Ileocecal valve that cannot be intubated in Crohn's disease: is this a sign of poor prognosis?

BACKGROUND: In Crohn's disease (CD), the inability to intubate the ileocecal valve during colonoscopy may be associated with a poor disease prognosis. In this study, we aimed to compare the long-term outcomes of CD patients with and without ileocecal valve intubation during colonoscopy to assess its value as a prognostic parameter. METHODS: This retrospective study involved CD patients with isolated ileal involvement who underwent colonoscopy between 1993 and 2022. We compared the basic characteristics and long-term clinical outcomes of two groups of patients: those with intubated and non-intubated ileocecal valves during colonoscopy. RESULTS: Of the 155 participants, 97 (62.5%) patients' ileum could be intubated and 58 (37.5%) could not be intubated. The non-intubated group was younger at diagnosis (39 years versus 30.5 years, p = 0.002), but other baseline characteristics such as sex, smoking status, disease duration, perianal disease, and upper gastrointestinal involvements were similar. The non-intubated group had higher rates of steroid dependence (67.2% versus 46.4%; p = 0.012), biologic treatment (89.7% versus 58.8%; p < 0.001), CD-related hospitalization (81% versus 24.7%; p < 0.001), and major abdominal surgery (58.6% versus 15.5%; p < 0.001). In the logistic regression analysis, the positive predictors of successful ileum intubation were inflammatory type CD (OR: 14.821), high serum albumin level (OR: 5.919), and older age (OR: 1.069), while the negative predictors were stenosing (OR: 0.262) and penetrating (OR: 0.247) CD behavior. CONCLUSIONS: In Crohn's disease patients with isolated ileal involvement, ileocecal valve cannot be intubated during colonoscopy may indicate the severity of the disease.

Are increased oxidative stress and asymmetric dimethylarginine levels associated with masked hypertension?

OBJECTIVE: In this study, our aim was to determine total oxidative stress and asymmetric dimethylarginine (ADMA) levels in patients with masked hypertension (MHT) and to examine their association with blood pressure. METHODS: Fifty patients diagnosed with MHT and 48 healthy volunteers without any known chronic diseases have been included in this study. RESULTS: When compared to the control group, patients with MHT had higher levels of mean ADMA (p < 0.001), total oxidant status (TOS) (p < 0.001), and oxidative stress index (OSI) (p < 0.001), and a lower mean total antioxidant status (TAS) (p < 0.001) level. While a positive correlation was determined between the systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels with ADMA, TOS, and OSI levels, a negative correlation was determined with the TAS level. During the stepwise multivariable logistic regression analysis, age (OR = 1.221; p = 0.003), body mass index (OR = 1.512; p = 0.005), low density lipoprotein (OR = 0.925; p = 0.016), ADMA (OR = 1.200; p = 0.002), and OSI (OR = 3.750; p = 0.002) levels were determined to be the predictors of MHT. During the linear regression analysis, it was determined that the independent risk factors of SBP and DBP are ADMA and OSI, and the independent risk factor of TOS, OSI, and ADMA is SBP. Our study found out that oxidative stress and ADMA levels of patients with MHT are higher than those of the control group. ADMA and OSI were determined to be predictors of MHT. CONCLUSION: Based on these results, it could be said that oxidative stress, and therefore the ADMA level, could have an effect on the etiopathogenesis of MHT.

Assessment of The Factors Related to The Spontaneous Passage of Common Bile Duct Stones.

Background: Common bile duct (CBD) stones may pass spontaneously without any intervention. Assessment of the predictors of spontaneous passage can contribute to avoiding unnecessary endoscopic retrograde cholangiopancreatography (ERCP) implementation. This study aimed to investigate the factors related to spontaneous passage of CBD stones. Methods: From January 2021 to August 2023, patients with naïve papilla who had undergone biliary ERCP and with CBD stones detected by MRCP before the procedure were analyzed retrospectively. Subjects were divided into two groups on the basis of the presence of stones during the ERCP procedure: the spontaneous passage group and the non-passage group. Groups were compared in terms of demographic, laboratory, and radiological data. Results: A total of 236 patients, including 26 in the spontaneous passage group and 210 in the non-passage group, were involved. Multivariate logistic regression analyses revealed that only stone size was significantly associated with spontaneous passage. From ROC curve analysis, stone size with a cut-off value of 4.3 mm predicted spontaneous passage with 58% sensitivity and 85% specificity. Conclusions: Stones with a size of less than 4.3 mm are more likely to pass spontaneously without endoscopic intervention. Paying attention to the stone diameter before ERCP procedures can contribute to avoiding unnecessary ERCP implementation.

