Appraising diagnostic performance of ELF test by pathological staging and digital quantification of liver fibrosis.

INTRODUCTION AND OBJECTIVES: A crucial issue when appraising the performance of non-invasive markers is the limitations of the reference standard they are compared to. Digital image analysis (DIA) was suggested as a reproducible approach expressing fibrosis numerically as a proportionate area (PA) (%). We aimed to evaluate ELF test with direct reference to PA (%), thereby explore the improvement in accuracy to discriminate significant fibrosis which may actually have been underestimated by categorical pathological staging. MATERIALS AND METHODS: PA (%) data were obtained by DIA of trichrome-stained liver biopsies of 52 chronic hepatitis patients. Paired serum samples of patients and additional 36 controls were performed to measure ELF test. Diagnostic performance characteristics of ELF test was derived in predicting significant fibrosis in the patient cohort, and also, in distinguishing healthy controls from patients with significant fibrosis. RESULTS: We found an AUROC value of 0.73 for ELF to predict significant fibrosis as assessed by DIA and a lower AUROC value of 0.66 when assessed by conventional pathology. Importantly, ELF test provided considerably high diagnostic accuracy to discriminate healthy controls from patients with significant fibrosis defined by Ishak F≥2 and TPA≥5% (AUROCs 0.93 and 0.94, respectively) with optimal ELF cut-off point of 8.4 for both. CONCLUSIONS: Digital quantification could represent a better reference standard than conventional pathology allowing a better discriminatory capability for ELF test. ELF test provided high diagnostic accuracy to discriminate healthy controls from patients with significant fibrosis suggesting a role as a screening strategy in the community setting.

Effect of perioperative inadvertent hypothermia on the ECG parameters in patients undergoing transurethral resection.

OBJECTIVE: Perioperative inadvertent hypothermia (PIH) (core body temperature to < 36 °C) is a common event during surgery. PIH may result from multiple factors. Elderly urology patients are at greater risk than other patients for hypothermia. PIH may cause adverse postoperative cardiac clinical manifestations. Our study aimed to determine the effects of postoperative alteration of core body temperature on the ECG parameters in patients undergoing transurethral resection. PATIENTS AND METHODS: Fifty-nine patients, 40-83 years of age, who were scheduled for elective Transurethral Resection Prostate and/or Bladder (TUR-P and/or TUR-B) were enrolled in the study. Patients with operation times more than 30 minutes were included. Core temperatures were measured and standard 12-lead ECG readings were taken before surgery and immediately upon arrival in the postanesthesia care unit. RESULTS: 59 patients were included this study. Prevalence of PIH (< 36ºC) was (57.6%). The postoperative temperature was found to be significantly lower than the preoperative of all patients (preop 36.46±0.39; postop 35.68±0.59, paired sample t-test, p<0.001). Also in all patients, postoperative QTc dispersions were found to be significantly longer than the preoperative QTc dispersions (preop 59.66±32.69; postop 74.57±37.47 ms, p<0.05). When we divided the patients; hypothermic and normothermic, postoperative QTc dispersions were significantly different between two groups (68.23±33.43 ms, and 83.20±41.50 ms; p=0.009). CONCLUSIONS: The prevalence of inadvertent intraoperative hypothermia in patients undergoing transurethral resection is relatively high. QTc dispersion of mild hypothermic patients was significantly longer than normothermic patients'.

Contribution of fragmented QRS on myocardial perfusion imaging in the assessment of functionally significant coronary artery stenoses.

