Evaluation of Plateletcrit and Platelet Distribution Width in Patients with Non-Alcoholic Fatty Liver Disease: A Retrospective Chart Review Study.

BACKGROUND Platelets are considered to be essential in proinflammatory environments, including atherosclerosis. The degree of platelet activation has been demonstrated to be correlated with plateletcrit and platelet distribution width. The main purpose of this study was to assess the relationship between plateletcrit (PCT), platelet distribution, and the degree of hepatic steatosis in patients with non-alcoholic fatty liver disease (NAFLD). MATERIAL AND METHODS We enrolled 225 biopsy-proven NAFLD patients and 142 control subjects without NAFLD. NAFLD patients were separated into 2 groups according to percentage of steatosis. Demographic and clinical data were collected retrospectively. RESULTS PCT level was significantly higher in NAFLD group I and group II than in the control group. PCT was higher in the NAFLD groups than in the control group. However, there was no difference according to PCT and PDW levels between NAFLD groups. CONCLUSIONS In this study, a relationship was found between PCT and hepatosteatosis, but no relationship was found with PDW. PCT might be a useful biomarker for early detection of steatohepatitis in patients with nan-alcoholic fatty liver disease.

Relationship Between Serum Uric Acid Levels and Nonalcoholic Fatty Liver Disease in Non-Obese Patients.

Background and objectives: Nonalcoholic fatty liver disease (NAFLD) is associated with multiple factors such as hypertension, diabetes, dyslipidemia, obesity, and hyperuricemia. We aim to investigate the relationship between uric acid and NAFLD in a non-obese and young population. Materials and Methods: This study was performed in January 2010-2019 with a group of 367 (225 patients in the NAFLD group and 142 in the control group) patients with liver biopsy-proven NAFLD or no NAFLD. Patients with NAFLD were classified according to the percentage of steatosis as follows, group I had 1-20% and group II >20%. Demographic, clinical, and laboratory (biochemical parameters) features were collected retrospectively. Results: The mean body mass index (BMI) and age of the patients were 26.41 ± 3.42 and 32.27 ± 8.85, respectively. The BMI, homeostatic model of assessment (HOMA-IR), and uric acid (UA) values of the NAFLD group were found to be significantly higher than those of the controls. A positive correlation was found between the NAFLD stage and UA. The following factors were independently associated with NAFLD: BMI, HOMA-IR, and UA. In addition, the cut-off value of UA was 4.75 mg/dl with a sensitivity of 45.8% and a specificity of 80.3%. Conclusions: UA is a simple, non-invasive, cheap, and useful marker that may be used to predict steatosis in patients with NAFLD.

Comparison of Controlling Nutritional Status Score with Bedside Index for Severity in Acute Pancreatitis Score and Atlanta Classification for Mortality in Patients with Acute Pancreatitis.

Background/Objectives: Acute pancreatitis (AP) is characterized by pancreatic gland inflammation, and its clinical course ranges from mild to severe. Predicting the severity of AP early and reliably is important. In this study, we investigate the potential use of the Controlling Nutritional Status (CONUT) score as a prognostic marker in acute pancreatitis. Methods: We examined 336 patients who had been hospitalized with an AP diagnosis in the internal medicine clinic. The patients included in the study were followed up for 5 years. The study analyzed the specific variables of age, gender, and AP etiology as recorded biochemical parameters for all study participants and calculated the effects of age, sex, Bedside Index of Severity in AP (BISAP), the revised Atlanta classification, and the CONUT score on mortality. Results: When compared with surviving patients, non-surviving patients had higher scores for BISAP, CONUT, and the Atlanta Classification (p ˂ 0.001). In the non-surviving group, hemoglobin, lymphocyte, and albumin levels were significantly lower and creatinine, uric acid, and procalcitonin levels were significantly higher compared to the surviving group (p ˂ 0.001, 0.003, ˂0.001, ˂0.001, 0.005, ˂0.001, respectively). The multivariate analysis showed a significant association of mortality with age, CONUT, and BISAP scores (p ˂ 0.003, 0.001, 0.012 respectively). The CONUT score was separated into two groups based on the median value. The predicted survival time in the group with a CONUT score > 2 (53.8 months) was significantly lower than in the group with a CONUT score ≤ 2 (63.8 months). The cumulative incidence of all-cause mortality was significantly higher in the patients with higher CONUT scores. Conclusions: This study has assigned the CONUT score as an independent risk factor for mortality in AP.

