Functional constipation as a neglected condition in laryngectomized patients.

Ischaemia-reperfusion injury (IRI) is a factor leading to the damages of the transplanted kidney, what affects mainly the proximal tubules. Early monitoring of tubule damage can be an efficient tool to predict the allograft dysfunction. Present in proximal tubules, N-acetyl-beta-glucosaminidase (NAG) is a lysosomal enzyme whose excretion rises as a result of IRI or acute rejection. The aim of this study was to monitor the NAG urine activity to evaluate the early proximal tubule damage, and to try to predict the long-term function of the transplanted kidney. The study enrolled 87 Caucasian renal transplant recipients (61.7% males, 38.3% females, mean age 45.56±14.34 years). Urine samples were collected for NAG and creatinine analysis on the 1st day after transplantation, and then in the 3rd and 12th month. Protocol biopsies were performed in the 3rd and 12th month. A significant positive correlation between NAG urine activity in the 3rd month after transplantation and creatinine concentration on the 14th (p=0.004) and 30th day (p=0.05), in the 3rd month (p=0.009) and after the 1st (p=0.005) and 2nd year (p=0.003) was observed. A statistically significantly higher urinary NAG activity in samples collected in the first 3 days and in the 3rd month after transplantation among patients with DGF (p=0.006 and p=0.03 respectively) was found. There was a significant positive correlation between NAG urine activity in the 3rd month and the grade of tubular atrophy in specimens collected in the 3rd (p=0.03) and 12th (p=0.04) month. Monitoring of NAG urine activity is useful in the evaluation of early proximal tubule damage and predicting the long-term function of the transplanted kidneys.

Aim: To evaluate the efficacy of early duloxetine therapy in stress urinary incontinence occurring after radical prostatectomy (RP). Material and Method: Patients that had RP were randomly divided into 2 groups following the removal of the urinary catheter. Group A patients (n = 28) had pelvic floor exercise and duloxetine therapy. Group B patients (n = 30) had only pelvic floor exercise. The incontinence status of the patients and number of pads were recorded and 1-hour pad test and Turkish validation of International Consultation on Incontinence Questionnaire-Short Form test were applied to the patients at the follow-up. Results: When the dry state of the patients was evaluated, 5, 17, 3, and 2 of 28 Group A patients stated that they were completely dry in the 3rd, 6th, 9th and 12th month respectively and pad use was stopped. There was no continence in 30 Group B in the first 3 months. Twelve, 6, and 8 patients stated that they were completely dry in the 6th, 9th and 12th month, respectively. But 3 of 4 patients in whom dryness could not be provided were using a mean of 7.6 pads in the first day and a mean of 1.3 pads after 1 year. When pad use of the patients was evaluated, the mean monthly number of pad use was determined to be 6.2 (4-8) in the initial evaluation, 2.7 (0-5) in the in 3rd month, 2 (0-3) in the 6th month and 1.6 (0-2) pad/d in the 9th month in the group taking medicine. The mean monthly number of pads used was determined to be 5.8 (4-8) in the initial evaluation, 4.3 (3-8) in the 3rd month, 3 (0-6) in the 6th month and 1.6 (0-6) pad/d in the 9th month in the group not taking medicine. Conclusion: According to the results, early duloxetine therapy in stress urinary incontinence that occurred after RP provided early continence.

