Kemal Yildiz

Role of gut microbiota: Obesity and NAFLD

Non-alcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease in developed countries. Obesity is the most important risk factor for metabolic syndrome and NAFLD. Accumulated evidence has revealed that gut microbial compositional changes may be associated with more energy harvesting from the diet, which promotes increased fatty acid uptake from adipose tissue and shifts lipid metabolism from oxidation to de novo production. Furthermore, changes in intestinal barrier function contribute to metabolic endotoxemia in the form of low-grade microbial inflammation. Persistent inflammation exacerbates NAFLD progression. In this review, we discuss the role of gut microbiota in obesity and NAFLD.

Assessment of serum apelin and lipocalin-2 levels in patients with subclinical hypothyroidism.

OBJECTIVES Subclinical hypothyroidism is the precursor to hypothyroidism because it has a tendency to transform into hypothyroidism. Subclinical hypothyroidism is considered one of the risk factors causing metabolic syndrome. Metabolic syndrome can be characterized by plasma levels of apelin and lipocalin-2, both released from adipocytes. In the present study, we aimed to measure serum apelin and lipocalin-2 levels of patients with subclinical hypothyroidism and compare them with serum apelin and lipocalin-2 levels from healthy individuals. METHODS This was a cross-sectional study. A total of 80 subjects were enrolled in the study and divided into two groups: Group A included 39 patients (females, n=34) diagnosed with subclinical hypothyroidism, and Group B (the control group) comprised 41 healthy volunteers (females, n=38). Serum samples were obtained from each participant for the measurement of apelin and lipocalin-2. These were then stored at minus 80°C until the time of analysis, when serum apelin and lipocalin-2 levels of the two groups were compared. RESULTS Patients with subclinical hypothyroidism (Group A and Group B subjects [healthy controls]) were comparable with respect to gender, age, and body mass index (BMI) (P=0.412, P=0.863, and P=0.269, respectively), nor was there a statistically significant difference between groups in terms of apelin and lipocalin-2 levels (P=0.87, and P=0.67, respectively). Apelin levels showed a positive and significant correlation with BMI (P=0.034). Serum lipocalin-2 levels showed significant positive correlations with BMI and creatinine levels (P=0.002, and P=0.025, respectively). CONCLUSION In the present study, no significant difference of serum apelin and lipocalin-2 levels was observed between patients with subclinical hypothyroidism and healthy control subjects. Positive correlations were found, however, between serum apelin level and BMI as well as between serum lipocalin-2 and BMI and creatinine levels.

Fatty liver disease might increase the risk of abdominal operation in patients with fatty liver and the prevalence of cancer in first-degree relatives.

BACKGROUND/AIMS We investigated the risk of abdominal operation in patients with fatty liver and the risk of any cancer in first-degree relatives of patients with fatty liver. MATERIALS AND METHODS We evaluated 105 patients with nonalcoholic fatty liver disease (NAFLD), 121 patients with biopsy-proven hepatitis C (61 patients with fatty liver and 60 patients without fatty liver), 50 patients with inflammatory bowel disease (IBD), and 109 patients with dyspepsia. RESULTS There was no difference in sex, mean age, and marital status among the groups except that patients with IBD were younger than the others (p<0.001). The frequency of cancer among family members was 18% in IBD, 9% in dyspepsia, 28% in hepatitis C with steatosis, 21.5% in hepatitis C without steatosis, and 27% in NAFLD (p=0.006). Then, we divided the study group into two groups as follows: group 1: (IBD+dyspepsia+hepatitis C without steatosis) and group 2: (hepatitis C with steatosis+NAFLD). We found that the frequency of cancer was 16% in group 1 versus 24.4 % in group 2 (p=0.037). We also investigated the risk of abdominal operation in patients with fatty liver. The results were as follows: 33% in group without fatty liver versus 43% in group with fatty liver (p=0.043). CONCLUSION Understanding the underlying causes of fatty liver forms might decrease the cancer frequency in the population and number of operations in patients with fatty liver.

Role of serum myeloperoxidase, CPK, CK-MB, and cTnI tests in early diagnosis of myocardial ischemia during ERCP

