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Aims:The atherogenic index of plasma (AIP) is a marker used to predict atherosclerosis and cardiovascular disease (CVD). In this study, we examined the relationship of AIP with markers of endothelial dysfunction (ED) [asymmetric dimethylarginine (ADMA) and adiponectin] and early atherosclerosis [high-sensitivity C-reactive protein (hs-CRP)] in patients with metabolic associated fatty liver disease (MAFLD).Methods:This was a cross-sectional study with retrospective enrollment. AIP was defined as the logarithmically transformed ratio of triglyceride to high-density lipoprotein cholesterol. All patients were divided into two groups according to whether they had steatohepatitis or fibrosis and were compared. Mean differences between two independent groups were assessed using the independent Student's t-test and Mann-Whitney U test as appropriate.Results:A total of 129 male subjects with biopsy-proven MAFLD were enrolled. There were no significant differences regarding AIP (0.64±0.039 vs. 0.62±0.033, p=0.773) between patients with steatohepatitis (n=54) and without steatohepatitis (n=75). Additionally, similar findings were observed among subjects with fibrosis (n=84) and without fibrosis (n=45). However, there was no association of AIP with ADMA, adiponectin, hs-CRP, insulin and HOMA-IR levels (p=0.176, p=0.636, p=0.810, p=0.068, and p=0.126, respectively).Conclusion:The lack of association between AIP and the biomarkers of ED or early atherosclerosis implies that this index may not be a significant predictor of CVD in MAFLD.

ABSTRACT Purpose: While cholecystectomy is recommended for the treatment of symptomatic gallstones in current guidelines, surgery is not recommended in asymptomatic cases. In this study, we aimed to investigate the frequency of cholecystectomy and the factors affecting the approach to asymptomatic gallstones in clinical practice. Material and Methods: This study was designed as a prospective survey study. In this study, cases who had undergone cholecystectomy for gallstones in the past were evaluated. The survey was administered by face-to-face interview method and each patient was asked questions about surgical indication, medical information and symptoms. Results: In this study (n=212); 75 (35.4%) cases had asymptomatic gallstones and were operated on for prophylactic purposes; 137 (64.6%) cases were found to have been operated on due to certain indications (presence of dyspeptic symptoms, acute cholecystitis, porcelain gallbladder, etc.). In the surgical decision with inappropriate indication; it was observed that the departments of general surgery (64%), internal medicine (29.3%) and gastroenterology (4%) played a role. However, in some of the cases; it was found that dyspeptic complaints such as abdominal pain, bloating, nausea and epigastric burning continued after the surgery. Conclusion: Today, inappropriate surgical treatment in asymptomatic gallstones is common, and approximately one out of every three patients is decided to undergo surgery. Therefore, it is considered that the medical and legal adverse situations that may occur can be prevented by reconsidering the issue by the relevant fields of speciality.

Dermatitis herpetiformis, a specific cutaneous manifestation of Celiac disease, is characterized by herpetiform clusters of pruritic urticated papules and vesicles on the skin and granular IgA deposits in the dermal papillae. In the present report, we describe a case of 39-year old male who is previously diagnosed as DH, and after this diagnosis he was serologically and histologically confirmed to have CD. [Med-Science 2020; 9(4.000): 1083-5]

Protein-losing enteropathy (PLE) is a rare gastrointestinal condition that has been related to inflammatory bowel disease (IBD), namely ulcerative colitis (UC) and Crohns disease (CD). These pathologies damage the mucosal integrity, thereby leading to an increased transfer of plasma proteins into the bowel lumen. Because of its rarity, incidence and prevalence of this condition are not well known. Depending upon the underlying cause, the clinical course of PLE is highly variable, but mainly consists of edema, ascites, pericardial and pleural effusions. Here, we report a case of PLE caused by UC, in which total colectomy lead to complete improvement of hypoalbuminemia. [Med-Science 2019; 8(4.000): 1041-3]

