Prevalence and Prognostic Importance of High Fibrosis-4 Index in COVID-19 Patients.

Introduction: The fibrosis 4 (FIB-4) index was developed to predict advanced fibrosis in patients with liver disease. We aimed to evaluate the association of FIB-4 with risk factors for progression to critical illness in middle-aged patients hospitalized for coronavirus disease 2019 (COVID-19). Method: We included patients aged 35-65 years who were hospitalized following a positive RT-PCR SARS-Cov-2 test in a tertiary hospital. All data were obtained from the medical records of the patients during the first admission to the hospital. The FIB-4 index was calculated according to the equation (age (years) x AST (IU/L)/platelet count (109/L)/√ALT (IU/L)). The FIB-4 index was divided into three categories according to the score categorisation: <1.3 = low risk, 1.3-2.67 = moderate risk, and >2.67 = high risk. Results: A total of 619 confirmed COVID-19 patients (mean age = 52 yrs.) were included in this study; 37 (6.0%) were admitted to the intensive care unit (ICU), of which 44% were intubated and eight (1.3%) patients died during follow-up. The results of patients with high FIB-4 scores were compared with those with low FIB-4 scores. In patients with high FIB-4 scores, male gender, and advanced age, decreased neutrophil, lymphocyte, thrombocyte, and albumin counts, elevated AST, LDH, CK, ferritin, CRP, and D-dimer, and low GFR were the high-risk factors for critical illness. Additionally, the number of patients referred to ICU with high FIB-4 who died had higher scores than from those with low scores. Conclusion: The FIB-4 index derived from baseline data obtained during hospitalisation can be used as a simple, inexpensive, and straightforward indicator to predict ICU requirement and/or death in middle-aged hospitalized COVID-19 patients.

Coronavirus disease 2019 (COVID-19) as a potential trigger for benign recurrent intrahepatic cholestasis.

Benign recurrent intrahepatic cholestasis (BRIC) is a rare disease characterized by recurrent severe itching and jaundice. Coronavirus disease 2019 (COVID-19) is a multisystemic acute viral disease and the liver is frequently affected. Here, we wanted to present a BRIC case triggered by COVID-19 infection, discussing it together with current information.

Effects of Long-Term Tenofovir and Entecavir Treatment on Bone Mineral Density in Patients with Chronic Hepatitis B.

Background: We aimed to investigate the long-term effects of tenofovir disoproxil fumarate and entecavir treatment on bone mineral density and evaluated the fracture risk assessment tool score in patients with chronic hepatitis B. Methods: A total of 58 chronic hepatitis B patients treated with tenofovir disoproxil fumarate (n = 40) and entecavir (n = 18) were included in this prospective study from 2012 to 2016. To evaluate bone mineral density, dual-X-ray absorptiometry, fracture risk assessment tool, and laboratory examinations were performed in all patients first at baseline and second at the end of the study. Results: Age, sex, body mass index, fibrosis score, and viral load were similar in both groups. The mean follow-up was 33 months in the tenofovir disoproxil fumarate group and 31 months in the entecavir group. In patients treated with entecavir, there was no statistically significant difference between baseline and second bone mineral density including lumbar spine (L) and total hip T score. In patients treated with tenofovir disoproxil fumarate, there was a significant difference in the second bone mineral density compared with baseline bone mineral density for L3 (P = .033) and the major fracture risk assessment tool score (P = .03). When patients were divided into 3 groups (normal bone mineral density, osteopenic, and osteoporotic), there was a significant increase in the number of osteopenic patients in the total hip T score after tenofovir disoproxil fumarate treatment (P = .034). Conclusion: Our results suggest a decrease in the bone mineral density for lumbar spine (L3), an increase in the number of patients with hip osteopenia, and major fracture risk assessment tool score after long-term tenofovir disoproxil fumarate treatment in patients with rechronic hepatitis B.

The Main Determinants of Serum Resistin Level in Type 2 Diabetic Patients are Renal Function and Inflammation not Presence of Microvascular Complication, Obesity and Insulin Resistance.

