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.

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 추계학술발표논문집 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.

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 추계학술발표논문집 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-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 추계학술발표논문집 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-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 추계학술발표논문집 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.

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 추계학술발표논문집 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-END-37 ; Endocrinology : The Relationship Between Epicardial Adipose Tissue Thickness and Vitamin D in Patients with Metabolic Synrome

( Irem Kirac Utku ),( Yildiz Okuturlar ),( Esra Demir ),( Ozlem Harmankaya ),( Bulent Demir ),( Gonul Aciksari ),( Turgut Uygun ),( Alev Kural ),( Hanise Ozkan ),( Meral Mert ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: Metabolic syndrome is a systemic disorder and manifests a group of conditions such as abdominal obesity, dyslipidaemia, hypertension, coronary artery diseases. The importance of epicardial adipose tissue recognized its contribution to inflammation by pro-inflammatory cytokines discharge has been proved. Several investigations were performed on vitamin D receptor in different tissues except bone. In this study the epicardial adipose tissue thickness (EATT) and the levels of vitamin D were measured and compared with healthy control group. Methods: A total of 148 patients (84 patients who had metabolic syndrome without diabetes and 64 healthy individuals) were enrolled into the study. In all patients, the EATT was calculated by ecocardiography and the level of serum 25(OH) vitamin D was monitored. Results: It has been observed that the EATT in patients with metabolic syndrome increases significiantly compared with healthy control group (p<0.001). No significant difference between patients and control group was found on the levels of 25 (OH) vitamin D (p=0.507). There was no correlation between 25 (OH) vitamin D and the EATT (p=0.622). Conclusion: We observed that the EATT increased in patients with metabolic syndrome. In contradiction to the literature; the levels of 25(OH) vitamin D has not been found high in patients with metabolic syndrome. The reason of this can be small number of patients in our study. A significant correlation was not found between the EATT and the levels of 25 (OH) vitamin D. Further studies with a larger patient population are required assess the relationship.

Poster Session : PS 0446 ; Infectious Disease ; Fever of Unknown Cause Which is the Cause of Intestinal Tuberculosis

( Tugrul Burak Genc ),( Yildiz Okuturlar ),( Ozlem Harmankaya ),( Suut Gokturk ),( Bulent Durdu ),( Samet Sayilan ),( Selcuk Sezikli ),( Meral Mert ),( Abaki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: In developing countries, tuberculosis (tbc) incidence is reduced; but immunocompromised patients still remain at high risk for the disease. Malignancy and Crohn`s disease should be considered in the differential diagnosis of gastrointestinal (GIS) tbc in immunocompromised patients. We present here the clinical course of a patient with fever of unknown origin and rectal bleeding. Methods: A 31-year-old male cachectic patient was admitted to hospital with abdominal pain, fever and diarrhea. The history of the patient revealed systemic lupus erythematosus, lupus nephritis and left middle cerebral artery infarction. Right hemiparesis was present. He was on warfarin 5mg/day, cilazapril 2,5mg/day, methylprednisolone 4mg/day, mycophenolate mofetil 2g/day, hydroxychloroquine 200mg/ day, levodopa+benserazide 375mg/day, levetiracetam 1 g/day. Creatinine was 2,79mg/dL, and C-reactive protein was 10 mg/dL. No pneumonic infi ltration was shown. Blood, urine and faeces cultures, Chlamydia IgM, mycoplasma IgM, toxoplasma IgM, EBV IgM, CMV IgM and PPD test were negative. Transesophageal echocardiography excluded infective endocarditis. Empiric antibiotic treatment with ceftriaxone, piperacillin-tazobactam and moxifi oxacin, and antifungal fi uconazole was started. On the 15th day hematochezia occured. Colonoscopy revealed three different massive lesions straightening the lumen in caecum, hepatic fi exure of colon and transverse colon (figure-1). Results: Pathologic examination demonstrated granulomatous lesion. Considering the positive results of Tbc-PCR treatment, the patient was diagnosed as GIS tbc and isoniazid, rifampicin, pyrazinamide and ethambutol were started. Conclusions: The ileocecal region is the most frequent localization of intestinal tbc. Colonic tbc is often localized in proximal colon and caecum, and usually associated with ileal tbc. It is rarely seen in transverse colon. Our patient is a rare case of gastrointestinal tbc presenting without pneumonic infi ltration and with an unusual localization in colon.

Slide Session : OS-END-46 ; Endocrinology : A Rare Cause of Secondary Hypertension: An Unusual Case of Conn`s Syndrome

( Samet Sayilan ),( Yildiz Okuturlar ),( Meral Mert ),( Ozlem Soyluk ),( Serkan Enki ),( Yesim Ozden Inan ),( Ozlem Harmankaya ),( A Baki Kumbasar ) 대한내과학회 2014 대한내과학회 추계학술발표논문집 Vol.2014 No.1

Background: Primary hyperaldosteronism (PHA) is a syndrome arising from autonomous aldosterone secretion from the adrenal gland and suppression of plasma renin activity. PHA is usually seen due to unilateral adenoma or bilateral hyperplasia. We present a case of Conn`s syndrome with bilateral adrenal lesions but unilateral functioning adenoma. Methods: A 43 years old female admitted to the emergency service due to inability to walk for 3 days, fatigue and generalised pain. She had a history of diabetes mellitus and hypertension for 15 years. She was receiving angiotensin receptor blocker with thiazide, calcium channel blocker, beta-blocker and insulin treatment. Her blood tests revealed alkalosis and severe hypokalemia with normal renal function. In the examinations for the causes of secondary hypertension; 24-hour urinary cortisol, metanephrine, normetanephrine and VMA levels were normal. Results: After cessation of diuretic treatment plasma renin activity (PRA) was measured 0.17 ng / mL/ h while plasma aldosterone level (PAL) was measured 71 ng / dl. The ratio of PAL / PRA was very high. Her abdominal MRI revealed bilateral adrenal lesions with 23x14 mm and 12x8 mm in diameters in the right and left adrenal gland respectively compatible with adenoma. On the other hand adrenal venous sampling (AVS) showed lateralisation for the right side. Conclusions: Most common causes of PHA are unilateral aldosterone secreting adenoma and bilateral adrenal hyperplasia. Although the appearance of bilateral adrenal lesions in MRI in our case, results of AVS were compatible with autonomous aldosteron production on the right side. According to these findings we accepted the case as a unilateral functioning adenoma with an incidentaloma on the other side.