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Serum levels of neopterin, inflammatory markers and oxidative stress indicators in hyperemesis gravidarum.

To investigate whether serum levels of neopterin and inflammatory markers including C‐reactive protein (CRP), tumor necrosis factor‐α (TNF‐α), interleukin‐6 (IL‐6) and oxidative status indicators were altered in patients with hyperemesis gravidarum (HG) compared to asymptomatic pregnant women.

Bir bölge hastanesi acil servisine kuduz şüphesiyle başvuran olguların değerlendirilmesi

Objectives: Rabies is one of the highest mortality rates infectious disease. The aim was the evaluation of the patients who admitted to The Batman Regional State Hospital Emergency Service with suspect of rabies in the dates between June 2011 and November 2011. Materials and methods: Totally, 166 cases who admitted to our center was recorded according to the following data: place of residence (rural/urban), contact type and wound information, time after the contact, whether vaccine or immunoglobulin is applied or not and also the species, breed and being owned of suspected animal. Results: Our study population consisted of a total of 166 cases including 38 women (23%), 128 men (77%) with the mean age of 22.01 p 17.90 years. Of all subjects, 105 (63%) lived in urban and 61 (37%) lived in rural areas. Eighty-five percent of suspicious animals (51%) had an owner, while 81 animals were unattended. Conclusions: Our results showed that all admitted patients were vaccinated and the ones contacted with pets or had a surface wound were vaccinated with 3 doses. Moreover, since the 49% of our cases were contacted with animals which cannot be follow-up, our study obviously reveals that in our country deficiencies in the control of waifs still is a public health problem and increases the cost of vaccination.

Kadın doğum polikliniğine başvuran kadınlarda gebelik ve demir eksikliği anemisi ilişkisi

Objectives: Iron deficiency anemia that is very funda mental for all stage of life can especially affect health of childbearing aged women and even can cause death of mothers and their babies. This study aimed to investigate the relationship between iron deficiency anemia and ges tational condition (gravidity, parity, abortion, number of alive) of women applied to outpatient clinic of obstetric. Materials and methods: Between November-December 2011, totally 61 patients who applied to Gynecology and Obstetrics Outpatient clinic were retrospectively investigated. The patients’ data including; age, gestational medical history (gravidity, parity, number of alive and abortion), hematocrit, hemoglobin, iron, serum iron binding capacity, and transferrin saturation values were evaluated. Results: Anemia was found in only 12 of the patients (19.7%). The anemia frequency in patients whose gravidity ≤3 was 18.2%, whose gravidity >3 was 21.4%. Anemia ratio for patients having parity ≤2 was 16.6%, >2 was 21.6%. For patients having abortion ≤2 anemia frequency was 13.3% but it was 21.7% for patients having >2. We found that there was a negative correlation between the groups (gravidity, parity, abortion) and hemoglobin-transferrin saturation (p<0.05). Conclusions: In our study, it was shown that the frequency of iron deficiency anemia increases with gravidity, parity, and number of alive. For this reason, gynecologic consulting and iron support should be provided to prevent anemia in childbearing aged women. J Clin Exp Invest 2012; 3(1): 49-52

Is ischemia-modified albumin a reliable tool for the assessment of acute pancreatitis?

Purpose Oxidative stress has been implicated in several disorders, including acute pancreatitis (AP). Ischemia-modified albumin (IMA), which reflects the ability to bind cobalt, has been found to be elevated in conditions of oxidative stress and tissue hypoxia. This study examined IMA and adjusted IMA levels in patients with AP, and examined the associations of IMA and adjusted IMA levels to the severity of AP. Patients and methods A total of 42 consecutive patients with AP and 43 age- and sex-matched control subjects were enrolled. Serum samples were obtained from patients with AP on admission as well as 48–72 hours after hospitalization, and from the controls, at the time of enrollment. Adjusted IMA was calculated by multiplying the IMA value of each patient with the ratio of the patient’s albumin value and the median albumin value of the study population. The severity of AP was assessed according to the modified Atlanta classification, and the patients were divided into 2 groups: mild AP and severe AP. Results The serum IMA and adjusted IMA values of patients with AP on admission and those of the controls did not differ (p=0.86 and p=0.99, respectively). The second measurements of IMA and adjusted IMA in the AP group were higher than the first measurements of both the AP group and controls (for all, p<0.01). Among the IMA measurements, only adjusted IMA on admission had the ability to predict the severity of AP. Severe AP was correlated with albumin, and the area under the curve of adjusted IMA values on admission was 0.746 for differentiating patients with severe AP from mild AP with statistical significance (p=0.005). Conclusion It was shown that IMA and adjusted IMA levels rise with the progression of AP. Lower levels of adjusted IMA predict the severity of AP. Further studies with serial measurements of IMA are warranted to explore the indicative role of IMA in the course of AP.