Oral high-dose ankaferd administration effects on gastrointestinal system.

BACKGROUND AND AIMS: Ankaferd Blood Stopper (ABS) is a herbal extract obtained from five different plants. It has a therapeutic potential for the management of external hemorrhage and controlling gastrointestinal bleeding. However, ABS's effects are not unknown on gastrointestinal systems. The aim of this study was to assess the effect of short- and long-term systemic exposure and gastrointestinal safety following the oral administration of high-dose ABS in rats. METHODS: Eighteen healthy adult male rats were included into the study. The rats were divided into 4 groups: group A was fed with high dose ABS (2ml/Kg) for one week, group B for one month, group C for three months and group D's diet did not contain any ABS. On termination of the ABS treatment, the gastrointestinal system from the esophagus to the anus and the liver were surgically removed and histological investigated. RESULTS: During the study period, there was no mortality; signs of intoxication in any of the studied groups. No gastrointestinal tissue fibrosis, dysplasia, or metaplasia was detectable in any of the groups. The stomach had a normal morphology in all groups. However, the other gastrointestinal tract sections showed mucosal inflammation, goblet cell decrements, and intra-epithelial lymphocyte infiltration. The most common changes were mucosal inflammation in all rats in group B and C. Frequency of inflammation was greater in groups B and C in comparison to group A (P= 0.001). Loss of goblet cell and intra-epithelial lymphocyte infiltration were not significantly different between groups A and B (P=0.308 and P=0.189, respectively). However, there was significantly higher intra-epithelial lymphocyte infiltration in group C than in group A (P=0.04). Histopathological examination of the liver showed no inflammation, fibrosis, bile duct destruction or proliferation in any of the groups. However, each groups revealed vascular dilatation and erythrocyte accumulation at the sinusoidal structures of the liver. CONCLUSIONS: ABS seems to be a safe agent and it can be used for hemorrhage originated from gastric lesions. Further work needs to be done to establish whether ABS leads to be used to stop gastrointestinal bleeding.

Clinical trial: transcutaneous interferential electrical stimulation in individuals with irritable bowel syndrome - a prospective double-blind randomized study.

BACKGROUND: The exact etiology of irritable bowel syndrome (IBS) remains unclear. Curative treatment is not available and current treatment modalities are mainly directed against the predominant symptoms. There are a few studies reporting the beneficial effects of transcutaneous electrical stimulation in patients with chronic constipation, gastroparesis, and functional dyspepsia. AIM: To investigate whether transcutaneous electrical stimulation is an effective procedure in IBS patients. METHODS: IBS patients were randomly placed in vacuum interferential current (IFC) and placebo groups. Both treatments consisted of 12 sessions administered over 4 weeks. Symptoms due to IBS were documented via questionnaires, including the IBS Global Assessment of Improvement Scale, numeric rating scales, visual analogue scale, and IBS Quality of Life Scale at the beginning of, end of, and 1 month after the treatment. RESULTS: Patients in the therapy (29 cases) and placebo (29 cases) groups were homogeneous with respect to demographic data and gastrointestinal system symptoms. When compared to the beginning scores, severity of abdominal discomfort, bloating, and abdominal distension and rumbling improved significantly in either interference or placebo groups at both the end of treatment and 1 month after treatment. In the IFC group, severity of symptoms continued to decrease significantly at 1 month after treatment when compared to scores at just the end of treatment, whereas in the placebo group severity of these symptoms did not change significantly on numeric severity scales. Also, the visual analogue scale of the first month after treatment continued to decrease significantly when compared to the level at the end of treatment in the IFC group. Total quality score increased significantly in the IFC group. CONCLUSIONS: Vacuum IFC therapy can significantly improve symptoms and quality of life in patients with IBS. It may represent a novel treatment modality for drug-refractory IBS patients.

