Ayse Kefeli

Steatosis Grade is the Most Important Risk Factor for Development of Endothelial Dysfunction in NAFLD

AbstractIt is shown that there are strong associations between nonalcoholic fatty liver disease (NAFLD) and endothelial dysfunction. The aim of our study was to reveal whether steatosis or fibrosis score is more important in the development of endothelial dysfunction in patients with NAFLD in a prospective manner.This cross-sectional study included 266 subjects. These subjects were divided into 2 groups depending on presence of hepatosteatosis sonographically. Patients with hepatosteatosis were also divided into 3 subgroups depending on degree of steatosis: grade 1, 2, and 3. In all patients, Aspartate aminotransferase-to-Platelet Ratio Index and Fibrosis-4 (FIB4) scores were calculated. In addition, flow-mediated dilatation (FMD) measurements were recorded.There was NAFLD in 176 (66.2%) of 266 patients included. There were no significant differences in sex and age distributions between patients with NAFLD (group 1) and controls without NAFLD (group 2) (P = 0.05). Mean Aspartate aminotransferase-to-Platelet Ratio Index score was significantly higher in group 1 compared with the control group (P = 0.001), whereas no significant difference was detected regarding FIB4 scores between groups (P = 0.4). Mean FMD value was found to be significantly lower in group 1 (P = 0.008). Patients with grade 3 hepatosteatosis had significantly lower FMD values than those with grade 1 steatosis and controls (P = 0.001). In univariate and multivariate analyses in group 1, no significant difference was detected regarding mean FMD measurements (P = 0.03). Again, no significant difference was detected in mean FMD measurement between FIB4 subgroups among patients with NAFLD and the whole study group (P = 0.09).The endothelial dysfunction is associated with steatosis in patients with NAFLD.

Should screening for colorectal neoplasm be recommended in patients at high risk for coronary heart disease: a cross-sectional study.

AbstractColorectal neoplasm (CRN) and coronary heart disease (CHD) share common risk factors. We aimed to assess the risk for CRN in patients who are at high risk for developing CHD determined by measurements, which are independent from the risk factors for CRN.This study was conducted on individuals who underwent total colonoscopic examination and were without history of CHD. Two-hundred thirty-five subjects (82 with CRN and 153 with normal colonoscopic findings) participated in the study. Colorectal carcinoma (CRC) was defined as the presence of adenocarcinoma. We measured carotid intima media thickness (CIMT), flow-mediated dilation (FMD), and calculated Framingham risk score (FRS) for all participants. An increased CIMT (≥1.0 mm), a decreased FMD (<10%), and a high FRS (>20%) were defined as high risks for developing CHD. The risk and the prevalence of CRN were analyzed in relation to the risk for developing CHD.The ratio of the patients with overall-CRN and CRC was significantly higher in individuals who are at high risk for developing CHD compared with individuals who are at low risk for developing CHD by each 3 risk estimation method (P < 0.05 for all). An increased CIMT, a decreased FMD, and a high FRS score were significantly associated with the high risk for the presence of CRC (odds ratio [OR]: 6.018, OR: 3.699, and OR: 4.120, respectively). An increased CIMT, a decreased FMD, and an intermediate FRS were significantly associated with the risk for the presence of overall-CRN (OR: 3.607, OR: 1.866 and OR: 2.889, respectively).The risk for CRN increases as the risk for developing CHD increases. It can be suggested that screening for CRN can be recommended for individuals who are at high risk for developing CHD.

Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastalarında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi

