Oxidative stress, apoptosis, inflammation, and proliferation modulator function of visnagin provide gonadoprotective activity in testicular ischemia-reperfusion injury

OBJECTIVE: Visnagin (Vis) is a compound found in the flowers and seeds of the Ammi visnaga plant with promising antioxidant and anti-inflammatory properties. We aimed to investigate the dose-dependent gonadoprotective effects of visnagin in rats while considering oxidative stress, apoptosis, and inflammation-related protein expression levels. MATERIALS AND METHODS: Twenty-eight adult rats were divided into four groups of seven animals each; control, ischemia/reperfusion (I/R), I/R+30Vis, and I/R+60Vis. Animals in control received no surgical application and were sacrificed at the end of the experiment. The rats in I/R, I/R + Vis30, and I/R + Vis60 were exposed to testicular ischemia and the animals in I/R + Vis30, and I/R + Vis60 groups received either 30 or 60 mg/kg visnagin intraperitoneal. At the end of the experiment, testis tissues were used for the measurement of oxidative stress, apoptosis, and inflammation. RESULTS: Our microscopic examinations indicated that I/R resulted in testicular degenerations and morphological alterations, which were improved in visnagin-treated animals. The biochemical analyses demonstrated that oxidative stress in the I/R group increased significantly (p<0.05) compared to the control group. The immunohistochemical examinations showed that pro-apoptotic Bax and Caspase 3 expressions, and pro-inflammatory tumor necrosis factor-alpha (TNF-α) levels were significantly up-regulated (p<0.05) but proliferating nuclear antigen (PCNA) levels in I/R group was significantly (p<0.001) down-regulated compared to the control group. CONCLUSIONS: Ischemia leading to testicular torsion is a reproductive health-affecting problem, and current surgical treatment methods might be insufficient to recover the testis due to the accumulation of reactive oxygen species (ROS). Our observations indicate that visnagin is a potential co-modality along with the surgical interventions for the recovery of ischemia encountered testis, but we believe the requirement of more detailed studies to explore the underlying signaling pathways and the strength of visnagin against testicular ischemia-reperfusion injury.

Graphical Abstract

https://www.europeanreview.org/wp/wp-content/uploads/GRAB.jpg.

Lymphocyte/mean platelet volume ratio, a new marker; is it effective in predicting the prognosis of COVID-19 cases?

OBJECTIVES

This study aims to determine the prognostic significance of the lymphocyte/mean platelet volume ratio (LMR) in terms of the clinical course of the disease in patients with COVID-19.

METHODS

Patients over 18 who were evaluated for COVID-19 during the period from April 1, to April 30, 2020 were retrospectively scanned. Patients with at least 1 positive PCR test result were as assigned to Group 1 while patients with negative test results were assigned to Group 2. The LMR ratio was calculated by dividing the lymphocyte value by that of MPV. The relationship between LMR, severity of patients' CT findings and 28-day mortality was evaluated.

RESULTS

A total of 938 patients were included in the study. It was observed that the lymphocyte and LMR levels were significantly different in those who died within 28 days (p < 0.001, p ≤ 0.001). In the ROC analysis for the LMR level, the area under the curve (AUC) was found to be 0.737 (95% CI 0.639‒0.834). When the cut‑off value of LMR was 0.045, the sensitivity was found to be 99.0 % and specificity was 15.2 %.

CONCLUSION

LMR can be a guide in multiple cases of care provided to critical patients, as is the case in the COVID-19 pandemic and can be used in recognizing critical patients (Tab. 5, Fig. 1, Ref. 21).

Evaluation of cardiac arrhythmias by electrocardiographic markers in pediatric patients who have tuberous sclerosis without cardiac rhabdomyoma

BACKGROUND

Tuberous sclerosis (TS) is an autosomal dominant and hereditary disorder. Cardiac rhabdomyoma and arrhythmias are the most deleterious risk factors linked to TS. Although arrhythmias in pediatric patients with TS who have cardiac rhabdomyoma have been frequently reported, arrhythmia in patients who have TS without rhabdomyoma is rarely reported in the literature. The study aimed to assess the susceptibility of pediatric patients who have TS without cardiac rhabdomyoma to cardiac arrhythmia using electrocardiographic (ECG) markers.

METHODS

This prospective study included 10 patients who had TS without cardiac rhabdomyoma. The control group was made up of 30 healthy children of the same age and sex as the patient group. P wave, P wave dispersion, QT dispersion, QTc dispersion, TP-e interval, and TP-e interval dispersion were calculated on 12-lead surface ECGs for each patient in both groups and compared.

RESULTS

P wave, P wave dispersion, QT dispersion, and QTc dispersion were found to be significantly higher in the patient group (P<0.001). Furthermore, patients had a greater Tp-e interval and Tp-e interval dispersion than healthy children (P<0.001).

CONCLUSION

Pediatric patients with TS without cardiac rhabdomyoma might be prone to atrial and ventricular arrhythmias according to their prolonged ECG markers. Our findings suggest that patients with TS without cardiac rhabdomyoma need close monitoring for atrial and ventricular arrhythmias.

IgG4 producing POEMS syndrome: A rarely recognized subtype

Serum IgG4 is typically measured for Immunoglobulin G4-related Disease (IgG4-RD), a fibroinflammatory condition associated with polyclonal increase in serum IgG4. Yet, increased IgG4 may still be monoclonal, and little is known about IgG4 POEMS syndrome. We present a case of 40-year-old male with a mass lesion in the left sacral ala. The mass was composed of non-neoplastic fibrous tissue and dense infiltrate of mature plasmacytes with dense eosinophilic cytoplasm and eccentrically placed nuclei that express monoclonal Lambda free light chains and show diffuse positivity for IgG and IgG4. We discuss clinical manifestations and challenges encountered in the diagnosis and treatment of this rare coexistence.

