Noninvasive Liver Fibrosis Indices as Indicators of Microvascular and Macrovascular Complications in Type 2 Diabetes.

Objective: Nonalcoholic fatty liver disease (NAFLD) is more prevalent in patients with obesity, diabetes, and metabolic syndrome, which are risk factors for nonalcoholic steatohepatitis and liver fibrosis. NAFLD is related to cardiovascular outcomes in diabetes. We aimed to investigate the relationship between diabetic complications and NAFLD fibrosis score (NFS) and Fibrosis-4 score (FIB-4). Methods: Three hundred patients with type 2 diabetes mellitus (T2DM) were retrospectively evaluated according to NAFLD diagnosis on ultrasound in outpatient clinic. Risk of advanced fibrosis was estimated using FIB-4 and NFS. Diabetic complications of the patients were noted. Results: Presence of diabetic retinopathy is related to FIB-4 (P = 0.001) and NFS (P < 0.001) scores. NFS score (P = 0.037), not FIB-4 (P = 0.517), is related to diabetic nephropathy. Among macrovascular complications, only coronary artery disease is related to NFS and FIB-4 scores (P = 0.037 and P = 0.004, respectively). Although we cannot establish any association between fasting blood glucose, glycosylated hemoglobin (HbA1c) values and noninvasive liver fibrosis scores (P > 0.05), diabetes duration, and age positively correlated with the FIB-4 score (P = 0.033, P = 0.001). In logistic regression analysis, NFS > 0.676 values are associated with increased rates of diabetic retinopathy, independent of age, sex, HbA1c, and duration diabetes (odds ratio: 1.155, P = 0.030). FIB-4 has no relation with microvascular complications according to logistic regression analysis (P > 0.05 for all). Neither FIB-4 nor NFS has an effect on the presence of macrovascular complications (P > 0.05 for all). Conclusion: Our findings suggest that increase in NFS score is associated with the presence of diabetic retinopathy, independent of confounding factors. Further studies are needed on the applicability of noninvasive fibrosis scores in monitoring the presence of diabetic microvascular and macrovascular complications.

Factors related to the presence of nonalcoholic fatty liver disease in patients with type 2 diabetes: a single center study.

Aim of the study: There is a close relationship between the development of diabetes and nonalcoholic fatty liver disease (NAFLD). The aim of the study was to determine the frequency and associated factors of NAFLD in type 2 diabetes mellitus (T2DM) patients according to the ultrasound examination and noninvasive hepatic fibrosis indices. Material and methods: 316 patients who were followed up in the Internal Medicine Diabetes clinic, over the age of 18, diagnosed with T2DM were included retrospectively. NAFLD was noted using ultrasound. NAFLD fibrosis score (NFS), fibrosis-4 index (FIB-4) and AST to platelet ratio index (APRI) were used as non-invasive hepatic fibrosis indices. Results: The prevalence of NAFLD with hepatic ultrasound was 89.7% in T2DM patients. Among non-invasive fibrosis indices, NFS and FIB-4 were similar, but APRI was significantly higher in moderate-severe hepatosteatosis group (p values = 0.355, 0.246 and 0.003 respectively). In logistic regression analysis, while mild hepatosteatosis was associated with BMI and NFS (p = 0.004, p = 0.008), moderate to severe hepatosteatosis as associated with BMI and serum triglycerides (p < 0.001, p = 0.019). Conclusions: The prevalence of NAFLD is high in patients with T2DM. The frequency and degree of NAFLD is associated with the NFS, BMI and hypertriglyceridemia. While NFS is associated with mild hepatosteatosis; moderate to severe hepatosteatosis is associated with BMI and serum triglycerides.

Relationship between Metabolic Syndrome Components and COVID-19 Disease Severity in Hospitalized Patients: A Pilot Study.