To evaluate the change of corneal epithelial thickness (ET) in subjects using isotretinoin with spectral-domain optical coherence tomography and further to explore reflection of changes on corneal topography. Forty eyes of 40 subjects with acne vulgaris scheduled for oral isotretinoin were included in this prospective study. Subjects were examined with RTVue-XR and Pentacam at baseline, 1th, 3rd, and 6th months of treatment, and 3rd month of isotretinoin cessation. A statistically significant increase was detected in each sector of ET map except inferonasal 7 to 9 mm between baseline and following visits (P<0.05, for all visits). The increase in superior (2-7 mm), inferior (2-7 mm), and maximum values in epithelium statistics and the decrease in superior (2-7 mm), inferior (2-7 mm), minimum, and maximum values in stroma statistics at follow-up visits were significant (P<0.05, for all visits). Central corneal thickness, maximum Ambrosio-relational thickness, average pachymetric-progression index at 1th, 3rd, and 6th months, and thinnest pachymetry, index of surface variance (ISV) at 3rd, and 6th months differed significantly (P<0.05, for specified visits). The regression in parameters was observed at 3rd month of isotretinoin cessation. Isotretinoin treatment induces epithelial thickening and stromal thinning. Remodeling of corneal layers causes statistical differences in ISV and pachymetry-related parameters of Pentacam. The pachymetry changes in cornea return to baseline at the 3rd month of discontinuation of treatment.

ObjectivesWe aim to address several clinical interests regarding lung volume reduction surgery (LVRS) for severe emphysema using meta-analysis and systematic review of randomized controlled trials (RCTs).MethodsEight RCTs published from 1999 to 2010 were identified and synthesized to compare the efficacy and safety of LVRS vs conservative medical therapy. One RCT was obtained regarding comparison of median sternotomy (MS) and video-assisted thoracoscopic surgery (VATS). And three RCTs were available evaluating clinical efficacy of using bovine pericardium for buttressing, autologous fibrin sealant and BioGlue, respectively.ResultsOdds ratio (95%CI), expressed as the mortality of group A (the group underwent LVRS) versus group B (conservative medical therapies), was 5.16(2.84, 9.35) in 3 months, 3(0.94, 9.57) in 6 months, 1.05(0.82, 1.33) in 12 months, respectively. On the 3rd, 6th and 12th month, all lung function indices of group A were improved more significantly as compared with group B. PaO2 and PaCO2 on the 6th and 12th month showed the same trend. 6MWD of group A on the 6th month and 12th month were improved significantly than of group B, despite no difference on the 3rd month. Quality of life (QOL) of group A was better than of group B in 6 and 12 months. VATS is preferred to MS, due to the earlier recovery and lower cost. And autologous fibrin sealant and BioGlue seems to be the efficacious methods to reduce air leak following LVRS.ConclusionsLVRS offers the more benefits regarding survival, lung function, gas exchange, exercise capacity and QOL, despite the higher mortality in initial three postoperative months. LVRS, with the optimization of surgical approach and material for reinforcement of the staple lines, should be recommended to patients suffering from severe heterogeneous emphysema.

About 300 million people are suffering from asthma globally and about 10% of it about 30 million asthmatics belong to India. Current treatment involves use of preventer and reliever inhalers, antileukotrines and methyl xanthines. Many studies have shown the effect of yoga on bronchial asthma as significant improvement in pulmonary functions, quality of life and decrease in medication use but only a few studies have attempted to show the effect of yoga on bio- chemical changes. The present study was conducted on 276 subjects with mild or moderate bronchial asthma who were allocated randomly to either the cases/ yoga (intervention) group (n= 121) and the control group (n= 120) in the Department of Pulmonary Medicine, King George’s Medical University, Lucknow, U.P. The yoga group received an intervention based on yoga (asanas, pranayama & meditation), in addition to standard medical treatment and the control group received only standard medical treatment and both groups were assessed at 0th, 3rd and 6th month. There was a significant improvement found in asthma symptom score and Asthma Quality of Life scores in yoga group than control group. There was significant improvement found in day time symptoms in yoga group at 3rd month & 6th month than control group. Significant improvement was found in yoga group at 3rd month (p- value 0.004) & 6th month (p- value < 0.0001) in total AQOL score and its sub- domains (activity limitation (p- value <0.0001) & emotional function (p- value 0.006 & < 0.0001) in comparison to control group. In the yoga group, there was a steady and progressive improvement found in pulmonary functions as compared to the control group. There was significant difference found in haemoglobin, TLC, Eosinophils, Monocytes & Super oxide dismutase level. The rescue medication use has a significant decreased in comparison to control group. The present study showed that yoga group has significant improvement in asthma symptom scores, spirometrical, bio- chemical changes, quality of life and also helps in reduction of inhalation therapy, thus reducing the cost of therapy. So, it can be useful cost effective add on therapy of asthmatics.

