Birol Özer

Age as a predictor of hyperphosphatemia after oral phosphosoda administration for colon preparation

Background and Aim:  It has been reported that oral phosphosoda (OPS), commonly used in bowel cleansing, may cause complications such as hyperphosphatemia and hypocalcemia. This has been observed in patients with normal kidney function and in those with renal insufficiency. Few controlled studies have been performed with respect to age on healthy subjects after OPS administration.

Impact of Helicobacter pylori on the Development of Vitamin B12 Deficiency in the Absence of Gastric Atrophy

Background. Cobalamin (vitamin B12) deficiency is associated with Helicobacter pylori infection. This study examined how serum vitamin B12 levels relate to gastric mucosa H. pylori density and histology, and to hematological findings in patients with minimal or no gastric atrophy. A second aim was to confirm that H. pylori eradication therapy increases serum B12.

Halitosis in patients with Helicobacter pylori-positive non-ulcer dyspepsia: an indication for eradication therapy?

BACKGROUND: The aims of this study were to investigate the frequency of halitosis before and after eradication therapy and to determine whether halitosis is a valid indication for eradication therapy in patients with Helicobacter pylori (H. pylori)-positive non-ulcer dyspepsia. METHODS: Dyspepsia, related symptoms, and halitosis were investigated by way of a questionnaire. Only H. pylori-positive patients who showed no organic lesions on endoscopic examination and no atrophy histopathologically were included. A total of 148 patients fulfilled the above criteria and completed the study. Four weeks after the end of eradication treatment, the symptoms were re-evaluated and repeat endoscopy was done to check for H. pylori in the gastric mucosa. Results: H. pylori eradication was successful in 109 patients (73.6%). Prior to treatment, bloating was the most frequent symptom (74.3%), followed by diurnal pain (62.2%) and halitosis (61.5%). The most successfully resolved symptoms in the group as a whole, regardless of eradication status, were halitosis, diurnal pain, and hunger-like pain, respectively. In the patients with confirmed H. pylori eradication, the most successfully resolved symptoms were halitosis and hunger-like pain, respectively. CONCLUSION: Halitosis is a frequent, but treatable, symptom of H. pylori-positive non-ulcer dyspepsia and may be a valid indication for eradication therapy.

Agenesis of the dorsal pancreas in a patient with recurrent acute pancreatitis: case report and review

CASE REPORTA 33-year-old Turkish woman presented with severeepigastric abdominal pain, nausea, and vomiting. Anepisode of acute pancreatitis had occurred 1 year earlier.There also was a history of frequent urinary-tract in-fections over the previous 15 years; a diagnosis ofvesicoureteral reflux was made 3 years earlier. Peritonealdialysis on an ambulatory basis was begun 2 years beforepresentation because of chronic renal failure secondary tochronic pyelonephritis. Noninsulin-dependent diabetesmellitus was diagnosed 1 year before presentation. Upperabdominal tenderness was elicited on examination atadmission. Laboratory test results at admission were thefollowing: serum amylase, 1512 IU/L (normal: 30-110 IU/L); lipase, 1563 IU/L (23-300 IU/L); calcium, 8.9 mg/dL(8.40-10.0 mg/dL); triglycerides, 430 mg/dL (55-175mg/dL); aspartate aminotransferase, 26 IU/L (12-50 IU/L);alanine aminotransferase, 12 IU/L (10-70); gammaglutamyl transferase, 154 IU/L (7-40 IU/L); alkalinephosphatase, 188 IU/L (25-100 IU/L); total bilirubin,0.4 mg/dL (0.4-1.35 mg/dL); direct bilirubin, 0.2 mg/dL(0.10-0.50mg/dL);C-reactiveprotein,96mg/dL(0-6mg/dL);and blood glucose, 333 mg/dL (70-110 mg/dL). Analysisof peritoneal dialysis fluid revealed 10 white blood cellsper high-power field.On transabdominal US, the head of the pancreasappeared as a hypoechoic glandular structure in thenormal location, but the body and the tail were not visible.Afewmillimeter-sizedpolypswerenotedinthegallbladderwall;freeintraperitonealfluidwasattributedtoperitonealdialysis. CT with and without contrast revealed onlya prominent head of the pancreas (Fig. 1). At ERCP, theorifice of the major duodenal papilla was in the normalposition, but careful examination revealed no minorpapilla.Injectionofcontrastmaterialintothemajorpapillademonstrated a short, branching duct that was notconsistent with a normal main pancreatic duct (Fig. 2).MRCP also was obtained in an attempt to visualize thepancreas and bile ducts in greater detail. The head of thepancreas appeared normal on cross-sections, but no otherpancreatic tissue was evident. The scan also revealeda dilated common bile duct and a short main pancreaticductofnormaldiameterintheheadoftheglandbutnoductin the body and the tail (Fig. 3). Triphasic dynamic CTrevealed only the head portion of the pancreas. Based onthecollectiveimagingstudies,adiagnosisofagenesisofthedorsal pancreas was made.With conservative treatment, the clinical status of thepatient and the laboratory parameters of pancreaticinflammation improved rapidly and her overall statushad returned to baseline after 3 days of hospitalization.Blood pressure, fundic examination, and neurologic func-tion remained normal throughout follow-up.

