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Sarcopenia is one of the most significant contributors to morbidity in patients with chronic liver disease. Serum myokines are potential biomarkers for detecting early sarcopenia. We aimed to investigate the relationship between serum myokines and cirrhosis-related mortality in the early stages of the disease.In total, 262 patients and 50 healthy controls were enrolled in this study, which was designed as a multicenter cross-sectional study. At the beginning of the study, sarcopenia was defined by computed tomography scans using the third lumbar vertebra skeletal muscle index. Serum myostatin, irisin, and follistatin levels, nutritional status of the patients, and muscle strength as measured by the handgrip test were recorded. Cirrhosis-related mortality and overall survival were evaluated in the fourth year of the study as the second checkpoint of cross-sectional analysis.A total of 145 (55.3%) patients were diagnosed with sarcopenia. Multivariate analysis revealed that low BMI, high levels of myostatin, and decreased irisin levels were independent predictors of sarcopenia. While serum irisin level was the most predictive parameter in terms of 4th-year cirrhosis-related mortality in the CHILD A group, serum myostatin levels were found more indicative in the CHILD BC group regardless of sarcopenia status ( Plt; 0.001).Serum myostatin levels predict sarcopenia in all stages of cirrhosis. Serum irisin levels can also be used as a potential biomarker to predict both treatable sarcopenia and cirrhosis-related mortality in CHILD A patients.

Fibroblast growth factor 19 (FGF19) and small heterodimer partner (SHP) are molecules responsible for controlling serum bile acid levels. We designed this study for evaluating the effects of FGF 19 and SHP in intrahepatic cholestasis of pregnancy (ICP). Fifty-six pregnant women having ICP and 20 healthy pregnant women were included in the study. The patients were followed up until delivery in terms of pregnancy-related morbidity/mortality. Serum FGF 19 and SHP levels were determined by enzyme-linked immunosorbent assay (ELISA). Serum FGF 19 and SHP levels were significantly higher in the patient group compared to the control group (

Background Giant tumefactive perivascular spaces (PVSs) are uncommon benign cystic lesions. They can imitate cystic neoplasms. Purpose To evaluate the contribution of advanced neuro magnetic resonance imaging (MRI) techniques in the diagnosis of giant tumefactive PVSs and to further characterize these unusual cerebral lesions. Material and Methods The MRI scans of patients with tumefactive PVS diagnosed between 2010 and 2019 were retrospectively reviewed. All imaging studies included three plane conventional cerebral MRI sequences as well as precontrast 3D T1 MPRAGE, post-gadolinium 3D T1 acquisitions, sagittal plane 3D T2 SPACE, diffusion-weighted imaging, and time-of-flight (TOF) angiography. Some patients received perfusion MR, MR spectroscopy, diffusion tensor imaging (DTI), and contrast-enhanced TOF MR angiography. Results A perforating vessel was demonstrated in 16 patients (66.7%) by TOF imaging. In four patients, there were intracystic vascular collaterals on contrast-enhanced TOF MR angiography. Septal blooming was observed in four patients in susceptibility-weighted imaging. On perfusion MR, central hyperperfusion was observed in four patients, and peripheral hyperperfusion was observed in one patient. On MR spectroscopy, choline increase was observed in two patients, and there was a lactate peak in three patients, and both a choline increase and lactate peak in one patient. On DTI, there was fiber distortion in five patients and fiber deformation in one patient. Conclusion Advanced MRI techniques and 3D volumetric high-resolution MRI sequences can provide a valuable contribution to the diagnosis and can be successfully used in the management of these lesions.

Introduction: The COVID-19 pandemic has shown that patients should be categorized according to their risk group, patient follow-up and the use of health resources should be arranged according to this categorization. Therefore, practical and inexpensive biomarkers are needed. In this study, the relationship between neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), mean platelet volume (MPV) and red blood cell distribution width (RDW) levels, which can be easily calculated by complete blood count, with mortality and intensive care unit (ICU) admission in COVID-19 disease was evaluated. Materials and Methods: 748 inpatients with positive COVID-19 PCR test were evaluated retrospectively. The NLR, PLR, MPV and RDW levels calculated from the complete blood count parameters of the patients at hospital admissions and their relationship with the mortality and the ICU admission in COVID-19 disease were evaluated. Results: In terms of mortality, a statistically significant difference was found between RDW levels in the evaluation performed in the patient groups who survived and died (p: 0.014). No statistically significant difference was found in NLR, PLR and MPV levels. In the evaluation made between ICU (+) and ICU (-) groups, a statistically significant difference was found in RDW and NLR levels (p: 0.042, p: 0.01, respectively). There was no statistically significant difference between PLR and MPV levels for ICU admission. Conclusion: RDW level was found to be associated with COVID-19 related mortality and ICU admission.