Objectives: To compare endothelial changes after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in clear corneal graft. Methods: In this study, fifty six eyes undergone DALK (DALK Group) and eighty two eyes undergone PK (PK Group) due to various reasons are included. After operation at 1st, 12th, 24th and 36th month central corneal endothelial cell density (CD) and variability coefficient(CV) value examined by specular microscopy of clear graft which have not had additional surgery, greft rejection or glaucoma during follow up period were compared. Results: Endothelial cell density in DALK group were 2426p587 cell/mms 2289p579 cell/mms, 2222p541 cell/mms, 2175p521 cell/mms, in PK group were 2595p589 cell/mms, 2064p583 cell/mms, 1759p510 cell/mms 1509p494 cell/mms at 1st, 12th, 24th and 36th month respectively. Decrease in CD values were 5.9% at 12th month, 7.5% at 24th month and 9.4% at 36th month comparing with first month in DALK group. Decrease in CD values were 18.4% at 12th month, 30.2% at 24th month and 40.3% at 36th month comparing with first month in PK group. Variability coefficient (CV) values in group DALK were 23.3p6.2, 24.2p6.4, 24.2p6.1 and 24.5p5.6 at 1st,12th, 24th and 36th month respectively. Variability coefficient (CV) values in group PK were 19.6p3.4, 23.2p5.4, 25.9p6.2 and 27.5p5.7 at 1st,12th, 24th, and 36th months respectively. Conclusion: More polymegatism and more decrease in endothelial cell density with time were assessed in grafts undergone PK compared with grafts undergone DALK.Objectives: The aim of this study was to determine the effect of fracture type and angular deterioration on the outcome of calcaneal fractures. Materials and methods: Thirty-two patients (23 males, 9 females; mean age 45 years) with calcaneus fractures retrospectively reviewed. Twenty-four fractures were closed, and eight fractures were open. Bohler and Gissane angles were measured using patient’s before, and after reduction X-ray films. According to the EssexLopresti classification there were three type I, 14 type II, and 15 type III fractures. Five patients were treated with casting (Group I), 19 patients with closed reduction K-wire application (Group II), and 8 patients with plate fixation. Final clinical outcome were assessed by Maryland Foot Score. Mean follow-up period was 109 weeks.Amac: Bu calismada kalsipotriol-betametazon dipropionat ile tedavi edilen plak psoriazisli olgularda doku duzeyinde hucresel immunitenin ve serumda sitokin duzeylerinin rolunun arastirilmasi amaclandi. Gerec ve yontem: Calismaya plak tip psoriazisli 20 olgu alindi. Hastalarin tedavi oncesi ve sonrasi psoriatik lezyonlari ile saglam deriden biyopsi ve periferik kan ornekleri alindi. Bulgular: Immunohistokimyasal incelemede, CD4+, CD8+ ve CD25+ T lenfositler, tedavi oncesi lezyonlu dokuda saglam doku ve tedavi sonrasi doku ile kiyaslandiginda anlamli bir sekilde yuksekti (sirasiyla, p0.05). Sonuc: Calismamizda lezyonlu deride CD4+ ve CD8+ hucre birikimi oldugunu ve CD4+ T lenfositlerin daha hâkim hucre grubu oldugu gosterildi. Uygulanan topikal tedavinin etkinligine paralel olarak lezyonlarda duzelme olmasi ve lezyonlu bolgelerde CD4+ ve CD8+ T hucrelerinde anlamli bir azalma meydana gelmesi, Th lenfositlerin hastaligin immunopatogenezinde onemli rolunun oldugu tezini desteklemektedir. Ancak, sonuclarimiz, hastaligin kronik ozelligi ile uyumlu olarak T hucrelerin dokuda yine de yeterince kaldigini ve topikal tedavinin hastaligin aktivasyonunu engelleyemedigini gostermektedir.

Serum 8 Hydroxydeoxyguanosine and Cytotoxin Associated Gene A as Markers for Helicobacter pylori Infection.

BACKGROUND Helicobacter pylori (H.pylori) is associated with chronic gastritis, peptic ulcers, gastric adenocarcinomas and mucosa associated tissue lymphomas. Cytotoxin associated gene A (CagA) is one of the virulence factors of H.pylori. It is hypothesized that reactive oxygen species (ROS) play roles in H.pylori associated disease especially in development of gastric adenocarcinoma. Individuals infected with H.pylori bearing CagA produce more ROS than others. 8-hydroxydeoxyguanosine (8OHdG) is an in vitro marker of DNA damage and oxidative stress. The aim of this study was to investigate the relationship between 8OHdG level, H.pylori infection and CagA and alterations of serum 8OHdG level after H.pylori eradication. MATERIALS AND METHODS Patients admitted with dyspeptic complaints and upper gastrointestinal endoscopy were assessed. H.pylori was determined from histopathology of specimens. Serum 8OHdG levels of three groups (H.pylori negative, H. pylori positive CagA negative and H.pylori positive CagA positive) were compared. Patients with H.pylori infection received eradication therapy. Serum 8OHdG levels pretreatment and posttreatment were also compared. RESULTS In total, 129 patients (M/F, 57/72) were enrolled in the study. Serum 8OHdG level of H.pylori negative, H. pylori positive CagA negative and H.pylori positive CagA positive groups were significantly different (5.77±1.35 ng/ml, 5.43±1.14 ng/ml and 7.57±1.25 ng/ml respectively, p=0.05). Furthermore, eradication therapy reduced serum 8OHdG level (6.10±1.54 ng/ml vs 5.55±1.23 ng/ml, p=0.05). CONCLUSIONS Individuals infected with H.pylori bearing CagA strains have the highest serum 8OHdG level and eradication therapy decreases the serum 8OHdG level. To the best of our knowledge this is the first study that evaluated the effect of CagA virulence factor on serum 8OHdG level and the effect of eradication therapy on serum 8OHdG levels together. Eradication of CagA bearing H.pylori may prevent gastric adenocarcinoma by decreasing ROS. 8OHdG level may thus be a good marker for prevention from gastric adenocarcinoma.

