Gut bacteria after recovery from COVID-19: a pilot study.

OBJECTIVE: COVID-19 has been a major infectious disease lately in humans. 10% of people experience persistent symptoms twelve weeks after having COVID-19. The gut microbiota is essential for host immunity. Thus, gut microbiota composition may contribute to the recovery of COVID-19 patients. The impact of COVID-19 on the gut microbiota of patients during recovery is less explored. We investigated the potential alterations of bacterial gut microbiota of immediately recovered COVID-19 patients, and six months after their recovery. MATERIALS AND METHODS: Stool samples were collected from 8 patients with COVID-19 immediately after their recovery, and six months after SARS-CoV-2 clearance, as well as from 8 healthy donors as a control group. 16S rRNA gene sequencing was performed to analyze the correlation between disease recovery and microbiota using the immediately recovered and control group. Specific primers were designed for the most significantly altered bacteria and used to analyze the changes in intestinal microbiota composition of patients using qPCR. qPCR comparisons were performed on three groups: newly recovered from COVID-19, after six months of COVID-19 recovery, and healthy controls. RESULTS: Compared with the healthy control group, patients who immediately recovered from COVID-19 had significantly less presence of 15 bacterial groups. The immediately recovered patients had a very significantly higher relative abundance of the opportunistic pathogen Mycolicibacterium. No differences were found between the immediately recovered patients, and after six months of recovery using the qPCR analyses. CONCLUSIONS: Our results contribute novel insights regarding the alteration of human gut microbiota and the emergence of opportunistic pathogens in recovered patients of COVID-19. Further studies with a larger experimental size are needed to reveal balance or dysbiosis in patients after COVID-19 recovery.

Hexagonal boron nitride nanoparticles trigger oxidative stress by modulating thiol/disulfide homeostasis.

BACKGROUND: Hexagonal boron nitride nanoparticles (hBN NPs) are encouraging nanomaterials with unique chemical properties in medicine and biomedical fields. Until now, the optimal hBN NP's dosage and biochemical mechanism that can be used for in vivo systems has not been fully revealed. The main aim of this article is to reveal characteristics, serum and tissue interactions and any acute cytotoxic effect of different dose of hBN NPs for the first time. METHODS: hBN NPs at concentrations varying between 50-3200 µg/kg was administered by intravenous injection to Wistar albino rats (n = 80) divided into seven dosage and control groups. Blood and tissue samples were taken after 24 hours. RESULTS: Our findings suggested that higher doses hBN NPs caused oxidative stress on the serum of rats dose-dependently. However, hBN NPs did not affect thiol/disulfide homeostasis on kidney, liver, spleen, pancreas and heart tissue of rats. Furthermore, hBN NPs increased serum disulfide formation by disrupting the thiol/disulfide balance in rats. Also, LOOH and MPO levels increased at high doses, while CAT levels decreased statistically. CONCLUSION: The results revealed that hBN NPs induce oxidative stress in a dose-dependent manner by modulating thiol/disulfide homeostasis in rats at higher concentrations.

Protective effect of betaine against skeleton muscle apoptosis in rats induced by chronic alcohol and statin consumption.

AIM: The aim of the present study was to investigate the effect of apoptosis on rat skeletal muscle caused by chronic alcohol and statin consumption with modified liquid diet and to elucidate protective effects of betaine supplementation. METHODS: TNF-α (tumor necrosis factor), NF-kB (Nuclear Factor kappa B), cytochrome c and caspase-3 levels with or without betaine treatment in alcohol and/or statin-induced skeleton muscle apoptosis rats as well as in controls were measured in serum and tissue. Histologic examinations of the muscle tissues were also performed. RESULTS: In our study, betaine treated treatment groups we found that calpain and caspase activities and cytokine c release were decreased caused by alcohol, statin and more importantly alcohol+statin group and TNF and NF-kB levels were also close to the levels of control group. Similarly, significant improvements have been observed in our morphological and histological examination results also supporting our biochemical data. CONCLUSION: We found that combined consumption of ethanol and statin is capable of triggering apoptotic cell death in rat muscles more than the consumption of only alcohol or only statin. Betaine was able to reduced this muscle cell death induced by alcohol and/or statin consumption (Tab. 4, Fig. 4, Ref. 43).

