GPR, King's Score and S-Index are superior to other non-invasive fibrosis markers in predicting the liver fibrosis in chronic Hepatitis B patients.

Background and study aims: In this study, we investigated the efficacy of nine non-invasive fibrosis markers in the assessment of the degree of fibrosis in patients with chronic Hepatitis B (CHB) in comparison with liver biopsy. Patients and methods: A total of 1454 untreated CHB patients from two different centers who underwent liver biopsy were included in the study. Laboratory results of patients were reviewed retrospectively and the pathology slides were re-evaluated in accordance with the Ishak score. Degree of fibrosis ≥ 3 was accepted as "significant fibrosis", ≥ 4 as "advanced fibrosis", and ≥ 5 as cirrhosis. The diagnostic performance of the markers Aspartate aminotransferase to Platelet Ratio Index (APRI), Fibrosis-4 score (FIB-4), Aspartate aminotransferase to Alanine aminotransferase Ratio (AAR), AAR to Platelet Ratio Index (AAPRI), Gamma-glutamyl transpeptidase to Platelet Ratio (GPR), King's Score, Fibro quotient (Fibro-Q), S Index and Platelet to Lymphocyte Ratio (PLR) were evaluated with ROC analysis. Results: In detecting significant fibrosis, APRI, GPR, King's Score and S Index had AUROC values over 0.70. For advanced fibrosis, all of the models except AAPRI; and for cirrhosis, all of the models had AUROC values over 0.70. In accordance with the chosen staging system, GPR, King's Score and S Index had high diagnostic efficacy whereas APRI, FIB-4, FibroQ and PLR had moderate diagnostic efficacy, AAR and AAPRI had low diagnostic efficacy. Conclusions: GPR, King's Score and S Index had moderate diagnostic performance in detecting significant fibrosis and advanced fibrosis, and high diagnostic performance in detecting cirrhosis.

Preoperative parathyroid hormone levels are correlated with parathyroid adenoma volume and bone mineral density but not serum calcium levels.

AIM: The aim of this study was to determine the relationship between biochemical parameters, parathyroid adenoma volume, and bone mineral density with respect to intact parathyroid hormone (iPTH) levels in patients with primary hyperparathyroidism. METHODS: Data were collected retrospectively from patients with primary hyperparathyroidism who were diagnosed and followed in our clinic between 2005 and 2008. Forty-eight (female/male=42/6) patients with a mean age of 52.8±13.1 years were enrolled into the study. RESULTS: Bone pain was the most common presenting feature, seen in 41.7% of patients, while 29.1% of patients were asymptomatic. The mean serum calcium and iPTH concentrations were 2.9±0.6 mmol/L and 657.1±682 ng/L, respectively. The mean total Z/T scores of dual-energy X-ray absorptiometry (DEXA) scan at the femur and lumbar spine were -0.4±1.6/-1.0±1.7 and -1.4±1.6/-2.2±1.5, respectively. Preoperative iPTH levels were correlated with serum phosphate (r=-0.412, P=0.005), alkaline phosphatase (r=0.698, P=0.0001), and femur (r=-0.402, P=0.020) and lumbar spine total Z scores (r=-0.441, P=0.013), whereas parathyroid adenoma volume was correlated with iPTH (r=0.367, P=0.036) and alkaline phosphatase (r=0.570, P=0.001). There was no correlation between iPTH, serum calcium levels and total T scores at the femur and lumbar spine. After excluding patients with 25-OHD insufficiency, there was still no correlation between serum iPTH and calcium levels. Parathyroid adenoma volume, serum iPTH and calcium levels were also not different between patients with and without 25-OHD insufficiency. CONCLUSION: These results suggest that serum iPTH level may be useful in predicting parathyroid adenoma volume and it is also well correlated with femur and lumbar spine Z scores.

The effect of vitamin D replacement therapy on insulin resistance and androgen levels in women with polycystic ovary syndrome.