AIM: The association of increased resistin levels in chronic kidney disease with diabetic nephropathy has not yet been clarified. Our aim was to analyze the relationship between serum resistin levels and various diabetic microvascular complications in patients. METHODS: A total of 83 patients were enrolled in this cross-sectional study. The subjects were divided into 3 groups: 27 patients with type 2 diabetes mellitus (T2DM) having no diabetic retinopathy (DRP) or microalbuminuria and having normal renal function were included in Group-1, 28 patients with T2DM having DRP and normal renal function in Group-2, and 28 patients with T2DM with DRP and microalbuminuria and an estimated glomerular filtration rate (eGFR) of<60 ml/min/1.73 m2 in Group-3. Serum resistin levels were analyzed by enzyme-linked immunosorbent assay. RESULTS: The mean age of the patients [46 female (55.4%)] was 54.8±9.1 years. The resistin level in Group-3 was significantly higher than in Group-1 and Group-2 (p<0.001).However the resistin level was not different between Group-1 (without microvascular complications) and Group-2 (with microvascular complications). The resistin level was found to be correlated negatively with eGFR (r=-0.459; p<0.001) and albumin (r=-0.402; p<0.001), and positively with high-sensitivity C-reactive protein (hs-CRP) (r=0.366; p=0.001). In multivariate analysis, it was observed that eGFR and hs-CRP were independent determinants of plasma resistin level. CONCLUSION: The main determinants of resistin level in patients with T2DM are the level of renal function and inflammation rather than presence of microvascular complications, obesity and insulin resistance.

Electroencephalography Findings in Crohn's Disease.

OBJECTIVES: Crohn's Disease (CD) is a chronic systemic inflammatory disease associated with various extraintestinal manifestations, including seizure as a neurological finding. In this study, the prevalence of seizure and electroencephalographic abnormalities in patients with CD was investigated. MATERIALS AND METHODS: This study involved 41 patients with CD (female/male: 25/16) and 39 subjects in the control group (female/male: 25/14). Patients in the CD group were diagnosed and monitored according to the European Crohn's and Colitis Organization diagnostic criteria. The control group was composed of healthy subjects with similar age and sex as the CD group. Seizures were classified according to the criteria of the International League Against Epilepsy. Electroencephalography (EEG) was performed for all patients with CD and for healthy subjects. Seizure prevalence and EEG findings were also compared. RESULTS: One patient in the CD group had history of seizures. EEG abnormality was significantly higher in the CD group (16/41, 39%) ( P = .001). The most common EEG abnormality was intermittent generalized slow wave abnormality in theta frequency. DISCUSSION: Our study indicated that CD was associated with EEG abnormalities rather than seizure. The results also indicated that EEG was a potential indicator for detecting subclinical neurological abnormalities in CD.

Are adipocytokines inflammatory or metabolic mediators in patients with inflammatory bowel disease?

This study examined the adiponectin and leptin levels and insulin resistance (IR) in patients with inflammatory bowel disease (IBD) and the associations between these factors and IBD characteristics. Fasting serum leptin, adiponectin, glucose, and insulin levels, as well as inflammatory parameters, were measured in 105 patients with IBD (49 patients with Crohn's disease [CD], 56 patients with ulcerative colitis [UC]) and 98 healthy controls [HC]. IR was evaluated using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Disease activity and severity in patients with UC were evaluated using the Truelove-Witts index, and patients with CD were evaluated using the Crohn's Disease Activity Index. Serum adiponectin levels were found to be significantly lower in patients with CD and UC (p<0.001). Serum leptin levels were also found to be significantly higher in both the UC and CD groups (p<0.001). When HOMA-IR levels were compared, no significant difference was detected for either the CD or UC groups compared with the controls. In conclusion, it was shown that leptin levels increased and adiponectin levels decreased in patients with IBD, which is thought to be related to chronic inflammation. The effects of adipocytokines in patients with IBD with inflammatory and metabolic processes need to be investigated in further broader studies.

Is duodenal biopsy appropriate in areas endemic for Helicobacter pylori?