Bladder cancer is the 7th most commonly diagnosed cancer in males worldwide and the 11th when both genders are considered. Seventy five per cent of bladder cancer cases are non-muscle invasive bladder cancer (NMIBC). Bacillus Calmette–Gu rin (BCG) immunotherapy remains the standard intravesical agent for NMIBC. The exact mechanism by which BCG prevents recurrence is unknown. The aim of this study was to evaluate NLR4 gene expression and IL-1β as possible prognostic indicators for NMIBC recurrence and BCG treatment failure, and to detect the difference in their levels among muscle invasive bladder cancer (MIBC) and NMIBC that may aid in primary differentiation between cases. This study was conducted in 30 patients who had NMIBC and 17 patients who had MIBC. Urine samples were obtained in sterile cups before operation. From NMIBC cases, four more samples were obtained as mentioned below. Evaluation of NLR4 gene expression was performed in pre-surgical sample for MIBC and in 4 samples for NMIBC: pre-surgical sample, sample collected 4 hours after the 3rd dose of BCG instillation, and samples collected during follow up (3 and 6 months post-surgically). There was statistical significant increase in NLRP4 expression levels in NMIBC (CT=0.87±1.48) compared to MIBC (CT=2.82±2.07). As far as we searched, no published results were found regarding comparative gene expression levels between NMIBC and MIBC cases. Gene expression in recurrent cases was higher in pre-surgical urine samples than in non-recurrent cases. The expression level further increased up to 21 fold than the pre-surgical level in the sample taken after injection of the 3rd dose of BCG. This level decreased distinctly to become 1-fold increase over pre-surgical level at the 3rd month follow up then to only 0.9-fold at the 6th month. In non- recurrent cases, gene expression level started pre-surgically in much lower levels than those encountered in recurrent cases. There were 11-fold increase in expression level after 3rd dose of BCG instillation and then decreased to be 5.6 folds higher in the sample taken at 3rd month follow up than in presurgical samples. Gene expression further decreased to become 4.1 fold higher in samples taken at 6 month follow up than the pre-surgical levels. IL-1β levels were estimated for NMIBC and MIBC cases in urine samples pre-surgically and during BCG therapy in case of NMIBC before and 4 hours after the 3rd dose and during 3rd month follow-up of those cases for searching its possible use of for primary differentiation between NMIBC and MIBC, and also as a prognostic factor for possible recurrence in case of NMIBC cases. The level of IL-1β was generally higher in pre-surgical samples (0.62±0.12 pg/ml) when compared to its level before the 3rd dose of BCG induction therapy (0.53±0.13 pg/ml). Its level was distinctly higher four hours after administration of the 3rd dose BCG (1.96±0.62 pg/ml) than both previous levels. Levels decreased bellow pre-surgical level at 3rd month follow up (0.57±0.099 pg/ml). The levels of IL-1β estimated in samples collected four hours after the 3rd dose BCG was higher in cases that showed recurrence later on than non-recurrent cases. The levels decreased in both cases and became higher in non-recurrent cases (0.64±0.05 pg/ml) than in cases already developed recurrence at the 3rd month diagnosed during follow-up (0.45±0.05 pg/ml). To conclude, on following NLRP4 gene expression and IL-1β levels during BCG administration among recurrent and non-recurrent cases of thirty NMIBC cases, there was a significant statistical difference in both levels for the samples collected after the third dose BCG, being higher in patients who showed subsequent recurrence at the 3rd and 6th month of follow-up. If these preliminary reported findings will be confirmed in upcoming larger cohort’s studies, it could be promising in prognosis of such cases, with the possibility of early manipulation of individualized treatment schedule, keeping patients most probably prone to encounter recurrence safe from possible side effects of BCG therapy. The assessment of NLRP4 expression and IL-1β levels could help predict failure of BCG therapy, playing an appreciable role in early deciding radical surgery. When comparing NLRP4 expression and IL-1β levels between MIBC and NMIBC cases, increased values were noted among non-invasive ones. This finding may serve as a possible diagnostic tool, which represents a challenging issue. Hence, cut-off values for gene expression and cytokine level are to be specified.

