Medical Science and Discovery

Inflammatory prognostic markers in endometrial carcinoma: Systemic immune-inflammation index and prognostic nutritional index

2020-02-02T20:13:00+03:00

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

2020-01-30T20:11:37+03:00

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

2020-01-30T20:11:35+03:00

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

2020-01-30T20:11:34+03:00

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.

Protective effects of dehydroepiandrosterone (DHEA) vs caffeic acid phenethyl ester (CAPE) against ischemia-reperfusion injury in rat ovary

2020-01-30T20:11:31+03:00

Objective: In this study, the effectiveness of caffeic acid phenethyl ester (CAPE) and Dehydroepiandrosterone (DHEA) in preventing ischemia reperfusion injury associated with ovarian torsion have been investigated.

Materials and Methods: Twenty four adult female Wistar Albino rats were randomly divided into four groups. Ovaries were not twisted, and only healthy ovarian tissues were removed from the rats in the first group, while ovaries were twisted for 3 hours in the other groups. The second group did not receive any medications before the ovaries were untwisted, while 20 micromole/kg of CAPE was applied on peritoneal surface to the third group, and 60 mg/kg of DHEA was administered intraperitoneally to the fourth group.

Results: The level of primordial follicles was higher in the third group compared to the second group after the torsion of the ovary (p=0.017). The mean level of primary follicles was higher in the first group compared to the number of follicles in the third and fourth groups after the torsion of the ovary (p<0.001). The median hemorrhage level was higher in the second group following ovarian torsion compared to that in the first group (p=0.005).

Conclusion: Agents that have been considered to reduce injury resulting from ischemia-reperfusion proved ineffective during the early stages in terms of the number of follicles in the ovaries; however, we believe that long-term studies may be more beneficial.

Periodontal and Systemic Treatment Approach on Pemphigus Vulgaris: A Case Report

2020-01-30T20:11:32+03:00

Objective: In this case report, both the diagnosis of pemphigus vulgaris and the periodontal treatment approach including the use of local/systemic medications are presented.

Case Presentation: 36-year-old female patient applied to the periodontology clinic with complaints of burning mouth and pain. Physical examination revealed cutaneous blisters on nose, hand and fingers while intra-oral examination showed widespread desquamation and ulcers depending on PV and severe gingival inflammation due to the lack of oral hygiene and oral PV. Initial periodontal treatment (IPT) was implemented to the patient along with local and systemic medications. Periodontal parameters including plaque Index (PI), gingival Index (GI), probing depth (PD) and clinical attachment level (CAL) were recorded before and six weeks after IPT. Periodontal treatment procedures did not cause any negative effect on the lesions. Six weeks following IPT and the use systemic medications, all clinical parameters improved significantly. Furthermore, lesions including mucosal blisters and desquamations partially recovered, the patient started to perform oral hygiene more effectively.

It was concluded that atraumatic and non-invasive periodontal treatment supported by the use of local/systemic corticosteroid and immunosuppressive medications was efficient on controlling of widespread desquamations and gingival inflammation of PV patients.