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Kadri Atay Department of Gastroenterology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, TurkeyWe read with interest the report of Saito et al1 regarding the association between long-term effects of gastrectomy in patients with spirometry-defined chronic obstructive pulmonary disease (COPD) and those at risk of COPD.Read the original article

Kadri Atay,1 Omer Kaya2 1Istanbul University, Cerrahpasa School of Medicine, Division of Gastroenterology, 2Medipol University, Department of Internal Medicine, Istanbul, TurkeyWe read with interest the report by Wang et al regarding the association between Helicobacter pylori infection and atrial fibrillation.1Read the original article

High repetition rate laser systems enable new strategies for diagnosing plasma behavior with large datasets. Here, we define an ensemble technique that relies on randomized targeting of x-ray tracer micro-stripes. On each shot, a high-intensity laser pulse is focused on a solid target with Ti tracer stripes embedded in an Al foil, randomly targeting a micro-stripe, a portion of a stripe, or a gap between stripes. High-resolution, time-integrated x-ray spectrometers capture line emission from the portion of the micro-stripe that is heated to sufficiently high electron temperatures. Accumulation of many such cases is used to construct ensemble distributions of x-ray line intensities that encompass all relative offsets of the laser focus to the micro-stripe centers. Synthetic intensity distributions are likewise generated using collisional-radiative modeling. Bayesian fitting of modeled to measured intensity distributions establishes the most likely radial temperature profiles, enabling comparison to hydrodynamic models and calling into question the cylindrical symmetry of these micro-stripe-embedded systems. Ensemble techniques have significant potential for high-energy-density plasma diagnostics, especially with the advent of high repetition rate experiments. [ABSTRACT FROM AUTHOR]

X-ray line emission spectra can thoroughly characterize hot plasmas, especially when line shapes and ratios convey distinct aspects of plasma conditions. However, the high spectral resolution required for observing line shapes is often at odds with the large bandwidth required to observe many line ratios across a wide spectral range. One strategy to obtain high spectral resolution over a wide bandwidth is to use multiple crystals with calibrated reflectivity so that line intensities across different crystals can be compared. Here, we explore the use of a low-resolution, wide-bandwidth mica survey spectrometer to infer relative reflectivity of two high-resolution, narrow-bandwidth quartz crystals. A Monte Carlo error analysis determines comparable x-ray line ratios measured from both spectrometers, resulting in an in situ calibration factor and associated uncertainty for the relative reflectivity of the high-resolution crystals. [ABSTRACT FROM AUTHOR]

Introduction: Pneumonia is a common symptom of coronavirus disease-2019 (COVID-19), and this study aimed to determine how analyzing initial thoracic computerized-tomography (CT) scans using semi-quantitative methods could be used to predict the outcomes for hospitalized patients., Materials and Methods: This study looked at previously collected data from adult patients who were hospitalized with a positive test for severe acute respiratory syndrome coronavirus-2 and had CT scans of their thorax at the time of presentation. The CT scans were evaluated for the extent of lung involvement using a semi-quantitative scoring system ranging from 0 to 72. The researchers then analyzed whether CT score could be used to predict outcomes., Result: The study included 124 patients, 55 being females, with a mean age of 46.13 years and an average duration of hospitalization of 11.69 days. Twelve patients (9.6%) died within an average of 17.2 days. The non-surviving patients were significantly older, had more underlying health conditions, and higher CT scores than the surviving patients. After taking age and comorbidities into account, each increase in CT score was associated with a 1.048 increase in the risk of mortality. CT score had a good ability to predict mortality, with an area under the curve of 0.857 and a sensitivity of 75% and specificity of 85.7% at a cut-off point of 25.5., Conclusions: Radiologic severity index, which is calculated using a semi-quantitative CT scoring system, can be used to predict the mortality of COVID-19 patients at the time of their initial hospitalization.