Peripheral inflammatory biomarkers as predictors of recurrence in surgically-treated anogenital condylomata acuminata patients

The aim of this study was to examine the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) in patients with anogenital condylomata acuminata (CA) and their association with recurrence and squamous intraepithelial neoplasia development. We conducted a descriptive study in 95 patients that had undergone surgical treatment for CA. The descriptive data, disease characteristics, and pre-treatment peripheral inflammatory biomarkers (PIBs) were recorded retrospectively. All parameters were compared in those with recurrent and non-recurrent CA. All PIBs were significantly higher in patients with the greatest genital wart size of >2 cm in the squamous intraepithelial lesion (SIL) group. Human papillomavirus (HPV) types 16, 18, 31 and 33, known to carry high risk for anogenital cancer, were significantly related to higher SII. Greater wart size, high-grade squamous intraepithelial lesion (HSIL), and higher PLR and SII values were highly associated with recurrent disease (p = 0.003, 0.006, 0.005 and 0.000, respectively). Of all recurrences, 34.1% were explained by HSIL and increased PLR and SII values. The prediction of CA recurrence is important to determine those patients at high risk. PLR and SII can be used for risk analysis in selected patient groups.

Nesfatin-1 protects from acute pancreatitis: role of melanocortin receptors

Nesfatin-1, a recently discovered peptide, was shown to have anti-inflammatory effects. Acute pancreatitis (AP) is a life-threatening condition caused by various reasons. Although the etiology of AP is well-known, its pathogenesis is not clear. The aim of this study is to investigate the possible anti-inflammatory role of nesfatin-1 and its probable protective underlying mechanisms in an acute pancreatitis model. Caerulein was applied intraperitoneally to induce acute pancreatitis in Sprague-Dawley female rats. Nesfatin-1 was administered 5 minutes before the application of caerulein to determine its potential anti-inflammatory role on AP. Five minutes before nesfatin-1 injection, in order to investigate the underlying mechanism, oxytocin receptor antagonist (atosiban), melanocortin receptor antagonist (HS024), or ghrelin receptor antagonist (cortistatin) were administered. Five minutes after nesfatin-1 administration, two doses of caerulein were applied one hour apart. The rats were sacrified 12 hours after the first caerulein dose for serum and pancreatic tissue sampling. Microscopic damage scoring, malondialdehyde and glutathione levels, myeloperoxidase activity, luminol and lucigenin chemiluminescence levels in pancreatic tissue and amylase, lipase, trypsinogen-2 levels in serum were evaluated. Oxidative damage was decreased with nesfatin-1 treatment in the acute pancreatitis model (P < 0.05 - 0.001). The administration of HS024 reversed the effect of nesfatin-1, via increasing lipase, amylase, trypsinogen-2, malondialdehyde (MDA), myeloperoxidase (MPO) and lucigenin levels (P < 0.05 - 0.01). Atosiban pre-treatment elevated MPO activity, luminol and lucigenin chemiluminescence levels (P < 0.01 - 0.001) and cortistatin increased lucigenin and luminol chemiluminescence (P < 0.05 - 0.01). Although receptor antagonists reversed the effect of nesfatin-1 on related biochemical parameters, no significant difference was found in histological scoring. Our results indicated that nesfatin-1 had an anti-inflammatory effect on acute pancreatitis via mainly effecting melanocortin receptors.

Structural and spectroscopic properties of LaAlBO3 doped with Eu3+ ions

In this study, we performed X-ray diffraction (XRD) and environmental scanning electron microscope (ESEM) techniques to examine the structure and morphological observation of the samples and thermoluminescence (TL) experiments to extract the trapping parameters and dosimetric properties of LaAlBO₃ phosphors doped with Eu at various doping concentrations. Diffraction patterns of obtained sample were well consistent JCPDS card No 98-009-7945, indicating the formation of pure phase. The TL kinetic parameters were estimated by CGCD software. TL glow curves of LaAlBO₃:Eu³⁺ consist of 12 trap levels and exhibited dominantly first order kinetics. Photoluminescence (PL) emission was observed in the range 400-800 nm for LaAlBO₃ phosphor doped with Eu³⁺. The dominant emission of Eu³⁺ corresponding to the electric dipole transition ⁵D₀ → ⁷F₂ is located at 616 nm. The sharp emission properties exhibited demonstrate that the LaAlBO₃ is a suitable host for rare-earth ion doped phosphor material. It is observed that for the variable concentration of Eu³⁺ on PL studies, the PL intensity augments with increase in the dopant concentration and the concentration quenching was found after 1 mass% of Eu³⁺. The PL experimental results reveal that LaAlBO₃:Eu³⁺ phosphor as an red emitting phosphor may be promising luminescence materials for the optoelectronic applications.

Platelet-to-lymphocyte Ratio and Neutrophil-to-lymphocyte Ratio Predict Mucosal Disease Severity in Ulcerative Colitis

Background

We investigated the sensitivity of neutrophil to lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as well as a combination of NLR and PLR to predict endoscopic disease severity based on mucosal assessment in ulcerative colitis (UC).

Methods

The study group consisted 104 patients with active UC, 104 patients in remission, and 105 healthy individuals. Disease activity was described with Rachmilewitz endoscopic activity index (EAI). Curve analysis was used to determine the optimal cutoff values of NLR and PLR for obtaining remission. The patients with both PLR and NLR values higher than the cutoff values were coded as »high risk,« those with one parameter higher were coded as »moderate risk«, those with both parameters lower than the cutoff values were coded as »low-risk« patients.

Results

The mean NLR and PLR values in the endoscopically active disease group were higher than the others, with higher values in the endoscopic remission group compared with the control group (p<0.001). Rachmilewitz EAI in high-risk patients was significantly higher than that in others (p<0.001). In Cox regression analyses, moderate and high risk, high erythrocyte sedimentation rate and high EAI were found as independent predictors of endoscopic active disease.

Conclusions

This is the first study that investigated the use of NLR and PLR combination to assess endoscopic disease severity in UC. Either high NLR or PLR levels can predict active endoscopic disease. However, the use of these parameters in combination is more accurate in evaluating mucosal disease and inflammation in UC.

A New Marker to Determine Prognosis of Acute Pancreatitis: PLR and NLR Combination

Background

We aimed to investigate the prognostic importance of platelet-lymphocyte ratio (PLR) and neutro - phil-lymphocyte ratio(NLR) combination for patients diagnosed with acute pancreatitis and its relationship with mortality.

