Sedat Ciftel

Kolorektal kanserler, tüm dünya genelinde en sık görülen maligniteler arasında yer almaktadır ve kansere bağlı morbidite ve mortalitenin önemli bir nedenidir. İnsidansı farklı popülasyonlar arasında önemli ölçüde farklılık göstermekte olup gelişmiş ülkelerde daha yüksektir. Etiyolojisinde diyet, alkol, sigara, obezite ve diyabet, mikrobiyota, yaşam tarzı ve ailesel ve genetik faktörler önemli bir yer almaktadır. Histopatolojik olarak çoğunlukla adenokarsinom yapısında olup evrelemesinde TNM evreleme sistemi kullanılır. Kolorektal kanserler yavaş büyürler ve semptomlar ortaya çıkmadan yıllar önce mevcut olabilirler. Tanı ve taramada altın standart yöntem kolonoskopi olup ortalama riske sahip bireylerde 45 yaşından sonra 10 yılda bir yapılması önerilir. Tedavi seçenekleri arasında cerrahi, kemoterapi ve immünoterapi yer almaktadır.

Background: Hemorrhoidal disease is a common anorectal condition characterized by the enlargement and distal displacement of the typical vascular structures in the anal canal. The relationship between DM, lipid metabolism, and hemorrhoidal disease remains underexplored. This study aims to investigate the prevalence of hemorrhoids and the association between glycemic control and lipid profile in diabetic patients. Methods: This retrospective cross-sectional study included 752 patients who underwent colonoscopy at Erzurum Regional Training and Research Hospital between June 2021 and August 2024. The study population comprised 452 patients with type 2 diabetes mellitus (mean age 63.4 ± 11.0) and 300 nondiabetic patients (mean age 62.8 ± 10.8). The presence of hemorrhoids was confirmed through colonoscopy. Glycemic control parameters, lipid profile, and other biochemical parameters were analyzed. Results: Hemorrhoids were found in 47.3% (n = 214) of diabetic patients and 17.3% (n = 52) of nondiabetic patients, indicating a significantly higher prevalence in the diabetic group (OR = 4.3, CI = 3.0–6.2, p < 0.001). Diabetic patients with hemorrhoids had significantly higher mean HbA1C (8.1 ± 2.1 vs. 7.5 ± 1.8, p < 0.001), low-density lipoprotein (p < 0.001), and triglyceride levels (p = 0.005) compared to those without hemorrhoids. Additionally, a longer duration of diabetes and higher hypertension prevalence were observed in the hemorrhoid group. Conclusions: The findings suggest that poor glycemic control and dyslipidemia are significantly associated with an increased prevalence of hemorrhoids in diabetic patients. These results highlight the importance of comprehensive management of diabetes, including lipid control, to potentially reduce the risk of hemorrhoidal disease.

Aim: The aim of this study is to investigate the impact of obesity on fibrosis by comparing fibrosis markers between obese and non-obese patients with Chronic Hepatitis B (CHB). Material and Method: A total of 172 CHB (50.6±9.4 mean aged) patients were included in this retrospective study. The patients were divided into two groups: Obese (n=72) and Non-obese (n=100). Inclusion criteria were those diagnosed with chronic hepatitis B and ≤ 50 IU/mL or undetectable HBV-DNA, and exclusion criteria were other chronic diseases other than CHB and pregnancy. The height, body weight, and waist circumferences were measured. BMI ≥30 kg/m2 was classified as the obese group. Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Gamma-glutamyl transferase, albumin, bilirubin, and prothrombin time were analyzed. Fibrosis-4 score (FIB-4) was calculated with the formula Age x AST / platelet count x √(ALT), and AST-Platelet Ratio Index (APRI) was calculated with the formula [AST/AST (upper limit of normal)]/ platelet count. Results: AST levels were significantly higher in obese patients (p