Objectives: To evaluate the macular and optic nerve head (ONH) vascular density, foveal avascular zone area, and outer retina and choriocapillaris flow in Multisystemic Inflammatory Syndrome in Children (MIS-C) using optical coherence tomography angiography (OCTA)., Methods: Thirty-four eyes of 34 patients with MIS-C and 36 age and sex-matched healthy controls were investigated in this prospective, cross-sectional study. The superficial capillary plexus (SCP) and deep capillary plexus (DCP), ONH, FAZ parameters, the flow area of the outer retina, and choriocapillaris were evaluated using OCTA., Results: All VD parameters in SCP were significantly lower in MIS-C patients. There was no significant difference between the groups in VD parameters of both DCP and ONH, as well as FAZ area and FAZ perimeter. However, foveal density (FD-300) was significantly decreased in the MIS-C group. (p = 0.024). The outer retina flow area at 1 mm, 2 mm, and 3 mm radius and CC flow area at 1 mm and 2 mm radius were significantly lower in the MIS-C group than in the control group. Although CC flow area at 3 mm radius was decreased in the MIS-C group compared to healthy controls, the difference was not statistically significant., Conclusions: We demonstrated a decreased vessel density in SCP, choriocapillaris flow area, and outer retinal flow area in MIS-C patients. Hence, we proposed that OCTA could reveal retinal and choroidal microvascular changes in MIS-C patients who were completely healthy before the diagnosis of MIS-C., (© 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Background and Study Aims: Non-alcoholic fatty liver disease (NAFLD) is an independent risk factor for chronic kidney disease (CKD). Previous studies argued that leptin levels increase significantly with the progression of CKD. But the association between leptin and CKD has not been investigated in patients with NAFLD. Therefore, we conducted this study to establish whether increased leptin level is associated with CKD in NAFLD patients., Patients and Methods: In our prospective study with a follow up period of six months thirty-five teetotaller biopsy-proven NAFLD patients were divided as groups with mild, versus advanced, fibrosis. Liver fibrosis was also assessed with Fibroscan. Serum leptin levels were measured by radioimmunoassay. For insulin resistance we used the homeostasis model assessment method (HOMA-IR). For the kidney function, we used the abbreviated formula Modification of Diet in Renal Disease (MDRD) formula, which estimates GFR. For statistical analysis, Student's-t test, Mann-Whitney test, linear regression-binary logistic regression analyses and the ROC curve analysis were used., Results: Advanced fibrosis and increased HOMA-IR were risk factors for decreased eGFR. Leptin correlated inversely with advanced fibrosis (p: 0.03) and low leptin was a risk factor for CKD (p: 0.02). In ROC curve analysis, advanced fibrosis and low leptin were risk factors for decreased eGFR (p: 0.007 and 0.004, respectively). Low leptin level was dependently associated with decreased eGFR., Conclusion: Advanced fibrosis in NAFLD patients is a risk factor for CKD. Leptin correlated inversely with advanced fibrosis. Unlike the previous studies, which were not performed in NAFLD patients, we found decreased leptin in NAFLD patients with decreased eGFR. Low leptin level was found to be a dependent predictor for differentiating NAFLD patients with high risk for CKD., Competing Interests: Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.)

Background: We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH)., Patients and Methods: Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression., Results: We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients., Conclusion: Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Demonstration of diagnostic contribution of Papanicolaou Society of Cytopathology-standardized nomenclature for pancreaticobiliary cytology (PSC-PC) in endoscopic ultrasonography (EUS) fine-needle biopsy (FNA) biopsies is important for widespread use and further development., Methods: 179 EUS-FNA biopsies (89: solid, 90: cystic) and PSC-PC categories were compared with surgical definite histopathology and definite clinical diagnosis. Overall risk of malignancy (oROM) was calculated for each PSC-PC category. Diagnostic accuracy was evaluated., Results: The cytopathology of lesions was nondiagnostic in 27%. Ductal dilatation, lymphadenopathy, and solid characteristic (independently) were associated with diagnostic result, while lesion size was not. PSC-PC categories had 89% diagnostic consistency with surgical definite histopathology. Category mismatch was detected in 3 patients (11%), of which 2 had adenocarcinoma. oROM was 14.3% for nondiagnostic group, 46% for cat. III (atypia), and 12% for cat. IVB (neoplastic - other). In terms of malignancy, the PSC-PC system had 100% specificity; PPV, 92% sensitivity, and 81% NPV; and the diagnostic accuracy was 94%., Conclusion: Using PSC-PC in EUS-FNA biopsies, pancreatic malignancy can be diagnosed with high diagnostic accuracy. In mucinous cystic lesions, some malignancies may be missed. To predict the malignancy risk of cat. IVB, assessment of dysplasia seems important. Although PSC-PC is not the only parameter in terms of diagnosing malignancy, its contribution to the clinical decision is quite high., (© 2022 S. Karger AG, Basel.)

