Serum ghrelin levels in inflammatory bowel disease with relation to disease activity and nutritional status

Ghrelin possesses various biological activities-it stimulates growth hormone (GH) release, plays a major role in energy metabolism, and is one of the hormones that affects body composition. It also plays a role in modulating immune response and inflammatory processes. In this study we aimed to determine whether serum ghrelin levels had correlation with markers associated with disease activation. We also investigated any probable relationship between serum ghrelin level and nutritional status. Serum levels of ghrelin and its relationship with disease activity and nutritional status were evaluated in 34 patients with ulcerative colitis (UC), 25 patients with Crohn's disease (CD), and 30 healthy controls. Serum ghrelin levels, serum IGF-1 and GH levels, and markers of disease activity (sedimentation, C-reactive protein, and fibrinogen) were measured in all subjects. Body composition and nutritional status was assessed by both direct (by anthropometry) and indirect (by bioimpedance) methods. Serum ghrelin levels were significantly higher in patients with active UC and CD than in those in remission (108 +/- 11 pg/ml vs. 71 +/- 13 pg/ml for UC patients, P < 0.001; 110 +/- 10 pg/ml vs. 75 +/- 15 pg/ml for CD patients, P < 0.001). Circulating ghrelin levels in UC and CD patients were positively correlated with sedimentation fibrinogen and CRP and was negatively correlated with IGF-1, BMI, TSFT, MAC, fat mass (%), and fat free mass (%). This study demonstrates that patients with active IBD have higher serum ghrelin levels than patients in remission and high levels of circulating ghrelin correlate with the severity of disease and the activity markers. Ghrelin levels in inflammatory bowel disease (IBD) patients show an appositive correlation with IGF-1 and bioelectrical impedance analysis, body composition, and anthropometric assessments. Finally, we arrived at the conclusion that ghrelin level may be important in determination of the activity in IBD patients and evaluation of nutritional status

The relationship between insulin resistance, metabolic syndrome and nonalcoholic fatty liver disease in non-obese non-diabetic Turkish individuals: a pilot study

Background/Aims: Nonalcoholic fatty liver disease is related to obesity, metabolic syndrome, and insulin resistance. Nonalcoholic fatty liver disease and metabolic syndrome may also be encountered in non-obese, non-diabetic individuals, and there are no published data about the prevalence of these conditions in non-obese, non-diabetic Turkish subjects. We aimed to determine the difference between non-obese, non-diabetic nonalcoholic fatty liver disease patients and healthy controls in terms of insulin resistance and metabolic syndrome in Turkish subjects. Materials and Methods: Non-obese, non-diabetic individuals (n=219) were enrolled. The cohort was divided into two groups according to presence of steatosis in ultrasonography: nonalcoholic fatty liver disease group (n=143) and healthy control group (n=76). Insulin resistance and metabolic syndrome were analyzed and compared between the two groups. Results: The prevalences of metabolic syndrome (32.2% vs. 5.3%, respectively; p<0.001) and insulin resistance (46.2% vs. 9.2%, respectively; p<0.001) were significantly higher in the nonalcoholic fatty liver disease group. According to multiple logistic regression analysis, age (odds ratio 1.534; p=0.0032), insulin resistance (odds ratio 1.074; p<0.001), and serum ALT levels (odds ratio 1.102; p<0.001) were independently associated with nonalcoholic fatty liver disease. Conclusion: Insulin resistance and metabolic syndrome are not rare in non-obese, non-diabetic Turkish subjects with nonalcoholic fatty liver disease. Ultrasonographically detected fatty liver was independently associated with insulin resistance, irrespective of the presence of metabolic syndrome

A rare case of juvenile-onset Behcet's disease: Fournier's gangrene followed by intestinal involvement

Behcet's disease (BD) is a multisystemic, inflammatory disease with still unknown etiology and rarely seen in childhood. BD has worse prognosis in young, male patients. BD exacerbations may be triggered by viral, bacterial, and other undefined antigenic stimuli in genetically predisposed individuals. Fournier's gangrene (FG) is a rapidly progressive, necrotizing fasciitis of the genital and perineal regions with high morbidity and mortality. FG is usually seen in immunocompromised patients and may be triggered by local factors such as trauma, trombosis, and vasculitis. Here, we present a adolescent, male patient with juvenile-onset BD who developed FG and afterwards entero-Behcet. This unique assocation without any other underlying immunocompromised condition is discussed. (C) 2017 Annals of Pediatric Surgery

A rare case of juvenile-onset Behçet's disease: Fournier’s gangrene followed by intestinal involvement

