Bora Aktas

Mean platelet volume in the diagnosis and prognosis of Crimean-Congo hemorrhagic fever.

Introduction: Crimean–Congo hemorrhagic fever (CCHF) is a viral tick-borne zoonosis, which is a severe illness, causing hemorrhages in humans. Mean platelet volume (MPV) is used as a surrogate marker of platelet function and has been shown to be a sign of inflammation. The objective of the present study is to examine the association between MPV and CCHF. We also aimed to investigate the association between MPV and coagulopathy markers in the mortality rates and prognosis of patients with CCHF. Patients and Methods: Ninety-three patients with CCHF were enrolled retrospectively into the study and 15 of them were excluded according to the exclusion criteria. Twenty-five healthy individuals were included as a control group which was age and gender matched with CCHF patients. We compared the levels of MPV between the patient and the control groups. We also compared the coagulopathy markers of fatal CCHF patients (n = 9) with nonfatal cases (n = 69). Results: Platelet counts were significantly lower in the CCHF group. Levels of international normalized ratio (INR), prothrombin time (PT), and activated partial thromboplastin time (aPTT) were significantly higher in CCHF group (P < .001, <.001, <.001, respectively). A statistically significant increase in MPV was observed in patients with CCHF compared with healthy controls (8.63 ± 1.23 fL vs 7.65 ± 0.42 fL, P < .001). Receiver–operating characteristic curve analysis suggested that the optimum MPV level cutoff points for patients with CCHF was 8.15 fL, with a sensitivity and specificity of 65% and 88%, respectively. The MPV levels were not significantly different between group 2 (nonsurvivor) and group 1 (survivor). However, platelet count, d-dimer, INR, PT, and aPTT were also positively correlated with the mortality rates (P = .008, <.001, <.001, <.001, and <.001, respectively). Multivariable logistic regression model showed an independent correlation between MPV and mortality rate (P < .001). Conclusion: In conclusion, MPV may be a beneficial marker in the diagnosis of CCHF, especially in cases with thrombocytopenia, the MPV levels are high. We also conclude that MPV may independently predict the prognosis of patients with CCHF.

Clinical Trial: Transcutaneous Interferential Electrical Stimulation in Individuals with Irritable Bowel Syndrome – A Prospective Double-Blind Randomized Study

Background: The exact etiology of irritable bowel syndrome (IBS) remains unclear. Curative treatment is not available and current treatment modalities are mainly directed against the predominant symptoms. There are a few studies reporting the beneficial effects of transcutaneous electrical stimulation in patients with chronic constipation, gastroparesis, and functional dyspepsia. Aim: To investigate whether transcutaneous electrical stimulation is an effective procedure in IBS patients. Methods: IBS patients were randomly placed in vacuum interferential current (IFC) and placebo groups. Both treatments consisted of 12 sessions administered over 4 weeks. Symptoms due to IBS were documented via questionnaires, including the IBS Global Assessment of Improvement Scale, numeric rating scales, visual analogue scale, and IBS Quality of Life Scale at the beginning of, end of, and 1 month after the treatment. Results: Patients in the therapy (29 cases) and placebo (29 cases) groups were homogeneous with respect to demographic data and gastrointestinal system symptoms. When compared to the beginning scores, severity of abdominal discomfort, bloating, and abdominal distension and rumbling improved significantly in either interference or placebo groups at both the end of treatment and 1 month after treatment. In the IFC group, severity of symptoms continued to decrease significantly at 1 month after treatment when compared to scores at just the end of treatment, whereas in the placebo group severity of these symptoms did not change significantly on numeric severity scales. Also, the visual analogue scale of the first month after treatment continued to decrease significantly when compared to the level at the end of treatment in the IFC group. Total quality score increased significantly in the IFC group. Conclusions: Vacuum IFC therapy can significantly improve symptoms and quality of life in patients with IBS. It may represent a novel treatment modality for drug-refractory IBS patients.

The association of vitamin D deficiency with non-alcoholic fatty liver disease

OBJECTIVE: Vitamin D deficiency has been related to diabetes, hypertension, hyperlipidemia and peripheral vascular disease. In this study, we aimed to investigate the role of vitamin D status in non-alcoholic fatty liver disease. METHODS: We included 211 consecutive subjects to examine the presence of non-alcoholic fatty liver disease. Of these subjects, 57 did not have non-alcoholic fatty liver disease and 154 had non-alcoholic fatty liver disease. RESULTS: The non-alcoholic fatty liver disease group had significantly higher fasting blood glucose (p = 0.005), uric acid (p = 0.001), aspartate aminotransferase (p<0.001), alanine aminotransferase (p<0.001), γ-glutamyltransferase (p<0.0001), alkaline phosphatase (p = 0.028), HbA1c (p<0.001), ferritin (p<0.001), insulin (p = 0.016), C-peptide (p = 0.001), HOMA-IR (p = 0.003), total cholesterol (p = 0.001), triglyceride (p = 0.001) and white blood cell (p = 0.04) levels. In contrast, the non-alcoholic fatty liver disease group had significantly lower 25(OH)D levels (12.3±8.9 ng/dl, p<0.001) compared with those of the control group (20±13.6 ng/dl). CONCLUSIONS: In this study, we found lower serum 25(OH)D levels in patients with non-alcoholic fatty liver disease than in subjects without non-alcoholic fatty liver disease. To establish causality between vitamin D and non-alcoholic fatty liver disease, further interventional studies with a long-term follow-up are needed.