Objective: The aim of the study was to identify the frequency of azathioprine-induced acute pancreatitis (AZA-AP) and related factors., Methods: Seven hundred eighty-seven inflammatory bowel disease (IBD) patients on AZA therapy were retrospectively analyzed. Azathioprine-induced AP was diagnosed with positive imaging and/or an at least 3-fold increased amylase level, in presence of typical abdominal pain. The AZA-AP group was compared with patients on AZA therapy with no history of pancreatitis and 4 numerical adjacent cases with the same diagnosis were selected (group B)., Results: Fifty-four patients developed gastrointestinal symptoms (6.9%); however, only half of them (26 of 54) had pancreatitis, except 1, all within the first 2 months under AZA. When the AZA-AP group was compared with group B, only budesonide usage and active smoking were significantly more common in group A (46.2% vs 25%, P = 0.034, and 77% vs 51%, P = 0.017, respectively). Active smoking was the only independent risk factor for AZA-AP development (odds ratio, 3.208 [95% confidence interval, 1.192-8.632])., Conclusions: All IBD patients developed AZA-AP nearly all within the first 2 months. Azathioprine intolerance may be a hidden diagnosis in at least half of the patients with AZA-AP symptoms. All smoker IBD patients should be monitored closely for AZA-AP development., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Aims: Data regarding outcome of COVID-19 in patients with autoimmune hepatitis (AIH) are lacking., Approach and Results: We performed a retrospective study on patients with AIH and COVID-19 from 34 centers in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes, defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity score-matched cohort of patients without AIH but with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase > 2 × the upper limit of normal) during COVID-19 was also evaluated. We included 110 patients with AIH (80% female) with a median age of 49 (range, 18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (P = 0.041; OR, 3.36; 95% CI, 1.05-10.78), while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (P = 0.009; OR, 0.26; 95% CI, 0.09-0.71). The rates of severe COVID-19 (15.5% versus 20.2%, P = 0.231) and all-cause mortality (10% versus 11.5%, P = 0.852) were not different between AIH and non-AIH CLD. Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (P < 0.001; OR, 17.46; 95% CI, 4.22-72.13). Continuation of immunosuppression or presence of liver injury during COVID-19 was not associated with severe COVID-19., Conclusions: This international, multicenter study reveals that patients with AIH were not at risk for worse outcomes with COVID-19 than other causes of CLD. Cirrhosis was the strongest predictor for severe COVID-19 in patients with AIH. Maintenance of immunosuppression during COVID-19 was not associated with increased risk for severe COVID-19 but did lower the risk for new-onset liver injury during COVID-19., (© 2021 by the American Association for the Study of Liver Diseases.)

