Frequency of fibrosis in patients with incidentally detected hepatosteatosis.

OBJECTIVE: In this study, we aimed to elucidate fibrosis in patients who visited our outpatient clinic with complaints such as abdominal pain and dyspepsia and who had fatty liver by ultrasound imaging. METHODS: A total of 119 patients who were admitted to the gastroenterology outpatient clinic of our institution with incidentally detected hepatosteatosis on ultrasound imaging were included in the study. Patients with hepatosteatosis were examined for fibrosis with the FibroScan-502-touch (Echosens, Paris, France) elastic tissue ultrasonography device. The effects of these parameters on hepatosteatosis and possible fibrosis degree were investigated. RESULTS: No fibrosis was detected in 75 (63.02%) patients with hepatosteatosis on ultrasound imaging, 20 (10.05%) F1, 22 (18.48%) F2, 1 (0.8%) F3, and 0.1 (0.8%) F4. Accordingly, as the degree of steatosis increases in patients with incidentally detected hepatosteatosis, the degree and frequency of fibrosis increase with statistical significance (p<0.05). A statistically significant difference was found between the alanine transaminase increase and the hepatosteatosis degree (p=0.028). The median value of gamma-glutamyltransferase was 15 U/L in S0, 18.5 U/L in S1, 22 U/L in S2, and 26 U/L in S3 (p<0.047). CONCLUSION: To date, no research exists on fibrosis in patients with incidental hepatosteatosis. The outcomes of this study elaborated that patients with hepatosteatosis in the community could be detected at least at an early stage by following up and diagnosing them with serum markers before they progress to end-stage fibrosis.

Effects of Arum dioscoridis Extract on Hepatic Toxicity Caused by Thioacetamide in Rats.

BACKGROUND: The aim of this study was to investigate the prophylactic and therapeutic effects of Arum dioscoridis (tirsik) plant extract against thioacetamide-induced experimental liver toxicity. METHODS: In this study, 35 male Wistar-Albino rats, of 12-14 weeks old, weighing between 200 and 270 g, were used. Rats were divided into 5 groups of 7 each. The first group was determined as the control group, the second group as the hepatotoxicity group, the third group as the prophylaxis group, the fourth group as the intraperitoneal treatment group, and the fifth group as the oral treatment group. Hepatotoxicity was achieved with a single intraperitoneal dose of 350 mg/kg of thioacetamide (TAA). On the seventh day, the rats were sacrificed under general anesthesia. Their blood was taken and liver enzymes were studied. Malondialdehyde (MDA), glutathyon peroxi dase (GPx), catalase (CAT), superoxit dismutase (SOD) enzymes were studied from liver tissues. In addition, liver tissues were evaluated histopathologically. RESULTS: With Arum dioscoridis treatment and prophylaxis, improvements in all parameters and increases in tissue antioxidant levels were detected. CONCLUSION: It was determined that Arum dioscoridis plant extract has prophylactic and therapeutic effects on liver toxicity. In cases of acute liver injury and hepatotoxicity, we suggest the potential application of Arum dioscoridis for effective and inexpensive treatment.

Could an Increased Percentage of Immature Granulocytes Accompanying Dyspepsia Predict COVID-19?

Background and Aim: Although vaccination practices continue at a fast pace around the world, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) still threatens people's lives. In this study, we aimed to determine the presence of SARS-CoV-2 in patients who do not have the typical symptoms of the novel coronavirus disease 2019 (COVID-19), but only present with dyspepsia, and to investigate the role of immature granulocytes in the early diagnosis of these patients. Material and Methods: Adult and pediatric patients suffering from dyspepsia were included in the study. The patients were divided into two groups, ''positive'' and ''negative'', based on their SARS-CoV-2 polymerase chain reaction test results. Immature granulocyte count (IG), immature granulocyte percentage (IG%), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) values were recorded. Results: A total of 238 patients, including 25 (10.5%) pediatric and 213 (89.5%) adult patients, were included in the study. A total of 2 (8%) pediatric patients and 17 (7.9%) adult patients tested positive for SARS-CoV-2. The IG, IG%, and CRP parameters were significantly higher in the SARS-CoV-2-positive patients compared to the SARS-CoV-2-negative patients. The optimal cut-off value predictive of COVID-19 infection was determined to be ≥0.650 (sensitivity: 52.6% and specificity: 95.5%, p = 0.001) for IG%. Conclusions: It should be noted that dyspepsia may also be a COVID-19 symptom. IG% values, which can be determined with a hemogram test, a cheap and easily accessible test, may be a warning in the early detection of patients who do not have the typical symptoms of COVID-19.

