ESS. The aim of the present study was to contribute to literature by reporting the histo-pathological findings, clinical characteristics of ESS patients and the data about the accuracy of preoperative diagnosis and prognosis.
Material and Methods: A total of 33 patients who were diagnosed and followed up with ESS at Department of Gynecology and Obstetrics of Bursa Uludağ University between 2007 and 2017 were retrospectively analyzed with regard to clinical and pathologic characteristics, surgical procedures they underwent and survival.
Results: Mean age of the patients was 49.5 years and 60.2 years for low grade ESS (LG-ESS) and high grade ESS (HG-ESS) (p=0,01). Post-menopausal hemorrhage was the most common complaint on admission. Correct histological diagnosis was made in only 72.7% of the patients from whom pre-operative endometrial biopsy was obtained. Twelve out of 16 cases (75%) were in Stage 1. While all patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO), 14 underwent pelvic and para-aortic lymphadenectomy for surgical staging. Lymph node involvement was detected in no patients who underwent lymphadenectomy. The patients with LG-ESS were found to have a good prognosis however the ones with HG-ESS had a high mortality rate even in the early stages (mean survival of 10 months).
Conclusion: High grade ESS cases show different clinical characteristics and prognosis than LG-HSS. Diagnostic accuracy of endometrial sampling is much lower when compared to epithelial uterine malignancies. Metastasis of pelvic-paraaortic lymph nodes of which removal is reported which not to contribute to survival is rare.
The Significance of inflammation markers in complete blood count in patients with fibromyalgia (2020-01-21)
Objective: Fibromyalgia is a chronic pain disorder mostly seen in women, it mainly characterized by diffuse body pain accompanied by chronic fatigue and depression-like mood disorders. Its etiology still remains unknown but in some studies, fibromyalgia has been reported to be an inflammatory disease several cytokines shown to be responsible for the possible inflammatory basis of the disease. No laboratory marker is currently available to diagnose the disease. We aimed to investigate the diagnostic significance of inflammation markers in fibromyalgia, including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte (MLR) ratio, and mean platelet volume (MPV).
Material and Methods: This retrospective and case-control study included 188 patients who were followed up and treated for fibromyalgia in physical therapy and rehabilitation outpatient clinic from 2017 through 2019 and 64 age-matched healthy controls. The PLR, NLR, MLR, MPV and vitamin D were calculated from the results of complete blood count test. The differences between the two groups were examined.
Results: The mean age, hemoglobin levels, and erythrocyte sedimentation rates were not different between the groups. In fibromyalgia group, the values of PLR (p = 0.031), NLR (p = 0.044), MLR (p = 0.023), and MPV (p = 0.013) were higher than those in control group, whereas vitamin D levels were significantly lower (p = 0.021). In multivariate regression analysis, PLR, NLR and MLR were not found to be independent predictors (p> 0.05).
Conclusion: The findings of this study reveal that NLR, MLR, PLR, and MPV are not independent markers for the diagnosis of fibromyalgia, suggesting that fibromyalgia does not appear to be an inflammatory disease.
Peripapillary Microvasculature in Branch Retinal Vein Occlusion (BRVO) Treated With Anti-VEGF: An OCTA Study (2020-01-21)
Objective: Aim of this study is to evaluate the changes in peripapillary vessel density (VD) and peripapillary nerve fiber layer thickness (PPRNFL) after intravitreal anti-VEGF injections in patients with Branch Retinal Vein Occlusion (BRVO) with macular edema.
Material and Methods: Sixty eyes of 30 patients with unilateral macular edema due to BRVO who underwent 3 dose loading anti-VEGF treatments were included in the study. The peripapillary capillary vessel density (RPCVD) and PPRNFL were evaluated with optical coherence tomography angiography (OCTA). The measurements were done before and at least one month after a loading dose of anti-VEGF. The measurements of BRVO eyes before treatment were compared with the healthy fellow eyes and the values measured after treatment.
Results: There was a statistical difference between the pre-injection and post-injection periods at the inside disc and peripapillary VD parameters (p<0.001, p=0.01, respectively). Compared with the fellow eyes of the patients, the vessel density in the eyes with BRVO was significantly lower in the whole image, inside the disc, and peripapillary area. (p=0.015, p=0.020, p=0.027, respectively). There was no significant change in PPRNFL values before and after injections. When eyes with BRVO were compared with healthy eyes, eyes with BRVO showed reduced PPRNFL values initially but that was not statistically significant.
Conclusion: Inside disc and peripapillary VD values were increased after injection. Even though anti-VEGF agents may contribute to neurodegeneration, we think that this increase in perfusion prevents possible neurodegeneration.
A comparative evaluation of the effects on postoperative pain of systemic and topical forms of benzydamine hydrochloride after periodontal flap surgery: A randomized controlled clinical trial (2020-01-22)
Objective: The aim of this study was to evaluate comparatively the topical and systemic forms in the postoperative pain control periodontal flap surgery in spite of the daily dose of benzydamine hydrochloride spray form about one in twenty of the oral dose,.
Materials and Methods: In this randomized trial, the 48 systemic healthy individuals in need double-blind study with periodontal flap surgery were evaluated. Consent, demographic information and periodontal clinical parameters were obtained before surgery and periodontal flap surgery was performed with local anesthesia. The patients who underwent surgery were randomly assigned to two groups. One of the groups was prescribed tablet form of postopertive benzydamine hydrochloride and for the other was spray form as topical application. Postoperative pain was assessed by visual analog scale at 2, 6, 8, 12, 24 and 48 hours.
Results: There was no difference between systemic and topical drug groups in terms of demographic characteristics and periodontal clinical parameters. A statistically significant difference was found between 2 and 6 hours in favor of topical application. (p <0.05), but there was no significant difference in pain intensity at the 8th, 12th, 24th and 48th hours.
Conclusion: Although the topical form of benzydamine hydrochloride was 1/20 lower in postoperative pain control after periodontal flap surgery, it was found to be more effective in the early period compared to the systemic form, but equally effective in the late period. We premierly recommend that topical application should be preferred primarily in the prevention of overdose and toxicity in postoperative pain control after periodontal flap operation.