Ali Riza Koksal,1,2 Paul Thevenot,3 Yucel Aydin,1 Kelley Nunez,3 Tyler Sandow,4 Kyle Widmer,5 Leela Nayak,5 John Scott,1 Molly Delk,2 Martin W Moehlen,2 Ari J Cohen,3,6 Srikanta Dash1,2,5 1Department of Pathology and Laboratory Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA; 2Department of Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, LA, USA; 3Department of Gastroenterology and Hepatology, Institute of Translational Research, Ochsner Health, New Orleans, LA, USA; 4Department of Radiology, Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA, USA; 5Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA; 6Department of General Surgery, Multi-Organ Transplant Institute, Ochsner Health, New Orleans, LA, USACorrespondence: Srikanta Dash, Department of Pathology and Laboratory Medicine, Tulane University Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA, 70112, USA, Tel +1 504-988-2519, Fax +1 504-988-7389, Email sdash@tulane.eduBackground and Aim: HCC development in liver cirrhosis is associated with impaired autophagy leading to increased production of extracellular vesicles (EVs) including exosomes and microvesicles. The goal of the study is to determine which of these particles is primarily involved in releasing of HCC-specific biomarker glypican-3 (GPC3) when autophagy is impaired.Methods: Streptavidin-coated magnetic beads were coupled with either biotinylated CD63 or Annexin A1 antibodies. Coupled beads were incubated with EVs isolated from either HCC culture or serum. EVs captured by immuno-magnetic beads were then stained with FITC or PE fluorescent-conjugated antibodies targeting exosomes (CD81), and microvesicles (ARF6). The percentage of GPC3 enrichment in the microvesicles and exosomes was quantified by flow cytometry. The impact of autophagy modulation on GPC3 enrichment in exosomes and microvesicles was assessed by treating cells with Torin 1 and Bafilomycin A1. For clinical validation, GPC3 content was quantified in microvesicles, and exosomes were isolated from the serum of patients with a recent HCC diagnosis.Results: The immune-magnetic bead assay distinguishes membrane-derived microvesicles from endosome-derived exosomes. The GPC3 expression was only seen in the CD63 beads group but not in the Annexin A1 beads group, confirming that in HCC, GPC3 is preferentially released through exosomes. Furthermore, we found that autophagy induction by Torin1 decreased GPC3-positive exosome secretion and decreased microvesicle release. Conversely, autophagy inhibition by Bafilomycin A1 increased the secretion of GPC3-positive exosomes. Serum analysis showed CD81+ve EVs were detected in exosomes and ARF6+ve vesicles were detected in microvesicles, suggesting that immunoaffinity assay is specific. The exosomal GPC3 enrichment was confirmed in isolated EVs from the serum of patients with HCC. The frequency of GPC3-positive exosomes was higher in patients with HCC (12.4%) compared to exosomes isolated from non-cirrhotic and healthy controls (3.7% and 1.3% respectively, p< 0.001).Conclusion: Our results show that GPC3 is enriched in the endolysosomal compartment and released in exosome fractions when autophagy is impaired.Keywords: hepatocellular carcinoma, glypican 3, exosome, biomarker, magnetic beads