The relationship between hepatic fibrosis and arterial stiffness in hemodialysis patients.

INTRODUCTION: The main cause of death in hemodialysis patients is cardiovascular diseases. Increased arterial stiffness is a predictor of cardiovascular events for hemodialysis patients. Among the nondialysis patient population, arterial stiffness increases in those with hepatic fibrosis and nonalcoholic fatty liver disease. This study aims to examine the relationship between hepatic fibrosis and arterial stiffness in hemodialysis patients for the first time in the literature. MATERIAL AND METHOD: The study includes chronic hemodialysis patients over 18 years of age who had been treated for hemodialysis for at least 6 months. Patients with chronic liver disease, chronic viral hepatitis (HBV and HCV), alcohol use, or liver disease accompanied by polycystic kidney disease and active infection were excluded. Hepatic fibrosis scores were measured using the FibroScan device. Single-cuff Mobil-o-Graph was used for measurement of arterial stiffness. RESULTS: Fifty-nine patients were enrolled; 54.2% of the patients were male, and the mean age was 53.9 ± 12.9 years. Thirty-nine percent of the patients had diabetes. Average pulse wave velocity (PWV) value of the patients was 8.3 ± 1.6 m/s, and it had positive correlation with age, CAP score, fibrosis score, and body mass index and showed negative correlation to albumin. It was seen that the patients with a PWV value ≥ 10 m/s have significantly higher CAP score compared with the patients with a PWV < 10 m/s. When the factors predicting PWV were examined in the regression analysis, age and systolic blood pressure were found to be determinants. CONCLUSION: Increased hepatic fibrosis in hemodialysis patients is associated with increased arterial stiffness, but this relationship is not independent.

Comparison between prognostic indicators in organ insufficiency with acute pancreatitis.

BACKGROUND: Organ failures that develop due to acute pancreatitis (AP), some laboratory values and the anthropometric characteristics of the patients have been shown to play a role in the prognosis AP and have been increasingly used to investigate the prognosis of the disease although classification systems, such as Ranson's criteria, are still used habitually. In this stud, we aimed to investigate the relationship of the organ failures observed during the course of AP, the biochemical parameters and the anthropometric characteristics of the patients and compare using Ranson's and Atlanta Classifica-tion (AC) systems. METHODS: Laboratory values, anthropometric data, including the waist circumference and body mass index, Systemic inflammatory response syndrome (SIRS) and organ failures developed during the course of the disease, were investigated prospectively in 153 AP patients and the Ranson and Modified Atlanta Classifications (MAC) were made. RESULTS: A relationship was observed between the organ failures that were established in the course of the disease (lung, liver, kidney, heart and MOF (multiple organ failure)) and higher Ranson's and MAC scores (p<0.05). Among the patients included in this study, 13 (8.4%) had multiple organ failure and 17 (11.1%) had SIRS. Exitus occurred in 10 patients (6.5%). A statistically significant relationship was found with organ failure, multiple organ failure and SIRS; and ensuing exitus (p<0.05). While no relationship was observed between the waist circumference, body mass index, Ranson's score, there was a significant relationship between the MAC and the waist circumference (p<0.01). Among the laboratory values, high urea and ALT values showed a relationship with the Ranson and MAC (p<0.001), while between the CRP values tested at the 0 time point and the 48th hour, only the CRP value at the 48th hour had a relationship with Ranson's score (p<0.05). Organ failure, MOF, and SIRS showed a correlation with both the severity scores and the mortality rate. In addition, a significant corre-lation was observed between the cholesterol, triglycerides and the CRP level at the time of hospitalisa-tion and mortality. On the contrary, no significant relationship was observed with the other laboratory results, including calcium, lipase and hematocrit. CONCLUSION: In conclusion, to determine the severity and prognosis of acute pancreatitis, and ex-pect the organ failures that may occur in severe pancreatitis, the body mass index, waist circumference and laboratory values, including cholesterol, triglycerides, ALT, and CRP may supply important prog-nostic data besides the conventional disease severity scoring methods.