Aim.&nbsp;Assessment of the dynamics of the structural and functional state of the myocardium in patients with non Q-wave myocardial infarction in 3 and 6 months depending on the use of the blocker of the mineralocorticoid receptors eplerenone. Material and Methods.&nbsp;We examined 77 patients (63.6% males) with non Q-wave myocardial infarction aged from 50 to 79 (mean 64.1±1.0) years. Hospital management strategy was elaborated in accordance with modern standards for the treatment of acute coronary syndrome without ST-elevation, which envisaged stratification of risk on the GRACE scale (estimated risk of mortality in the near future) and the choice of adequate procedure of the invasive strategy. The structural and functional state of the myocardium was evaluated using echocardiography, which was performed in the M-, B- and D-modes. Results and Discussion.&nbsp;A substantial increase in the total score of echocardiographic dynamics at the 6th month was demonstrated, as compared to the 3rd month of treatment, indicating a certain association of positive hemodynamic changes with the duration of basic treatment. An analysis of the total score of echocardiographic dynamics during the 3rd and 6th months of treatment indicated a significant increase in the indicator for all periods of observation in the eplerenone group, which showed a more convincing anti-remodeling effect in the group of patients with non-Q myocardial infarction who were administered the drug. Conclusions.&nbsp;The use of eplerenone in addition to basic treatment is associated with more convincing anti-remodeling and hemodynamic effects during the 3rd and 6th months of treatment. Positive hemodynamic effects of the drug exhibit a certain dependence on the duration of treatment, which is characterized by more powerful dynamics of most echocardiographic parameters on the 6th compared to the 3rd month of observation.

Understanding the postoperative dynamics of the nasal soft-tissue envelope (NSTE) is necessary to obtain the desired cosmetic results after rhinoplasty. This study was conducted to determine the changes of NSTE thickness and its effects on periorbital edema and ecchymosis following rhinoplasty. Thirty-five patients who underwent rhinoplasty were included in the study. Nasal skin and subcutaneous tissue thickness at the tip, supratip, rhinion, and nasion were measured using ultrasonography preoperatively and at the postoperative 3rd and 10th months. Periorbital edema and ecchymosis were evaluated at postoperative days 1, 3, and 7. The patients were categorized as the thick NSTE group (n = 17) and the thin NSTE group (n = 18) according to the preoperative median NSTE thickness. In the thin NSTE group, supratip skin, subcutaneous tissue, and total NSTE thickness were lowest on the preoperative day but no statistically significant difference was found for the thick NSTE group. In the thin NSTE group, total NSTE thickness of the rhinion was highest at the postoperative 3rd month, but in the thick NSTE group, there was no statistically significant difference between postoperative 3rd and 10th months. In both groups, total NSTE thickness of the nasion was highest at the postoperative 3rd month and lowest at the postoperative 10th month. Supratip fullness occurs more prominent in patients with thin NSTE. Postoperative edema in the rhinion is greater in patients with thin NSTE for the early postoperative period but it lasts longer in patients with thick NSTE. Soft-tissue envelope atrophy at the nasion occurs in both groups in the late postoperative period. Periorbital edema and ecchymosis severity are not affected by NSTE thickness.

