Background/aims: This study aimed to provide supporting evidence for prevention and prognostic evaluation of bleeding complications in the early stage by exploring the risk and predicting factors in patients with acute-on-chronic liver failure (ACLF).
Materials and methods: A total of 101 hospitalized patients with ACLF were retrospectively included from January 1, 2014 to December 31, 2015. The patients were divided into bleeding (n=38) and nonbleeding groups (n=63). Demographic data and laboratory tests were recorded and compared between the two groups. The incidence, risk factors, and prognosis of bleeding complications among patients with ACLF were investigated.
Results: A total of 38 cases (37.62%) had bleeding complications: 26 (25.74%) were spontaneous and 12 (11.88%) were postprocedural. Patients with bleeding complications had lower platelet (p=0.008), fibrinogen (p<0.001), factor V (p=0.001), and factor VII (p=0.026) levels; higher serum creatinine levels (p=0.004); and a higher proportion of cirrhosis (p=0.013). Logistic regression analysis showed that cirrhosis (odds ratio=3.251, p=0.046), fibrinogen level (odds ratio=0.352, p=0.007), and factor VII level (odds ratio=0.951, p=0.011) contributed to the development of bleeding complications. A subgroup analysis of invasive manipulation-induced bleeding complications showed lower levels of factors V (p=0.018) and VII (p=0.021) in the postprocedural bleeding group. Follow-up studies showed that the nonbleeding group had a higher survival rate than the bleeding group at day 90 (73.33% versus 51.85%, p=0.040).
Conclusion: Liver cirrhosis, lower levels of fibrinogen, and major coagulation factor activity in patients with ACLF were associated with an elevated risk of bleeding events during hospitalization, which further impaired the 90-day survival rate.
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Background/aims: This study was aimed to investigate the protective effects of swimming exercise on nonalcoholic fatty liver disease (NAFLD) associated with high fat diet-induced obesity, using microscopical and biochemical parameters.
Materials and methods: Sprague Dawley male rats were fed either standard chow (STD group; 6% fat) or high-fat diet (HFD group; 45% fat) for 18 weeks. Animals were divided into four groups, STD, STD + EXC, HFD, HFD + EXC. Exercise groups were submitted to swimming training 5 days of week and 1h of per day, during the last 6 weeks of the experiment. At the end of the experiment, liver samples were evaluated for morphologically and ultrastructurally. Moreover, malondialdehyde (MDA) and glutathione (GSH) levels were evaluated in liver samples.
Results: Normal morphology of liver parancyma with hepatocytes and sinusoids was observed in the STD and STD+EXC groups. Steatosis, lipid accumulation, ballooned hepatocytes, decrease of glycogen deposits and fibrosis in periportal area were observed in HFD group. Liver MDA level was increased and GSH level was decreased in HFD group. Exercise treatment ameliorated these morphological and oxidative changes in HFD induced liver damage.
Conclusion: Based on morphological and biochemical analysis, we could conclude that swimming training ameliorated obesity-induced liver damage by regulating lipid accumulation and oxidative damage.
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Background/aims: Pancreatic steatosis (PS) is a subject of current interest and its prevalence has been reported to range from 16.1% to 30.7% using various radiological methods. This study aimed to evaluate PS prevalence with non-contrast computed tomography (CT).
Materials and methods: The non-contrast CT scans taken in 2016 and 2017 in our hospital were retrospectively screened. A total of 637 cases (320 males, 317 females) were included in the study. CT number measurements were performed from three anatomic regions of the pancreas using regions of interest (ROI) of approximately 1 cm2. The cases with a <0.7 ratio of the pancreatic over splenic CT number were accepted as quantitatively steatosis-positive. Anthropometric evaluations were undertaken by determining various parameters defined on CT.
Results: PS was determined visually in 30.6% of the males and 29% of the females, and quantitatively in 32.8% and 30.6%, respectively. A positive agreement was determined between the quantitative and visual evaluations of steatosis (Cohen's kappa coefficient=0.587, p<0.001). Although PS was seen to be mostly diffuse, the tail region of the pancreas was determined to be the area with most steatosis.