Evaluation of knowledge level related to obstructive sleep apnea syndrome.

OBJECTIVE: Our aim in this study is to evaluate the knowledge level of outpatients about obstructive sleep apnea syndrome (OSAS). SUBJECTS AND METHODS: This cross-sectional analytical study included 1651 patients and patient relatives who applied to Konya Training and Research Hospital outpatient clinics. Sociodemographic data form and OSAS knowledge level questionnaire were applied to participants. SPSS 21 package program was used for the statistical analysis of the data. It was accepted that p value was <0.05. RESULTS: The average knowledge score in the knowledge level questionnaire was 15.1 (3-33). 61% of the participants had never heard of OSAS before. Those who are married, those living in the city center and women have a higher level of knowledge. When age, education level and income level increased, the score of information also increased. Most of the participants' information source was the social media with 56.5% (n = 364) and least were health workers with 19.8% (n = 127). The knowledge level of people whose information sources were doctors, were significantly higher than other information sources such as nurses, friends, internet and television as. There was no significant difference between the other groups. CONCLUSION: In our study, it was concluded that the level of knowledge about OSAS in the society was not sufficient and that the society had to be informed about this disease which has serious complications and awareness should be established.

DOES GRAVES' DISEASE AFFECT ESOPHAGEAL MOTILITY?

CONTEXT: The gastrointestinal tract is one of the most affected systems in hyperthyroidism. Although thyrotoxicosis is thought to be associated with gastrointestinal dysmotility, there are limited studies focused on motility disorders in hyperthyroidism. OBJECTIVES: We aimed to investigate the manometric measurements to determine if esophageal motility is affected in Graves' disease. MATERIALS AND METHODS: Thirty patients with Graves' disease (18 female and 12 male) and 30, age and sex matched, healthy controls (22 female and 8 male) were recruited to the study between 2015 and 2016. Esophageal manometry was performed using MMS (Medical Measurement Systems bv. The Netherlands) Solar GI - Air Charged Intelligent Gastrointestinal Conventional Manometry. RESULTS: The mean lower esophageal sphincter pressure (LESP) was 16.9 ± 5.3 mmHg in hyperthyroid patients and 20.1 ± 8.8 mmHg in the control group and there was no significant difference (p>0.05). It was observed that the duration of contraction was 3.9 ± 0.7 s in healthy subjects and, significantly shorter 3.2 ± 0.5 s in hyperthyroid patients (p<0.001). Duration of contraction was negatively correlated with TSH receptor Ab titer in patients (p=0.006, r= -0.48). Also, it was observed that the duration of relaxation was negatively correlated with fT4 levels in the patient group (p<0.05, r= -0.46). CONCLUSION: In this study, we observed that esophageal motility can be affected via shortened duration of contraction in Graves' disease. The gastrointestinal symptoms due to possible motility dysfunctions should be considered in the evaluation of hyperthyroid patients.

Overview of dendritic cell-based vaccine development for leishmaniasis.

Leishmaniasis is one of the most serious vector-borne diseases in the world and is distributed over 98 countries. It is estimated that 350 million people are at risk for leishmaniasis. There are three different generation of vaccines that have been developed to provide immunity and protection against leishmaniasis. However, their use has been limited due to undesired side effects. These vaccines have also failed to provide effective and reliable protection and, as such, currently, there is no safe and effective vaccine for leishmaniasis. Dendritic cells (DCs) are a unique population of cells that come from bone marrow and become specialized to take up, process and present antigens to helper T cells in a mechanism similar to macrophages. By considering these significant features, DCs stimulated with different kinds of Leishmania antigens have been used in recent vaccine studies for leishmaniasis with promising results so far. In this review, we aim to review and combine the latest studies about this issue after defining potential problems in vaccine development for leishmaniasis and considering the importance of DCs in the immunopathogenesis of the disease.

