den Gür

DOES ERADICATION OF HELICOBACTER PYLORI INFECTION HELP NORMALIZE SERUM LIPID AND CRP LEVELS

It is still unclear whether Helicobacter pylori infection is associated with risk factors for coronary artery disease. The aim of this study was to determine whether eradication of H. pylori infection affects serum lipid levels and C-reactive protein (CRP) levels. Seventy-eight patients who had H. pylori antigen positivity in their stools were enrolled. Clarithromycin, 1 g/day, amoxicillin, 2 g/day, and omeprazole, 40 mg/day, were given for 14 days. Serum total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG), and CRP were measured at baseline and 8 weeks after therapy. According to H. pylori stool antigen study after 8 weeks, individuals in whom H. pylori was eradicated were recruited as group A and those in whom H. pylori was not eradicated formed group B. Group A comprised 57 patients, and group B 21 patients. Patients in group A comprised 32 women and 25 men and their ages ranged from 35 to 59 years. Patients in group B included 13 women and 8 men, aged 32–61 years. No significant difference in LDL, TC, or TG serum levels were found between group A and group B. Although CRP and HDL serum levels were found to be the same before and after treatment in group B, CRP levels were found to decrease and HDL levels to increase significantly in group A (P < 0.05). We conclude that H. pylori infection may affect lipid metabolism in a way that could increase the risk of atherosclerosis. Thus H. pylori infection is an independent risk factor for coronary artery disease.

THE RELATIONSHIP OF ABO BLOOD GROUP, AGE, GENDER, SMOKING, AND HELICOBACTER PYLORI INFECTION

It is well known that blood group antigens are related to the development of peptic ulcer and gastric carcinoma. This study sought to determine the relationship between H. pylori and ABO/Rhesus blood groups, age, gender, and smoking. Patients (335 women and 205 men; mean age, 51.68 ± 15.0 years; range, 18–85 years) who attended our outpatient clinic were enrolled in the study. All patients were randomly selected in each age group. Demographic data recorded for each patient included age, gender, and tobacco use. Blood samples were tested for H. pylori antibodies, and ABO/Rhesus blood group antigen typing was performed. Serum antibodies were tested against H. pylori infection. Prevalences of all blood groups were O (29.2%), A (38.2%), B (17.8%), and AB (14.8%). As expected from previous studies, we found that seropositivity for H. pylori increased with age. H. pylori Ig G antibody positivity was detected in 185 of 335 women (60.6%), compared with 88 of 205 men (42.9%), a statistically significant difference (P < 0.05). H. pylori Ig G antibody positivity was detected in 206 of 379 nonsmokers (54.3%) compared with 67 of 161 smokers (41.6%), a statistically significant difference (P < 0.05). Patients in blood groups A and O were more prone to H. pylori infection than were patients in other blood groups (P < 0.05), and patients in the AB blood group were less prone to H. pylori infection compared with patients in other blood groups (P < 0.05). The results of this study demonstrate that H. pylori infection can be related to ABO blood group, age, gender, and smoking.

Interferon therapy in haemodialysis patients with acute hepatitis C virus infection and factors that predict response to treatment

In view of the high rate of chronicity of acute hepatitis C and the low efficacy of interferon (IFN) treatment in advanced liver disease, it may be beneficial to treat patients during the acute phase of the infection. Here we assessed the effects of variable‐dose IFNα‐2b treatment in haemodialysis patients with acute hepatitis C virus (HCV) infection, and identified factors that may predict response to this therapy. The study population included 67 patients, but 14 were excluded due to side‐effects or because they were lost to follow‐up. Seventeen patients who received no specific treatment were used as controls (Group 1). Sixteen and 20 patients received low‐(3 MU) and high‐dose (6–10 MU) IFNα‐2b three times weekly for 3 months (Groups 2 and 3, respectively). Virological end‐of‐treatment response (ETR) was observed in 1 (5.6%), 13 (56.5%), and 17 (65.4%) patients in Groups 1, 2, and 3, respectively, and virological sustained response (SR) was observed in 1 (5.6%), 6 (26.1%), and 13 (50%) patients in the three groups. The rates of virological ETR and SR in the treated groups were significantly higher than those of the control group (P < 0.01 for all comparisons). In multivariate logistic regression analysis, single stranded confirmational polymorphysm (SSCP) band number (P=0.02) was the only factor that was significantly associated with virological SR. In conclusion, IFN‐α treatment initiated during the acute phase of HCV infection is associated with a higher rate of virological ETR and SR. This study suggested that quasispecies heterogeneity has predictive value with regard to virological SR.

