Correlation of CAT Score With Peak Expiratory Flow in Acute Exacerbation of COPD Patients.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) leads to physical activity limitation and a significant reduction in quality of life. This study aimed to investigate the correlation between The COPD Assessment Test (CAT) score and peak expiratory flow (PEF), and the factors effecting hospital admission rates of patients with COPD. METHODS: This observational study was conducted prospectively. CAT score was calculated and PEF measured at the time of emergency department admission. Descriptive statistics were expressed as number (n), percentage (%), and mean ± standard deviation. Chi-Square and correlation tests were used for statistical analyses. A p value of less than 0.05 was considered statistically significant. RESULTS: Of 123 patients included in the study, 85 (69.1%) were male and 38 (30.9%) were female. Pulse pressure, pH, blood urea nitrogen, oxygen saturation measured by pulse oximetry (SpO2), PO2, PCO2, and SpO2 values on arterial blood gas analysis, and PEF value were significantly correlated to CAT score (p < 0.05). CONCLUSION: High CAT score and low PEF value can be used to make the decision of hospitalization from emergency department in acute exacerbations of COPD.

Prevalence and consultation behavior of self-reported rectal bleeding by face-to-face interview in an Asian community.

BACKGROUND AND AIM: Although rectal bleeding is a common gastrointestinal symptom, there are very few community-based studies, and all of these studies were conducted in the West. So far the epidemiologic characteristics of rectal bleeding have not been defined in an Asian country. We aimed to characterize self-reported rectal bleeding and its association with functional bowel disorders in Turkey. Factors affecting healthcare-seeking behavior were reviewed as well. SUBJECTS AND METHODS: In this study, 760 subjects were chosen randomly. Questionnaires were completed by nurses during face-to-face interviews with each participant. RESULTS: Of the 707 (93%) subjects included in this study, 9.5% had functional dyspepsia, 8.6% had irritable bowel syndrome (IBS), 24.5% had functional constipation, and 13.8% had functional abdominal bloating. The prevalence of rectal bleeding in the previous year was 14.7%. The recent onset of rectal bleeding was 2.7%. Rectal bleeding was more common among subjects younger than 45 years. Subjects who had functional constipation or constipation-dominant IBS reported rectal bleeding more frequently than others. The rate of consultation was only 41.3% among the subjects with rectal bleeding. Subjects aged > or =45 years and who had marked bleeding or bleeding more than twice a day or fear of cancer sought healthcare more frequently than others. CONCLUSION: Rectal bleeding is as common a symptom in Turkey as in Western countries. Advanced age and fear of cancer were independent predictors of consultation behavior in this group.

Preventive role of genistein in an experimental non-alcoholic steatohepatitis model.

BACKGROUND AND AIM: The aim of the present study was to evaluate the preventive role of genistein, a phytoestrogen with a wide variety of pharmacological effects, in an experimental non-alcoholic steatohepatitis (NASH) model. METHODS: Thirty-six Sprague-Dawley rats were divided into three groups. Group 1 (control) received only a standard rat diet, group 2 (placebo) was given a high fat diet (HFD) plus 0.5 mL/day saline subcutaneously, and group 3 (genistein group) a HFD plus subcutaneous genistein injection at dose of 0.2 mg/kg/day for 6 weeks. All rats were killed after 6 weeks. Serum aminotransferases, tumor necrosis factor (TNF)-alpha, transforming growth factor (TGF)-beta, and plasma and liver malondialdehyde (MDA) levels were measured. Additionally, steatosis, ballooning degeneration and inflammation of the liver were examined histopathologically. RESULTS: Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (P < 0.001 for each), plasma and liver tissue MDA and plasma TNF-alpha levels (P < 0.001, <0.001, <0.01, respectively) were found to be higher in the placebo group than in the control group. TGF-beta levels, however, were comparable in the placebo and control groups (P > 0.05). Histopathologically, steatosis, inflammatory cells per mm(2) and ballooning degeneration were significantly higher in the placebo group than in the control group (P < 0.001 for each). Nevertheless, AST and ALT (P < 0.05 for each), plasma and liver tissue MDA (P < 0.05 for each) and plasma TNF-alpha levels (P < 0.001) were significantly decreased in the genistein group compared to the placebo group. Histopathologically, steatosis (P < 0.05), inflammatory cells per mm(2) and ballooning degeneration (P < 0.01 for each) in the genistein group were also significantly lower than in the placebo group. CONCLUSIONS: Genistein, a strong antioxidant agent, significantly decreased the plasma TNF-alpha level and remarkably prevented the emergence of NASH by improving the biochemical and histopathological abnormalities via attenuating oxidative stress.

