Background and objectives: Nonalcoholic fatty liver disease (NAFLD) is associated with multiple factors such as hypertension, diabetes, dyslipidemia, obesity, and hyperuricemia. We aim to investigate the relationship between uric acid and NAFLD in a non-obese and young population. Materials and Methods: This study was performed in January 2010–2019 with a group of 367 (225 patients in the NAFLD group and 142 in the control group) patients with liver biopsy-proven NAFLD or no NAFLD. Patients with NAFLD were classified according to the percentage of steatosis as follows, group I had 1–20% and group II >20%. Demographic, clinical, and laboratory (biochemical parameters) features were collected retrospectively. Results: The mean body mass index (BMI) and age of the patients were 26.41 ± 3.42 and 32.27 ± 8.85, respectively. The BMI, homeostatic model of assessment (HOMA-IR), and uric acid (UA) values of the NAFLD group were found to be significantly higher than those of the controls. A positive correlation was found between the NAFLD stage and UA. The following factors were independently associated with NAFLD: BMI, HOMA-IR, and UA. In addition, the cut-off value of UA was 4.75 mg/dl with a sensitivity of 45.8% and a specificity of 80.3%. Conclusions: UA is a simple, non-invasive, cheap, and useful marker that may be used to predict steatosis in patients with NAFLD.

OBJECTIVE:This study was performed to evaluate the effects of metabolic parameters and thyroid dysfunction on the development of non-alcoholic fatty liver disease (NAFLD).METHODS:The current study evaluated a total of 115 patients, 75 female and 40 male. Physical examination and anthropometric measurements were applied to all participants. Hypothyroidism was considered at a thyroid stimulating hormone level ≥ 4.1 mIU/L. Patients with euthyroidism and patients with hypothyroidism were compared. Abdominal ultrasonography was used to diagnose non-alcoholic fatty liver disease. The participants were further compared with regard to the presence of non-alcoholic fatty liver disease. Logistic regression modeling was performed to identify the relationship between non-alcoholic fatty liver disease and independent variables, such as metabolic parameters and insulin resistance.RESULTS:Non-alcoholic fatty liver disease was identified in 69 patients. The mean waist circumference, body mass index, fasting plasma insulin, HOMA-IR (p<0.001) and FT3/FT4 ratio (p=0.01) values were significantly higher in the patients with NAFLD compared to those without it. Multivariate regression analysis revealed that FT3/FT4 ratio, waist circumference and insulin resistance were independent risk factors for non-alcoholic fatty liver disease.CONCLUSION:Insulin resistance, enlarged waist circumference, elevated body mass index, higher FT3/FT4 ratio and hypertriglyceridemia are independent risk factors for NADLF, whereas hypothyroidism is not directly related to the condition.

Departmental sources Background:Platelets are considered to be essential in proinflammatory environments, including atherosclerosis. The degree of platelet activation has been demonstrated to be correlated with plateletcrit and platelet distribution width. The main purpose of this study was to assess the relationship between plateletcrit (PCT), platelet distribution, and the degree of hepatic steatosis in patients with non-alcoholic fatty liver disease (NAFLD). Material/Methods:We enrolled 225 biopsy-proven NAFLD patients and 142 control subjects without NAFLD. NAFLD patients were separated into 2 groups according to percentage of steatosis. Demographic and clinical data were collected retrospectively. Results:PCT level was significantly higher in NAFLD group I and group II than in the control group. PCT was higher in the NAFLD groups than in the control group. However, there was no difference according to PCT and PDW levels between NAFLD groups. Conclusions:In this study, a relationship was found between PCT and hepatosteatosis, but no relationship was found with PDW. PCT might be a useful biomarker for early detection of steatohepatitis in patients with nan-alcoholic fatty liver disease.

Background Factors causing progression from nonalcoholic fatty liver to nonalcoholic steatohepatitis (NASH) and liver cirrhosis remain relatively unknown. We aimed to evaluate the power and effectiveness of the free triiodothyronine (FT3)-to-free thyroxine (FT4) ratio to predict non-alcoholic fatty liver disease (NAFLD)/liver fibrosis and NASH cirrhosis severity. Methods Patients (n = 436) with NASH-associated liver cirrhosis (n = 68), patients with liver biopsy-proven NAFLD (n = 226), or healthy participants (n = 142) were enrolled between January 2010 and January 2020. The aspartate aminotransferase-to-thrombocyte ratio (APRI), NAFLD fibrosis score, albumin–bilirubin score (ALBI), aspartate aminotransferase (AST)-to-alanine aminotransferase (ALT) ratio, FT3-to-FT4 ratio, and Fibrosis-4 (FIB-4) were calculated and evaluated. Results All parameters were significantly higher in NASH cirrhosis than in the healthy group. Body mass index, ALT, fasting insulin, homeostatic model assessment for insulin resistance, and triglyceride levels were significantly higher in liver biopsy-proven NAFLD than in the healthy group. The APRI, NAFLD fibrosis score, ALBI, AST-to-ALT ratio, FT3-to-FT4 ratio, and FIB-4 were significantly higher in the NASH cirrhosis group than in the healthy group. In patients with biopsy-proven NAFLD, the FT3-to-FT4 ratio was significantly lower than in the healthy group. Conclusion The FT3-to-FT4 ratio is an effective and useful indicator to predict NAFLD/liver fibrosis and NASH cirrhosis severity.

