The association between gallstone disease and plaque in the abdominopelvic arteries.

BACKGROUND: The aim of this study was to assess the atheromatous plaque, in the abdominopelvic arteries as a marker of cardiac risk in patients with or without gallstone disease (GD). MATERIALS AND METHODS: A total of 136 patients were enrolled in this cross-sectional study. Forty-eight patients had GD and the remaining 88 patients did not. The presence or absence of gallstones was noted during abdominal ultrasonography while vascular risk factors such as plaque formation, intima-media thickness, plaque calcification, mural thrombus, stenosis, aneurysm, and inflammation were recorded during an abdominopelvic computed tomography scan. In addition, percentage of the abdominopelvic aorta surface covered by atheromatous plaque was calculated. RESULTS: The mean age of patients with GD and without GD was 50.81 ± 16.20 and 50.40 ± 12.43, respectively. Patients with GD were more likely to have diabetes mellitus, a higher body mass index (BMI) (P < 0.001), and higher cholesterol (P < 0.01), and low-density lipoprotein-cholesterol (P < 0.02) levels. No significant differences were found between the groups regarding other atherosclerotic risk factors. Patients with GD had significantly higher rates of the vascular risk factors as intima-media thickness, plaque formation, calcification, aneurysm, mural thrombosis, stenosis, and inflammation in all abdominal arterial segments other than aneurysm in the femoral arteries. In addition, patients with GD had severe atheromatous plaques in the abdominal aorta, common iliac, external iliac, and common femoral artery (CFA). In patients with GD, parameters of age, BMI, and systolic and diastolic blood pressure were all correlated with the severity of the atheromatous plaque in abdominal aorta, common iliac, external iliac, and CFA. CONCLUSION: We demonstrated a direct relationship between GD and abdominopelvic atheromatous plaque, which is a marker for increased cardiovascular risk, for the first time in the literature. Patients with GD exhibit greater abdominopelvic atherosclerosis and therefore, have a higher risk of cardiovascular disease.

Serum Visfatin Levels in Ulcerative Colitis.

BACKGROUND: Previous studies have suggested that adipokines play a role in inflammatory bowel disease by inducing proinflammatory cytokines, but it is uncertain whether visfatin is causally involved in ulcerative colitis (UC). We evaluated visfatin levels in patients who presented with UC flares before and after treatment. METHODS: In this cohort study, we assessed 31 patients with UC in the activation period and remission in the same patients after treatment, and a healthy control group, consisting of 29 persons, at a single academic medical centre between 2010 and 2013. Disease severity was evaluated clinically using Trulove and Witt's criteria. RESULTS: Serum visfatin levels did not vary according to the extent of disease and were significantly higher in patients in the activation period (7.77 ± 2.41 ng/ml) than in remission (6.18 ± 2.04 ng/ml) and the healthy controls (6.54 ± 2.20 ng/ml; P < 0.01 and < 0.05, respectively). In a comparison of patients in the inactive period with the control group, there was no statistically significant difference (P > 0.05). To assess activation of the disease, a visfatin cut-off point for active UC was determined as 6.40, with sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV) of 72%, 52%, 66.7% (43.0-85.4) and 50.0% (29.1-70.9), respectively. CONCLUSIONS: The visfatin level was higher in the active group than in post-treatment remission and the healthy control group. Sensitivity and specificity were similar to other inflammatory markers for assessing clinical activity, which did not improve clinical outcomes in patients with acute respiratory distress syndrome (ARDS). These findings did not provide a rationale for assessment of UC activation.

Neutrophil-lymphocyte ratio in patients with familial Mediterranean fever.