Early cardiac electrical and structural changes in patients with non-obese non-alcoholic fatty liver disease.

Background    Obese non-alcoholic fatty liver disease (NAFLD) was found to increase the risk of developing atrial fibrillation (AF) regardless of the metabolic syndrome subgroups that may accompany it. In this study, the effect of NAFLD on the structural and electrical functions of the heart was investigated using tissue Doppler echocardiography (TDE) in non-obese NAFLD patients without any known risk factors for AF.Material and methods    The study included 43 female patients (31.3±3.8 years), who had stage 2-3 hepatosteatosis detected by liver ultrasonography and diagnosed as non-obese NAFLD (patient group), and 31 healthy women (control group, 32.5±3.6 years). In addition to standard echocardiographic parameters, inter- and intra-atrial electromechanical delay (EMD) were evaluated by TDE.Results    Interatrial EMD (PA lateral - PA tricuspid) and intraatrial EMD (PA septum - PA tricuspid) were significantly longer in patient group (16.1±3.4 vs. 12.5±2.3 ms, p<0.001, and 8.4±1.6 vs. 6.6±1.6 ms, p<0.001, respectively). At the subclinical level. atrial size, left ventricular diastolic function, and left ventricular wall thickness measurements were greater in the patient group.Conclusion    Inter-atrial and intra-atrial EMD were detected in young women with non-obese NAFLD. In addition, at the subclinical level, structural and functional impairment was detected However, large-volume prospective studies are required to cobfirm these findings regarding the development of AF in non-obese NAFLD patients.

Can family physicians have a role in eradication of hepatitis c infection?

BACKGROUND/AIMS: Hepatitis C Virus (HCV) infection is an important global public health problem. The application of screening programs is important for the elimination of HCV in addition to DAA therapies. The aim of this study was to measure the knowledge, attitudes and behaviours of family physicians, who are important in screening programs for the diagnosis, natural history, and treatment of HCV infection. MATERIALS AND METHODS: This cross-sectional study aimed to measure the knowledge levels in respect of HCV screening, diagnosis, natural history and treatment, of family physicians working nationwide in Turkey, through a survey. RESULTS: The most common reason to perform an anti-HCV test stated by 70.9% (n:420) of the participants was the mandatory screening program before marriage. Of the participants included in the study, 29.6% (n=175) had encountered anti-HCV test positivity at least once within the last year, and of these, 15.4% (n=27) had no knowledge of whether the patient went to a higher level center for further diagnosis, while 58.9% (n=103) did not know the disease stage. In response to questions about current drug options for hepatitis C infection, 14.5% were aware of DAA and 34.8% of participitant reported interferon+ ribavirin. CONCLUSION: Family physicians have gaps in their knowledge of the screening, natural history and treatment of HCV infection. The results of this study show that HCV training plans for family physicians should cover all aspects of the infection, and emphasize the necessity for the establishment of guideline-based screening recommendations.

Severe cholestasis due to azathioprine in Behcet's disease.

Azathioprine (AZA) is an immunosuppressive drug that is widely used in the treatment of autoimmune diseases. Although AZA is used widely, many studies reported that AZA-related hepatotoxicity is rather rare. We aimed to present a case with severe cholestatic hepatitis due to AZA use for Behcet's disease. Three weeks after starting AZA for the treatment of uveitis, the patient was admitted to our clinic with cholestasis and constitutional symptoms. In liver biopsy, findings were in accordance with drug reaction, and the AZA treatment was stopped. After 2 months, bilirubin levels and liver tests results became normal. As a result, given that AZA may cause severe cholestasis, the drug should be stopped if idiosyncrasy or hypersensitivity develops. If there is a debate in the diagnosis, histopathological evaluation of the liver would be the major issue because of the correct diagnosis of the drug toxicity and excluding other aetiologies.