Effect of pre-operative red blood cell distribution on cancer stage and morbidity rate in patients with pancreatic cancer.

BACKGROUND: The red blood cell distribution (RDW) is a test measure of erythrocyte variation and the volume level which shows the heterogeneity and it is a proven test in literature for the determination of survival on cardiovascular diseases. The main purpose of this research is to investigate the relationship between the RDW level and postoperative morbidity as well as its stages in diagnosed pancreatic cancer patients. METHODS: In this study we covered 104 diagnosed pancreatic cancer patients who have been operated in 2011-2014. The RDW levels were separated into two groups. Group 1 contains higher level RDW patients (> 14) whereas group 2 contains only lower level RDW patients. We compared both groups in terms of the patients' demographic data, duration of hospitalization, ratio of pancreatic fistula, disease period, and the mortality rates. RESULTS: In group 1 contains 39 patients whereas group 2 contains only 65 patients. We determined the positive correlation between stages of disease with RDW levels as well as the correlation between low level of blood albumin and Ca 19.9 levels (p = 0001). However we did not observe statistically important difference in postoperative morbidity. CONCLUSIONS: Based on this study we report that RDW levels can be use as a marker to show the stages of pancreatic cancer in diagnosed patients.

The examination of protective effects of gallic acid against damage of oxidative stress during induced-experimental renal ischemia-reperfusion in experiment.

AIM: In this study, probable effects of gallic acid were investigated in experimentally induced renal I/R injury in rats. MATERIAL AND METHODS: For this purpose, each group consisted of 7 Spraque dawley male albino rats. Groups were defined as follows; Group I: control group; Group II: I/R group; Group III, IV and V: I/R+Gallic acid (50, 100 and 200 mg.kg-1 respectively-i.p.). Left kidney was removed by nephrectomy except for Group I. I/R was induced in the other kidney. Gallic acid was given 15 mins before ischemia induction. SOD, CAT and Gpx activities were determined by electrophoresis. MDA, MPO levels were determined spectrophotometrically. Histopathological investigations were also performed in kidney tissues. BUN and Creatinine levels in serum were determined. RESULTS: BUN, Creatinine and MDA levels were statistically significant but MPO level was not statistically significantly increased in Group II. For SOD, CAT, Gpx activities in Group II, an increase was determined with respect to Group I. Histopathological investigations revealed widespread hyperemia in glomerulus, expansion of the structure between tubules and cell disruptions in Group II. In Group V (200 mg.kg-1 gallic acid), in terms of biochemical parameters, in spite of the significant decrease in BUN, Creatinine and MDA levels; a decrease was determined in SOD, CAT and Gpx isoenzyme activities. Group V showed histologically that I/R injury had been prevented to a greater extent and appearances were close to the control. CONCLUSION: As a result, in terms of our study, evaluations regarding kidney functions and histopathology have shown that gallic acid has protective effects in renal I/R injury (Tab. 2, Fig. 5, Ref. 36).

Metallic stent in the endoscopic treatment of pancreatic fluid collections.

