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The ability of respiratory mucosal surfaces to eliminate foreign particles and pathogens and to keep mucosal surfaces moist and fresh depends on mucociliary activity. Chronic renal failure (CRF) is an irreversible medical condition that may result in important extrarenal systemic consequences, such as cardiovascular, metabolic, and respiratory system abnormalities. Although there are studies describing nasal manifestations of CRF, data are lacking concerning the effects of the condition on nasal mucosa. The goal of the current study was to evaluate nasal mucociliary clearance (NMC) time in patients with CRF. This prospective cohort study conducted in a tertiary referral center included 32 non-diabetic end-stage CRF patients and 30 control individuals. The control group consisted of voluntary participants who had been referred to our clinic for symptoms other than rhinological diseases. The mean NMC times in CRF patients and control individuals were 12.51 ± 3.74 min (range 7–22 min) and 8.97 ± 1.83 min (range 6–13 min), respectively. The mean NMC time in patients with CRF was significantly longer than that in control individuals (p

Chronic kidney diseases (CKD) is a disease that has become widespread all around the world and poses a gradually increasing problem; treatment choices are basically dialysis, peritoneum dialysis and kidney transplantation. Eight % of the patients around the world that undergo dialysis treatment have PD treatment. PD is basically the solute diffusion between blood and diffusate in peritoneum capillary, causing ultrafiltration at peritoneal cavity by hypertonic solutions, and finally using peritoneum as a dialysis membrane. PD is an ESRD treatment that is cheap, enabling patients to move freely and that has no survival difference than HD and even has some common points. Interestingly, number of patients that undergo PD has decreased in recent years. Many factors are known to have played a role in that. increase in the number of large-scale dialysis organisations, recurrent peritonitis, transition to HD, increase in the number of patients that undergo transplantation, technical troubles relating to PD catheter, and social and economic condition of the individual can be referred to amongst these factors. In this review, we will endeavour to scrutinise the factors that has affected termination of PD, and strategies of prevention. Key Words : Peritoneal Dialysis, Reasons for drop-out, strategies of prevention DOI: 10.12973/ejms.2014.101p

Urinary calculi are a common and severe problem, which are formed by urolithiasis or by the formation of calcium oxalate (CaOx) crystals in the kidneys. Many treatment options such as drugs, various herbal preparations, surgical removal of the stones, and extracorporeal shock wave lithotripsy have been applied for this condition. The aim of this study is to assess the effects of the drug amlodipine in an experimentally induced urolithiasis rat model.The effect of 5 mg/kg amlodipine was studied in rats that were first treated with 1% ethylene glycol and 1% ammonium chloride for 21 days to induce urolithiasis. The weight differences and the levels of calcium, magnesium, and phosphate were measured in serum and urine. In addition, urine CaOx level was defined and histopathological analyses were performed on the kidneys.Urolithiasis caused a significant increase in both serum and urine parameters compared with healthy rats. Urolithiasis plus amlodipine administration increased the levels of these same parameters. Urine CaOx level was high in urolithiasis rats and was also increased by urolithiasis plus amlodipine administration. The weight of the rats decreased in the urolithiasis plus amlodipine group when compared with the urolithiasis group. Histopathological examinations revealed extensive intratubular crystal depositions and degenerative tubular structures in the urolithiasis group and the amlodipine treatment group.We showed that amlodipine may increase susceptibility to urolithiasis by raising hyperoxaluria and hypercalciuria. Further studies should be performed to elucidate the urolithiasis activity of amlodipine and to confirm the data.

OBJECTIVE: Comparison of urinalysis used for pre-diagnosis of urinary tract infections UTI as a rapid test with results of bacterial culture taken a long time and determination of their sensitivity and spesivity ratesMETHODS: Primarily, chemical and microscopic analysis of urine were carried out for the patients admitted to Kutahya State Hospital Nephrology policlinic and those diagnosed with UTI. Urine culture was requested from the patients whose positive one or more of leucocyte esterase, nitrite, proteinuria, pyuria tests by using fully autotomatic urine analyzer iQ 200 IRIS Diagnostics, U.S.A . The growth of ≥103 cfu/ml at presence of pyuria or pure growth of ≥105 cfu/ml with or without pyuria were accepted ‘culture + ’. The results were statistically compared. RESULTS: Urine cultures were positive in 75 53,2% out of total 141 patients that all were symptomatic. Positive predictive values of leucocyte esterase, nitrite, pyuria and proteinuria tests were 55,4%, 78,5%, 52,9% and 48,2% while negative predictive values were calculated as 60%, 57%, 40% and 39,3% respectively. The test that has highest sensitivity rate was pyuria 96% , that has highest specifity rate was nitrite 86,4% .CONCLUSION: Leucocyte esterase, pyuria and nitrite tests are not sufficient to diagnose for patients who are clinically compatible with UTI by themselves, so pyuria and nitrit tests should be together interpreted, an absolute correlation with culture results should not be expected. False positivities or negativities in urine strip tests, possible sterile pyuria reasons and very low colony counts ≤ 102cfu/ml be able to leave out of assesment may be causes., AMAÇ: İdrar yolu enfeksiyonlarının İYE ön tanısında hızlı bir test olarak kullanılan tam idrar analizinin, daha uzun zaman alan kültür sonuçları ile karşılaştırılarak duyarlılık ve özgüllük oranlarının belirlenmesi. YÖNTEMLER: Kütahya Devlet Hastanesi nefroloji polikliniğine başvuran idrar yolu enfeksiyonu ön tanısı alan hastalara öncelikle idrarın kimyasal ve mikroskopik analizi uygulandı. Tam otomatik idrar analizörü iQ 200 IRIS Diagnostics, U.S.A kullanılarak yapılan lökosit esteraz, nitrit, proteinüri veya mikroskopik analiz sonuçlarından biri veya birkaçı pozitif olan hastalardan idrar kültürü istemi yapıldı. Piyüri varlığında >=103 cfu/ml üreme ve piyürili/piyürisiz >=105 cfu/ml saf üreme kültür + olarak kabul edildi. Sonuçlar istatistiksel olarak karşılaştırıldı.BULGULAR: Tamamı semptomatik olan toplam 141 hastanın 75 %53,2 ’inde idrar kültürü + idi. Lökosit esteraz, nitrit, piyüri ve proteinüri testlerinin pozitif prediktif değerleri sırasıyla %55,4, %78,5, %52,9, %48,2 olarak bulunurken negatif prediktif değerleri sırasıyla %60, %57, %40, %39,3 olarak hesaplandı. Duyarlılık düzeyi en yüksek test piyüri %96 , özgüllük düzeyi en yüksek test ise %86,4 nitrit testi idi. SONUÇ: Klinik olarak İYE ile uyumlu hastalar için lökosit esteraz, piyüri ve nitrit testleri tek başlarına tanı koymak için yeterli olmayıp lökosit ve nitrit testleri birlikte değerlendirilmeli, kültür sonuçları ile mutlak korelasyon beklenmemelidir. Strip testlerinde yanlış pozitiflik ya da negatiflikler, muhtemel steril piyüri nedenleri ve kültürde değerlendirme dışı bırakılabilen çok düşük koloni sayıları

