Sevim Shefket

Background: Type 1 diabetes mellitus (T1D) is associated with chronic inflammation, platelet-related alterations, and increased cardiovascular risk (CVR). The relationships between adipokines and platelet indices in long-standing T1D remain incompletely defined. Objective: To explore the relationships between adipokines (adiponectin and leptin), platelet indices, and inflammatory status in adults with long-standing T1D. Methods: This cross-sectional study included 124 adults with long-standing T1D and 59 non-diabetic controls. Platelet indices were obtained from automated blood count, and serum leptin (LEP), adiponectin (ADNC), and C-reactive protein (CRP) were measured using standardized assays. Associations were evaluated using correlation and multivariable regression analyses with adjustment for body mass index (BMI). Results: Platelet count (PLT) and plateletcrit (PCT) were higher in T1D compared with non-diabetic individuals (p = 0.003 for both), while mean platelet volume (MPV) and platelet distribution width (PDW) showed non-significant upward trends. ADNC levels were higher in T1D (p < 0.001), whereas LEP and the leptin–adiponectin ratio (LAR) did not differ between groups. In T1D, LEP correlated with PLT (rho = 0.235), PCT (rho = 0.263), and CRP (rho = 0.474), all p < 0.05. Similar associations were observed for LAR. No significant associations were found in non-diabetic controls. In multivariable analyses, PCT remained associated with LEP in T1D after adjustment for BMI, whereas in the control group, LEP was associated with BMI only. Conclusions: LEP and platelet-related indices were associated in individuals with long-standing T1D, whereas ADNC showed no such relationships. These findings suggest a distinct pattern of adipokine–platelet associations in long-standing T1D.

Background and Objectives: Individuals with long-standing type 1 diabetes (T1D) remain at elevated cardiovascular risk (CVR). Adiponectin (ADNC) and leptin (LEP) are adipokines involved in metabolic and vascular homeostasis, yet their relevance for CVR stratification in T1D is unclear. This study examined the associations of ADNC and LEP with CVR categories derived from the Steno Type 1 Risk Engine (ST1RE) and the 2019 ESC Guidelines on Diabetes, Pre-diabetes and Cardiovascular Diseases (ESC 2019), with particular attention to potential sex-related differences. Materials and Methods: A cross-sectional study included 124 adults with long-standing T1D and 59 age- and sex-matched non-diabetic participants. Serum ADNC and LEP concentrations were measured using standardized immunoassays. CVR was assessed using ST1RE and ESC 2019 algorithms. Multivariable models adjusted for age and body mass index (BMI) were used to examine determinants of adipokine concentrations and their associations with CVR categories. Results: Participants with T1D exhibited higher circulating ADNC concentrations than non-diabetic individuals (p < 0.001). LEP levels were significantly associated with sex (p < 0.001). In adjusted analyses, sex and BMI remained significantly associated with adipokine concentrations. Higher LEP levels showed a significant positive association with higher ESC 2019 CVR category (OR 1.84; 95% CI 1.19–2.84; p = 0.006), whereas ADNC and the LEP × sex interaction showed no significant association. Neither adipokine was significantly associated with ST1RE-derived risk categories. Conclusions: In adults with long-standing T1D, LEP showed an association with ESC 2019-based CVR stratification, whereas neither LEP nor ADNC was associated with ST1RE-derived risk categories.

Background: Type 1 diabetes mellitus (T1D) is associated with chronic inflammation, platelet activation, and increased cardiovascular risk (CVR). The relationships between adipokines and platelet indices in long-standing T1D remain incompletely defined. Objective: To explore the relationships between adipokines (adiponectin and leptin), platelet indices, and inflammatory status in adults with long-standing T1D. Methods: This cross-sectional study included 124 adults with long-standing T1D and 59 non-diabetic controls. Platelet indices were obtained from automated blood count, and serum leptin (LEP), adiponectin (ADNC), and C-reactive protein (CRP) were measured using standardized assays. Associations were evaluated using correlation and multivariable regression analyses with adjustment for body mass index (BMI). Results: Platelet count (PLT) and plateletcrit (PCT) were higher in T1D compared with non-diabetic individuals (p=0.003 for both), while mean platelet volume (MPV) and platelet distribution width (PDW) showed non-significant upward trends. ADNC levels were higher in T1D (p< 0.001), whereas LEP and the leptin–adiponectin ratio (LAR) did not differ between groups. In T1D, LEP correlated with PLT (rho=0.235), PCT (rho=0.263), and CRP (rho=0.474), all p< 0.05. Similar associations were observed for LAR. No significant associations were found in non-diabetic controls. In multivariable analyses, PCT remained associated with LEP in T1D after adjustment for BMI, whereas in the control group LEP was associated with BMI only. Conclusion: LEP and platelet-related indices were associated in individuals with long-standing T1D, whereas ADNC showed no such relationships. These findings suggest a distinct pattern of adipokine–platelet associations in long-standing T1D.

