Utility of Peripheral Blood Parameters in Predicting Breast Cancer Risk

Okuturlar, Yildiz,Gunaldi, Meral,Tiken, Elif Eda,Oztosun, Bugra,Inan, Yesim Ozdem,Ercan, Tarik,Tuna, Savas,Kaya, Ali Osman,Harmankaya, Ozlem,Kumbasar, Abdulbaki Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.6

Purpose: We aimed to study the inflammatory parameters of complete blood count in breast cancer cases. Materials and Methods: This retrospective study covered 178 breast cancer patients and 107 age and body mass index matched healthy women. Complete blood count parameters, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and MPV/platelet were analyzed. Results: The leukocyte, neutrophil and neutrophil/lymphocyte ratio were higher in the patient group (p values 0.001, 0.0001 and 0.0001, respectively) while haemoglobin and hematocrit were higher in the control group (p=0.0001 for both). Logistic regression analysis showed that elevated neutrophils and platelet distribution width (PDW) (OR: 0.627, 95%CI: 0.508-0.774, p=0.001 and OR: 1.191 95%CI: 1.057-1.342 p=0.003) were independent variables for predicting breast cancer. The cut-off value for the neutrophil/lymphocyte ratio was 2.56. Conclusions: According to our study results, neutrophil levels as part of complete blood count may be used as an independent predictor of breast cancer risk.

Slide Session : OS-END-45 ; Endocrinology : Effect of Business Life on Obesity in Women

( Yildiz Okuturlar ),( Gulseren Gunduz ),( Nilgul Akalin ),( Meral Mert ),( Didem Acarer ),( Ozlem Soyluk ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: The most important factor in the fight against obesity is thought to be change in lifestyle. Business life can effect weight and body fat distribution through its effects on levels of eating, sleeping, exercise and stress. In our study the relation between BMI, body fat distribution, 25-hydroxycholecalciferol (25-OH-D3), homeostasis model assessment (HOMA-R) and A1c levels were evaluated in working and non-working obese patients having a BMI of 30. Methods: Total number of 122 patients (62 of working and 60 of non-working) were enrolled in to the study. Medical history, weight-height-BMI- body fat ratio measurements and A1c- insulin- glucose- cortisol- 25-OH-D3- HOMA-R levels of all patients were recorded. Results: Between the working and non-working groups there were significant differences in average age (35.30±11.96 and 44.51±11.84 respectively, p=0.0001), weight (89.18±11.90 kg and 94.34±13.45 kg respectively, p=0.029), BMI (34.47±4.167 kg/ m2 and 37.39±5.65 kg/m2 respectively, p=0.002), body fat ratio (41.23±5.447% and 43.53±6.077% respectively, p= 0.029) and cortisol level (11.66±4.441 μg/dL and 14.12±5.402 μg/dL, respectively, p=0.029). Unlikely there were no significant differences in insulin, A1c, glucose, 25-OH-D3 and HOMA-R values. There were positive correlations between age and Alc and between BMI and age. Conclusions: Business life may lead to increase in weight and BMI. But in our study weight and BMI was significantly lower in the working group. This finding may be related to certain meal times, sleeping regime and physical activity of the working life which are effective on fat distribution and weight management.

Slide Session : OS-HEM-11 ; Hematology : Single Centre Experience of Serum Galactomannan Levels in the Diagnosis of Invasive Aspergillosis

( Yildiz Okuturlar ),( Fahir Ozkalemkas ),( Beyza Ener ),( Sibel Ocak Serin ),( Esra Kazak ),( Tulay Ozcelik ),( Vildan Ozkocaman ),( Atilla Ozkan ),( Halis Akalin ),( Meral Gunaldi ),( Ridvan Ali ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Invasive aspergillosis (IA)) is a serious cause of morbidity and mortality in immunocompromised patients with haematologic malignancy. The serum galactomannan enzyme immunoassay (GM-EIA; Platelia Aspergillus EIA; Bio-Rad) was cleared by the Food and Drug Administration at an optical density index cut-off of 0.5 for a probable diagnosis of invasive aspergillosis. In this prospective study GM-EIA (Platelia Aspergillus EIA, Bio-Rad) with 0.5cut-off value and sequential sensitivity-specificity for single, consecutive two and consecutive three positivity were investigated for the diagnosis of IA in neutropenic hematologic patients. Methods: Serum samples were taken twice a week from patients during their hospitalization. IA was classified according to European Organisation for Research and Treatment of Cancer and Mycoses Study Group Guidelines as “proven”, “probable”, and “possible”. The sensitivity was calculated from the results of patients with proven/propable and the specificity was calculated from the results of patients non-IPA patients. Results: In 165 consecutive febrile episodes in 106 patients, 80 (48.5%) episodes were defined with IA (4 proven, 11 probable, 65 possible) and 85 (51.5%) episodes were defined as non-IA. Per episode average 8.3 serum samples were examined for a total of 1385 serum samples. Cut-off value of single GM-EIA = 0.5 for proven/probable IA with sensitivity/specificity 100%/ 27%, two consecutive positive GM-EIA = 0.5 with sensitivity/specificity 86%/ 71% and three consecutive positive GM-EIA = 0.5 with sensitivity/specificity 73%/85% were obtained. Conclusions: Measuring the level of galactomannan twice a week and consecutive monitoring reduced the sensitivity and increased the specificity. Monitoring of the GM-EIA frequently from the first positivity can increase sensitivity/specificity.