Background: Urinary tract infections UTI are most common causes of bacterial infections in adults. The causative agent spectrum and resistance patterns are affected by many factors. In this study, we aimed to determine the microorganisms that cause UTI and their antibiotic resistance rates and efficient several demographic features. Method: In this study, between December 2008-May 2010, microorganisms isolated from midstream urine specimens sent to Kütahya State Hospital Microbiology laboratory with pre-diagnosis of UTI from various clinics, their antibiotic resistance rates and several demographic features age, gender, policlinic / service/intensive care unit ICU where the sample was sent of these patients were retrospectively analysed. Statistical analysis was done by using SPSS version 15.0. Results: Out of 4100 urine samples, in 935 22,8% , significant bacteriuriae was determined. In order of frequency isolated microorganisms were Enterobacteriaceae spp 77,2% , Enterococcus spp 8% ve non-fermenting NF gram negative bacteria 5,3% , Staphylococcus spp 4,8% ve Candida spp 3,9% . NF bacteria and Enterococcus spp were isolated in significantly higher rates in men, 65 years of age and over and service/ICU patients. Conclusion: Because of variations in the causative agent spectrums and in the resistance rates of antibiotics using for empiric treatment in outpatients and inpatients, identification and antibiotic susceptibility testing of UTI isolates and screening for extended spectrumlu beta lactamase ESBL producing Enterobacteriaceae should necessarily be performed for a successful treatment. Statistical analysis of this type of laboratory data at the local, provincial or national level with the several intervals will be very instructive for the relevant clinicians about empiric therapy., Amaç: : İdrar yolu enfeksiyonları İYE yetişkinlerde bakteriyel enfeksiyonların en sık görülen sebebi olup etken spektrumu ve direnç paternleri birçok faktörden etkilenmektedir. Bu çalışmada İYE’na neden olan mikroorganizmaları, antibiyotik direnç oranlarını ve etkili bazı demografik özellikleri belirlemeyi amaçladık. Yöntem: Bu çalışmada, Aralık 2008 ile Mayıs 2010 tarihleri arasında Kütahya Devlet Hastanesi Mikrobiyoloji laboratuvarına çeşitli kliniklerden İYE şüphesi ile gönderilen orta akım idrar örneklerinden izole edilen mikroorganizmalar, bu hastalara ait demografik bazı özellikler yaş, cinsiyet ve numunenin gönderildiği poliklinik/servis/yoğun bakım ünitesi YBÜ ve antibiyotik direnç oranları retrospektif olarak araştırıldı, istatistiksel analiz SPSS 15.0 programı kullanılarak yapıldı. Bulgular: Toplam 4100 idrar örneğinin 935 %22,8 ’inde anlamlı bakteriüri saptandı. Sıklık sırasına göre izole edilen mikroorganizmalar, Enterobacteriaceae spp %77,2 , Enterococcus spp %8 ve nonfermenter NF gram negatif bakteriler %5,3 , Staphylococcus spp %4,8 ve Candida spp %3,9 idi. NF bakteriler ile Enterococcus spp erkeklerde, 65 yaş ve üzeri ve servis/yoğun bakım hastalarında belirgin olarak yüksek oranda izole edildi. Sonuç: Ayaktan ve yatan hastalarda ampirik tedavi için kullanılan antibiyotiklere direnç oranları ve etken patojen spektrumundaki farklılıklar nedeniyle, başarılı bir tedavi için İYE etkenlerin tanımlanması, antibiyogram testlerinin yapılması ve genişlemiş spektrumlu beta laktamaz GSBL çalışması da mutlaka yapılması gerekir. Bu sonuçları içeren laboratuvar verilerinin, hastane veya il bazında ya da ulusal düzeyde belli aralıklarla istatistiksel olarak analiz edilmesi, gerek ayaktan gerekse yatan hastalar için klinisyenlere ampirik tedavide önemli ölçüde yol gösterecektir.

Objective We aimed to investigate the frequency of oral yeast colonization (OYC) and the risk factors for patients who received continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD) or were renal transplant recipients (RTRs). The patients admitted to the Nephrology Clinic at Ataturk University Medical School from January through April 2013 were included in the study. A questionnaire about risk factors was filled out, and swab cultures were taken from the tongue surface of each participant. OYC was detected in 32.1% of the RTRs, 40% of the HD patients, 20.9% of the CAPD patients, and 18% of the healthy control (HC) group. Of the 42 yeast strains isolated from the renal replacement therapy groups, 26 strains (61.9%) were Candida albicans , nine (21.4%) were Candida glabrata , two (4.7%) were Candida krusei , two (4.7%) were Candida kefyr , one (2.38%) was Candida parapsilosis , and two (4.7%) were Geotrichum candidum . Risk factors for OYC in the RTRs group included antibiotic use and the presence of dental prostheses; however, in patients with chronic renal failure undergoing CAPD, only the presence of dental prostheses was found to be a statistically significant risk factor. Although OYC was mostly detected in patients with chronic kidney disease (undergoing HD, a variety of isolated yeast strains in the RTRs was noted. The rates of OYC and isolated Candida species in CAPD were similar to those of the HC group.