Insulin resistance (IR) is one of the common features of the polycystic ovary syndrome (PCOS), and recent studies indicate the possible role of vitamin D in the pathogenesis of IR and glucose metabolism. Aim of this study was aimed to determine the effect of vitamin D replacement therapy on glucose metabolism, insulin, and androgen levels in obese, insulin-resistant women with PCOS. Eleven women with PCOS were included in the study. Mean age of the patients was 23.6+/-5.7 yr, body mass index 33.9+/-5.1 kg/m(2). Six patients (54.5%) had acantosis nigricans and 10 (90.9%) oligoamenorrhea. The mean Ferriman Gallwey score was 14.1+/-4.6. Only 2 women were within the normal limits of vitamin D levels as >20 ng/ml. Three weeks after the administration of the single dose of 300,000 units of vitamin D3 orally, 25-hydroxyvitamin D3 significantly increased from 16.9+/-16 ng/ml to 37.1+/-14.6 ng/ml (p: 0.027) and only 2 women were detected to have vitamin D3 levels <20 ng/ml. Although glucose and insulin levels were decreased non-significantly, homeostasis model assessment (HOMA)-IR significantly decreased from 4.41+/-1.38 to 3.67+/-1.48 (p: 0.043). No significant alterations were witnessed at the levels of DHEAS, total and free testosterone, androstenedione. No correlation was found between vitamin D with HOMA and other hormonal parameters. In conclusion, women with PCOS have mostly insufficient vitamin D levels, and vitamin D replacement therapy may have a beneficial effect on IR in obese women with PCOS.

The investigation of the efficacy of insulin glargine on glycemic control when combined with either repaglinide or acarbose in obese Type 2 diabetic patients.

Combinations of insulin and oral antidiabetic drugs (OAD) are often prescribed instead of insulin alone. In this study, the effects of insulin glargine (IG) in combination with repaglinide or acarbose on glycemic parameters were investigated. Obese Type 2 diabetic patients with fasting blood glucose (FBG) levels >or= 7.7 mmol/l [corrected] and hemoglobin glycated (A1C) >or=9% under maximal OAD combination therapy were enrolled. Previous therapies were discontinued, and patients were randomized into 2 groups. The combinations of IG and repaglinide were administered to group 1, and of IG and acarbose to group 2 for 13 weeks. Twenty patients in group 1 and 18 patients in group 2 completed the study. A1C levels were significantly decreased from 10.9+/-1.4% to 7.7+/-1.1% in group 1 and 11.0+/-1.4% to 8.1+/-1.4% in group 2. FBG levels were significantly decreased from 11.9+/-2.7 to 7.1+/-2.3 mmol/l in group 1 and 11.1+/-2.5 to 6.8+/-1.4 mmol/l in group 2. Post-prandial glucose levels were significantly decreased from 15.3+/-3.8 to 10.3+/-3.0 mmol/l in group 1 and 14.0+/-3.1 to 8.9+/-2.2 mmol/l in group 2. Intergroup comparisons indicated no significant differences. More weight gain was detected in group 1, compared to the baseline. Symptomatic hypoglycemia incidence was similar in both groups. Severe hypoglycemic attacks were seen in two patients in group 1. Flatulence incidence was higher in acarbose group. Conclusively, repaglinide and acarbose were equally effective when combined with IG for obese Type 2 diabetic patients controlled inadequately with OAD alone. Furthermore, acarbose seems to have advantages over repaglinide concerning weight gain and severe hypoglycemic attacks.

Frequency of atopy and allergic disorders among adults with Type 1 diabetes mellitus in the southern Marmara region of Turkey.

AIM: Autoimmune disorders are considered to be associated with a Th1 immune response whereas allergic diseases with a Th2 response. Studies mainly performed on children revealed conflicting results regarding the association of atopy/allergic disease and autoimmune disorders. Therefore, we aimed to investigate the prevalence of allergic diseases in adult Type 1 diabetic patients. METHODS: Eighty-nine Type 1 diabetic patients and 64 controls were enrolled into the study. Skin-prick test and European Community Respiratory Health Survey questionnaire were performed on all cases. Patients who gave at least one positive answer to questions about asthma in the questionnaire underwent pulmonary function test and methacholine challenge test. RESULTS: Patients' mean age were similar in diabetic patients and controls (28.2+/-8.9 and 28.1+/-5.2 yr; respectively). In skin-prick test, the rate of positive response to at least one allergen was not significantly different in diabetes (29.2%) and in the control group (31.3%). In European Community Respiratory Health Survey questionnaire, diabetic patients waked up by an attack of cough more than controls did. The rate of physician-diagnosed asthma was similar in both groups. There was no difference between the 2 groups based on the answers of other questions about asthma and other allergic diseases such as allergic rhinitis, eczema, and drug allergy. CONCLUSION: We found that atopy frequencies were similar in an adult population of Type 1 diabetic patients and controls. Although asthmatic symptom prevalence is increased in diabetic patients, the incidence of current asthma was similar in both groups.