Conclusion: PS is usually overlooked in radiology practice but it has a clinical presentation with non-insignificant prevalence. Current radiological methods are adequate in the evaluation of PS. The determination of the cut-off values for various criteria on non-contrast CT can provide more objective evaluations.
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Background/aims: To analysis the appendiceal mucinous lesions according to the World Health Organization (WHO) 2019 classification of tumors of the digestive system (non-neuroendocrine tumors of the appendix vermiformis)
Materials and methods: Clinical and histopathological data of 37 patients with histopathologically proven appendiceal mucinous lesion from January 2010 to May 2019 were evaluated retrospectively. Pathology slides were re-evaluated by two pathologists according to the WHO 2019 classification of tumors of the digestive system.
Results: Totally 37 patients (male:19 female: 18) aged 23 to 93 years were analyzed. Majority of the patients (75.7 %) had underwent appendectomy due to preliminary diagnosis of acute appendicitis (n=22) or periappendiceal tumoral lesions (n=9), the others (n=9) underwent incidental appendectomy. Whereas acute appendicitis was histopathologically diagnosed in 16 (43.2%) patients, perforation was diagnosed in 12 (32.4%) patients (perforation without appendicitis=3, perforation with appendicitis=6). According to the initial, pathology reports were prepared as follows: mucocele (n=10), mucinous cystadenoma (n=9), low-grade mucinous neoplasm (n=6), mucinous adenocarcinoma (n=5), mucosal hyperplasia (n=5), hyperplastic polyp (n=1), adenomatous polyp (n=1). On the basis of the WHO 2019 classification, pathology reports were prepared as follows: low-grade mucinous neoplasm (n=17), simple retention cysts (n=6), hyperplastic polyp (n=6), mucinous adenocarcinoma (n=5), ruptured appendiceal diverticula (n=2), sessile serrated lesion (n=1).
Conclusion: The term of appendiceal mucinous lesion, which is recently introduced into medical literature is suitable to distinguish between lesions with and without malignancy potential. The WHO 2019 classification system has been an important step in simplifying the classification of non- neuroendocrine tumors of the appendix vermiformis.
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Background/Aims: This study gives a clue about genotypes, subgenotypes, and subtypes of hepatitis B (HBV), Hepatitis C (HCV), and Hepatitis D (HDV) viruses in general population of Afghanistan. Materials and Methods: A total of 234 Hepatitis B surface antigen (HBsAg), 44 anti-HCV, and 5 antidelta positive patients from 25–70- age group were studied through a rapid screening test among 5898 residents of Afghanistan. After quantifying viral load, genotyping
of 61 HBV, 29 HCV, and 1 HDV samples were accomplished by sequencing of a segment of the HBV Pre S, HCV NS5B, and HDV Delta antigen regions, respectively. Clinically important variants of the HBV polymerase gene, the “a” determinant of HBsAg, HCV NS5B, and NS3 regions were assessed.
Results: All HBV isolates were dispersed throughout the genotype D branch and ayw2 was the only subtypes found. The anti-HDV prevalence among HBsAg-positive individuals was 2.2% and the single HDV sample, from HDV genotype I. Analysis of HCV isolates revealed subtype HCV genotype 1b (HCV-1b) in 75.86%, HCV-3a in 20.69%, and HCV-3b in 3.44% patients. The observed mutant variants in the major hydrophilic region (MHR) of HBsAg were Y100 15%, Q101 5%, G102 15%, T115 45%, P120 5%, and T131 5%. Likewise, S213T 10%, Q215P 5%, and N248H 100% mutations were detected in the HBV polymerase region. C316N mutation was prevalent in 72.7% of HCV-1b participants.