OBJECTIVE: The primary reason for obtaining duodenal biopsy sample is to diagnose celiac disease. Helicobacter pylori (H. pylori) and drug injury are common causes of duodenitis. The aim of this retrospective study was to explore effects of H. pylori and drugs on duodenal mucosa. METHODS: Duodenal biopsy samples of patients who underwent upper gastrointestinal endoscopy (UGIE) between February 2014 and December 2014 were retrospectively examined. Clinical symptoms, referral indications, endoscopic findings, H. pylori status, and drug history were recorded. Duodenal biopsy findings were compared based on presence of H. pylori and drug history. RESULTS: Of 2389 patients who underwent UGIE, 206 had duodenal biopsy. Eight patients (3.9%) were diagnosed with celiac disease. After excluding cases with celiac disease, 76 patients of remaining 198 patients (36.9%) had duodenal histopathological abnormality. H. pylori was found in 95 (47.9%) patients. Drug usage was less common (42%). Of patients who had histopathological duodenitis, 59% were H. pylori-infected. Rate of duodenitis was higher in H. pylori (+) group than in H. pylori (-) group (45% vs 27.1%; odds ratio, 2.4; 95% confidence interval, 1.3-4.4; p=0.005). There was no difference between groups regarding drug use in terms of histopathological duodenitis. CONCLUSION: H. pylori is the major contributor to duodenitis in high prevalence regions. Serological testing may be more appropriate before performing duodenal biopsy in patients with suspected celiac disease.

The Prevalence of Headache in Crohn's Disease: Single-Center Experience.

Objectives. This study is aimed at studying the prevalence and characteristics of different types of headaches in patients with Crohn's disease. Materials and Methods. 51 patients in Crohn's disease group (F/M: 26/25) and 51 patients in control group (F/M: 27/24) were involved. Patients in Crohn's disease group were diagnosed and monitored according to European Crohn's and Colitis Organization diagnostic criteria. The control group composed of healthy subjects with similar age and sex to Crohn's disease group. Headache was classified using the International Headache Society II criteria. Results. Headache was reported by 35/51 (68.6%) patients in Crohn's disease group and 21/51 (41.2%) patients in the control group. The prevalence of headache was statistically high in the group with Crohn's disease (OR: 3.125 (95% CI: 1.38-7.04); p = 0.01). Comparing two groups with respect to their subtypes of headaches resulted in that the tension-type headache was statistically (p = 0.008) higher in Crohn's disease group (26/51) than in the control group (12/51). However, no significant difference was found in the migraine-type headache (p = 1). Conclusions. This study indicates that the prevalence of headache is high in patients with Crohn's disease and most commonly associated with the tension-type headache.

A Lethal Complication of Endoscopic Therapy: Duodenal Intramural Hematoma.

Duodenal intramural hematoma (DIH) usually occurs in childhood and young adults following blunt abdominal trauma. It may also develop in the presence of coagulation disorders and may rarely be an iatrogenic outcome of endoscopic procedures. Management of DIH is usually a conservative approach. A case of intramural duodenal hematoma that developed following endoscopic epinephrine sclerotherapy and/or argon plasma coagulation and that was nonresponsive to conservative therapy in a patient with chronic renal failure who died from sepsis is being discussed in this report. Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders.

Serum interleukin 17 levels in patients with Crohn's disease: real life data.

UNLABELLED: The aim of this study was to investigate serum IL17 levels in patients with Crohn's disease (CD) and to investigate the relationship between serum IL17 levels with disease activity. METHODS: Fifty patients with CD and sex- and age-matched 40 healthy controls were included in the study. The serum IL17 levels, complete blood count, blood chemistry, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were measured, and Crohn's disease activity was calculated using Crohn's disease activity index (CDAI). RESULTS: The mean serum IL17 level of CD patients did not differ from those of healthy controls (P > 0.05). There was no difference between the mean serum IL levels of active CD patients and of quiescent CD patients (P > 0.05). However, the mean IL17 level of active patients was lower than of control subjects (P = 0.02). Serum IL17 was not correlated with inflammatory markers (ESR, CRP, white blood count, platelet count, and albumin) and CDAI. CONCLUSIONS: Peripheral blood serum IL17 levels of CD patients were not higher than of healthy controls, and also, serum IL17 level was not correlated with clinical disease activity. Peripheral IL17 measurement is not a useful tool for detecting and monitoring Crohn's disease which is understood to have complex etiopathogenesis.

Antineutrophil cytoplasmic antibody frequency in chronic hepatitis B patients.