Materials with strong magnetoresistive responses are the backbone of spintronic technology, magnetic sensors, and hard drives. Among them, manganese oxides with a mixed valence and a cubic perovskite structure stand out due to their colossal magnetoresistance (CMR). A double exchange interaction underlies the CMR in manganates, whereby charge transport is enhanced when the spins on neighboring Mn 3+ and Mn 4+ ions are parallel. Prior efforts to find different materials or mechanisms for CMR resulted in a much smaller effect. Here an enormous CMR at low temperatures in EuCd 2 P 2 without manganese, oxygen, mixed valence, or cubic perovskite structure is shown. EuCd 2 P 2 has a layered trigonal lattice and exhibits antiferromagnetic ordering at 11 K. The magnitude of CMR (10 4 %) in as-grown crystals of EuCd 2 P 2 rivals the magnitude in optimized thin films of manganates. The magnetization, transport, and synchrotron X-ray data suggest that strong magnetic fluctuations are responsible for this phenomenon. The realization of CMR at low temperatures without heterovalency leads to a new regime for materials and technologies related to antiferromagnetic spintronics., (© 2021 Wiley-VCH GmbH.)

Purpose: To evaluate ophthalmic parameters in adult celiac patients., Methods: This cross-sectional study included 31 celiac patients (58 eyes) and 25 healthy controls (50 eyes). Tear break up time (TBUT), schirmer test were measured; corneal thickness, anterior chamber parameters were obtained using scheimpflug camera; retinal nerve fiber layer thickness (RNFL) evaluated by using spectral domain optical cohorence tomography., Results: There were no statistically significant differences between the groups in terms of gender, age, and intraocular pressure ( p > .05). Schirmer's test results and TBUT were significantly lower in celiac patients ( p < .001, p < .001). Additionally, the superior RNFL was significantly thinner ( p = .017), nasal RNFL thicker ( p = .007), and anterior chamber depth larger ( p = .037) in celiac patients. The tissue transglutaminase 2 IgA antibody and superior RNFL were negatively correlated (r = -0.394, p = .012). The anterior chamber volume and anti-gliadin IgA antibody were positively correlated (r = 0.369 p = .027)., Conclusion: Celiac disease affects Schirmer's test results, TBUT, segmental RNFL thickness, and anterior chamber parameters. Ocular parameters might be affected in celiac disease especially in the presence of high antibody titer.

Pott's puffy tumor is a rare and serious complication of frontal sinusitis, characterized by the development of osteomyelitis and subperiostal abscess in the frontal bone. Paranasal sinus osteomas are benign osteoblastic tumors, usually seen in the 3 rd and 4 th decades of life. In this report, we present a case of Pott's puffy tumor due to frontal sinus osteoma in an adolescent male patient. In the literature, we found no similar case in the pediatric age group and we wanted to emphasize the development of Pott's tumor as a rare complication of chronic or recurrent sinusitis and draw attention to the fact that paranasal sinus osteomas may be the underlying cause., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (Copyright: © 2020 Turkish Archives of Pediatrics.)

Weak evidence is present for choosing amongst different temporary hemodialysis catheter (THC) designs with regards to the risk of venous thrombosis, therefore two THC designs for the right internal jugular vein (RIJV) were compared. Patients aged ≥18 years who needed THC insertion into the RIJV for acute hemodialysis due to either acute or chronic renal failure were included. The type of THC (precurved/straight) was dependent on the date of hospital admission. Clinical and ultrasonographic surveillance was conducted prospectively. Thrombosis of the RIJV was the primary objective. Precurved and straight catheters were inserted into 32 and 23 patients (mean age 63 ± 15 years, females 28), respectively. The baseline characteristics and catheter dwell-times were similar in both groups. Partial and total thrombosis of the RIJV during catheter dwell-time developed at a higher rate in the straight group (52% vs. 9.3%, P = 0.000; 47.8% vs. 9.3%, P = 0.001, respectively). At least 2 weeks after catheter removal, total thrombosis was found in 43.4% vs. 9.6% (P = 0.004) of patients with straight and precurved THCs, respectively. The hazard ratios for total thrombosis was 0.161 (P = 0.006) during catheter dwell-time and 0.190 (P = 0.012) after catheter removal. Catheter dysfunction did not occur and only one catheter-related bloodstream infection (CRBI) was seen. Thrombosis rates of the RIJV were higher with straight vs. precurved THCs, both during catheter dwell-time and after catheter removal. Catheter dysfunction was not noted in any group and the rate of CRBI was extremely low., (© 2018 International Society for Apheresis, Japanese Society for Apheresis, and Japanese Society for Dialysis Therapy.)

