The effects of thyroid dysfunctions on insulin resistance in patients with hepatosteatosis.

BACKGROUND: Hepatosteatosis can develop due to insulin resistance. The effect of thyroid function status on insulin sensitivity and resistance is of great interest but the data is still conflicting. OBJECTIVES: The aim of this study was to evaluate the effects of thyroid dysfunctions on insulin resistance in patients with hepatosteatosis. MATERIAL AND METHODS: A total of 407 patients with hepatosteatosis were divided into three groups: 102 subjects with hypothyroidism, 103 with hyperthyroidism and 202 with normal thyroid function (control group). We measured serum thyroid stimulating hormone (TSH), free T4 (FT4) and free T3 (FT3) concentrations, blood glucose and insulin levels, serum lipid levels, hepatic transaminases and the homeostasis model assessment of insulin resistance (HOMA IR). RESULTS: Neither hypothyroidism patients nor hyperthyroidism patients showed significant differences in HOMA IR, glucose and insulin levels (p>0.05 for each). The frequency of insulin resistance was similar in all groups (p>0.05). CONCLUSIONS: Based on our findings, hypothyroidism and hyperthyroidism are not correlated to insulin resistance in patients with hepatosteatosis. Different causes which are associated with insulin resistance should be investigated in patients with thyroid dysfunction and hepatosteatosis.

ß-Globin chain abnormalities with coexisting α-thalassemia mutations.

INTRODUCTION: The frequency of hemoglobinopathies is still high in Adana, the biggest city of the Cukurova Region that is located in the southern part of Turkey. Our aim was to identify the concomitant mutations in α- and ß-globin genes which lead to complex hemoglobinopathies and to establish an appropriate plan of action for each subject, particularly when prenatal diagnosis is necessary. MATERIAL AND METHODS: We studied the association between the ß-globin gene and α-thalassemia genotypes. The reverse hybridization technique was employed to perform molecular analysis, and the results were confirmed by amplification refractory mutation system (ARMS) or restriction fragment length polymorphism (RFLP) technique. RESULTS: We evaluated 36 adult subjects (28 female and 8 male; age range: 18-52 years) with concomitant mutations in their α- and ß-globin genes. The -α(3.7)/αα deletion was the commonest defect in the α-chain as expected, followed by α(3.7)/-α(3.7) deletion. Twenty-five of 36 cases were sickle cell trait with coexisting α-thalassemia, while seven Hb S/S patients had concurrent mutations in their α-genes. The coexistence of α(PolyA-2)α/αα with Hb A/D and with Hb S/D, which is very uncommon, was also detected. There was a subject with compound heterozygosity for ß-globin chain (-α(3.7)/αα with IVSI.110/S), and also a case who had -α(3.7)/αα deletion with IVSI.110/A. CONCLUSIONS: Although limited, our data suggest that it would be valuable to study coexisting α-globin mutations in subjects with sickle cell disease or ß-thalassemia trait during the screening programs for premarital couples, especially in populations with a high frequency of hemoglobinopathies.

ß-Thalassemia mutations and hemoglobinopathies in Adana, Turkey: results from a single center study.