BACKGROUND: Blood neutrophil-to-lymphocyte (N/L) ratio is an indicator of the overall inflammatory status of the body, and an alteration in N/L ratio may be found in patients with familial Mediterranean fever (FMF). The aim of this study was to investigate the interrelationship between N/L ratio and FMF. METHODS: One hundred and fifteen patients and controls were enrolled in the study. The cases in the study were categorized as FMF with attack, FMF with attack-free period, and controls. The neutrophil and lymphocyte counts were recorded, and the N/L ratio was calculated from these parameters. All patients were diagnosed according to Tel Hashomer criteria. RESULTS: A total of 79 FMF patients were included in the study and all subjects were receiving colchicine treatment at the time. The serum N/L ratios of active patients were significantly higher than those of attack-free FMF patients and controls (P < 0.001). The optimum N/L ratio cut-off point for active FMF was 2.63 with sensitivity, specificity, positive predictive value, and negative predictive value of 0.62 (0.41-0.80), 0.85 (0.72-0.93), 0.67 (0.44-0.85), and 0.82 (0.69-0.91), respectively. The overall accuracy of the N/L ratio in determination of FMF patients during attack was 71%. CONCLUSION: Our results demonstrate that N/L ratio is higher in patients with active FMF compared with FMF patients in remission and controls, and a cut-off value of 2.63 can be used to identify patients with active FMF.

Red blood cell distribution width as a non-invasive marker for the assessment of inflammation in non-alcoholic steatohepatitis.

BACKGROUND/AIMS: The aim of this study was to assess the association between red cell distribution width and inflammation in biopsy proven non-alcoholic steatohepatitis. METHODOLOGY: Fifty four subjects with non-alcoholic steatohepatitis and thirty nine controls were enrolled for the study. Liver biopsy specimens were scored by using non-alcoholic fatty liver disease activity score by a single experienced liver pathologist. RESULTS: Red cell distribution width was higher in the severe inflammation group in non-alcoholic steatohepatitis (p < 0.05). The areas under the receiver operating characteristic curves for the predictive performance of aspartate aminotransferase, alanine aminotransferase, gamma glutamyl transferase and red cell distribution width in identifying inflammation in non-alcoholic steatohepatitis were 0.55 (0.41-0.68), 0.51 (0.37-0.64), 0.53 (0.39-0.67) and 0.73 (0.59-0.84) respectively and the differences of these values between red cell distribution width and other parameters were found to be statistically significant (p < 0.05). To determine the grading of inflammation, the specificity for using the red cell distribution width as an indicator in non-alcoholic steatohepatitis patients was calculated to be 73.3%, with 79.5% sen- sitivity. CONCLUSION: Red cell distribution width was a sensitive and specific method for the assessment of the inflammation in patients with non-alcoholic steatohepatitis.

Non-alcoholic fatty liver disease in patients with migraine.

Evidence suggests that migraine is associated with metabolic syndrome, which is also implicated in non-alcoholic fatty liver disease (NAFLD). Reported for the first time, we aimed to investigate the relationship between migraine and NAFLD in patients with migraine. A total of 90 consecutive migraine patients were enrolled in this cross-sectional study. The diagnosis of migraine was determined according to the International Classification of Headache Disorders-II diagnostic criteria. The diagnosis of NAFLD was based on abdominal ultrasonography findings. Anthropometric indices and the homeostasis model assessment of insulin resistance (HOMA-IR) were calculated, and serum insulin level measurements and other biochemical analyses were performed for each subject. The measurements of body mass index and waist circumference were significantly higher in migraine patients with NAFLD than in those without NAFLD (p < 0.001). Regarding the laboratory results, insulin (p = 0.024), alanine aminotransferase (p = 0.027), and triglyceride levels (p = 0.001) and the HOMA-IR (p = 0.039) were higher in migraineurs with NAFLD than in those without NAFLD. Among the headache characteristics, the presence of aura was higher, and disease and attack durations were significantly longer in migraineurs with NAFLD than in those without NAFLD (p = 0.005, p = 0.024, and p = 0.023; respectively). However, the headache characteristics did not correlate with either the hepatosteatosis grade or HOMA-IR in migraine patients (p > 0.05). Our results show that NAFLD may present in migraine patients with higher frequency of auras and longer disease and attack durations.