BackgroundIron deficiency increases cardiovascular risk and all-cause mortality in hemodialysis patients. However, standard diagnostic tests, serum ferritin and transferrin saturation (TSAT), have limitations and are costly. Reticulocyte hemoglobin equivalent (RET-He) is a novel, less expensive marker for diagnosing iron deficiency. This study aimed to assess the non-inferiority of RET-He-guided intravenous (IV) iron supplementation compared with TSAT-guided supplementation in hemodialysis patients. MethodsA total of 138 hemodialysis patients were randomized into TSAT-guided (n = 68) and RET-He-guided (n = 70) groups. Both groups received intravenous iron according to a prespecified protocol. The primary outcome was the erythropoietin resistance index (ERI) at the 3rd and 6th months. RET-He was considered non-inferior if the upper bound of the 95% confidence interval (CI) for the between-group difference was ≤160 units/week/g/dL. Secondary outcomes included death, hospitalization, cardiovascular events, blood transfusion, and infection. ResultsBaseline characteristics were similar between the groups. At the 3rd and 6th months, RET-He-guided supplementation was non-inferior to TSAT-guided supplementation in reducing the erythropoietin resistance index (ERI): 814.37 ± 355.19 and 766.87 ± 368.60 units/week/g/dL in the TSAT group, and 834.59 ± 335.47 and 743.04 ± 390.86 units/week/g/dL in the RET-He group (p for non-inferiority = 0.0027 and 0.001); with mean differences of –35.92 (95% CI: –174.07 to 102.24) and –89.25 (95% CI: –246.76 to 68.25) at the 3rd and 6th months, respectively. Patients in the RET-He group received significantly less IV iron (498 ± 247 mg/3 month vs. 605 ± 278 mg/3 month; p = 0.01 at the 3rd month and 412 ± 248 mg/3 month vs. 507 ± 306 mg/3 month; p = 0.03 at the 6th month). Secondary outcomes, including death, hospitalization, cardiovascular events, blood transfusion, and infection, were not significantly different between the groups. ConclusionRET-He-guided IV iron supplementation demonstrated non-inferior efficacy in reducing ERI over six months compared with TSAT-guided supplementation and required significantly less iron. RET-He may offer a lower cost for iron management in hemodialysis patients by reducing both laboratory and treatment expenses.

The study aimed to investigate the effect of high dose radioactive iodine (RAI) on parathyroid function in patients with differentiated thyroid cancer. Nineteen patients (8 men/11 women, age 46.5 +/- 13.2 years) undergoing RAI for thyroid remnant ablation were enrolled in the study. The biochemical parameters related to parathyroid function [serum calcium (Ca), phosphate (P), creatinine (Cr), alkaline phosphatase (ALP), intact parathyroid hormone (iPTH), urinary Ca, cAMP concentrations and the maximum tubular capacity for phosphate per unit volume of glomerular filtrate (TmP/GFR)] were evaluated at baseline and at the 1st, 3rd, 6th and 12th months of RAI administration. SPSS 15.0 was used for statistical analysis. For all patients, thyroid-stimulating hormone levels were >30 U/ml at baseline and <0.1 U/ml at the following visits. Serum iPTH levels were decreased significantly at the 6th month and reached basal levels at the 12th month (baseline vs. 6th p = 0.027, 1st vs. 6th p = 0.011, 3rd vs. 6th p = 0.047, 3rd vs. 12th p = 0.014, 6th vs. 12th p = 0.001). At the 6th month, P and TmP/GFR levels were higher (p = 0.036, 0.017, respectively), and urinary cAMP measurements were lower (p = 0.020) compared to those of the 1st month. No difference was detected concerning the other parameters. Serum Ca levels decreased below 2.1 mmol/l in several patients (n = 5 at 1st month, n = 4 at 3rd month, n = 8 at 6th month and n = 3 at 12th month) without clinical symptoms. The study indicated a transient decline in PTH levels at the 6th month following RAI therapy. Although this decrease did not cause symptoms in any of the present cases, this pattern might be important especially in individuals with diminished parathyroid background.