Pancreatic exocrine insufficiency (PEI) is found in 30-50% of diabetes mellitus (DM). Insulin resistance is triggering factor in both DM and nonalcoholic fatty liver disease (NAFLD). Therefore, we aimed to investigate frequency of PEI in NAFLD, and relationship of fecal pancreatic elastase (PE) levels with liver histology and pancreatic fat.Ninety-seven biopsy proven NAFLD patients and 50 controls were enrolled. Pancreas exocrine functions were measured by PE. Magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF) was used to quantify fat.NAFLD patients had significantly lower PE levels than controls (297 [204-517] vs. 500 [298-678] μg/g, p 0.01). PEI (PE 200 μg/g) ratio of NAFLD patients (22.7%, n = 22) was higher than PEI ratio of controls (6%, n = 3) (p = 0.011). Among diabetic (n = 35) NAFLD patients, 9 (25.7%) exhibited PEI, compared to 13 (21%) of non-diabetics. There was no significant difference in patients with and without DM in terms of PEI (p = 0.592). Among NASH (n = 68) patients 16 (23.5%) exhibited PEI, compared to (20.7%) of non-NASH (p = 0.76). Multiple analysis revealed NAFLD as a predictor of PEI independent of age, sex and DM (OR = 4.892, p = 0,021). Mean pancreas MRI-PDFF was significantly higher in diabetics (13.7% ± 3.6% vs. 8.7% ± 5.1%, p = 0.001). There was no significant pancreas MRI-PDFF difference between NASH and non-NASH (P = 0.95). Mean pancreas MRI-PDFF was significantly higher in patients with PEI (13.7% ± 3.4% vs. 8.9% ± 5.2%, P 0.01).This is the first study demonstrating the high frequency of PEI in NAFLD independent of DM. Moreover, increasing pancreatic steatosis appears to be associated with higher frequency of PEI in NAFLD.

Aim: In our study, we investigated the efficiency of the prognostic nutritional index (PNI) score and the CRP, age, platelet count, albumin level (CAPA) score predicting mortality and intensive care unit (ICU) admission in COVID-19 disease. Materials & methods: PNI and CAPA score of patients confirmed with COVID-19 calculated by using the complete blood count and biochemical parameters at admission to the hospital, in predicting the COVID-19-associated mortality and ICU admission were analyzed. Results: PNI and CAPA scores in predicting mortality were detected as AUC: 0.67 (p, Lay abstract The COVID-19 pandemic is a global health problem that affects all societies. In order to deal with this urgent situation, the rapid spread of the disease in outbreaks requires categorizing patients according to risk group and regulating follow-up and use of resources accordingly. Effective, practical and inexpensive biomarkers are needed. We present to you the CAPA score calculated from CRP, age, platelet count, albumin levels, which is an effective score in predicting mortality and ICU admission in COVID-19.

Background and aims: Favipiravir is a ribonucleic acid (RNA)-dependent RNA polymerase (RdRP) inhibitor antiviral agent used in the treatment of coronavirus disease-2019 (COVID-19). In this study, we investigated the changes in serum transaminase levels of patients and the relationship between serum transaminase elevation with mortality in patients who were hospitalized with the diagnosis of COVID-19 and received favipiravir treatment. Materials and methods: 454 patients who received favipiravir and 113 patients who did not receive favipiravir were evaluated. Serum transaminase levels of the patients were compared at baseline and after five days of treatment, and the relationship between serum transaminase elevation and mortality was investigated. Results: No significant aspartate aminotransferase (AST) or alanine aminotransferase (ALT) elevation was detected due to favipiravir treatment. AST elevation was found, respectively, as 133 (29.3%), 32 (28.3%) (p=0.100), ALT elevation as 112 (24.7%), 35 (29.3%) (p=0.100) in the groups receiving and not receiving favipiravir. High AST level was found as a risk factor for mortality in all patient groups (p=0.008). Conclusions: There was no statistically significant elevation in serum transaminase levels due to favipiravir use in patients hospitalized for COVID-19. A high level of AST is a significant risk factor to show mortality and intensive care unit (ICU) admission in patients with COVID-19.

Background Cystatin C is a genuine marker for detecting minor reductions in estimated glomerular filtration rate (e-GFR). Study question We aimed to investigate the efficiency of cystatin C levels in predicting nephrotoxicity due to antiviral therapy in patients with chronic hepatitis B virus infection. Study design Seventy-six naive hepatitis B virus patients and 44 controls were enrolled in this prospective cohort study. Measures and outcomes Serum cystatin C, phosphate and creatinine levels, and urinary albumin/creatinine ratios of all patients were measured at baseline, 3rd, 12th, and 24th months. Nephrotoxicity was determined according to the amount of change in creatinine level at the fourth year of treatment compared with baseline ([INCREMENT]Cr0-4). Results Mean age was 36.1 ± 9.2 years and 40 (52.2%) of patients were women. There was no significant difference between baseline values of tenofovir disoproxil fumarate and entecavir groups. Although the creatinine level at the fourth year of treatment was statistically nonsignificant compared with baseline in the entecavir group, it was significantly higher in the fourth year of tenofovir treatment compared with baseline (0.95 ± 0.27 mg/dL vs. 0.76 ± 0.16 mg/dL, P = 0.002). While the increase in [INCREMENT]Cr0-4 was ≥0.2 mg/dL in 43.2% of patients in the tenofovir group, this rate was 18.8% in the entecavir group. Diagnostic accuracy in identifying decreased renal function as area under the curve (AUC) was high for baseline serum cystatin C level; furthermore, the highest AUC was calculated for cystatin C plus creatinine-based e-GFR equation (AUC: 0.81, P Conclusions Long-term tenofovir disoproxil fumarate nephrotoxicity can be predicted by serum cystatin C plus creatinine-based e-GFR measured before treatment.