Conclusion: Genotypic variation in Afghan patients is in line with the ones existing in neighboring countries and regions. HBV genotypes D1, subtype ayw2, HDV RNA type I, and HCV RNA genotype 1b are likely to be dominant in Afghan patients
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Background/Aims: An anal fissure (AF) is a linear tear in the distal anal canal and is one of the most common causes of anal pain. Hemorrhoidal disease (HD) is a symptomatic growth and distal displacement of normal anal cushions. Numerous studies have addressed the contributing factors of these conditions, yet the results remain controversial. In this study, we hypothesize that increasing patients’ awareness of hidden risk factors could reduce the rate of HD and AF.
Materials and Methods: A questionnaire-based controlled study was planned. After power analysis, patients with HD (n=60) and AF (n=60) were enrolled consecutively into the study group and compared with the control group (n=60) of healthy individuals. The survey was designed to assess the participants’ toilet and dietary habits and anxiety risk. Odds ratios were calculated and a binary logistic regression model was constructed to identify associated factors.
Results: Hard stools, spending more than 5 minutes in the toilet, frequent straining during defecation, and increased spice intake were more frequent in the patients with HD; and hard fecal consistency, time elapsed in toilet greater than 5 min, straining during defecation, and high anxiety risk were more frequent in the patients with AF as compared to the control group (p<0.05).
Conclusion: Possible associations were identified between habitual factors or conditions (i.e., fecal consistency, the time elapsed in the toilet, straining during defecation) and anxiety and benign anorectal diseases (i.e., HD and AF). Patients should be advised about these hidden threats.
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Background/Aims: Alterations in the gut microbiota due to a high-fat diet and diet-induced illness have been found in both mouse models and humans. Observational studies suggest that probiotic administration and diet shifts may treat diet-related diseases. However, the effect of these interventions on the colonic mucosa has not yet been elucidated. This study investigated the efficacy of probiotic supplementation and dietary intervention as prophylactic tools under high-fat diet conditions.
Materials and Methods: A total of 36 volunteers that normally consumed a high-fat diet were enrolled and treated with either a control diet, a low-fat dietary intervention, Bifidobacterium triple viable capsule therapy, or a combination of a low-fat diet and Bifidobacterium triple viable capsule therapy. Pyrosequencing of the V3 and V4 regions of the 16S rRNA genes was conducted to determine the extent to which probiotics and dietary intervention altered the mucosal microbiota.
Results: This study demonstrated that interventional treatment with probiotics and a low-fat diet increased the diversity of the mucosal microbes, dietary intervention alone produced the most significant effect, whereas the combined intervention exhibited no synergetic improvement. Pyrosequencing demonstrated that probiotics and dietary intervention significantly elevated the abundance of some bacterial taxa assigned to the phylum Firmicutes and the beneficial genera Prevotella, Gemmiger, Coprococcus, and Faecalibacterium and reduced some harmful bacterial taxa assigned to the phylum Proteobacteria and genus Streptophyta.
Conclusion: The results of this study suggested that the addition of probiotics and dietary intervention could improve the composition of the colonic mucosal microbiota in high-fat diet populations.
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Background/Aims: The aim of this study was to investigate the indications, technical and clinical success, and complications of the endoscopic retrograde cholangiography (ERC) via a permanent access loop (PAL).
Materials and Methods: Twenty patients who underwent ERC through PAL between 2009 and 2017 were included in this study. The technical success was described as achieving access to the bile ducts through PAL and the clinical success was described as the clinical and laboratory improvement of the patients after the procedure.
Results: The study was performed with 20 patients. The median follow-up duration was 24 months (3-96) and the median number of ERC sessions was 3.9 (1-10). The most common ERC indications through PAL were stones (40%) and cholangitis (30%). In 16 patients (75%), anastomotic or branched strictures were observed. The improvement of strictures via intermittent stenting and dilatation was observed in 6 patients, but no improvement was observed in 5 patients. The treatment of those 5 patients continues. In this study, the technical success was 100% and clinical success was 85%. While no mortality due to PAL-mediated ERC was observed, free wall perforation was seen in one patient who was referred to surgery.
Conclusion: PAL-mediated ERC procedure is a technique with high technical and clinical success and low complication rate in patients who require frequent percutaneous procedures and those with difficult access to the biliary tract.
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