Relationship between Helicobacter pylori infection and celiac disease: a cross-sectional study and a brief review of the literature

Introduction Whether Helicobacter pylori triggers celiac disease (CD) or protects against CD is currently the subject of research. In the literature, there are epidemiologic studies that have reported conflicting results regarding the association between H. pylori and CD. Aim To compare the prevalence of CD autoantibody positivity and the levels of CD autoantibodies between H. pylori-positive and H. pylori-negative subjects. Material and methods This study was prospectively designed and included 240 dyspeptic patients who underwent upper gastrointestinal endoscopy with gastric and duodenal biopsies. The patients were divided into two groups according to presence of H. pylori infection. The serum levels of immunoglobulin (Ig) A, tissue transglutaminase antibodies (tTGA; IgA and IgG classes), and anti-endomysial antibodies (EMA; IgA and IgG classes) were measured for all participants by a blinded biochemistry expert. Results There were no significant differences in the serum levels of CD autoantibodies or IgA between the two groups. There were also no significant differences in the percentages of subjects with positive CD serologies or subjects with IgA deficiencies between the groups. Conclusions Helicobacter pylori remains one of the bacterial species that is most likely to trigger autoimmunity. However, studies have failed to reveal a relationship between H. pylori and CD; thus, additional basic work on the immunological aspects of the microbial-host interactions and longitudinal studies enrolling patients at very early stages of the disease may help us to address this issue.

Different treatment choice for first-line treatment of Helicobacter pylori in an area with a high antibiotic resistance.

We included 90 Hp-infected patients diagnosed histologically. The patients with chronic disease who previously received Hp eradication therapy and underwent gastric surgery were excluded. Patients were randomly divided into 2 groups. The therapy protocol, containing rabeprazole 2x20 mg (Bilim, Kocaeli, Turkey), amoxicillin 2x1 g (Glaxo Smith Kline, İstanbul, Turkey), metronidazole 3x500 mg (I.E. Ulagay, İstanbul, Turkey), and bismuth 2x300 mg (Astellas Pharma Europe B.V., İstanbul, Turkey), was given to the first study group for a period of 1 week and the second study group for a period of 2 weeks. At least 1.5 months after the end of therapy, participants provided a urea breath test (UBT). (Heliprobe analyzer, Wedholm Medical, Kibion, Sweden).

Eosinophilic colitis presenting with lower gastrointestinal bleeding: An uncommon entity with a rare presentation.

A 54-year-old woman was admitted with complaints of rectal bleeding and severe abdominal pain. She had no other comorbid diseases. Laboratory findings were as follows: serum hemoglobin, 9.7 g/dL; white cell count, 14.000/L with 10% eosinophils (eosinophil count, 1400/L); platelet count, 297.000/L; and other blood cell counts and biochemical tests were within normal limits. She neither had any allergic diseases nor did she use any antibiotics. No unusual findings were observed on physical examination except for diffuse abdominal tenderness. The colonoscopic features were nonspecific, including erythema and oedema. Multiple biopsies were obtained from each segment of the colon. On histopathological examination, the depth of eosinophilic infiltration through the colonic layers varied (>20 eosinophils/high-powered file) (Figure 1). Treatment with 40-mg/d prednisone was initiated. Two weeks after the treatment, rectal bleeding and abdominal pain resolved. The patient was discharged from the hospital, and she had no symptoms at the 2-month follow-up.

