The porphyrias are a rare group of metabolic disorders that can either be inherited or acquired. Along the heme biosynthetic pathway, porphyrias can manifest with neurovisceral and/or cutaneous symptoms, depending on the defective enzyme. Porphyria cutanea tarda, the most common type of porphyria worldwide, is caused by a deficiency of uroporphyrinogen decarboxylase, a crucial enzyme in heme biosynthesis, which results in an accumulation of photosensitive byproducts, such as uroporphyrinogen, which leads to the fragility and blistering of sun-exposed skin. Porphyria cutanea tarda is a condition that affects the liver and skin by reduction and inhibition of uroporphyrinogen decarboxylase enzyme in erythrocytes. Areas of skin that are exposed to the sun can generate blisters, hyperpigmentation, and, sometimes, lesions that heal leaving a scar or keratosis. Liver damage might present in a wide range of ways from liver function test abnormalities to hepatocellular carcinoma. The toxic effect of iron plays a role in liver damage pathogenesis. A 59-year-old Turkish man presented with hyperpigmented skin lesions, fatigue, and elevated ferritin level and liver function tests. He was diagnosed as having porphyria cutanea tarda after a clinical investigation and treated with phlebotomy. Porphyria cutanea tarda is a rare condition of the liver but it must be remembered in a differential diagnosis of liver disease with typical skin involvement to decrease morbidity and health costs with early treatment.

Leuconostoc species are Gram-positive, non-motile, vancomycin-resistant bacteria placed within the family of Streptococcaceae. They naturally exist in food and are important in the sauerkraut, milk and wine industries due to their role in fermentation. Infections caused by Leuconostocs are generally reported in immunosuppressed patients with an underlying disease, or in those who were previously treated with vancomycin. Central venous catheter insertion is also a risk factor for introducing bacteria into the body. Although they are resistant to vancomycin, leuconostocs are sensitive to erythromycin and clindamycin. Here, we report a case with pleural empyema due to Leuconostoc mesenteroides in an otherwise healthy person whose occupation is known to be selling pickles.

Microparticles are procoagulant membrane vesicles that play role in endothelium dysfunction pathogenesis and are increased in hypertension, acute/chronic vascular pathological events. Here; we aimed to compare MPs levels of hypertensive geriatric patients with healthy age-match-patients, discuss its availability as a cardiovascular biomarker and investigate its relationship with other inflammatory markers. Forty seven hypertensive geriatric patients (M/F;15/32) and 47 healthy controls (M/F;19/28) were included in the study. MPs levels were examined functionally through thrombin generation test (TGT) parameters (MPS Lag time, MPS ETP, MPs Peak, MPS start Tail) and compared with CRP, N/L ratio, ALT, GGT, thrombocyte parameters. Decrease in MPS Lag time, increase in MPS ETS and MPs Peak elevation were accepted as tendency to coagulation which meant an increase in number and function of MPs. No significant difference was found between 2 groups for MPS tests (MPS Lag time, MPS ETP, MPs Peak, MPS start Tail). Platelet count was significantly higher in hypertensive patient group. There was a negative correlation between age and MPs Peak, MPS Lag time. There was a positive correlation between CRP and MPS ETP, MPs Peak values. Our present findings might help to understand the hemostasis via TGT parameters, in the elderly. Contribution of MPs to thrombosis tendency seen with aging and increased number of circulating MPs caused by hypertensive endothelial dysfunction must be taken into consideration. MPs might be accepted as vascular inflammation and damage markers and used as follow up tools of medical treatment of vascular inflammation-related diseases.

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive tumor often accompanied by various metabolic abnormalities both before and after clinical diagnosis. Diagnosis at advanced stages significantly increases mortality risk. This study aimed to investigate the potential relationship between metabolic and inflammatory parameters at the time of diagnosis and disease stage, and their impact on prognosis in patients with pancreatic cancer. Materials and Methods: A total of 89 patients (43.8% male, 56.2% female) diagnosed with PDAC were included in the retrospective, single-center study. Disease stages at diagnosis that were categorized as stages 1-2 (resectable) and stages 3-4 (locally advanced and metastatic), height, weight, accompanying diseases, body mass index (BMI), inflammatory parameters (C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), and metabolic parameters (glucose, HbA1c %, triglyceride, High-Density Lipoprotein [HDL]-cholesterol, Low-Density Lipoprotein [LDL]-cholesterol) were recorded. These parameters were compared between early and advanced stage patients, and their effect on one-year survival was evaluated. Results: The mean age of the patients was 62.7 years; 45.1% of the patients were in stages 1-2, while 48.3% were in stage 4. The one-year overall mortality rate was 32.6%, and the mortality rate was 52.1% in advanced stage (stages 3-4) patients and 9.8% in early stage (stages 1-2) patients. Mean CRP and NLR levels were significantly higher in patients who died compared to those who survived (7.4 vs. 4.4, p = 0.001; p = 0.000, respectively). Mean HDL-cholesterol level was lower in patients who died compared to survivors (34 mg/dL vs. 47.2 mg/dL, p = 0.001). Mean fasting blood glucose and HbA1c levels were higher in patients who died compared to survivors (167 mg/dL vs. 135 mg/dL, 7.5% vs. 6.6%; p = 0.008; p = 0.037, respectively). There were no significant differences in gender, BMI, presence of co-morbidities, triglyceride, or LDL-cholesterol levels between the groups. Conclusion: Recognizing clinical biomarkers predicting prognosis in PDAC could significantly contribute to disease management.

Alpha lipoic acid (ALA) acts as essential co-factor for mitochondrion respiratory enzymes. It has an increasing importance in diabetic neuropathy treatment. Its positive effects on weight gain and metabolic parameters have also been discussed. In this study, we aimed to search for the effect of ALA on weight, appetite, adiponectin and metabolic parameters in type 2 diabetes mellitus patients. This study is designed as a randomised, double-blind, placebo controlled, prospective study. 23 type 2 diabetes mellitus patients with peripheral neuropathy (6 normal weight, 17 obese) and 21 normal weight control group were included in the study. Patients were given 600mg/day oral ALA for 6 weeks, added to their routine therapy. Body mass index (BMI), adiponectin, fasting plasma glucose, HbA1C, lipid parameters and CRP levels were tested before and after ALA treatment. Results were evaluated using SPSS 15.0 for Windows. Adiponectin levels were statistically significantly lower and CRP levels were higher in diabetes group when compared to control group. Although ALA treatment caused a slight weight loss, it was not statistically significant. Appetite scores were decreased in the diabetes group but it did not cause statistically significant weight loss. There was no significant change in metabolic parameters or adiponectin after the treatment. 600mg/dL ALA treatment for 6 weeks did not favor for metabolic parameters in type 2 diabetes patients. This result might be due to the dose or the duration of the treatment, genetic predisposition or dietery habits. Trial of higher doses for long terms might be needed for recovery.

Pseudomonas putida (P. putida) is a rare pathogen that causes various infections in newborns, neutropenic and cancer patients, or in patients with risk factors leading to immunosuppresion. Antibiotic resistance in P. putida is seen in growing numbers. Although it is less virulent compared to Pseudomonas aeruginosa, mortal infections are reported. Here, a P. putida case after an invasive procedure in a patient with gastrointestinal malignancy is reported. Although, it caused an antibiotic resistant bacteremia, it resolved spontaneously without any treatment. P. Putida might have lower virulence and a different antibiotic susceptibility when compared to Pseudomonas aeruginosa in different cases. More clinical information is needed for further evaluation.