The Role of Tenascin-C in the Physiopathology of Familial Mediterranean Fever.

OBJECTIVE: Familial Mediterranean fever (FMF) is an autoinflammatory disease common in the Mediterranean basin. It has been determined that tenascin-C level is increased in rheumatic inflammatory diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus, and systemic sclerosis. However, the role of tenascin-C has not been investigated in FMF. This study aimed to investigate serum tenascin-C levels in FMF patients and to investigate possible relationships between them. MATERIALS AND METHODS: About 38 patients diagnosed with FMF and 40 healthy controls were included in the study. The patient's sex, age, clinical symptoms, physical examination, and laboratory results were recorded. Serum tenascin-C levels were determined by the enzyme-linked immunosorbent assay (ELISA) method. RESULTS: The serum tenascin-C levels were significantly lower in the FMF patients (10297 ± 8107 pg/ml) compared to the healthy control group (29461 ± 13252 pg/ml) (p < 0.001). In receiver operating characteristic (ROC) analysis, when the cut-off point was chosen as 11076 pg/ml, sensitivity was 77.1% and specificity was 91.9%. When the cut-off point was chosen as 19974 pg/ml, sensitivity was 91.4% and specificity was 75.7%. It was determined that the serum tenascin-C levels did not correlate with age, gender, and laboratory parameters in the healthy control group and FMF patients (p > 0.05). CONCLUSION: This is the first study investigating tenascin-C levels in FMF. Tenascin-C levels in FMF patients were lower than in healthy controls. Low tenascin-C levels in FMF, which are high in other chronic rheumatic diseases, may be a valuable indicator. Therefore, serum tenascin-C level seems to be a useful marker in distinguishing FMF patients from healthy individuals.

An investigation of the relationship between Behçet's disease and tenascin-C.

Objectives: The study aimed to investigate serum tenascin-C levels and its relationship with pathogenesis of Behçet's disease (BD) with inflammatory processes. Patients and methods: This prospective and analytical study included 34 BD patients (19 males, 15 females; mean age: 31.5±8.2 years; range, 18 to 48 years) who met the 2014 International Criteria for Behçet's Disease and had no comorbidities and 37 healthy volunteers (21 females, 16 males; mean age: 29.6±5.3 years; range, 21 to 45 years). Sex, age, age at diagnosis, clinical and laboratory data, medication use, and smoking history of the participants were recorded. Serum tenascin-C levels were measured using a commercially available tenascin-C enzyme-linked immunosorbent assay kit. Results: There was no significant difference between the groups in terms of age (p=0.262) and sex (p=0.287). Serum tenascin-C levels were significantly lower in the BD group (10,824±7,612 pg/mL) compared to the control group (27,574±14,533 pg/mL, p<0.001). In the receiver operating characteristic analysis performed for the diagnostic value of tenascin-C level in BD, the sensitivity was determined as 79.4% and the specificity as 82.5% (p<0.001). No statistically significant difference was observed in tenascin-C levels in correlation with clinical characteristics, laboratory values, medication use, and smoking in the BD group. Conclusion: In contrast to other chronic inflammatory diseases, lower levels of tenascin-C were observed in patients with BD than in the healthy individuals, which can be attributed to the absence of prolonged chronic inflammatory course in BD. The fact that tenascin-C levels are high in other rheumatic inflammatory diseases but low in BD may be useful in the differential diagnosis of BD.

The Potential Use of Monocyte-to-High-Density Lipoprotein Ratio as a Chronic Inflammatory Marker in Major Depressive Disorder.

