Heart Rate Recovery Is Impaired in Patients with Inflammatory Bowel Diseases.

OBJECTIVE: In this study we aimed to investigate heart rate recovery (HRR) in patients with inflammatory bowel disease (IBD). SUBJECTS AND METHODS: A total of 40 patients with IBD and 30 healthy controls were included in this study. A treadmill stress test was performed in all the patients to calculate the HRR index based on the age-specific maximum heart rate. The HRR indices were calculated as follows: HRR1, 2, 3, 4, 5 = heart rate at peak exercise - heart rate at 1, 2, 3, 4, and 5 min. The independent samples t test was used to compare HRR indices between the patient and control groups. The Pearson correlation coefficient was used to examine the association between the duration of IBD and the HRR indices. Multivariate regression analysis was carried out to identify predictors of impaired HRR in patients with IBD. RESULTS: HRR indices at various time intervals were significantly lower in the patients with IBD than in the controls: HRR1 (1.18 ± 8 vs. 31 ± 7, p < 0.001), HRR2 (36 ± 12 vs. 51 ± 8, p < 0.001), HRR3 (46 ± 12 vs. 62 ± 11, p < 0.001), HRR4 (54 ± 7 vs. 65 ± 8, p < 0.001), and HRR5 (55 ± 13 vs. 71 ± 15, p < 0.001). Mean duration of IBD was 7.8 ± 3.6 years. In addition, there was a significant negative correlation between disease duration and HRR at the first minute (r = -0.704, p < 0.001). Multivariate logistic regression analysis showed that symptom duration (OR: 1.742, 95% CI: 1.148-2.636, p = 0.009) was an independent predictor of impaired HRR in patients with IBD. CONCLUSION: In this study, the data showed that the HRR was impaired in patients with IBDs. Hence, given the prognostic value of the test, patients with IBD should be monitored for future cardiovascular events.

Usefulness of the Neutrophil-to-lymphocyte Ratio and Platelet Morphologic Parameters in Predicting Hepatic Fibrosis in Chronic Hepatitis C Patients.

BACKGROUND: Chronic hepatitis C (CHC) can progress to fibrosis and cirrhosis. The current gold standard for the diagnosis and staging of hepatic fibrosis is liver biopsy, but liver biopsies have various limitations. We evaluated the neutrophil-to-lymphocyte ratio (NLR) and platelet morphologic parameters to determine fibrosis in CHC patients. METHODS: We retrospectively reviewed the data of 144 patients who were diagnosed with CHC by percutaneous liver biopsy. Patients' fibrosis scores and histological activity indices were calculated according to the Ishak scoring system. RESULTS: Eighty-six patients (60%) were female, and the mean age of the whole group was 53.7 years. The low fibrosis (F1-2) group included 56 patients, the high fibrosis group (F3-6) included 88 patients, and the cirrhosis group (F5-6) included 38 patients. There was no statistically significant difference between low and high fibrosis groups or cirrhotic and noncirrhotic groups in terms of NLR. However, plateletcrit (PCT) was significantly lower in patients with cirrhosis and high fibrosis. CONCLUSIONS: NLR is not associated with histological severity and is not an adequate test to determine either significant fibrosis or cirrhosis. For the first time in the literature, this study showed that PCT was significantly lower in patients with significant fibrosis and that NLR was positively correlated with cholestatic liver enzyme leves.

Acute Pancreatitis Caused By Mushroom Poisoning: A Report of Two Cases.

Of the more than 5000 species of mushrooms known, 100 types are toxic and approximately 10% of these toxic types can cause fatal toxicity. A type of mushroom called Amanita phalloides is responsible for 95% of toxic mushroom poisonings. In this article, we report 2 cases of mushroom poisonings caused by Lactarius volemus, known as Tirmit by the local people. The patient and his wife were admitted to the emergency room with abdominal pain, nausea, and vomiting 20 hours after consuming Lactarius volemus, an edible type of mushroom. The patients reported that they had been collecting this mushroom from the mountains and eating them for several years but had never developed any clinicopathology to date. Further examination of the patients revealed a very rare case of acute pancreatitis due to mushroom intoxication. The male patient was admitted to the intensive care unit while his wife was followed in the internal medicine service, because of her relative mild clinical symptoms. Both patients recovered without sequelae and were discharged. In this article, we aimed to emphasize that gastrointestinal symptoms are often observed in mushroom intoxications and can be confused with acute pancreatitis, thus leading to misdiagnosis of patients. Early diagnosis and appropriate treatment can improve patients' prognosis and prevent the development of complications.

The association of serum gamma-glutamyl transpeptidase level and other laboratory parameters with blood pressure in hypertensive patients under ambulatory blood pressure monitoring.

BACKGROUND: Hypertension is a very important cause of morbidity and mortality. Serum gamma-glutamyl transpeptidase (GGT) is a biomarker of oxidative stress and associated with increased risk of hypertension and diabetes. The aim of this study was to evaluate the association of serum GGT level, which is an early marker of inflammation and endothelial dysfunction, with the deterioration of the diurnal rhythm of the blood pressure. METHODS: A total of 171 patients with hypertension were included in this study. Patients whose nighttime mean blood pressure, measured via ambulatory blood pressure monitoring, decreased between 10% and 20% compared with the daytime mean blood pressure were defined as "dippers", whereas patients with a nighttime blood pressure decrease lower than 10% were defined as "non-dippers". RESULTS: A total of 99 hypertensive patients (65 females/34 males) were classified as dippers and 72 patients (48 females/24 males) as non-dippers. The mean age of the non-dipper group was significantly greater than the dipper group. Serum GGT, C-reactive protein and uric acid levels were significantly higher among patients in the non-dipper group. Negative correlations were detected between GGT levels and diurnal systolic and diastolic blood pressure decreases. CONCLUSION: Our findings revealed that GGT level was higher in the non-dipper group, and was negatively correlated with the nighttime decrease of diurnal blood pressure. C-reactive protein and uric acid levels were also higher in the non-dipper group. However, future randomized controlled prospective studies with larger patient populations are necessary to confirm our findings.