BACKGROUND: Chronic hepatitis B (CHB) is a viral disease, common across the world, and associated with several extraintestinal manifestations including vasculitis. Antineutrophil cytoplasmic antibodies (ANCAs) are sensitive and specific markers for vasculitides. There is limited data available in the literature on whether ANCA formation is stimulated by CHB infection. In the present study we aimed to identify the frequency of ANCA in CHB patients. METHODS: A total of 174 subjects were included in the study (87 CHB patients, 87 control subjects). Perinuclear-ANCA (P-ANCA), cytoplasmic-ANCA (C-ANCA), myeloperoxidase ANCA (MPO-ANCA), and proteinase 3-ANCA (PR3-ANCA) were studied. IFA was used for P-ANCA and C-ANCA assays, and ELISA was used for MPO-ANCA and PR3-ANCA assays. RESULTS: ANCA positivity was high in both groups (31% in the CHB group and 26% among controls). There were no significant differences between the groups for P-ANCA and MPO-ANCA (P = 0.6 and P = 0.6, resp.). Frequency of borderline positive C-ANCA and all positive PR3-ANCA (positive + borderline positive) was significantly higher in the CHB group (P = 0.009 and P = 0.005, resp.). CONCLUSIONS: In the present study, the frequency of ANCA was high in both groups. The CHB group had a relatively higher frequency of ANCA positivity compared to controls. Borderline positive C-ANCA and positive PR3-ANCA were significantly higher in the CHB group. These results suggest that ANCA may have a high prevalence in Turkey. Patients with CHB should be evaluated particularly for C-ANCA and PR3-ANCA in the presence of vasculitic complaints and lesions.

Efficacy of two levofloxacin-containing second-line therapies for Helicobacter pylori: a pilot study.

BACKGROUND: An ideal second-line therapeutic regimen for the treatment of patients who do not respond to standard triple therapy is currently being investigated. In this study, we aimed to investigate the efficacy of two levofloxacin-containing second-line therapies for Helicobacter pylori (H. pylori). MATERIALS AND METHODS: One hundred and forty eight consecutive H. pylori -positive patients who did not respond to the standard triple therapy (77 female, 71 male) were enrolled in the study. The patients were randomized consecutively to two-second-line therapy groups; 73 to the levofloxacin-containing sequential (LCS) and 75 to the levofloxacin-containing quadruple (LCQ) therapy group. The LCS therapy group received pantoprazole 40 mg and amoxicillin 1,000 mg twice daily for 5 days followed by pantoprazole 40 mg twice daily and metronidazole 500 mg three times daily and levofloxacin 500 mg one time daily for 7 days. The LCQ therapy group received pantoprazole 40 mg twice daily, tetracycline 500 mg four times daily, bismuth subcitrate 300 mg four times daily and levofloxacin 500 mg one time daily for 10 days. H. pylori eradication was confirmed by stool antigen testing at least 6 weeks after cessation of therapy. Side-effects and compliance were assessed by a questionnaire. RESULTS: Intention-to-treat cure rates were: 82.2% (95%CI; 73-91) and 90.6% (95%CI; 79-95) in the LCS and LCQ therapy, respectively. Per protocol cure rates were: 85.7% (95%CI; 75-92) and 93.1% (95%CI; 85-98) in the LCS and LCQ therapy, respectively. No statistically significant difference was found between two groups (p = .1). No differences in compliance or adverse effects were demonstrated between two groups. CONCLUSIONS: This prospective trial demonstrates that both levofloxacin-containing sequential therapy and levofloxacin-containing quadruple therapy regimens have higher H. pylori eradication rates and are well tolerated. The levofloxacin-containing quadruple therapy is likely the best treatment option for a second-line therapy, at least in the Turkish population.

Bone density in proton pump inhibitors users: a prospective study.