Purpose A relationship between liver diseases and serum vitamin B12 levels was observed in previous reports. The purpose of this study was to determine if a similar relationship existed between vitamin B12 and nonalcoholic fatty liver disease (NAFLD), a common chronic liver disorder. Materials and Methods A total of 45 consecutive patients with NAFLD formed the NAFLD group, whereas 30 healthy controls (HC) formed the HC group. The subjects in all of the groups were of similar age and body mass index (BMI). A fatty liver is described in 3 ultrasonographic grades. Fasting blood samples were obtained, and serum vitamin B12 levels were measured. In addition, liver enzymes including aspartate aminotransferase, alanine aminotransferase (ALT), and alkaline phosphatase, and folic acid and other serum parameters were evaluated. The Mann-Whitney U test, χ2 test, and Spearman correlation analysis were used to compare the vitamin B12 levels and other serum parameters in both groups. Results The mean ± SD age and BMI of the NAFLD were 47.2 ± 11.2 and 28.8 ± 3.5. The mean ± SD age and BMI of the HC were 47.1 ± 8.8 and 27.7 ± 2.9, respectively. The serum aspartate aminotransferase and ALT levels of the patients with NAFLD were statistically higher compared with those of the controls ( P = 0.001). The levels of vitamin B12 and folate were statistically lower in the NAFLD patients compared with those of the controls ( P < 0.05). We found that there was a reduction of vitamin B12 levels, especially in grade 2 to grade 3 hepatosteatosis. In addition, in the Spearman correlation analysis between the vitamin B12 levels and ALT, the grade of fatty liver and the liver dimension were found to have an important negative correlation. Conclusion The serum vitamin B12 levels were significantly lower in the patients with NAFLD than in those of the control group; however, these still remain in the reference range. Consequently, low vitamin B12 levels may be associated with NAFLD especially in grade 2 to grade 3 hepatosteatosis.

WOS: 000290670300006, PubMed: 21545312, Background: In this study, we aimed to determine the nasal carriage rate of Staphylococcus aureus and risk factors in hemodialysis (HD) patients. Methods: One hundred eighty-four HD patients were evaluated. A second sample was taken from the subjects, the wipe samples of whom were isolated as S. aureus. And subjects whose second samples' results were the same were deemed as S. aureus carriers. Results: Fifty-two (28.3%) patients were identified as S. aureus carriers. In the control group, S. aureus carriage has been found out as 14.9% in 116 healthy subjects. The isolation rate of S. aureus has been found statistically significantly high in the age group of 41-61 years. But, methicillin-resistant S. aureus (MRSA) isolation ratio has been statistically high in the group over the age of 61 years. Sepsis history and gastrointestinal system disease development is closely related to bacterial isolation. MRSA isolation ratios have been found high in chronic lung disease patients, diabetic patients, patients with infection history, and patients with impaired general state of health. The carriage ratios have been found higher in the patients who are settled in urban areas, are subjected to dialysis for more than 10 years, and are hospitalized in the past year. However, the difference between the other groups is not statistically significant. Conclusions: S. aureus carriage must be screened on regular intervals in HD patients. Nasal S. aureus carriage follow-up and treatment is a process that will protect patients from more severe clinical pictures.

A 32 year old female patient was admitted to our clinic with complaints of recurrent speech disorder (stuttering), hypertension and paresthesia of the tongue and below the knee in particular. According to the assessments, the patient was hypocalcemic and hypomagnesemic and treated with intravenous calcium and magnesium infusions. The patient has had no hypoparathyro- idism and vitamin D deficiency. In this case report, we present a rare case of hypocalcemia-related dysarthria by reviewing the literature. Keywords: Hypocalcemia, dysarthria DOI: 10.12973/ejms.2014.112p

BACKGROUND It is unclear whether hemostasis plays a role in the pathogenesis of ischemic stroke subtypes. OBJECTIVE We aimed to investigate the possible relationship between different hemostatic markers and lacunar stroke. RESULTS The study consisted of 30 patients with symptomatic lacunar stroke and 30 healthy age-matched healthy individuals. We analyzed the values of "Mean Platelet Volume," D-dimer, "soluble p-selectin," "Plasminogen Activator Inhibitor Type-1" (PAI-1), "Thrombin-Activatable Fibrinolysis Inhibitor" (TAFI), and "Platelet Factor 4" (PF4) in patients with lacunar infarct and compared these values to those of control individuals. There were significant differences for D-dimer, mean platelet volume, thrombin-activatable fibrinolysis inhibitor, and platelet factor 4 values in symptomatic lacunar stroke group compared with the control group (P < 0.01). CONCLUSIONS Different hemostatic factors may play a role in the pathogenesis of lacunar stroke. Evaluating the role of hemostatic factors on different types of strokes may help us identify new therapeutic strategies and different prognostic stratifications for ischemic stroke.

Introduction: The aim of the present study was to evaluate the role of erythropoietin (EPO) in liver and renal injury following hemorrhagic shock (HS) after inhibition of tyrosine kinase activity in rats. Methods: Forty-eight Sprague-Dawley rats were assigned to six groups: (I) HS alone; (II) HS followed by retransfusion; (III) EPO and genistein followed by HS; (IV) EPO and genistein followed by HS, followed by retransfusion; (V) HS followed by EPO and genistein; and (VI) HS followed by EPO and genistein, followed by retransfusion. HS was induced for 60 minutes after withdrawal of 30% of the calculated total blood volume of each rat from the left femoral artery. Blood and tissue samples (from the kidney and liver) were obtained 60 minutes after HS in Group I, III, and V; blood and tissue samples were obtained 60 minutes after retransfusion in Group II, IV, and VI. In Group III and IV, EPO was given 60 minutes before HS, and genistein 30 minutes before HS. In Group V and VI, EPO and genistein were given 30 minutes after HS. Results: Liver and renal injury were significantly attenuated with EPO and genistein administration. Conclusion: These results suggest that EPO is effective in attenuating liver and renal injury in HS, even with inhibition of tyrosine kinase activity with genistein.

