Assessment of the Frequency of Autoantibodies in Chronic Viral Hepatitis.

OBJECTIVE: To examine the occurrence frequency of auto-antibodies and autoimmune diseases in patients with chronic hepatitis B or C. METHODS: A total of 67 patients diagnosed with chronic hepatitis B and 77 patients diagnosed with chronic hepatitis C infection based on HBs Ag, Anti HCV, HBe Ag, Anti HBe Ag, HBV DNA, HCV RNA, liver ultrasound, and liver biopsy results as well as 48 healthy individuals were included in this study. ANA, anti dsDNA, anti LKM, Anti-SMA, AMA, C-ANCA, P-ANCA, anti-SSA, anti-SSB, anti-Scl-70, anti Jo-1, anti-U1snRNP, anti-centromere, anti-Jo-1, anti tpo, and anti tg were studied in all individuals in each study group. RESULTS: ANA positivity was detected in 8 (12%), 15 (19%) and 2 (4%) individuals in HBV, HCV and control groups, respectively. The difference between the groups was significant (P=0.04). Similarly, anti Tg was positive in one subject in HBV group, in 6 subjects (7%) in HCV group, and in one subject among controls, the difference being significant (P=0.04). There were no significant differences between the study groups in the frequency of other auto-antibodies. CONCLUSION: Similar to studies involving patients who received interferon and/or antiviral agents, an increased frequency of auto-antibodies was also detected in our patient group consisting of interferon and anti-viral naive subjects. The increase in the frequency of auto-antibodies reached statistical significance among individuals with HCV infection. Thus, pre-treatment assessment of auto-antibodies in newly diagnosed cases of chronic hepatitis B or hepatitis C infection may provide beneficial information on the future occurrence of auto-immune responses in these patients.

Atherogenic index as a predictor of atherosclerosis in subjects with familial Mediterranean fever.

BACKGROUND AND OBJECTIVE: Numerous inflammatory and innate immune pathways are involved in atherogenesis. We aimed to investigate the atherogenic index and other lipid parameters in individuals with familial Mediterranean fever (FMF), as a predictor of atherosclerosis. MATERIALS AND METHODS: A total of 60 patients with FMF and 60 healthy age- and sex-matched controls were included in this study. The patients with acute infection, chronic metabolic and rheumatic diseases, use of drugs other than colchicine and smoking history were excluded. CRP, ESR, total cholesterol, triglycerides, LDL-C, and HDL-C levels of patients and the control group were measured. Atherogenic index (TG/HDL-C) was calculated. RESULTS: We found that the atherogenic index values of the patients were significantly higher than those of the control group. HDL-C levels were lower and ESR and TG levels were higher in patients. Total cholesterol, LDL-C and CRP levels did not differ significantly between the two groups. There was no significant difference in the values of total cholesterol, LDL-C, triglycerides (TG), HDL-C, and atherogenic indexes between the groups of patients with and without M694V mutation. CONCLUSIONS: Elaboration of clinical models of inflammation-induced atherogenesis may further advance our knowledge of multiple inflammatory pathways implicated in atherogenesis and provide a useful tool for cardiovascular prevention. We believe that the atherogenic index also be used as a preliminary indication of accelerated atherosclerosis in FMF. However, large-scale prospective studies on this issue are needed.

Comparison of FISH, RFLP and agar dilution methods for testing clarithromycin resistance of Helicobacter pylori.

BACKGROUND/AIMS: Clarithromycin resistance is an important factor of Helicobacter pylori (H. pylori) eradication failure in adults and children. There are some tests to determine resistance such as restriction fragment length polimorphism (RFLP), fluorescence in situ hibridisation (FISH), PCR and (culture) agar dilution. Clarithromycin resistance is reported between 16.8%-48.2% in Turkey using PCR, 18% in Japan using RFLP. The aim of the study is to compare the efficacy of FISH, RFLP and culture. MATERIALS AND METHODS: Patients with gastric complaint underwent endoscopic examination. H. pylori status of all patients was tested with urea breath test. Gastric biopsy samples obtained from adult patients and children were studied. Each tissue was analised with FISH, PCR-RFLP anda gar dilution. RESULTS: A total 100 patients were positive by UBT and histology for H. pylori. Tissues from 89 adults and 11 children were evaluated. According to FISH and RFLP clarithromycin resistance was 26% and 16% respectively. Among 100 patients H. pylori was cultured in 52 tissue samples, among these samples 7 were resistant to clarithromycin. There was strong correlation between the results of FISH and RFLP; RFLP and culture; and FISH and culture. CONCLUSION: There is a high ratio of clarithromycin resistance in the studied population. All 3 tests are valuable, but FISH seems to be more sensitive among these tests. We suggest FISH should be used for detecting clarithromycin resistance among H. pylori infected patients before eradication therapy.

Comparison of infusion or low-dose proton pump inhibitor treatments in upper gastrointestinal system bleeding.