INTRODUCTION: ß-Thalassemia and hemoglobinopathies are common genetic disorders in Turkey and in this retrospective study our aim was to determine the frequency of ß-thalassemia and hemoglobinopathies in Adana, which is one of the biggest cities located in the southern part of Turkey. MATERIAL AND METHODS: Data from 3000 individuals admitted to Seyhan Hereditary Blood Disorders Center in Adana were evaluated. The blood samples were collected into EDTA-containing tubes and hematological parameters were analyzed using an automatic cell counter. High performance liquid chromatography technique was used to determine the type of hemoglobin. Molecular screening of the ß-globin gene was performed with ß-Globin StripAssay. RESULTS: Of 3000 cases, 609 were diagnosed as ß-thalassemia or hemoglobinopathy. We have found that the rates of occurrence of ß-thalassemia and hemoglobinopathies are 13.46% and 6.83% respectively in this area. We have identified 18 different ß-thalassemia mutations and three separate abnormal hemoglobins: HbS, HbD Los Angeles, and HbE. In molecular analyses, ß-thalassemia gene mutations of IVSI.110 (G > A), codon 8 (-AA), IVSI.1 (G > A), IVSI.6 (T > C), -30 (T > A), IVSII.1 (G > A), codon 39 (C > T), codon 44 (-C), IVSI.5 (G > C), codon 5 (-CT), codon 8/9 (+G), IVSII.745 (C > G), codon 22 (7bp del), -101(C > T), codon 36/37 (-T), IVSI.15 (T > G), codon 6 (-A), -88 (G > A) were detected. CONCLUSIONS: Considering the high incidence of mutations that we have found, ß-thalassemia and hemoglobinopathies still seem to be a public health problem in Adana.

Interleukin (IL)-6, interleukin (IL)-8 levels and cellular composition of the vitreous humor in proliferative diabetic retinopathy, proliferative vitreoretinopathy, and traumatic proliferative vitreoretinopathy.

PURPOSE: To investigate the interleukin (IL)-6 levels, IL-8 levels, and cellular composition of the vitreous humor in patients with proliferative diabetic retinopathy (PDR), proliferative vitreoretinopathy (PVR), and traumatic PVR. METHODS: Vitreous samples from 14 patients with PDR, 10 patients with PVR, and 10 patients with traumatic PVR were analyzed. Fifteen cadaver eyes were used as controls. Cytokine levels were measured by ELISA. RESULTS: Elevated IL-6 levels were detected in the vitreous of 12 (85.7%) of the PDR patients, eight (80%) of the PVR patients, and all (100%) of the traumatic PVR patients. None of the control IL-6 results were elevated. Vitreous IL-8 levels were elevated in 12 (85.7%) of the PDR patients, six (60%) of the PVR patients, all (100%) of the traumatic PVR patients, and one (6.7%) of the control eyes. Cytological examination of the vitreous specimens revealed a predominance of macrophages (50%) in the PDR samples and a predominance of retinal pigment epithelial (RPE) cells (60%) in the PVR samples. In contrast, neutrophils predominated (88%) in the traumatic PVR samples. CONCLUSION: The findings suggest that IL-6 and IL-8 may be involved in the pathogenesis of PDR, PVR, and traumatic PVR. High proportions of RPE cells and macrophages are associated with elevated IL-6 and IL-8 levels in the vitreous of PDR and PVR patients; however, the fact that these cells are not predominant in traumatic PVR suggests that different immune response mechanisms may be active in the pathogenesis of these disorders.

Systemic lupus erythematosus and thrombotic thrombocytopenic purpura: a case report.

BACKGROUND: Thrombotic thrombocytopenic purpura (TTP) is a multisystem disorder characterised by platelet aggregation causing microvascular occlusion. Early diagnosis and utilization of plasmapheresis can provide an improvement in prognosis. CASE REPORT: A 17 year old male with classical findings of TTP was later diagnosed as systemic lupus erythematosus (SLE). Plasmapheresis resulted in the significant amelioration of the course. CONCLUSION: The coexistence of TTP and SLE may facilitate a better understanding of in the pathophysiology of TTP. These association may provide the role of autoimmunity in TTP. SLE should be considered in the differential diagnosis of patients with TTP because of therapeutic implications.

The aqueous levels of TGF-beta2 in patients with glaucoma.

PURPOSE: To evaluate the aqueous levels of transforming growth factor beta-2 (TGF-beta2) in open angle glaucoma patients. METHODS: The aqueous levels of active TGF-beta2 were detected in 17 eyes of 17 patients using ELISA method. The control group consisted of 6 cataract extracted patients. RESULTS: Mean age of the patients (60.8 +/- 8.8 years) was similar to that of the controls (57.5 +/- 9.8 years) (p = 0.516). Levels of TGF-beta2 in aqueous samples of glaucoma patients (2.74+/- 1.23 ng/ml) were found to be elevated when compared to those of controls (1.67 +/- 0.32 ng/ml) (p = 0.020). CONCLUSION: We might suggest that the elevated levels of TGF-beta2 in the aqueous of glaucoma patients could play a role in the pathogenesis of glaucoma.