Comparison of three different regimens against Helicobacter pylori as a first-line treatment: A randomized clinical trial

Treatments with bismuth-containing quadruple therapy (QT), sequential therapy (ST), or concomitant therapy (CT) have been proposed as empirical first-line regimens for Helicobacter pylori. We compared the efficacy and tolerability of 10 days bismuth-containing quadruple QT, 10 days ST, and 10 days CT with as first-line treatments for H. pylori in a randomized crossover study. The subjects were randomly divided into three groups. The first 130 patients were treated with rabeprazole, bismuth potassium citrate, metronidazole, and tetracycline for 10 days. The second 130 patients in the sequential group were treated with rabeprazole and amoxicillin for 5 days, and then rabeprazole, clarithromycin, and metronidazole for an additional 5 days. The last 130 patients in the concomitant group were treated with rabeprazole, amoxicillin, clarithromycin, and metronidazole for 10 days. H. pylori eradication was confirmed by urea breath test at 6 weeks. The primary outcome was eradication rates of first-line treatment by intention to treat and per protocol (PP) analyzes. There was no difference between the average ages and the male/female ratio of the groups. The PP analysis was performed on 121, 119, and 118 patients in the QT, ST, and CT groups, respectively. In the PP analysis, the successful eradication 94.2% (114/121), 95.0% (113/119), and 95.8% (113/118) the QT, ST, and CT groups, respectively. There was no significant difference among the three groups (p = 0.86). 10 days QT, ST, and CT are highly effective as empirical first-line therapies for H. pylori in the region with high clarithromycin resistance.

The Relationship between Helicobacter pylori and Beta-2 Microglobulin in Humans

H. pylori is related to various gastrointestinal diseases. β 2 Microglobulin (β 2M) is an intrinsic element of major histocompatibility complex (MHC I). Serum β 2M level may increase in inflammatory states. The aim of current study is to evaluate the relationship between β 2M and H. pylori bearing CagA strains. Methods. H. pylori status was determined by histopathology of samples taken from stomach. CagA status and β 2M level were measured from blood samples of patients. Eradication therapy was administered to the patients with H. pylori infection. β 2 Microglobulin levels were measured before and after treatment. Results. 35 (29.2%) H. pylori(−) patients and 85 (70.8%) H. pylori (+) patients were included in the study. There were 52 (43.3%) patients with CagA negative and 33 (27.5%) patients with CagA positive H. pylori infection. The mean serum β 2M level was 1.83 mg/L in H. pylori (−) group, 1.76 mg/L in H. pylori (+) CagA (−) group, and 1.93 mg/L in H. pylori and CagA (+) group (P > 0.05). Serum β 2M levels (1.82 versus 1.64 mg/L P < 0.05) were decreased after eradication. Conclusion. H. pylori and CagA status did not affect β 2M level. Relationship between low grade systematic inflammation and H. pylori should be investigated to find out new predictors for diseases associated with inflammation.

Diagnosis of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the commonest cancers worldwide, particularly in the developing countries HCC occurs predominantly in patients with underlying chronic liver disease and cirrhosis, especially due to chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infection. Tumors progress with local expansion, intrahepatic spread, and distant metastases, and the life expectancy of patients with HCC is poor, with a mean survival of 6–20 months. Thus, developing effective and efficient care for patients with HCC must become a significant subject. Removal of HCC by surgical, transplantation or resection of the tumors, means offers the best chance for possible cure. Criteria for such intervention have been refined over the last decade to optimize long-term survival in selected patients with Milan criteria. Not many patients are candidate given the advanced stage of their cancer at diagnosis or degree of liver disease. The other main limiting factor is inadequate organ storage. Unfortunately, many patients die when they are waiting a donor organ. Local ablative therapies may be effective for time saving as a bridge therapy, and may provide palliation, in these patients. Diagnostic tools commonly used include radiographic imaging, and rarely serum markers and liver biopsy. A suspicious lesion on the ultrasound generally requires additional imaging studies to confirm the diagnosis of the tumor. Histologic confirmation is not required in a patient at increased risk for hepatocellular carcinoma whose lesion(s) fulfill criteria for hepatocellular carcinoma which are presence of typical features, including hypervascularity during arterial phase followed by decreased enhancement (washout) during portal venous phases on computerized tomography or has increased T2 signal intensity on magnetic resonance imaging.