OBJECTIVE: To evaluate the efficacy of cyanocobalamin treatment in patients having recurrent aphthous ulcers (RAUs) with normal or decreased serum vitamin B12 (cobalamin) levels. METHODS: Seventy-two patients with RAU were included in the study. In addition to serum cobalamin levels, hemanitic and biochemistrical parameters were measured. Patients with serum cobalamin levels

Objectives: We compared the short-term results of antiinflammatory drugs alone or in combination with local injection of a corticosteroid and anesthetic mixture in the treatment of tennis elbow.Methods: The study included 21 patients (12 males, 9 females; mean age 45 years; range 19 to 72 years) with tennis elbow. The patients were randomized to oral and topical anti-inflammatory drugs alone (group 1, n=10) or combined with a single local injection of a corticosteroid and anesthetic mixture (group 2, n=11). The patients were evaluated with a pain score (0 to 10 points) and clinical examination before and one month after treatment.Results: Complete or near-complete relief of pain and unlimited function were obtained in four patients (40%) in group 1, and in 10 patients (90.9%) in group 2. On physical examination, two patients (20%) in group 1 and eight patients (72.7%) in group 2 were pain-free upon pressure on the lateral epicondyle or dorsiflexion of the wrist. Pain scores differed significantly in both groups after treatment (p=0.026 and p=0.003, respectively); however, combination treatment was associated with a significantly higher efficacy (p=0.036).Conclusion: It was concluded that significantly enhanced efficacy of the combination treatment used in this study might be limited to the short-term and that adverse effects of steroids on the tendons should be taken into consideration., Amaç: Tenisçi dirseği tedavisinde antienflamatuvar ilaç tedavisinin tek başına ve lokal kortikosteroid ve anestezik karışımı enjeksiyonla birlikte kullanılmasının erken dönemdeki etkinliği karşılaştırıldı.Çalışma planı: Çalışmaya, lateral epikondilit tanısı konan 21 hasta (12 erkek, 9 kadın; ort. yaş 45; dağılım 19-72) alındı. Rastgele seçimle 10 hastaya (grup 1) sadece oral antienflamatuvar ilaç ve topikal antienflamatuvar ilaç tedavisi, 11 hastaya (grup 2) ise, buna ek olarak, bir kez lokal kortikosteroid ve lokal anestezik ilaç enjeksiyonu uygulandı. Hastalar tedavi öncesinde ve tedaviden bir ay sonra ağrı skorlaması (0-10 puan) ve klinik muayene ile değerlendirildi. Sonuçlar: Grup 1’de dört hastada (%40), grup 2’de 10 hastada (%90.9) ağrı yakınması tam veya tama yakın derecede düzeldi ve fonksiyon kısıtlılığı kalmadı. Fizik muayenede, grup 1’de iki hasta (%20), grup 2’de sekiz hasta (%72.7) lateral epikondil üzerine bastırmakla ve el bileği dorsifleksiyonu ile ağrısızdı. Tedavi öncesine göre iki grupta da ağrı skorlarında anlamlı derecede düşüş sağlandı (p=0.026 ve p=0.003); ancak, grup 2’de uygulanan tedavinin etkinliği anlamlı derecede daha fazlaydı (p=0.036). Çıkarımlar: Çalışmamızda uygulanan kombinasyon tedavisi kısa dönemde büyük yarar sağlasa da, bu etkinin geçici olabileceği ve steroidlerin tendonlar üzerindeki yan etkilerinin de dikkate alınması gerektiği sonucuna varıldı.

Ozbek, Orhan/0000-0002-7388-0542 WOS: 000251826200006 PubMed: 18091366 Background: Obesity and related disorders have a high prevalence all over the world. Increased C-reactive protein (CRP) value in obese individuals and its potential adverse effects have been reported. Here we have investigated the relationship between CRP levels and renal functions in nondiabetic, nonhypertensive, overweight, and obese individuals. The aim of this study was to evaluate the predictive value of CRP levels on future severe renal disease. Methods: One hundred sixty individuals were included in the study. They were grouped as normal weight, overweight, and obese. Anthropometric measurements, renal function tests, and serum hsCRP values were obtained. Mean values were compared and correlation analysis was performed. Results: Significant differences were detected between the groups according to body mass index, waist circumference (WC), and body fat percentage. There was a significant difference with respect to creatinine clearance (CC). Difference in the mean urinary albumin excretion (UAE) was significant between normal-weight and overweight subjects. There was a linear increase in serum CRP values in parallel to the increase in body weight; mean values were significant between groups. A positive correlation was detected between CC and body mass index and WC, and there were significant correlations between CRP and anthropometric measurements, CC and UAE. Conclusions: This study showed that increased CRP levels in nondiabetic, nonhypertensive, overweight, and obese individuals could possibly associated with impaired renal functions that might be originating from endothelial dysfunction. Determination of cutoff levels of CRP, as in cardiovascular diseases, may be useful for early estimation and prevention of renal diseases.

Objectives: To evaluate dry eye symptoms and clinical tear film alterations in patients with chronic renal failure (CRF). Materials and methods: Thirty-five non-diabetic CRF patients undergoing hemodialysis, and 31 healthy individuals were enrolled. An ocular surface disease index questionnaire (OSDI) was administered, and after a complete ocular examination, Schirmer and tear break-up time (TBUT) tests were performed. Results: OSDI scores were significantly higher (p

Objectives Renal transplantation (RT) is the most appropriate form of treatment for end-stage renal disease (ESRD). Pre-emptive RT decreases the rates of delayed graft function and acute rejection episodes, increasing patient and graft survival, while reducing costs and complications associated with dialysis. In this study, we investigated the relationship between a predialysis education program (PDEP) for patients and their relatives and pre-emptive RT. Methods We divided 88 live donor kidney transplant recipients into 2 groups: transplantation without education (non-PDEP group; n = 27), and enrollment in an education program before RT (PDEP group n = 61). Results Five patients in the non-PDEP group underwent pre-emptive transplantation, versus 26 of the PDEP group. The rate of pre-emptive transplantations was significantly higher among the educated (42.62%) versus the noneducated group (18.51%; P Conclusion PDEP increased the number of pre-emptive kidney transplantations among ESRD patients.