Anti-D and Intravenous Immunoglobulin Treatments in Chronic Idiopathic Thrombocytopenic Purpura.

The aim of this prospective study was to evaluate the data from 29 patients diagnosed as chronic refractory idiopathic thrombocytopenic purpura (ITP) treated with anti-D immunoglobulin and intravenous immunoglobulin G (IVIG). We used anti-D and IVIG in 11 and 18 patients respectively in whom the previous treatments including corticosteroids and splenectomy had been unsuccessful. The complete response rates were significantly higher in IVIG arm (55.5% to 18.1%) with a duration of 8 weeks. The overall efficacy of IVIG in the chronic ITP is similar to previous data, however we found lower platelet responses in patients treated with anti-D that can be attributed to the lower sucess in the splenectomized patients.

Serum profile of T helper 1 and T helper 2 cytokines in patients with chronic hepatitis C virus infection.

BACKGROUND/AIMS: T cell immunoregulatory cytokines may play a crucial role in the host response to hepatitis C virus infection. While T-helper type 1 cytokines are required for host antiviral immune responses, T-helper type 2 cytokines can inhibit the development of these effector mechanisms. The aim of the present study was to determine T-helper type 1 and T-helper type 2 cytokine levels in chronic hepatitis C infection. METHODS: Serum levels of T-helper type 1 cytokine, interferon-gamma (IFN-g), and T-helper type 2 cytokines, IL-4 and IL-10 were measured in 30 patients with hepatitis C infection and 25 healthy controls using ELISA. Serum levels of alanine transaminase were also assessed in both patients and controls. Histologic activity score was evaluated in the chronic hepatic C infected patients. RESULTS: Serum levels of IFN-g were 59.03+/-46.24 pg/mL, IL-4 were 213.59+/-135.67 pg/mL and IL-10 were 106.73+/-60.85 pg/mL in hepatitis C infected patients whereas in healthy controls they were found to be 61.84+/-54.87 pg/mL, 67.39+/-59.74 pg/mL and 60.14+/-50.73 pg/mL respectively. Serum levels of IL-4, IL-10 but not IFN-g were found to be significantly increased in chronic HCV patients compared to those of control subjects. CONCLUSIONS: Our findings may suggest the involvement of Th2 cytokines in the pathogenesis of chronic hepatitis C virus liver disease.

Methylenetetrahydrofolate reductase gene C677T mutation and plasma homocysteine level in Behçet's disease.

OBJECTIVE: The aim of this study was to assess whether homozygosity for the 5, 10-methylenetetrahydrofolate reductase (MTHFR) C677T mutation and plasma homocysteine concentration are related to deep vein thrombosis in Behçet's disease (BD) patients. METHODS: Forty BD patients (23 males, 17 females; mean age 40.2+/-8.4 years) and 60 healthy controls (HC) (34 males, 26 females; mean age 41.6+/-6.9 years) were included in the study. Fourteen of the BD patients had a history of deep venous thrombosis (DVT), as confirmed by Doppler ultrasound. RESULTS: The rates of homozygosity for the MTHFR C677T mutation in the BD and HC groups were 7.5% and 10%, respectively. The distribution of MTHFR genotypes was similar in the two groups ( p>0.05), and analysis showed that homozygosity for the mutation was not a risk factor for DVT. The mean plasma homocysteine levels were 13.4+/-4.2 micro mol/l for the overall BD patients and 12.6+/-3.8 micromol/l for HC ( p>0.05). However, the mean plasma homocysteine level in the BD patients with DVT history (15.9+/-4.6 micromol/l) was significantly higher than the level in the BD patients with no DVT history (12.1+/-3.3 micromol/l) ( p=0.013) and the level in the HC group (12.6+/-3.8 micromol/l) ( p=0.025). CONCLUSION: The study results suggest that elevated plasma homocysteine level may play a role in the pathogenesis of venous thrombosis in BD.