Impact of interleukin 28B rs12979860 C/T polymorphism on severity of disease and response to treatment in hepatitis delta.

INTRODUCTION: Pegylated-interferon alpha (Peg-IFN α) is the therapy most commonly used to treat chronic hepatitis delta virus (HDV) infection. In the present study, we planned to investigate effect of IL28B polymorphism on response to Peg-IFN α therapy and disease progression in patients with chronic HDV. METHODOLOGY: A total of 47 patients who received Peg-IFNα therapy for at least one year were investigated. The patients were divided into three groups based on their response to treatment: sustained viral response (SVR) (32%), unresponsive (53%), and relapse (15%). The groups were compared in terms of age, gender, blood biochemistry (albumin, total bilirubin, lactic acid dehydrogenase, ALT, AST, ALP, GGT), complete blood count, HBeAg, HBsAg, HBV-DNA, HDV-RNA, IL28B genotypes (CC, CT, TT), and results of liver biopsy. RESULTS: Regarding the investigation of IL28B genotype, the prevalence of CC, CT, and TT showed no difference among the three groups. In the SVR group, the prevalence of CC was 53%, CT was 47%, but there was no patient with TT. In the unresponsive group, prevalence of CC was 52%, CT was 32%, and TT was 16%. In the relapse group, prevalence of CC was 43%, CT was 57%, but there was no patient with TT genotype. No significant difference was found among the groups with sustained response, no response, and relapse in terms of CC and CT polymorphisms (p>0.05). CONCLUSIONS: No relationship was found between IL28B rs12979860 polymorphism and response to treatment and disease severity in patients with chronic HDV infection.

Role of Renin-Angiotensin-converting Enzyme Level and ACE Gene Polymorphism in Patients with Nonalcoholic Fatty Liver Disease.

INTRODUCTION: In this study, we aimed to investigate the histological and clinical effect of angiotensin-converting enzyme (ACE) and ACE gene polymorphism in nonalcoholic fatty liver disease (NAFLD) and their roles in the progression of the disease. MATERIALS AND METHODS: Liver function tests, body mass index, waist circumference, lipid parameters, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), homeostasis model assessment-IR (HOMA-IR), ACE, and ACE gene polymorphism were evaluated in the NAFLD group and control group. The study group was evaluated by dividing the group into four subgroups by ACE gene polymorphism (D/D homozygous, I/I homozygous, D/I heterozygous, I/D heterozygous). Liver biopsies were evaluated according to Brunt Classification. RESULTS: A total of 31 patients who were diagnosed with NAFLD and 40 healthy individuals were included in the study. The ACE level was found to be 11.69 ± 1.99 in the NAFLD group and 11.52 ± 1.72 in the control group (p = 0.70). There was a negative correlation between ACE levels and HOMA-IR levels (p = 0.008, r= -0.512). Biochemical parameters were not different among ACE gene polimorphism subgroups, except FBG (between D/D, I/D and D/I, I/D; p = 0.02). When the ACE levels were compared in terms of grade and stage, no significant difference was found (for stage and grade p = 0.68). The ACE gene polymorphism subgroups did not differ by histopathologic findings; grade and stage (for grade p = 0.42, for stage p = 0.92). CONCLUSION: In this study, we could not find a correlation of ACE and ACE gene polymorphism with metabolic risk factors and the disease severity in NAFLD. HOW TO CITE THIS ARTICLE: Tekatas DD, Bahcecioglu IH, Ispiroglu M, Sahin A, Ilhan N, Yalniz M, Demirel U. Role of Renin-Angiotensin-converting Enzyme Level and ACE Gene Polymorphism in Patients with Nonalcoholic Fatty Liver Disease. Euroasian J Hepato-Gastroenterol 2016;6(2):137-142.

Pistacia Terebinthus Coffee Protects against Thioacetamide-Induced Liver Injury in Rats.

