Mehmet Yücesoy

Neutrophil–Lymphocyte Ratio as a Predictor of Disease Severity in Ulcerative Colitis

Blood neutrophil‐to‐lymphocyte (N/L) ratio is an indicator of the overall inflammatory status of the body, and an alteration in N/L ratio may be found in ulcerative colitis (UC) patients. The aims of this study were to investigate the utility of N/L ratio as a simple and readily available predictor for clinical disease activity in UC. J. Clin. Lab. Anal. 27:72–76, 2013.

Colonic subepithelial collagenous thickening in diabetic patients

PURPOSE: This study was designed to investigate the effect of intestinal subepithelial collagenous thickening on diabetic diarrhea because one of the seven patients diagnosed with collagenous colitis was diabetic. METHODS: Rectosigmoidoscopic rectal biopsies were taken from 50 diabetic patients (8 with and 42 without diarrhea), 20 nondiabetic patients with diarrhea, and 10 healthy patients. Histopathologic examinations and measurements of subepithelial collagen layers were performed on these biopsies. RESULTS: In diabetic patients who had diarrhea, the subepithelial collagen layer (SCL) was thicker than it was in diabetics without diarrhea (P<0.05). In diabetic groups, the SCL was thicker than it was in both nondiabetics with diarrhea and those without diarrhea (P<0.05). There was no statistical difference between nondiabetics with diarrhea and those without (P>0.05). There was no correlation between collagen thickness, age, and diabetes duration (P>0.05). CONCLUSION: It was concluded that there was a thickening of the colonic SCL in diabetic patients.

Effects of testosterone gel treatment in hypogonadal men with liver cirrhosis

INTRODUCTIONnHypogonadism characterized by low serum testosterone level, loss of libido, small testes, impotence and gynecomastia is a common clinical situation in male patients with advanced chronic liver disease. The aim of the study was to assess the efficacy and safety of testosterone replacement on muscle strength, bone mineral density (BMD), body composition and gynecomastia in hypogonadal men with liver cirrhosis.nnnMETHODSnSixteen hypogonadal male cirrhotic patients were included and twelve completed the study. Abdominal USG and/or MRI were performed to exclude hepatocellular cancer. Testogel 50mg/day was administered for 6 months. Liver enzymes, hormone profiles and muscle strength were evaluated monthly. Body composition parameters, BMD and gynecomastia were evaluated before and after 6 months.nnnRESULTSnSerum free testosterone level was higher (20.13 ± 10.06 pmol/L; 57.26 ± 39.56 pmol/L, P=0.002) after treatment. Testosterone replacement resulted in an increase in muscle strength (34.03 ± 7.24 kg; 39.18 ± 5.99 kg, P<0.001), the subscapular site subcutaneous fat tissue (P=0.012) and the sum of the four regions (P=0.04). Subareolar breast tissue was lower (28.83 ± 17.18 mm; 15.00 ± 6.74 mm, P=0.007) after treatment. No significant adverse effects were detected.nnnDISCUSSIONnTestosterone gel 50mg/day raises free testosterone to values below supraphysiological levels in cirrhotic men. Transdermal testosterone replacement improves muscle strength, ameliorates gynecomastia, alters body fat distribution and causes upper body adiposity in hypogonadal men with cirrhosis. Application of testosterone gel, which undergoes no hepatic first-pass metabolism, seems as a safe and well-tolerated agent in liver cirrhosis as compared to other anabolic steroids, which may be associated with various adverse events.

Noninvasive assessment of liver damage in chronic hepatitis B

AIMnTo evaluate the efficacy of the aspartate aminotransferase/platelet ratio index (APRI) and neutrophil-lymphocyte (N/L) ratio to predict liver damage in chronic hepatitis B (CHB).nnnMETHODSnWe analyzed 89 patients diagnosed with CHB by percutaneous liver biopsy and 43 healthy subjects. Liver biopsy materials were stained with hematoxylin-eosin and Massons trichrome. Patients fibrosis scores and histological activity index (HAI) were calculated according to the Ishak scoring system. Fibrosis score was recognized as follows: F0-1 No /early-stage fibrosis, F2-6 significant fibrosis, F0-4 non-cirrhotic and F5-6 cirrhotic. Significant liver fibrosis was defined as an Ishak score of ≥ 2. APRI and N/L ratio calculation was made by blood test results.nnnRESULTSnThe hepatitis B and control group showed no difference in N/L ratios while there was a significant difference in terms of APRI scores (P < 0.001). Multiple logistic regression analysis revealed that the only independent predictive factor for liver fibrosis in CHB was platelet count. APRI score was significantly higher in cirrhotic patients than in non-cirrhotic patients. However, this significance was not confirmed by multiple logistic regression analysis. The optimum APRI score cut-off point to identify patients with cirrhosis was 1.01 with sensitivity, specificity, positive predictive value and negative predictive value of 62% (36%-86%), 74% (62%-83%), 29% (13%-49%) and 92% (82%-97%), respectively. In addition, correlation analyses revealed that N/L ratio has a negative and significant relationship with HAI (r = -0.218, P = 0.041).nnnCONCLUSIONnN/L ratio was negatively correlated with HAI. APRI score may be useful to exclude cirrhosis in CHB patients.