DISTRIBUTION OF HCV GENOTYPES IN PATIENTS WITH END-STAGE RENAL DISEASE ACCORDING TO TYPE OF DIALYSIS TREATMENT

The objective of this study was to investigate the effects of types of dialysis treatments on hepatitis C virus infection and the epidemiologic properties of hepatitis C virus (HCV) infection at three Baskent University hospitals, in Ankara, Adana, and Izmir, Turkey, in 655, 326, and 118 patients with end-stage renal disease, respectively. One hundred thirty patients with HCV viremia among 271 patients with end-stage renal disease seropositive for HCV were included in this cross-sectional study. HCV RNA-positive patients were classified according to the renal replacement therapies (hemodialysis or continuous ambulatory peritoneal dialysis), and viral load, transaminase levels, and distribution of genotypes were compared between these subgroups. In the continuous ambulatory peritoneal dialysis group, 26 of 165 patients (16%) were serum anti-HCV positive, and 11 of 26 patients (42%) were serum HCV RNA positive. Twenty-six percent of the patients undergoing hemodialysis were anti-HCV positive, and 49% were HCV RNA positive. The prevalence of genotype 1b was 68% and 73% for patients in the continuous ambulatory peritoneal dialysis and hemodialysis groups, respectively. No significant differences were found between the genotype 1b and the non-1b groups or between different dialysis types with regard to age and sex and serum aspartate transaminase, alanine aminotransferase, and HCV RNA levels. We conclude that HCV seropositivity may differ between different types of dialysis treatments, although viral load and genotypes may be similar in persons with end-stage renal disease and those without.

Is Hepatitis C virus positivity a contributing factor to occult Hepatitis B virus infection in hemodialysis patients

Hepatitis B (HBV) infections continue to occur in adult hemodialysis units. Occult HBV infection (serum hepatitis B surface antigen [HBsAg] negative but HBV DNA positive) may be a contributing factor in these patients. This study was designed to (1) investigate the prevalence of occult HBV infection in hemodialysis patients and (2) compare the prevalence of occult HBV infection among hepatitis C (HCV)-positive and HCV-negative hemodialysis patients. The study included 138 patients on chronic hemodialysis. Eighty-four patients were HCV positive and 54 were HCV negative. HBV DNA testing was performed by polymerase chain reaction. We also recorded general characteristics of the patients, duration of hemodialysis, and serum alanine aminotransferase and aspartate aminotransferase levels. Twenty-one (15.2%) of the 138 hemodialysis patients were HBV DNA positive. Nine (16.6%) of the 54 anti-HCV antibody negative hemodialysis patients were HBV DNA positive. Twelve (14.2%) of the 84 anti-HCV antibody positive patients were HBV DNA positive. The prevalence in anti-HCV Ab positive and negative hemodialysis patients were same (P > .05). Hemodialysis duration, demographic features, and biochemical parameters were not significantly different in patients with and without occult HBV infection in both HCV-positive and -negative hemodialysis patients (P > .05). HCV positivity is not a contributing factor to occult HBV infection in hemodialysis patients. None of the parameters tested help to distinguish patients with occult HBV infection from those who are HBV DNA negative.

Gastroesophageal reflux disease in chronic renal failure patients with upper GI symptoms: multivariate analysis of pathogenetic factors.

OBJECTIVE:The association between gastroesophageal reflux disease and end-stage renal disease remains unclear. We aimed to assess the prevalence of gastroesophageal reflux disease and also to identify possible pathogenetic factors in the development of reflux in symptomatic end-stage renal disease patients.METHODS:The study involved 42 end-stage renal disease patients with upper GI symptoms (group I) and 46 age- and sex-matched controls who did not have renal disease but had the same symptoms (group II). Endoscopy, endoscopic biopsies, and 24-h esophageal pH studies were used to diagnose gastroesophageal reflux disease. Subjects were also investigated for Helicobacter pylori gastritis and GI amyloidosis.RESULTS:The prevalences of gastroesophageal reflux disease in the two groups were similar (81% vs 84.8%, p = 0.423). The prevalence of H. pylori infection was significantly lower in group I than in group II (38.1% vs 67.4%, p = 0.01). There were 11 cases of GI amyloidosis in group I. Multivariate logistic regression analysis in group I showed that GI amyloidosis (OR = 7.28, 95% CI = 1.13–46.93), chronic ambulatory peritoneal dialysis treatment (OR = 5.54, 95% CI = 1.01–30.43), and absence of H. pylori infection (OR = 3.75, 95% CI = 1.01–13.9) were significantly associated with reflux esophagitis.CONCLUSIONS:Upper GI symptoms are important in predicting gastroesophageal reflux disease in end-stage renal disease patients. Chronic ambulatory peritoneal dialysis, GI amyloidosis, and absence of H. pylori infection seem to be risk factors for the development of gastroesophageal reflux disease in end-stage renal disease patients.