Background: Monocytes secrete pro-inflammatory and pro-oxidant cytokines as part of inflammatory reactions. High-density lipoproteins have anti-inflammatory and antioxidant effects. This study investigated the potential use of the monocyte-to-high-density lipoprotein ratio in the follow-up of major depressive disorder. Methods: The study group was composed of patients with newly diagnosed or preexisting major depressive disorder who applied to a psychiatric clinic and did not receive antidepressant treatment in the last 2 weeks. These patients were tested for the monocyte-to-high-density lipoprotein ratio in the psychiatric outpatient clinic both in the first interview and at their follow-up at 2 months. The control group, on the other hand, consisted of subjects who presented to the checkup clinic without any complaints. Results: The study included a total of 98 individuals aged between 18 and 62 years, including 66 women and 32 men. The proportion of women in the study group was higher than that in the control group (P = .002). Patients in the study group had higher first high-density lipoprotein levels than healthy controls (P = .026). Beck's Depression Inventory scores of the study group decreased significantly from the first to the second interview (P < .001). There was no significant correlation between the percentage of change in Beck's Depression Inventory scores and the percentage of change in the monocyte-to-high-density lipoprotein ratio (P = .271). Conclusion: The high-density lipoprotein levels in healthy controls were not higher than those in the group with major depressive disorder; monocyte levels did not differ between the groups and the monocyte-to-high-density lipoprotein ratio was not superior to Beck's Depression Inventory and could not be used in prognosis.

Clinical Evaluation of Patients with COVID-19 Within the Framework of Comorbidities.

Objectives: Chronic systemic diseases (CSD) and cancer are closely related to the clinical course, severity and mortality of COVID-19 due to the immunosuppressive conditions caused by these diseases. The purpose of this study was to investigate the differences between the effects of cancer and CSD on the clinical and laboratory parameters of patients with COVID-19. Methods: The study included patients who received inpatient treatment with the diagnosis of COVID-19 at Ondokuz Mayis University between March 16, 2020, and December 1, 2020. The participants were divided into four groups as follows: Those without comorbidities (Group 1), those with only CSD (Group 2), those with only cancer (Group 3), and those with both CSD and cancer (Group 4). Comparative statistical evaluation was performed in terms of clinical symptoms, biochemical parameters, and admission to intensive care and survival. Results: In total, 750 patients were included: 242 patients in Group 1, 442 in Group 2, 27 in Group 3, and 39 in Group 4. The mean age of the patients was 57.1±9.4 years and 53.7% were male. Patients of Group 1 were significantly different from those of the other groups in terms of age, requirement for intensive care and intubation, complications, survival, white blood cell and lymphocyte count, neutrophil/lymphocyte ratio and levels of hemoglobin, lactic acid dehydrogenase, ferritin, D-dimer, and C-reactive protein (for each p<0.001). Conclusion: No difference was observed among laboratory parameters, intensive care admission, intubation need, complication frequency, and survival rates in patients with CSD or cancer. It was detected that all three groups with CSD and cancer were worse than Group 1 in terms of intensive care need, intubation, and survival.

The Relationship Between COVID-19 Disease Severity and Zonulin Levels.

Introduction Zonulin is a protein that plays a role in the reversible regulation of epithelial permeability. As zonulin is released in large amounts into the intestinal lumen, it disrupts the integrity of the tight junctions and causes continuous migration of antigens to the submucosa. Consequently, it can trigger inflammatory processes and severe immune reactions. In severe cases, SARS-CoV-2 may have a major impact on the clinical manifestations of the disease by directly or indirectly affecting intestinal cells and triggering systemic inflammation. Therefore, our study aimed to investigate the role of one of the possible mediators, zonulin, in the severity of the COVID-19 infection. Methods  Thirty COVID-19 patients and 35 healthy controls were included in the study. Blood samples were taken from the patients on the 1st, 4th, and 8th days of hospitalization. Serum zonulin levels were determined by enzyme-linked immunosorbent assay (ELISA). Complete blood count (white blood cell [WBC], neutrophil, lymphocyte, and platelet), biochemical parameters (serum lactic acid dehydrogenase [LDH], erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], D-dimer, ferritin, fibrinogen levels) were determined and chronic systemic disease states of the patients were assessed. Results  Serum zonulin levels were notably higher in the healthy control group compared to the patient group (p=0.003). Although there was an increase in the zonulin values by time in hospitalization, this rising was not significant. Conversely, ESR and CRP levels were significantly higher in the patient group (p<0.001). There was no significant difference between the two groups regarding gender, age, and WBC counts. Conclusion  The serum zonulin levels of COVID-19 patients with the mild clinical course were lower than the healthy control group. Moreover, serum zonulin levels were not correlated with ESR, CRP, and other inflammation markers. Our results suggest that low serum zonulin levels in COVID-19 patients might represent a mild disease course.

