Kadri Atay

Role of oxidative stress and insulin resistance in disease severity of non-alcoholic fatty liver disease.

BACKGROUND/AIMS Oxidative stress and insulin resistance (IR) are major contributors in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). The purpose of this study was to find the relation between oxidative stress parameters and histopathological findings in NAFLD patients with and without insulin resistance (IR). MATERIALS AND METHODS Thirty-two patients with no alcohol intake and biopsy-proven diagnosis of NAFLD were studied (M/F: 17/15; mean age 46.5±11.4 years). Twenty-one NAFLD patients with IR were compared with 11 patients without IR. The fasting insulin level was measured, and the insulin resistance index was calculated using the homeostasis model assessment (HOMA) method. Malondialdehyde (MDA) and superoxide dismutase (SOD) activities were measured in tissue and serum specimens. Glutathione (GH) was measured in tissue homogenates. Nitric oxide (NO), vitamin E and C levels were measured in serum. RESULTS Patients with IR had significantly higher tissue MDA levels (p=0.001) and significantly decreased tissue SOD and GH levels (p=0.001 and 0.002, respectively) than those without IR. The steatosis grade, necroinflammatory grade and stage were significantly higher in patients with IR (p=0.035, 0.003 and 0.001, respectively). HOMA IR significantly correlated with the necroinflammatory grade, stage, tissue MDA, SOD and GH (p=0.013, 0.001, 0.008, 0.001 and 0.001, respectively). Serum MDA (β=1.88, p=0.002), serum SOD (β=0.57, p=0.006), tissue MDA (β=0.22, p=0.006), tissue SOD (β=1.48, p=0.071) and stage (β=2.81, p=0.003) were independently associated with increased HOMA IR. Increased MDA [OR: 1.51; 95% CI: (1.03-2.22); p=0.034] was a risk factor for non-alcoholic steatohepatitis (NASH), and increased SOD activity had a preventive effect against NASH [OR: 0.008; 95% CI: (0.001-0.98); p=0.04]. CONCLUSION This study shows that insulin resistance in NAFLD correlates with enhanced oxidative stress. Histopathological disease severity significantly correlated with oxidative stress parameters. These data show that NAFLD patients with IR may have increased risk for disease progression.

Cystatin C is better than albuminuria as a predictor of pulse wave velocity in hypertensive patients

Abstract Introduction: Arterial stiffness is important in the evaluation of the cardiovascular risk in both general population and hypertensive patients. In this study, we aimed to investigate the associations of both serum cystatin C levels and albuminuria with arterial stiffness in healthy controls and hypertensive patients. Patients and methods: Seventy-six healthy controls (male/female = 44/32) and 76 hypertensive patients (male/female = 43/33) were enrolled. Arterial stiffness parameters such as augmentation index (AIx) and pulse wave velocity (PWV) were non-invasively measured with the Arteriograph (Tensiomed Ltd., Budapest, Hungary). Results: AIx (31.92 ± 14.31 vs. 27.95 ± 11.03, p = 0.03) and PWV (9.84 ± 1.62 vs. 8.87 ± 2.04, p < 0.001) were significantly higher in hypertensive patients compared to healthy controls. Patients with microalbuminuria had significantly higher AIx (43.47 ± 9.91 vs. 30.37 ± 14.13, p = 0.002) and higher serum cystatin C levels [0.76 (0.67–0.95) vs. 0.68 (0.62–0.78) mg/L, p = 0.03]. In the hypertensive group, AIx was significantly correlated with PWV (r = 0.519, p < 0.001), glomerular filtration rate (cystatin C) (r = –0.438, p = 0.003), mean arterial pressure (MAP) (r = 0.288, p = 0.015) and urinary albumin–creatinine ratio (ACR) (r = 0.386, p = 0.004). PWV was associated with serum cystatin C (r = 0.442, p = 0.003) and MAP (r = 0.377, p = 0.001). In the linear regression analysis (model r = 0.577, p = 0.006) for the prediction of PWV in hypertensive patients, MAP, urinary ACR, age and serum cystatin C levels were included as independent variables. Cystatin C was found to be the significant determinant of PWV in hypertensive patients. Conclusion: Multivariate analysis revealed that serum cystatin C but not albuminuria was significantly associated with PWV in hypertensive patients. Serum cystatin C may be better than albuminuria as a predictor of arterial stiffness in hypertensive patients.

Effect of proton pump inhibitor use on Helicobacter pylori positivity and atrial fibrillation

Dear editor We read with interest the report by Wang et al regarding the association between Helicobacter pylori infection and atrial fibrillation.1 One of our concerns about this well designed study is the lack of reporting of proton pump inhibitor (PPI) use in the patients and controls. It is well known that use of PPIs influences the results of some tests for H. pylori, including the urea breath test, which the authors used in their study. Notably, the frequency of H. pylori antibody positivity was similar between all three groups while H. pylori infection seems to be significantly more common in subjects with long-standing atrial fibrillation. More frequent use of PPIs may potentially explain the lower frequency of H. pylori positivity in the control group and short-term atrial fibrillation group. Further, there are some recent reports indicating a protective effect of PPIs on the risk of atrial fibrillation, especially in people with gastroesophageal reflux disease.2 In conclusion, use of PPIs may have influenced some of the test results in this study, including the risk of atrial fibrillation.