Background/aims: The aim of the present study was to compare the demographic features and long-term outcomes of patients with inflammatory bowel disease (IBD) with or without ankylosing spondylitis (AS)., Materials and Methods: Among 1640 IBD (Crohn's disease and ulcerative colitis), 76 patients with IBD+AS were identified. The study group consisted of 76 patients with IBD with synchronous AS. The control group consisted of patients with only IBD, and those were selected according to their registry sequence number being the previous and next case to the diseased case with IBD+AS. The primary endpoint was to compare the rate of intestinal resections between both groups (IBD vs. IBD+AS)., Results: Among 76 patients with IBD+AS, 52 (68%) first presented with IBD, 11 (15%) with AS, and the remaining 13 (17%) had both diagnoses at the same time. The mean follow-up time was significantly longer in patients with IBD+AS (43.4 vs. 27.8 months; p=0.01). Twenty-two percent of patients with IBD and 14% of those with IBD+AS had an intestinal resection (p=NS). Biologic and systemic corticosteroid treatments were significantly more common among patients with IBD+AS (32% vs. 7% for biologics, p<0.0001 and 44% vs. 28% for corticosteroids, p=0.042). Age-sex-adjusted regression analysis for both groups disclosed IBD duration as the only independent predictor for resection (R2=0.178; p=0.016)., Conclusion: The present study shows that up to 5% of patients with IBD may have AS. Patients with IBD+AS do not have a worse disease outcome than solo patients with IBD.

Hermansky-Pudlak syndrome (HPS) is an autosomal recessive disorder consisting of oculocutaneous albinism, platelet storage pool deficiency, and lysosomal accumulation of ceroid lipofuscin. The storage pool deficiency of HPS is associated with the lack of dense bodies in the platelets, resulting in impaired response in the secondary phase of aggregation. Patients with HPS have normal coagulation tests; however, their bleeding time is usually prolonged despite normal or increased platelet counts. Essential thrombocythemia (ET) is an uncommon condition, with an incidence of approximately 1.1 per 100,000/year, and it is the most common cause of primary thrombocytosis. JAK2 V617F positivity can be observed in approximately half of the patients with ET. Bleeding events in ET have usually been associated with acquired von Willebrand syndrome paradoxically occurring when the platelet counts are extremely high. We, herein, present a case with bleeding diathesis diagnosed as having both HPS and JAK2 V617F -positive ET.

Background: Data on the prevalence of fecal incontinence in elderly patients admitted to outpatient clinics in Turkey are scarce., Aims: The aim of this study was to assess the prevalence of fecal incontinence and the associated risk factors in the elderly outpatients., Methods: Patients 60 years and older admitted to a geriatrics outpatient clinic between October 2013 and March 2014 were included. Demographic characteristics, anthropometric measurements, marital status, educational status, parity (for females), fecal incontinence (FI), urinary incontinence (UI), constipation, comorbid conditions, and medications were recorded. FI assessment was based on the Fecal Incontinence Severity Index (FISI)., Results: A total of 364 patients (64.8% female, n = 236) with a mean age of 73.2 ± 8.1 years were enrolled in the study. The prevalence of FI was 9.9% (10.2% female, 9.4% male). UI was 42.6%. Co-occurrence of FI and UI was 7.4%. According to the FISI, the most frequent type of defecation was liquid stool (61.1%). While the predictive factors for FI were polypharmacy (standardized coefficient, [r] = 0.203, 95% confidence interval [CI] = 0.009-0.040, p = 0.002), UI (r = 0.134, 95% CI = 0.006-0.156, p = 0.035), and being married (r = 0.200, 95% CI = -0.088 to -0.020, p = 0.002) in females, those were UI (r = 0.306, 95% CI = 0.093-0.309, p < 0.001) and polypharmacy (r = 0.251, 95% CI = 0.009-0.043, p = 0.003) in males., Conclusions: In both genders, urinary incontinence and polypharmacy seem to be the most important risk factors for fecal incontinence. Fecal incontinence should be questioned in detail and evaluated using FISI in elderly outpatients.