Hepatitis C virus (HCV) infection promotes autophagic degradation of viral replicative intermediates for sustaining replication and spread. The excessive activation of autophagy can induce cell death and terminate infection without proper regulation. A prior publication from this laboratory showed that an adaptive cellular response to HCV microbial stress inhibits autophagy through beclin 1 degradation. The mechanisms of how secretory and degradative autophagy are regulated during persistent HCV infection is unknown. This study was performed to understand the mechanisms of viral persistence in the absence of degradative autophagy, which is essential for virus survival. Using HCV infection of a CD63-green fluorescence protein (CD63-GFP), labeled stable transfected Huh-7.5 cell, we found that autophagy induction at the early stage of HCV infection increased the degradation of CD63-GFP that favored virus replication. However, the late-stage of persistent HCV infection showed impaired autophagic degradation, leading to the accumulation of CD63-GFP. We found that impaired autophagic degradation promoted the release of extracellular vesicles and exosomes. The impact of blocking the release of extracellular vesicles (EVs) on virus survival was investigated in persistently infected cells and sub-genomic replicon cells. Our study illustrates that blocking EV and exosome release severely suppresses virus replication without effecting host cell viability. Furthermore, we found that blocking EV release triggers interferon lambda 1 secretion. These findings suggest that the release of EVs is an innate immune escape mechanism that promotes persistent HCV infection. We propose that inhibition of extracellular vesicle release can be explored as a potential antiviral strategy for the treatment of HCV and other emerging RNA viruses.

Chronic hepatitis C virus (HCV) infection causes hepatocellular carcinoma (HCC). Although HCV clearance has been improved by the advent of direct-acting antiviral agents (DAA), retrospective studies have shown that the risk of subsequent HCC, while considerably decreased compared with active HCV infection, persists after DAA regimens. However, either the mechanisms of how chronic HCV infection causes HCC or the factors responsible for HCC development after viral eradication in patients with DAA treatments remain elusive. We reported an in vitro model of chronic HCV infection and determined Wnt/β-catenin signaling activation due to the inhibition of GSK-3β activity via serine 9 phosphorylation (p-ser9-GSK-3β) leading to stable non-phosphorylated β-catenin. Immunohistochemical staining demonstrated the upregulation of both β-catenin and p-Ser9-GSK-3β in HCV-induced HCC tissues. Chronic HCV infection increased proliferation and colony-forming ability, but knockdown of β-catenin decreased proliferation and increased apoptosis. Unexpectedly, Wnt/β-catenin signaling remained activated in chronic HCV-infected cells after HCV eradication by DAA, but metformin reversed it through PKA/GSK-3β-mediated β-catenin degradation, inhibited colony-forming ability and proliferation, and increased apoptosis, suggesting that DAA therapy in combination with metformin may be a novel therapy to treat HCV-associated HCC where metformin suppresses Wnt/β-catenin signaling for HCV-infected patients.

The ability of translated cellular proteins to perform their functions requires their proper folding after synthesis. The endoplasmic reticulum (ER) is responsible for coordinating protein folding and maturation. Infections, genetic mutations, environmental factors and many other conditions can lead to challenges to the ER known as ER stress. Altering ER homeostasis results in accumulation of misfolded or unfolded proteins. To eliminate this problem, a response is initiated by the cell called the unfolded protein response (UPR), which involves multiple signaling pathways. Prolonged ER stress or a dysregulated UPR can lead to premature apoptosis and an exaggerated inflammatory response. Following these discoveries, ER stress was shown to be related to several chronic diseases, such as diabetes mellitus, neurodegenerative disorders, fatty liver disease and inflammatory bowel disease that have not yet been clearly demonstrated pathophysiologically. Here, we review the field and present up-to-date information on the relationship between biological processing, ER stress, UPR, and several chronic diseases.