A rare but significant cause of priapism in the elderly: multiple myeloma

Priapism is a rare symptom with diverse etiological factors. Although most cases in adults are secondary to drug use and intracavernosal injections, blood dyscrasias and hypercoagulable states, vasculitis, penile metastases, neurological conditions, spider bites, carbon monoxide poisoning, and total parenteral nutrition may also result in priapism. We report a case of recurrent and refractory priapism in a 61-year-old man which was diagnosed as multiple myeloma after emergence of hypercalcemia and renal failure due to progression of the underlying pathology. The value of the initial diagnostic approach is emphasized.

Mucosal gastric calcinosis in a hypocalcaemic patient

1Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey 2Department of Gastroenterology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey 3Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey 4Department of Internal Medicine Endocrinology, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul, Turkey

Prevalence of fecal incontinence and associated risk factors in elderly outpatients: a cross-sectional study

BackgroundData on the prevalence of fecal incontinence in elderly patients admitted to outpatient clinics in Turkey are scarce.AimsThe aim of this study was to assess the prevalence of fecal incontinence and the associated risk factors in the elderly outpatients.MethodsPatients 60 years and older admitted to a geriatrics outpatient clinic between October 2013 and March 2014 were included. Demographic characteristics, anthropometric measurements, marital status, educational status, parity (for females), fecal incontinence (FI), urinary incontinence (UI), constipation, comorbid conditions, and medications were recorded. FI assessment was based on the Fecal Incontinence Severity Index (FISI).ResultsA total of 364 patients (64.8% female, n = 236) with a mean age of 73.2 ± 8.1 years were enrolled in the study. The prevalence of FI was 9.9% (10.2% female, 9.4% male). UI was 42.6%. Co-occurrence of FI and UI was 7.4%. According to the FISI, the most frequent type of defecation was liquid stool (61.1%). While the predictive factors for FI were polypharmacy (standardized coefficient, [r] = 0.203, 95% confidence interval [CI] = 0.009–0.040, p = 0.002), UI (r = 0.134, 95% CI = 0.006–0.156, p = 0.035), and being married (r = 0.200, 95% CI = −0.088 to −0.020, p = 0.002) in females, those were UI (r = 0.306, 95% CI = 0.093–0.309, p < 0.001) and polypharmacy (r = 0.251, 95% CI = 0.009–0.043, p = 0.003) in males.ConclusionsIn both genders, urinary incontinence and polypharmacy seem to be the most important risk factors for fecal incontinence. Fecal incontinence should be questioned in detail and evaluated using FISI in elderly outpatients.

Five-year results of oral antiviral therapy in HBeAg-negative chronic Hepatitis B.

BACKGROUND/AIMS Several guidelines recommend the use of tenofovir or entecavir as the first-line treatment for hepatitis B due to the lower resistance rates of these drugs than lamivudine, although lamivudine may still be preferred because of its low adverse effect profile and cost. It is important to know which patients might benefit from lamivudine as the first-line treatment. We aimed to assess the success rates of lamivudine, entecavir, and tenofovir, as well as the resistance rates, frequencies of HBsAg clearance, and risk factors for lamivudine resistance. MATERIALS AND METHODS A total of 191 patients with chronic HBeAg-negative hepatitis who were treated with lamivudine, entecavir, or tenofovir were included. Predictors of resistance to lamivudine were analyzed. RESULTS The cumulative first-, second-, third-, fourth-, and fifth-year rates of virologic breakthrough during extended lamivudine therapy were 24%, 30%, 38%, 46%, and 54%, respectively. The rate of undetectable DNA at the 60th month of those who took lamivudine was 51%. Cox regression analysis revealed that positive HBV DNA at the sixth month (HR=15; 95% CI: [7.1-33], p=0.001), being aged 41 years or more (HR=3.4; 95% CI: [1.8-6.4], p=0.001), and baseline HBV DNA of 170,500 IU/mL or higher (HR=2.1; 95% CI: [1.2-3.7], p=0.01) were independently associated with the development of resistance to lamivudine. CONCLUSION In HBeAg-negative chronic hepatitis B, baseline serum hepatitis B virus DNA levels exceeding 170,500 IU/mL, partial virologic response in the sixth month, and age of 41 years or more were independent predictors for virologic breakthrough. Moreover, 2% of these patients cleared HBsAg.

The effect of postgastrectomy reflux on lung functions.

Dear editor We read with interest the report of Saito et al1 regarding the association between long-term effects of gastrectomy in patients with spirometry-defined chronic obstructive pulmonary disease (COPD) and those at risk of COPD. Notably, the level of paO2, exercise capacities, and distances in the 6-minute walk test were lower compared with patients who were without a history of gastrectomy. One of our concerns about this well-designed study is lack of the reporting of previous exacerbations of COPD in these patients or controls. It is well known that reflux esophagitis is commonly seen postgastrectomy; thus, this situation may increase exacerbations of COPD. A more frequent rate of exacerbations of COPD may potentially worsen lung functions. Furthermore, there are some recent reports associating gastroesophageal reflux disease-risk with exacerbations of COPD.2 Although the authors report that none of the subjects experienced exacerbations during the last 3 months before enrollment, previous exacerbations might have caused functional decline and also muscle loss via decline in oral intake during exacerbations and systemic corticosteroid use. Furthermore, questioning of the participants regarding the symptoms of gastroesophageal reflux may provide important information. In conclusion, exacerbations of COPD caused by gastroesophageal reflux disease may influence the main outcomes of this study.