Competing Interests: The authors declare no conflict of interest.

Background/aims: Oxidative stress and insulin resistance (IR) are major contributors in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). The purpose of this study was to find the relation between oxidative stress parameters and histopathological findings in NAFLD patients with and without insulin resistance (IR)., Materials and Methods: Thirty-two patients with no alcohol intake and biopsy-proven diagnosis of NAFLD were studied (M/F: 17/15; mean age 46.5±11.4 years). Twenty-one NAFLD patients with IR were compared with 11 patients without IR. The fasting insulin level was measured, and the insulin resistance index was calculated using the homeostasis model assessment (HOMA) method. Malondialdehyde (MDA) and superoxide dismutase (SOD) activities were measured in tissue and serum specimens. Glutathione (GH) was measured in tissue homogenates. Nitric oxide (NO), vitamin E and C levels were measured in serum., Results: Patients with IR had significantly higher tissue MDA levels (p=0.001) and significantly decreased tissue SOD and GH levels (p=0.001 and 0.002, respectively) than those without IR. The steatosis grade, necroinflammatory grade and stage were significantly higher in patients with IR (p=0.035, 0.003 and 0.001, respectively). HOMA IR significantly correlated with the necroinflammatory grade, stage, tissue MDA, SOD and GH (p=0.013, 0.001, 0.008, 0.001 and 0.001, respectively). Serum MDA (β=1.88, p=0.002), serum SOD (β=0.57, p=0.006), tissue MDA (β=0.22, p=0.006), tissue SOD (β=1.48, p=0.071) and stage (β=2.81, p=0.003) were independently associated with increased HOMA IR. Increased MDA [OR: 1.51; 95% CI: (1.03-2.22); p=0.034] was a risk factor for non-alcoholic steatohepatitis (NASH), and increased SOD activity had a preventive effect against NASH [OR: 0.008; 95% CI: (0.001-0.98); p=0.04]., Conclusion: This study shows that insulin resistance in NAFLD correlates with enhanced oxidative stress. Histopathological disease severity significantly correlated with oxidative stress parameters. These data show that NAFLD patients with IR may have increased risk for disease progression.

Background/aims: Several guidelines recommend the use of tenofovir or entecavir as the first-line treatment for hepatitis B due to the lower resistance rates of these drugs than lamivudine, although lamivudine may still be preferred because of its low adverse effect profile and cost. It is important to know which patients might benefit from lamivudine as the first-line treatment. We aimed to assess the success rates of lamivudine, entecavir, and tenofovir, as well as the resistance rates, frequencies of HBsAg clearance, and risk factors for lamivudine resistance., Materials and Methods: A total of 191 patients with chronic HBeAg-negative hepatitis who were treated with lamivudine, entecavir, or tenofovir were included. Predictors of resistance to lamivudine were analyzed., Results: The cumulative first-, second-, third-, fourth-, and fifth-year rates of virologic breakthrough during extended lamivudine therapy were 24%, 30%, 38%, 46%, and 54%, respectively. The rate of undetectable DNA at the 60th month of those who took lamivudine was 51%. Cox regression analysis revealed that positive HBV DNA at the sixth month (HR=15; 95% CI: [7.1-33], p=0.001), being aged 41 years or more (HR=3.4; 95% CI: [1.8-6.4], p=0.001), and baseline HBV DNA of 170,500 IU/mL or higher (HR=2.1; 95% CI: [1.2-3.7], p=0.01) were independently associated with the development of resistance to lamivudine., Conclusion: In HBeAg-negative chronic hepatitis B, baseline serum hepatitis B virus DNA levels exceeding 170,500 IU/mL, partial virologic response in the sixth month, and age of 41 years or more were independent predictors for virologic breakthrough. Moreover, 2% of these patients cleared HBsAg.