Context: It is well known that oral isotretinoin treatment causes numerous ocular side-effects.Objective: To investigate the effect of systemic isotretinoin treatment on central corneal thickness (CCT) values due to meibomian gland disease (MGD).Participants: In this prospective study, 47 patients (27 men, 20 women) with nodulocystic acne vulgaris treated with oral isotretinoin (0.8 mg/kg daily) were included.Methods: All patients were analyzed with the Pentacam Scheimpflug topography at baseline, on the 3rd and 6th month of treatment. Main outcome measures were MGD scores and CCT.Results: The mean age of patients was 25.1 ± 4.4 years. The mean MGD scores were significantly higher at 3rd month (1.3 ± 0.9) and 6th month (1.5 ± 1.0) of treatment compared with baseline (1.1 ± 0.9) (p < 0.001). The mean CCT value at baseline was 540.5 ± 22.1 µm; 536.9 ± 20.5 µm at 3rd month and 531.4 ± 22.2 µm at 6th month. The differences between baseline and 6th month CCT measurements were statistically significant (p < 0.001). There was negative correlation between mean MGD scores and CCT values at the 6th month of treatment which was statistically significant (p = 0.038, r = −0.221).Conclusion: Isotretinoin treatment causes higher MGD scores. A statistically significant decrease in CCT due to MGD was detected at 6th month of treatment.

To observe liver function changes from pre-operative to post-operative 12 months in patients with treatment-naive hepatocellular carcinoma (HCC) and chronic hepatitis B (CHB) undergoing partial hepatectomy, and explore the utility of peri-operative metrics, including two-dimensional shear wave elastography (2D-SWE) measurements, in predicting the liver function recovery thereof. Totally 253 patients were prospectively enrolled and followed for one year. Data were collected pre-operatively and at post-operative 5th day and 1st, 3rd, 6th, and 12th months. Variance analysis with Tukey's correction explored the changes in albumin-bilirubin (ALBI)-measured liver function. Logistic regression analyzed the relationship between peri-operative indicators and post-operative liver function recovery (ALBI grade 1). The receiver operating characteristic curve assessed the logistic computation's discrimination. ALBI score increased on post-operative 5th day compared to pre-operative levels (p < 0.001), then fell below pre-operative levels by the post-operative 1st month (p < 0.001) and stabilized by the 3rd month (all p > 0.050). Liver function recovered in 155 (61.3%) patients. The fewer lesions (p = 0.027), lower 2D-SWE measurement value (p = 0.010), lower pre-operative ALBI score (p < 0.001), and the absence of post-hepatectomy liver failure (PHLF; p = 0.030) were the predicting factors of liver function recovery. The derived computation could differentiate the likelihood of liver function recovery at post-operative 1st, 3rd, and 12th months (all p < 0.050). Liver function may stabilize by the post-hepatectomy 3rd month. Pre-operative 2D-SWE measurements, ALBI score, the number of lesions, and PHLF could affect liver function recovery in patients with HCC and CHB.

Long-Term Real-World Follow-up Study of Luspatercept for Lower-Risk Myelodysplastic Neoplasms

