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INTRODUCTION: Asprosin is a hormone that was first reported by Romere et al. [2016]. Its secretion is induced in the case of starvation. Asprosin promotes hepatic glucose release. There is no literature information available in humans to demonstrate how blood and saliva asprosin levels of patients with the newly identified type 2 diabetes mellitus (T2DM) changed after metformin treatment. We aim to examine these changes and contribute to the literature in this sense. MATERIAL AND METHODS: A total of 60 individuals: 30 healthy volunteers and 30 newly identified cases of T2DM whose treatment had been initiated, were included in the investigation. Blood and saliva sample specimens were carefully taken from both groups. Saliva asprosin and serum levels were tested using the ELISA method. Immunohistochemical methods were used to test asprosin formation sites in salivary gland tissues. RESULTS: Similarly increased asprosin levels were observed in patients from the newly diagnosed T2DM group compared with the healthy control group (p = 0.003). In the newly defined T2DM group, blood asprosin levels decreased significantly after three months of metformin treatment (p = 0.032). In terms of saliva asprosin levels, when the healthy control group and the newly identified T2DM group were compared, saliva asprosin levels were found to be higher in the newly identified T2DM group (p < 0.001). With immunohistochemical staining, asprosin immunoreactivity was observed in the submandibular and parotid glands. CONCLUSIONS: In our study, serum and saliva asprosin levels increased significantly in the newly identified individuals with type 2 diabetes, which suggests that asprosin could form a critical risk related to T2DM. Higher asprosin levels are an important marker for predicting diabetes development, and that this hormone can be signified as a main or target molecule in the treatment of diabetes.

Introduction Major depressive disorder (MDD) is an important risk factor for cardiovascular mortality and morbidity. Red blood cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) can be obtained with a basic hemogram test. These parameters have been found as a predictor of mortality in the general population and in several diseases such as cardiovascular disease. Methods Our study included 100 patients with newly diagnosed MDD and 100 healthy control patients (who had no depressive symptoms and without heart disease) admitted to our outpatient clinics. Patients with MDD were started on selective serotonin reuptake inhibitor (SSRI) treatment and followed up for 3 months. Both MDD and control patients’ laboratory tests and physical, neurological, and psychiatric examinations were performed both at diagnosis and after 3 months of treatment. Results In total, 100 patients with MDD were evaluated and 80 were included in our study. The control group consisted of 91 healthy individuals. The mean age was 44 ± 10.6 years for patients with MDD and 39.8 ± 11.4 years for the control group. There was no significant difference between the age for groups ( P  = 0.13); 55% of patients with MDD and 33% of the control group was male. NLR levels were found to be 2.55 ± 0.7 and RDW levels were found to be 14.3 ± 2.6 in patients with MDD; NLR levels were found to be 1.41 ± 0.8 and RDW levels were found to be 13.4 ± 1.8 in the control group. RDW and NLR levels were significantly higher in patients with MDD compared to the control group. The significant difference between the levels of RDW and NLR in patients with MDD and the control group was dissolved after SSRI treatment ( P  < 0.001). RDW [median 14.3, interquartile range (IQR) 2.8 vs. median 13.25, IQR 2.45; P  < 0.001] and NLR (median 2.3, IQR 1.1 vs. median 2.0, IQR 1.15; P  < 0.001) levels were significantly higher in patients with MDD compared to the control group. Conclusion Our study showed that hematological inflammatory markers might be useful parameters that can be used in patients with MDD for coronary artery disease risk. Specifically, RDW and NLR seem to be more hopeful. Advanced, detailed, and larger studies are needed.