Factors affecting the success of endoscopic bougia dilatation of radiation-induced esophageal stricture.

AIMS: The purpose of this retrospective study was to assess clinical outcomes of endoscopic bougie dilation of esophageal strictures after radiation therapy for head and neck cancer, and to assess the risk factors which affect the treatment success. METHODS: Thirty-one patients with esophageal stricture due to radiation therapy were treated with endoscopic bougie dilation. The following parameters were evaluated; age, gender, primary site of the tumor, initial treatment of the tumor, prescribed dose of radiation, the time to onset of esophageal stricture after radiation therapy, grade of esophageal stricture according to clinical and endoscopic findings, number of dilatations, recurrence of esophageal stricture, and the result of the therapy. RESULTS: The average follow-up was 26 months with a range of 1-84 months. Successful endoscopic bougie dilation was achieved in 26 of 31 patients. The median time to onset of esophageal stricture after radiation therapy was significantly shorter in patients who did not respond to endoscopic bougie dilation. CONCLUSION: Endoscopic bougie dilation is a safe and effective procedure for the management of radiation-induced esophageal stricture. Time to onset of esophageal stricture is the most important factor for the treatment success. In addition, the total prescribed dosage of radiation has minimal effects on the result of endoscopic bougie dilation.

A novel appetite peptide, nesfatin-1 in patients with non-alcoholic fatty liver disease.

BACKGROUND AND AIMS: Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver pathology worldwide and is strongly associated with obesity and insulin-resistance and food intake. Nesfatin-1 is a new peptide that controls appetite and food intake. The objective of this research was to examine the serum concentrations of nesfatin-1 in NAFLD. MATERIAL AND METHODS: Thirty NAFLD patients who had elevated liver enzymes and 40 age- and sex-matched healthy subjects were included in this study. NAFLD was diagnosed and graded with the findings of liver ultrasound scan. Nesfatin-1 concentrations were measured using an ELISA method and the relationship between nesfatin-1 and metabolic parameters were investigated. The subjects were divided into two groups according to their body mass index (≥ 30 and < 30) and nesfatin-1 concentrations were examined between both groups. RESULTS: Serum nesfatin-1 concentrations in NAFLD patients were lower than healthy controls (0.26 ± 0.14 ng/ml, 0.38 ± 0.18 ng/ml, respectively, and p = 0.008). We found a negative correlation between nesfatin-1 and fasting glucose and body mass index. In obese subjects, serum nesfatin-1 concentrations were significantly lower when compared with non-obese subjects (0.26 ± 0.12 ng/ml, 0.37 ± 0.19 ng/ml, respectively; p = 0.014). In addition, we showed that nesfatin-1 concentrations in subjects with insulin resistance were significantly lower in comparison with insulin-sensitive ones (0.27 ± 0.17 ng/ml, 0.38 ± 0.17 ng/ml, respectively; p = 0.015). CONCLUSION: Our study has shown that nesfatin-1 concentrations were reduced in NAFLD. The results of this study indicate that nesfatin-1 may have a significant role in NAFLD.

Evaluation of serum TWEAK concentration in patients with acute pancreatitis.

BACKGROUND AND AIM: Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) is a member of the tumor necrosis factor super family of structurally-related cytokines. The aim of this study was to determine the diagnostic and prognostic role of serum TWEAK concentration in patients with acute pancreatitis. METHODS: Twenty four patients with acute pancreatitis and 24 consecutive healthy age- and sex-matched control subjects were included in the study. The serum concentrations of TWEAK were measured at admission and then at remission. The average time between admission and remission was 7-10 days. RESULTS: At admission, TWEAK concentration was significantly lower in patients with acute pancreatitis compared to control subjects (p < 0.001). Serum TWEAK concentrations were elevated after the remission period, however the differences were not statistically significant. In addition, serum TWEAK concentration showed a significant, inverse correlation with amylase, lipase, CRP, AST, fibrinogen, LDH and a positive correlation with calcium, albumin and platelet count. CONCLUSIONS: Patients with acute pancreatitis have lower serum TWEAK concentration than healthy subjects. These results suggest that serum TWEAK concentration could be a potential biomarker of acute pancreatitis.