Serum leptin level can be a negative marker of hepatocyte damage in nonalcoholic fatty liver

Background. The aim of this study was to determine whether leptin and insulin resistance (IR) showed differences between steatotic patients with and without elevated serum transaminases. Methods. The study included 32 patients with fatty liver and high serum transaminase level (group I), 31 patients with fatty liver and normal serum transaminase level (group II), and 8 nonobese and nonsteatotic controls. The presence of steatosis was demonstrated by ultrasonography. Due to the effect of body mass index (BMI) on leptin levels, groups I and II were divided to form four subgroups for analysis (group IA, BMI ≤30; group IB, BMI >30; group IIA, BMI ≤30; and group IIB, BMI >30. Results. The serum leptin levels in group IIB were significantly higher than the levels in group IB (P = 0.017). Serum leptin was also higher in group IIA than in group IA, but this difference was not statistically significant (P = 0.097). Logistic regression analysis revealed a significant negative correlation between serum leptin level and the presence of a high transaminase level (odds ratio, 0.97; 95% confidence interval, 0.95–0.99). The levels of IR in the four patient groups were comparable, but the controls had significantly lower IR levels than group IIA. Conclusions. Elevated serum leptin seems to be a feature of steatotic patients with normal transaminase levels, and the level of serum leptin seems to decrease as the hepatocyte injury develops. IR is a common feature of fatty liver disease, irrespective of the presence of hepatocellular necrosis.

Methylenetetrahydrofolate Reductase C677T Mutation and Nonalcoholic Fatty Liver Disease

A mutation in the methylenetetrahydrofolate reductase (MTHFR) gene is known as one of the causes of hyperhomocyteinemia. The oxidation products of homocysteine can initiate lipid peroxidation, which has a central role in the pathogenesis of nonalcoholic fatty liver disease (NAFLD). We aimed to assess the possible role of the MTHFR C677T mutation in the progression of simple steatosis to an advanced form of NAFLD. Thirty-four patients with NAFLD diagnosed by histologic analysis and 282 healthy controls were included in the study. The discrimination of nonalcoholic steatohepatitis (NASH) from another NAFLD was made by NAFLD activity score (NAS), and a NAS≥5 was considered NASH. Patients with either NASH or nonalcoholic fatty liver (NAFL) and controls were evaluated for frequency of the MTHFR C677T mutation. The frequency of the MTHFR C677T mutation was 53.5% (CT, 44.7%; TT, 8.9%) in controls and 41.5% (CT, 37.7%; TT, 3.8%) in patients (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.34–1.12). There was no statistical difference in the frequency of this genotype between patients with NAFL and those with NASH (36% [CT, 28%; TT, 8%] vs 46.4% [CT, 46.4; TT, 0%]; OR, 0.65; 95% CI, 0.22–1.96). According to this study, the MTHFR C677T mutation does not seem to be a risk factor for the progression of NAFL to NASH.