BACKGROUND AND AIMS: The endoscopic treatment of pancreatic fluid collections (PFCs) has become the preferred first-line approach. Fully covered self-expandable metal stents (FCSEMS) were considered as an alternative to multiple double pigtail stents. The aim of this study was to evaluate the results of the endosonography guided drainage (EUS-GD) of PFCs with FCEMS. MATERIALS AND METHODS: A total of 33 consecutive patients were included. Cystogastrostomy and cystoduodenostomy were created with a linear echoendoscope under endosonographic and fluoroscopic control. Procedures were performed in a standard way of, puncture with a 19 gauge needle, bougie dilation and insertion of FCSEMS. RESULTS: A total of 33 patients (mean age 52 years, 21 men, range: 18-77 years), were included. PFCs were 22 non-infected symptomatic pseudocyst and 11 walled-off necrosis or abscess. EUS-GD was successful in 30 (90.9%) patients. Stent insertion failed in one patient. Two patients needed surgery. Complications were observed in 8 (25%) patients (stent dislocation in 3, perforation in 2, bleeding in 2 and pneumoperitoneum in 1 patient). Procedure related mortality was not seen. The mean cyst size was 11.3 cm (5-22). FCSEMS were successful in the treatment of pseudocysts (after 1 month mean cyst size is 6.2 cm, range: 0-15 cm, with 54.8% decrement rate). During a mean follow-up of 15 months complete resolution was 66.6% (20 patients) and recurrence due to stent malfunction was 10%. All these cases were submitted to a new session of endoscopic drainage. CONCLUSIONS: EUS-GD, FCSEMS insertion provides an effective, minimally invasive, and safe approach in the management of PFCs.

Carrier element-free coprecipitation with 3-phenly-4-o-hydroxybenzylidenamino-4,5-dihydro-1,2,4-triazole-5-one for separation/preconcentration of Cr(III), Fe(III), Pb(II) and Zn(II) from aqueous solutions.

A separation/preconcentration procedure, based on the coprecipitation of Cr(3+), Fe(3+), Pb(2+) and Zn(2+) ions using a new organic coprecipitant, 3-phenly-4-o-hydroxybenzylidenamino-4,5-dihydro-1,2,4-triazole-5-one (POHBAT) without adding any carrier element has been developed. The method, thus, has been called carrier element-free coprecipitation (CEFC). The resultant concentrated elements were determined by flame atomic absorption spectrometric determinations. The influences of some analytical parameters including pH of the solution, amount of the coprecipitant, standing time, centrifugation rate and time, sample volume and diverse ions were investigated on the quantitative recoveries of analyte ions. The validation of the present preconcentration procedure was performed by the analysis of two certified reference materials. The recoveries of understudy analytes were found in the range of 93-98%, while the detection limits were calculated in the range of 0.3-2.0 microg L(-1). The precision of the method evaluated as relative standard deviation (R.S.D.), was in the range of 3-7% depend on the analytes. The proposed method was successfully applied to environmental samples for the determination of the analytes.

Splenic abscess after splenic artery ligation in living donor liver transplantation: a case report.

Although recent developments in living donor liver transplantation (LDLT) yield promising results, a size mismatch between the weights of the graft and the recipient remains a significant problem. Recipients of LDLT may have hyperdynamic splanchnic circulations resulting in graft hyperperfusion and increased portal vein flow leading to small-for-size syndrome. Splenic artery ligation is one of the least invasive measures to prevent occurrence of this syndrome. Despite its potentially devastating consequences, splenic infarction following splenic artery ligation has received little attention to date. Herein we have reported a patient who developed a splenic abscess due to a splenic infarction following splenic artery ligation during LDLT.

Chronic hepatitis C responds poorly to combination therapy in chronic hepatis B carriers.

