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.

Comparison of endoscopic and pathological findings of the upper gastrointestinal tract in transplant candidate patients undergoing hemodialysis or peritoneal dialysis treatment: a review of literature.

BACKGROUND: Dyspepsia is a common disorder in kidney transplant recipients, and the risk of post-transplant complications is increased in candidates with upper gastrointestinal disease. We evaluated gastrointestinal lesions of kidney transplant candidates on dialysis. METHODS: In this study, endoscopic and pathological findings in hemodialysis (HD) and peritoneal dialysis (PD) patients with gastrointestinal symptoms on the waiting list were compared. RESULTS: The most common non-ulcerous lesions in the endoscopic examination were gastritis (62.3%), erosive gastritis (38.7%), duodenal erosion or duodenitis (18.9%) and esophagitis (13.2%). The ulcerous lesion was present in only 3 patients. Gastroesophageal reflux disease, ulcerated lesion and non-ulcerated lesion rates were similar in both dialysis groups. Histopathological examination revealed Helicobacter pylori (HP) positivity in 28.3% of patients. HP positivity rate was significantly higher in PD patients than in HD patients (38.7% vs. 13.6%, p = 0.046). Chronic gastritis (75.5%) was the most common pathological finding. HP positivity rate was 37.5% in patients with chronic gastritis, but HP was negative in patients without chronic gastritis. In multivariate analysis, male gender, urea and albumin levels were associated with the presence of pathological chronic gastritis. The presence of gastritis, total cholesterol and ferritin levels were found significant for HP positivity. A total cholesterol > 243 mg/dL was significantly related to an increased risk of the presence of HP positivity. CONCLUSIONS: Gastrointestinal lesions and HP infection are common in dialysis patients. Dialysis modality may affect the frequency of some lesions. It may be useful to have an endoscopic examination before entering the transplant waiting list for all candidates.

Levels of TAFI, TFPI and ADAMTS-13 in inflammatory bowel disease.

BACKGROUND/AIMS: There is an increased tendency for thrombosis and thromboembolic complications in patients with inflammatory bowel disease (IBD). The aim of the present study was to determine the serum concentrations of thrombin-activatable fibrinolysis inhibitor (TAFI), tissue factor pathway inhibitor (TFPI) and a disintegrin and metalloproteinase with thrombospondin motif-13 (ADAMTS-13) in patients with IBD and to assess their possible role in the etiopathogenesis of the disease. MATERIALS AND METHODS: Thirty-four patients with IBD (23 ulcerative colitis and 11 Crohn's disease) and 20 healthy controls were included in the present study. TAFI, TFPI, and ADAMTS-13 concentrations were determined by enzyme-linked immunosorbent assay. RESULTS: Mean TAFI, TFPI, and ADAMTS-13 concentrations in the patient group were 17.75 ng/ml, 72.10 ng/ml, and 14.90 U/l, respectively. In the control group, these values were 117.10 ng/ml, 300 ng/ml, and 191.55 U/l, respectively. TAFI, TFPI, and ADAMTS-13 values were significantly lower in the patient group than in the control group (all p<0.01). CONCLUSION: TAFI, TFPI, and ADAMTS-13 levels were significantly lower in the patient group. These findings indicate the presence of a clear, multifactorial imbalance in the coagulation-fibrinolytic system in the patient group. It is also possible that this imbalance in the coagulation and fibrinolytic system may play a role in the still unclear etiopathogenesis of the disease.

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.

Prognostic value of bone marrow microvessel density and angiogenic cytokines in patients with multiple myeloma undergoing autologous stem cell transplant.

Angiogenesis is important for the proliferation and metastasis of most malignant neoplasms including multiple myeloma (MM). The aim of this study was to evaluate the role of bone marrow angiogenesis and angiogenic cytokines in patients with MM prior to and after autologous stem cell transplant (ASCT). Twenty-nine patients with MM who underwent ASCT had serial samples of serum and bone marrow biopsies at diagnosis, prior to ASCT, and at the 3rd and 6th months post-transplant. Besides bone marrow microvessel density (MVD), serum angiogenic cytokines including vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) and markers of disease activity such as interleukin-6 (IL-6), IL-1ß, C-reactive protein (CRP), ß(2)-microglobulin, and bone marrow plasma cells (BMPCs) were also determined. Bone marrow MVD, serum levels of IL-6, CRP, and ß(2)-microglobulin, and BMPCs decreased significantly from diagnosis to the 6th month post-transplant (p < 0.05). Serum FGF and IL-1ß levels decreased significantly until 3 months post-transplant, however lost this significance at the 6th month. Serum VEGF levels did not vary significantly during follow-up. MVD, serum angiogenic cytokine levels, and parameters reflecting disease activity were similar in responders and non-responders to induction chemotherapy. Cytokines and MVD both at diagnosis and prior to transplant did not show any correlation with overall survival (OS) and progression-free survival (PFS) after a median follow-up of 55 months after transplant (p > 0.05). Our findings suggest that bone marrow MVD decreases significantly with ASCT in MM, however without an impact on OS and PFS.

Current prevalence of intestinal metaplasia and Helicobacter pylori infection in dyspeptic adult patients from Turkey.

BACKGROUND: The aim of this study was to investigate the prevalence of Helicobacter pylori (H. pylori) infection and intestinal metaplasia in adult dispeptic patients. (attending an endoscopy clinic at our training and referral hospital in Turkey). METHODOLOGY: A total of 3301 consecutive dyspeptic patients, with a mean age +/- SD of 45.97 +/- 15.15 years, had two antral and two corporal biopsies, during routine upper gastrointestinal endoscopy. Patients were divided into three groups according to age; 18-40 years old, 41-60 years old and over 60 years old. Histological specimens were examined and graded according to the Updated Sydney System for H. Pylori infection and intestinal metaplasia. RESULTS: H. pylori was established in 2353 patients (71.3%). Intestinal metaplasia was found in 586 patients (17.8%). Of these patients, 86% (n:504) had complete and 14% (n:82) had incomplete intestinal metaplasia. Frequency and severity of H. pylori infection decreased significiantly in the older group (p < 0.001). Patients with intestinal metaplasia were older (53.6 +/- 14.9 years) than patients without intestinal metaplasia (44.3 +/- 14.7 years) (p < 0.001). There was no statistically significant relationship between intestinal metaplasia and H. pylori presence (p > 0.05). Intestinal metaplasia was more prevalant in patients with mild infection (21.9%) than in patients without Helicobacter pylori infection (16.3%) or with moderate (16.2%) or severe infection (14.6%) (p < 0.01) CONCLUSION: H. pylori infection and density decreases, while the prevalence of intestinal metaplasia and incomplete intestinal metaplasia percentage increases in older dyspeptic patients. Mild H. Pylori colonisation could be a sign of intestinal metaplasia, especially in the elderly.