Behçet's disease (BD) is a multisystemic, inflammatory disease with still unknown etiology and rarely seen in childhood. BD has worse prognosis in young, male patients. BD exacerbations may be triggered by viral, bacterial, and other undefined antigenic stimuli in genetically predisposed individuals. Fournier’s gangrene (FG) is a rapidly progressive, necrotizing fasciitis of the genital and perineal regions with high morbidity and mortality. FG is usually seen in immunocompromised patients and may be triggered by local factors such as trauma, trombosis, and vasculitis. Here, we present a adolescent, male patient with juvenile-onset BD who developed FG and afterwards entero-Behçet. This unique assocation without any other underlying immunocompromised condition is discussed.Keywords: Behçet's disease, colitis, Fournier’s gangrene, juvenile onse

Seropositivity for delta hepatitis in patientswith chronic hepatitisb and liver cirrhosis inturkey: ameta-analysis

Background: Recent reports suggest a decline of delta hepatitis (DH) in theWest as well as in the Far East. Aim: To study the DH seroepidemiology in Turkey. Methods: Statistical power analysis was utilized based on data available in a recent article using prevalence figure estimates. Binominal distribution was applied in order to assess the number of samples required to estimate the prevalence with a given precision. Results: Out of 62 studies in the original study, 32 were eliminated because of insufficient power. A total of 6734 patients (5231 with chronic hepatitis and 1503 with cirrhosis) were analysed. Anti-HDV seropositivity among patients with chronic hepatitis B (CHB) and hepatitis B-induced cirrhosis was lowest in the west of the country and highest in the southeast (5 vs. 27%, Po0.0001 and 20 vs. 46%, Po0.0001) respectively. Compared with data obtained before 1995, after 1995, DH prevalence in patients with CHB and cirrhosis decreased from 29 to 12% (Po0.0001) and from 38 to 27% (P = 0.03) in central and southeast Turkey and from 38 to 20% (Po0.0001) and from 66 to 46% (Po0.002) in west and southeast Turkey respectively. Conclusion: Despite the decrease of its prevalence in Turkey, DH remains a significant health problem in parts of the country with low socio-economic level. Hepatitis B, C and D are the three hepatotrop viruses that can lead to chronic liver disease. Among these three hepatotrop viruses, hepatitis B virus (HBV) and hepatitis C virus infections are the most important and common causes of chronic liver disease in Turkey in parallel to the rest of the world. These infections are a major cause of morbidity and mortality. Almost forgotten is the impact of the third virus, the hepatitis D virus (HDV), on the burden of chronic liver disease. The hepatitis delta virus (HDV) leads to liver disease through the helper function of the HBV (1). Chronic delta hepatitis (DH) is significant in the context that it is associated with the most severe form of chronic viral hepatitis (1). In the 1990s, a number of reports have indicated a decline in the prevalence of HDV infection in the West as well as in the Far East (2–4); however, it needs to be seen and assessed whether the trend is similar in other areas of the world. Turkey is a hepatitis B endemic country where studies in blood donors reported an HBsAg carrier rate between 4 and 5% with striking differences in prevalence rates between the west and the east of the country (5). This variance in prevalence between west and east Turkey is also reflected in studies on HDV prevalence. A major limitation is that these studies (6–8) either were presented only in abstract form or were published in Turkish and thus are practically not available for the rest of the world liver community. A retrospective analysis of data on antiHDV seropositivity rate in chronic hepatitis B (CHB) and liver cirrhosis (LC) patients from different regions of Turkey has recently been published (9). The time period of interest was between 1980 and 2005. In the current study, the above mentioned study was re-analysed with the aim of reaching a more objective epidemiological estimate of the DH burden in Turkey. The prevalence of HDV in the setting of both chronic hepatitis and LC was analysed separately. Regional differences as well as potential chronological changes were investigated

An Ankylosing Spondylitis Case Which Accompanies Portal Hypertension and Lichen Amyloidosis

In this paper, we present a case that has been followed with Ankylosing Spondylitis (AS) for forty years and developed diabetes, iridocyclitis, lichen amyloidosis and hypertension over time. A 73-year-old male patient presented to our hospital with dyspnea and massive ascites with portal hypertension in the last one year. Cardiac and hepatic venous pressure measurements revealed mild pericardial thickening and intrahepatic sinusoidal portal hypertension in the liver. An infiltrative reason as metabolic, viral, autoimmune to develop portal hypertension was not found and systemic inflammation and vascular involvement due to AS was thought. TIPS was applied to the patient due to resistant ascites. After this operation, albumin was not needed, acid regressed and general condition improved. We aimed to present a very rarely seen association of AS, lichen amyloidosis and portal hypertension, and the curative result of TIPS operation in this case

A case of ulcerative colitis complicated with acute mesenteric ischemia, deep vein thrombosis, and pulmonary thromboembolism