Effect of Anti-HCV positivity on markers of malnutrition and inflammation in hemodialysis patients

Aim. To investigate the influence of anti-HCV positivity on markers of malnutrition and inflammation in hemodialysis (HD) patients. Methods. Stable HD patients who had persistently negative or positive HCV antibodies (at least three) and without elevated aminotransferase levels in routine periodical tests with a duration of more than 12 months were included. Patients with conditions known to be associated with acute-phase responses or clinically active (HCV RNA positive) or advanced liver failure were excluded. Thirty-six anti-HCV-positive patients (22 male, 14 female, mean age 47.3 ± 14.5 years, mean time on HD 72.0 ± 39.0 months), were compared with 36 anti-HCV negative patients with similar age and HD duration (25 male, 11 female, mean age 49.2 ± 13.8 years, mean time on HD 59.7 ± 27.1 months). Malnutrition-Inflammation Score (MIS), a fully quantitative score adopted from subjective global assessment, was recorded for each patient (ranges from 0 to 30). High sensitivity serum C-reactive protein (hs-CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR), and hematocrit-corrected ESR were compared as indices of the degree of inflammation beyond anthropometric evaluation and routine laboratory tests. Results. There was no significant difference in MIS of two groups (6.1 ± 3.2 vs. 5.6 ± 3.2, p> 0.05). In the comparison of components of MIS, co-morbidity including number of years on dialysis was higher in anti-HCV-positive patients (p = 0.04). Anthropometric values and serum levels of hs-CRP, IL-6, ESR, and hematocrit-corrected ESR of two groups were not statistically different from each other (p> 0.05 for all). ALT (p = 0.0001) and AST (p = 0.001) levels were higher in anti-HCV-positive patients. Conclusion. Anti-HCV positivity without active infection seems to have no additional negative effect on malnutrition and inflammation in maintenance HD patients.

Ultrasonographic evaluation of gallbladder functions in patients with irritable bowel syndrome

Background:  The aim of the present study was to evaluate gallbladder function in irritable bowel syndrome (IBS) patients.

The impact of B12 treatment on gastric emptying time in patients with Helicobacter pylori infection

GOALS The role that vitamin B12 deficiency plays in upper gastrointestinal motor dysfunction is not clear. The aim of this study was to determine whether B12 replacement therapy improves prolonged gastric emptying time in dyspeptic patients with Helicobacter pylori infection. MATERIALS AND METHODS The study included 34 H. pylori-positive patients who had low serum levels of B12 but had no other factors associated with altered gastric motility. Each patient underwent a radionuclide gastric emptying study before and after 3 months of B12 replacement therapy. Dyspepsia scores were calculated pretherapy and posttherapy using a semiquantitative scale. A vitamin B12 preparation (1000 microg/d) was given intramuscularly for the first 10 days and then orally for 80 days. H. pylori eradication therapy was delayed for 3 months until the posttreatment radionuclide study was completed. RESULTS The mean gastric emptying time before B12 treatment was significantly longer than that after treatment (230 +/- 190 minutes vs. 98 +/- 29 minutes, respectively; P < 0.0001). The mean dyspepsia score was also significantly improved by treatment (5.4 +/- 1.0 vs. 1.2 +/- 1.0, respectively; P < 0.0001). CONCLUSION Vitamin B12 deficiency appears to play an important role in the development of gastric dysmotility and its clinical consequences. Replacement therapy will improve gastric emptying in some patients with dyspepsia.

Turkish doctors’ cohort: healthy despite low screening

ABSTRACT Objectives: We aimed to determine the prevalence of chronic diseases and unhealthy lifestyle behaviors of Turkish doctors as compared with the general population and the frequency of compliance with preventive clinical practices among doctors. Methods: This was an observational, prospective cohort study that enrolled graduates between 1975 and 2004 from six medical schools in Turkey. Data on demographics, disease conditions, and unhealthy lifestyle behaviors were gathered. Preventive care practices were analyzed with regards to age and gender. Results: A total of 7228 doctors participated in the study. Comparison with the national data revealed higher hyperlipidemia and coronary artery disease rates. While 54.5% of the doctors had a doctor visit in the last 12 months, only 31.5% of those over 40 years of age reported a recent blood pressure measurement. Colon cancer screening rate over 50 years of age with any of the acceptable methods was only 3%. One-fourth of the female doctors over 40 years of age underwent mammography within the last two years. Only 7.1% of the doctors over 65 years of age and 10% of the doctors having an indication for a chronic disease had a pneumococcal vaccine, while nearly one-fifth had no hepatitis B vaccine. Conclusion: In this cohort of mainly middle-aged Turkish doctors, the age-standardized rates of chronic diseases were lower than the rates in the general population except for the rates of hyperlipidemia and coronary artery disease. However, doctors did show quite low rates of receipt of screening practices. These results might provoke questions about how to use Turkish doctors’ health behaviors to further improve doctors’ and, relatedly, patients’ health.