OBJECTIVE: The evaluation of the functional significance of coronary artery stenosis is of great clinical importance in patient management or for decisions concerning coronary intervention. Recently, fragmented QRS (fQRS) on electrocardiography (ECG) has been introduced as a predictor of myocardial scarring as well as myocardial ischaemia in coronary artery disease. We aimed to investigate any additive value of fQRS to myocardial perfusion SPECT in evaluating the functional significance of the intermediate degree of coronary stenosis. PATIENTS AND METHODS: Patients who were referred for myocardial perfusion imaging (MPI) to evaluate the functional significance of intermediate (40-70%) coronary artery stenosis were analyzed retrospectively; 102 patients were included in the study. ECG records were evaluated to detect fQRS. MPI was interpreted visually and semiquantitatively by two nuclear medicine physicians blinded to the electrocardiographic findings. Summed stress scores (SSS), summed rest scores and summed difference scores (SDS) were calculated according to the 17-segment model. RESULTS: The mean age of the patients was 62.56±9.5 years, and 64 were males (62.7%). Ischaemia was detected in 30 patients, and the frequency of fQRS was significantly higher in patients with ischaemia than in patients with normal perfusion (54.8% vs. 23.8%, respectively; p<0.001). Myocardial scarring was detected in 15 patients, 7 of whom had coexistent myocardial ischaemia. fQRS was positively correlated with the SSS (r=374, p=0.001), SDS (r=0.460, p=0.001) and summed motion score (r=0.228, p=0.024). fQRS was an independent predictor of myocardial ischemia in multivariate analyses (OR=11.181; CI=3.900-32.057; p<0.001). CONCLUSIONS: The presence of fQRS on ECG is associated with myocardial ischaemia in patients who had an intermediate degree of coronary stenosis.

Is an elevated neutrophil-to-lymphocyte ratio a predictor of metabolic syndrome in patients with chronic obstructive pulmonary disease?

OBJECTIVE: This study aimed to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) in early detection of metabolic syndrome (MetS) in patients with chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: We retrospectively enrolled hospital records of 140 COPD patients and 50 sex and age-matched healthy controls. The diagnostic values of NLR were estimated using the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). RESULTS: In total, 140 patients with COPD of which 63 patients had MetS and 50 healthy subjects were included in the study. We found that the NLR values of the stable COPD patients were significantly higher than those of the controls (p < 0.001). Among patients with COPD, the NLR was significantly higher in patients with than without MetS (p < 0.001). The AUC of the NLR was 0.898 in patients with MetS. The optimal NLR cut-off was 2.56 and was validated in the testing set. For evaluation of MetS, the sensitivity and specificity were 84.1% and 84.4% in patients with COPD under the suggested cut-offs. CONCLUSIONS: The NLR is a simple, effective, and practical predictor of MetS in patients with stable COPD. It has potential value in public health practice for management of patients with COPD.

The pure effects of obstructive sleep apnea syndrome on cardiac autonomic functions: heart rate turbulence analysis.

OBJECTIVES: To demonstrate the pure effect of obstructive sleep apnea syndrome (OSAS) on cardiac autonomic function (CAF) using heart rate turbulence (HRT) parameters. PATIENTS AND METHODS: A total of 64 patients with OSAS and 30 age- and gender-matched healthy subjects were enrolled. All subjects had normal coronary arteries and were free from diabetes mellitus (DM) and hypertension (HT). The HRT parameters (TO, turbulence onset; TS, turbulence slope) were obtained from 24-h ambulatory electrocardiogram (ECG) recordings. HRT parameters were compared between groups, and the relationship between HRT and the apnea-hypopnea index (AHI) was examined. RESULTS: No between-group differences were found in age or gender. Mean TO was significantly higher in the OSAS group than in healthy controls (0.89 ± 0.5, -0.08 ± 0.26; p < 0.001; respectively). The mean TS did not differ between the two groups (2.81 ± 3.06 versus 3.14 ± 2.33; p = 0.212). The AHI was positively correlated with TO (r = 0.845, p < 0.001). The multiple logistic regression analysis revealed that after adjustment for other variables, TO was a significant and independent predictor of AHI, OR 2.394 (95% CI: 1.596-3.591). CONCLUSIONS: HRT (TO in particular) is correlated with AHI. Thus, impaired HRT may be an important factor underlying the occurrence of arrhythmia and sudden cardiac death in patients with OSAS.

Oxidase activity of ceruloplasmin and some acute phase reactant and trace element concentrations in serum of patients with chronic lymphocytic leukemia.