Effects of Origanum onites on endothelial function and serum biochemical markers in hyperlipidaemic patients.

The effects of Origanum onites on endothelial function and antioxidative status were investigated in 48 patients with mild hyperlipidaemia who required no drug therapy. All participants were given lifestyle and low-fat dietary advice, however 32 of the patients (study group) were also prescribed 25 ml of aqueous distillate of Origanum onites to be taken after each meal for 3 months. The remaining 16 patients were the control group. Various biochemical markers and endothelial function parameters were measured at baseline and after 3 months. A significantly greater increase in high density lipoprotein-cholesterol and significantly greater decreases in low density lipoprotein-cholesterol, apolipoprotein B, lipoprotein(a) and high sensitivity C-reactive protein occurred in the study group compared with the control group over the 3-month study period. Paraoxonase and arylesterase activities, and flow- and nitroglycerine-mediated dilatation of the brachial artery showed significantly greater increases in the study group compared with the changes in the control group. In conclusion, consumption of Origanum onites distillate had beneficial effects on lipid profiles, antioxidant status and endothelial function in patients with mild hyperlipidaemia.

Does birth weight discordance in preterm twins affect neonatal outcome?

OBJECTIVE: To compare neonatal morbidity and mortality between hospitalized discordant and concordant preterm twin pairs. STUDY DESIGN: This was a retrospective, hospital-based study of preterm twins, followed in neonatal intensive care unit. Twins were classified as discordant when the difference in birth weight was >15%. Morbidity and mortality rates were compared between discordant and concordant groups. RESULTS: Of 136 preterm twins in the study, 54 were discordant and 82 were concordant. In discordant twins hypoglycemia and cesarean delivery rate was higher than concordant pairs. The mortality rate did not differ between concordant and discordant groups. CONCLUSIONS: Hospitalized preterm discordant twin pairs have an increased risk of hypoglycemia compared to concordants. Discordant growth is not a risk factor for prolonged hospitalization and increased mortality.

A retrospective analysis of thyroid cancer.

We reviewed the results of 2071 thyroidectomies performed during the past 11 years at Uludag University School of Medicine Hospital. Of all the patients 1602 (77.4%) were women and 469 (22.6%) were men (F:M = 3.4:1). Seventy-eight of the thyroid surgery patients (3.77%) had thyroid carcinoma, with a female to male ratio of 2.0:1. The relative risk of thyroid cancer in male versus female patients with thyroid nodules was determined to be 1.75:1. Patient distribution by thyroid carcinoma type was: papillary carcinoma 49%, follicular carcinoma 24%, undifferentiated carcinoma 10%, metastatic carcinoma 10%, and medullary carcinoma 6%. Fine needle aspiration biopsy (FNAB) has been used routinely in our hospital for the last 4 years. During this period, the average number of operations decreased from 201 to 130 per year and the surgical diagnosis of thyroid carcinoma increased from 2.85 to 7.65%. We conclude that papillary carcinoma is relatively less prevalent in our population and that fine needle aspiration biopsy is the preferred method of diagnosing nodular thyroid disease.

Bone mineral density measurement by quantitative computed tomography in a normal Turkish population.

