Gulali Aktas

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver condition, affecting approximately 30% of the general population. Type 2 diabetes mellitus (T2DM) and MASLD are closely linked, and similar management strategies often apply to both conditions. For example, weight reduction has beneficial effects on both diseases. Sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists have transformed the treatment landscape of T2DM. Recent evidence suggests that these agents may also provide benefits in MASLD, as they promote weight loss and reduce hepatic fat content. The aim of this minireview is to provide a detailed overview of current literature from clinical and experimental studies regarding the role of sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in the management of MASLD, with a particular focus on their mechanisms of action, therapeutic efficacy, and impact on liver-related and cardiometabolic outcomes in patients with or at risk for T2DM.

Background: Rhabdomyolysis is a clinical and biochemical syndrome characterized by the release of cellular contents into circulation due to skeletal muscle injury. Important indicators of muscle damage include myoglobin, creatinine kinase (CK), and lactate dehydrogenase. The severity of the condition can vary from asymptomatic increases in muscle enzymes to life-threatening electrolyte disturbances and renal failure. Electrolytes released into circulation along with myoglobin secondary to myocyte membrane damage are responsible for the development of complications. Acute kidney injury can occur, especially when myoglobin accumulation in renal tubules is accompanied by hypovolemia and renal vasoconstriction. This case presentation aims to discuss an exercise-related rhabdomyolysis case with a CK level of 71150 IU/L, in conjunction with current literature. Case Presentation: A 32-year-old male patient presented to the emergency department with complaints of weakness and severe pain in both legs after intense exercise. His work up revealed a CK level of 71150 IU/L, alanine aminotransferase (ALT) 92 IU/L, aspartate aminotransferase (AST) 691 IU/L, and potassium (K) 5.7 mEq/L. He is diagnosed with acute rhabdomyolysis due to exercise and intravenous fluids administered. He didn’t require hemodialysis. On 17th day of admission, he is discharged with full recovery. Conclusions: Physicians should be aware of rhabdomyolysis in patients presenting with weakness and muscle pain, especially in those reporting intensive physical exercise.

Dear Editor, I read the recent article with great interest (title: The Relationship of Sarcopenia With Prognosis in Patients Diagnosed with Metastatıc Gastric Cancer Receiving Palliative Chemotherapy) exploring the relationship between sarcopenia and prognosis in metastatic gastric cancer patients on palliative chemotherapy, which was published in your journal [1]. The findings align with a growing body of literature demonstrating that sarcopenia is a clinically significant prognostic factor, yet several points merit emphasis, clarification, or further exploration to strengthen both the interpretation and implications for clinical practice.

Hashimoto's thyroiditis (HT) is a T-cell mediated autoimmune disease characterized by the progressive destruction of thyroid gland. Hemoglobin-Albumin-Lymphocyte-Platelet (HALP) score and systemic inflammatory index (SII) are novel markers of inflammation. We aimed to compare HALP score and SII values of patients with HT to those in healthy control subjects in the present study. Patients diagnosed with HT and healthy volunteers (as controls) were included in the study. The SII and HALP score were calculated using the following formulas: SII = (Platelet count×Neutrophil count)/Lymphocyte count. HALP score = (Hemoglobin×Serum Albumin×Lymphocyte count)/Platelet count. SII and HALP score of patients with HT and healthy controls were compared. Median SII of the patients with HT (510 (140-3646)) was significantly higher than that of the control subjects (422 (102-2173)) (p < 0.001). Median HALP score of the HT group (47 (7-149)) was significantly lower than that of the control group (54 (10-160)) (p < 0.001). The sensitivity and specificity of SII (when higher than 452%) in detecting HT were 61% and 62%, respectively (AUC: 0.64, p < 0.001, 95%CI: 0.61-0.67). A HALP score lower than 49.5% threshold had 64% sensitivity and 57% specificity in detecting HT (AUC: 0.61, p < 0.001, 95%CI: 0.57-0.64). In logistic regression analysis (considering age, gender, eGFR, TSH, CRP, ESR, BMI), a unit increase in SII increased the risk of HT by 0.3% (p < 0.001, OR: 1.003, 95%CI: 1.002-1.004). HALP score was also an independent risk factor for HT. A unit increase in HALP score decreased the risk of HT by 2% (p < 0.001, OR: 0.977, 95%CI: 0.968-0.985). We recommend that, due to their inexpensive and easily assessable nature, SII and HALP score could serve as additional diagnostic tools in HT.

Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation and destruction of cartilage, as well as by extra-articular manifestations. Rheumatoid nephropathy is a common complication of RA and its principal target is the renal corpuscle. Vitamin D and its analogs exert immunomodulatory actions throughout the body due to the widespread of their receptors. Our study aimed to compare the effects of cholecalciferol (vitamin D3) and alfacalcidol on renal corpuscle changes in pristane-induced RA model following a 28-day treatment, using geometric morphometrics. Forty female Wistar rats (190–210 g; 12–13 weeks old) were randomly assigned to four groups: the control (Cont) group (n = 10) received saline i.c., the PIA group (n = 10) was administered pristane i.c., PIA-ALF group (n = 10) was administered pristane i.c. and alfacalcidol orally, and the PIA-CH group (n = 10) was injected i.c. with pristane and received cholecalciferol orally. Pristane administration was used for RA induction. At the end of the experiment, the left kidneys were removed and processed by standard histological procedures for geometric morphometric analysis. Geometric morphometric analysis demonstrated that, compared with the control group, the architecture of the renal corpuscles was altered in the PIA (p < 0.0001) and PIA-CH (p = 0.0065) groups. In contrast, no statistically significant differences were observed in the PIA-ALF group (p = 0.3011). Geometric morphometric analysis demonstrated that alfacalcidol, but not cholecalciferol, exertedaprotective effect on the renal corpuscle architecture in pristane-induced rheumatoid arthritis in rats.

Chronic low-grade inflammation is a major contributor to both the onset and advancement of type 2 diabetes mellitus (T2DM), and its associated microvascular complications, including diabetic nephropathy, retinopathy, and peripheral neuropathy. This review aims to overview the roles of high sensitivity C-reactive protein (hs-CRP), C-reactive protein (CRP), CRP-to-lymphocyte count ratio (CLR), and the CRP-to-albumin ratio (CAR) as biomarkers for assessing systemic inflammation and predicting the development and severity of diabetic chronic microvascular complications. Elevated levels of CRP and hs-CRP have been consistently associated with increased risk of these complications, reflecting ongoing inflammatory processes that contribute to endothelial dysfunction and tissue damage. Furthermore, CAR and CLR, which combine CRP with albumin and lymphocyte counts respectively, offer a more nuanced understanding of the inflammatory and immune response in T2DM patients. While individual studies have demonstrated the clinical relevance of these biomarkers in predicting disease onset and progression, further investigation is needed to establish their utility in clinical practice. This review highlights the potential of these biomarkers for enhancing early detection, risk stratification, and personalized management of diabetic patients, ultimately aiming to improve outcomes and reduce the burden of diabetic chronic microvascular complications.

Sentinel lymph node biopsy (SLNB) is a pivotal technique employed to assess the necessity for axillary lymph node dissection (ALND), evaluated during the preoperative phase through clinical and radiological findings. The preoperative identification of sentinel lymph node metastasis has gained paramount importance in the surgical management of breast cancer. Tumor budding (TB) has emerged as a significant prognostic marker across various cancers, including breast cancer, where it is instrumental in detecting lymph node metastasis. This study aims to investigate the role of tumor budding in predicting sentinel lymph node metastasis in preoperative breast biopsies. We included patients diagnosed with breast cancer, specifically those with invasive ductal carcinoma (IDC), who underwent preoperative needle biopsy and subsequent evaluation of postoperative surgical specimens, as well as SLNB at our medical center. The histological slides of these cases were reevaluated, and tumor cell clusters comprising up to four cells were classified as TB. Lymph nodes exhibiting tumor cell involvement, limited to macrometastasis, were classified as positive. A total of 65 patients were enrolled in the study. Among these, 36 patients exhibited TB in their preoperative biopsies, while 29 did not. The median tumor sizes were 20 mm (range: 6–50 mm) in the TB-positive group and 19 mm (range: 2–50 mm) in the TB-negative group (p=0.3). Sentinel lymph node metastasis was detected in 18 patients with TB, compared to only five patients without TB, a difference that was statistically significant (p=0.006). We conclude that evaluating tumor budding in breast tru-cut specimens, in conjunction with clinical and radiological findings, may enhance the preoperative assessment of breast cancer cases requiring SLNB.