Methods

This retrospective study was included 142 patients diagnosed with acute pancreatitis. Ranson, Atlanta and BISAP 0h, 24h and 48h scores of the patients were calculated by examining their patient files. The patients were divided into three groups as low-risk, medium-risk and high-risk patients according to their PLR and NLR levels.

Results

The number of patients with acute pancreatitis complications such as necrotizing pancreatitis, acute renal failure, sepsis and cholangitis was significantly higher in the high-risk group compared to other groups. Mortality rate was found to be 90% in the high-risk group, 16% in the medium-risk group, and 1.9% in the low-risk group. The number of patients with a Ranson score of 5 and 6, a severe Atlanta score, a BISAP 0h score of 3 and 4, a BISAP 24h and 48h score of 4 and 5 was higher in the high-risk group compared to other groups. PLR-NLR combination, Atlanta and Ranson scores, and C-reactive protein level were determined to be independent risk factors predicting mortality in stepwise regression model. PLR-NLR combination had the highest area under curve value in terms of predicting acute claspancreatitis prognosis and had a similar diagnostic discrimination with other scoring systems.

Conclusion

In our study it was found that PLR-NLR combination had a similar prognostic importance with other scoring systems used to determine acute pancreatitis prognosis.

The role of the PLR-NLR combination in the prediction of the presence of Helicobacter pylori and its associated complications

BACKGROUND/AIM

The aim of this study was to investigate the role of the platelet-to-lymphocyte ratio (PLR)-neutrophil-to-lymphocyte ratio (NLR) combination, in the prediction of the presence of Helicobacter pylori (HP) and its associated complications in the gastrointestinal system.

PATIENTS AND METHODS

In all, 1289 patients who underwent esophagogastroduodenoscopy and biopsy for HP were included in the study.

RESULTS

The ratio of patients with moderate and severe chronic gastritis was higher in HP (+) group than HP (-) group. The ratio of patients with levels 1-3 atrophy and intestinal metaplasia was higher in HP (+) group. Compared with HP (-) group, HP (+) had higher PLR and NLR levels. The ratio of HP (+) patients was higher in high-risk group compared with low- and medium-risk groups. HP invasion stage, the intestinal metaplasia level, and the ratio of patients with atrophy level "3" were higher in high-risk group compared with low- and medium-risk groups. Regression analysis showed that the PLR-NLR combination was an independent risk factor for both HP presence and moderate and severe chronic gastritis.

CONCLUSION

We found the PLR-NLR combination to be a good predictor of HP presence and gastrointestinal complications associated with HP.

Is Oxidative Stress Associated with Activation and Pathogenesis of Inflammatory Bowel Disease?

Background

We aimed to determine the levels of total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI) and paraoxonase1/arylesterase levels in inflammatory bowel disease (IBD), and the relation be - tween these molecules and the activity index of the disease.

Methods

Eighty IBD patients (ulcerative colitis (UC)/Crohn disease (CD) 40/40) and 80 control group participants were included in the study. Oxidative stress parameters were measured using the colorimetric method. As disease activity indexes, the endoscopic activity index (EAI) was used for UC and the CD activity index (CDAI) was used for CD.

Results

In IBD patients, mean TAS (1.3±0.2 vs 1.9±0.2, respectively; p<0.001) and arylesterase (963.9±232.2 vs 1252.9±275, respectively; p<0.001) levels were found to be lower and TOS level (5.6±1.6 vs 4.0±1.0, respectively; p<0.001) and OSI rate (4.5±1.6 vs 2.2±0.8, respectively; p<0.001) were found to be higher compared to the control group. A strong positive correlation was found between EAI and TOS levels (r=0.948, p<0.001) and OSI rate (r=0.894, p<0.001) for UC patients. A very strong positive correlation was found between EAI and TOS levels (r=0.964, p<0.001) and OSI rate (r=0.917, p<0.001) for CD patients. It was found in a stepwise regression model that C-reactive protein, OSI and arylesterase risk factors were predictors of IBD compared to the control group. Conclusion: Increased oxidative stress level in IBD patients and the detection of OSI rate as an independent predictor for disease activity indexes lead to the idea that oxidative stress might be related to the pathogenesis of IBD.

Anti-inflammatory effects of nesfatin-1 on acetic acid-induced gastric ulcer in rats: involvement of cyclo-oxygenase pathway

In order to elucidate the contribution of cycloxygenase (COX) enzymes in the anti-oxidant and anti-inflammatory mechanisms of nesfatin-1, which improves the healing process of chronic gastric ulcers, either acetic acid (80%; ulcer groups; n = 40) or saline (control groups; n = 40) was applied to the serosal surface of male Sprague Dawley rats' stomachs for 1 min. Both the control and ulcer groups were treated daily with either i.p. saline or nesfatin-1 (0.3 μg/kg; for 3 days). Nesfatin-1-treatment was preceded with i.p. saline, COX-2 inhibitor NS-398 (2 mg/kg), COX-1 inhibitor ketorolac (3 mg/kg) or non-selective COX inhibitor indomethacin (5 mg/kg) for 3 days. The rats were decapitated at the end of the third day, and their trunk blood was collected for the measurements of tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and IL-10 using ELISA. The induction of ulcers resulted in increased macroscopic scores, along with elevated gastric malondialdehyde, luminol- and lucigenin-enhanced chemiluminescence levels and myeloperoxidase activity. On the other hand, nesfatin-1 treatment abolished these elevations. Depleted glutathione, superoxide dismutase and catalase activity levels in the saline-treated ulcer group were preserved in the nesfatin-1-treated ulcer group. Increased levels of serum TNF-α, IL-1β, IL-10 in the saline-treated ulcer group, as compared to control group, were significantly decreased in the nesfatin-1-treated ulcer group. The inhibition of COX-1, and/or COX-2 reversed most of the alterations induced with nesfatin-1, but COX-2-blockade was consistently more effective to abolish all nesfatin-1-induced changes. Our results suggest that nesfatin-1 ameliorates ulcer-induced inflammatory response through the modulation of oxidant-antioxidant balance. As selective pharmacological inhibition of COX-1 or COX-2 suppresses the antioxidant/anti-inflammatory effects of nesfatin-1, it appears that nesfatin-1 decreases inflammatory mediators and neutrophil migration by a COX-dependent mechanism, especially by a COX-2- dependent mechanism, during the ulcer healing stage.