Relationship between diverticulosis and nonalcoholic fatty liver disease in elderly patients

Objective To compare clinical and laboratory features of elderly patients with and without diverticulosis and assess factors related to hepatosteatosis. Method This retrospective case–control study analysed the clinical and laboratory data, colonoscopy and abdominal ultrasonography records of patients >65 years who underwent colonoscopies. Subjects were categorized according to the presence and absence of colonic diverticulosis. Univariate/multivariate logistic regression analyses were performed to evaluate the independent predictive factors of hepatosteatosis. Results A total of 355 patients were enrolled in the study: 169 had colonic diverticulosis; and 186 without colonic diverticulosis formed the control group. Age, sex and chronic disorders associated with the metabolic syndrome did not differ between the diverticulosis and control groups. The rate of hepatosteatosis was lower in patients with diverticulosis compared with the control group (27% versus 42%, respectively). Diabetes mellitus, hyperlipidaemia and hepatosteatosis were more common among patients aged <75 years. In the multivariate logistic regression analysis, diverticulosis remained an independent predictor of hepatosteatosis (odds ratio 0.529; 95% confidence interval 0.323, 0.866). Other independent predictive factors in the multivariate analysis were triglyceride and albumin. Conclusion Diverticulosis in the elderly was found to be a negative predictor of hepatosteatosis. Higher values of albumin and triglyceride in conjunction with the absence of diverticulosis may be suggestive of nonalcoholic fatty liver disease in the elderly.

Hematological Indices in Portal Hypertension: Cirrhosis versus Noncirrhotic Portal Hypertension

Portal hypertension (PHT) leads to several alterations on hematological indices (HI). The aim of the study is to investigate the differences in HI between cirrhotic subjects and subjects who have noncirrhotic PHT (NCPHT). This retrospective study included 328 patients with PHT (239 cirrhosis and 89 NCPHT). Demographic and clinical features, endoscopic and radiological findings, and HI including neutrophil to lymphocyte ratio (NLR) at the time of PHT diagnosis were recorded. Severity of cirrhosis was assessed according to the Child–Turcotte–Pugh (CTP) classification and Model for End-Stage Liver Disease (MELD) scores. Hematological abnormalities were found in 92.5% of cirrhotic patients and in 55.1% of patients with NCPHT (p < 0.001). While thrombocytopenia was the most common HI in patients with cirrhosis, anemia was the most prevalent HI in NCPHT group. In the cirrhotic group, the NLR was the only parameter to differentiate each CTP group from two others. The NLR value increased with the severity of cirrhosis (2.28 ± 0.14 in CTP-A, 2.85 ± 0.19 in CTP-B and 3.26 ± 0.37 in CTP-C). The AUROC of NLR was 0.692 for differentiating compensated cirrhotic patients from decompensated. Hematological abnormalities are more prevalent and more severe in cirrhotic patients compared to patients with NCPHT. NLR may be used to assess the severity of cirrhosis.

A Neglected Issue in Ulcerative Colitis: Mesenteric Lymph Nodes

Data evaluating the presence and characteristics of mesenteric lymph nodes (LNs) in patients with ulcerative colitis (UC) are scarce. The aim of this study is to determine the presence and characteristics of LNs in UC. The LN characteristics in computed tomography (CT), including LN dimension and attenuation, were evaluated retrospectively in 100 patients with UC (61 active and 39 inactive cases). Clinical characteristics and laboratory parameters, including CBC, biochemical analysis, erythrocyte sedimentation rate (ESR), and C reactive protein (CRP) were also compared. Mesenteric LNs were evident in all patients with UC. The attenuation and dimension of mesenteric LNs did not differ between active and inactive patients with UC. No correlation was found among patients with UC in terms of LN dimension, attenuation, ESR, CRP, leucocyte, and albumin (all with p > 0.05). The current study suggested that inflammation results in the development of mesenteric LN in UC, similar to Crohn’s disease and other inflammatory disorders.

An Overlooked Potentially Treatable Disorder: Idiopathic Mesenteric Panniculitis

Objective: The aim of this study was to determine the prevalence of mesenteric panniculitis (MP) and to describe its clinical characteristics, therapy, and outcome. Subjects and Methods: This retrospective study was carried out among patients with MP based on computed tomography (CT) scans from January 2012 to December 2015. The CT images were reanalyzed by study radiologists to confirm the previous MP diagnosis. Patients were divided into 2 groups, i.e., idiopathic and secondary, based on the presence or absence of associated predisposing factors such as trauma, malignancy, autoimmune disorders, ischemia, or previous abdominal surgery. The clinical characteristics of the 2 groups, as well as treatments, were assessed. Results: Among the 19,869 CT scans, 36 patients (0.18%) with MP were identified (i.e., 19 [53%] females and 17 [47%] males). The median age was 54 years (range 26 - 76). Twenty-four patients (67%) were categorized into the idiopathic group. Malignancy was the predisposing factor in 8 (22%) of those patients. Furthermore, abdominal pain was the cardinal symptom observed in 22 patients (92%) in the idiopathic group. In the idiopathic group, 15 patients (63%) were treated with antibiotics and 16 (67%) were treated with nonsteroidal anti-inflammatory drugs (NSAID). One unresponsive patient was treated with colchicine. Symptomatic relief was achieved in all of the treated patients. Conclusion: In this study, a symptomatic idiopathic subgroup of patients with MP did not have any associated disorder. The response to treatment with antibiotics and NSAID was effective in most of the patients. Based on these findings, anti-inflammatory treatments beyond NSAID and surgery should be reserved for patients who are unresponsive to antibiotics and NSAID.