PURPOSE: To observe the trabecular and cortical bone mineral density values of a normal Turkish population, to examine the effect of age in males, and age and duration of menopause in a female population on bone mineral density. Also to compare Turkish population bone mineral density values with the reference values in developed countries. MATERIALS AND METHODS: Trabecular and cortical bone mineral densities were measured by the quantitative CT method in 255 (110 male and 145 female) normal cases. RESULTS: According to the linear regression test results, loss of bone mineral density per year was 1.97 mg/ml and 2.09 mg/ml for females and 1.37 mg/ml and 1.04 mg/ml for males in the trabecular and cortical bone compartments, respectively. A 70-year-old female loses 56.7% and 31.3% of the bone mass at 20 years of age for the trabecular and cortical compartments, respectively. These ratios were 41% and 16.1% for the male population. Most loss in bone mass was observed in the premenopausal and early postmenopausal period. In the postmenopausal period, duration of menopause had more effect on bone mass than age. Loss of trabecular bone mass per year in the postmenopausal period was 2.36 mg/ml and 2.84 mg/ml with respect to age and duration of menopause, respectively. CONCLUSIONS: Quantitative CT is a valuable method to determine bone mass because it allows to detect bone mass of trabecular and cortical bone separately. Loss in trabecular bone was found to be higher than in cortical bone for both sexes, while overall bone loss was higher in females. Rate of loss increases in the menopause period. Duration of menopause had more effect on bone mass than age. Bone mineral density values in Turkey were similar to reference values of western countries.

Total thyroidectomy or lobectomy in benign nodular disease of the thyroid: changing trends in surgery.

METHODS: Over a 23-month period (January 1994-December 1995) in the era of fine needle aspiration (FNA), 344 thyroid surgery operations were performed for benign diseases of the thyroid. Of these 55 total thyroidectomies or lobectomies were evaluated. Mean age was 43.6 + 9.7 and the female/male ratio was 47/8 (5.8). All cases were operated on with the consensus of the surgery + endocrinology + pathology council according to a protocol based on FNA, thyroid function tests, scintigraphy and ultrasound. Suspected FNA or suspected nodules during the surgery were verified by frozen section also. Of these 55 benign nodules, 7 (12.7%) had total bilateral, 48 (87.3%) unilateral lobectomies. RESULTS: Postoperatively 3 cases (5.8%) of seroma, one transient hypoparathyroidism (1.8%) and one unilateral vocal cord paralysis (1.8%) were seen as complications. CONCLUSIONS: In our center, FNA cytology has been a routine procedure since 1992. Surgery for benign thyroid disease has been reduced 50% since than. This study was started after two years of the FNA procedure. Resident nodules are the most common cause of recurrence in nodular thyroid disease, so some cases need radical surgery when it is decided to operate. Morbidity of surgery for recurrent disease is unacceptably high and is comparable to lifelong supplement therapy.

[Campylobacter jejuni in patients with diarrhea]. / Diyareli hastalarda Campylobacter jejuni yönünden bir arastirma.

In this study the stools 125 patients with diarrhea applied to Research Hospital of Medical School of Atatürk University and the stools of 69 healthy persons were investigated for gastroenteritis agents C. jejuni as well as Salmonella and Shigella. Of the zooparasiter agents protozoon and helminths were also investigated. We determined the mentioned agents in 28 of 125 patients (% 22.40). C. jejuni was isolated the most frequent cause of diarrhea with 8.80 percent. C. jejuni was isolated in high ratio from women more than men and from children more than adults. No bacterial infection agents were determined in control group but intestinal zooparasites were found with 18.85 percent.

[The prevalence of hepatitis B in prostitutes working at the Erzurum brothel]. / Erzurum genelevinde çalisan hayat kadinlarinda Hepatit B prevalansi.

In this study, 101 prostitutes working at Erzurum brothel house, considered as risk group for HBV infection, in 51 (50.5%) of them Anti-HBs, in 9 (8.9%) of them HBsAg, in 4 (3.9%) of them Anti-HBs+HBsAg were found to be positive. The results in various age groups are as follows: In the 23-27 age group 9.5% HBsAg, 42.9% Anti-HBs and 9.5% HBsAg+Anti-HBs, in the 28-32 age group; 13.1% HBsAg and 50% Anti-HBs; In the 33-37 age group 4.3% HBsAg, 52.1% Anti-HBs and 4.3% HBsAg+Anti HBs; in the age group above 38, 5.2% HBsAg, 57.9% Anti HBs and 5.2% HBsAg-HBs were found to be positive.