Factors associated with increased irisin levels in the type 1 diabetes mellitus

OBJECTIVE

The aim of the present study was to determine the irisin levels in patients with the type 1 diabetes mellitus (T1DM) and to examine the relation of irisin levels with the inflammation and autoimmunity.

METHODS

This study included 35 cases diagnosed with T1DM and 36 healthy volunteers. Antiglutamic acid decarboxylase (anti-GAD), islet cell antibody (ICA), and insulin autoantibody levels were measured in patients at the time when they were included into the study and recorded from the patient files. Serum irisin levels were measured by ELISA kit.

RESULTS

The median irisin levels were determined higher in T1DM group compared to the control one (6.8 ng/ml vs. 4.8 ng/ml, p=0.022; respectively). Median irisin levels were higher in anti-GAD (p=0.022) and ICA (p=0.044) positive groups compared to negative groups. In T1DM group, irisin levels displayed positive correlation with glycosylated hemoglobin (HbA1c) (r=0.377, p<0.001) and anti-GAD (r=0.392, p=0.020) and negative correlation with creatinine (r=-0390, p=0.021). In multivariate regression model, HbA1c (B±SE: 2.76±17683, p<0.001), and anti-GAD (B±SE: 2.311±0.610, p=0.001) were determined as independent predictors for predicting the irisin levels.

CONCLUSION

In patients with T1DM, which chronic inflammation and autoimmunity take part in their etiopathogenesis, anti-GAD levels were an independent risk factor for the irisin. Th is may suggest that factors such as inflammation and autoimmunity can be effective in the synthesis of irisin.

Predictive value of C-reactive protein/albumin ratio in acute pancreatitis

BACKGROUND

Serum C-reactive protein (CRP) increases and albumin decreases in patients with inflammation and infection. However, their role in patients with acute pancreatitis is not clear. The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients.

METHODS

This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015. Ranson scores, Atlanta classification and CRP/albumin ratios of the patients were calculated.

RESULTS

The CRP/albumin ratio was higher in deceased patients compared to survivors. The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time, CRP and erythrocyte sedimentation rate. In addition to the CRP/albumin ratio, necrotizing pancreatitis type, moderately severe and severe Atlanta classification, and total Ranson score were independent risk factors of mortality. It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk. A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity. It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28. Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death.

CONCLUSION

The CRP/albumin ratio is a novel but promising, easy-to-measure, repeatable, non-invasive inflammation-based prognostic score in acute pancreatitis.

Thiol/disulphide homeostasis in celiac disease

AIM

To determine dynamic thiol/disulphide homeostasis in celiac disease and to examine the associate with celiac autoantibodies and gluten-free diet.

METHODS

Seventy three patients with celiac disease and 73 healthy volunteers were enrolled in the study. In both groups, thiol/disulphide homeostasis was examined with a new colorimetric method recently developed by Erel and Neselioglu.

RESULTS

In patients with celiac disease, native thiol (P = 0.027) and total thiol (P = 0.031) levels were lower, while disulphide (P < 0.001) level, disulphide/native thiol (P < 0.001) and disulphide/total thiol (P < 0.001) ratios were higher compared to the control group. In patients who do not comply with a gluten-free diet, disulphide/native thiol ratio was found higher compared to the patients who comply with the diet (P < 0.001). In patients with any autoantibody-positive, disulphide/native thiol ratio was observed higher compared to the patients with autoantibody-negative (P < 0.05). It is found that there is a negative correlation between celiac autoantibodies, and native thiol, total thiol levels and native thiol/total thiol ratio, while a positive correlation is observed between disulphide, disulphide/native thiol and disulphide/total thiol levels.

CONCLUSION

This study is first in the literature which found that the patients with celiac disease the dynamic thiol/disulphide balance shifts through disulphide form compared to the control group.

The evaluation of renal parenchymal scarring using static renal scintigraphy after percutaneous nephrolithotomy operations

OBJECTIVE

To analyze whether operative techniques and other variables related to patient and renal stone characteristics affect potential renal parenchymal damage.

MATERIALS AND METHODS

The study population comprised 64 patients who underwent percutaneous nephrolithotomy operations (PCNL). Data of the operated renal units, renal stone burden, route and number of entries, dilation techniques, duration of surgery, preoperative and postoperative glomerular filtration rate (GFR) and relative dimercaptosuccinic acid (DMSA) uptakes, as well as the changes in hemoglobin values, were recorded and analyzed for all patients.

RESULTS

The mean age of the patients was 44 years. In 11 (17.1%) cases, renal cortical defects in the 3rd month were detected on DMSA scintigraphy. When the patients with and without renal cortical defect were compared regarding their preoperative and postoperative GFR values, no statistically significant difference was noticed between the groups (P > 0.05). Similarly, when postoperative relative DMSA uptakes were compared with preoperative relative DMSA uptakes of the same kidneys, no statistical significance was seen. When preoperative relative DMSA uptake values between groups with and without renal scarring were compared, no statistically significant difference was observed (P > 0.05).

CONCLUSION

We did not observe any significant difference in scintigraphic parameters and GFR values. Hence, in the current trial, significant loss in renal function after PCNL operations was not observed. Thus, PCNL operations should be regarded as safe, but still, the risk of loss of kidney function should always be considered.

Crohn's disease in the elderly: Clinical presentation and manifestations from a tertiary referral center in Turkey

OBJECTIVE

There is no precise consensus at present on age to define elderly patients with inflammatory bowel disease (IBD), but recently, age of more than 60 years has been widely accepted. Characteristics of IBD in the elderly are somewhat different from what is seen in younger patients. The elderly have milder disease activity, and therapeutic options are fewer because of their age and features such as comorbidities, drug interactions, and loss of organ function. There are few reports on Crohn's disease in the elderly. Herein, first report on this topic with respect to population of this country is presented.

METHODS

Characteristics of 95 patients with Crohn's disease, who were over age 60 from 3125 patients with IBD treated in our clinic between 1996 and 2015 were analyzed. Research was performed using patient files, and outpatient clinic visits, when possible.