Introduction: Diabetes mellitus (DM) has become a global economic burden due to treatment costs and attendant complications. Albuminuria is the precursor of end stage renal failure and is an inflammatory process. In the recent past, it has been reported that the neutrophil/lymphocyte ratio (NLR), which is a cost-effective and accessible marker, may be a favorable indicator of the inflammatory status. The aim of this study was to investigate the relationship between the neutrophil/lymphocyte ratio and the presence and level of diabetic nephropathy (DN). Material and methods: A total of 112 patients with type-2 DM who were followed by our internal medicine and nephrology clinics between February 2013 and June 2014 were included in this pilot study and were retrospectively evaluated. All participants had a 24-hour urinary albumin excretion (UAE) record. Demographic parameters, biochemical parameters and albuminuria levels were recorded. Patients were divided into three groups according to their level of albuminuria. Results: Significant differences were detected between the groups in terms of NLR (p < 0.001). There was a linear increase in NLR in parallel to the increase in 24-hour UAE mean values (p < 0.001). A positive correlation was detected between NLR and C-reactive protein, urea, creatinine, and red cell distribution width. However, 24-hour UAE was negatively correlated with lymphocyte count (p < 0.001). Conclusions: A high degree of correlation was determined among albuminuria, glomerular filtration rate and NLR levels. These results may suggest the notion that diabetic nephropathy involves an inflammatory process. Copyright © 2016 Termedia & Banach.

Multiple sclerosis (MS) is a progressive demyelinating disease presenting with a relapsing-remitting course and affects large areas of the brain and the spinal cord. Surgical stress often induces exacerbation of MS symptoms. It is mandatory to prepare the MS patient very carefully for the surgery and anaesthesia with an effective premedication and an effective postoperative analgesia following a safe and minimal-risk anaesthesia management. In recent reports, results of general and regional anaesthesia in MS patients have been discussed. To our knowledge this is the first case report of the use of desflurane anaesthesia in a patient with MS. In conclusion, desflurane anaesthesia is a safe and useful method for MS patients. Copyright © 2010 Termedia & Banach.

Increased platelet activation contributes to cardiovascular mortality in chronic kidney disease patients (CKD). Larger platelets are more active and this increased activity had been suggested as a predictive biomarker for cardiovascular disease. In this study, we aimed to evaluate mean platelet volume (MPV) as an inflammatory marker in a broadened group of CKD patients. Our study is unique in literature as it covers all types of CKD including renal replacement therapies.200 patients (50 renal transplanted, 50 hemodialysis, 50 peritoneal dialysis, 50 chronic renal failure stages 3-4) were investigated who were between 18 and 76 years of age. The collected data included demographic properties, platelet count, MPV, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and hemoglobin. All of the patients had at least 12 month of therapy of either renal replacement modality.The mean CRP value was detected statistically significantly higher in hemodialysis (HD) patients compared to the resting three groups of patients (p 0.01). Mean CRP level was detected significantly higher in the pre-dialysis group compared to transplanted and peritoneal dialysis (PD) patients (p 0.01). There is no statistically significant difference detected among the mean MPV values of all patient groups (p 0.05).ESR and CRP were significantly increased in hemodialysis patients compared to the other groups. We did not detect a significant difference among MPV between the groups. ESR was detected lowest in transplanted patients. Transplantation is coming forward as the favorable choice of renal replacement therapy which decreases inflammation.

Background and Objective: Renal transplant is the best form of treatment for most patients with end-stage renal disease (ESRD), because that therapy improves quality of life, prolongs survival, and is cost-effective. The objective of the study being reported was to compare the sociodemographic characteristics and registration status for renal transplantation of ESRD patients in Turkey who were registered for transplant or not. Methods: The study was conducted between June and September 2012 on patients of several Dialysis Centers. They all were informed in a one on one interview about the risks and benefits of renal transplants; they were also asked to fill out the questionnaires given to them. The study questionnaire was designed with the help of already published reports to include among others the patient’s age, sex, waiting time and educational status. Results: Patients who had been registered in the cadaver kidney waiting list were aged 43.85±13.48 in the average, with a balanced sex ratio, average dialysis duration 57.30±51.46 months. Of these patients 45 had finished high school, 87 lived in rural areas and 67 had an income equivalent to expenses. Conclusion: There was a significant difference among the groups depending on the patients’ residence in an urban or rural environment. Such a difference might be following the greater ease of obtaining relevant information in the urban areas.

Meropenem is one of the most commonly used antibacterial agents with relatively few side effects. Serious adverse reactions reported with meropenem are rare with an incidence of 1 %. Recently we came across two rare adverse effects of meropenem in one patient with acute renal failure. There was pancytopenia and sepsis, respectively. To the best of ourknowledge, a only few cases have been reported in the literature that document an association between meropenem administration and pancytopenia, and about half of these cases were sepsis. With the use of meropenem becoming more widespread, these two rare but fatal complications of meropenem should be borne in mind.Keywords: Meropenem, Pancytopenia, Sepsis, Fatal complications

Objective: Recently, it has reported that nebivolol might be useful in the treatment of diabetes mellitus foot ulcers. The aim of this study was to examine treatment of the wounds in streptozotocin-induced diabetic rats with topical nebivolol. Methods: Two 15 × 15 mm-sized wounds were created in 56 streptozotocin-induced rats. A total of 56 diabetic wounds were studied in eight groups (n = 7). No treatment was administered to the first and second groups. The third and fourth groups consisted of diabetic rats that were administered 1:1 mixture of lanolin and vaseline for 7 and 14 days, respectively. Five percent nebivolol plus 1:1 mixture of lanolin and vaseline was administered to rats in the fifth and sixth groups for 7 and 14 days, respectively, and 10% nebivolol plus 1:1 mixture of lanolin and vaseline was administered to rats in the seventh and eighth groups for 7 and 14 days, respectively. On days 7 and 14, wound healing was observed, and the percent of wound healing was determined by measuring its size and histopathologic examination. The ratio was calculated by the formula, healing ratio (%) = 100 × (1-wound area/initial wound area). Statistical analysis was performed by ANOVA with Tukey's HSD test and Mann-Whitney U test, using SPSS 15.0 software. Results: On days 7 and 14, rates of wound healing in the fifth, sixth, seventh, and eighth groups were 57.42%, 89.16%, 60.80%, and 91.80%, respectively. Multiple comparison showed that rates of wound healing were significantly higher in rats administered 5% and 10% nebivolol than those in rats administered a mixture of lanolin and vaseline and in the untreated group (P < 0.05). Conclusion: Topical nebivolol therapy may be useful for wound healing in diabetic rats. Further studies are needed to support these data. © 2012 Elsevier B.V. All rights reserved.