BACKGROUND: The effect of conventional interferon-based therapy of hepatitis B virus (HBV) and hepatitis C virus (HCV) dual infection is controversial. Yet, no studies have been carried out into pegylated interferon treatment for chronic HBV/HCV coinfection. We aimed to evaluate the response rate and side effects of conventional or pegylated interferon combined with ribavirin on chronic HBV/HCV coinfection therapy. METHODS: The study included 36 chronic hepatitis patients (M/F: 28/8, mean age 47+/-12 years) who were positive for HBsAg and anti-HCV. They were tested for the presence of HBV-DNA by hybridisation assay, and the samples giving negative results were retested by polymerase chain reaction (PCR). All patients were tested for HCV-RNA using PCR, and the HCV genotype was determined. RESULTS: Nineteen patients were given standard interferon either alone or in combination with ribavirin, whereas 17 were given pegylated interferon and ribavirin combination therapy. None of the patients had HBV-DNA positivity; however, all had HCV-RNA detectable by PCR. All the patients had HCV genotype 1b. The mean alanine aminotransferase and aspartate aminotransferase levels were 118+/-65 U/l and 90+/-95 U/l respectively. Five patients in each group discontinued the treatment due to side effects. Only two patients (one from each group) reached sustained virological response. CONCLUSION: Neither pegylated nor conventional interferon based regimes were effective for HBV/HCV coinfection, in which the dominant virus was HCV. Pegylated interferon and ribavirin therapy was not superior to conventional interferon based regimes in the treatment of HBV/HCV coinfection.

Treatment of chronic delta hepatitis with lamivudine vs lamivudine + interferon vs interferon.

Chronic delta hepatitis is the most severe form of chronic viral hepatitis for which interferon (IFN) is the only available treatment. In 39 patients (25 were treatment-naïve, 14 had previously used IFN), efficacy of 1-year treatment with IFN (9 MU, t.i.w.) or lamivudine (LAM; 100 mg, q.d.) alone was compared with IFN and LAM combination (2 months of LAM to be followed by combination treatment). IFN monotherapy was given only to treatment-naïve patients. In both treatment-naïve and previous IFN users, end of treatment virological and biochemical responses were similar with IFN-LAM combination and superior to LAM monotherapy (P < 0.05). Improvement in liver histology occurred more often with IFN +/- LAM than with LAM alone (P < 0.05). In treatment-naïve patients, combination treatment was not superior to IFN monotherapy. After treatment discontinuation, virological and biochemical response rates decreased in LAM and IFN combination and IFN monotherapy. On treatment virological response at month 6 of treatment predicted sustained virological response. The results of this study suggest that addition of LAM to IFN for the treatment of delta hepatitis is of no additional value and that both treatment modalities are superior to LAM monotherapy.

Clinical, biochemical and histological correlations in a group of non-drinker subjects with non-alcoholic fatty liver disease.

The correlation between biochemistry, imaging-studies and histology is a matter of controversy in non-alcoholic fatty liver disease (NAFLD) and the major pathophysiology of non-alcoholic steatohepatitis (NASH) is still unknown. We aimed to perform a comparative analysis between clinical, biochemical and histological variables of NAFLD. One-hundred and five NAFLD patients (F/M: 51/54), were studied, all with no-alcohol intake. The groups were followed-up for six months. Necroinflammation and fibrosis were more severe in patients with diabetes (p = 0.002, and p = 0.0001, respectively). In comparing NAFL to NASH, plasma nitric-oxide and malondialdehyde levels were significantly higher (p = 0.05, for-both), and vitamin-E and-C levels were significantly lower in NASH (p = 0.002, and 0.001, respectively). The serum ferritin levels were higher in NASH patients (p = 0.016). While the ultrasonographic grade was significantly higher, the liver-spleen density gradient was significantly lower in NASH group (p = 0.017, and 0.005, respectively). Within a six month period, serum ALT levels dropped into the normal range in 23/76 (30.3%) patients and serum ALT in the 6th month correlated significantly with the severity of steatosis, inflammation and fibrosis in initial biopsy (p = 0.023, 0.035, 0.011, respectively). In conclusion, the probability of severe liver disease is higher in patients with elevated-ALT in NAFLD. Serum ferritin levels have some prognostic significance in liver damage and fibrosis. Overt diabetes is predictive of advanced fibrosis and inflammation. However impaired glucose-tolerance is not. The advice on diet and exercise for six months after diagnosis may be a good strategy in NAFLD. The patients with normal-ALT without hepatomegaly, morbid-obesity and diabetes seem to have a good prognosis, however some of these patients may still require liver biopsy.