Ovarian Reserve and Pelvic Ultrasound Assessment in Familial Mediterranean Fever.

Introduction Familial Mediterranean fever (FMF) is an inflammatory rheumatic disease that affects people in their reproductive period. The aim of this study was to investigate the number of gravida, ovarian reserve, and ovarian doppler characteristics in FMF patients. Methods The study design is cross-sectional. Between November 1, 2018, and October 31, 2019, 40 FMF patients, and 40 age-matched volunteers were included in the study. Early follicular phase follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2), progesterone, and anti-Mullerian hormone (AMH) levels, as well as ovarian volume, antral follicle count (AFC), ovarian stromal artery doppler findings, and pelvic pathologies, were evaluated. Results The number of gravida, and the AFC was significantly higher in the control group (16.00 ± 5.22) compared to the patients with FMF (13.00 ± 4.09) (p = 0.026). LH values were significantly higher in the FMF group. Thirteen patients (32.5%) received anakinra and colchicine, and 27 patients (67.5%) received only colchicine. There was no significant difference between the patients receiving anakinra, and the patients receiving colchicine in terms of AMH, FSH, AFC, and E2 values. Conclusion FMF patients were found to have low gravida and AFC, and a significant portion was observed to have pelvic fluid and hydrosalpinx. In conclusion, the presence of pelvic fluid, hydrosalpinx, and low AFC persist in FMF patients despite colchicine and/or anti-interleukin-1 treatments. The low gravida may be related to these pathologies detected in patients with FMF.

Investigation of the effects of anti-TNF agents on hemoglobin levels in patients with inflammatory bowel disease.

Inflammatory bowel disease (IBD) is characterized by many clinical features. Anemia is 1 of the most frequent complications and/or extraintestinal manifestations of IBD. There are conflicting data regarding the relationship between changes in hemoglobin levels and disease prevalence in IBD patients with and without antitumor necrosis factor (antiTNF) therapy. In our study, we aimed to investigate the long-term effect of antiTNF agents on anemia in IBD. The records of IBD patients followed-up in our hospital between January 2011 and January 2021 were reviewed retrospectively. Demographic, clinical, endoscopic, radiological and medical treatment data of the patients were recorded. Complete blood count and laboratory markers of inflammation and disease activation, were recorded at the beginning and at the first year of treatment in all patients. The data of patients with and without antiTNF therapy were analyzed statistically. A total of 240 IBD patients who met the inclusion criteria were enrolled in the study. The number of patients with and without antiTNF therapy was 102 (42.5%) and 138 (57.5%), respectively. The change in all laboratory parameters between the beginning and the first year of treatment was statistically significant (P < .001) in all IBD patients with and without antiTNF therapy. The change in Hb level after 1 year of treatment was significantly different in patients with antiTNF therapy compared to those without therapy (3.00 ± 1.78 g/dL vs 1.19 ± 1.38 g/dL, P < .001). In the multiple regression analysis, male gender, antiTNF therapy, baseline Hb level and iron therapy were independent significant variables of hematopoietic response. This study showed that with appropriate treatment, hemoglobin levels of IBD patients with and without antiTNF therapy increased within 1 year, and the use of antiTNF agents in the treatment of IBD was an independent variable in correcting anemia.

The impact of obesity on fertility and sexual function in women of child bearing age.