Portal hypertension due to Echinococcus alveolaris: a case report.

Infection of the liver with Echinococcus alveolaris (EA) contemplates with a fatal course though it is a rare condition. We present herein a patient with upper gastrointestinal bleeding due to portal hypertension caused by the involvement of the liver with EA.

Amelioration of steatohepatitis with pentoxifylline in a novel nonalcoholic steatohepatitis model induced by high-fat diet.

We sought to evaluate the effects of pentoxifylline (PTX) on steatohepatitis in a novel experimental nonalcoholic steatohepatitis (NASH) model induced by a high-fat diet (HFD). Thirty-three male Sprague-Dawley rats were randomly divided into 3 groups. The first group received only standard rat diet (control group); groups 2 (placebo group) and 3 were given HFD, ad libitum. After week 4, 0.5 mL of physiologic serum was injected subcutaneously to the placebo group and 50 mg/kg/d PTX was given intraperitoneally to the third group (group PTX). After 6 weeks all rats were humanely killed. Serum biochemistry, tumor necrosis factor-alpha (TNF-alpha), plasma, and liver tissue malondialdehyde (MDA) were analyzed. Histopathologically, steatosis, ballooning degeneration, inflammation, and fibrosis were determined. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels, plasma and liver tissue MDA, and plasma TNF-alpha levels were significantly higher in placebo group than in the control group. Tumor growth factor-beta levels, however, were comparable in the placebo and control groups. On histopathologic examination, steatosis, inflammatory cells per square millimeter, and ballooning degeneration were significantly higher in the placebo group than in the control group. No fibrosis or Mallory bodies were found in the placebo group. AST, ALT, plasma and liver tissue MDA, and plasma TNF-alpha levels were significantly lower in PTX group compared to the placebo group. Histopathologically, steatosis, mean number of inflammatory cells/mm(2) and ballooning degeneration in PTX group were also significantly lower than in the placebo group. In conclusion, PTX strikingly ameliorates steatohepatitis in this novel NASH model not only by inhibiting the TNF-alpha but also suppressing the oxidative stress markers.

Case study on drug-related adverse effects of hepatitis C therapy.

The case of a 46-year-old woman with chronic hepatitis C who was prescribed subcutaneous pegylated interferon once a week and oral ribavirin once a day is presented. Within 24 h after the first injection to her left arm, the patient developed pruritus and erythematous papules at the injection site and painful papules on her hands. After immediate administration of antihistamines, the pruritus and papules remitted. One wk later, after injection in the right arm, skin lesions and pruritus were seen. After the third injection to the abdomen, the patient developed a rash, and after the fourth and fifth injections to other areas of the abdomen, injection-site papules were seen. The patient had no skin reactions for the next 12 mo, with the exception of injection-site papules. Hepatitis C virus RNA was negative after 12 mo of treatment. Clearly, patience is important during hepatitis C therapy in order to avoid unnecessary examinations and to promote successful outcomes.

The levels of ghrelin, leptin, TNF-alpha, and IL-6 in liver cirrhosis and hepatocellular carcinoma due to HBV and HDV infection.