Should screening for colorectal neoplasm be recommended in patients at high risk for coronary heart disease: a cross-sectional study.

AbstractColorectal neoplasm (CRN) and coronary heart disease (CHD) share common risk factors. We aimed to assess the risk for CRN in patients who are at high risk for developing CHD determined by measurements, which are independent from the risk factors for CRN.This study was conducted on individuals who underwent total colonoscopic examination and were without history of CHD. Two-hundred thirty-five subjects (82 with CRN and 153 with normal colonoscopic findings) participated in the study. Colorectal carcinoma (CRC) was defined as the presence of adenocarcinoma. We measured carotid intima media thickness (CIMT), flow-mediated dilation (FMD), and calculated Framingham risk score (FRS) for all participants. An increased CIMT (≥1.0 mm), a decreased FMD (<10%), and a high FRS (>20%) were defined as high risks for developing CHD. The risk and the prevalence of CRN were analyzed in relation to the risk for developing CHD.The ratio of the patients with overall-CRN and CRC was significantly higher in individuals who are at high risk for developing CHD compared with individuals who are at low risk for developing CHD by each 3 risk estimation method (P < 0.05 for all). An increased CIMT, a decreased FMD, and a high FRS score were significantly associated with the high risk for the presence of CRC (odds ratio [OR]: 6.018, OR: 3.699, and OR: 4.120, respectively). An increased CIMT, a decreased FMD, and an intermediate FRS were significantly associated with the risk for the presence of overall-CRN (OR: 3.607, OR: 1.866 and OR: 2.889, respectively).The risk for CRN increases as the risk for developing CHD increases. It can be suggested that screening for CRN can be recommended for individuals who are at high risk for developing CHD.

Unusual Cause of Upper Gastrointestinal Hemorrhage: Spontaneous Dissection of the Celiac Trunk

To the Editor: A 56-year-old man was admitted to our hospital with hematemesis and melena for 3 hours. He had also a history of upper abdominal pain after meal for 6 months and no any diseases. His vital signs were within normal limits. Physical findings were normal, but rectal examination revealed melena. Laboratory tests showed unremarkable findings and also hemostasis parameters were normal. Endoscopy revealed pulsatile submucosal arterial vascular collaterals with nipple sign in stomach [Figure 1]. There was a small amount of fresh blood in stomach, but no active bleeding. He was treated conservatively and remained asymptomatic in follow-up. Abdominal-enhanced computed tomography (CT) showed dissection of the celiac trunk and enhancement perigastric and gastric intramural vascular collaterals due to chronic ischemia caused by celiac artery dissection [Figure 1]. Figure 1 Endoscopic image of the pulsatile submucosal arterial vascular collaterals with nipple sign in the stomach (a), computed tomography (CT) angiographic image of dissection of the celiac trunk and perigastric and gastric intramural vascular collaterals (b ... Spontaneous dissection of the celiac trunk is uncommon and is rarely considered in the diagnosis of upper gastrointestinal (GI) hemorrhage. Its complications are ischemia to the supplied organs, aneurysm, and rupture.[1] To our knowledge, no cases of GI hemorrhage caused by celiac artery dissection are reported in the medical literature. Hence, we firstly report a case with upper GI hemorrhage caused by spontaneousdissectionof the celiac trunk.

Different treatment choice for first-line treatment of Helicobacter pylori in an area with a high antibiotic resistance.

We included 90 Hp-infected patients diagnosed histologically. The patients with chronic disease who previously received Hp eradication therapy and underwent gastric surgery were excluded. Patients were randomly divided into 2 groups. The therapy protocol, containing rabeprazole 2x20 mg (Bilim, Kocaeli, Turkey), amoxicillin 2x1 g (Glaxo Smith Kline, İstanbul, Turkey), metronidazole 3x500 mg (I.E. Ulagay, İstanbul, Turkey), and bismuth 2x300 mg (Astellas Pharma Europe B.V., İstanbul, Turkey), was given to the first study group for a period of 1 week and the second study group for a period of 2 weeks. At least 1.5 months after the end of therapy, participants provided a urea breath test (UBT). (Heliprobe analyzer, Wedholm Medical, Kibion, Sweden).

Drinking pineapple juice for undigested food in stomach.