Obesity and infertility are health problems that are increasing in frequency. In this study, sexual dysfunction in obese infertile women was investigated. A total of 450 women who met the inclusion criteria were recruited for the study; 150 women who had obesity without infertility, 150 women who had obesity with infertility and 150 women with normal weight but without infertility, which was the control group. The mean age of the groups were 31.3 ± 3.9, 31.2 ± 3.8 and 31.1 ± 4.5, respectively. The participants were administered a sociodemographic data form, the Female Sexual Function Index (FSFI) and the Beck Depression Inventory following the measurement of body mass index (BMI). FSFI score below 26.55 was defined as sexual dysfunction. Our data were analysed using SPSS (Statistical Package for Social Sciences) 21.0 for Windows (SPSS Inc., Chicago, IL). FSFI scores were observed to be statistically significantly lower in the group of obese women with infertility than in the other two groups. In our study, sexual dysfunction was found to be statistically significantly higher in obese women with infertility compared to the control group. Therefore, healthcare professionals should evaluate infertility in obese women in terms of sexual dysfunction as well as infertility treatment.Impact StatementWhat is already known on this subject? Psychological problems such as depression and anxiety, changes in sex hormones, and adipokines were reported to have negative impacts on sexual functions (Plaisance et al. 2009; Kendler et al. 2010; Yaylali et al. 2010). There are also various reports stating that female infertility has negative effects on sexual satisfaction and that fertility anxiety may affect sexual functions as an independent factor (Pakpour et al. 2012; Kaya et al. 2021). Even so there is a limited amount of information concerning the effects of obesity and infertility on female sexual function.What do the results of this study add? It has been found in our study that sexual dysfunction is higher in women with obesity and infertility and that this dysfunction is correlated with BMI.What are the implications of these findings for clinical practice and/or further research? It is therefore important that healthcare professionals adopt a holistic approach that incorporates sexual health consultancy to improve the treatment and quality of life of women with obesity and infertility.

A novel intubation prediction model for patients hospitalized with COVID-19: the OTO-COVID-19 scoring model.

OBJECTIVE: The method for predicting the risk of intubation in patients with coronavirus disease 2019 (COVID-19) is yet to be standardized. This study aimed to introduce a new disease prognosis scoring model that may predict the intubation risk based on the symptoms, signs, and laboratory tests of patients hospitalized with the diagnosis of COVID-19. METHOD: This cross-sectional retrospective study analyzed the intubation status of 733 patients hospitalized with COVID-19 diagnosis between March and December 2020 at Ondokuz Mayis University Faculty of Medicine, Turkey, based on 33 variables. Binary logistic regression analysis was used to select the variables that significantly affect intubation, which constitute the risk factors. The Chi-square Automatic Interaction Detection algorithm, one of the data mining methods, was used to determine the threshold values of the important variables for intubation classification. RESULTS: The following variables found were mostly associated with intubation: C-reactive protein, lactate dehydrogenase, neutrophil-to-lymphocyte ratio, age, lymphocyte count, and malignancy. The logistic function based on these variables correctly predicted 81.13% of intubated (sensitivity), 99.52% of nonintubated (specificity), and 96.86% of both intubated and nonintubated (accurate classification rate) patients. The scoring model revealed the following risk statuses for the intubated patients: very high risk, 75.47%; moderate risk, 20.75%; and very low risk, 3.77%. CONCLUSIONS: On the basis of certain variables measured at admission, the OTO-COVID-19 scoring model may help clinicians identify patients at the risk of intubation and subsequently provide a prompt and effective treatment at the earliest.

Attention! Cardiac tamponade may be caused by underlying Castleman's disease.

Castleman's disease is a rarely observed lymphoproliferative disease. In the literature, various signs and symptoms of the disease have been reported; one of these is secondary cardiac tamponade. We describe the case of a 41-year-old man who developed cardiac tamponade during examination, and who was later diagnosed with Castleman's disease, based on his lymph node biopsies.