Mean platelet volume in biopsy-proven non-alcoholic fatty liver disease.

Non-alcoholic fatty liver disease (NAFLD) is increasingly recognized as the most common cause of chronic liver disease worldwide. It has been shown that NAFLD has a strong association with metabolic syndrome and its component like insulin resistance (IR). Cardiovascular disease has a relation with NAFLD. Platelet volume is an indicator of platelet function and activation. Mean platelet volume (MPV) has been reported as a risk factor for atherothrombosis. In our study, we aimed to investigate the relation of MPV with NAFLD and IR in the NAFLD patients. A total of 54 patients with histologically proven NAFLD and 41 healthy age-matched control subject were enrolled in this study. The NAFLD subjects were divided into two subgroups: 42 patients in the insulin resistant group (median age 39.5, females 22 [52%]) and 12 patients in the insulin sensitive group (median age 38, females 5 [41.7%]). MPV were significantly higher in the NAFLD group in univariate analysis (p < 0.05). In the NAFLD patients, we did not find any relation between steatosis grade, lobular inflammation, hepatocellular ballooning, NAFLD activity score and fibrosis with MPV value. Among the insulin resistant and sensitive groups in the NAFLD patients MPV values were similar. The results of this study showed that MPV, an indicator of platelet activation, increased in biopsy proven NAFLD patients but MPV is not correlated with the increase of IR in NAFLD patients. MPV is not related with inflammation and steatosis degree, hepatocellular ballooning and fibrosis in NAFLD patients.

Neutrophil-lymphocyte ratio as a predictor of disease severity in ulcerative colitis.

BACKGROUND: Blood neutrophil-to-lymphocyte (N/L) ratio is an indicator of the overall inflammatory status of the body, and an alteration in N/L ratio may be found in ulcerative colitis (UC) patients. The aims of this study were to investigate the utility of N/L ratio as a simple and readily available predictor for clinical disease activity in UC. METHODS: Twenty-six patients and 28 healthy controls were enrolled in the study. The neutrophil and lymphocyte counts were recorded, and the N/L ratio was calculated from these parameters. The extent of disease classified according to the Montreal classification, clinical disease activity was evaluated using a modified Truelove-Witts severity index, and endoscopic disease activities were classified according to Schroder et al. RESULTS: The serum N/L ratios of active patients were significantly higher than those of inactive UC and controls (P < 0.001). The optimum N/L ratio cut-off point for active UC was 2.47. There was no significant difference between inflammation parameters, disease extension, and disease activity. CONCLUSION: Our results demonstrate that N/L ratio is higher in patients with active UC compared with controls and UC patients in remission and a cut-off value of 2.47 can be used to identify patients with active ulcerative colitis.

Assessment of heart rate recovery index in patients with familial Mediterranean fever.

Heart rate recovery after exercise is a function of vagal reactivation, and its impairment is an independent prognostic indicator for cardiovascular and all-cause mortality. The aim of our study was to evaluate heart rate recovery in patients with familial Mediterranean fever (FMF). The study population included 38 patients with FMF (14 men; mean age, 36.2 ± 12.1 years, and mean disease duration = 11.3 ± 6.5 years) and 35 healthy control subjects (12 men; mean age = 34.1 ± 9.9 years). Basal electrocardiography, echocardiography, and treadmill exercise testing were performed in all patients and control participants. The heart rate recovery index was defined as the reduction in the heart rate from the rate at peak exercise to the rate 1st-minute (HRR(1)), 2nd-minute (HRR(2)), 3rd-minute (HRR(3)), and 5th-minute (HRR(5)) after the cessation of exercise stress testing. There are significant differences in HRR(1) and HRR(2) indices between patients with FMF and control group (26.4 ± 7.4 vs. 35.0 ± 8.0; P = 0.001 and 47.3 ± 11.8 vs. 54.8 ± 10.3; P = 0.002, respectively). Similarly, HRR(3) and HRR(5) indices of the recovery period were lower in patients with FMF, when compared with indices in the control group (56.0 ± 14.0 vs. 63.7 ± 11.2; P = 0.01 and 64.1 ± 14.7 vs. 71.5 ± 12.7; P = 0.02, respectively). There were also remarkably positive correlations between the disease duration and HRR(1) (r = 0.31, P = 0.02), and HRR(2) (r = 0.26, P = 0.04). The heart rate recovery index impaired in patients with FMF compared to control subjects. When the prognostic significance of the heart rate recovery index is considered, a useful, simple, and noninvasive test may be clinically helpful in the recognition of high-risk patients with FMF.