Prevalence patterns of gastric cancers in Turkey: model of a developing country with high occurrence of Helicobacter pylori.

Aim:u2002 In developed countries, there has been a recent increase in the prevalence of adenocarcinoma of the esophagus and cardia, along with a decrease in distal gastric cancers. Little is known regarding the prevalence of these diseases in developing countries. The aim of the present study was to evaluate changes in the prevalence of gastric adenocarcinomas in Turkey as a function of anatomic location.

Acute adrenocortical failure due to tuberculosis

A 55-year-old woman presented with acute adrenal failure, active pulmonary tuberculosis and an enlarged adrenal mass which was subsequently removed surgically. Histopathologic examination disclosed adrenal tuberculoma. It was concluded that tuberculosis might result not only in chronic adrenocortical insufficiency but also in acute adrenal failure.

Noninvasive assessment of the effect of treatment in nonalcoholic fatty liver disease: neutrophil to lymphocyte ratio

To the Editor: We read with great interest the article recently published in Liver International by Alkhouri et al. (1), presenting that the neutrophil/lymphocyte (N/L) ratio is higher in patients with nonalcoholic steatohepatitis (NASH) and advanced fibrosis. They mentioned that N/L integrates information on the inflammatory milieu and physiological stress. They found higher N/L ratio in NASH patients compared with controls. Also they implicated that this ratio is correlated with the individual histological features of NASH, especially inflammation and fibrosis. We want to add some points which may take into consideration. In a recent study, diet and physical exercise intervention significantly reduces the N/L ratio in a population of overweight, male adolescents (2). They also conclude that weight loss was associated with a significant decrease of pro-inflammatory cytokine levels. Although various medical treatment strategies are under evaluation, we know that the current management of NAFLD relies on weight loss and exercise (3). The N/L ratio a novel noninvasive, inexpensive and simple accessible marker can be used to predict advanced disease. Also according to our opinion, the N/L ratio can be used for following patients and also can be used for evaluating the affectivity of novel treatment strategies in NASH.

ACUTE RENAL FAILURE DUE TO RIFAMPICIN TREATMENT

Dr. Cengiz Utas, Erciyes Universitesi Tip Fakültesi, Nefroloji Bilim Dali, 38039 Kayseri (Turkey) Dear Sir, In patients treated with rifampicin, acute renal failure may occur following influenzalike symptoms. Typical symptoms in these patients are chills, fever, lumbar pain, oligoa-nuria and hematuria. Serious side effects of rifampicin occur especially in patients on intermittent tuberculous therapy and irregular use of rifampicin [1-5]. We report 5 patients who developed acute renal failure following rifampicin intake. Case 1: Male, 54 years old, treatment with antituberculous drugs was initiated because of pulmonary tuberculosis. Three months later the therapy was ceased by himself. On feeling worse after 2 months without therapy, he again started to use rifampicin on his own accord. After 2 h of 300 mg rifampicin intake he had chills, fever, nausea and vomiting. He was admitted to our hospital for 60 h of oli-goanuria. On the fifth day 48-hour peritoneal dialysis therapy was performed because of acidosis. Polyuria was started on the 10th day and normal renal functions were achieved 8 weeks later. Case 2: Male, 19 years old, antituberculous therapy was started for pulmonary tuberculosis. At the end of the second month, intermittent therapy was initiated. In the 3rd week of the intermittent therapy he had complained of dizziness and nausea 20 min after taking the antituberculous drugs. He was admitted to the hospital, providing the emergency conditions 300 mg single dose of rifampicin were given orally and after 15 min nausea, vomiting, facial edema, fever dyspnea and hypotension occurred. Parenteral adrenaline, corticosteroids and antihistaminics were administered immediately and in 20-25 min the symptoms stabilized. Thirty-six hours of oliguria developed with acute impairment of renal function, polyuria started on the 4th day and 2 weeks later the renal function normalized without dialysis. Case 3: A 48-year-old woman who was taking antituberculous therapy because of miliary tuberculosis was admitted to the hospital in the second month of the intermittent therapy period for chills, fever, nausea, vomiting and lumbar pain a few hours after the intake of the drugs. The acute impairment of renal function without any oliguric state followed a full recovery in 3 weeks.