WOS: 000303043900009, PubMed: 22510290, Nontyphoid salmonella (NTS) serotypes can cause gastroenteritis, bacteriemia, and focal infections. However, these focal infections, including urinary tract infections (UTI), are occasionally observed; in particular, the presence of several predisposing factors, such as immunodeficiency and structural abnormality in the urinary tract, increase the possibility of the occurrence of infection. We present a case of UTI caused by Salmonella enterica serovar Virchow in an elderly and debilitated patient with benign prostatic hyperplasia (BPH). Administration of appropriate antibiotic treatment resulted in recovery of the patient's clinical course.

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49–54, 2011)

IgA nephropathy is one of the most common forms of glomerulopathies. It is an immune complex-mediated glomerulonephritis diagnosed by the presence of mesangial IgA deposits that are often associated with mesangial cell proliferation. The IgG, C3, IgM, or other immunoglobulin light chains may be co-existed with IgA. Its pathogenesis suggested that it is responsible for enhancing the production of proinflammatory cytokines, chemokines, and growth factors. Platelet-derived growth factor (PDGF) has also been implicated as a modulator of disease activity. Immune thrombocytopenic purpura (ITP) is a bleeding disorder caused by thrombocytopenia that is not associated with a systemic disease. Its pathogenesis suggested an autoimmune disease in which IgG is thought to damage megakaryocytes, which are the precursors of platelet cells. Several studies reported that PDGF levels were higher in normal subjects than in patients with ITP. Moreover, ITP is a disease related to the antibody. Thus, our aim is to examine whether a similar pathophysiological relationship exist between ITP and IgAN that may be mediated by PDGF and/or IgG. © 2014 Informa Healthcare USA, Inc.

WOS: 000280519300018, PubMed: 20639669, Objective: To present a case of a rare variation of the renal artery and multiple (7) renal arteries by multidetector computed tomography (MDCT) angiography. Clinical Presentation and Intervention: A 36-year-old male patient was admitted to our hospital as a potential living donor for renal transplantation. An MDCT angiography was performed using a 16-detector row CT scanner to obtain a detailed image of vascular structures and associated pathologies. The MDCT clearly revealed the presence of 3 right and 2 left renal arteries arising from the abdominal aorta. Additionally, the accessory renal artery arose from the inferior mesenteric artery on the left side and from the common iliac artery on the right side. Conclusion: This case highlights the importance of awareness of renal artery variations if surgical procedures are indicated in this region. Copyright (C) 2010 S. Karger AG, Basel

Nebivolol is a β-blocker that is highly selective for β1-adrenergic receptors with vasodilating properties. This property can be attributed to an endothelial release of nitric oxide (NO). It has been reported that nebivolol also reduces intracellular oxidative stress. There are some studies conducted in humans and animal models which have shown that NO is an important regulator of bone metabolism. However, oxidative stress and antioxidant systems may play important roles in the pathogenesis of osteoporosis. In this paper, we hypothesized that nebivolol may have beneficial effects via nitric oxide and antioxidant action in osteoporosis treatment.

Background. Asthma is characterized by inflammation and airway hyperesponsiveness, which results in episodic airflow obstruction. A relationship between inflammation and insulin resistance (IR) has been previously characterized, and asthma is known to correlate with increasing IR. Thus, we tested whether patients with asthma bronchiale exhibited abnormally low glucose tolerance. The aim of this study was to compare the occurrence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), two precursors of type 2 diabetes mellitus (DM), in patients with asthma bronchiale and paired control patients. Patients and Methods. We examined patients diagnosed with asthma bronchiale. We excluded patients taking any medications other than inhaler broncodilators, patients with a history of other systemic illness, and patients with any diabetic risk factors. Age- and sex-matched healthy volunteers were included as the control group in this study. History, physical examination, and laboratory analyses were performed for both study and control groups. Results. Mean age of the study group was 40.3 > 7.8 (F/M: 32/19), and mean BMI of the study group was 26.7 > 2.2. Mean age of the control group was 39.5 > 6.7 (F/M: 25/15) and mean BMI of the control group was 26.0 > 2.1. Fasting blood glucose (FBG), Pg2hBG, Plasma insulin, Homeostasis Model Assessment-Insulin Resistance (HOMA IR), IFG, IGT, both IFG and IGT and (LDL) C levels were significantly higher in the asthmatic group, while HDL C levels were significantly higher in the control group. Conclusion. Our results suggest that disturbance of the glucose metabolism caused by inflammation-induced insulin resistance may occur in asthmatic patients and that this phenomenon may increase the risk of diabetes mellitus in these individuals.

Coskun, Abdurrahman/0000-0002-1273-0604; Annakkaya, Ali Nihat N/0000-0002-7661-8830 WOS: 000266882200007 PubMed: 19494536 Objective: To investigate serum levels of CA 19.9, CA 125 and carcinoembryonic antigen (CEA) in patients with different stages of chronic obstructive pulmonary disease (COPD). Patients and Methods: Fifty-three consecutive patients (50 males, 3 females, mean age 67.6 +/- 10.1 years) with COPD were included in this study. Serum levels of CA 19.9, CA 25 and CEA were determined by the chemiluminescent immunometric method. Based on values obtained from pulmonary function tests, the patients were divided into 3 groups: moderate (21), severe (18) and very severe (14). Data were analyzed with a Kruskal-Wallis one-way analysis of variance test and Mann-Whitney U test. Results: The mean serum levels of CA 125 and CA 19.9 were significantly higher in patients with very severe COPD (p = 0.013 and p = 0.017, respectively) than in patients with severe and moderate COPD (p < 0.05). Patients with cor pulmonale had significantly high mean serum levels of CEA, CA 19.9 and CA 125 (p < 0.05). Patients using a long-acting beta-agonist and theophylline showed significantly higher mean serum levels of CA 125 than patients who were not (p < 0.05). Conclusion: Data showed that the increased serum tumor markers in patients with COPD might be due to the severity of COPD, medication and cor pulmonale. Copyright (c) 2009 S. Karger AG, Basel

The aim of this study was to compare the occurrence of prediabetes [impaired fasting glucose and/or impaired glucose tolerance are considered to be precursors to type 2 diabetes mellitus (DM)] in irritable bowel syndrome (IBS) cases and matched controls. Ninety-two patients with IBS and 104 healthy matched controls were included in this study. Type 2 DM was considered an exclusion criterion in both groups. Fasting blood glucose, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels were examined; after 1 night of fasting, an oral glucose tolerance test with 75 g glucose was administered, and the blood glucose levels after 2 hours were examined. Although there were no significant differences in the triglyceride levels, significant differences were found for total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels (P < 0.001, 0.001, and

