Background: The association between vitamin D levels and non-alcoholic fatty liver disease (NAFLD) has been increasingly determined in recent researches. The aim of this study was to determine the association between vitamin D levels, measured as serum 25-hydroxy vitamin D (25(OH)D) and NAFLD. Serum 25(OH)D was prospectively determined in 80 patients. Of them, 40 subjects had NAFLD, whereas 40 subjects served as healthy control. Vitamin D deficiency was defined as serum 25(OH)D level < 20 ng/ml. Receiver operating characteristic (ROC) and regression analysis methods were used in our analysis. Results: About 70% of patients with NAFLD had vitamin D deficiency, but only 35% in the control group had. The mean serum 25 (OH)D was significantly lower in patients with NAFLD than the healthy control group (16.13 ± 10.23 versus 27.35 ± 10.58 ng/mL; P < 0.001). ROC curve analysis revealed that serum 25(OH)D level of less than 11.2 ng/ml increases the risk of NAFLD with 45% sensitivity and 97.5% specificity (Serum 25(OH)D level ≤ 18.1 ng/ml in males and ≤ 9.4 ng/ml in females increase the risk of NAFLD). Multivariate regression analysis showed that vitamin D deficiency, high age, and high BMI were associated with a significant high risk of NAFLD. Conclusion: NAFLD patients have low serum vitamin D concentrations, suggesting that vitamin D may have a role in the development of NAFLD. Future studies are recommended to determine the important therapeutic implications of vitamin D for the prophylaxis or the treatment of NAFLD.

Patient: Female, 19Final Diagnosis: Erdheim-Chester diseaseSymptoms: Exophthalmos, orthopneaMedication: Prednisolone • azathioprineClinical Procedure: —Specialty: Internal MedicineObjective:Unknown ethiologyBackground:Erdheim-Chester disease is a rare non-Langerhans-cell histiocytosis of unknown etiology with multi-organ involvement.Case Report:A 19-year-old woman presented with orthopnea, severe fatigue, bilateral exophthalmos, and gradual loss of vision. She had anemia and mild leucocytosis related to chronic illness. Marked left side pleural effusion and massive pericardial effusion with bilateral hydronephrosis were detected by plain X-ray, echocardiography, and computed tomography, respectively. Retro-orbital tissue and bone marrow biopsy revealed histiocytic infiltration, which was CD68-positive and CD1a-negative.Conclusions:This report describes the first case presentation of Erdheim-Chester disease in our country. This case report may advance our understanding of an orphan disease. Our patient’s young age and stable clinical status may allow long-term follow-up of treatment results.

Background: the study was undertaken with an objective to study the spectrum of thyroid dysfunction in elderly and to correlate comorbidity with abnormal thyroid function. Methods: a total of 246 subjects aged more than 60 years, admitted to General Medicine or attended the outpatient clinic who were presented with vague symptoms like easy fatigability and lethargy, were subjected to detailed clinical examination and thyroid function testing by biochemical means. Results: a total of 246 patients were included in the study. Thyroid disorders were present in 51.2%. Clinical hypothyroidism in 8.13%, subclinical hypothyroidism in 4.88% cases, hyperthyroidism in 3.3% and Low triiodothyronine (T3) syndrome in about one third of our patients were noted. There were no correlation between the thyroid hormones and most of clinical and laboratory parametes. The prevalence of abnormal thyroid patterns were significantly high in patients with comorbidities in comparison to those without. Conclusions: Elderly patients especially those with comorbidity have high prevalence of thyroid dysfunction. Clinical diagnosis is difficult to make because of vague symptomology and comorbid diseases. So, high clinical suspicion and thyroid function tests always helps in diagnosing the disease.

Background: A considerable amount of evidence showed how metabolic factors may influence the natural history of patients with chronic hepatitis C and affect the outcome of antiviral therapies. Aim: To evaluate the clinical significance of visceral adiposity index (VAI) as a new predictor of early and sustained virological response (SVR) in hepatitis C patients. Materials and Methods: A total of 50 hepatitis C virus infected patients under treatment with pegylated interferon and ribavirin and who had a baseline serum lipid profile were included in this prospective study. Results of lipoprotein profiles and clinical data, including body mass index and waist circumference, were compared between patients with a sustained virological response and non-SVR or a non-virological response (NVR) and virological responses other than NVR (non-NVR). In addition, significant predictive factors independently associated with virological response to peg-IFNα-2b plus RBV were determined by statistical analysis. Results: End of treatment complete response was seen in 56% (n=28) and whereas 26% (n=13) were breakthroughers. SVR was seen in 40% (n=20) patients giving 60% failure response. The basal VAI was low in SVR (mean + SD = 1.27 + 0.7) in comparison to the failure group (1.7 + 0.8) and tend to be not markedly elevated at the 48 week when compared with the failure group (1.6 + 56 and 2.22 + 0.71, respectively). Conclusion: Pre-treatment and on-treatment VAI can predict response to treatment and SVR that can help in individualizing treatment and patient selection and optimize treatment outcomes.

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