Abstract Context Bone mineral density is normal in acromegalic patients and the cause of increased fracture risk that characterizes active acromegaly is unknown. Objective This study compared serum sclerostin levels between patients with active acromegaly and healthy individuals. Design, Setting, and Participants The serum sclerostin levels of patients with active acromegaly were compared with those of healthy volunteers in a cross-sectional study. The mean age of the 30 acromegaly patients (male/female: 14/16) was 47.26 ± 12.52 years (range, 18–64 years) and that of the healthy volunteers (male/female: 17/13) was 44.56 ± 10.74 years (range, 19–62 years). IGF-1 and GH levels were measured using an electrochemiluminescence method, and serum sclerostin levels using an ELISA. The Mann-Whitney U test was used to compare sclerostin levels between the 2 groups. The correlations of sclerostin level with IGF-1 and GH were determined using Spearman’s test. Results The 2 groups did not differ in age or sex (P > 0.05). The median GH and IGF-1 levels in the patient group were 2.49 ng/mL (range, 0.22–70.00 ng/mL) (interquartile range [IQR], 1.3–4.52) and 338.5 ng/mL (range, 147–911 ng/mL) (IQR, 250–426), respectively. The median GH and IGF-1 levels in the control group were 0.95 ng/mL (range, 0.3-2.3) and 144 ng/mL (range, 98–198), respectively. The median sclerostin level was 29.95 ng/mL (range, 7.5–78.1 ng/mL) (IQR, 14.37–37.47) in the acromegaly group and 22.44 ng/mL (range, 8.45–36.44 ng/mL) (IQR, 13.71–27.52) in the control group (P < 0.05). There was a moderate positive correlation between the sclerostin and IGF-1 levels (rho = 0.54; P < 0.01), and between the sclerostin and GH levels (rho = 0.41; P < 0.05). Conclusions High sclerostin levels may contribute to the increased fracture risk seen in patients with acromegaly.

Background/Objectives: Isthmin-1 (ISM1) is a secreted protein involved in immune regulation, inflammation, and angiogenesis. Although ISM1 has been implicated in chronic inflammatory conditions, its clinical relevance in rheumatoid arthritis (RA) remains unknown. This study aimed to evaluate serum ISM1 levels in RA patients and assess their associations with disease activity, autoantibody status, and inflammatory markers. Methods: This cross-sectional study included 90 RA patients fulfilling the 2010 ACR/EULAR criteria and 30 age- and sex-matched healthy controls. Serum ISM1 concentrations were measured using ELISA. Disease activity was assessed using DAS28-CRP and DAS28-ESR. Statistical analyses included group comparisons, correlation testing, multivariate linear regression, and ROC curve analysis to evaluate the predictive performance of ISM1 for remission or low disease activity. Results: Serum ISM1 levels were significantly lower in RA patients than in controls (454 ± 378 vs. 972 ± 809 ng/L, p < 0.001). ISM1 concentrations were inversely correlated with CRP, ESR, and both DAS28 indices. Multivariate regression confirmed independent associations between lower ISM1 concentrations and higher disease activity. ISM1 levels were significantly reduced in RF- and anti-CCP-positive patients, as well as in treatment-naïve early RA. ROC analysis identified a cut-off value of 673.73 ng/L for predicting remission or low disease activity, with an AUC of 0.713 (95% CI: 0.596–0.820), 100% specificity, and 38.9% sensitivity. Conclusions: This study is the first to demonstrate that serum ISM1 is independently associated with disease activity and autoantibody positivity in RA. High ISM1 levels may serve as a specific indicator of clinical remission or low disease activity, supporting its potential as a non-invasive biomarker for disease monitoring.

Background and Objectives: Type 2 Diabetes Mellitus (T2DM) is a metabolic disease caused by the failure of the skeletal muscle, liver and adipose tissue to respond to insulin. Metformin is the first choice for the treatment of T2DM. Isthmin 1 (Ism1) is a newly discovered adipokine that affects all carbohydrate, lipid and protein metabolism. This study examines the changes in serum and salivary levels of Ism1 in patients using metformin, considering its potential as a follow-up marker for T2DM if present in the salivary glands. Materials and Methods: The study included 30 newly diagnosed T2DM patients and 30 non-diabetic controls. Ism1 was measured by ELISA in serum and saliva after 3 months and compared with routine biochemical parameters. Immunostaining of Ism1 was performed in salivary glands. Results: Ism1 was immunohistochemically detected in salivary glands for the first time. Serum Ism1 levels increased significantly after 3 months of metformin treatment (p = 0.028). The increase in salivary Ism1 levels did not reach statistical significance. Fasting plasma glucose (FPG) (p < 0.001), HbA1c (p < 0.001) and LDL (p = 0.015) levels decreased with metformin. There was a significant negative correlation between the increase in Ism1 levels and the decrease in LDL levels (rho = −0.362, p = 0.05). Conclusions: Despite its first detection in salivary glands, the hypothesis that Ism1 may be a surveillance marker in T2DM could not be confirmed. The negative correlation of Ism1 with LDL levels suggests that Ism1 may contribute to the ameliorative effect of metformin on serum lipids. Further studies are needed to support this conclusion.