Despite many studies, the molecular mechanisms of hepatocellular carcinoma (HCC) development remain unclear. Thyroid hormone (TH) levels may vary in many chronic diseases including cirrhosis. The aim of this study was to evaluate TH status in patients with cirrhosis and HCC and to investigate the relationship between THs and HCC development. Five hundred seventy-seven patients with cirrhosis who applied to Demiroğlu Bilim University, Faculty of Medicine, Gastroenterology Department between 2004 and 2019 were included the study. Three hundred sixty-seven patients who applied to Internal Medicine Unit for general health check-up were included in the study as healthy control group. Demographic, laboratory, and imaging findings of study groups were retrospectively reviewed and recorded from hospital information system. In the cirrhosis group, 252 patients had HCC (43.67%), and 325 patients had non-HCC cirrhosis (56.33%). Free thyroxine (FT4) levels were higher in the control group than in the cirrhotic group but there was no significant difference ( P = .501). Thyroid-stimulating hormone (TSH) and FT4 levels were similar between groups, while free triiodothyronine (FT3) levels were significantly different between HCC group, non-HCC cirrhosis group, and control group ( P = .299 for TSH, P = .263 for FT4, P < .001 for FT3). FT3 levels were significantly higher in HCC group than non-HCC cirrhosis group, but significantly lower than control group ( P < .05). Our study confirmed the presence of hypothyroidism in cirrhosis patients and clearly demonstrated a strong relationship between FT3 levels and HCC development.

Background: This study is performed to evaluate vitamin D levels and metabolic parameters in patients with prediabetes, compared to healthy controls.Methods: This study was conducted between October and December 2013 in İstanbul Haseki Training and Research Hospital, internal medicine department. We enrolled total 247 individuals, 122 prediabetic (PreDM) patients (79 female, 43 male) and 125 control healthy individuals (94 female, 31 male) between 20-65 ages who admitted randomizely to the outpatient clinic with non spesific complaints. FPG, urea, creatinine, calcium, phosphate, albumin, alkaline phosphatase, thyriod stimulan hormon (TSH), 25 hydroxy vitamin D (25[OH]D), parathormon (PTH), c-peptide, insulin were analyzed.Results: Pre DM patients’ mean plasma 25[OH]D level (25.7±14.9 nmol/l) was statistically lower than the control group (31.4±17.8 nmol/l). Pre DM patients’ mean plasma insulin, c-peptide, calcium, PTH, HOMA-IR (10.8±8.7 IU/ml, 3.3±2.0 ng/ml, 9.7±0.4 mg/dl, 56.5±22.5 pg/ml, 3.0±2.68, respectively) levels were statistically higher than the control group’s (6.3±3.8 IU/ml, 2.4±1.0 ng/ml, 9.5±0.5 mg/dl, 44.0±16.0 pg/ml, 1.4±0.8, respectively) mean levels. There were negative correlations between 25[OH]D and BMI (r:- 0.13, p:0.03), FBG (r:- 0.14, p:0.02) and plasma insulin (r:-0.16, p:0.01) values. A multivariate logisitic regression model for prediabetes was performed and variables as female gender, age, HOMA-IR and lower 25[OH]D values were risk factors for pre DM.Conclusions: Serum low 25[OH]D level correlated with insulin resistance and metabolic parameters in prediabetic patients. Also, it may play an important role in the development of type 2 diabetes.

Purpose Metabolic parameters are important for the development of portopulmonary hypertension (PoPH) during nonalcoholic steatohepatitis (NASH)-associated cirrhosis. This study evaluated patients with NASH-associated cirrhosis to determine metabolic risk factors for portopulmonary hypertension. Patients and Methods Data on 171 patients (120 men and 51 women) with NASH-associated cirrhosis who were seen in Florence Nightingale Hospital’s gastroenterology Clinic from 2009 to 2018 was obtained from the Hospital database. A pulmonary artery systolic pressure >35 mmHg was defined as PH (pulmonary hypertension) according to standard transthoracic echocardiography. Portal hypertension was diagnosed from clinical symptoms and dilated portal veins shown by abdominal ultrasound or computed tomography (CT). Pulmonary patients with portal hypertension were diagnosed with portopulmonary hypertension (PoPH). Results A total of 171 patients with NASH-associated cirrhosis were included in this study. Of these, 43 patients had PoPH. These patients had increased TSH (p=0.004), bilirubin (p=0.023) and triglyceride (p=0.048) levels, higher MELD scores (p=0.018) and decreased hemoglobin (p=0.05). MELD score and hemoglobin, total bilirubin, TSH, and triglyceride levels were all included in a multivariate logistic regression model and TSH levels were independently associated with increased risk of PoPH. Conclusion Increased TSH is an independent risk factor for PoPH.

Acute pancreatitis (AP) is an inflammatory condition, characterized by elevated levels of amylase and lipase, with manifestation of abdominal pain and acute abdomen, and high mortality and morbidity rates. The most common causes of AP other than gallbladder stones and alcohol include hypercalcemia, infections, hypercalcemia, and drugs. One such drug associated with AP is azathioprine. Azathioprine is used to prevent acute exacerbations in Crohn's disease. Herein, we present a case of azathioprine-related AP in a patient with Crohn's disease.Azatiyoprin ilişkili bir akut pankreatit olgusu ve ilaç-ilişkili akut pankreatit ÖZ Akut pankreatit (AP), amilaz ve lipaz düzeylerinin yüksekliği ile karakterize, karın ağrısı ve akut batın tablosu izlenen ve mortalite ve morbidite oranları yüksek enflamatuvar bir tablodur. Akut pankreatitin en sık nedenleri arasında safra kesesi taşı ve alkol dışında hiperlipidemi, enfeksiyonlar, hiperkalsemi ve ilaçlar sayılabilir. Akut pankreatit ile ilişkili ilaçlardan biri de azatiopurindir. Azatiopurin, Crohn hastalığında akut alevlenmenin önlenmesinde kullanılmaktadır. Burada Crohn hastalığı olan bir hastada azatiyoprin ile ilişkili bir AP olgusu sunuldu.