High-fat diets have detrimental health impacts that increase the likelihood of developing obesity and metabolic syndrome. This study aimed to examine the potential antioxidant and anti-inflammatory effects of orlistat and white tea in rats fed a high-fat diet. Thirty-two rats were randomized into four groups: control (standard diet), HFD (high-fat diet), HFD+Orlistat (high-fat diet+orlistat), and HFD+WT (high-fat diet+white tea extract). A significant increase in malondialdehyde (MDA) levels and a decrease in total thiol (TT) levels were detected in the HFD group (p < 0.001). On the other hand, a decrease in the MDA level (p < 0.001) and an increase in the TT level were observed in the orlistat and white tea groups compared with those in the HFD group (p < 0.001). Histopathological examinations revealed that, compared with the HFD alone, orlistat and white tea reduced fat accumulation, prevented degenerative changes in hepatocytes, and decreased the histopathological damage score (p = 0.001). Immunohistochemical examinations of nuclear factor-kappa B (NF-kB/p65) revealed that compared with the HFD, orlistat and white tea reduced immunopositivity (p = 0.001). White tea decreases lipid peroxidation and oxidative stress. Both white tea and orlistat decreased fat formation and inflammation in the liver and regulated inflammation by reducing Nf-kB positivity. Nevertheless, further research is needed to assess their impact on human subjects.

Background/Objectives: Acute mesenteric ischemia can lead to severe liver damage due to ischemia–reperfusion (I/R) injury. This study investigated the protective effects of trimetazidine (TMZ) and dexmedetomidine (DEX) against liver damage induced by mesenteric artery I/R via endoplasmic reticulum stress (ERS) mechanisms. Methods: Twenty-four rats were divided into four groups: control, I/R, I/R+TMZ, and I/R+DEX. TMZ (20 mg/kg) was administered orally for seven days, and DEX (100 µg/kg) was given intraper-itoneally 30 min before I/R induction. Liver tissues were analyzed for creatinine, alanine ami-notransferase (ALT), aspartate aminotransferase (AST), thiobarbituric acid reactive substances (TBARS), and total thiol (TT) levels. Results: Compared with the control group, the I/R group presented significantly increased AST, ALT, TBARS, and TT levels. TMZ notably reduced creatinine levels. I/R caused significant liver necrosis, inflammation, and congestion. TMZ and DEX treatments reduced this histopathological damage, with DEX resulting in a more significant reduction in infiltrative areas and vascular congestion. The increase in the expression of caspase-3, Bax, 8-OHdG, C/EBP homologous protein (CHOP), and glucose-regulated protein 78 (GRP78) decreased with the TMZ and DEX treatments. In addition, Bcl-2 positivity decreased both in the TMZ and DEX treatments. Conclusions: Both TMZ and DEX have protective effects against liver damage. These effects are likely mediated through the reduction in ERS and apoptosis, with DEX showing slightly superior protective effects compared with TMZ.

Colorectal polyps, precursors to colorectal cancer (CRC), require precise identification for appropriate diagnosis and therapy. This study aims to investigate the differences in hematological and inflammatory markers, specifically the CALLY index, HALP score, and immuno-inflammatory indexes, between neoplastic and nonneoplastic polyps. A retrospective cross-sectional study was conducted on 758 patients aged 61.0 ± 11.8 who underwent polypectomy between June 2021 and May 2024. Patients with colorectal adenocarcinoma (n = 22) were excluded. The polyps were classified into neoplastic and nonneoplastic categories based on histopathological evaluation. The study compared the CALLY index, HALP score, and various inflammatory indexes between neoplastic and nonneoplastic polyps. Out of 758 polyps analyzed, 514 were neoplastic, and 244 were nonneoplastic. Neoplastic polyps exhibited significantly lower CALLY and HALP scores (p < 0.05) and higher immuno-inflammatory indexes (p < 0.05) compared to nonneoplastic polyps. Dysplasia status, polyp diameter, and sigmoid colon localization were significant factors in determining neoplastic growth potential. No significant differences were observed in polyp localization in the proximal and distal colon segments or in solitary versus multiple polyps. The CALLY and HALP scores and immuno-inflammatory indexes can serve as valuable markers for distinguishing neoplastic from nonneoplastic polyps. These indexes reflect underlying inflammatory and immune responses, highlighting their potential utility in the early detection and risk stratification of colorectal polyps. Integrating these markers into clinical practice may enhance diagnostic accuracy and improve patient management, leading to timely interventions and better outcomes for individuals at risk of CRC.