Patients with gastroesophageal reflux disease (GERD) receive long-term therapy with proton pump inhibitor (PPI) agents. Several studies have recently been published suggesting that treatment with PPI may cause bone fractures, although the number of prospective studies in this regard is limited. The aim of this study is to prospectively investigate the effect of PPIs on bone density. Between March 2009 and January 2011, 114 GERD patients (18-56 years) and 110 healthy controls were included in the present study. Bone mineral densitometry (BMD) by using dual-energy X-ray absorptiometry was assessed at lumbar spine and femur neck. BMD measurements were performed on all subjects at the beginning of the study. The patients were divided according to three drugs by their treatment with esomeprazole, lansoprazole, or pantoprazole. The study group was followed for at least 6 months on PPI therapy, and then BMD measurements were repeated. The mean duration of treatment with PPIs was 8.5 ± 2.3 months. In patients receiving PPIs, the mean reduction in total vertebra T score following treatment compared to pre-treatment values was 00.23 ± 0.42 units (95 % CI 0.15-0.30) (p < 0.01), while the mean reduction in the femur T score was 0.10 ± 0.40 units (95 % CI 0.03-0.18) (p = 0.03). Reduction following treatment in L4 and total vertebra T scores of lansoprazole group was significantly higher than of pantoprazole group (p = 0.04). Reduction in femur T score of esomeprazole group was higher than of lansoprazole group and pantroprazole group, but it is not statistically significant. Treatment with a PPI results in a significant reduction in bone density. Close monitoring is beneficial for patients who are to receive long-term treatment with PPI.

Patients with inflammatory bowel disease have a lower response rate to HBV vaccination compared to controls.

BACKGROUND: Hepatitis B (HBV) is a vaccine-preventable infection that may cause severe infections, particularly in patients who are being treated with immunosuppressive therapy [(i.e., inflammatory bowel disease (IBD)]. Limited data are available about IBD patients' response rate to HBV vaccine. AIM: To assess the efficacy of HBV vaccine in IBD patients and healthy controls. METHODS: Serological markers of HBV were assessed in IBD patients, and HBV vaccine was administered to seronegative patients. The subsequent determination of anti-HBs antibody was recorded. An adequate immune response (AIR) and an effective immune response (EIR) to HBV were defined as more than 10 and 100 mIU/ml, respectively. The single dose vaccine was administered at 0, 1 and 6 months. RESULTS: A total of 102 patients with IBD (39 Crohn's disease, 63 ulcerative colitis; 54 female, 48 male) and 52 (25 female, 27 male) healthy controls were included. Mean age for patients and controls were 38 ± 12 and 31 ± 8, respectively (P < 0.001). Both AIR and EIR were significantly lower in patients than in controls (P < 0.001), but they were similar between patients with CD and UC (P = 0.302). Forty-four (43%) patients were on immunosuppressive therapy before vaccination. After vaccination, 76 and 53% of the patients had AIRs and EIRs, respectively, whereas 100 and 87% of the controls had AIRs and EIRs, respectively (P < 0.001 and P < 0.001, respectively). CONCLUSIONS: The response rate of IBD patients receiving HBV vaccinations were significantly lower compared to controls. The response rate of those receiving immunosuppressive therapy and with active disease was much too low. Vaccination should be given during remission and at immunosuppression-free times.

The frequency of microscopic and focal active colitis in patients with irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder. The frequency of microscopic colitis and focal active colitis in the colonic mucosa has been investigated in IBS patients. METHODS: Between June 2007 and September 2010, 378 patients (between 16 and 84 years) were recruited prospectively. Of these 378 patients, 226 patients were diagnosed with IBS using the Rome III criteria. 152 control patients were also enrolled who were undergoing colonoscopy for colorectal cancer screening or investigation of anemia. Histopathological abnormalities identified during colonoscopy were compared between the IBS and control groups. RESULTS: The average age of the IBS group was 46.13 ± 14.16 years and and the average age of the control group was 57.01 ± 13.07 years. The prevalence of microscopic colitis (MC) in the diarrhea predominant and the mixed subgroup of IBS patients was 4.32% (7/162) whereas in all IBS patients, the prevalence was 3.09% (7/226). MC was not found in the 152 control cases, (p = 0.045). Lymphocytic colitis was seen in 7 IBS patients, with 1 case in the mixed group and 6 cases in the diarrhea group and there was a significant difference in the frequency of lymphocytic colitis between the IBS subgroups (p < 0.01). Focal active colitis was found in 6.6% (15/226) of the IBS patients and in none of the controls (p < 0.01), and there was no differences between IBS subtypes. CONCLUSION: Microscopic colitis was more often found in the diarrhea predominant/mixed subgroups of IBS patients and in patients who were older women. In patients who are older woman with non-constipated IBS, it may be reasonable to perform a biopsy to screen for microscopic colitis. Focal active colitis was significantly increased in patients with IBS compared to controls.