Slide Session : OS-END-16 ; Endocrinology : Brachial intima-Media Thickness and Paraoxonase -1 Activity in Different Patients Group

( Yildiz Okuturlar ),( Meral Mert ),( Pinar Karakaya ),( Aysun Erbahceci Salik ),( Asuman Gedikbasi ),( Nilgul Akalin ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Atherosclerosis is one of the most important causes of death worldwide. Detection and prevention of the organ damage and determination of the risk due to atherosclerosis is getting more and more important in recent days. Brachial Intima-Media Thickness (B-IMT), mean platelet volume (MPV), paraoxonase (PON) and arylesterase (ARE) are accepted as markers of atherosclerosis. In this study we aimed to determine the importance of B-IMT, ARE, PON and MPV levels in four patient groups which are expected to have increased risk of atherosclerosis without vascular complications. Methods: A total of 100 patients (32 prediabetic patients = group 1, 13 subclinical hypothyroidism + prediabetic = group 2, 20 subclinical hypothyroidism = group 3, 35 diabetic patients = group 4) are enrolled into the study. Height, weight, BMI, age, gender, smoking, alcohol, exercise, family history of diabetes mellitus and cerebrovasculer disease, childbirth, menopause status and HOMA levels of all patients were recorded. Routine biochemical tests and Alc, lipid profiles, homocysteine, PON, ARE were performed and brachial artery index was measured. Results: There were no significant differences in age, B-IMT, BMI, homocysteine, MPV, PON and LDL, HDL levels between the groups. We found a significant difference in A1c (p=0.001), glucose (p=0.0001), ARE (p=0.0001), triglyceride (p=0.005) and HOMA-R (p=0.0001) levels between groups. The significant correlations were shown in Table-1. Conclusions: The relationship between insulin resistance, lipid profile, TSH, B-IMT, PON, ARE and MPV are not similar in different patient groups. This is probably due to varying degrees of atherosclerosis in patients.

Slide Session : OS-NEP-06 ; Nephrology : Paraoxonase-1 Activity in Patients with Anemia with or Without Chronic Renal Failure

( Yildiz Okuturlar ),( Nilgul Akalin ),( Ozlem Harmankaya ),( Nurten Turan Guner ),( Deniz Yilmaz ),( Asuman Gedikbasi ),( Ozlem Soyluk ),( Meral Mert ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Paraoxonase (PON)-1 is an antioxidant enzyme. It has three known activities, paraoxonase, arylesterase and diazoxonase. It has been reported that PON-1 defi ciency is related to increased susceptibility to development of atherosclerosis and cardiovascular disease. The aim of this study is to evaluate antioxidative status and carotid intima-media thickness (CIMT) in patients with anemia with/without chronic renal failure. Methods: 42 patients with anemia and a control group of 47 patients were enrolled in to the study. Patients were divided into two groups as Group 1 with iron defi ciency anemia and Group 2 with chronic renal failure and anemia of chronic disease and Group 3 as the healthy control group. In all three groups antioxidative status was evaluated by measuring free sulfhydryl groups (-SH = total thiol), paraoxonase and arylesterase levels. CIMT measurements were also performed at the same time. Results: In all three groups, age, weight, average height, gender, presence of diabetes and smoking habit were not signifi cantly different (p>0.05). Hemoglobin levels were 7.85 ± 1.25 in Group 1, 8.62 ± 1.09 in Group 2 and 13.45±1.63 in Group 3. We have found that Arylesterase and -SH levels were decreased both in Group 1 and 2 according to Group 3. Bilateral CIMT was increased only in Group 2. Between group 1 and group 2 the only difference was the the more signifi cant decrease in Arylesterase levels in group 2 (Table 1-2). Conclusion: PON-1 activity and -SH levels may be independently associated with the presence of atherosclerosis.

