Mevlut Baskol

Serum Paraoxonase 1 Activity and Lipid Peroxidation Levels in Patients with Age-Related Macular Degeneration

Our objective was to investigate antioxidant paraoxonase 1 (PON1) activity together with malondialdehyde (MDA) levels to evaluate oxidative stress in patients with age-related macular degeneration (AMD), an important cause of blindness in the elderly population. Serum PON1 activity and MDA levels were analyzed in 37 patients with AMD and compared with 29 healthy controls using a spectrophotometric method. Serum MDA levels were significantly higher in the patient group (2.76 ± 1.28 nmol/ml) than controls (1.00 ± 0.36 nmol/ml; p < 0.001), whereas PON1 activity was lower in the patient group (132.27 ± 63.39 U/l) than controls (312.13 ± 136.23 U/l; p < 0.001). There was a negative correlation between MDA and PON1 levels (r = –0.470, p < 0.001). We conclude that the observed increase in MDA levels may be related to decreased PON1 activity; the present data also demonstrated that an obvious negative correlation between PON1 activity and MDA levels exists in patients with AMD. PON1 is also an antioxidant agent, therefore effective antioxidant therapy to inhibit lipid peroxidation is necessary and agents to increase PON1 activity may be a therapeutic option in AMD.

Common Familial Mediterranean Fever gene mutations in a Turkish cohort

Familial Mediterranean Fever (FMF) is an autosomal recessive autoinflammatory disorder with the responsible gene of MEFV which primarily affects Jewish, Armenian, Turkish and Arab populations. The FMF gene (MEFV) has recently been cloned to chromosome 16p, which encodes pyrin. In the present study, we enrolled 2,067 unrelated patients with the suspicion of FMF in Middle Anatolia between the years 2006–2009 and identified the 12 MEFV mutations. DNA was amplified by PCR and subjected to reverse hybridization for the detection of MEFV gene mutations. Among the 2,067 patients, 866 (41.9%) were males and 1,201 (58.1%) were females. The mutations were homozygous in 176 (16.85%) patients, compound heterozygous in 314 (30.1%) patients, heterozygous in 546 (52.25%) patients and the other forms of mutations were found in 8 patients (0.76%). No mutation was detected in 1,023 (49.5%) patients. The most frequent mutations were M694V, M680I (G/C), E148Q and V726A. We could not find any significant differences between the two common mutations according to the gender. The high incidence of MEFV gene mutations in the Turkish population indicated that newborn screening may be discussed in the future. Because of the ethnic origin of Anatolia, larger serial analyses are necessary to investigate the rate and coexistence of these mutations.

Circulating microRNAs in patients with non-alcoholic fatty liver disease

AIM To identify novel non-invasive biomarkers for non-alcoholic fatty liver disease (NAFLD). METHODS Twenty patients with histologically proven NAFLD and 20 controls were included. All NAFLD cases were scored using the NAFLD activity score. The relative expressions of miR-197, miR-146b, miR-10b, miR-181d, miR-34a, miR-122, miR-99a and miR-29a were analyzed using real-time polymerase chain reaction. RESULTS Serum levels of miR-181d, miR-99a, miR-197 and miR-146b were significantly lower in biopsy-proven NAFLD patients than in the healthy controls. Serum levels of miR-197 and miR-10b were inversely correlated with degree of inflammation and miR-181d and miR-99a were inversely correlated with serum gamma glutamyl transferase levels in non-alcoholic steatohepatitis patients. CONCLUSION NAFLD is associated with altered serum miRNA expression pattern. This study provides clues for defining the non-invasive diagnosis of NAFLD.

Advanced Oxidation Protein Products : A Novel Marker of Oxidative Stress in Ulcerative Colitis

Background/Goals The etiology and pathogenesis of chronic inflammatory bowel diseases are still poorly understood. Oxidative stress takes place in the pathogenesis of ulcerative colitis (UC) and advanced oxidation protein products (AOPP) are accepted as a novel marker of oxidative stress. There are no data concerning whether AOPP may be used as a simple serum marker to assess the disease activity, predict severity of the disease course in UC. Study In this study, we determine the importance of neutrophil activation and the role of oxidative stress in the pathogenesis of UC, by quantification of AOPP and total thiol levels as markers of oxidative protein damage, malondialdehyde levels as a marker of lipid peroxidation, and myeloperoxidase activity as a marker of neutrophil activation in patients with UC. Results Serum levels of AOPP, thiol, myeloperoxidase activity, and malondialdehyde were found as increased in UC group compared with controls (P=0.004, 0.047, 0.001, and 0.001 respectively). Conclusions Our finding of increased levels of plasma AOPP levels supports the presence of oxidative stress and protein oxidation in UC and this marker may be used as a simple serum marker to assess disease activity, predict the severity of disease course, and perhaps response to therapy.

Endoscopic Topical Application of Ankaferd Blood Stopper® in Gastrointestinal Bleeding

AIM This was a prospective study investigating the efficacy of Ankaferd Blood Stopper(®) (ABS), an herbal preparation, in patients with upper gastrointestinal (UGI) bleeding. MATERIALS AND METHODS A total of 30 patients (22 male, 8 female) who had UGI bleeding (with differing causes) were included in the study. ABS was used to stop the bleeding. RESULTS Primary hemostasis was achieved in 26 of the 30 cases. CONCLUSIONS ABS is an effective and safe agent to use in patients with UGI bleeding.