RESULTS

Median age of the group was 66 years, and male:female ratio was 1.6. Of the total, 48.4% of the patients had colonic disease, 37.9% had ileocolonic disease, and 13.7% had small bowel disease. Data indicated that 23.1% of patients had undergone surgical procedures, which were primarily right hemicolectomy and ileotransversostomy. Disease was most often managed with mesalazine or azathioprine. It was also determined that 12.6% patients had 2 or more comorbidities, and findings indicated coronary heart disease and hypertension were most prevalent.

CONCLUSION

Analysis revealed similar features in characteristics of disease compared with recent knowledge reported in the literature. This is the first report from our country to describe Crohn's disease in the elderly population, and the number of patients is sufficient to provide general information about this group.

The induction of autoimmune hepatitis in the human leucocyte antigen-DR4 non-obese diabetic mice autoimmune hepatitis mouse model

Autoimmune hepatitis (AIH) is a chronic liver disease characterized by progressive inflammation, female preponderance and seropositivity for autoantibodies such as anti-smooth muscle actin and/or anti-nuclear, anti-liver kidney microsomal type 1 (anti-LKM1) and anti-liver cytosol type 1 (anti-LC1) in more than 80% of cases. AIH is linked strongly to several major histocompatibility complex (MHC) alleles, including human leucocyte antigen (HLA)-DR3, -DR7 and -DR13. HLA-DR4 has the second strongest association with adult AIH, after HLA-DR3. We investigated the role of HLA-DR4 in the development of AIH by immunization of HLA-DR4 (DR4) transgenic non-obese diabetic (NOD) mice with DNA coding for human CYP2D6/FTCD fusion autoantigen. Immunization of DR4 mice leads to sustained mild liver injury, as assessed biochemically by elevated alanine aminotransferase, histologically by interface hepatitis, plasma cell infiltration and mild fibrosis and immunologically by the development of anti-LKM1/anti-LC1 antibodies. In addition, livers from DR4 mice had fewer regulatory T cells (T_regs ), which had decreased programmed death (PD)-1 expression. Splenic T_regs from these mice also showed impaired inhibitory capacity. Furthermore, DR4 expression enhanced the activation status of CD8⁺ T cells, macrophages and dendritic cells in naive DR4 mice compared to naive wild-type (WT) NOD mice. Our results demonstrate that HLA-DR4 is a susceptibility factor for the development of AIH. Impaired suppressive function of T_regs and reduced PD-1 expression may result in spontaneous activation of key immune cell subsets, such as antigen-presenting cells and CD8⁺ T effectors, facilitating the induction of AIH and persistent liver damage.

Diagnosis of fasciola hepatica cases in an operating room

Fascioliasis is a zoonotic disease that is acquired by ingestion of the metacercaria form on uncooked aquatic plants, and humans act as an accidental host. Diagnosis is confirmed by the demonstration of the parasites or evidence of them in faeces and serology. In the absence of these data, delays or misdiagnosis may occur since it may mimic many diseases. In this study, we present three cases, among them two were similar to the above-mentioned statement. The first case, to the best of our knowledge, is the first case with adult-type living fluke in the gall bladder, diagnosed by laparoscopic cholecystectomy.

Is ischemia modified albumin a disease activity marker for inflammatory bowel diseases?

BACKGROUND AND AIM

We aimed to identify ischemia-modified albumin (IMA) levels in inflammatory bowel disease (IBD) and IBD subgroups, and to examine its relation with disease activity index.

METHODS

Sixty-eight patients with IBD (35 ulcerative colitis [UC] and 33 crohn disease [CD]) and 65 healthy volunteers were included in the study. Rachmilewitz scoring system (endoscopic activity index [EAI]) was used to determine UC activity, and as for CD activity, CD activity index (CDAI) scoring was used. IMA measurement was performed with ELISA kit.

RESULTS

Ischemia-modified albumin levels in IBD, UC, and CD groups were comparably higher than the control group (37.7 ng/mL vs 42.4 ng/mL vs 36.4 ng/mL vs 21.8 ng/mL, respectively; P < 0.05). In IBD group, a positive correlation was identified between IMA level and CRP (r = 0.325, P = 0.011), EAI(r = 0.302, P = 0.020), and CDAI (r = 0.311, P = 0.013). In stepwise regression model; it was identified that IMA(OR = 1.496; P = 0.016) and CRP(OR = 3.457; P = 0.015) are predictors of IBD in comparison with the control group. In linear regression model, it was identified that risk factors such as log(IMA) and log(CRP) were independent predictors of log(CDAI) and log(EAI) levels.

CONCLUSION

This is the first study showing that IMA levels in IBD were determined higher in comparison with the control group. Moreover, IMA being a predictor for IBD and being positively correlated with disease activity indexes were determined for the first time in the study. In accordance with these results, it is possible to say that IMA in IBD might be related with the pathogenesis of disease and correlated with the severity of the disease.

The role of soluble tumor necrosis factor like weak inducer of apoptosis and interleukin-17A in the etiopathogenesis of celiac disease: A cross-sectional study

Our aim in this study was to determine soluble tumor necrosis factor (TNF)-like weak inducer of apoptosis (sTWEAK) and interleukin-17A (IL-17A) levels in celiac disease, and their association with the gluten diet and autoantibodies. Eighty patients with celiac diagnosis and 80 healthy control individuals with similar age, gender and body mass index to the patient group were included in the study. Serum sTWEAK and IL-17A levels were measured by the serum enzyme-linked immunosorbent assay kit. The median IL-17A (117.5 pg/mL vs. 56.7 pg/mL; P = 0.001) level in celiac patients was higher than in the control group, while the median sTWEAK (543 pg/mL vs. 643 pg/mL; P = 0.016) level in patients was determined to be lower. In the patient group, patients who complied with the gluten diet had a lower level of median IL-17A (98.1 pg/mL vs. 197.5 pg/mL; P = 0.034) and a higher level of sTWEAK (606 pg/mL vs. 522.8 pg/mL; P = 0.031) than those who did not adhere. Furthermore, the IL-17A level was higher and the sTWEAK level was lower in celiac patients with positive antibody than those with negative antibody. A positive correlation was determined among anti-gliadin antibody IgA, anti-gliadin antibody IgG, anti-tissue transglutaminase IgG levels and the IL-17A level, and a negative correlation was determined with the sTWEAK level. In celiac disease, the sTWEAK and IL-17A levels differ between patients who cannot adapt to the gluten diet and who are autoantibody positive, and patients who adapt to the diet and are autoantibody negative. We believe that sTWEAK and IL-17A are associated with the inflammation in celiac pathogenesis.