Ülseratif kolit inşamatuvar bir barsak hastalığıdır. Kanlı diyare, karın ağrısı, kilo kaybı gibi intestinal bulguların dışında, çeşitli ekstraintestinal komplikasyonlar klinik tabloya eşlik edebilir. Tromboembolik hadiseler ülseratif kolite eşlik edebilen nadir ekstraintestinal komplikasyonlardır. Biz daha önceden ülseratif kolit tanısı olan, klinik tablosu akut mezenter iskemisi, pulmoner tromboemboli ve derin ven trombozu ile komplike olan bir olgu sunacağız.Ulcerative colitis is an inflammatory bowel disease. In addition to intestinal symptoms such as bloody diarrhea, abdominal pain, and weight loss, various extraintestinal complications may be encountered. Thromboembolic events rarely complicate ulcerative colitis. Herein, we present a case of established ulcerative colitis, which was complicated with acute mesenteric ischemia, deep vein thrombosis, and pulmonary thromboembolism

Evaluation of hepatitis b viraemia levels in patients with hbeag-negative chronic hepatitis b virus infection

OBJECTIVES: To evaluate patients with chronic hepatitis B virus (HBV) infection and low-level viraemia in terms of determining HBV DNA cut-off values and levels of alanine aminotransferase (ALT) and other possible markers for discriminating between chronic hepatitis B e-antigen (HBeAg)-negative patients and hepatitis B surface antigen (HBsAg) inactive carriers. METHODS: HBV-infected patients who were HBeAg-negative with undetectable HBV DNA by standard hybridization assay and high (HBeAg-negative group, n = 81) or normal (HBsAg inactive carrier group, n = 77) ALT levels were enrolled. Quantitative polymerase chain reaction assay using a COBAS Amplicor HBV monitor test was performed to detect low HBV DNA levels. RESULTS: The HBV DNA level was found to be significantly higher in the HBeAg-negative chronic HBV group (mean +/- SD 94 477 +/- 167 528 copies/nil) compared with the HBsAg inactive carrier group (mean +/- SD 19 215 +/- 57 970 copies/ml). CONCLUSIONS: A low level of viral replication may persist in chronic HBV-infected patients who are HBeAg-negative, and the level of HBV DNA was higher in the HBeAg-negative group than in the inactive HBsAg carrier group. Necroinflammation also persisted in the HBeAg-negative group and these patients had a higher level of ALT than the inactive HBsAg carriers

Türkiye'nin doğu ve güneydoğu bölgesinde hepatoselüler karsinomalı vakaların klinik ve epidemiyolojik özellikleri: çok merkezli retrospektif çalışma

Objective: In this multicenter retrospective study, we aimed to investigate the epidemiological and clinical characteristics of patients with hepatocellular cancer (HCC) in the Eastern and Southeastern Anatolian regions of Turkey. Material and Methods: This study included 218 patients from 7 centers-Dicle University (n=96), Yüzüncü Yıl University (n=30), İnönü University (n=28), Fırat University (n=24), Gaziantep University (n=20), Atatürk University (n=19), and Harran University (n=1) hospitals. Information about patients was obtained through pre-prepared forms. Diagnosis of HCC was made histologically or with a combination of clinical, radiological, and laboratory findings. Results: The mean age of the patients was 57.67±12.03 with a male-to-female ratio of 5.8:1. Etiologically, 45% of the study group had HBV infection alone, 29% had HDV co-infection, 15% had HCV infection and 10% were idiopathic cases with unknown etiology. Cirrhotic background was present in 94% of the patients and 89% of cases had an advanced stage disease according to the Okuda classification. Alpha-fetoprotein levels were over 300 ng/ml in 81% of the patients. Conclusion: Hepatitis B virus infection followed by hepatitis delta virus infections appeared to be the leading etiological factors for HCC cases in our region. HBsAg carriage continues to be an important risk factor for HCC in Turkey. The fact that most of the HCC cases are in the late stages of disease, makes it necessary to use effective diagnosis and treatment methods with efficient screening and monitoring programs in our country

The effects of viral cirrhosis on cardiac ventricular function

Liver cirrhosis is a severe disease with complications and viruses take the first place in the etiology of cirrhosis. In this study, the effects of liver cirrhosis due to viral hepatitis cardiac ventricular functions were analyzed. Thirty patients (mean age 43.6±12, 20 male) with liver cirrhosis underwent echocardiographic studies and were compared with 30 healthy controls (mean age 37.3±2, 22 male). Right and left atrium and right ventricle dimensions, interventricular septum, right ventricle free wall thickness, pulmonary artery diameter and assumed mean pulmonary artery pressure measured with 2-dimensional echocardiography were significantly increased in the patient group. In Doppler echocardiographic studies, right ventricle diastolic functions were significantly impaired in the patient group. There were no significant differences in left ventricle systolic and diastolic functions between the groups. In conclusion, liver cirrhosis causes dilatation in right heart spaces and diastolic dysfunction