INTRODUCTION: Meteorin-like (Metrnl), also known as subfatin, is a recently discovered adipokine with a favourable effect on insulin sensitivity. Studies have shown lower Metrnl levels in obese patients. However, data on its circulating levels in type 2 diabetes mellitus (T2DM) patients are contradictory. This study aims to evaluate serum Metrnl levels in T2DM patients and determine the relationship between serum Metrnl levels and insulin resistance in these patients. MATERIAL AND METHODS: This cross-sectional study was conducted among 150 participants. The study was carried out between June 2019 and December 2019 at the internal medicine outpatient clinic of a tertiary university hospital. The participants were divided into three groups: group 1 (control group, n = 50), group 2 (newly diagnosed T2DM, n = 50), and group 3 (long-standing diagnosed T2DM, n = 50). An enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of Subfatin (Metrnl), and the correlations of Metrnl level with anthropometric parameters, HOMA index, and biochemical measurements were assessed. RESULTS: There was no statistically significant difference between the gender (p = 0.468) and age (p = 0.067) characteristics of the three groups. The Metrnl (subfatin) levels of the participants were as follows: control group – 20.05 (1.56–103.78); newly diagnosed T2DM group – 2.62 (1.25–103.78); and long-standing diagnosed T2DM group – 2.01 (0.80–19.84) pg/mL. The Metrnl (subfatin) levels of the participants in the control group were higher than in the participants in the newly diagnosed T2DM and long-standing diagnosed T2DM groups (p < 0.001). Subfatin demonstrated a negative correlation with insulin and HOMA-IR in the control group and long-standing diagnosed T2DM group. CONCLUSIONS: The subfatin level was found to be higher in the healthy control group than in both diabetic patient groups. Subfatin level showed negative correlation with both insulin level and HOMA index. There was a relationship between subfatin and insulin resistance. Low levels of subfatin in the diabetic patient groups may play a role in the pathogenesis of T2DM by increasing insulin resistance.

INTRODUCTION: Diabetes mellitus (DM) is a primary disease of the carbohydrate metabolism that is characterised by absolute or relative insulin deficiency, or insulin resistance. Although life expectancy is low for diabetic patients, the prognosis has been improved in recent decades. Metformin is an oral antidiabetic that reduces insulin resistance and plasma glucose levels by decreasing glucose production in the liver. It can be used as a standalone treatment or in combination with other antidiabetic medications or insulin. Urotensin 2 (U-II), which is one of the most effective known vasoconstrictor peptides, was observed to act as a vasoconstrictor in diseases such as hypertension and heart failure, and to induce vasodilation in healthy volunteers. Some studies have proposed that the activation of the U-II system could lead to metabolic syndrome. Certain studies have determined a link between DM and U-II. However, there exist no studies on the effects of U-II in recently diagnosed type 2 DM patients after metformin treatment. This study aims to investigate the plasma and saliva levels of U-II at diagnosis and after a three-month metformin treatment in recently diagnosed type 2 DM patients, and to compare these levels to those of healthy volunteers. MATERIAL AND METHODS: Our study compared 30 recently diagnosed type 2 DM patients to their states after three-month metformin treatment and 30 healthy volunteers. RESULTS: When compared with the control group, there was no significant increase in the plasma and saliva U-II levels of recently diagnosed type 2 DM patients. We determined a statistically significant increase in the plasma and saliva ureotensin-2 levels of recently diagnosed type 2 DM patients after a three-month metformin treatment (p < 0.05).Conclusions: It was concluded that the patients with type 2 DM have a multifactorial aetiopathogenesis and an increase in U-II levels after metformin treatment. Metformin has no known effect on the U-II metabolism; therefore, the findings need confirmation through more clinical and experimental studies with more participants.