Recurrent pyogenic cholangitis in a case with congenital biliary anomaly.

Recurrent pyogenic cholangitis is endemic to South-east Asia but has been very rarely reported from natives of other parts of the world. A 43-years-old woman was presented with sepsis that had a history of recurrent epigastric pain and fever attacks. Her liver tests were unremarkable suggesting any hepatobiliary diseases. Recurrent pyogenic cholangitis and congenital extrahepatic biliary anomaly have been diagnosed after serial diagnostic and therapeutic procedures including endoscopic retrograde cholangiography, MR-cholangiography, percutaneous transhepatic cholangiography and finally left hepatectomy. She was cured completely following surgical treatment.

Adipokine levels in the course of mild biliary pancreatitis.

OBJECTIVES: Obesity markedly increases the risk of severe acute pancreatitis (AP). Several adipokines have been ascribed a role as a predictor of clinical severity in AP. Therefore, the aim of this study was to investigate a possible relationship between leptin and adiponectin and mild biliary AP. METHODS: We included 24 consecutive patients with mild biliary AP and 24 consecutive healthy age- and sex-matched controls. Clinical severity was classified by the Ranson score. ELISA was used to assess leptin and adiponectin levels on admission and in remission. Complete blood cell counts and other laboratory tests were also performed at baseline and in remission. RESULTS: Leptin, adiponectin, insulin and HOMA-IR measurements showed no difference in pancreatitis patients both on admission and in remission compared to the control group. No difference was found in leptin, insulin or HOMA-IR levels in the course of pancreatitis. However, adiponectin levels were higher in remission compared to admission. CONCLUSIONS: Increased adiponectin levels in remission may be an indication of improvement in this condition. Further studies are needed to determine whether adiponectin provides protection from AP.

Visfatin levels in nonalcoholic fatty liver disease.

PURPOSE: Recently, role of adipokin in the pathogenesis of nonalcoholic fatty liver disease (NAFLD) has been suggested. Among adipokins, role of leptin and adiponectin is rather well known; however, there are only a few data concerning visfatin. MATERIAL AND METHODS: NAFLD is confirmed in 30 patients by ultrasonography. As a control group, patients without fatty liver or other liver diseases were included. Viral hepatitis, metabolic liver diseases, and autoimmune hepatitis and consumption of alcohol were excluded in all patients. Fasting serum level of visfatin was determined by ELISA method. RESULTS: Serum visfatin concentration in the NAFLD group (14.7 ± 8.1 ng/ml) was significantly higher than in controls (9.4 ± 1.6 ng/ml) (P < 0.001). There were no correlations between visfatin and anthropometric parameters, transaminases, lipids, and homeostasis model assessment-estimated insulin resistance (HOMA-IR). CONCLUSION: Serum visfatin concentration increases in patients with NAFLD.

An unusual cause of unilateral hydronephrosis: invasive colonic amebiasis.

A 62-year-old man was admitted to our hospital with complaints of abdominal pain and rectal bleeding. Although the colonoscopic examination was highly suggestive of a carcinoma, the histopathological examinations were consistent with chronic inflammation. CT examination revealed a solid lesion from cecum to the ascending colon with right urethral invasion. Percutaneous right nephrostomy was performed for grade 2-3 hydronephrosis. Three days after hospitalization, ileus developed and right hemicolectomy was performed. During surgery we observed that the lesion had invaded the middle part of ureter. So the middle part of ureter was removed with side-to-side urethral anastomosis and 6F double-J catheter was placed. The histopathological findings of resected specimen were consistent with ameboma. Reviewing the literature unilateral hydronephrosis due to colonic amebiasis has not been reported.

The endoscopic course of scattered white spots in the descending duodenum: a prospective study.