Pineapple juice, which contains bromelain, a proteolytic enzyme, was reported as a good choice to dissolve phytobezoars in the literature (3-5). Despite the high success rates and fewer side effects, drinking cola is not always suitable for patients presenting with epigastric discomfort and bloating. For these purposes, we aimed to show the efficacy of drinking pineapple juice in dissolving gastric pre-bezoar formations in seven gastrectomized patients. All patients who were referred to our clinic to perform upper gastrointestinal (GI) endoscopy due to histories of gastrectomy over 10 years and presenting with undigested food endoscopically were included in the study. Upper GI endoscopies were performed by AA and EF in the outpatient endoscopy unit from August, 2010 to May, 2011.

The Relationship between Helicobacter pylori and Beta-2 Microglobulin in Humans

H. pylori is related to various gastrointestinal diseases. β 2 Microglobulin (β 2M) is an intrinsic element of major histocompatibility complex (MHC I). Serum β 2M level may increase in inflammatory states. The aim of current study is to evaluate the relationship between β 2M and H. pylori bearing CagA strains. Methods. H. pylori status was determined by histopathology of samples taken from stomach. CagA status and β 2M level were measured from blood samples of patients. Eradication therapy was administered to the patients with H. pylori infection. β 2 Microglobulin levels were measured before and after treatment. Results. 35 (29.2%) H. pylori(−) patients and 85 (70.8%) H. pylori (+) patients were included in the study. There were 52 (43.3%) patients with CagA negative and 33 (27.5%) patients with CagA positive H. pylori infection. The mean serum β 2M level was 1.83 mg/L in H. pylori (−) group, 1.76 mg/L in H. pylori (+) CagA (−) group, and 1.93 mg/L in H. pylori and CagA (+) group (P > 0.05). Serum β 2M levels (1.82 versus 1.64 mg/L P < 0.05) were decreased after eradication. Conclusion. H. pylori and CagA status did not affect β 2M level. Relationship between low grade systematic inflammation and H. pylori should be investigated to find out new predictors for diseases associated with inflammation.

An unusual cause of epigastric pain: a fishbone stuck in the duodenum

A 56-year-old woman presented with epigastric pain for 5 days after eating fish. She had no history of any disease or medication. Her vital signs were normal. On examination, the epigastric region was tender. No abnormalities were found in the laboratory tests. Abdominal ultrasonography was normal. Endoscopy showed a fishbone stuck in second part of the duodenum (Figure 1). The oesophagus and stomach were unremarkable. Approximately 2 cm in length, the fishbone was removed using standard grasping forceps. The patients pain dramatically improved immediately after removing the fishbone and she was stable in follow up. Figure 1 Endoscopic image of fishbone stuck in the second part of the duodenum Fishbones are the most often ingested foreign bodies that become impacted in the upper gastrointestinal tract. Most foreign bodies generally pass spontaneously through the gastrointestinal tract. However, A minority of patients require endoscopic removal and surgical intervention [1, 2]. To the best of our knowledge, this is the first reported case of a stuck fishbone successfully removed from the duodenum with dramatic improvement immediately afterwards.

Assessment of the Correlation between Endoscopic Activity and Histological Activity in Ulcerative Colitis Patients.

Objective: The aim of this study was to assess the concordance between the Rachmilewitz endoscopic activity index (EAI) and the Harpaz histopathological activity scoring system (HSS), which are used for evaluating the disease activity of ulcerative colitis (UC). Subjects and Methods: This study included 109 patients with UC. Based on the disease extent, patients were divided into two groups as left-sided colitis and pancolitis. Patients were grouped as inactive, mild, moderate and severe depending on the Rachmilewitz EAI and Harpaz HSS. Kendals tau and kappa (κ) statistics were used to assess the agreement between endoscopic and histopathological scores. A receiver operating characteristic (ROC) curve was also analyzed to evaluate the sensitivity and specificity of endoscopic scores to predict inactive histopathological disease. Results: In the left-sided colitis group, there were slight and poor agreements in the inactive endoscopic subscores (ESS) with inactive Harpaz HSS (κ: 0.598, p < 0.001) and moderate ESS with moderate Harpaz HSS (κ: 0.236, p = 0.046). There was no agreement between mild ESS and mild Harpaz HSS and between severe ESS and severe Harpaz HSS (κ: 0.071, p = 0.573 and κ: 0.160, p = 0.151, respectively). In the pancolitis group, there was no significant agreement between inactive, mild, moderate and severe ESS and the equivalent Harpaz HSS grades (κ: -0.194, p = 0.187; κ: 0.125, p = 0.397; κ: 0.148, p = 0.175 and κ: 0.174, p = 0.153, respectively). The ROC curve showed that the ESS indicating inactive disease had a low sensitivity to predict histologically inactive disease. Conclusion: The concordance between the endoscopic and histopathological indices was poor. Using both scores in the follow-up of patients with UC is necessary for treatment planning.