•TMAO and interleukins can be markers of sepsis and sepsis shock.•TMAO levels are higher in patients after sepsis and COVID-19 than only sepsis.•COVID-19 curtails resistance to sepsis diseases. Inflammation is a response of the immune system to protect the body against various diseases or injuries. Serum trimethylamine N-oxide (TMAO) levels may vary depending on age, gender, habits, comorbidities, and microbiota. In this study, we investigated whether TMAO levels have diagnostic significance and their potential as a marker in the early diagnosis of the disease. Another aim of the research was to identify changes in TMAO levels as a reflection of the deterioration in the microflora, and IL-6, IL-10, IL-1β, TNF-alpha, and LPS levels in patient groups. Then, we recognized relationships between these parameters in patients infected with COVID-19 without septic shock and with COVID-19 who were without transmission of COVID-19 in septic shock. A total of 160 patients were investigated, including 40 patients infected with COVID-19 without septic contact, 40 patients with COVID-19 positive septic shock, 40 patients with COVID-19 negative septic shock, and 40 healthy individuals as the control group. TNF-α and IL-1β levels were significantly lower (P < 0.001) and IL-6 and IL-10 levels were significantly higher (P < 0.001) in patient groups than in control groups. IL-1β showed a significant decrease, especially in the groups infected with COVID-19. Although IL-6, increased even more in the groups infected with COVID-19. LPS level was remarkably high in the sepsis group infected with COVID-19 compared to the other groups. TMAO level was significantly higher (P < 0.001) in the sepsis group. Therefore, TMAO is a potential biomarker in sepsis and septic shock.

Objective: To examine potential associations between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, mean platelet volume (MPV), HbA1c and microvascular complications in diabetic patients from a cost-effectiveness perspective. Methods: One hundred patients with type 2 diabetes attending our outpatient unit between May 2018 and October 2018 were included, and 100 healthy individuals served as the control group. A retrospective file search was performed to collect information on hemoglobin, mean platelet volume (MPV), glycosylated haemoglobin (HbA1c), hematocrit (Hct), neutrophil and lymphocyte count, neutrophil/lymphocyte ratio (NLR), platelets (Plt), platelet/lymphocyte ratio (PLR), and microvascular complications (neuropathy, retinopathy, nephropathy). Results: Demographic and laboratory data were retrospectively controlled between diabetes (n=100) and healthy control (n=100) groups. The mean age in diabetic patients and healthy controls was 56.34 and 36.68 years, respectively. The mean NLR in diabetics and healthy controls was 2.48 and 2.11, the difference in NLR being significant (p=0.002). MPV in diabetics and controls was 8.54 and 8.53, respectively, and the difference was not significant (p=0.93). PLR was also similar, i.e. 149.7 and 145.3 in diabetics and healthy controls (p=0.067). With respect to microvascular complications, retinopathy was found to be significantly associated with MPV and NLR (p=0.015, and p=0.051), and nephropathy showed a significant association with NLR (p=0.027) among diabetics. In contrast with the two other microvascular complications, no significant association between neuropathy and NLR could be detected, while PLR and neuropathy was significantly associated (p=0.003). Conclusion: Microvascular complications may be associated with certain hematologic parameters, as suggested by comparisons both between diabetics and healthy individuals and within the group of diabetic individuals. We believe that hematologic parameters such as hematocrit, MPV, NLR, and PLR, which can be obtained through a simple complete blood count, may be utilized as cost-effective predictors of diabetic microvascular complications. Further prospective studies with larger sample size are required to better delineate these associations. doi: https://doi.org/10.12669/pjms.35.6.1150 How to cite this:Onalan E, Gozel N, Donder E. Can hematological parameters in type 2 diabetes predict microvascular complication development? Pak J Med Sci. 2019;35(6):1511-1515. doi: https://doi.org/10.12669/pjms.35.6.1150 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objectives Platelet (PLT) indices are predictive in many diseases and conditions. The relationships of these indices with proteinuria and progression of renal disease are not well known. This study aimed to assess PLT indices in patients with primary glomerular nephrotic range proteinuria (PGNRP), with and without chronic kidney disease (CKD), and to compare these indices with those of healthy individuals (His). Methods This cross-sectional study was performed from January 2015 to May 2015. HIs (n = 57) and patients with PGNRP (n = 41) were enrolled. PLT indices and blood biochemistry parameters were compared between HIs and patients with PGNRP, as well as between subgroups of patients with PGNRP who had CKD (n = 23) and those who did not have CKD (n = 18). Results There were no statistically significant differences in any PLT indices (i.e., platelet number, mean platelet volume, plateletcrit, and platelet distribution width) between HIs and patients with PGNRP, or between the subgroups of patients with PGNRP. However, patients with PGNRP who had CKD exhibited higher median C-reactive protein and mean albumin levels, compared with patients who did not have CKD. Conclusions Pathological processes in proteinuria and CKD are not associated with PLT indices.