AIM/BACKGROUND: Pistacia terebinthus is used as a coffee substitute in the East and Southern Anatolia regions of Turkey. It contains unsaturated fatty acids, tocopherols, polyphenols and carotenoids. P. terebinthus has anti-inflammatory and potential antioxidant activity. In this study we evaluated the protective effects of P. terebinthus coffee (PTC) on thioacetamide (TAA)-induced liver injury in rats. MATERIALS AND METHODS: Twenty-eight male Sprague-Dawley rats were equally randomized into four groups. Chronic liver injury was induced with TAA (100 mg/kg i.p. three times weekly). The first group of rats served as control and received only tap water (G1), and the remaining groups of rats received PTC, p.o (G2); TAA (G3); TAA plus PTC, p.o (G4), respectively. RESULTS: After 8 weeks, PTC intake significantly reduced fibrosis/inflammation scores (p PTC intake reduced transforming growth factor beta (TGF-ß) concentrations in the liver (p PTC intake. DISCUSSION AND CONCLUSION: PTC intake provided beneficial effects against TAA-induced liver injury in rats. PTC probably suppresses the proinflammatory cytokines through NF-κB signaling pathway.

What approach should we take for the incidental finding of increased 18F-FDG uptake foci in the colon on PET/CT?

INTRODUCTION: F-Fluorodeoxyglucose (F-FDG) PET/CT represents an imaging modality that is gaining increasingly more prominence in screening, staging, and therapeutic monitoring of malignant diseases. An incidental focus of uptake in different regions of the body is not an uncommon finding during PET/CT imaging. Patients with incidental gastrointestinal tract findings comprise ∼3% of the overall patient group. The aim of the current study was to provide contributory information in relation to the answer on the most appropriate approach in cases with incidental colonic F-FDG uptake. PATIENTS AND METHODS: A retrospective examination was performed on PET/CT results of 5258 patients. Of these, 152 were recommended to undergo colonoscopy because of the presence of suspicious foci and 31 underwent colonoscopy within 60 days with biopsy from all visible lesions. These dates were also examined. RESULTS: Of the 24 patients undergoing colonoscopy with a suspicion of malignancy, five (20.83%) had no pathological findings. Of the 19 (79.17%) cases with a pathological finding in endoscopy, histopathology showed a benign lesion in five (20.83%), premalignant lesion in seven (29.17%), and a malignant lesion in seven (29.17%). Among seven patients undergoing colonoscopy because of a suspicion of inflammatory bowel disease, five were free of pathological signs and two patients with pathological endoscopy findings had nonspecific inflammation as documented by histopathological examination. CONCLUSION: Colonoscopic and histopathological examination of the increased foci of colonic F-FDG uptake incidentally detected at PET/CT seems to be a plausible approach.

Pegylated Interferon α Therapy in Chronic Delta Hepatitis: A One-Center Experience.

BACKGROUND: The only established therapy for chronic viral delta hepatitis, the most severe form of viral hepatitis is treatment with pegylated-interferon α (Peg IFN α). OBJECTIVES: In this study, we aimed to determine the efficacy of pegylated-interferon α 2a (Peg-IFN α 2a) and 2b (Peg IFN α 2b) in the treatment of patients infected with chronic delta hepatitis virus. PATIENTS AND METHODS: The sample size was based on available patients potentially to be recruited. Data of 63 patients receiving either Peg IFN alpha 2a or Peg IFN alpha 2b were retrospectively assessed in the present cohort study performed in Turkey. Of 56 patients completed the study, 41 received Peg IFN α 2a and 15 received Peg IFN α 2b for 12 months. Patients were evaluated for biochemical and virological responses at the end of given treatment and six months after the treatment. RESULTS: Stage of fibrosis was found high in both groups (85.4% vs. 86.7%), while cirrhosis was higher in the group of Peg IFN α 2b (53.3% vs. 34.1%). At the end of treatment, either hepatitis delta virus RNA (HDV RNA) alone or both HDV RNA and hepatitis b virus DNA (HBV DNA) had negative results in 32% of patients. Although HDV RNA negativity was sustained in 30.3% of patients, negativity of both HDV RNA and HBV DNA was decreased to 19.6% six months after completion of the treatment. HBV DNA became positive in one third of patients with response at six months after completion of the treatment (10.7% of all patients). HDV RNA negativity at month six was found as a predictor of positive response. No significant difference was found between Peg IFN α 2a and Peg IFN α 2b for virological response rate. CONCLUSIONS: Treatment with Peg IFN α achieved a sustained negativity of HDV RNA in about one third of patients. Duration of Peg IFN α therapy might be prolonged to at least 24 months or more to prevent the occurrence of Hepatitis B virus (HBV) relapse encountered six months after completion of the treatment.