Extreme elevation of serum alpha fetoprotein in decompensated cirrhosis without HCC: an ominous sign.

Three cases of extreme elevation of serum alpha fetoprotein (>10,000 ng/mL) with decompensated cirrhosis without demonstrable hepatocellular carcinoma are reported. While 2 patients died of liver failure, 1 survived after liver transplantation. Extreme elevation of alpha fetoprotein not associated with hepatocellular carcinoma in liver cirrhosis heralds an ominous prognosis necessitating urgent liver transplantation.

The safety of pegylated interferon alpha-2b in the treatment of chronic hepatitis B: predictive factors for dose reduction and treatment discontinuation.

BACKGROUND: Treatment with interferon-alpha has been shown to be effective in one-third of hepatitis B e antigen-positive chronic hepatitis B patients, but is clinically associated with relevant adverse events. AIM: To investigate the safety of pegylated interferon alpha-2b in 300 hepatitis B e antigen-positive patients with compensated liver disease. METHODS: Patients were treated with pegylated interferon alpha-2b for 52 weeks combined with either lamivudine 100 mg/day or placebo. Pegylated interferon alpha-2b was administered for 100 microg once a week for 32 weeks; thereafter, the dose was reduced to 50 microg once a week. Adverse events and their effect on study medication were reported at monthly visits in a standardized way. RESULTS: The most frequently reported side-effects were flu-like syndrome (68%), headache (40%), fatigue (39%), myalgia (29%) and local reaction at the injection site (29%). These symptoms typically occurred within the first month of therapy and subsided during the course of therapy. Neutropenia and thrombocytopenia induced by pegylated interferon alpha-2b increased the risk of infections and bleeding complications, but these complications were rare and mild. The frequency of all side-effects was not different between patients treated with pegylated interferon alpha-2b combined with lamivudine or placebo. In 69 (22%) patients the dose of pegylated interferon alpha-2b was reduced prematurely. Of these dose reductions, 36 (52%) were because of neutropenia. Therapy was discontinued in 28 (8%) patients. The most frequent reasons for early discontinuation were psychiatric side-effects (depression, psychosis) and flu-like symptoms. Multivariate Cox regression analysis showed that low neutrophil count at baseline and cirrhosis were independent predictors of dose reduction or therapy discontinuation. CONCLUSION: We conclude that in patients with chronic hepatitis B and compensated liver disease prolonged pegylated interferon alpha-2b therapy is safe, and that pre-existent cirrhosis and neutropenia are the most important predictors of dose reduction or early treatment discontinuation.

Spontaneous hematoma of the rectus abdominis muscle: a rare cause of acute abdominal pain in the elderly.

A rectus abdominis sheath hematoma (RSH) is uncommon. It may mimic other acute abdominal disorders. The underlying conditions are trauma, coagulation disorders, or anticoagulant therapy, complications related to operations, subcutaneous injections to the abdominal wall, although it can also develop spontaneously. Acute abdominal pain and a palpable mass after muscular strain such as coughing, sneezing, and twisting were features highly suggestive of RSH. The diagnostic means of choice is computerized tomography. The treatment is usually conservative, but surgery may be needed in cases with large or progressing hematomas or with severe symptoms. We herein report an elderly woman presenting with an acute painful abdominal mass, without any underlying conditions, which was diagnosed as spontaneous RSH. She needed an operation. We concluded that RSH should be considered in the differential diagnosis of acute abdominal pain in the elderly, even in the absence of underlying conditions.

Sarcoidosis after use of interferon for chronic hepatitis C: report of a case and review of the literature.

Although interferon has not been classified in the pathogenesis of sarcoidosis, it may rarely lead to this disease during treatment of chronic hepatitis C. The case of a 36-year-old woman with chronic hepatitis C who developed sarcoidosis within 10 weeks of treatment with recombinant interferon-alpha2a and ribavirin is described and all seven similar cases published in English from 1989 to 2001 are discussed.