[The local prevalence of group B streptococcus in pregnant women and newborn infants]. / Yöremizde gebe kadinlar ve yenidoganlarda B grubu streptokok prevalansi.

In this study, group B streptococcus (GBS) were investigated in vaginal swabs obtained from 76 pregnant women and in samples of newborn infants obtained from different areas of their bodies. GBS were determined in 5.2% of women and 3.96% of infants. GBS were recovered in 15.4% of the women in their first pregnancy and in 13.3% of women in their second pregnancy. GBS could not isolated from the women in their third and more pregnancies. All eight species of GBS were sensitive to AMP + Sulbactam, Clavulanic acid + Amox, Lincomycin, Clindamycin, Penicillin G and SMZ + TMP.

[Comparison of the Gruber-Widal and ELISA technics used to study Salmonella typhi and Salmonella paratyphi infections in patients]. / Salmonella typhi ve Salmonella paratyphi infeksiyonu kuskulu hastalardan alinan kan serumlari ile Gruber-Widal ve ELISA yöntemlerinin karsilastirmali incelenmesi.

In this study, antibody levels were determined against the agents of typhoid and paratyphoid fever in 168 patient's sera and 40 healthy control sera by Gruber-Widal and ELISA techniques. We compared the results of these two techniques, and discussed. The needed antigens for both techniques were prepared from the local strains of the agents of these infections which were isolated in our laboratory. The widal's tube agglutination test was carried out by classical method, and the ELISA technique was done by the method of Woller et al. As a result, we found that the titers obtained by ELISA were as 4-6 times higher as than those of Widal's. Additionally nonspecific reactions were less seen in ELISA than in Widal.

[Distribution of HSV-1 and HSV-2 antibodies in pregnant women]. / Hamile kadinlarda HSV-1 ve HSV-2 antikorlarinin dagilimi.

In this study, the distributions of Anti-HSV 1 and HSV 2 IgG and IgM antibodies have been investigated in sera obtained from 296 pregnant women who were admitted to the gynecology clinics of Medical Faculty of Atatürk University, Erzurum, Turkey. While the 24 (8.11%) of 287 HSV 1 IgG antibody positive patients were IgM positive but Anti-HSV 1 IgM alone was not detected in any patients. On the other hand, in 16 (5.41%) of 125 (42.23%) patients who were Anti-HSV 2 IgG antibody positive, HSV 2 IgM antibodies were detected too. In the 4 patients (1.35%), HSV 2 IgM antibodies were detected alone.

Prion protein gene (PrP) polymorphisms in healthy sheep in Turkey.

Scrapie, a transmissible spongiform encephalopathy (TSE) or prion disease, is a fatal, neurodegenerative disease in sheep and goats. This disease has been known in Europe for more than 250 years. Susceptibility to scrapie is associated with polymorphisms in the sheep prion protein gene (PrP) gene. In sheep, polymorphism in the PrP gene has been identified at a number of codons, and polymorphisms at codons 136, 154 and 171 have reported linkage with susceptibility to scrapie. Polymorphisms at the PrP locus were studied in 413 animals representing three native sheep breeds (Imroz, Chios and Kivircik) in Turkey. Genomic DNA was obtained from blood, and genotypes were screened using PCR and direct DNA sequencing. We report 17 genotypes derived from seven different alleles. The most frequent genotype in the Kivircik sheep is ARQ/ARQ, whereas the ARR/ARQ genotype is predominant in the Chios and Imroz breeds. In general, the ARQ haplotype was the predominant haplotype. ARQ haplotype was also predominant in the Kivircik and Chios sheep breeds, whereas the Imroz sheep predominantly had the ARR haplotype. The susceptibility-associated VRQ haplotype was found in 2.38%, 0.35% and 0.81% of the Imroz, Kivircik and Chios sheep, respectively. Moreover, seven additional polymorphisms have been detected at codons G127S, G127V, H143R, G145S, Y172D, N174Y and Q189L. Among these polymorphisms, the N174Y allele is a novel polymorphism, and the G145S allele is a novel allele for a known polymorphic locus.