Serum galactomannan levels in the diagnosis of invasive aspergillosis

( Yildiz Okuturlar ),( Fahir Ozkalemkas ),( Beyza Ener ),( Sibel Ocak Serin ),( Esra Kazak ),( Tulay Ozcelik ),( Vildan Ozkocaman ),( Hasan Atilla Ozkan ),( Halis Akalin ),( Meral Gunaldi ),( Ridvan A 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.6

Background/Aims: In this study, the sensitivity-specificity of galactomannan-enzyme immunoassay (GM-EIA) with a cut-off value of 0.5 for a single, two, or three consecutive positivity in the diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients with hematological malignancy was investigated. Methods: IPA was classified as “proven,” “probable,” or “possible” as described in the guidelines prepared by the European Organization for Research and Treatment of Cancer and Mycoses Study Group.” Serum samples were collected from the patients twice a week throughout their hospitalization. A total of 1,385 serum samples, with an average of 8.3 samples per episode, were examined. Results: Based on the 165 febrile episodes in 106 patients, 80 (48.5%) were classified as IPA (4 proven, 11 probable, 65 possible) and 85 (51.5%) as non-IPA. The sensitivity/ specificity was 100%/27.1% for a single proven/probable IPA with the cut of value of GM-EIA ≥ 0.5, 86.7%/71.8% for two consecutive positive results, and 73.3%/85.9% for three consecutive positive results. Conclusions: With the galactomannan levels measured twice a week, consecutive sensitivity decreased and specificity increased. Therefore, an increase may be obtained in sensitivity-specificity by more frequent monitoring of GM-EIA starting from the first day of positivity is detected.

Slide Session : OS-END-23 ; Endocrinology : The Relationship Between Testosterone and Homa-R Levels in Overweight Patients

( Yildiz Okuturlar ),( Meral Mert ),( Ozlem Soyluk ),( Ozlem Harmankaya ),( Pinar Karakaya ),( Samet Sayilan ),( Didem Acarer ),( A Baki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: It was shown that there is a correlation between low testosterone level and insulin resistance. Insulin resistance is related with metabolic syndrome and type 2 diabetes which represent a risk factor for cardiovascular disease. Obesity has become an important public health problem and it is known that it has an adverse effect on reproductive system and fertility. In our study it was aimed to investigate the relation between testosterone level and insulin resistance in overweight male and female patients. Methods: In our study total number of 2699 female and 377 male patients who admitted to our hospital because of weight problem and had BMI>25 were evaluated retrospectively. Correlation analyses between total testosterone level and parameters like fasting blood glucose, insulin level, Alc and HOMA values were performed. Results: While average age was 41.38±12.50 years in female patients it was detected 39.15±13.73 years for male patients. While negative correlations were found between testosterone level and age, testosterone level and glucose, testosterone level and Alc in the female group there were no correlations between testosterone level and HOMA, testosterone level and insulin in the same group. Whereas in the male group negative correlations were found between testosterone level and glucose, testosterone level and insulin, testosterone level and Alc and testosterone level and HOMA in the male group (Table 1). Conclusions: The correlation between testosterone level and insulin was reported in female patients with polycystic ovary syndrome. In our study glucose and A1c levels may increase while testosterone level decreases in both male and female groups. In addition to this finding insulin level and HOMA also increases with the decrease of testosterone in male patients. This may be explaned by the metabolic effect of testosterone.

Poster Session:PS 0191 ; Endocrinology : In Circulation Increased Antithyroid Peroxidase Antibody and Matrix Metalloproteinase-9 Levels at Patients with Metabolic Syndrome

( Sibel Serin ),( Yildiz Okuturlar ),( Asuman Gedikbasi ),( Irem Kilic Utku ),( Sema Ucak Basat ),( Ozlem Harmankaya ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Objective: Frequent changes in parameters like blood pressure, plasma lipid changes, waist circumference which are accepted as a metabolic syndrome (MS) are observed in thyroid patients with hypothyroid. In this study we investigated serum levels of TPO which is the diagnosis of hypothyroid and prognosis criteria antithyroid peroxidase antibody (Anti-TPO) in patients with MS and we analysed the correlation with matrix metalloproteinases-9 (MMP-9) which is accepted as an indicator of infl ammation in MS. Method: 51 patients with MS and 35 controls were enrolled in the study. Age, body mass index (BMI), waist circumference and hypertension (HT) values of both group were recorded in the beginning. Medical records of HT were noted and cardiovascular diseases in their family were queried. Insulin, glucose, HOMA-IR, total cholesterol, LDL, HDL, TG, TSH and Anti-TPO levels were measured. Blood samples for measuring MMP- 9 were stored at -80°C. Measurement of MMP-9 was performed by using solid phase platinum ELISA kits (Biosource). Results: Study was performed with 51(59,3%) MS group and 35(40,7%) control group. Both Anti-TPO and MMP-9 levels of patients with MS were statistically and signifi cantly higher than the levels of control group (p<0.01 for both group). There is a statistically signifi cant correlation (positive, 83.2%) between MMP-9 and TPO in patients with MS (p<0.01). There is a statistically signifi cant correlation (positive, 37.5%) between MMP-9 and TPO in controls (p<0.05). Discussion: Researching Anti-TPO in patients with MS might be an indicator of higher rate of both hypothyroid and MS. High levels of both MMP-9 (>76 mg/ml) and TPO show that TPO can be used as a cheaper and more easily provided marker in patients with MS without acute thyroid. Anti-TPO follow-up might be necessary in MS diagnosis and monitoring.