Coskun, Abdurrahman/0000-0002-1273-0604 WOS: 000265263400004 PubMed: 19365167 Background: Pregnancy-associated plasma protein-A (PAPP-A) has insulin-like growth factor (IGF)-dependent IGFBP-4 protease activity and plays an important role in amplifying local IGF-1 activity in wound healing, vascular repair. and bone remodeling. We postulated that PAPP-A may contribute to the availability and activity of IGFs, which affect lung cancer. Therefore, we determined the levels of PAPP-A in patients with lung cancer and their possible clinical significance. Methods: The study population consisted of 83 patients with lung cancer and 33 healthy subjects as a control group. Serum PAPP-A levels were determined using an ultrasensitive enzyme-linked immunosorbent assay. Results: The serum PAPP-A levels were higher in patients with lung cancer [median (interquartile range) 10.7 (7.6-14.2) ng/mL] than in the control group [6.2 (5.2-9.8) ng/mL, P < 0.001]. There was a significant negative correlation between the serum PAPP-A levels and Karnofsky performance status (r = -0.330; P < 0.001) and a positive correlation with patient age (r = 0.358; P < 0.001). Conclusion: PAPP-A is a proatherosclerotic metalloproteinase that is also thought to be an inflammatory marker. We found that the serum PAPP-A levels increased in patients with lung cancer and postulated that PAPP-A levels may be a prognostic factor in such cases.

SummaryFamilial Mediterranean fever is an autosomal recessive disease characterized by periodic attacks of fever and polyserositis, while Hashimoto's thyroiditis is the most common cause of hypothyroidism. We suggest that common autoimmune mechanisms may underlie both disorders, describe their clinical co-existence in a patient, and discuss a possible causal link between them.

[No abstract available]

PubMed ID: 19667969 BACKGROUND: Currently, it is reported that statins may be useful in the treatment of diabetes mellitus foot ulceration. The aim of this study was to evaluate treatment of the wounds in streptozotocin-induced diabetic rats with local atorvastatin. METHODS: Two 15 × 15 mm-sized wounds were created in 28 streptozotocin-induced rats. A total of 56 diabetic wounds were studied in 8 groups (n = 7). No treatment was administered in the first and second groups, which lasted for 7 and 14 days, respectively. Third and fourth groups consisted of diabetic rats that were administered 1:1 mixture of lanolin and vaseline therapy for 7 and 14 days, respectively. One percent statin plus 1:1 mixture of lanolin and vaseline was used in the fifth and sixth groups for 7 and 14 days, respectively; and in seventh and eighth groups, 5% statin plus 1:1 mixture of lanolin and vaseline therapy was used for 7 and 14 days, respectively. On the 7th and 14th days, state of the wound healing was observed, and the percent of wound healing was determined by measuring its size and by performing a histopathologic study. The statistical analyses were performed by Mann-Whitney U test, using SPSS 14.0 software. RESULTS: On the 14th day, the rates of wound healing in the first, second, third, and fourth groups were 14%, 40%, 96.59%, and 96.51%, respectively. This ratio was calculated by the formula healing ratio (%) = 100 × (1-wound area/initial wound area). Accordingly, in the multiple comparisons, the rates of wound healing were found to be significantly higher in the diabetic rat groups administered 1% and 5% atorvastatin compared with those administered a mixture of lanolin-vaseline and the untreated group (for comparison each one P < 0.001). CONCLUSIONS: Local atorvastatin therapy may be useful for healing the wounds in diabetic rats. Further clinical and experimental studies are needed to confirm these results. © Copyright 2009 Southern Society for Clinical Investigation.

[No abstract available]

WOS: 000253399700012, PubMed: 18287802, Objective: To present a case of myocardial infarction due to Behcet's syndrome. Clinical Presentation and Intervention: A 27-year-old man who was known to have Behcet's syndrome for 1 year presented with retrosternal fluctuating chest pain, which radiated to the epigastrium 5 h prior to admission. Coronary angiography showed total occlusion of the left anterior descending coronary artery, which was successfully treated with coronary stent implantation. Conclusion: This case shows that patients with Behcet's syndrome who had acute chest pain should be thoroughly examined for any signs of acute myocardial infarction. Copyright (C) 2008 S. Karger AG, Basel.

International-Bone-and-Mineral-Society Davos Workshop on Bone Biology and Therapeutics -- MAR 09-14, 2008 -- -- Davos, SWITZERLAND, WOS: 000253799600158, …, Int Bone & Mineral Soc, Alliance Better Bone Hlth, Amgen, F Hoffman La Roche LTD, Hologic Inc, Novartis Oncol, Merck, Pfizer

WOS: 000254806700034 PubMed: 18391739 …

Aim To assess the prevalence of hepatitis B and C viruses among Turkish patients with type 1 and type 2 diabetes mellitus and to determine the risk factors affecting the prevalence in these patient groups. Methods This study included 630 diabetic and 314 nondiabetic patients. Serologic testing for anti-hepatitis C virus (anti-HCV) and HbsAg was done using a third-generation commercial enzyme-linked immunosorbent assay, and samples positive for anti-HCV and HbsAg were confirmed by a polymerase chain reaction assay. Diabetic patients were classified by HbsAg and anti-HCV status and were evaluated according to demographic features, diabetic characteristics and nondiabetic general risk factors, harmful habits, and aminotransferase (alanine aminotransferase and aspartate aminotransferase) levels. Results HbsAg and anti-HCV seropositivity rates were 5.1% and 3.2% in diabetic patients and were 3.8% and 1.3% in control group, respectively. There was no statistically significant difference between the 2 groups with respect to either marker. Shared risk factors for both hepatitis infections were increased aminotransferase levels and history of hospital admission. In addition, long duration of diabetes mellitus, poor diabetic regulation, and insulin treatment usage were found to relate to HbsAg, whereas a history of blood transfusions and surgical procedures were found to associate with anti-HCV seropositivity. Conclusions We determined that hepatitis B virus and hepatitis C virus infections were slightly but not significantly higher in diabetic patients compared with a normal population. If it is considered that different results might be obtained in various countries or even in various regions of same country, it may be concluded that multicenter and comprehensive studies are needed to elucidate true infection rates and to identify other risk factors affecting the prevalence of these infections.