Background/aims: Low lipase levels, which may be an indication of low production due to organ failure, are frequently encountered in a clinical setting, but are usually overlooked. This study examined the values of low serum lipase levels and other clinical parameters in the diagnosis of several clinical conditions, such as in pancreatic cancer., Materials and Methods: Patients with low lipase levels (≤8 U/L) were included in this retrospective study. Clinical data, including diagnostic category, demographic properties, and biochemical and hematological measurements, including serum lipase levels, were extracted. A multivariate analysis was used to identify the independent predictors of certain diagnostic categories., Results: A total of 198 patients with low lipase levels were included. Among these patients with low lipase levels, 45 (22.7%) were diagnosed with pancreas cancer. Multivariate analysis identified low lipase level as a significant predictor of pancreas cancer (OR 0.70 [%95 CI, 0.52-0.93], p=0.02). For predicting pancreatic cancer, an optimal cut-off value of ≤5.5 U/L for lipase was utilized, which had a sensitivity and specificity of 76% and 37%, respectively., Conclusion: Low lipase levels close to zero may be an indication of pancreatic cancer and should not be underestimated in the clinical setting. However, large studies are warranted to delineate the exact diagnostic significance of such low lipase levels.

Introduction: Arterial stiffness is important in the evaluation of the cardiovascular risk in both general population and hypertensive patients. In this study, we aimed to investigate the associations of both serum cystatin C levels and albuminuria with arterial stiffness in healthy controls and hypertensive patients., Patients and Methods: Seventy-six healthy controls (male/female = 44/32) and 76 hypertensive patients (male/female = 43/33) were enrolled. Arterial stiffness parameters such as augmentation index (AIx) and pulse wave velocity (PWV) were non-invasively measured with the Arteriograph (Tensiomed Ltd., Budapest, Hungary)., Results: AIx (31.92 ± 14.31 vs. 27.95 ± 11.03, p = 0.03) and PWV (9.84 ± 1.62 vs. 8.87 ± 2.04, p < 0.001) were significantly higher in hypertensive patients compared to healthy controls. Patients with microalbuminuria had significantly higher AIx (43.47 ± 9.91 vs. 30.37 ± 14.13, p = 0.002) and higher serum cystatin C levels [0.76 (0.67-0.95) vs. 0.68 (0.62-0.78) mg/L, p = 0.03]. In the hypertensive group, AIx was significantly correlated with PWV (r = 0.519, p < 0.001), glomerular filtration rate (cystatin C) (r = -0.438, p = 0.003), mean arterial pressure (MAP) (r = 0.288, p = 0.015) and urinary albumin-creatinine ratio (ACR) (r = 0.386, p = 0.004). PWV was associated with serum cystatin C (r = 0.442, p = 0.003) and MAP (r = 0.377, p = 0.001). In the linear regression analysis (model r = 0.577, p = 0.006) for the prediction of PWV in hypertensive patients, MAP, urinary ACR, age and serum cystatin C levels were included as independent variables. Cystatin C was found to be the significant determinant of PWV in hypertensive patients., Conclusion: Multivariate analysis revealed that serum cystatin C but not albuminuria was significantly associated with PWV in hypertensive patients. Serum cystatin C may be better than albuminuria as a predictor of arterial stiffness in hypertensive patients.

Priapism is a rare symptom with diverse etiological factors. Although most cases in adults are secondary to drug use and intracavernosal injections, blood dyscrasias and hypercoagulable states, vasculitis, penile metastases, neurological conditions, spider bites, carbon monoxide poisoning, and total parenteral nutrition may also result in priapism. We report a case of recurrent and refractory priapism in a 61-year-old man which was diagnosed as multiple myeloma after emergence of hypercalcemia and renal failure due to progression of the underlying pathology. The value of the initial diagnostic approach is emphasized.