The role of serum zinc and other factors on the prevalence of muscle cramps in non-alcoholic cirrhotic patients

Background/Aims: To determine the prevalence of muscle cramps in patients with liver cirrhosis and to identify factors associated with their development, especially serum zinc. Method: One hundred cirrhotic patients and 85 healthy subjects were enrolled into the study. True muscle cramp was defined as at least 1 painful leg cramp either occurring at rest or strong enough to waken a patient from sleep, occurring at least once a week persisting for a period of greater than 1 year. Creatinine, calcium, magnesium, sodium, potassium, zinc, glucose, alanine aminotransferase, total bilirubin, and albumin levels were detected in sera. Prothrombine time was measured in cirrhotic patients. Presence or absence of ascite was determined by sonography. Results: True muscle cramps were significantly more common in patients with cirrhosis when compared with the control group (59% vs. 7.1%, respectively, P < 0.001). Cramp (+) cirrhotic patients had older age (49.54 ± 10.09 vs. 55.54 ± 7.90, respectively; p: 0.001) and higher Child-Pugh scores (7.56 ± 2.32 vs. 9.02 ± 2.55, respectively; p: 0.004) when compared with cramp (−) patients. None of the serum related factors such as creatinine, calcium, magnesium, sodium, potassium, zinc, glucose, alanine aminotransferase, total bilirubin, and albumin levels had any statistically significant contribution to the etiology. Conclusion: Muscle cramps are frequent complication of cirrhosis. Neither biochemical characteristics including decreased serum zinc levels nor the use of diuretics explained the greater prevalence of cramps in patients with cirrhosis. We conclude that the detrimental effect of cirrhosis on muscle fibers may be the major factor.

Effects of testosterone gel treatment in hypogonadal men with liver cirrhosis

INTRODUCTION Hypogonadism 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. METHODS Sixteen 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. RESULTS Serum 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. DISCUSSION Testosterone 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.

Five days of ceftriaxone to treat culture negative neutrocytic ascites in cirrhotic patients.

The goal of this study is to establish whether 5 days of ceftriaxone treatment was sufficient to cure culture-negative neutrocytic ascites in cirrhotic patients. We studied 50 cirrhotic patients with culture-negative neutrocytic ascites. All were treated with ceftriaxone, 1.0 g IV, twice a day for 5 days. A control paracentesis was performed 48 hours after starting the therapy to assess response to the treatment. A total of 17 demographic, clinical, and laboratory variables were recorded in all cases on the day of diagnosis of CNNA. The mean age of the patients was 57.7 ± 13.2 years. Thirty-two patients were males and 18 females. The etiology of cirrhosis was hepatitis C virus in 20 patients (40%), hepatitis B virus in 16 patients (32%), cryptogenic in 13 patients (26%), and alcohol abuse in 1 patient (2%). Eighty percent of the patients were in Child–Pugh Class C. Resolution rate of culture-negative neutrocytic ascites on day 5 of treatment was 78%. Hospital mortality in cirrhotic patients with culture negative neutrocytic ascites was 4%. Statistical analysis showed that none of the 13 selected variables as covariates significantly related with the resolution of culture-negative neutrocytic ascites. Five days of ceftriaxone treatment is an adequate therapy for culture-negative neutrocytic ascites.

Efficacy of different therapeutic regimens on hepatic osteodystrophy in chronic viral liver disease.

Background and aims Metabolic bone disease is common in patients with chronic liver disease. Comparative studies on the efficacies of antiosteoporotic agents in hepatic osteodystrophy have not been conducted yet. The aim of this study was to evaluate the safety and efficacy of different therapeutic regimens on hepatic osteodystrophy. Methods Eighty-one patients (mean age 48.9±10 years; 50 cases with chronic viral hepatitis and 31 patients with cirrhosis) were enrolled in the study. Treatment groups consisted of 61 patients who had reduced T scores in at least one region, selected randomly and treated for 1 year with vitamin D 400 IU, calcitonin 200 IU, alendronate 10 mg, alendronate 70 mg, or risedronate 5 mg. An untreated group consisting of 20 patients who had no reduction in T scores was followed up during the study period. Results No significant adverse effects, including esophageal variceal hemorrhage, were detected. According to the T score at the end of the first year compared with baseline, significant improvements in bone mineral density were observed at all regions with alendronate 70 mg; improvements at the lumbar spine (LS) and distal radius regions with alendronate 10 mg; at the LS and distal radius regions with risedronate; at the LS region with calcitonin; and at the femoral neck region with vitamin D. Conclusion All therapeutic regimens seemed to be safe, and oral biphosphonates were the most effective in preventing both cortical and trabecular bone loss in patients with chronic viral liver disease. Larger studies with longer follow-up are warranted in hepatic osteodystrophy of chronic viral liver diseases.

Is increased colon subepithelial collagen layer thickness in diabetic patients related to collagenous colitis? An immunohistochemical study

In this study, we evaluated immunohistochemically whether increased thickness of the colon subepithelial collagen layer in diabetic patients relates to collagenous colitis. A total of 100 patients (25 in each group) were included in this study. There were diabetic patients with chronic diarrhea in the first group, diabetic patients without chronic diarrhea in the second group, non-diabetic patients with chronic diarrhea in the third group, and control patients in the fourth group. The endoscopic biopsy specimens were obtained from the rectum, sigmoid colon, and descending colon. The thickness of the subepithelial collagen layer was measured using the ocular micrometer method. The immunohistochemical staining was performed with type 1 collagen and fibronectin antibody. The thickness of the colon subepithelial collagen layer in diabetic patients with or without diarrhea was significantly greater than that in control patients. This thickened subepithelial collagen layer in diabetic patients was stained with fibronectin antibody, but not with type 1 collagen antibody in the immunohistochemical study. These immunohistochemical staining characteristics were not similar to those in collagenous colitis, but were similar to those in normal subjects. Increased colon subepithelial collagen layer thickness in diabetic patients does not relate to collagenous colitis.