Murat Kantarcioglu

Comparison of levofloxacin-containing sequential and standard triple therapies for the eradication of Helicobacter pylori

BACKGROUND There is an important concern about the success of standard triple treatment for Helicobacter pylori (H. pylori) in recent years. Better eradication rates have been reported with sequential treatment in current studies. This study aimed to compare the success of a novel levofloxacin-containing sequential regimen with standard triple therapy. METHODS H. pylori-positive patients with non-ulcer dyspepsia were randomly allocated to one of the study groups. The patients on sequential arm were given esomeprazole 40 mg BID and amoxicillin 1g BID for the first week followed by esomeprazole 40 mg BID, levofloxacin 500 mg QD and metronidazole 500 mg TID for the second week. The patients on standard triple arm were given esomeprazole 40 mg BID, amoxicillin 1g BID and clarithromycin 500 mg BID for 2 weeks. Eradication was assessed by urea breath test on 6th weeks. RESULTS Seventy-five patients were enrolled in each group; 72 in sequential arm and 67 in standard arm completed the protocols. H. pylori eradication rate of per protocol was 90% in sequential versus 57% in standard treatment groups with a statistical significance (p<0.000). Both regimens were similarly well tolerated and side effects were comparable. Only one patient in sequential arm stopped the treatment because of side effects. CONCLUSION The levofloxacin-containing sequential therapy is a significantly better strategy than the standard triple treatment for H. pylori eradication. Standard triple treatment is no more effective for H. pylori in our population and levofloxacin-containing sequential regimen might be used as a first-line eradication option.

Circulating vaspin and its relationship with insulin sensitivity, adiponectin, and liver histology in subjects with non-alcoholic steatohepatitis.

Abstract Objective. Non-alcoholic steatohepatitis (NASH) is closely associated with components of metabolic syndrome. Vaspin is a novel adipocytokine that may link obesity, insulin resistance (IR), and type 2 diabetes mellitus. We aimed to investigate circulating vaspin levels in subjects with NASH and also to search for the association of vaspin with IR, adiponectin, and histological findings. Material and methods. A total of 50 male patients with NASH and 30 healthy male controls were enrolled. Vaspin and adiponectin were measured with ELISA method. Insulin sensitivity determined by homeostasis model assessment (HOMA-IR) index. Results. Plasma vaspin levels were higher and adiponectin levels were lower in NASH group compared with controls (p < 0.01 and p < 0.001, respectively). However, in multivariate analysis adjusted for glucose and lipid parameters, and HOMA-IR indexes, the difference in vaspin concentrations was disappeared. Nonetheless, the difference regarding the adiponectin levels remained significant between groups (p = 0.03). Vaspin was negatively correlated with low-density lipoprotein cholesterol (r = -0.32, p = 0.03) in subjects with NASH. Conclusions. This study indicates that circulating vaspin levels are not altered in male subjects with NASH. These results suggest that in the absence of metabolic risk factors, vaspin per se may not be involved in the pathogenesis of NASH.

Low Efficacy of Clarithromycin Including Sequential Regimens for Helicobacter Pylori Infection

Background:  Sequential treatment for Helicobacter pylori (H. pylori) appears to achieve a better eradication rate than triple therapy. However, most of the data have been reported from the Italy, and studies from different population are needed before it is recommended in clinical practice. The present study aimed to assess and compare the efficacy of two separate clarithromycin including sequential regimens in Turkey which is well known with high clarithromycin and metronidazole resistance to H. pylori.

The efficacy of mesenchymal stem cell transplantation in caustic esophagus injury: an experimental study.

Introduction. Ingestion of corrosive substances may lead to stricture formation in esophagus as a late complication. Full thickness injury seems to exterminate tissue stem cells of esophagus. Mesenchymal stem cells (MSCs) can differentiate into specific cell lineages and have the capacity of homing in sites of injury. Aim and Methods. We aimed to investigate the efficacy of MSC transplantation, on prevention of esophageal damage and stricture formation after caustic esophagus injury in rats. 54 rats were allocated into four groups; 4 rats were sacrificed for MSC production. Group 1, untreated controls (n: 10). Group 2, membrane labeled MSCs-treated rats (n: 20). Group 3, biodistribution of fluorodeoxyglucose labeled MSCs via positron emission tomography (PET) imaging (n: 10). Group 4, sham operated (n: 10). Standard caustic esophageal burns were created and MSCs were transplanted 24 hours after. All rats were sacrificed at the 21st days. Results. PET scan images revealed the homing behavior of MSCs to the injury site. The histopathology damage score was not significantly different from controls. However, we demonstrated Dil labeled epithelial and muscle cells which were originating from transplanted MSCs. Conclusion. MSC transplantation after caustic esophageal injury may be a helpful treatment modality; however, probably repeated infusions are needed.