AIM: Scattered white spots (SWSs) in the descending duodenum are an uncommon finding of upper gastrointestinal system endoscopy (UGSE). Intestinal lymphangiectasia, chronic nonspecific duodenitis and giardiasis are associated with a SWS appearance. The aim of this study was to determine the frequency of SWS during routine endoscopy, as well as to evaluate the effect of treatment on this finding. MATERIALS AND METHODS: Patients undergoing UGSE with a SWS appearance in the descending duodenum were included prospectively. Appearance of SWSs was graded endoscopically based on density, after which patients were divided into two groups; group 1 (treated group) and group 2 (untreated group). Patients with Helicobacter pylori infection were given eradication therapy, whereas a diet was recommended to patients with intestinal lymphangiectasia. Proton pump inhibitors were initiated for patients with H. pylori negative gastritis. All patients were re-evaluated three months after therapy for the presence of any changes in the SWS appearance. RESULTS: SWSs were observed in 97 (3.2%) out of 3010 patients. This appearance was most commonly associated with chronic non-specific duodenitis followed by intestinal lymphangiectasia. While in the untreated group no statistically significant change in SWS appearance was observed, the decrease in endoscopic grade seen in the treated group was statistically significant (p<0.001). CONCLUSION: The prevalence of SWSs during routine UGSE was 3.2%, with this finding being more commonly associated with chronic non-specific duodenitis and intestinal lymphangiectasia. Treatment of the underlying causes, including H. pylori eradication, proton pump inhibitors and diet decreased the density of the SWSs.

Evaluation of Predisposing Metabolic Risk Factors for Portopulmonary Hypertension in Patients with NASH Cirrhosis.

PURPOSE: Metabolic parameters are important for the development of portopulmonary hypertension (PoPH) during nonalcoholic steatohepatitis (NASH)-associated cirrhosis. This study evaluated patients with NASH-associated cirrhosis to determine metabolic risk factors for portopulmonary hypertension. PATIENTS AND METHODS: Data on 171 patients (120 men and 51 women) with NASH-associated cirrhosis who were seen in Florence Nightingale Hospital's gastroenterology Clinic from 2009 to 2018 was obtained from the Hospital database. A pulmonary artery systolic pressure >35 mmHg was defined as PH (pulmonary hypertension) according to standard transthoracic echocardiography. Portal hypertension was diagnosed from clinical symptoms and dilated portal veins shown by abdominal ultrasound or computed tomography (CT). Pulmonary patients with portal hypertension were diagnosed with portopulmonary hypertension (PoPH). RESULTS: A total of 171 patients with NASH-associated cirrhosis were included in this study. Of these, 43 patients had PoPH. These patients had increased TSH (p=0.004), bilirubin (p=0.023) and triglyceride (p=0.048) levels, higher MELD scores (p=0.018) and decreased hemoglobin (p=0.05). MELD score and hemoglobin, total bilirubin, TSH, and triglyceride levels were all included in a multivariate logistic regression model and TSH levels were independently associated with increased risk of PoPH. CONCLUSION: Increased TSH is an independent risk factor for PoPH.

A New Risk-Scoring System for Colorectal Cancer and Polyp Screening by Turkish Colorectal Cancer and Polyp Study Group.

BACKGROUND: Colorectal cancer is one of the most commonly diagnosed types of cancer worldwide. An early diagnosis and detection of colon cancer and polyp can reduce mortality and morbidity from colorectal cancer. Even though there are a variety of options in screen- ing tests, the question remains on which test is the most effective for the early detection of colorectal cancer. In this prospective study, we aimed to develop a simple, useful, effective, and reliable scoring system to detect colon polyp and colorectal cancer. METHODS: We enrolled 6508 subjects over the age of 18 from 16 centers, with colonoscopy screening. The age, smoking status, alcohol consumption, body mass index, polyp incidence, polyp size, number and localization, and pathologic findings were recorded. RESULTS: The age, male gender, obesity, smoking, and family history were found as independent risk factors for adenomatous polyp. We have developed a new scoring system which can be used for these factors. With a score of 4 or above, we found the following: sensitivity 81%, specificity 40%, positive predictive value 25.68%, and negative predictive value 89.84%, for adenomatous polyp detection; and sensitivity 96%, specificity 39%, positive predictive value 3.35%, negative predictive value 99.29%, for colorectal cancer detection. CONCLUSION: Even though the first colorectal cancer screening worldwide is generally performed for individuals over 50 years of age, we recommend that screening for colorectal cancer might begin for those under 50 years of age as well. Individuals with a score ≥ 4 must be included in the screening tests for colorectal cancer.