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.

Helicobacter pylori seroprevalence in patients with coronary artery disease.

Recent studies have suggested that chronic infections such as Helicobacter pylori may be a risk factor for coronary artery disease (CAD). The aim of thIS study was to investigate the seroprevalence of H. pylori in patients with CAD. We enrolled 151 patients with CAD (93 men and 58 women, aged 48.1 ± 17.3 years [mean ± SD]) and 149 control subjects matched by age and sex (90 men and 59 women, aged 51.4 ± 13.9 years). An enzyme-linked immunosorbent assay immunoglobulin (Ig) G test for H. pylori diagnosis was performed on all enrolled subjects (CAD patients and controls). Ninety-one of 151 patients with CAD (60.2%) and 86 of the 149 subjects in the control group (57.7%) were H. pylori positive (P > 0.05). H. pylori infection rates were similar in patients with CAD and control groups. The main conclusion of this study is that H. pylori infection is not a risk factor for developing CAD. Further studies should be undertaken to confirm our results.

Lamivudine in renal transplant candidates with chronic hepatitis B infection

CHRONIC hepatitis B virus (HBV) is one of the most common and serious infectious diseases throughout the world, currently affecting 400 million persons globally. Although the incidence of chronic HBV infection among patients on hemodialysis has declined, the illness remains an important problem in renal transplant recipients. HBV infection is a frequent and major risk factor for acute and chronic liver disease, causing increased morbidity and mortality both before and after transplantation. Treatment of HBV in kidney recipients is difficult but probably necessary to reduce morbidity and mortality. Interferon has been associated with an increased incidence of rejection and limited success. Recent reports have noted promising results with the antiviral agent lamivudine, a pyrimidine nucleoside analogue. Lamivudine therapy significantly decreases serum HBV-DNA levels and improves the histologic findings, reduces serum aminotransferase levels, and slows progression to cirrhosis in patients with chronic HBV. In renal transplant patients with recurrent hepatitis B, it stabilizes liver enzymes and decreases HBV replication. Our aim in this study was to assess the efficacy and safety of lamivudine in renal transplant candidates with replicative HBV.

Efficacy and safety of sodium phosphate for colon cleansing in type 2 diabetes mellitus.

Objectives: The need for colonoscopy is common among diabetic patients. However, there are no standards per se for bowel preparation in patients with type 2 diabetes. In this study, we evaluated the efficacy, safety, and tolerability of sodium phosphate (NaP), and the quality of bowel cleansing in relation to glycemic control and late complications. Methods: A total of 50 consecutive type 2 diabetic patients and 50 non-diabetic patients underwent bowel preparation by NaP. Fasting blood glucose, sodium (Na), potassium (K), calcium (Ca), phosphorus (P), magnesium, and creatinine levels were measured on the procedure day. Patients were given a tolerability questionnaire regarding symptoms. Results: With regard to bowel preparation quality, optimal bowel cleansing was achieved in 35 (70%) diabetic and 47 (94%) non-diabetic patients (P = 0.002). Abdominal pain or discomfort during and an hour after the procedure was similar in both groups (P >0.05). The changes in Na, K, Ca, P and creatinine levels after NaP use did not reach statistical significance between the groups (P >0.05). In the diabetic patients, there was a significant correlation between the quality of bowel cleansing and mean age, duration of diabetes mellitus, level of hemoglobin A1c (HbA1c), fasting blood glucose level, and diabetic late complications (P <0.05). Conclusion: These data suggest that NaP is safe and tolerable in diabetic patients, but the quality of bowel cleansing is worse than in non-diabetic patients. These observations support the concept that the quality of bowel cleansing in those with type 2 diabetes is closely related to the duration and regulation of the disease and the presence of late complications.