BACKGROUND/AIM: Malnutrition, a common problem in liver cirrhosis and HCC, may readily deteriorate the clinical functions with resultant poor prognosis. Beside the hyper catabolic state frequently encountered in chronic liver disease and HCC, anorexia and reduced food intake also worsen the malnutrition. The recently discovered peptide hormone ghrelin acts as a counterpart of leptin in regulation of food intake and fat utilization. The aim of the present study was to investigate the ghrelin and leptin levels in cirrhosis and HCC due to hepatitis B and D viruses, and the association of ghrelin and leptin with TNF-alpha, IL-6 and the severity of the disease. MATERIALS AND METHODS: We measured serum ghrelin, leptin, TNF-alpha, and IL-6 levels using specific immunoassay in 45 patients (23 cirrhosis, 22 HCC) with HBV and/or HDV and in 25 control subjects. RESULTS: In comparison to controls, serum ghrelin, TNF-alpha, and IL-6 levels were significantly higher in cirrhosis and HCC (P < .05), whereas serum leptin levels were found decreased (P < .05). There was a positive correlation between ghrelin and TNF-alpha, and a negative correlation between leptin and TNF-alpha (P < .05). CONCLUSION: In cirrhosis and HCC due to HBV or HDV, serum ghrelin levels were increased with a corresponding decrease in serum leptin concentrations, acting as a physiological counterpart of ghrelin. The increasing of ghrelin is more prominent in Child C cirrhosis and the level was correlated with TNF-alpha. The presence of nutritional and metabolic abnormalities, including malnutrition, in cirrhosis and HCC may, at least partly, elucidate high ghrelin and low leptin levels.

A splenic hydatid cyst case presented with lumbar pain.

A splenic hydatid cyst is a rare clinical entity from among abdominal hydatid cysts, even in endemic countries. Here, a case with lumbar pain due to a giant splenic hydatid cyst is presented. The importance of this case is that the patient presented at the clinic with only lumbar pain. Initial direct abdominal plain radiography showed a giant abdominal calcification in the spleen and further examinations revealed involvement of three organs: spleen, lung, and liver.

Two siblings with fulminant viral hepatitis A: case report.

Fulminant hepatitis is a rare complication of acute hepatitis A infection. Nevertheless, the seroepidemiology of the infection is rapidly changing with the developing world, rendering more adults susceptible to the infection, in particular with more severe course. We report here fulminant hepatitis A infection with a mortal course during an epidemic period in two siblings. Although it causes a self-limited mild disease, hepatitis A virus may have a severe course including fulminant hepatitis and may lead to mortality, especially in older ages. Hence, the risk of hepatitis A virus infection and its complications should be reduced with measures of immunization and sanitation.

Epidemiological features of irritable bowel syndrome in a Turkish urban society.

BACKGROUND AND AIM: Irritable bowel syndrome (IBS) is a widespread functional bowel disorder and its prevalence in Western societies ranges from 3-20%. The present study aimed to determine the prevalence of IBS in eastern Turkey, particularly in urban parts of Elazig where 250 000 people live. METHODS: Of the 18 primary care centers, four were randomly selected for this study. All individuals (aged >17 years) living around the service area of these health centers were included. A total of 1900 subjects were randomly selected using the personal health records from the primary care centers. The total number of subjects that could be contacted was 1766. A questionnaire with multiple choice questions was applied to the subjects by medical students using the face-to-face technique. Prevalence of IBS and distribution of symptoms were evaluated by the Rome II criteria. RESULTS: Of the 1766 subjects, 45.4% were male and 54.6% were female. Prevalence of IBS was 5% in males, 7.4% in females and 6.3% overall. The percentage of subjects with IBS in the 17-30 years age group was 26.2%; 52.3% in the 30-50 years age group and 21.6% in the above 50 years age group. Prevalence of IBS was highest (10.2%) in persons who were illiterate and lowest (3.0%) in university graduates. A positive correlation was determined between low economical status and prevalence of IBS (P < 0.05). CONCLUSION: Although IBS is widely present in Turkey, its prevalence is lower than that reported in Western communities. In the region where this study was carried out, IBS was more prevalent in females and in individuals with low educational and economical status.