Isolated ACTH deficiency is an uncommon cause of secondary adrenocortical insufficiency and accompaniment with primary empty sella has been reported in several cases. We present a case of isolated ACTH deficiency associated with empty sella. A sixty-two year old woman was admitted to our endocrine clinic with complaints of weakness, fatigue, weight loss, nausea, vomiting, and lack of appetite for about one month. Physical examination indicated orthostatic hypotension and epigastric tenderness. Laboratory investigations revealed hypoglycemia, hyponatremia and anemia, in addition low plasma cortisole and ACTH levels. Serum cortisole responses to short and prolonged ACTH stimulation were tested and partial and accurate responses were obtained, respectively. Plasma ACTH and serum cortisole levels failed to respond after intravenous injection of human corticotropin releasing hormone. Other hypophysial hormone levels were within the normal reference ranges. Although cranial and abdominal computerized tomography images were evaluated as normal, cranial magnetic resonance imaging of the pituitary gland revealed 'primary empty sella turcica'. Replacement therapy with methylprednisolon resulted in the improvement of hypoglycemia, hyponatremia and clinical symptoms. Based on these results, the patient was diagnosed as isolated ACTH deficiency and was scheduled for follow up by our outpatient clinic. Our report is consistent with other reports pointing out that primary empty sella may be responsible for pathogenesis of isolated ACTH deficiency.

WOS: 000264581500024, PubMed: 19231193, Behcet's disease (BD) is a systemic inflammatory disease commonly characterized by oral and genital ulcerations, with skin and eye involvement. Its cause is still unknown, but vasculitis is the major pathologic feature. BD is a rare condition, seen more commonly in Turkey, as well as in Middle Eastern, Mediterranean and Far Eastern countries. Neurological involvement is reported to manifest as brainstem or corticospinal tract syndromes, increased intracranial pressure mostly related to venous sinus thrombosis or aseptic meningitis, isolated behavioral symptoms or isolated headache. This report presents a 34-year-old BD patient with secondary cerebral infarction due to head trauma. The clinical and central nervous system findings of BD are discussed. (c) 2008 Elsevier Ltd. All rights reserved.

Diabetic foot ulcers (DFUs) consist of an interaction of neuropathy, ischemia and infection. Neuropathy affects sensory, motor and autonomic pathways. Pathogenic factors for neuropathy include hyperglycemia, nonenzymatic glycosylation, oxidative stress, ischemic and hypoxic factors, nerve growth factor anomalies, activation of polyol pathway and immunologic abnormalities. All these factors are stated to contribute to microvascular disease and neural dysfunction. Peripheral neuropathy and ischemia combined with repetitive traumas can lead to diabetic foot ulceration. Fifteen percent of diabetic patients develop foot ulcers during their lifetime and nonhealing ulcers are responsible for 85% of nontraumatic lower extremity amputation. On the other hand, the treatment cost of foot disease in diabetic patients is estimated at $1 billion annually. When these conditions are considered, it is very important to design improved and novel strategies for treatment and prevention of diabetic foot disease. Lipid-lowering agents, such as statins, have been shown to prevent cardiovascular events in patients with diabetes. However, in addition, to preventing macrovascular diseases, statins may also be able to retard the progression of microvascular complications of diabetes. Statins alter the balance between vasodilatation and vasoconstriction in favor of vasodilatation by increasing nitric oxide (NO) synthesis, by downregulating endothelin 1 (ET-1) synthesis and reducing vascular response to angiotensin-2 (AT-2). These agents have been shown to augment cerebral blood flow by upregulating endothelial nitric oxide synthase (eNOs) and to reduce cerebral infarct size in a murine model of cerebral ischemia. In addition, recent in vivo and in vitro investigations have evidenced that statins have a favorable effect on diabetic peripheral neuropathy independent of its lipid-lowering effect by demonstrating restoration or preservation of microcirculation of the sciatic nerve. We hypothesized that statins can be useful for the prevention and treatment of diabetic foot. Possible mechanisms include the reduction of neuropathy and ischemia or through growth factors, the effectiveness of which has been shown for fracture healing in animal models. © 2007 Elsevier Ltd. All rights reserved.

[No abstract available]

Aim: Approximately 10-20% of general population has irritable bowel syndrome (IBS) and/or urolithiasis (U) and it seems that there is a significant association between them. Methods: We randomly took consecutive patients with and without IBS, among the cases applying to internal medicine polyclinic. U was diagnosed either by medical history or current findings. Results: Female/male ratio of IBS cases was 1.62. On the other hand, U was detected in 111 cases, totally, and female/male ratio was 0.94. So the rates of U were 13.7 and 15.2% in female and males, respectively. As a significant finding, U was detected in 61 (17.9%) of cases with IBS, whereas this ratio was 11.6% (50 in number) among the cases without (p < 0.01). On the other hand, there was no significant difference between groups of IBS and U according to obesity and hyperuricemia (p > 0.05 for both). Conclusions: Although IBS predominantly keeps females, relationship between IBS and U is still significant. IBS is probably a cascade of many physiological events, being initiated with infection, inflammation, psychological disturbances like many stresses and eventually terminating with gut dysfunction. So U may be one of the terminating points of the physiological events' cascade, IBS. By this way, the giant gap about the underlying etiologies of most of U cases may be explained by the high incidance of IBS in society. Keeping in mind this association will be helpful during prevention, treatment, and follow up of these pathologies.

Osteoporosis is a systemic skeletal disorder characterized by decreased bone mass and deterioration of bony microarchitecture. It is a chronic condition of multifactorial etiology and is usually clinically silent until a fracture occurs. Fatty liver disease can range from fatty liver alone (steatosis) to fatty liver associated with inflammation. This state can occur with the use of alcohol (alcohol-related fatty liver) or in the absence of alcohol (NASH). It has been known that liver has important a role in bone metabolism via production of the active vitamin D. Here, we have discussed whether a relationship between NASH and osteoporosis. © 2009 Elsevier Ltd. All rights reserved.