Background: Preliminary data suggest that patients with comorbidities are more susceptible to severe COVID-19 infection. However, data regarding the presence of metabolic syndrome (MetS) in patients with COVID-19 are scarce. Aim: In the present study, we aim to investigate the association between MetS components and disease severity in hospitalized COVID-19 patients. Methods: We conducted a prospective observational study of 90 hospitalized patients with COVID-19 pneumonia at a tertiary hospital. The study population consisted of inpatients who tested positive by the reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2. Patients with critical COVID-19 disease on admission were excluded. Adult Treatment Panel III of the National Cholesterol Education Program (NCEP-ATP III) criteria were used to define MetS. Laboratory analysis and thorax CT were performed on admission. Results: 90 patients, 60 moderate and 30 severe COVID-19 patients, included in the study. The percentage of MetS cases was higher among severe COVID-19 patients (p=0.018). Of the MetS criteria fasting blood glucose (p=0.004), triglycerides (p=0.007) were significantly higher in patients with severe COVID-19 disease with no statistical significance found in waist circumference (WC) (p=0.348), systolic blood pressure (p=0.429), and HDL-C levels (p=0.263) between two groups. Body mass index (BMI) values were similar in both severe and moderate cases (p=0.854). In logistic regression analysis, serum triglycerides (p=0.024), HDL-C (p=0.006), and WC (p=0.004) were found as independent prognostic factor for severe COVID-19 infection. Conclusion: Severe COVID-19 patients have higher rates of MetS. Serum triglycerides, HDL-C, and WC have an impact on disease severity in COVID-19.

COVID-19 pneumonia in patients with impaired fasting glucose, newly diagnosed diabetes and pre-existing diabetes: a tertiary center experience.

COVID-19 infection is known to increase mortality in patients with diabetes. We aim to demonstrate the differences in disease course and clinical outcomes of patients with COVID-19 regarding the presence of impaired fasting glucose, pre-existing diabetes mellitus (DM) or new-onset DM. 236 patients with positive reverse transcription-PCR tests for SARS-CoV-2 were included in this single-center, retrospective observational study between March 2020 and May 2021. Laboratory results, comorbidities, medications and imaging findings were noted. Logistic regression was used to estimate associated factors for admission to the intensive care unit (ICU). 43 patients with normal glucose, 53 with impaired fasting glucose, 60 with newly diagnosed DM, and 80 with pre-existing DM were classified. Patients with pre-existing DM had higher fasting glucose and glycated hemoglobin than the other groups (p<0.001 for all). Patients with newly diagnosed DM were more likely to need dexamethasone 6 mg (p=0.001). In both newly diagnosed diabetes and impaired fasting glucose groups, 250 mg methylprednisolone was needed at higher rates (p=0.002). Newly diagnosed DM had higher rates of intubation (21.6%) and more mortality (20.0%) (p=0.045 and p=0.028, respectively). Mortality and hospitalization in the ICU were lower in the group receiving antidiabetic treatment. The risk of ICU attendance was higher in patients with impaired fasting glucose (HR=1.71, 95% CI: 0.48 to 6.08) and newly diagnosed DM (HR=1.88, 95% CI: 0.57 to 6.17), compared with pre-existing DM and non-diabetics. Newly diagnosed DM and impaired fasting glucose are associated with increased mortality and intubation in inpatients with COVID-19.

Effect of abdominal fat distribution on severity of acute pancreatitis.

