The relationship of circulating MOTS-c level with liver fibrosis and metabolic components in patients with metabolic dysfunction-associated fatty liver disease.

OBJECTIVE: Mitochondrial open reading frame of the 12s ribosomal RNA type-c (MOTS-c) is a novel identified mitochondrial signal transmission peptide that plays an important role in glucose, amino acid and lipid metabolism. In this study, we aimed to investigate the relationship of circulating MOTS-c level with noninvasive scores of fibrosis and the components of metabolic syndrome (MetS) in patients with metabolic dysfunction-associated fatty liver disease (MAFLD). PATIENTS AND METHODS: This was a single-center cross-sectional study, and the participants were divided into two groups based on their liver ultrasound results: the fatty liver group and the healthy control group. The MOTS-c level was measured by the ELISA method. Non-alcoholic fatty liver disease fibrosis score (NFS) and fibrosis 4 (FIB-4) were used to determine the level of liver fibrosis. Statistical analyses were performed using Statistical Package for Social Science 15.0 package program. RESULTS: One hundred fifty patients (male, n=57) with MAFLD [median age 41.0 (14) years] and 84 healthy controls (male, n=34) [median age 36.0 (22) years] were included in this study. Patients with MAFLD had significantly lower MOTS-c levels than the healthy controls (p=0.009). The MOTS-c level was significantly lower in subjects with MetS (n=48) compared to those without MetS (n=186) (p=0.01). In the total population (n=234), MOTS-c levels negatively correlated with the presence of MAFLD, NFS, FIB-4, and components of MetS. CONCLUSIONS: Individuals diagnosed with MetS and MAFLD tend to have lower levels of MOTS-c. Additionally, these lower levels are inversely correlated with both the components of MetS and noninvasive fibrosis scores. MAFLD negatively correlated to the MetS components and noninvasive scores of fibrosis.

Clinical features and predisposing factors of delirium due to COVID-19 pneumonia in intensive care units.

OBJECTIVE: Delirium is an acute disorder in which attention, perception, memory, thought, mood, psychomotor activity and sleep-wake cycles change rapidly. Delirium is also a common clinical syndrome in patients hospitalized in intensive care units due to COVID-19 pneumonia. We reviewed clinical features and predisposing factors of delirium according to psychomotor subtype in patients hospitalized in the intensive care units due to COVID-19 pneumonia. PATIENTS AND METHODS: 64 patients who were hospitalized in the intensive care units due to COVID-19 pneumonia were included. Delirium status and psychomotor subtype were determined by applying the Confusion Assessment Method for the Intensive Care Unit scale to the patients daily. The gender, age, comorbidity, treatments, intubation, and mortality rates of the patients were recorded. Multivariate analyses were performed by examining predisposing factors, arterial blood gases, hemograms, biochemistry, and brain magnetic resonance imaging. RESULTS: There were 64 patients in delirium clinic, 65.6% (n=42) of them were male. Hypokinetic delirium was more common in 60.9% (n=39). 79.4% of the patients who received ventilator support were male (p=0.013).When mortality was analyzed in this group, hypoactive delirium was found to be significantly higher (p=0.035). In addition, leukocyte levels were higher in patients with hypokinetic delirium (p=0.029). Ferritin and fibrinogen levels were higher in patients with hyperkinetic delirium (p=0.039, p=0.008, respectively). CONCLUSIONS: The presence of additional diseases such as advanced age, male gender, hypertension, coronary artery disease, dementia, and hypoxia were factors that increased the frequency of delirium. In addition, the mortality rate was higher in patients with hypokinetic delirium.

Correlations between transverse carpal ligament thickness measured on ultrasound and severity of carpal tunnel syndrome on electromyography and disease duration.