Combined hepatocellular and cholangiocarcinoma associated with hepatolithiasis: report of a case.

Combined hepatocellular and cholangiocarcinoma is a rare form of primary hepatic carcinoma. We present a case of combined hepatocellular and cholangiocarcinoma coexisting with hepatolithiasis in a 53-year-old woman. The tumor was detected during surgery for the treatment of intrahepatic stones. A left hepatectomy was performed. A histologic examination of the specimen revealed typical features of combined hepatocellular and cholangiocarcinoma. Immunohistochemical analyses showed a biphenotypic antigen expression profile of the tumor cells. Risk factors commonly related to the development of this type of tumor include viral hepatitis and cirrhosis. This report describes an unusual etiologic factor that has not been reported previously.

Primary hepatic carcinosarcoma.

BACKGROUND: Primary hepatic carcinosarcoma is a rare malignant tumor containing an intimate mixture of carcinomatous and sarcomatous elements. Reports on risk factors, epidemiology, and pathogenesis of the tumor as well as the experience in its treatment are limited. METHOD: We present a case of primary carcinosarcoma of the liver in a 69-year-old man who complained of right hypochondrial pain and weight loss for two months. RESULTS: Magnetic resonance imaging revealed a 14 x 12 cm mass in segments 7-8 and 4 of the liver with vena hepatica invasion. An ultrasonography-guided biopsy showed osteoid tissue without osteoblastic rimming. Vascular structures accompanied the osteoid tissue. The patient underwent surgery after a diagnosis of hemangioma. Intraoperative frozen sections revealed a carcinosarcoma associated with an osteosarcoma and cholangiocellular carcinoma components. CONCLUSIONS: Preoperative diagnosis of this rare primary hepatic malignant tumor may be difficult by biopsy owing to intratumoral heterogeneity. Highly mature areas of the osteosarcomatous component may lead to misdiagnosis of metaplastic bone tissue. Clinicopathologic features of this rare entity are discussed.

Cognitive assessment of patients with nonalcoholic fatty liver disease.

OBJECTIVE: The aim of this study was to investigate cognitive performance for the first time in participants with nonalcoholic fatty liver disease (NAFLD) using the Montreal Cognitive Assessment (MoCA). PARTICIPANTS AND METHODS: In total, 70 participants with NAFLD and 73 age-matched and sex-matched healthy participants were enrolled in this prospective cross-sectional study. The diagnosis of NAFLD was made on the basis of abdominal ultrasonography findings. Anthropometric indices were calculated, and routine laboratory analyses were carried out for each participant. All participants provided sociodemographic data and completed the Beck Depression Inventory-II. Cognitive functions were evaluated using the Turkish version of the MoCA, with a cut-off score for mild cognitive impairment of less than 21 points. RESULTS: The MoCA scores were significantly lower in participants with NAFLD than in the healthy group (P<0.05). In addition, more NAFLD participants than healthy participants presented with deficits in the visuospatial (P<0.05) and executive function domains (P<0.05). In the multivariate model, education level [2.79 (1.12-6.96); P<0.05] and area of residence [5.68 (2.24-14.38); P<0.001] were associated independently with cognitive dysfunction in both the NAFLD and the healthy groups. The MoCA scores were correlated negatively with fibrosis 4 scores in NAFLD participants (r=-0.359; P<0.05). However, hepatosteatosis grade and the presence of metabolic syndrome were not correlated with MoCA scores in the NAFLD group (P>0.05). CONCLUSION: Our results show that NAFLD patients may have early or subtle cognitive dysfunction, including in the visuospatial and executive function domains, as indexed by scores on the MoCA test. Further targeted psychometric testing will be required to confirm the presence of cognitive impairment in this population.