Çölyak hastalığı; 5 yıllık takip, antikor-patoloji korelasyonu

Giris ve Amac: Bu calismanin amaci colyak hastaligi tanisi ile takip edilen hastalarin klinik, laboratuvar ve patolojik ozelliklerinin arastirilmasidir. Gerec ve Yontem: Klinigimizde colyak hastaligi tanisi ile takip edilen hastalar retrospektif olarak degerlendirildi. Anti-gliadin antikor immunglobulin A, anti-endomisyum, doku transglutaminaz immunglobulin A ve immunglobulin G antikorlari kaydedildi. Hastalarin tani aninda klinik ve laboratuvar ozellikleri patolojik Marsh siniflamasina gore gruplara ayrilarak gruplar arasi farkliliklar saptanmaya calisildi. Bulgular: Calismaya klinigimizde takip edilen toplam 174 hasta alindi. Hastalarin 107’si (%61,5) kadin, 67’si (%38,5) erkekti. Ortalama tani yasi 30,67 (min/mak:18/73)’tu. Tani aninda hastalarin %24’unde anemi, 118 hastanin 24’unde (%20,3) vitamin B12 eksikligi, 110 hastanin 27’sinde (%24,5) folik asit eksikligi mevcuttu. D vitamini eksikligi 84 hastanin 63’unde (%75) saptandi. Kemik mineral dansitometresi bakilan 53 hastanin %49,1’inde (26/53) osteoporoz, %41,5’inde osteopeni (22/53) saptandi ve %9,4’u normaldi. Endoskopik biyopsi sonuclari Marsh siniflamasina gore; 17’si (%14) sinif 1, 20’si (%16,5) sinif 2, 71’i (%58,6) sinif 3 ve 13’u (%10,7) sinif 4 grubundaydi. Marsh 1’de sirasiyla anti-gliadin antikor immunglobulin A, anti-endomisyum, doku transglutaminaz immunglobulin A, doku transglutaminaz immunglobulin G pozitiflik oranlari %22.2, %50, %54.5 ve %20 iken Marsh 4’te pozitiflik oranlari sirasi ile %100, %100, %81.8 ve %87’ye cikmaktadir. Antikor pozitifliginin Marsh 1’den Marsh 4’e giderek arttigi gozlendi. Sonuc: Marsh 1 hastalarinda dusuk oranda antikor pozitifligi saptanmasi bu grup hastalarin bir kisminin colyak olmayabilecegini dusundurmektedir. Marsh 1 saptanan olgularin kesin colyak hastaligi tanisi oncesi, diger hastaliklar yonunden irdelenmesi gerekmektedir.

Bir bölge hastanesi gastroskopi ünitesinde tanı konulan eroziv reflü hastalığı olgularının endoskopik ve klinik özellikleri

Objectives: Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder, presenting with a broad spectrum of symptoms and can be associated with a variety of complication. It has been defined into three groups of patients: nonerosive reflux disease, ero sive esophagitis, and Barrett’s esophagus. The aim of the study was to evaluate patients with erosive reflux disease in our endoscopic unit. Materials and methods: All patients underwent gastroscopy were evaluated retrospectively. H.pylori statuses were evaluated in erosive reflux disease (ERD) patients. All patients were evaluated by videoendoscopy. Evaluation was made by the same operator at single center. Biopsy specimen was taken for H.pylori. Diagnosis of esophagitis was done based on Los Angeles classifica tion criteria. Results: All patients that underwent gastroscopy in our Endoscopy Unit are evaluated. Endoscopically ERD was detected in 104 (13.5%) of 773 patients. The mean age of the ERD patients evaluated in the study was 43.74±18.79 years. Sixty five (62.3%) patients were female, and 39 (38.7%) were male. In 104 patients with ERD, the sliding hiatal hernia and Barrett’s esophagus was seen in 18 and 10 patients, respectively. H.pylori was positive in 50.9% of 104 ERD patients. Conclusion: GERD is a common gastrointestinal disorder and should always be considered during gastroscopy. J Clin Exp Invest 2012; 3(2): 260-262