Slide Session : OS-END-20 ; Endocrinology : Hemorheological Approach for Early Detection of Diabetic NephropathyCardiovascular Risk Rates in Metabolic Syndrome and Atherosclerotic Marker Serum MatrIx MetalloproteIn-ase-9 Levels

( Sibel Serin ),( Yildiz Okuturlar ),( Asuman Gedikbasi ),( Esra Demir ),( Sema Ucak Basat ),( Ozlem Harmankaya ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Introduction: Metabolic syndrome (MS) is associated with increased cardiovascular risk. There are a lot of study that is releated with the correlation between metabolic syndrome and low grade inflammation. We have attempted to compare Framingham Risk Score(FRS) that calculates cardiovascular risc rates and Matrix Metalloproteinase- 9 levels that is an aterosclerotic proinflammatory marker, on metabolic syndrome`s between other healties. Method: We included 86 patients that contains 51 MS and 35 healties to this study..In both groups, age, length, weight, BMI, waist circumference, familial hearth disease and HT on family was registered. Framingham risk score (FRS) was calculated. Insulin, glucose, HOMA-IR, total cholesterol, LDL, HDL, Triglyceride levels saved. Blood samples for MMP -9 levels were taken and stored at -80 ℃. MMP-9 levels measured by the way of solid phase platinium ELISA (BIOSOURCE). Results: This case contained 86 patients, 51 of them is MS (%59.3) and the others are called as control group (%40.7). Ages of patients are changed between 20-55 years and the mean age is 38.52±10.02. FRS of MS patients were calculated statistically high compaired to control group (p=0.017). MMP-9 levels of MS patients were calculated statistically high compaired to control group (p=0.001).In both goups, there is no statistically significant relationship between MMP-9 levels and FRS (p>0.05) Conclusion: MMP-9 changes between the groups of MS young aged of 20-55 and health group may show us early atherosclerosis. At the group of high MMP-9 levels, even age releated cardiovasculary hearth disease risks are lower, risk was statistically calculated high compared to the other healthy populations. This situation is important in order to control risk factors as MS at early ages.

Slide Session : OS-END-12 ; Endocrinology : Is There a Correlation Between Paraoxanase-1 Activity, MPV and Other Atherosclerotic Risk Factors in Prediabetic and Diabetic Patients?

( Meral Mert ),( Yildiz Okuturlar ),( Pinar Karakaya ),( Asuman Gedikbasi ),( Filiz Islim ),( Ozlem Harmankaya ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: It has been reported that MPV is increased in diabetes while the status of MPV in prediabetes is not well known. It has been reported that decreasing level of paraoxonase-1 is related to increased probability of development of atherosclerosis and cardiovascular disease (CVD). In this study we compared the mean platelet volume (MPV), paraoxonase-1 (PON) and arylesterase (ARE) levels in patients with the diagnosis of prediabetes and diabetes mellitus (DM). Methods: Forty five prediabetic patients and 135 type 2 diabetic patients were enrolled into the study. Height, weight, BMI, age, gender, smoking, alcohol, exercise, family history of DM and CVD, childbirth, menopause status of all patients were recorded. Routine biochemical tests and A1c, lipid profiles, homocysteine, PON, ARE and MPV levels were performed. Results: Mean age of diabetics and prediabetic patients are 53.4 ±13.7 and 53.0±12.8 respectively. Age, weight, height, BMI and MPV levels were not significantly different in both groups but PON, ARE, A1c and HOMA levels were significantly different (p=0.0001). There were no significant differences in smoking, hypertension, hyperlipidaemia, exercise, coronary heart disease between the two groups. There was no significant correlation between MPV and PON, ARE but there was a negative correlation between Alc, glucose, WBC values and PON, ARE. We also found a negative correlation between triglyceride and PON levels and microalbuminuria and ARE levels. Conclusions: There was no difference in MPV level in both groups having different risk of atherosclerosis and probably because of the limited number of prediabetic patients in our study. However, lower levels of PON and ARE may have been caused by high risk of atherosclerosis in diabetic patients. It would be more reliable to analyse MPV, PON and ARE according to biochemical and clinical conditions.