Betatrophin, a liver hormone, regulates glucose and lipid metabolism. We investigated the betatrophin levels in nonalcoholic fatty liver disease (NAFLD) and searched for any relationship with histological severity and metabolic parameters. Fifty males with NAFLD [Nonalcoholic Steatohepatitis (NASH) (n = 32); non-NASH (n = 18)] and 30 healthy controls were included. Plasma betatrophin was measured by ELISA method. Insulin sensitivity was assessed by HOMA-IR index. Histological features were scored by the semi quantitative classification and combined as the NAFLD activity score (NAS). Betatrophin levels in the non-NASH group were significantly higher than the controls. Betatrophin was positively correlated to the age, waist circumference, total cholesterol, triglycerides, LDL cholesterol, glucose, insulin, HOMA-IR index and gamma glutamyl transpeptidase levels, and negatively correlated to the steatosis and NAS. In the stepwise linear regression analysis, the triglyceride (β = 0.457, p < 0.001), glucose (β = 0.281, p = 0.02) and NAS (β = −0.260, p = 0.03) were the independent determinants of betatrophin. Betatrophin levels are higher in the early stages of NAFLD and tend to decrease when the disease progresses. This could be an important preliminary mechanistic finding to explain the increased frequency of glucose intolerance during the course of NAFLD.

Background/Aims: Fetuin-A, a glycoprotein with anti-inflammatory properties, plays an important role in counter-regulating inflammatory responses. It has also been associated with insulin resistance and metabolic syndrome. We aimed to investigate circulating concentrations of fetuin-A and its possible association with hepatic and systemic inflammation in nondiabetic subjects with nonalcoholic fatty liver disease (NAFLD). Patients and Methods: We included 105 nondiabetic male subjects with NAFLD [nonalcoholic steatohepatitis (NASH, n = 86) and simple steatosis (SS, n = 19)]. Plasma levels of fetuin-A and markers of inflammation [high-sensitive C reactive protein (hsCRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), and adiponectin] were measured by enzyme-linked immunosorbent assay method. Insulin sensitivity was determined by homeostasis model assessment of insulin resistance (HOMA-IR) index. Results: Fetuin-A was negatively correlated with age (r = −0.27, P = 0.006), however there was no association between fetuin-A and body mass index, waist circumference (WC), glucose, insulin, HOMA-IR, lipid parameters, and inflammatory markers. In addition, no significant association was observed between fetuin-A and histological findings including liver fibrosis. Conclusion: This study demonstrated that plasma fetuin-A levels are not correlated with the hepatic histology and systemic markers of inflammation in nondiabetic subjects with NAFLD. Our data also suggested that age is significantly associated with fetuin-A in this clinically relevant condition.

Background. Visfatin is a proinflammatory and insulin-mimetic adipokine contributing to whole body glucose and lipid metabolism. Studies to date are conflicting regarding the relationship between visfatin and non-alcoholic fatty liver disease (NAFLD). The aim of the present study was to evaluate the relationship of circulating visfatin with NAFLD. Material and methods. The study included 114 NAFLD patients and 60 healthy non-diabetic controls. Plasma visfatin, adiponectin, tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) levels were measured by ELISA. High sensitive C-reactive protein (hsCRP) levels were measured by immunoturbidimetric fixed rate method. Insulin sensitivity determined by homeostasis model assessment (HOMA-IR) index. Results. TNF-α, IL-6 and hsCRP levels were higher and, Adiponectin levels were lower in NAFLD group when compared to healthy controls (p < 0.001, for all). However, no difference was found regarding to visfatin levels between two groups. Different histologic subgroups of NAFLD had a significantly higher TNF-α, IL-6 and hsCRP, and lower adiponectin levels than those with controls (p < 0.001, for all). On the other hand, no statistically significant difference was found regarding to visfatin levels among different histologic groups. Visfatin was found to be negatively correlated with TNF-α (r = −0.236, p = 0.011) in NAFLD group. However, no association was found between visfatin and histological findings. Conclusion. Our findings show that plasma visfatin levels are not altered in the early stages of NAFLD. However, it is inversely associated with TNF-α. These findings suggest a role for visfatin in protection against liver injury in this widespread disease.

Unlike diabetes mellitus and impaired glucose tolerance, it is not clear whether the subjects with impaired fasting glucose (IFG) are at increased risk of atherosclerosis and cardiovascular diseases. The CD40-CD40 ligand interaction is involved in the mechanism of atherosclerosis. We investigated whether soluble CD40L (sCD40L) as well as high sensitive C-reactive protein (hsCRP) levels are increased in subjects with IFG having no confounding factors for inflammation or atherosclerosis. Twenty four IFG subjects with no additional disorders and 40 appropriate healthy controls were studied. sCD40L and hsCRP levels in the IFG and control groups were similar. Blood pressures, total and LDL-cholesterol, and triglyceride levels were also similar, whereas HDL-cholesterol was lower and HOMA-IR indexes were higher in the IFG group. Though the sample size was small, the present data show that sCD40L seems not to alter in subjects with IFG suggesting that it might not be an independent risk factor for atherosclerosis.