Pentraxin 3 Is a Predictor for Fibrosis and Arterial Stiffness in Patients with Nonalcoholic Fatty Liver Disease

Objective. The aim of the present study was to investigate whether pentraxin 3 (PTX3) can be a new noninvasive marker for prediction of liver fibrosis in patients with NAFLD. We also aimed to evaluate the relationship between PTX3 and atherosclerosis in patients with NAFLD. Method. Fifty-four male patients with biopsy-proven NAFLD and 20 apparently healthy male volunteers were included. PTX3 levels were determined, using an ELISA method (R&D Sysytems, Quantikine ELISA, USA). To detect the presence of subclinical atherosclerosis in NAFLD, measurements of CIMT, FMD, and cf-PWV levels were performed. Results. PTX3 levels in NAFLD patients with fibrosis were higher than both NAFLD patients without fibrosis and controls (P = 0.032 and P = 0.028, respectively), but there was no difference between controls and NAFLD patients without fibrosis in terms of PTX3 levels (P = 0.903). PTX3 levels were strongly correlated with cf-PWV (r = 0.359, P = 0.003), whereas no significant correlation was found with other atherosclerosis markers, CIMT and FMD. Conclusion. Elevated plasma PTX3 levels are associated with the presence of fibrosis in patients with NAFLD, independently of metabolic syndrome components. This study demonstrated that for the first time there is a close association between elevated PTX3 levels and increased arterial stiffness in patients with NAFLD.

The degree of mucosal damage to the small intestine and serum immunoglobulin G4 levels correlate with celiac disease.

Background Celiac disease (CD) is an immune-mediated and chronic inflammatory enteropathy, triggered by the ingestion of gluten in genetically susceptible individuals. Immunoglobulin G4 (IgG4)-related diseases are a recently defined emerging clinical condition, characterized by increased serum IgG4 concentrations. The aim of this study was to investigate whether IgG4 levels correlate with the titers of intestinal antibodies and the degree of mucosal damage in CD patients. Materials and methods A total of 41 CD patients and 28 healthy controls were included in the study. All patients underwent a duodenal biopsy and were then diagnosed with the modified Marsh classification. Blood samples were obtained for IgG4 measurements. Serums were kept at −80°C until the analysis was carried out and plasma IgG4 levels were determined using an enzyme-linked immune sorbent assay method with a diagnostic cutoff value of 135 mg/dl. Results The mean age of the CD and the control group was 26.8±8.3 and 26.9±6.2 years, respectively. The mean IgG4 levels were significantly higher in CD patients (283.21±39.02 mg/dl) compared with the healthy control group (68.97±15.89 mg/dl, P<0.0001). In the CD group, 27/41 patients and in the control group, 4/28 patients had high IgG4 levels (>135 mg/dl, P<0.0001). A close correlation was found between the grade of mucosal damage, IgG4 levels, and antigliadin-IgA; the higher the grade Marsh score, the higher the measured IgG4 (P<0.05). Conclusion In our study, IgG4 levels of CD patients were higher than normal ranges whereas the results of the control group were within physiologic limits. We also showed for the first time that there was a correlation between IgG4 levels, autoantibody, and severity of mucosal damage. To the best of our knowledge, this is the first study to evaluate IgG4 levels and mucosal damage in CD patients.