Tp-e Interval, Tp-e/QTc Ratio, and Fragmented QRS Are Correlated with the Severity of Liver Cirrhosis

BACKGROUND

Arrhythmias and electrocardiographic changes are reported in several noncardiac diseases, including liver cirrhosis (LC). We intended to evaluate the interval from the peak to the end of the electrocardiographic T wave (Tp-e), Tp-e/QTc ratio, and fQRS as presumed markers of arrhythmias in LC.

METHODS

In this cross-sectional study, a total of 88 consecutive patients with LC according to clinical, biological, ultrasonographic, or histological criteria and 73 control subjects were enrolled. The severity of cirrhosis was classified according to Pugh-Child's classification and Model for End-Stage Liver Disease (MELD) score. Tp-e interval, Tp-e/QTc ratio, and fQRS rates were measured from the 12-lead electrocardiogram.

RESULTS

Tp-e interval, Tp-e/QTc ratio and fQRS rates were significantly increased in parallel to the severity of LC (P < 0.001, P < 0.001, and P = 0.003, respectively). In correlation analysis, Pugh-Child stage showed a significantly positive correlation with Tp-e interval (r = 0.462, P < 0.001), QTc interval (r = 0.373, P < 0.001), Tp-e/QTc ratio (r = 0.352, P < 0.001), and fQRS (r = 0.407, P < 0.001). Furthermore, Tp-e interval (r = 0.414, P < 0.001) and Tp-e/QTc ratio (r = 0.426, P< 0.001) had significant positive correlation with MELD score.

CONCLUSIONS

Our study demonstrated that Tp-e interval, Tp-e/QTc ratios, and fQRS rates were significantly increased in parallel to the severity of LC. Thus, these findings may implicate that Tp-e interval, Tp-e/QTc ratio, and fQRS may be novel and useful indicators for prediction of arrhythmias in LC.

The Prevalence of Barrett Esophagus Diagnosed in the Second Endoscopy: A Retrospective, Observational Study at a Tertiary Center

At present, we do not know the exact prevalence of Barrett esophagus (BE) developing later in patients without BE in their first endoscopic screening. The purpose of this study was to determine the prevalence of BE on the second endoscopic examination of patients who had no BE in their first endoscopic examination.The data of the patients older than 18 years who had undergone upper gastrointestinal system endoscopy more than once at the endoscopy unit of our clinic during the last 6 years were retrospectively analyzed.During the last 6 years, 44,936 patients had undergone at least one endoscopic examination. Among these patients, 2701 patients who had more than one endoscopic screening were included in the study. Of the patients, 1276 (47.3%) were females and 1425 (52.7%) were males, with an average age of 54.9 (18-94) years. BE was diagnosed in 18 (0.66%) of the patients who had no BE in the initial endoscopic examination. The patients with BE had reflux symptoms in their medical history and in both endoscopies, they revealed a higher prevalence of lower esophageal sphincter laxity, hiatal hernia, and reflux esophagitis when compared to patients without BE (P < 0.001).Our study showed that in patients receiving no diagnosis of BE on their first endoscopic examination performed for any reason, the prevalence of BE on their second endoscopy within 6 years was very low (0.66%).

Determination of thiol/disulphide homeostasis in type 1 diabetes mellitus and the factors associated with thiol oxidation

In this study, we aimed to examine dynamic thiol/disulfide homeostasis in type 1 diabetes mellitus (T1DM) and identify the factors associated with thiol oxidation. Thirty-eight subjects (18 male, 20 female) diagnosed with T1DM and 38 (17 male, 21 female) healthy volunteers without any known diseases were included in the study. Thiol/disulfide homeostasis concentrations were measured by a newly developed method (Erel & Neselioglu) in this study. After native thiol, total thiol and disulfide levels were determined; measures such as disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol were calculated. In T1DM patients, compared to the control group, disulfide (p = 0.024), disulfide/native thiol (p < 0.001), and disulfide/total thiol (p < 0.001) were determined higher, while native thiol (p = 0.004) and total thiol (p < 0.001) levels were much lower. In the patient group, a positive correlation was determined between c-reactive protein (r = 325, p = 0.007; r = 316, p = 0.010, respectively), fasting blood glucose (r = 279, p = 0.018; r = 251, p = 0.035, respectively), and glycosylated hemoglobin (r = 341, p = 0.004; r = 332, p = 0.005, respectively) and rates of disulfide/native thiol and disulfide/total thiol. We determined that thiol oxidation increase in T1DM patients compared to the control group. We thought that hyperglycemia and chronic inflammation might be the major cause of increase in oxide thiol form. In order to determine the relationship between the status of autoimmunity and dynamic thiol/disulfide in T1DM, dynamic thiol/disulfide homeostasis in newly diagnosed-antibody positive-T1DM patients is required to be investigated.

Association between the neutrophil to lymphocyte ratio and prehypertension

OBJECTIVES

To explore the neutrophil-lymphocyte ratio (NLR) in patients with prehypertension (PHT).

BACKGROUND

Inflammation plays an important role in the development of cardiovascular diseases. A pathophysiological link also exists between inflammation and PHT. NLR is a simple marker for the assessment of inflammatory status. There is a lack of data regarding the association between NLR and pre-hypertensive state.

METHODS

The present cross-sectional study included 33 newly diagnosed PHT patients and 35 normotensive control subjects. Prehypertension was defined as a systolic blood pressure (BP) of 120-139 mm Hg and/or a diastolic BP of 80-89 mm Hg.

RESULTS

Patients were divided into tertiles based on NLR values: 1.17 (0.9-1.42) in tertile 1; 1.57 (1.43-1.78) in tertile 2; and 2.40 (1.82-4.5) in tertile 3. The frequency of PHT was significantly higher for patients in the upper NLR tertile compared to the middle and lower NLR tertiles (21 (91.3%), 7 (30.4%), and 5 (22.7%), respectively; p<0.001). Systolic BP and diastolic BP were significantly higher among patients in the upper NLR tertile than among those in the other NLR tertiles.