In spite of the improvements in the clinical management of solid organ transplant (SOT) recipients provided by immunosuppresion and universal prophylaxis, human cytomegalovirus (CMV) infections continue to be one of the most leading causes of morbidity and mortality. Cell-mediated immunity specific to CMV (CMV-CMI) plays an important role in the control of CMV replication. Therefore, monitoring of CMV-specific T-cell response can be used to predict individuals at increased risk of CMV disease. The aim of this study was to investigate the levels of CMV-specific interferon (IFN)-γ producing CD4(+) and CD8(+) T cells in kidney transplant recipients before and after the transplantation, by cytokine flow cytometry. A total of 21 kidney transplant recipients (14 male, 7 female; age range: 18-66 years, mean age: 34.5 ± 9.9) who were all CMV seropositive have been evaluated in the study. Blood samples from the patients were obtained before and at the 1(st), 3(rd) and 6(th) months after transplantation. CMV seropositive healthy kidney donors (n= 20) constituted the control group. The main stages of our procedure were as follows; isolation of peripheral blood mononuclear cells from whole blood, freezing and storing of the samples, later on thawing the samples, ex vivo stimulation of lymphocytes with pooled CMV peptides and counting CMV-specific IFN- producing CD4(+) and CD8(+) T cells by flow cytometry following surface and intracellular cytokine staining. Monitoring of the viral load (CMV-DNA) was performed in 10 days intervals in the first 3 months followed by 3 week intervals until 6 months using COBAS AmpliPrep/COBAS TaqMan CMV test system (Roche Diagnostics, USA). The frequencies of pretransplant CMV-specific IFN-γ producing CD8(+) T cells in patient (3.53 ± 4.35/µl) and control (4.52 ± 5.17/µl) groups were not statistically different (p= 0.266). The difference between the number of virus-specific CD4(+) T cells in patients (8.84 ± 9.56/µl) and those in the control group (8.23 ± 11.98/µl) was at the borderline of significance (p= 0.057). The age and gender of the patients and type of antiviral prophylaxis protocols [valgancyclovir (n= 4); valacyclovir (n= 17)] did not have any significant effect on CMV-CMI (p> 0.05). Similarly, induction therapy administered to four patients did not show any effect on CMV-CMI (p> 0.05). CMV-specific immune responses of patients who received different immunosuppression protocols [tacrolimus + mycophenolate mofetil (MMF) + steroid (n= 17); cyclosporine + MMF + steroid (n= 2); mTOR inhibitor + MMF + steroid (n= 2)] were not different (p> 0.05). The number of CMV-specific CD4(+) T cells in all patients were significantly decreased in the 3rd month compared to the 1st month after the transplantation (p=0.003), indicating a relationship with the period of immunosuppressive therapy. In one of the patients who did not have CMV-specific CD4+ T-cell response but had cytotoxic T-cells (CD8(+) T= 0.6%) before transplantation, CD4(+) T-cell response have developed during monitorization (1.4%, 1.5% and 0.5% in 1st, 3rd and 6th months, respectively), and no viral reactivation was detected. Out of the two patients who had no CD4(+) and CD8(+) T cell response in the 3rd month, one of them developed low level viremia (150 copies/ml) in the 6th month. In this patient the level of CMV-CMI in the 6th month (CD4(+)T + CD8(+)T= 0.9%), have reached higher values than the values obtained before the transplantation (CD4(+) T + CD8(+) T= 0.5%). The viremia was cleared spontaneously in this patient and no antiviral therapy was required. In conclusion, our results suggested that pretransplant and posttransplant monitoring of CMV-specific T-cell responses might be helpful as well as viral load in the clinical management of CMV infection in SOT patients.

There is no consensus regarding the benefit of eradicating Helicobacter pylori (H. pylori) infection in patients with functional dyspepsia (FD). We intended to compare the symptom response to H. pylori eradication in FD patients in presence or absence of microscopic duodenitis (MD). Patients with dyspepsia, normal upper gastrointestinal endoscopy and no psychological comorbidity according to the 12-item General Health Questionnaire underwent duodenal biopsy sampling. Of those, subjects with positive rapid urease test and H. pylori colonization in Wright-Giemsa staining were included in the study and evaluated histologically for presence of MD. All patients received sequential H. pylori eradication therapy and underwent urea breath test 4 weeks after the completion of the treatment to confirm the H. pylori eradication. The severity of dyspepsia was assessed using the Leeds Dyspepsia Questionnaire (LDQ) at baseline, 3rd and 6th months after the H. pylori infection was eradicated. Thirty seven patients were included in the study [mean age: 34.9 (8.1), 54.05 % female]. MD was observed in 16 (43.2 %) of the subjects. The mean LDQ score in patients with MD decreased from 12.5 (4.1) at baseline to 4.3 (2.1) at 3rd month and 2.6 (1.9) at 6th month. In patients without microscopic duodenitis, the mean LDQ score decreased from 10.6 (5.2) at baseline to 6.8 (4.1) and 6.2 (3.8) at 3rd and 6th months, respectively. The improvement in severity of symptoms in presence of MD was significantly greater than when it was absent (P < 0.001). FD patients with MD achieved greater symptomatic response with H. pylori eradication than those without microscopic duodenitis.