This study aimed to evaluate the relationship between transverse carpal ligament thickness on ultrasonography and disease severity according to electromyography findings. Fifty-eight patients with carpal tunnel syndrome, aged 30-75 years, with severe (Group 1) or moderate (Group 2) electromyography findings, who underwent surgery for carpal tunnel syndrome complaints in the previous 2 years were enrolled. Patient characteristics and clinical information were recorded. The patients completed the Boston carpal tunnel syndrome questionnaire and visual analog scale (VAS) pain score. Ultrasonography and electromyography records were examined. Electromyography showed that the median nerve area was similar in the two groups. Mean age, transverse carpal ligament thickness and symptom duration were greater in group 1, but not significantly. Mean VAS and Boston scores were significantly higher in group 1. Symptom duration did not affect median nerve area. Nerve area did not correlate significantly with VAS or Boston scores, transverse carpal ligament thickness or mean age, although averages were higher in patients with long symptom duration. Disease severity and symptom duration did not affect the ultrasonography findings. Disease severity in carpal tunnel syndrome could not be determined by measuring transverse carpal ligament thickness and median nerve area on ultrasonography without electromyography.

No association of anti-osteoporosis drugs with COVID-19-related outcomes in women: a nationwide cohort study.

This study was performed to evaluate whether the use of drugs in the treatment of osteoporosis in women is associated with COVID-19 outcomes. The results showed that the risk of hospitalization, intensive care unit admission, and mortality was not altered in individuals taking anti-osteoporosis drugs, suggesting no safety issues during a COVID-19 infection. INTRODUCTION: Whether patients with COVID-19 receiving anti-osteoporosis drugs have lower risk of worse outcomes has not been reported yet. The aim of this study was to evaluate the association of anti-osteoporosis drug use with COVID-19 outcomes in women. METHODS: Data obtained from a nationwide, multicenter, retrospective cohort of patients diagnosed with COVID-19 from March 11th to May 30th, 2020 was retrieved from the Turkish Ministry of Health Database. Women 50 years or older with confirmed COVID-19 who were receiving anti-osteoporosis drugs were compared with a 1:1 propensity score-matched COVID-19 positive women who were not receiving these drugs. The primary outcomes were hospitalization, ICU (intensive care unit) admission, and mortality. RESULTS: A total of 1997 women on anti-osteoporosis drugs and 1997 control patients were analyzed. In the treatment group, 1787 (89.5%) women were receiving bisphosphonates, 197 (9.9%) denosumab, and 17 (0.9%) teriparatide for the last 12 months. Hospitalization and mortality rates were similar between the treatment and control groups. ICU admission rate was lower in the treatment group (23.0% vs 27.0%, p = 0.013). However, multivariate analysis showed that anti-osteoporosis drug use was not an independent associate of any outcome. Hospitalization, ICU admission, and mortality rates were similar among bisphosphonate, denosumab, or teriparatide users. CONCLUSION: Results of this nationwide study showed that preexisting use of anti-osteoporosis drugs in women did not alter the COVID-19-related risk of hospitalization, ICU admission, and mortality. These results do not suggest discontinuation of these drugs during a COVID-19 infection.

The association between cagL and cagA, vacAs-m, babA genes in patients with gastric cancer, duodenal ulcer, and non-ulcer dyspepsia related to Helicobacter pylori.

INTRODUCTION: As a component of the cag T4SS, the cagL gene is involved in the translocation of CagA into host cells and is essential for the formation of cag PAI-associated pili between H. pylori and gastric epithelial cells. AIM: We aimed to investigate the clinical association of the cagL gene with other virulence factors (VacA, CagA, EPIYA-C, and BabA protein) of H. pylori strains isolated from GC, duodenal ulcer (DU), and non-ulcer dyspepsia (NUD) cases. METHODS: The patient group (PG), including 47 patients (22 GC and 25 DU) and a 25 control group (CG= NUD) were included. Amplification of the H. pylori cagL, cagA, vacA, and babA2 genes and typing of EPIYA motifs were performed by PCR methods. RESULTS: Sixty-one (84.7%) H. pylori strains were detected with cagL (93.6% in SG, 68% in CG). We detected a significant difference between SG and CG for the presence of cagL (p=0.012) but no statistical comparison was done for (≥2) EPIYA-C repeats In the comparison of H. pylori strains with cagA/vacAs1m1 and cagA/ vacAs1m2 and babA2 for the presence of cagL, we could not detect a significant difference (p=1). CONCLUSION: We detected a significant difference between groups for the presence of cagL genotype (p=0.012). The vacAs1m1 (OR: 2.829), genotypes increased the GC and DU risk by 2.8 times, while multiple (≥2) EPIYA-C repeats incresed the GC and DU risk by 3.524 times. Gender (to be female) (OR: 0.454) decreased the GC and DU risk by inversly decreased in the multivariate analysis.