AIM OF THE STUDY: Obesity is a well-determined risk factor for acute pancreatitis. Increased visceral fat has been shown to increase the proinflammatory environment experienced by patients. In this study, we aimed to research the correlation between abdominal fat distribution parameters measured with computed tomography (CT) and severity of acute pancreatitis (AP). MATERIAL AND METHODS: The study included patients monitored due to AP in the internal medicine clinic of GOP Education and Research Hospital from January 2015 to December 2018. The Acute Physiology and Chronic Health Evaluation (APACHE) score, the Imrie score and the Bedside Index of Severity in Acute Pancreatitis (BISAP) scores were calculated. Advanced image processing analysis software (INFINIT Xelis, v 1.0.6.3) was used to calculate individual abdominal fat distribution parameters from CT screening with division of abdominal tissues. Measurements were performed from -50 to -250 Hounsfield units (HU) between vertebrae L2-L3. RESULTS: When mild and moderate AP groups were compared, there were statistically significant differences in duration of hospital stay and scoring (APACHE, Imrie and BISAP) (p < 0.001), while there were no significant differences in abdominal fat distribution parameters (p > 0.05). There was no significant correlation of visceral and subcutaneous fat volumes with development of systemic complications, while a significant correlation was identified for visceral to total fat tissue area ratio (VTR) with local complications (p < 0.001). Pearson correlation analysis found no correlations of mortality and pancreatitis severity with visceral (VFA) and subcutaneous fat area (SFA) (p > 0.05). Positive correlations were identified for VFA with Imrie, BISAP and APACHE scores (p < 0.01), and positive correlations were identified for visceral adipose tissue (VAT) with visceral to subcutaneous fat ratio (VSR) and APACHE scores (r = 0.256 and 0.252, respectively, p < 0.001). Positive correlations were identified for VTR and VSR ratios with BISAP scores (r = 0.266 and r = 0.277, respectively, p < 0.001). CONCLUSIONS: In patients with AP diagnosis and abdominal CT scans, increased VFA and VTR ratio were found to be associated with increased AP clinical scores with no significant correlation identified in terms of local/systemic complication development. Our study shows that VFA is linked to AP clinical scoring systems and should be included in AP predictive scoring systems.

Role of serum adropin measurement in the assessment of insulin resistance in obesity.

Obesity has recently been mentioned as a metabolic pandemic in developed and developing countries and is an important known risk factor for type 2 diabetes and cardiovascular diseases. The main mechanism responsible for obesity is insulin resistance. Adropin is a peptide-structured regulatory hormone that is suggested to play a role in insulin resistance and metabolic regulation. We aimed to evaluate the associations of serum adropin with insulin resistance and clarify the factors affecting serum adropin concentrations. The study included 50 obese patients and 22 healthy controls. Patients with chronic disease and drug use history were excluded. Serum adropin and other metabolic parameters were obtained after overnight fasting. ELISA was used to measure serum adropin concentrations. The homeostatic model assessment-insulin resistance (HOMA-IR) index was used to calculate insulin resistance. Insulin resistance was defined as HOMA-IR >2.5. Serum adropin values were found to be low in the obese otherwise healthy patient group (p<0.001). Linear regression analysis revealed that age, body mass index (BMI), waist circumference (WC), high-density lipoprotein cholesterol, fasting glucose, and HOMA-IR affect serum adropin level. In multiple regression analysis, age is the most significant factor affecting serum adropin concentration. Serum adropin concentrations were negatively correlated with BMI, WC, diastolic blood pressure, fasting glucose, and insulin. Serum adropin concentrations were low in obese patients and the optimum cut-off point for adropin to indicate HOMA-IR at 2.5 is 216.7 ng/L. The findings suggest that serum adropin may contribute to the regulation of glycolipid metabolism and insulin resistance in obese patients.

Endocan: A Biomarker for Hepatosteatosis in Patients with Metabolic Syndrome.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases, which has recently been mentioned as an independent cardiovascular risk factor. OBJECTIVES: Endocan is a novel molecule of endothelial dysfunction. We aimed to evaluate the associations of serum endocan levels with the hepatic steatosis index (HSI), fatty liver index (FLI), and degrees of hepatosteatosis in patients with metabolic syndrome with NAFLD. Design and Setting. This cross-sectional prospective study was performed in the outpatient clinic of an internal medicine department. METHODS: The study included 40 patients with metabolic syndrome with NAFLD as noted using hepatic ultrasound and 20 healthy controls. Secondary causes of fatty liver were excluded. FLI and HSI calculations were recorded. Serum endocan level values were obtained after overnight fasting. RESULTS: Higher values of HSI and FLI were found in the NAFLD groups than in the control groups (p < 0.001). Five (12.5%) of 20 patients with liver steatosis had grade 1 liver steatosis, 15 (37.5%) patients had grade 2 liver steatosis, and 20 (50%) patients had grade 3 liver steatosis. Serum endocan levels were lower in patients with NAFLD compared with the healthy controls (146.56 ± 133.29 pg/mL vs. 433.71 ± 298.01 pg/mL, p < 0.001). ROC curve analysis suggested that the optimum endocan value cutoff point for NAFLD was 122.583 pg/mL (sensitivity: 71.79%, specificity: 90%, PPV: 93.3%, and NPV: 62.1%). CONCLUSION: Serum endocan concentrations are low in patients with NAFLD, and the optimum cutoff point is 122.583 pg/mL. HSI and FLI were higher in patients with NAFLD; however, there was no correlation with serum endocan.

