Non-invasive fibrosis tests are correlated with necroinflammatory actvity of liver in patients with chronic hepatitis B.

BACKGROUND: The gold standarda method used for assessing necroinflammatory activity and fibrosis in the liver is a liver biopsy which has many disadvantages. Therefore, many investigators have been trying to develop non-invasive tests for predicting liver fibrosis score (LFS) of these patients. The aim of this study is to describe the relationship between certain non-invasive fibrosis markers with LFS and histological activity index (HAI) detected histopathologically by liver biopsy in chronic hepatitis B patients. MATERIALS AND METHODS: A total of 54 patients who had undergone a liver biopsy with the diagnosis of chronic HBV infection were included in the study. Ishak scoring was used for the evaluation of liver fibrosis, and a modified Knodell HAI was used for demonstration of necroinflammation. In this study, non-invasive fibrosis tests were calculated as described in previous studies. RESULTS: Histological acitivity index was positively correlated with age, age/platelet index, cirrhosis discriminant score (CDS), AST/platelet ratio index (APRI), AST/platelet/GGT/AFP index (APGA), fibro-quotient (Fibro-Q), Goteburg University Cirrhosis Index (Guci), and Platelet/Age/Phosphatase/AFP/AST index (PAPAS). When divided into two groups according to HAI, Guci and APGA were found significantly different both in >4 and >4 HAI groups than the other group. In ROC analysis performed for LFS; PAPAS, APGA, FFI and APRI were the markers having the highest AUC levels, and in ROC analysis performed for HAI; Guci, APRI and APGA were the markers with the highest AUC levels. CONCLUSIONS: APRI, APGA and GUCI tests may be helpful in prediction of necroinflammatory scores in the liver.

Evaluation of patients with Crimean-Congo hemorrhagic fever in Bolu, Turkey.

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF), which is associated with a high mortality rate in the Black Sea region of Turkey, has received increasing attention. OBJECTIVE: In this study, the epidemiological features, clinical and laboratory findings, treatments, and outcomes of patients diagnosed with CCHF between 2006 and 2012 based on data obtained from the Bolu Provincial Directorate of Health (BPDH) were evaluated. METHODS: BPDH data were reviewed for the period between 1 January 2006 and 31 July 2012. The locations where the tick had attached to the patient, the site of the tick bite on the patient's body, the dates of tick bite and removal, and the demographic characteristics of each patient were recorded. BPDH data on the total number of tick bites, patients with confirmed CCHF, and deaths due to CCHF in Bolu Province during the study period were also evaluated. RESULTS: A total of 46 patients with CCHF and 38 patients without CCHF but who had been bitten by ticks were admitted to the BPDH. Of the patients with CCHF, 54.3% were female. The mean age of the patients was 46.88 ± 2.05 years (range, 1-79 years). The mortality rate was 8.82%. Patients were predominantly observed in June and July. When the patients were distributed according to their occupations, the majority was houswife (48.6%), followed by animal husbandry worker (27.0%), farmer (10.8%), health worker (5.4%), and other (8.1%). The symptoms of the patients with CCHF included fatigue (60.9%), fever (60.9%), and myalgia (60.9%). Of those patients with CCHF, 41.3% were determined to have a high fever. CONCLUSIONS: The probability of developing CCHF decreased as the duration of tick attachment increased. Moreover, although the clinical presentation is important, it is not diagnostic. Physical examination and laboratory findings become more specific in later stages.

Significance of bacteriuria and leukocyturia in the outpatients with heart failure.

AIM: To investigate the relationship between severity of illness and hospitalization with the presence of leukocyturia and bacteriuria in outpatients with heart failure (HF). PATIENTS AND METHODS: Four hundred three patients admitted with the diagnosis of HF to cardiology outpatient clinic were included in this study. According to New York Heart Association (NYHA) classification, the patients were divided into two groups to be group A (decompensated) as stage 3 or 4 and group B as stage 1 or 2 (compensated HF). All subjects underwent standard 12-lead ECG and echocardiography. In all patients, full blood, biochemical tests as liver and kidney function tests, full urinary analysis (FUA) and thyroid function tests were analyzed. Mid-stream urine for culture was taken for the leukocytes number > or =5 mm3. RESULTS: The mean leukocyte number (MLN) in urine of patients was 16.56 +/- 13.63 in Group A and was 3.74 +/- 5.31 in Group B (p < 0.000). The moderately positive correlation was found between the MLN and NHYA class in all patients (r = 0.526; p < 0.000). In receiver operating characteristic (ROC) curve analysis, the optimal cut-off value of leukocytes in urinalysis to predict hospitalization of CHF was > or =5, with 76.1% sensitivity and 75.7% specificity (area under the curve 0.825, 95% confidence interval 0.781 to 0.862, p = 0.000). CONCLUSIONS: We found that the numbers of leukocytes in urinalysis of hospitalized patients with HF were significantly higher than non-hospitalized persons. Also, number of leukocyte in urinalysis was positively correlated with NYHA class of HF patients. Namely, leukocyturia may be an indicator of decompensations in HF patients.

Effect of intrapleural povidone-iodine lavage on thyroid hormones in thoracic surgery.

OBJECTIVE: Povidone-iodine (PI) is an effective disinfectant used in many surgical operations. It is known that PI is absorbed by the skin after application. Absorption is even greater in infants, as their skin is thinner and more permeable. Iodine absorption in the orbita, neck and during abdominal surgery has been previously investigated, but such a study has not been performed for the pleura, which has a greater area and capacity for absorption. In this study, we investigated the effect of intraoperative povidone-iodine lavage on thyroid hormones during thoracic surgery. MATERIAL AND METHOD: Fifty patients without any thyroid pathology scheduled for thoracotomy were divided into 2 groups. Group A (n = 25) was given intraoperative saline lavage, while group B (n = 25) had povidone-iodine lavage. Levels of free T3 (FT3), free T4 (FT4) and thyroid-stimulating hormone (TSH) measured 1 day preoperatively and 1 day postoperatively were analyzed. RESULTS: There was a statistically meaningful change in FT3 levels ( P = 0.033) between groups, but the measured changes in FT4 and TSH levels were not statistically significant ( P = 0.98 and P = 0.71, respectively). FT3 scores for group A were decreased postoperatively compared to the scores for group B, but all results were in normal ranges. In group A, the changes between preoperative and postoperative levels of FT3 and FT4 were statistically significant, while changes in TSH levels were not. In group B, changes in FT4 levels were statistically significant and changes in FT3 and TSH levels were not. CONCLUSIONS: The scores show that the iodine absorbed by the pleura during intraoperative povidone-iodine lavage has an effect on thyroid function. Intrapleural PI lavage results in changes to some thyroid hormone levels due to pleural absorption. Thus, intrapleural PI lavage should be used with care.