Levofloxacin based sequential and triple therapy compared with standard plus probiotic combination for Helicobacter pylori eradication.

BACKGROUND/AIMS: Development of resistance to standard therapy for Helicobacter pylori (H. pylori) eradication is rapid. The aim of this study is to compare the efficacy of alternative treatment modalities for H. pylori. Compared treatments were standard triple treatment plus probiotic, sequential therapy with levofloxacin, and a 14-day regimen of PPI (proton pump inhibitor) and levofloxacin/amoxicillin combination. METHODOLOGY: Overall 285 patients were enrolled in the study and allocated into three groups. Group I (n=98) received lansoprazole, clarithromycin, amoxicillin and saccharomyces boulardii (probiotic) and group II (n=95) received esomeprazole, levofloxacin and amoxicillin for 14 days. Finally, group III (n=92) received esomeprazole and amoxicillin for five days, followed by esomeprazole, levofloxacin and metronidazole for seven days. Testing for H. pylori infection post-treatment was done using a stool antigen test five weeks after the completion of therapy. RESULTS: Patients in all three groups were treatment-naive. Response to treatment (Per Protocol/ITT analysis) was 77.1/72.4% in Group I, 89.1/86.3% in Group II, and 95.5% in Group III. Response to treatment was significantly higher in Groups II and III compared to Group I (p=0.03 and p<0.001, respectively). There was no difference between Groups II and III in terms of response to treatment (p=0.1). CONCLUSIONS: Levofloxacin-based sequential therapy and levofloxacin based triple therapy were significantly superior to standard triple therapy plus probiotic.

Situs inversus totalis and secondary biliary cirrhosis: a case report.

Situs inversus totalis is is a congenital anomaly associated with various visceral abnormalities, but there is no data about the relationship between secondary biliary cirrhosis and that condition. We here present a case of a 58 year-old female with situs inversus totalis who was admitted to our clinic with extrahepatic cholestasis. After excluding all potential causes of biliary cirrhosis, secondary biliary cirrhosis was diagnosed based on the patient's history, imaging techniques, clinical and laboratory findings, besides histolopathological findings. After treatment with tauroursodeoxycholic acid, all biochemical parameters, including total/direct bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gama glutamyl transferase, returned to normal ranges at the second month of the treatment. We think that this is the first case in literature that may indicate the development of secondary biliary cirrhosis in a patient with situs inversus totalis. In conclusion, situs inversus should be considered as a rare cause of biliary cirrhosis in patients with situs inversus totalis which is presented with extrahepatic cholestasis.

A comparison of antineutrophil cytoplasmic antibody prevalence in patients treated and untreated for hyperthyroidism.

We aimed to compare the prevalence of antineutrophil cytoplasmic antibody (ANCA) and its subgroups between on-treatment (with anti-thyroid drugs; propylthiouracil, methimazole) and untreated patients with hyperthyroidism in our unit. Overall 78 consecutive patients were enrolled in the study; 45 patients were on-treatment (female/male 31:14) and 33 were newly diagnosed (female/male 20:13). We have studied ANCA, perinuclear-ANCA (p-ANCA), cytoplasmic-ANCA (c-ANCA), myeloperoxidase-ANCA (mpo-ANCA), and proteinase 3-ANCA (pr3-ANCA) in sera of all the patients. The data about clinical status, laboratory tests, and physical examination and mean duration of treatment in treated group were recorded. There was no statistically significant difference between the two groups for ANCA, c-ANCA, and pr3-ANCA (P=0.13, P=0.07, and P=0.63 respectively). p-ANCA and mpo-ANCA prevalences were significantly higher in on-treatment group than in untreated group (P=0.04 and P=0.01, respectively). The mean duration of treatment was 17 months in on-treatment group. The use of antithyroid drugs (propylthiouracil, methimazole) seems to be correlated with increased prevalence of ANCA. These drugs may especially increase p-ANCA and mpo-ANCA positivity.