Evaluation of serum endocan levels in relation to epicardial fat tissue thickness in metabolic syndrome patients.

INTRODUCTION: Metabolic syndrome has been recognized as a predictor of cardiovascular diseases. Epicardial fat tissue (EFT) thickness has recently been shown to be a predictor of cardiovascular diseases in metabolic syndrome patients. Endocan is a novel molecule which is considered to be an early marker of endothelial dysfunction. Our aim was to evaluate endocan serum levels for the first time in metabolic syndrome patients, in relation to EFT thickness. MATERIAL AND METHODS: The study included 44 patients with metabolic syndrome who had neither chronic kidney disease nor chronic inflammation and 26 healthy controls. Fasting blood samples were obtained from the groups. The serum levels of endocan were measured with a Sunred ELISA kit. EFT thickness of patients was measured by echocardiography. RESULTS: The serum endocan levels were significantly lower in the metabolic syndrome patients compared to the healthy controls (120.71 ±90.17 pg/ml vs. 414.59 ±277.57, p < 0.001). Metabolic syndrome patients demonstrated significantly higher EFT (p = 0.042). EFT thickness had a positive correlation with age (r = 0.397, p = 0.008) and weight (r = 0.010). However, there was no correlation with serum endocan (r = -0.021, p = 0.893) or other parameters. Regression analysis revealed that waist circumference is the parameter among metabolic syndrome criteria having the strongest relationship with serum endocan levels (ß = -0.499, p = 0.21). CONCLUSIONS: EFT thickness was high in metabolic syndrome patients and can be a useful marker for cardiovascular risk assessment. However, serum endocan levels were found to be low and there was no correlation with EFT thickness. Large sample sized prospective studies are needed to clarify the relation of endocan levels with the other clinical indicators of cardiovascular risk in metabolic syndrome.

Helicobacter pylori infection coexisting with intestinal metaplasia is not associated with colorectal neoplasms.

INTRODUCTION: Colorectal cancer is one of the most common cancers and is a major cause of morbidity and mortality in the world and our country. Studies have indicated that there might be a relationship between Helicobacter pylori (Hp) and colorectal neoplasia (CN), although others have not found any relationship. AIM: To determine whether there is a potential relationship between Hp and CN in our patients. MATERIAL AND METHODS: A total of 314 patients, aged 16-86 years, who underwent gastroscopy and colonoscopy at our department between 2015 and 2017 were evaluated retrospectively. The age, gender, endoscopy results, presence of Hp, complete blood count (CBC), vitamin B12, folic acid, C-reactive protein (CRP), and sedimentation levels of the patients were examined. RESULTS: CBC, ferritin, vitamin B12, and CRP measurements did not show statistical significance in terms of the presence of Hp (p > 0.05). Folate values of Hp-positive patients were significantly lower than Hp-negative patients (p = 0.007; p < 0.01). No significant relationship was detected between Hp and colon cancer (p > 0.05). Adenomatous polyps were not related to Hp (p > 0.05). Correlation between intestinal metaplasia (IM) and adenomatous polyps was insignificant. There was no statistically significant difference between colon and gastric pathology results. CONCLUSIONS: In our study, no significant relationship was noted between Hp and CN. A few studies have been conducted in our country, and our results are consistent with some of these studies while it is contradictory to others. Large populational multicentre studies are needed in order to identify the relationship between Hp and CN.