Elevated circulating sST2 associated with subclinical atherosclerosis in newly diagnosed primary hypertension.

The aims of this study were to measure the levels of interleukin-33 (IL-33) and soluble Suppression of Tumorigenicity 2 (sST2) in patients with newly diagnosed primary hypertension (HT) and to determine the relationship between carotid intima-media thickness (CIMT) and IL-33/sST2. Eighty-two patients with newly diagnosed primary HT and ninety healthy volunteers were included in the study. CIMT ⩾0.9 mm was considered as significant for subclinical atherosclerosis. The sST2 levels of patients with primary HT were higher than those of the control group, whereas the IL-33 levels of these patients were much lower than those of the control group. The sST2 levels were higher in patients with subclinical atherosclerosis than in control subjects or patients with primary HT but not with subclinical atherosclerosis. In the primary HT group, sST2 had a positive correlation with CIMT, 24-h systolic-diastolic blood pressure, low-density lipoprotein and C-reactive protein, whereas sST2 had a negative correlation with the IL-33 level. A stepwise multivariable logistic regression analysis revealed that sST2 is an independent risk factor for subclinical atherosclerosis. Although the diagnostic predictive value of HT risk was determined as >51.8 pg l(-1) in the receiver operating characteristic curve analysis in respect of the sST2 level, the diagnostic predictive value for subclinical atherosclerosis risk was determined to be >107.2 pg l(-1). The sST2 level displays a positive correlation with atherosclerotic changes, and is an independent risk factor for subclinical atherosclerosis expressed as increased CIMT.

Dynamic thiol/disulphide homeostasis in patients with newly diagnosed primary hypertension.

We aimed to investigate the thiol/disulphide homeostasis in patients with newly diagnosed primary hypertension with a novel and automated method. Blood thiol/disulphide homeostasis, which consists of native thiol/disulphide exchanges, was investigated in 45 patients with primary hypertension and 45 healthy controls. The levels of native thiol, total thiol, and native thiol/total thiol ratio were lower while the disulphide level and disulphide/native thiol and disulphide/total thiol ratios were higher in patients with primary hypertension when compared with those in the control group. Positive correlation was detected between 24-hour systolic and diastolic blood pressure levels and disulphide/native thiol ratio. With reference to the stepwise multiple linear regression model; increase in disulphide/native thiol ratio and log(24-hour urine microalbumin) and decrease in native thiol/total thiol ratio are independent predictors of 24-hour systolic and diastolic blood pressure. This study demonstrated that thiol/disulphide homeostasis was shifted toward disulphide formation in patients with primary hypertension.

How does thiol/disulfide homeostasis change in prediabetic patients?

AIMS: Our aim was to examine thiol/disulfide homeostasis, which has a critical role in many cellular activities such as antioxidant protection, detoxification, cell growth and apoptosis, in prediabetic patients. METHODS: The study population was formed of a total of 250 participants; 125 (54 males, 71 females) of which were newly diagnosed with prediabetes, aged over 18 and who had not received any prior treatment and 125 (52 males, 73 females) healthy volunteers. Prediabetic patients were diagnosed using a glucose tolerance test. In both groups, native thiol-disulfide exchanges were examined using the automated measurement method newly developed by Erel and Neselioglu. RESULTS: When compared to the control group, the native thiol (p<0.001) and total thiol (p=0.008) levels, and the native thiol/total thiol (p=0.022) ratio was lower; while disulfide (p=0.001) level and, disulfide/native thiol (p=0.003) and disulfide/total thiol (p=0.022) ratios were higher in prediabetic patients. A positive correlation was determined between disulfide and the fasting blood glucose levels (r=0.394, p=0.017) and glycolysed hemoglobin (HbA1c) (r=0.307, p=0.011). On the other hand, a negative correlation was determined between native thiol and fasting blood glucose levels (r=-0.335, p=0.004). CONCLUSION: With this study, we have shown for the first time that thiol oxidation increases in prediabetic patients and that there is a positive correlation between the disulfide and blood glucose and HbA1c levels.