Fibromyalgia syndrome in patients with hepatitis C infection.

Fibromyalgia syndrome (FS) is characterized by widespread pain and tenderness at specific anatomic sites. Different theories have been proposed in the etiopathogenesis of this syndrome, and besides genetic, neuroendocrine, psychologic, and traumatic causes, infections have also been reported. The aim of the present study was to evaluate the presence of FS in patients with hepatitis C virus (HCV) infection. Ninety-five patients with chronic HCV infection and 95 healthy controls were enrolled in the study. The 1990 American College of Rheumatology classification criteria were used for the diagnosis of FS. Tender point count, pain intensity, sleep disturbance, stiffness, headache, paresthesia, fatigue, irritable bowel syndrome (IBS), and sicca- and Raynaud-like symptoms were assessed. Fibromyalgia was found in 18.9% of patients and 5.3% of healthy controls. Mean tender point count, pain intensity scored on a visual analog scale (VAS), sleep disturbance, stiffness, paresthesia, and fatigue were higher in the HCV group. No significant relationship was observed between the two groups regarding headache, IBS, and sicca- and Raynaud-like symptoms. In addition, mean tender point count and pain intensity scores were also significantly higher in HCV patients with FS than in control subjects with FS. All of the symptoms except stiffness were not statistically significant between the HCV and control groups with FS. Our results demonstrate a tendency toward higher prevalence of FS in patients with HCV infection. Besides various extrahepatic features, musculoskeletal disorders including fibromyalgia might be expected in the progression of HCV infection. Detailed examination of the patients helps to differentiate FS from other musculoskeletal complications of HCV infection. This will provide appropriate management approaches and better quality of life for them.

Gastric emptying time and the effect of cisapride in cirrhotic patients with autonomic neuropathy.

GOALS To investigate the relationships between gastric emptying and autonomic dysfunction in hepatic cirrhosis and to assess the effects of cisapride on gastric emptying in cirrhotic patients. STUDY Twenty-four cirrhotic patients (8 patients in each Child-Pugh classification) and 25 healthy controls were enrolled. All the patients had viral (B or C) hepatitis. Patients with DM, alcoholic cirrhosis, active peptic ulcer, gastric malignancy and pyloric obstruction were excluded by esophagogastroduodenoscopy. Parasympathetic and sympathetic functions were assessed by the criteria set forth by Ewing and Clark. Drugs affecting GI motility and smoking were discontinued 48 hours and 12 hours prior to the study respectively. A solid-phase of gastric emptying study was conducted by scintigraphic method for the calculation of gastric half-emptying time (GET1/2). RESULTS The study revealed that 9 patients with Child-Pugh B and C cirrhosis had autonomic neuropathy and none of Child-Pugh A cirrhosis had autonomic neuropathy. Prolonged GET1/2 was noted in cirrhotics compared with the control group (p < 0.05). However, there was significant difference between 9 patients (Child B-C) with autonomic neuropathy compared with patients 15 patients without autonomic neuropathy. Again there was a significant difference in GET1/2 between Child A cirrhotic and Child B-C cirrhotic whether they had autonomic neuropathy or not. Cisapride decreased GET1/2 significantly in cirrhotic patients (Child B-C cirrhotic). Clearly, patients with autonomic neuropathy in Child B-C cirrhosis had significantly reduced GET1/2 after cisapride administration. Even though cisapride decreased GET1/2 in patients with Child B-C cirrhosis without autonomic neuropathy, this was not significant. CONCLUSION Autonomic neuropathy in advanced cirrhosis from viral hepatitis may cause prolonged gastric emptying. Cisapride can shorten gastric emptying time in such patients.