Moxifloxacin-tetracycline-lansoprazole triple therapy for first-line treatment of Helicobacter pylori infection: a prospective study.

AIM: To document the efficacy and tolerability of 14-day moxifloxacine-tetracycline-lansoprazole (MTL) regimens for Helicobacter pylori (Hp) eradication as a first-line therapy. METHOD: Fifty-six Hp-positive patients were enrolled. Patients were considered eligible for the study if they underwent upper gastrointestinal endoscopy, and Hp infection was diagnosed through histologic examination of antral and body bioptic samples. Primary end point of this study was to evaluate the eradication rate of 14-day MTL regimen therapies. Hp eradication was assessed using the 13C urea breath test performed. All patients were asked to fill in a validated questionnaire to report therapy-related side effects. Each symptom was graded from absent or present. RESULTS: Fifty-six patients (29 men and 27 women) were enrolled. The studied therapeutic regimens were completed by 96.4% patients. Two dropouts occurred in the MTL group because of side effects. The eradication rate in MTL regimens was 55.4%. The overall prevalence of side effects was high in the MTL group. CONCLUSION: The MTL regimen failed to achieve the recommended eradication rates and had higher adverse effect rate. Hence, MTL regimen does not seem to be a suitable choice as a first-line Hp eradication therapy.

NaOH-induced Crohn's colitis in rats: a novel experimental model.

AIM: Several models of experimental ulcerative colitis have been previously reported. To date, only one model of Crohn's colitis that was induced by trinitrobenzene sulfonic acid has been described. MATERIALS AND METHODS: Twenty-one male albino rats were divided into three groups: group I: sham control group (n = 7), group II: acetic acid group (n = 7), group III: NaOH group (n = 7). On the day of induction, all rats were lightly anesthetized with intramuscular ketamine (8 mg/kg). A 6F plastic catheter was inserted rectally until the tip was 5 cm proximal to the anus. Then, 2 ml of 0.9% saline, 2 ml of 4% acetic acid, and 2 ml of 6.25% NaOH was administered to groups I, II, and III, respectively. All rats were sacrificed 5 days after colitis induction. The distal colon segment was assessed macroscopically and microscopically. In addition, malondialdehyde (MDA) and nitric oxide (NO) levels of the colonic tissue and changes in body weight were measured. RESULTS: Macroscopic and microscopic examinations of colonic tissue samples showed morphological similarities to human Crohn's disease (CD). The MDA and NO levels of the colonic tissues were significantly higher in the NaOH group compared to the acetic acid and sham control groups (P = 0.001). CONCLUSION: NaOH may be used to induce Crohn's colitis as an experimental model.

Diagnostic and prognostic role of serum glypican 3 in patients with hepatocellular carcinoma.

α-Feto protein (AFP) is the widely used tumor marker in the diagnosis of hepatocellular carcinoma (HCC). The aim of this study was to assess the diagnostic and prognostic validity of a novel marker, serum Glypican-3 (GPC3) and to compare AFP in patients with HCC. One hundred and twenty-eight patients (75 patients with HCC, 55 patients with cirrhosis, and 28 healthy controls) were included in this study. Cut-off value of GPC3 was 3.9 pg/ml. AFP was divided into four subgroups, according to cut-off values with 13, 20, 100, and 200 ng/ml. Sensitivity, specificity, and positive and negative predictive values of GPC3 and AFP13, AFP20, AFP100, AFP200 subgroups and also GPC3+AFP13, GPC3+AFP20 , GPC3+AFP100 , GPC3+AFP200 combinations were compared. Serum GPC3 levels were significantly higher in patients with HCC and cirrhosis compared with control subjects (P<0.05). The median serum GPC3 levels were 3.9 pg/ml in controls, 5.51 pg/ml in patients with cirrhosis, and 5.13 pg/ml in those with HCC. The median serum AFP levels were 1.37 ng/ml in controls, 2.32 ng/ml in cirrhotics, and 50.65 ng/ml in HCC patients. The sensitivity, specificity, and positive and negative predictive values of GPC3 was 61.33, 41.82, 58.97, and 44.43%, respectively. The values for AFP were 68.57, 94.55, 94.12, and 70.27%, respectively. There was no correlation between GPC3 levels and prognostic parameters. GPC3 is not a useful diagnostic and prognostic marker for HCC.