CONCLUSION

An association exists between PHT and NLR. NLR measurement, as well as monocyte count, may be used to indicate increased risk of prehypertension (Tab. 2, Ref. 48).

Anti-inflammatory effects of nesfatin-1 in rats with acetic acid - induced colitis and underlying mechanisms

Mucosal balance impairment, bacterial over-proliferation, cytokines, inflammatory mediators are known as responsible for inflammatory bowel disease. Besides known anorexigenic, neuroprotective, and anti-apoptotic effects, the major effect of nesfatin-1 on colitis is unknown. Our aim was to investigate the possible anti-inflammatory effects of nesfatin-1 in acetic acid induced colitis model and potential underlying mechanisms. Male Spraque-Dawley rats were anesthetized by intraperitoneal ketamine (100 mg/kg) and chlorpromazine (0.75 mg/kg). For nesfatin-1 and antagonist applications some of the rats were intracerebroventricularly (i.c.v.) cannulated. In colitis group, intrarectally (i.r.) 4% acetic acid solution (1 ml) and 10 minutes later i.c.v. nesfatin-1 (0.05 μg/5 μl) or vehicle (5 μl) were administered. Treatments continued for 3 days. In control group, physiological saline solution was used intrarectally. To identify the underlying effective mechanism of nesfatin-1, rats were divided into 3 subgroups, 5 minutes following colitis induction; i.c.v. atosiban (oxytocin receptor antagonist), SHU9119 (melanocortin receptor antagonist) or GHSR-1a antagonist (ghrelin receptor antagonist) were administered, 5 minutes later nesfatin-1 was administered for 3 days. On the fourth day, rats were decapitated, and colon tissues were sampled. Macroscopic and microscopic damage scores of distal colon, and colonic tissue malondialdehyde, glutathione, myeloperoxidase, superoxide dismutase, catalase, luminol and lucigenin chemiluminescence measurements were analysed. The increased myeloperoxidase activity, malondialdehyde levels, luminol and lucigenin chemiluminescence measurements, macroscopic and microscopic damage scores with colitis induction (P < 0.05 - 0.001) were decreased with nesfatin-1 treatment (P < 0.05 - 0.001). Nesfatin-1 may show this effect by inhibiting neutrophil infiltration through tissues and by decreasing formation of free oxygen radicals. Atosiban and GHSR-1a administration alleviated the protective effect of nesfatin-1 from microscopic and oxidant damage parameters and lipid peroxidation (P < 0.05 - 0.001). The results of the study suggest that nesfatin-1 had a protective effect from colitis induction, and the anti-inflammatory and antioxidant effects of nesfatin-1 on colitis might occur via oxytocin and ghrelin receptors.

Treatment of Crohn’s disease and familial Mediterranean fever by leukopheresis: Single shot for two targets

Coexistence of Crohn's disease (CD) and familial Mediterranean fever (FMF) is a rare condition and knowledge about this clinical situation is limited with a few case reports in the literature. The treatment of both diseases depends on their individual therapies. However, it is very hard to deal with this coexistence when CD is refractory to standard therapies. Ongoing activity of CD triggers the clinical attacks of FMF and the symptoms like abdominal pain interfere with both disease presentations which can cause problems about diagnostic and therapeutic approach. The main therapeutic agent for FMF is colchicine and diarrhea is the most common side effect of this drug. This side effect also causes problems about management of these diseases when both of them are clinically active. Here we report probably the first case in the literature with coexisting CD and FMF who was successfully treated by leukopheresis since he was refractory to conventional therapies for CD.

St. John's wort may ameliorate 2,4,6-trinitrobenzenesulfonic acid colitis off rats through the induction of pregnane X receptors and/or P-glycoproteins

It is reported that deficiencies of the pregnane X receptor (PXR) and P-glycoprotein (P-gp), the latter of which is encoded by the MDR1 gene, are important factors in the pathogenesis of inflammatory bowel disease (IBD). It is also known that the activation of PXR is protective of IBD due to the mutual repression between PXR and nuclear factor kappa B (NF-κB) expression and because NF-κB was reported to play a pivotal role in the pathogenesis of ulcerative colitis. The goal of this study was to investigate whether St. John's wort (SJW) and spironolactone (SPL), both known to have strong inducing effects on cytochrome P 450 (CYP) enzymes as well as PXR and P-gp, have ameliorating effects on 2,4,6-trinitrobenzenesulfonic acid (TNBS) colitis of rats through induction of PXR and/or P-gp. Wistar albino rats (250 - 300 g) were divided into control and TNBS-colitis groups. Each group was then divided into a) control (saline), b) SJW (300 mg/kg p.o. bid), and c) SPL (80 mg/kg p.o.) groups. Drugs were given for 7 days. Both treatments ameliorated the clinical hallmarks of colitis, as determined by body weight loss and assessment of diarrhea, colon length, and bowel histology. Plasma levels of NF-κB, tumour necrosis factor-alpha (TNF-α) and tissue myeloperoxidase (MPO) activity, as well as the oxidative stress markers that increased during colitis, decreased significantly after both treatments. The PXR and P-gp expression in the intestinal tissues was diminished in the colitis group but increased after drug treatments. Both drugs appeared to have significant antioxidant and anti-inflammatory effects and ameliorated the TNBS colitis of the rats, most likely through their PXR- and P-gp-inducing properties.

Bridging data models and terminologies to support adverse drug event reporting using EHR data

INTRODUCTION

This article is part of the Focus Theme of METHODs of Information in Medicine on "Managing Interoperability and Complexity in Health Systems".

BACKGROUND

SALUS project aims at building an interoperability platform and a dedicated toolkit to enable secondary use of electronic health records (EHR) data for post marketing drug surveillance. An important component of this toolkit is a drug-related adverse events (AE) reporting system designed to facilitate and accelerate the reporting process using automatic prepopulation mechanisms.

OBJECTIVE

To demonstrate SALUS approach for establishing syntactic and semantic interoperability for AE reporting.