A Prospective, randomized study comparing 7-day and 14-day quadruple therapies as first-line treatments for helicobacter pylori infection in patients with functional dyspepsia

Objective: Standard triple therapy for Helicobacter pylori has a low eradication rate in Turkey. The aim of this study was to evaluate and compare the effectiveness of 7-day and 14-day lansoprazole, amoxicillin, clarithromycin, and bismuth subsalicylate (LACB) treatment regimens as first-line H. pylori eradication therapies. Materials and Methods: This study included 70 patients with symptoms of dyspepsia and a positive H. pylori stool antigen test (SAT). Thirty-five patients received the modified quadruple therapy regimen for 7 days (LACB-7) whereas the remaining 35 patients received the treatment for 14 days (LACB-14). Eradication was assessed by SAT 1 month after the end of therapy. Results: A total of 64 patients completed the therapy. The cumulative per-protocol (PP) and intention-to-treat (ITT) eradication rates were 89% (n = 57/64) and 81.4% (n = 57/70), respectively. Both the PP and ITT eradication rates were superior in the LACB-14 group, compared with the LACB-7 group (PP: 90.6% vs. 87.5%; ITT: 81.4% vs. 80%, respectively), but these differences were not statistically significant (P = 0.689). Conclusions: Both the 7-day and 14-day first-line LACB therapies provided a high cure rate, were well tolerated, and were equally effective against H. pylori infection in Turkey.

Prevalence of Helicobacter pylori Antibodies in Uremic Patients

Dr. Cengiz Utas, Erciyes Universitesi Tip Fakiiltesi, Nefroloji Bilim Dali, 38039 Kayseri (Turkey) Dear Sir, Helicobacter pylori (HP) is highly associated with histologically proven gastritis and peptic ulcer disease in patients with gastrointestinal symptoms [1]. Uremic patients are especially prone to develop dyspeptic symptoms and gastroduodenitis [2]. A high urea content of the mucus in the stomach may predispose to HP infection [3]. It has been postulated that IgG and IgA ELISA tests, used together, can diagnose HP infections with a specificity exceeding 90% [4]. Because of the excellent sensitivity, specificity and low cost we have studied IgG and IgA antibodies against HP, and the results were correlated with dialysis duration, mean blood urea nitrogen levels in 72 (52 were on chronic hemo-dialysis therapy) uremic (GFR < IO ml/min) patients and 36 agematched healthy as well as 36 nonulcer dyspepsia controls. The IgG, IgA and both antibodies against HP of the study groups are shown in figures 1 and 2. There was no correlation between dialysis duration, blood urea nitrogen levels and HP antibodies and also none between the results of dialyzed and nondialyzed patient groups. Our results are similar to the literature data based on different diagnostic methods [5-8]. In conclusion the high blood urea levels and dialysis therapy did not seem to affect the possibility of infection. To perform the nonin-vasive serological tests for HP may be particularly useful for screening a uremic population to help decide whether to perform endoscopy or not as it is known that many uremic patients suffer from dyspeptic complaints. IgA IgG + IgA Fig. 1. Prevalence of HP in healthy controls (¤), nonulcer dyspepsia (ü) and uremic patients (■). References Blaser MJ: Epidemiology of Helicobacter pylori infections; in Malfertheiner P, Ditschuneit H (eds): Helicobacter pylori, Gastritis and Peptic Ulcer. Berlin, Springer, 1990, pp 3-8. Ala-Kaila K: Upper gastrointestinal findings in chronic renal failure. Scand J Gastroenterol 1987;22:372376. Hazell SL, Lee A, Brady L, Hennessy W. Campy-lobacterpyloridis and gastritis: Association with intercellular spaces and adaptation to an environment of mucus as important factor in colonization of the gastric epithelium. J Infect Dis 1986;153:658-663.