Introduction: The objective of our study was to examine the correlation between hepatosteatosis and the triglyceride glucose index (TyG), plasma atherogenic index (PAI), and cardiometabolic index (CMI) in nondiabetic patients. We also aimed to assess the usefulness of these indices in evaluating cardiometabolic risk in metabolic dysfunction-associated steatotic liver disease (MAFLD).Material and methods: This retrospective cross-sectional study included 695 individuals who did not have diabetes, with an average age of 39.8±11.3 years. A total of 595 individuals, comprising 359 women and 236 men, were diagnosed with MAFLD. The control group consisted of 100 individuals who did not have MAFLD. All the subjects underwent transabdominal ultrasonography, anthropometric measurements, and blood analyses. The groups were assessed based on the TyG index, PAI, and CMI.Results: TyG, PAI, and CMI were greater in patients with MAFLD than those without MAFLD. The TyG index, with a cutoff point of 8.47, excluded significant simple steatosis with a sensitivity of 65.3% and a specificity of 66.0%. The PAI and CMI cutoff values were 0.39 and 1.40, with sensitivities of 66.6% and 70.1% and specificities of 67.0% and 70.1%, respectively. The TyG index was independently associated with MAFLD (OR=2.21, 95% CI: 1.339-3.665).Conclusions: The presence of MAFLD patients with a normal BMI and waist circumference indicates that these variables alone do not provide enough evidence for the diagnosis of MAFLD. Hence, it is advisable to incorporate the TyG index, the PAI, and the CMI into regular clinical practice to obtain a more precise and thorough evaluation of MAFLD and cardiometabolic risk.

Background/Aims: To compare CTGF (connective tissue growth factor) and P2/MS [platelet count (109 / L)] 2 / [monocyte fraction (%) x segment neutrophil fraction (%)] ratio as non-invasive tests with liver biopsy in the detection of liver fibrosis. Thus, to determine whether CTGF and P2/MS index results can be used as a noninvasive marker, in the diagnosis of chronic liver disease Materials and Methods: A total of 52 chronic hepatitis patients with concurrent liver biopsy (27 female, 25 male) were included in the study group. The subjects' ages ranged between 18 and 70, and none of the subjects had undergone liver disease-related treatment. The control group was made up of a total of 31 healthy individuals without liver disease (18 female, 13 male) from similar age groups. Liver biopsy results of patients were reported at 7 stages according to Modified Knodell Scoring (ISHAK). Results: CTGF levels were higher in patients with chronic hepatitis (1.06±0.70 ng/ml) than the control group (0,72±0,32 ng/ml) (P<0,05). When the P2/MS indexes were compared according to the liver biopsy results of the patients in the study group, the difference was found to be significant. As the degree of fibrosis increased, P2/MS index decreased. Conclusions: As a noninvasive test, it was seen that CTGF and P2/MS is parallel to liver biopsy in reflecting liver fibrosis. These noninvasive markers can be used where liver biopsies cannot be performed or where repetition is necessary, and in the follow-up of patients for early detection of fibrosis.

Pediatric guidelines on the diagnosis of celiac disease (CD) have reported that the positivity of anti-endomysium antibodies in the presence of anti-transglutaminase antibodies (TGA) 10 times higher than normal is sufficient for the diagnosis. In this study, we aimed to evaluate whether this diagnostic process for children can also be applied to adult patients. We retrospectively examined patients aged >18 years who were diagnosed with CD. The results of serological tests and endoscopic biopsy were evaluated. Patients with more than one month of duration between celiac serology and endoscopy, those diagnosed with CD before admission, those on a gluten-free diet, and those with selective IgA deficiency were excluded from the study. A total of 269 patients were included in the study. TGA value was significantly higher in patients with villous atrophy (p<0.001) and positively correlated with mucosal damage (r=0.60, p10 ULN) for the TGA antibodies, in line with the criteria regulated by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) for the diagnosis of CD, the sensitivity was 71.64%, the specificity was 100%, and the positive predictive value (PPV) was 100%. When the cut-off value was taken as 29.42 U/mL, the sensitivity was 100% and the specificity was 99.5%. For a TGA cut-off value of 52.7 U/mL (5.27 ULN), which determines the presence of partial or complete villous atrophy in the evaluation made considering mucosal damage, the sensitivity was 90%, the specificity was 100%, and the PPV was 100%. Based on our findings, TGA titers were highly effective in demonstrating CD-related mucosal damage. This study endorses a biopsy-free strategy in adult patients in line with the ESPGHAN criteria. Local validation of test-specific thresholds will ensure that this approach has a significant impact on adult patients.