Effects of rapamycin treatment on pancreatic fibrosis, cellular apoptosis and oxidative stress in experimental chronic pancreatitis model.

PURPOSE: Rapamycin reduces hepatic fibrosis by inhibiting hepatic stellate cell activation. The present study investigated whether rapamycin treatment could modify the degree of fibrosis, cellular apoptosis and oxidative stress (OS) in an experimental model of CP. METHODS: Fifty-five male, Sprague-Dawley rats weighing 200-400g were randomized into four groups. CP was induced by intraductal trinitrobenzene sulfonic acid (TNBS) infusion in group A (n = 15) and group B (n = 15). Group C (n = 15) received intraductal TNBS and was killed for histologic confirmation at four weeks. Group D (n = 10) received intraductal saline instead of TNBS. Group A and group D received oral rapamycin (2 mg/kg/d) for two weeks after CP was induced while group B received oral tap water instead of rapamycin. Blood and pancreatic tissue specimens were collected and oxidative stress parameters, fibrosis and cellular apoptosis were determined. RESULTS: Tissue and blood malondialdehyde (MDA) levels were significantly lower in rapamycin treated group compared to controls (p < 0.001). Superoxide dismutase (SOD) and glutathion peroxidase (GSH-Px) activities were also significantly higher in the active treatment group (p < 0.001 for both). Tissue and blood MDA, SOD, GSH-Px measurements was similar in rapamycin group and pancreatic cannulation group (p > 0.05). Histopathologic fibrosis scores were similar in rapamycin and control groups. Apoptotic cell counts tended to be lower in rapamycin treated animals. CONCLUSIONS: Administration of rapamycin alleviated OS and, in part, prevented apoptotic cell death in experimental CP, but did not reduce fibrosis.

Coring-out fistulectomy with a newly designed 'fistulectome' for complicated perianal fistulae: a retrospective clinical analysis.

AIM: Conventional surgery for complex anal fistula (AF) is associated with continence disturbance and recurrence. In the hope of reducing these we developed a new mechanical device, the 'fistulectome', to excise the entire fistula tract. METHOD: Between March 2001 and April 2011, 136 patients underwent surgery for a complex AF using the fistulectome. All fistulae were cryptoglandular in origin. Five patients were lost to follow up and were excluded from the analysis. RESULTS: Of the 131 fistulae, 76 were trans-sphincteric, 14 were suprasphincteric and 16 were extrasphincteric. Seven had a horseshoe extension and 18 were unclassified. Of the 131, 108 had recurred after conventional fistulotomy performed at another centre and 23 were primary. The mean duration of follow up was 34.6 months, the mean hospital stay was 5 days and the healing time was 14 days. Recurrence, flatus incontinence and soiling occurred in 17 (12.9%), four (3.5%) and two (1.52%) patients. CONCLUSION: The results of this series suggest that coring-out of a fistula using a fistulectome may be a valid treatment for complicated anal fistula.

Low frequency of a decreased ankle brachial index and associated conditions in the practice of internal medicine in a Turkish population sample.

AIM: Peripheral arterial disease (PAD) is a less known condition in the practice of internal medicine, mostly due to lack of specific symptoms and low rates of physician awareness. However, cardiovascular disease (CVD) incidence is not significantly different among patients with symptomatic or asymptomatic disease. Ankle brachial index (ABI) measurement is an easy and cost-effective tool for the diagnosis of PAD. In the present study, frequency of low ABI and associated factors were investigated in the setting of internal medicine practice. METHODS: Patients over 70 years of age and patients between 50 and 69 years with CVD or at least one atherothrombosis risk factor were included in the study. ABI was determined with handheld Doppler. Measurements were determined for both lower extremities. Lower of the right or left ABIs was taken as the final value. Low ABI was defined as ≤0.9. RESULTS: A total of 303 subjects between 50 and 83 years of age were enrolled (female/male: 186/117). Mean ABI was 1.14±0.15. A low ABI was detected in 15 cases (4.95%). Prevalence was 7% in females and 1.7% in males (P=0.039). Low ABI value was not associated with any of the demographic parameters, presence of major risk factors or basic laboratory values. A high ABI was found by 5.6%. CONCLUSION: In the present study, frequency of PAD as determined by ABI was found lower than those reported previously in most European countries. Nonetheless, our results showed that PAD affects at least 1 in 20 outpatients in the practice of internal medicine.