QT dispersion and transmural dispersion of repolarization in patients with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is a disease characterized by sporadic, paroxysmal attacks of fever and serosal inflammation. QT dispersion (QTd) and transmural dispersion of repolarization (TDR), simple noninvasive arrhythmogenic markers, that can be used to assess homogeneity of cardiac repolarization, have not been studied in FMF patients before. The aim of our study was to evaluate the QTd and TDR in FMF patients without overt cardiac involvement. A total of 50 patients with FMF (30 men, 20 women, 29.4 +/- 11.8 years) and 50 controls (30 men, 20 women; mean age 31.3 +/- 11.9 years) were included. QTd, corrected QTd (cQTd), maximum QT (QTmax), maximum corrected QT (cQTmax), minimum QT (QTmin), and minimum corrected QT intervals (cQTmin) and TDR were measured from standard 12-lead electrocardiography (ECG). We found that QTd, QTmax, and TDR were greater in FMF patients than in the control group (36.0 +/- 11.4 vs. 20 +/- 11.2, P < 0.001 and 354.8 +/- 30.9 vs. 342.8 +/- 18.0, P = 0.02; 62.0 +/- 16.0 vs. 49.0 +/- 9.5 P < 0.001, respectively), as were cQTd and cQTmax (40.4 +/- 13.5 vs. 21.9 +/- 12.4, P < 0.001 and 397.7 +/- 40.2 vs. 375.5 +/- 25.4 P = 0.001). A modest positive correlation was found between cQTd and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) (r = 0.30, P < 0.001; r = 0.40, P < 0.001; respectively). QTd, which is an index of inhomogeneity of ventricular repolarization and an important predictor of cardiovascular mortality, and TDR, which is a better marker of cardiac repolarization, increased in FMF patients similarly as in other rheumatologic diseases.

Assessment of atrial conduction time in patients with familial Mediterranean fever.

BACKGROUND: Increased inflammatory activity is known to be a pathophysiologic characteristic of atrial fibrillation. Familial Mediterranean fever (FMF) is a disease characterized by recurrent and sustained increased inflammatory activity. Atrial conduction abnormalities in these patients have not been investigated in terms of P-wave duration, P-wave dispersion (Pd), and atrial electromechanical delay measured by tissue Doppler echocardiography (TDE). We aimed to assess atrial conduction time in patients with FMF. METHODS: A total of 33 patients with FMF (13 males/20 females, 28.4 +/- 12.5 years), and 33 controls (13 males/20 females, 28.5 +/- 12.1 years) were included. Atrial electromechanical coupling (PA) and intra- and interatrial electromechanical delay were measured with TDE. From the 12-lead electrocardiogram Pd was calculated. RESULTS: Atrial electromechanical coupling at the left lateral mitral annulus (PA lateral) was significantly higher in FMF patients (58.0 +/- 9.0 vs 51.0 +/- 5.8, P < 0.001). Interatrial (PA lateral-PA tricuspid) and intraatrial electromechanical delay (PA septum-PA tricuspid) were significantly longer in FMF patients (21.3 +/- 7.4 vs 12.9 +/- 4.6, P < 0.001 and 4.7 +/- 5.5 vs 2.1 +/- 1.7, P = 0.01, respectively). Also, Pd and maximum P-wave duration were significantly higher in FMF patients (42.8 +/- 7.9 vs 35.3 +/- 6.1, P < 0.001 and 98.6 +/- 9.0 vs 93.1 +/- 8.5, P = 0.01, respectively). A positive correlation was detected between interatrial electromechanical delay and Pd (r = 0.622, P < 0.001). Plasma level of C-reactive protein (CRP) correlated with interatrial electromechanical delay and Pd (r = 0.733, P < 0.001; and r = 0.427, P < 0.001, respectively). CONCLUSION: This study shows that atrial electromechanical delay and Pd are prolonged in FMF patients. Atrial electromechanical delay is closely associated with Pd and plasma level of CRP.