METHOD

Standard (e.g. HL7 CDA-CCD) and proprietary EHR data models are mapped to the E2B(R2) data model via SALUS Common Information Model. Terminology mapping and terminology reasoning services are designed to ensure the automatic conversion of source EHR terminologies (e.g. ICD-9-CM, ICD-10, LOINC or SNOMED-CT) to the target terminology MedDRA which is expected in AE reporting forms. A validated set of terminology mappings is used to ensure the reliability of the reasoning mechanisms.

RESULTS

The percentage of data elements of a standard E2B report that can be completed automatically has been estimated for two pilot sites. In the best scenario (i.e. the available fields in the EHR have actually been filled), only 36% (pilot site 1) and 38% (pilot site 2) of E2B data elements remain to be filled manually. In addition, most of these data elements shall not be filled in each report.

CONCLUSION

SALUS platform's interoperability solutions enable partial automation of the AE reporting process, which could contribute to improve current spontaneous reporting practices and reduce under-reporting, which is currently one major obstacle in the process of acquisition of pharmacovigilance data.

Healthcare information technology infrastructures in Turkey

OBJECTIVES

The objective of this paper is to describe some of the major healthcare information technology (IT) infrastructures in Turkey, namely, Sağlık-Net (Turkish for "Health-Net"), the Centralized Hospital Appointment System, the Basic Health Statistics Module, the Core Resources Management System, and the e-prescription system of the Social Security Institution. International collaboration projects that are integrated with Sağlık-Net are also briefly summarized.

METHODS

The authors provide a survey of the some of the major healthcare IT infrastructures in Turkey.

RESULTS

Sağlık-Net has two main components: the National Health Information System (NHIS) and the Family Medicine Information System (FMIS). The NHIS is a nation-wide infrastructure for sharing patients' Electronic Health Records (EHRs). So far, EHRs of 78.9 million people have been created in the NHIS. Similarly, family medicine is operational in the whole country via FMIS. Centralized Hospital Appointment System enables the citizens to easily make appointments in healthcare providers. Basic Health Statistics Module is used for collecting information about the health status, risks and indicators across the country. Core Resources Management System speeds up the flow of information between the headquarters and Provincial Health Directorates. The e-prescription system is linked with Sağlık-Net and seamlessly integrated with the healthcare provider information systems. Finally, Turkey is involved in several international projects for experience sharing and disseminating national developments.

CONCLUSION

With the introduction of the "Health Transformation Program" in 2003, a number of successful healthcare IT infrastructures have been developed in Turkey. Currently, work is going on to enhance and further improve their functionality.

A study comparing the efficacy of antimicrobial agents versus enzyme (P-gp) inducers in the treatment of 2,4,6 trinitrobenzenesulfonic acid-induced colitis in rats

The intestinal microflora is an important cofactor in the pathogenesis of intestinal inflammation; and the epithelial cell barrier function is critical in providing protection against the stimulation of mucosal immune system by the microflora. In the present study, therapeutic role of the antibacterial drugs rifampicin and ciprofloxacine were investigated in comparison to spironolactone, an enzyme inducer, in 2,4,6-trinitrobenzenesulfonic acid (TNBS)-induced colitis of the rats. Drugs were administered for 14 days following induction of colitis. All drug treatments ameliorated the clinical hallmarks of colitis as determined by body weight loss and assessment of diarrhea, colon length, and histology. Oxidative damage and neutrophil infiltration as well as nuclear factor κB (NF-κB) and tumor necrosis factor α (TNF-α) expressions that were increased during colitis, were decreased significantly. Rifampicin and ciprofloxacin were probably effective due to their antibacterial and immunomodulating properties. The multidrug resistence gene (MDR1) and its product p-glycoprotein (P-gp) has been implicated in the pathogenesis of inflammatory bowel disease (IBD). In the present study, findings of the P-gp expression were inconclusive but regarding previous studies, it can be suggested that the beneficial effects of rifampicin and spironolactone may be partly due to their action as a P-gp ligand. Spironolactone has been reported to supress the transcription of proinflamatory cytokines that are considered to be of importance in immunoinflammatory diseases. It is also a powerful pregnane X receptor (PXR) inducer; thus, inhibition of the expression of NF-κB and TNF-α, and amelioration of inflammation by spironolactone suggest that this may have been through the activation of PXR. However, our findings regarding PXR expression were inconclusive. Activation of PXR by spironolactone probably also contributed to the induction of P-gp, resulting in extrusion of noxious substances from the tissue.

Primary Testicular Diffuse Large B-Cell Lymphoma: A Case Report

Testicular lymphoma was first reported by Malassez and Curling in 1866. Primary testicular lymphoma constitutes only 1-7% of all testicular neoplasms and less than 1% of all non Hodgkin lymphoma. We report the case of a 47-year-old man without a particular past medical history, who presented with a painful left testicular swelling that he has noticed for several weeks. Radiological findings consisted in multiple hypoechoic masses that corresponded in histological examination to a diffuse intratubular lymphomatous infiltration situated away from the spermatic cord, the epididymis, ductuli efferentes and rete testis. Immunohistochemical study showed positivity of MUM-1, Bcl-2 and B-cell marker (CD20) and TdT, CD 3, CD5, Bcl-1, CD10, Bcl-6 and Myeloperoksidaz were negative. Ki-67 proliferation index was 90% of neoplastic lenfoid infiltration. The patient underwent full staging for lymphoma by positron emission tomography, showing right superior paratrakeal, precarinal, subcarinal, left paraaortic and retrocrural and left iliac involvement lymph nodes also the right testis and of extra-testicular involvement by the skeleton sistem. The diagnosis of stage III primary testicular large B-cell lymphoma of germinal center B-cell-like group was made. The patient is now treated by chemotherapy. Primary testicular lymphoma is a rare tumor whose diagnosis is based on histological findings. There are non consensual etiological or predisposing factors. Treatment modalities consist in surgical excision, chemotherapy and radiation therapy but the accurate procedures are not standardized. Factors that have been linked to more favorable outcomes include younger patient age, localized disease, presence of sclerosis at pathologic analysis, smaller tumor size, lower histological tumor grade and lack of epididymal or spermatic cord involvement.