Mean platelet volume as a fibrosis marker in patients with chronic hepatitis B.

INTRODUCTION: Many noninvasive tests have been studied for the diagnosis and determining the liver fibrosis score (LFS). In this study, we aimed to research the correlation of mean platelet volume (MPV) and stage of liver fibrosis in patients with chronic hepatitis B (CHB). PATIENTS AND METHODS: Fifty-nine patients with CHB were enrolled retrospectively into the study. Age-sex matched 25 healthy subjects were used as control group. The following data were obtained from computerized patient registry database: HBV-DNA level, hepatitis B e-antigen seropositivity, liver enzymes and function tests, white blood cell count, platelet count, hemoglobin, histological activity index, LFS, and MPV. Patients were divided into two groups: patients without significant fibrosis (F0, F1, or F2) (Group 1) and patients with advanced fibrosis (F3, F4) (Group 2). RESULTS: A statistically significant increase in MPV was seen in patients with CHB compared with healthy controls (8.49±0.84 fl vs.7.65±0.42 fl, P<0.001). Receiver operating characteristic curve analysis suggested that the optimum MPV level cut-off points for CHB was 8.0 fl, with sensitivity, specificity, PPV, and NPV of 68, 76, 86, and 50%, respectively. MPV levels were significantly higher in Group 2 (8.91±0.94 fl, P: 0.009) compared with Group 1 (8.32±0.74 fl). ROC curve analysis suggested that the optimum MPV level cut-off points for Group 2 was 8.45 fl, with sensitivity, specificity, positive and negative predictive value of 77, 59, 45, and 85%, respectively. Multivariable logistic regression model, which consisted of HAI, ALT, HBV-DNA, platelet count, and MPV, was performed. We showed that MPV was independently associated with advanced fibrosis (P: 0.031). CONCLUSION: We suggest that MPV might help in the assessment of fibrosis in CHB. It should not be considered a stand-alone test for this use owing to nonspecificity with other diseases.

Comparison of the possible risk factors of bone mineral density in subjects with ulcerative colitis and healthy subjects.

OBJECTIVE: Inflammatory bowel disease (IBD) is a gastrointestinal system disorder with a variety of causes. The prevalence of reduced bone mineral density (BMD) is greater in people with IBD as compared with healthy individuals. In this study, we aimed to investigate the possible risk factors for low BMD in subjects with ulcerative colitis (UC) and in healthy control subjects. SUBJECTS AND METHODS: A total of 40 subjects with UC and 29 healthy subjects were enrolled in the study. Age; sex; body mass index; location and duration of disease; current corticosteroid, azathioprine, or other immunosuppressive medications; smoking; consumption of alcohol, milk, and milk products; menstrual pattern in women; and use of vitamin D, calcium, folic acid, multivitamins, and iron preparations were recorded. BMD was measured by dual-energy x-ray absorptiometry at L2-L4 of the spine and the femoral neck. RESULTS: The BMD of patients was found to be lower than that in the control group. The T and z scores of the lumbar vertebra and femoral neck were normal in 21 subjects (52.5%). A total of 17 (42.5%) subjects had osteopenia, and 2 (5%) subjects had osteoporosis. Parathyroid hormone, 1,25(OH)2 vitamin D3, osteocalcin, and urinary markers were found to be similar in both groups. There were no significant differences between subjects with UC and subjects in the control group according to age, sex, and conventional risk factors. CONCLUSIONS: The BMD of subjects with UC was found to be lower than that in subjects of similar age and sex in the control group. Our findings suggest that that the disease itself is the most important pathogenic factor contributing to low BMD.