Mixed connective tissue disease: a case with scleroderma renal crisis following abortion.

The term mixed connective tissue disease (MCTD) has been applied to a particular subset of patients with overlapping clinical features of systemic sclerosis, systemic lupus erythematosus, and polymyositis. Immune response to U1-ribonucleoprotein is the defining serological feature of MCTD. There are different organ and system involvements in MCTD including the heart, lung, kidney, muscle, joints, gastrointestinal, and hematologic involvements. Reports describing pregnancies in patients with MCTD are rare, and the results have been contradictory: a high risk of fetal loss and of disease exacerbation or no influence on fetus or mother. In MCTD, simultaneous pulmonary and renal involvement is very rare. In this paper, we report a case of MCTD with pulmonary involvement that developed scleroderma renal crisis after an abortion.

Functional gastrointestinal disorders in patients with familial Mediterranean fever.

AIM: Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease characterised by recurrent episodes of fever and polyserositis. To date, insufficient data regarding the prevalence of functional gastrointestinal disorders such as irritable bowel syndrome (IBS) and functional dyspepsia (FD) have been reported in patients with FMF. This study aimed to determine the prevalence of functional gastrointestinal disorders in patients with FMF. METHODS: This study included 122 patients with FMF and a control group of 122 healthy volunteers who were similar with respect to age and sex. Clinical data were collected and gastrointestinal complaints were evaluated according to the Rome III criteria. RESULTS: IBS was found in 18% of the patients and 10.7% of the controls (P > 0.05). Dyspepsia was reported in 37.7% of the patients and 35.2% of the controls. Constipation was significantly higher in the control group (15.6% vs. 7.4%, P = 0.045), whereas diarrhoea was reported significantly more often in patients with FMF (P = 0.001). CONCLUSIONS: IBS and dyspepsia were not increased in patients with FMF, whereas diarrhoea was more frequently reported.

Telbivudine attenuates gentamicin-induced kidney injury in rats.

Nephrotoxicity has been associated with nucleos(t)ide analogues other than telbivudine (LdT). This study investigated the potential effects of LdT and lamivudine (LAM) on renal function in an experimental rat model of gentamicin-induced acute nephrotoxicity. A total of 28 healthy Wistar albino rats were randomly divided into four experimental groups: negative control; positive control (PC); LdT; and LAM. Nephrotoxicity was induced by gentamicin in the LdT, LAM and PC groups. LdT and LAM were administered to two groups for 6 weeks starting on the ninth day. Blood samples were collected weekly and cystatin C levels were measured by ELISA. Animals were sacrificed on the 50th day and the kidneys were removed for histological examination. Serum cystatin C levels differed significantly between the LdT and LAM groups (P <0.007) and between the LdT and PC groups (P <0.001). Renal function was significantly improved in the LdT group at the start of antiviral treatment on Day 8 and at the end of treatment on Day 50 (P = 0.001 and 0.007). Glomerular injury, acute tubular necrosis and total injury score were significantly reduced in the LdT group relative to the PC and LAM groups upon histopathological examination. LdT was associated with significant improvements in renal function as measured by biochemical and histopathological methods. The acute kidney injury model data should be supported by clinical studies to suggest that LdT treatment may have advantages for patients with underlying chronic kidney disease receiving chronic hepatitis B treatment.