Severe serum amylase elevation, with only chronic kidney disease

This reportis about an elderly patient who has severely elevated serumamylase levels.An 80-year-old male patient with mild abdominal pain andheartburn complaint was referred to our clinic by nephrologyclinic. It was realized that the patient has been followed-upwith CKD by nephrology for 5 years and he did not have anyrenal replacement treatment. There was no abdominal rigidityand no tenderness at midline by palpation. Other examinationfindings shortly were normal heart and lung auscultation,blood pressure: 100/600mmHg, pulse: 74/min, temperature:36.6 C. And lab results were white blood cell (WBC): 3510/mm

Solitary Rectal Ulcer Syndrome in an Elderly Adult

intact reflexes. Laboratory tests were remarkable for normocytic anemia (hemoglobin 10.6 g/dL), impaired renal function (creatinine 7.8 mg/dL, 0.6 mg/dL 2 years prior), and a negative multiple myeloma screen. Lumbar magnetic resonance imaging (MRI) showed a large, irregularly shaped heterogeneous pelvic mass, 11 cm at its widest point, that was eroding into the sacrococcygeal spinal canal. There were also multiple hypointense T1 foci in the lower thoracic and lumbar spine, sacrum, and iliac bones. Subsequent computed tomography revealed many densities throughout the liver and retroperitoneal lymphadenopathy suspicious for metastases. Brain MRI excluded intracranial lesions. Image-guided biopsy of the sacrococcygeal mass confirmed the histological diagnosis of chordoma. He was diagnosed with cauda equine syndrome (CES) secondary to metastatic invasive sacrococcygeal chordoma and started on steroid therapy. Neurosurgery, oncology, and radiation oncology were consulted, and a consensus was reached that he should be treated conservatively. He was a poor surgical candidate in light of his poor functional status and the extent of his tumor burden. He declined palliative radiotherapy and was discharged to a hospice facility.

The Cumulative Colectomy Rate in Patients with Cytomegalovirus-Positive Ulcerative Colitis

To the Editor: With great interest, we read the article titled “Long-term outcomes of cytomegalovirus reactivation in patients with moderate to severe ulcerative colitis: a multicenter study” by Kim et al.1 In this very-well designed study, authors have found that the cumulative colectomy rate was significantly higher in the cytomegalovirus (CMV)-positive group than in the CMV-negative group. They concluded that the patients who had CMV-reactivated ulcerative colitis (UC) showed poor outcomes at the long-term follow-up, and the long-term efficacy of ganciclovir therapy was marginal. These findings provided important information regarding the association between UC and CMV infection. However, we have some suggestions regarding methodology of the study. In the study, CMV IgM antibody or histologic detection of inclusion bodies on hematoxylin and eosin (HE they would have visited a participating center if the patients experienced a flare-up. However, these 11 patients may be admitted due to flare up apart from 10 participating centers since there is no feedback information. In addition, authors reported that three patients showed evidence of CMV reactivation during the follow-up period in CMV-negative group and those patients were successfully treated with ganciclovir. However, this study has no information regarding the outcome of those patients. It seems like these patients had sustained remission. Moreover, we suggest that patients with CMV reactivation in CMV-negative group should be added to CMV-positive group because the complications which occurred after CMV diagnosis may be associated with viral reactivation. If these patients are included in CMV-positive group, cumulative colectomy rate will change. Consequently, we conclude that, before making certain interpretations, this work should be rearranged in light of the above mentioned suggestions. This could provide the readers of the journal clearer information regarding the role of CMV infection in cumulative colectomy rate and the clinical course of the UC.

Melatonin and Its Day and Night Rhythm of Alterations in Familial Mediterranean Fever: A Brief Research Letter

Objective: The pineal hormone melatonin plays a crucial role in immunomodulation, mainly by effecting T cells. The aims of the present study were to compare the melatonin levels in patients with Familial Mediterranean Fever (FMF) and healthy controls and to find out if it associates with interferon(IFN)γ and interleukin(IL)-10. Materials and Methodology: Twenty five patients with FMF and 16 healthy donors were enrolled into the study. Melatonin, IFN γ and IL-10 measurements were assayed by using enzyme immunoassay (EIA) method. Results: Serum melatonin levels at 03.30 am in both patients during attack-free phase and healthy controls were significantly higher than those levels of corresponding groups measured at 10.00 am. The melatonin levels at 03.30 and 10.00 am in patients during attack-free phase were higher than those levels measured in healthy controls at the same time points. IFNγ and IL-10 did not show any day and night rhythm in both patients and healthy controls. In addition, there was no association among day and night levels of melatonin, IFNγ and IL-10. Conclusions: We conclude that melatonin may play a role in FMF pathogenesis. However, its modulatory effect on immune response most likely does not depend on T cells. Further comprehensive studies should be performed in order to reveal the role of melatonin in the pathogenesis of this disease.