In the present study, we aimed to investigate the parameters in serum of patients with chronic lymphocytic leukaemia (CLL) and correlate with the cancer stage. The serum concentrations of ceruloplasmin, a-1-acid glycoprotein, albuminumin, transferrin, copper, zinc, manganese, and ceruloplasmin oxidase activity were measured, and compared with those from a healthy control group. The serum from 34 patients with CLL were extracted before chemotherapy. Serum transferrin, albuminumin and Zinc concentrations were lower in patients with CLL while serum a-1-acid glycoprotein, ceruloplasmin, copper concentrations, and ceruloplasmin oxidase activity were higher in CLL patients when compared with the control group. Although serum manganese concentration was lower in CLL groups than in the control group, the difference was not statistically significant. Serum transferrin concentration was lower in the early stage group compared with the advanced stage. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients from the early stage group. Serum ceruloplasmin level positively correlated with serum ceruloplasmin oxidase activity in patients with advanced stage. In conclusion, increased serum ceruloplasmin oxidase activity, ceruloplasmin, a-1-acid glycoprotein, copper levels and decreased transferrin and albuminumin, unchanged manganese levels are associated with CLL and appear to be a consequence of the disease itself.

Tumour necrosis factor-alpha levels in hepatitis B virus-related chronic active hepatitis and liver cirrhosis and its relationship to Knodell and Child-Pugh scores.

Although both chronic active hepatitis-B (CAH-B) and liver cirrhosis (LC) are characterised by various degrees of inflammation and hepatocyte necrosis, in advanced stage cirrhosis, marked fibrosis develops and inflammation and tissue necrosis diminishes. In this study, we aimed to investigate serum tumour necrosis factor-alpha (TNF-alpha) concentration in patients with CAH-B and LC and its relationship to disease activity. Serum samples were taken from 30 patients with CAH-B and 30 with LC at different stages of the disease. TNF-alpha concentrations were measured by the ELISA technique. Results were compared with those of 30 healthy controls. Mean plasma TNF-alpha levels were found as 2.47 +/- 2.98, 0.8 +/- 1.21 and 0.72 +/- 1.08 pg/ml in CAH-B, LC and control groups, respectively. TNF-alpha levels were significantly higher in CAH-B group than LC and control groups (p <0.01 and p < 0.05, respectively). Although mean plasma TNF-alpha level of cirrhotic patients at Child-A stage was markedly high (3.31 +/- 0.15), no significant difference has been found between LC and control groups (p > 0.05). TNF-alpha concentrations were positively correlated with hepatitis activity index (Knodell's score) in CAH-B group whereas negatively correlated with Child-Pugh score in LC group (r =0.73, p < 0.01 and r = -0.42, p < 0.05, respectively). Our study showed that TNF-alpha level increases in patients with CAH-B correlated with histologic activity index. So it can be used to evaluate disease activity. Additionally, marked reduction of TNF-alpha concentration in advanced cirrhosis suggested that TNF-alpha production is determined by hepatic damage and inflammation.

Tetanus antitoxin levels among adults over 40 years of age in Central Anatolia, Turkey.

OBJECTIVE: To determine tetanus antitoxin levels in adults and the aged. METHODS: This study was conducted on 249 adults over 40 years of age who applied to a blood-withdrawal unit in Kayseri, Central Anatolia. Tetanus toxoid-specific antibodies were measured in serum by enzyme-linked immunosorbent assay (ELISA). RESULTS: In the research group, only 63 persons (25.3%) were found to have protective levels (>0.1 IU/mL) of tetanus antitoxin. Antibody levels were significantly higher in educated people (30.7%), in those under 50 years of age (38.2%), in those who had been vaccinated at least twice (47.6%), and in those vaccinated not more than 10 years previously (58.3%). There was no association between antibody level and sex, occupation or place of residence. CONCLUSION: Our findings indicated that tetanus antibody values were under the protective level for most adults over 40 years of age, and vaccination programs directed at the adult population should be developed.

Outbreak of nosocomial fungemia caused by Candida glabrata.