Background: This study aims to examine the relationship between markers indicating systemic inflammatory response and epicardial fat volume (EFV) detected by computed tomography (CT) in type 2 diabetes mellitus (T2DM) patients. Methods: A total of 165 patients (92 patients with diabetes and 73 control group) who underwent thoracic CT examination were included in the study. Hemogram parameters, lipid profiles, HbA1c, glucose, C-reactive protein, and uric acid levels were recorded. The systemic inflammatory response was calculated using the formula P × N/L. CT images were analysed by an experienced radiologist using 3D Slicer software. Results: EFV and surface area were significantly higher in T2DM patients compared to the control group (P < .001). Additionally, the uric acid to HDL ratio (UHR) and systemic inflammatory index (SII) values of T2DM patients were significantly higher than those of control subjects (P = .04 for UHR and P = .035 for SII). Receiver operating characteristic analysis showed that EFV was >15.5 in T2DM patients with a sensitivity of 92% and a specificity of 37%. Conclusions: This study reveals that EFV is higher in T2DM patients and shows a positive correlation SII. Evaluating EFV, SII, and UHR together may be significant in assessing the inflammatory burden and cardiac risk of T2DM. The ease and cost-effectiveness of these markers increase their usability in clinical practice. Key messages What is already known on this topic: Epicardial fat volume (EFV) and systemic inflammatory index (SII) have been reported to be associated with type 2 diabetes mellitus (T2DM). What this study adds: Besides correlated with SII, EFV was further associated with T2DM and high sensitivity in detecting diabetic subjects. How this study might affect research, practice, or policy: The results of the present study may guide clinicians in personalizing preventive strategies, such as, identifying patients at higher cardiometabolic risk who could benefit from intensive lifestyle or pharmacological interventions.

Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) prevalence data in Türkiye is limited. We aimed to determine the nationwide prevalence of MASLD and advanced hepatic fibrosis risk in subjects with cardiometabolic risk factors (CMRF). Despite recent international consensus redefining fatty liver disease terminology, no nationwide MASLD study has been reported in Türkiye. Methods: This cross-sectional study included 14,371 adults with ≥1 CMRF from 44 centers across 31 cities. MASLD was diagnosed using liver ultrasonography plus cardiometabolic criteria. Advanced fibrosis risk was assessed by fibrosis-4 (FIB-4) score (≥1.3 for ≤65 years; ≥2.0 for >65 years). Logistic regression was used to identify independent predictors of high FIB-4. Results: A total of 61.4% of participants were women, the mean age was 51.3 ± 14.4 years, and the mean BMI was 31.4 ± 6.0 kg/m². MASLD prevalence was 75.7% (n = 10,873), rising with the number of CMRFs (56.5% with one factor vs. 83.4% with all). The prevalence of high FIB-4 scores was 12.0% overall, being lower in MASLD patients than non-MASLD patients (11.2% vs. 14.4%, p < 0.001). FIB-4 scores decreased with increasing BMI (28.1% underweight vs. 8.7% class III obesity). Male sex, T2DM, and hypertension independently predicted high FIB-4 scores, while smoking, higher BMI, and MASLD were inversely associated. Conclusions: Three-quarters of Turkish adults with CMRF have MASLD. Standard FIB-4 thresholds may underestimate fibrosis risk in obese and smoking populations, underscoring the need for adjusted cut-offs or alternative tools. This study is the first to provide nationwide MASLD prevalence data in Türkiye.