Background: Individuals with long-standing type 1 diabetes (T1D) remain at elevated cardiovascular risk (CVR). Adiponectin (ADNC) and leptin (LEP) are adipokines involved in metabolic and vascular homeostasis, yet their relevance for CVR stratification in T1D is unclear. This study examined the associations of ADNC and LEP with CVR categories derived from the Steno Type 1 Risk Engine (ST1RE) and the 2019 ESC Guidelines on Diabetes, Pre-diabetes and Cardiovascular Diseases (ESC 2019), with particular attention to potential sex-related differences. Methods: A cross-sectional study included 124 adults with long-standing T1D and 59 age- and sex-matched non-diabetic participants. Serum ADNC and LEP concentrations were measured using standardized immunoassays. CVR was assessed using ST1RE and ESC 2019 algorithms. Multivariable models adjusted for age and body mass index (BMI) were used to examine determinants of adipokine concentrations and their associations with CVR categories. Results: Participants with T1D exhibited higher circulating ADNC concentrations than non-diabetic individuals (p < 0.001). LEP levels were significantly associated with sex (p < 0.001). In adjusted analyses, sex and BMI remained significantly associated with adipokine concentrations. Higher LEP levels showed a significant positive association with higher ESC 2019 CVR category (OR 1.84; 95% CI 1.19–2.84; p = 0.006), whereas ADNC and the LEP×sex interaction showed no significant association. Neither adipokine was significantly associated with ST1RE-derived risk categories. Conclusion: In adults with long-standing T1D, LEP showed an association with ESC 2019-based CVR stratification, whereas neither LEP nor ADNC was associated with ST1RE-derived risk categories.

Background and Objectives: Cardiac injury caused by cancer therapy can be detected early using high-sensitivity cardiac troponins (hs-cTns), and this is crucial for preventing irreversible consequences. Clinically relevant issues regarding hs-cTns in oncologic settings—such as reliable cut-off values, the optimal assessment timeframe, factors influencing their levels, and their prognostic ability in relation to functional echocardiographic parameters—require further investigation. In this study, we aimed to examine the determinants of hs-cTnT variations during cancer therapy and the relationship between the biomarker and functional conventional echocardiographic parameters. Materials and Methods: We prospectively evaluated adult patients scheduled for chemotherapy for either breast or gastrointestinal cancers, excluding those with pulmonary and cardiac disorders. We enrolled 40 patients who underwent a minimum of one cycle of potentially cardiotoxic regimens containing at least one of the following agents: anthracyclines, cyclophosphamide, taxanes, 5-fluorouracil, platinum compounds, trastuzumab, or bevacizumab. We observed two-dimensional and tissue Doppler echocardiographic parameters and hs-cTnT levels for a median of 360 days (IQR 162, 478) following the start of chemotherapy. Results: The generalised estimating equation (GEE) analysis revealed significant elevations in hs-cTnT levels at three months (β = 1.2; p = 0.005) and six months (β = 2.3; p = 0.02) from baseline, influenced by anthracycline treatment (p = 0.009), renal function (p = 0.003), and increased cardiotoxicity risk (high: p = 0.013; medium: p < 0.001). Elevated hs-cTnT levels independently predicted the deterioration of the LV longitudinal myocardial function, measured by the systolic tissue velocities, according to the GEE analysis. The receiver operating characteristic curve-derived hs-cTnT thresholds—of 8.23 ng/L and 8.08 ng/L—had a high negative predictive value for identifying Average and Lateral LVS′ decreases, respectively. Conclusions: Our research supports the use of baseline and continuing hs-cTnT testing in cancer patients, showing the dependence of the biomarker on renal function, cardiovascular toxicity risk level, and anthracycline treatment. The hs-cTnT cut-off value of approximately 8 ng/L may suggest a low probability of longitudinal myocardial function impairment and this observation needs further validation in larger cohorts.

Background: Pediatric sepsis is a life-threatening emergency and remains complex to diagnose promptly due to the absence of universally reliable biomarkers. C-reactive protein (CRP) and procalcitonin (PCT) are widely used but have limited effectiveness. We evaluated the diagnostic reliability of presepsin and soluble mannose receptor (sMR) and identified optimal biomarker combinations for distinguishing sepsis from non-infectious systemic inflammatory response syndrome (SIRS) in children. Methods: A total of 80 children were enrolled in this prospective study, including 53 consecutive admissions to the pediatric intensive care unit (PICU) (sepsis, n = 42; non-infectious SIRS, n = 11) and 27 healthy controls. The serum levels of new biomarkers presepsin and soluble mannose receptor (sMR) levels were quantified by ELISA methods and their diagnostic reliability (both individually and combined with CRP and PCT) was assessed using receiver operating characteristic (ROC) curves and multivariate logistic regression. Results: Significantly higher concentrations of all measured markers were found both in septic and other critically ill patients than in healthy controls (p < 0.05). No single biomarker reliably differentiated sepsis from non-infectious SIRS. The sMR + CRP + PCT combination demonstrated the highest diagnostic accuracy (AUC = 0.78, p = 0.0007), surpassing the CRP + PCT model (AUC = 0.71, p = 0.0087). Conclusions: The addition of sMR to the established markers CRP and PCT improves the diagnostic effectiveness in pediatric sepsis. Larger multicenter studies are warranted to confirm clinical utility.