BACKGROUND: The most effective schedule of proton pump inhibitor (PPI) administration following endoscopic hemostasis of bleeding ulcers remains uncertain. AIM: To compare the treatment effects of continuous infusion and low-dose esomeprazole therapies in patients with non-variceal upper gastrointestinal (GI) bleeding. METHODS: This prospective clinical study compared continuous infusion of esomeprazole (80 mg bolus followed by 8 mg∕h continuous infusion for 72 h) and low-dose esomeprazole (40 mg twice daily IV) treatments in GI bleeding patients with peptic ulcer presenting a high risk of re-bleeding, who were administered a successful endoscopic homeostasis. The primary end point was the occurrence of re-bleeding during hospitalization and within one month of discharge. Secondary outcomes were defined as duration of hospitalization, need of transfusion, surgical treatment, and mortality rate. After 72 h, both groups were switched to oral esomeprazole therapy for one-month. RESULTS: A hundred thirty-two subjects were enrolled. Re-bleeding occurred in 11 (16.7%) patients in the infusion therapy group and in 12 (18.2%) patients in the low-dose group (P=0.819) within the first 72 h. No patient experienced re-bleeding in the first month following discharge. There was no statistical significant difference between the two groups in terms of transfusion need, durations of hospitalization, need for surgery and mortality rate. CONCLUSION: PPI infusion therapy following endoscopic hemostasis treatment was not found superior to low-dose PPI therapy in the terms of re-bleeding, need of surgery and mortality.

Novel approach for the prevention of contrast nephropathy.

OBJECTIVE: To date, there is no effective treatment of contrast medium (CM)-induced nephropathy. Multiple studies documented a protective role of hydration and N-acetylcystein (NAC) as prophylactic agents against CM-induced nephropathy in a high-risk population. In the present study, we investigated a new antioxidant agent, caffeic acid phenethyl ester (CAPE), and compare with NAC against contrast nephropathy. METHODS: Forty-two adult male rats were divided into six experimental groups, which were control, injected with intravenous (i.v.) CM, injected with i.p. CAPE, injected with i.p. NAC, injected with i.v. CM pretreated with i.p. CAPE, injected with i.v. CM pretreated with i.p. NAC. CAPE and NAC were given daily throughout the study. All rats were deprived of water for 24h at the third day of the study and then contrast medium was administered to CM, CAPECM and NACCM groups. The rats were sacrificed at the fifth day. Oxidant-antioxidant status was determined in renal tissues. The severity of injury was scored with a light microscope in renal tissue. Plasma creatinine levels were measured. RESULTS: Renal injury scores were higher in CAPECM and NACCM groups than in control, CAPE and NAC groups, but lower than the CM group. Likewise, creatinine levels of CAPECM and NACCM groups were higher than the control groups but they were significantly lower than the level of the CM group. Creatinine levels of the NACCM group were significantly higher than the CAPECM group. Malondialdehyde levels were significantly lower in CAPECM and NACCM groups than the CM group. CONCLUSION: CAPE might protect renal structure and functions as well as NAC against CM injury.

Increased serum osteoprotegerin levels associated with decreased bone mineral density in familial Mediterranean fever.

Familial Mediterranean fever (FMF) has episodic or subclinical inflammation that may lead to a decrease in bone mineral density (BMD). The aim of this study was to evaluate the effect of FMF on bone metabolism and to investigate the factors that can influence bone metabolism, such as body mass index (BMI), mutations in Mediterranean fever (MEFV) gene, osteoprotegerin (OPG), leptin and inflammatory cytokines, including interleukin (IL)-1beta, IL-6 and tumor necrosis factor-alpha (TNF-alpha). OPG, a soluble protein produced by osteoblasts, favors increased bone mass. Leptin may influence bone metabolism by acting on differentiated osteoblasts, having anabolic effects on bone. Thirty-one FMF patients in attack-free period (12 females and 19 males; mean age 31.4 +/- 9.3 years) and 18 healthy controls (11 females and 7 males; mean age 34.6 +/- 9.5 years) were compared according to the above parameters. BMD (g/cm(2)) and standard deviation scores (Z-score) were measured at the lumbar spine L(1)-L(4) (BMD-L(1-4)) and proximal femur by dual X-ray absorptiometry. Osteopenia is defined as a Z-score between -1 and -2.5 and osteoporosis is equal or below -2.5. FMF patients showed statistically significant reduction in BMD-L(1-4) and Z-score-L(1-4). Moreover, serum OPG concentration was significantly elevated in FMF patients. In contrast, MEFV gene mutations, leptin and the inflammatory cytokines did not differ between the patient and control groups. In conclusion, BMD was decreased and OPG was increased in our FMF patients. The high OPG levels may reflect a preventive mechanism against bone loss; namely, OPG might protect the FMF patients from excessive osteoporosis.

Does Helicobacter pylori-induced inflammation of gastric mucosa determine the severity of symptoms in functional dyspepsia?

BACKGROUND: Inflammation induces some structural and biochemical alterations and oxidative damage in gastric tissue. In this study, we aimed to investigate the relationship among the severity of symptoms, oxidative stress, and grading scales of Helicobacter pylori-induced gastric inflammation in functional dyspepsia. METHODS: Thirty-five patients with functional dyspepsia were enrolled in the study. The severity of dyspepsia within the last 6 months was evaluated by Glasgow Dyspepsia Severity Score. In biopsy specimens of gastric mucosa, severity of gastritis was estimated by the revised Sydney Classification System, and oxidative stress parameters were studied. RESULTS: Although there was no statistically significant relationship between symptom scores and degree of chronic inflammation, a tendency for symptoms to be more severe has been observed in low levels of gastritis. Levels of sulfhydryl groups were lower in subjects with high levels of chronic inflammation, and Helicobacter pylori intensity (P < 0.001 and P = 0.02, respectively). Levels of malondialdehyde were higher in subjects with high levels of chronic inflammation (P = 0.04). There was a statistically significant but a weak positive correlation between symptom scores and sulfhydryl levels (P < 0.001, r = 0.323). CONCLUSIONS: In conclusion, there may be an inverse relation between severity of symptoms and level of Helicobacter pylori induced gastric inflammation or oxidative stress in patients with functional dyspepsia.