An outbreak of Candida glabrata fungemia that was thought to be associated with bottles used for milk feeds occurred at our children's infectious diseases clinic. This cluster of cases was investigated using a case-control study. Isolates were identified by conventional methods and karyotyped using pulsed-field gel electrophoresis (PFGE) of genomic DNA. Potential risk factors for nine hospitalized children with candidemia and 14 controls were long-term hospitalization and treatments with more than two antibiotics. Electrophoretic karyotyping showed a single chromosomal pattern for these outbreak isolates and, in addition, they all had the same antifungal susceptibility results. These findings suggest that clonal dissemination of a single strain was responsible for this outbreak. Karyotyping by PFGE appears to be a useful molecular typing method for strains of C. glabrata.

Prevalence of hepatitis C virus and hepatitis G virus in patients with non-Hodgkin's lymphoma.

Hepatitis C virus (HCV) and hepatitis G virus (HGV) belong to the same family of flaviviridea. A causative role of HCV infection in the pathogenesis of non-Hodgkin's lymphoma (NHL) has been discussed widely. Little is known about the possible association between NHL and HGV discovered recently. In this study, anti-HCV and HGV-RNA prevalence were investigated in a group of 70 patients with NHL. The results were compared to a control group of 70 age- and sex-matched healthy subjects. One patient in each group (1.4%) was found to be anti-HCV-positive; the difference was not statistically significant (P > 0.05). Five subjects in the patient group (7.1%) were positive for HGV-RNA, while a single subject was positive in the control group (1.4%); the difference was not statistically significant (P > 0.05). Odds ratios for anti-HCV and HGV-RNA were 1 and 5.30, respectively. Our findings suggest that neither HCV nor HGV are causative or contributing factors in the aetiopathogenesis of NHL.

Thyroid abnormalities in lithium-treated patients with bipolar affective disorder.

The thyroid functions of 42 subjects with bipolar affective disorder receiving regular lithium therapy were analysed and their thyroid glands were examined by ultrasonography. Following the receipt of lithium therapy (duration 4-156 months), three subjects displayed subclinical hypothyroidism (7.1%), three subclinical hyperthyroidism (7.1%) and one hyperthyroidism (2.4%). Moreover, goitre was detected in 16 (38.1%) subjects. An increase in the conversion of free thyroxine (T4) to free tri-iodothyrosine (T3), which is an indication of mild thyroid dysfunction, was identified in 20 (47.6%) subjects, and was mostly seen in male subjects under 40 years of age and in those having weight gain. In conclusion, some thyroid dysfunctions were observed in the patients treated with lithium.

Side effects of tamoxifen in oophorectomized rats.

OBJECTIVE: Our objective was to evaluate the direct effect of tamoxifen citrate (TAM) on the endometrium, liver, breast tissue and the lipid profile in oophorectomized (OX) rats. STUDY DESIGN: An experimental animal study. MATERIAL AND METHODS: Forty-one mature rats (33 OX) were randomly divided into four groups and received either TAM (0.4 or 0.8 mg/kg p.o.) therapy or placebo over 60 days as follows: (1) sham; (2) OX + TAM (0.4 mg/kg); (3) OX + TAM (0.8 mg/kg); (4) OX. All histological changes in the endometrium, liver and breast tissue were evaluated under the light microscope by comparing the TAM-treated groups with the OX and sham-operated groups. Blood total cholesterol and low-density lipoprotein cholesterol levels were also analyzed. RESULTS: TAM-treated rats showed a significant reduction in body weight, blood cholesterol and low-density lipoprotein cholesterol levels, but the wet uterine weight was not affected. Estrogenic effects of TAM were not detected with either dosage on the endometrium. TAM-treated groups showed atrophic breast tissue. No histopathological changes were detected in the liver with TAM treatment. CONCLUSION: The data suggests that TAM may not act as an estrogen receptor agonist with the given dosage on the endometrium in OX rats. Two different doses of TAM do not cause histological changes in liver over 60 days of treatment.