BACKGROUND/AIMS Some patients may experience retrosternal pain during ERCP, which may be a pioneer of a serious myocardial problem, and early diagnosis is very important for the prognosis and management. In the study, we aimed to investigate the role of serum cardiac biomarkers, such as myeloperoxidase (MPO), creatine phospokinase (CPK), creatine kinase- myocardial band (CK-MB), and cTnI, on early diagnosis of myocardial ischemia during endoscopic retrograde cholangio pancreaticograpy (ERCP) procedures. MATERIALS AND METHODS In this prospective observational study, ERCP patients were separated into ischemic cardiac (n:48) and non-ischemic (n:76) groups. Serious cardiac, kidney, and liver disease patients were excluded from the study. Changes in electrocardigrapy (ECG), blood pressure, pulse rate, oxygen saturation, and serum MPO, CPK, CK-MB, and cTnI levels were investigated before and after the ERCP. Results were evaluated statistically (p<0.05). RESULTS Mean age was 59.76±16.62 (55♀, 69♂). Only one patient had clinically unimportant retrosternal pain (0.8%). ST-elevation was detected in 10.4% (n:5), ST-depression in 12.5% (n:6), and negative-T in 31.3% (n:15) of ischemic patients during ERCP. Systolic and diastolic blood pressure and pulse rates in both groups and oxygen saturations in the ischemic group were reduced after ERCP. Significance was not detected with MPO and CPK tests. CK-MB levels showed an increase after the ERCP in the non-ischemic group (p<0.001). cTnI means were higher among the ischemics when pre- and post-ERCP periods (p:0.001) were compared. CONCLUSION Clinically unimportant retrosternal pain, T negativity, and ST segment changes as well as reduced systolic, diastolic blood pressure, and heart rates can be seen during ERCP. MPO and CPK levels remain insignificant if myocardial injury does not develop. Increased CK-MB levels in non-ischemic patients and increased cTnI levels in ischemics may be seen.

Nonalcoholic fatty liver may increase the risk of operation in patients with fatty liver and the frequency of cancer in their first-degree relatives

SummaryBackgroundFatty liver is a common disease in developed countries. We investigated the frequency of operation in patients with fatty liver and the frequency of cancer in their first-degree relatives.MethodsIn this study, we evaluated 105 patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD), 121 patients with hepatitis C (61 patients with fatty liver and 60 patients without fatty liver), 50 patients with inflammatory bowel disease (IBD), and 109 patients with dyspepsia as a control group.ResultsThere was no difference for sex, mean age, and marital status among the groups, except that patients with IBD were younger than others (p < 0.001). The frequency of cancer in family was as follows: 18 % in IBD, 9 % in dyspepsia, 28 % in hepatitis C with hepatic steatosis, 21.5 % in hepatitis C without steatosis, and 27 % in NAFLD (p = 0.006). Then, we divided the study group into two groups—group 1: IBD + dyspepsia + hepatitis C without hepatic steatosis, and group 2: hepatitis C with hepatic steatosis + NAFLD—and performed the same analysis. We found that the frequency of cancer in family was 16 % in group 1 (the patients without fatty liver) vs. 24.4 % in group 2 (those with fatty liver; p = 0.037). We also investigated the rate of operation in patients. The results were as follows: 33 % in group 1 vs. 43 % in group 2 (p = 0.043).ConclusionsIndependently of the underlying chronic diseases, occurrence of fat in the liver increased the frequency of operation in patients with fatty liver and the rate of cancer in their first-degree relatives. Understanding the underlying causes of fatty liver forms might decrease the cancer frequency in the population and number of operation in patients with fatty liver.

Serum endocan levels in women with restless legs syndrome.

Background Endocan is a recently introduced marker of endothelial dysfunction. The objective of this study was to compare serum endocan levels in patients with restless legs syndrome (RLS) and control subjects in order to elucidate whether RLS is associated with endothelial dysfunction. Methods A total of 31 drug naïve female patients with RLS and 31 age- and BMI-matched women were included in the study. Patients with pathological or physiological conditions or with a history of medication use that could potentially influence endothelial functions were excluded, as well as those with alcohol or drug abuse history. The two groups were compared with routine blood tests and serum endocan levels. Results Patients with RLS had lower serum endocan levels than the controls (P=0.037). There was a negative bivariate correlation between RLS severity score and serum endocan levels (r=−0.406, P=0.023). While white blood cell count was significantly higher in RLS group, 25-hydroxy vitamin D3, vitamin B12, transferrin saturation rate, and HDL-cholesterol were significantly lower. Creatininemia and diastolic blood pressure were also marginally insignificantly lower in RLS group. Due to the presence of differences between two groups in these variables, a linear regression analysis was performed that showed a positive association between endocan and creatininemia (β=0.310, P=0.022), and a negative association between endocan and RLS (β=−0.502, P<0.001). Conclusion The results of this study seem to suggest that patients with RLS may have better endothelial functions when compared with the general population and that these patients may be better protected against atherosclerosis.

Gastroenterology Cases of Cutaneous Leukocytoclastic Vasculitis

Rarely, leukocytoclastic vasculitis can result from ischemic colitis, inflammatory bowel disease, and cryoglobulinemia. There is no established standard for the treatment of leukocytoclastic vasculitis associated with gastroenterologic diseases. This paper presents three cases of leukoytoclastic vasculitis, each of which is associated with a different gastroenterologic condition: ischemic colitis, Crohns disease, and chronic hepatitis C. Each condition went into remission by treatment of leukocytoclastic vasculitis, regardless of the underlying disease.