Women with polycystic ovary syndrome have increased plasma chitotriosidase activity: a pathophysiological link between inflammation and impaired insulin sensitivity?

Polycystic ovary syndrome (PCOS) is characterized by insulin resistance. Chronic low grade inflammation has been reported to participate in the pathogenesis of insulin resistance. Chitotriosidase (ChT), a protein secreted by activated macrophages, has been shown to be involved in chronic inflammatory responses. In the present study, serum chitotriosidase activity and its relationship with insulin resistance were determined in patients with PCOS.34 patients with PCOS and 44 age and body mass index (BMI) matched healthy controls were enrolled in the study. ChT activity was measured by the fluorescence method. High sensitivity C reactive protein (hs-CRP) and adiponectin levels were determined by enzyme immunoassay (EIA). Insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR) formula.Plasma ChT activity, hs-CRP level and HOMA-IR score were significantly higher (p=0.024, p=0.002, p=0.001, respectively) while plasma adiponectin concentration was significantly lower (p=0.018) in women with PCOS compared to healthy controls. Blood ChT activity correlated positively with age, waist-to-hip ratio (WHR), BMI, hs-CRP, HOMA-IR and negatively with blood adiponectin level. After adjustment for age and BMI, ChT activity, total testosterone level and WHR remained as the independent predictors of HOMA-IR score in logistic regression analysis.ChT activity is increased in patients with PCOS in concordance with insulin resistance. These findings may reflect the pronounced risk for metabolic syndrome and atherosclerotic diseases in this particular patient group.

Ewing's sarcoma of the fibula presenting with venous thrombosis

Malignancies account for about 20% of incidentally diagnosed venous thromboembolism. Surgery- or chemotherapy-induced risk of thrombosis is also high in patients with cancer. We report on a young male with skeletal Ewing's sarcoma who presented with deep vein thrombosis in the affected limb, which is quite a rare clinical condition. Venous thrombosis of the lower extremities in young patients should prompt the clinician to search for underlying local malignancies (AU)

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Low plasma apelin levels in newly diagnosed type 2 diabetes mellitus.

OBJECTIVE: To investigate blood apelin concentrations in patients with newly diagnosed and untreated type 2 diabetes mellitus (T2DM) who had no additional disorder and to investigate the association of apelin with adiponectin, body mass indexes (BMI) and insulin sensitivity. METHODS: Forty patients with T2DM and 40 healthy controls were enrolled. Apelin levels were measured along with BMI, lipids, glucose, insulin and adiponectin levels, and HOMA-IR indexes. Age, sex and BMI were similar in the two groups. RESULTS: Plasma apelin and adiponectin levels were significantly lower in the diabetic group compared to controls (p<0.001, for both). Insulin levels and HOMA indexes were significantly higher in patients with T2DM (p<0.001 and p=0.001, respectively). Apelin levels were negatively correlated with age (r=-0.315, p=0.006), fasting blood glucose (r=-0.556, p<0.001) and HOMA indexes (r=-0.411, p=0.001), and positively correlated with plasma adiponectin levels (r=0.593, p<0.001). Plasma adiponectin was negatively correlated to plasma insulin (r=-0.379, p=0.001), fasting glucose (r=-0.604, p<0.001), HOMA-IR (r=-0.559, p<0.001) and BMI (=-0.229, p=0.04). CONCLUSIONS: Plasma apelin is reduced in newly diagnosed and untreated patients with T2DM having no confounders. Regulation of circulating apelin and adiponectin seems to be in the same manner in patients with T2DM. Dysregulation of apelin might be involved in the mechanism of establishment of overt diabetes mellitus as well as associated atherosclerotic complications.