Idiopathic Intrahepatic Cholestasis as an Unusual Presentation of Hodgkin's Disease.

Intrahepatic cholestasis in the form of paraneoplastic phenomena is an uncommon presentation of Hodgkin's lymphoma (HL). Herein we report the diagnosis of mixed type HL-related idiopathic intrahepatic cholestasis in a 73-year-old man presenting with jaundice, after the inguinal lymph node biopsy indicative of mixed cellular type HL and liver biopsy consistent with intrahepatic cholestasis, following several diagnostic interventions including surgery for suspected extrahepatic obstructive cholestasis. Our findings emphasize the value of early liver biopsy in the diagnostic algorithm along with consideration of HL-related idiopathic intrahepatic cholestasis as a diagnosis of exclusion in cholestatic jaundice of obscure origin.

Relationship between plasma chemerin levels and disease severity in COPD patients.

BACKGROUND AND AIMS: Chronic inflammation of the lung is a characteristic finding in chronic obstructive pulmonary disease (COPD). The protein chemerin has been identified in inflammatory fluid and in inflamed tissues. This study aimed to determine the association between serum chemerin levels and the severity of COPD. METHODS: Forty-three COPD patients and 38 healthy subjects were enrolled in this study. Fasting plasma samples were obtained from the patient and the control group. Serum chemerin levels were measured using a commercial enzyme-linked immunosorbent assay. C-reactive protein levels, the erythrocyte sedimentation rate, and fibrinogen analysis were used to assess the inflammation status of the patients. Spirometric measurements with reversibility testing were performed in all the subjects. RESULTS: Serum chemerin levels were significantly elevated in the COPD patients (6.44 ± 0.52 vs 5.22 ± 0.59; P < 0.001). A Mann-Whitney U-test revealed that the serum chemerin levels of stage 2 COPD patients were higher than those of stage 1 and 3 COPD patients (P = 0.651). Cigarette smoking and plasma chemerin relation was also understudied; however, there was no significant relationship between current smokers and ex-smokers (P > 0.05). Pearson's correlation analysis indicated that serum chemerin levels were positively correlated only with total cholesterol (T. cholesterol) (P < 0.05, r = 0.382). In the linear regression analysis, chemerin levels were associated with age (ß = 0.321), triglycerides (ß = 0.299) and T. cholesterol (ß = 0.555). CONCLUSION: Our study points to a relation between plasma chemerin levels and COPD. Larger patient groups are needed to verify the role of chemerin in the severity of COPD.

Relationship between levels of brain-derived neurotrophic factor and metabolic parameters in patients with type 2 diabetes mellitus.

BACKGROUND AND AIM: Studies have suggested that brain-derived neurotrophic factor (BDNF) plays a role in glucose and lipid metabolism and inflammation. The aim of this study was to evaluate the relationship between serum BDNF levels and various metabolic parameters and inflammatory markers in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: The study included 88 T2DM patients and 33 healthy controls. Fasting blood samples were obtained from the patients and the control group. The serum levels of BDNF were measured with an ELISA kit. The current paper introduces a receiver-operating characteristic (ROC) generalization curve to identify cut-off for the BDNF values in type 2 diabetes patients. RESULTS: The serum levels of BDNF were significantly higher in T2DM patients than in the healthy controls (206.81 ± 107.32 pg/mL versus 130.84 ± 59.81 pg/mL; P < 0.001). They showed a positive correlation with the homeostasis model assessment of insulin resistance (HOMA-IR) (r = 0.28; P < 0.05), the triglyceride level (r = 0.265; P < 0.05), and white blood cell (WBC) count (r = 0.35; P < 0.001). In logistic regression analysis, age (P < 0.05), body mass index (BMI) (P < 0.05), C-reactive protein (CRP) (P < 0.05), and BDNF (P < 0.01) were independently associated with T2DM. In ROC curve analysis, BDNF cut-off was 137. CONCLUSION: The serum BDNF level was higher in patients with T2DM. The BDNF had a cut-off value of 137. The findings suggest that BDNF may contribute to glucose and lipid metabolism and inflammation.