WOS: 000454450900005, Objectives: Most of the patients with hepatitis B e (HBe)-negative hepatitis B have persistently normal transaminases (PNALT) levels. Patients, who have higher fibrosis and necroinflammatory activity scores, are at high risk for hepatocellular carcinoma and cirrhosis. Therefore, it is important to distinguish between active and inactive hepatitis in this group. Materials and Methods: Sixty-six treatment-naive, non-cirrotic, HBe antigen (HBeAg)-negative and a PNALT and a level of a hepatitis B virus (HBV) DNA level of >= 2000 IU/mL were included in this study. lshak's scoring system was used for histopathological evaluation. Chronic hepatitis was defined as a fibrosis score of higher than/equal to 2 and/or a histological activity index score of higher than 4. Results: The percentage of patients diagnosed with advanced fibrosis score and high necroinflammatory activity was 65% and 48%, respectively. Accordingly, 76% of patients were considered to have chronic hepatitis. Level of the HBV DNA was the most significant value for predicting chronic hepatitis. 94.1% of patients with a HBV DNA value over 20000 IU/mL had chronic hepatitis (p

It is known that depression is common in obese individuals. Besides the effects of obesity, pathogenic effects of increase in visceral and abdominal fat mass on depression are also being investigated. Our study aimed to show the relationship between visceral fat percentage detected with practical methods and the presence and severity of depression.Our study included 104 obese patients and 50 healthy controls. In all individuals, the severity of depression was assessed using the Beck Depression Inventory (BDI). Anthropometric measurements, visceral fat percentage, and body fat percentage were measured using the bioelectric impedance method.The mean age was 51.5±12.3 years, and 65 participants (62.5%) were women. BDI scores were statistically higher in the obese group than in the control group (23.1±10.9 and 12.1±9.4, p0.001). In the obese group, 63.5% of patients were depressed, and in the control group, this was 24%. Women were more depressed in the obese group, but there was no significant difference between men and women in the control group. Body fat percentage was the highest correlating parameter with depression severity. Positive correlation was found between depression severity and body mass index, waist circumference, hip circumference, and visceral fat percentage. In the logistic regression analysis, obesity was found as an independent risk factor for depression (OR: 4.84, 2.1-10.7, p0.001).According to the results of our study, obesity is a significant and independent risk factor for depression. Obesity type and body composition are important factors that determine the severity of depression.Depresyonun obezlerde sık görüldüğü bilinmektedir. Obezite varlığının yanında, viseral ve abdominal yağ kitlesindeki artışın depresyon üzerindeki etkileri de araştırılmaktadır. Biz de çalışmamızda pratik yöntemlerle tespit edilen viseral yağ oranı ile depresyon varlığı ve şiddeti arasındaki ilişkiyi göstermeyi amaçladık.Çalışmamıza 104 obez hasta ve 54 sağlıklı kontrol alındı. Tüm bireylerde depresyon şiddeti Beck depresyon ölçeği ile değerlendirildi (BDI). Antropometrik ölçümler, viseral yağ oranı ve vücut yağ oranı biyoelektrik impedans yöntemi ile ölçüldü.Ortalama yaş 51,5±12,3 olarak bulundu ve vakaların 65 tanesi (62,5%) kadındı. BDI skorları obez grupta kontrol grubuna göre istatistiksel olarak anlamlı biçimde yüksekti (23,1±10,9 ve 12,1±9,4 p0,001). Obez gruptaki hastaların % 63,5’i, kontrol grubundakilerin ise %24’ü depresifti. Obez gruptaki kadınlarda depresyon daha fazla idi, ancak kontrol grubunda kadınlar ve erkekler arasında anlamlı fark yoktu. Vücut yağ oranı, depresyon şiddeti ile en yüksek korelasyon gösteren parametreydi. Depresyon şiddeti ile vücut kitle indeksi, bel çevresi, kalça çevresi ve viseral yağ oranı arasında pozitif korelasyon vardı. Lojistik regresyon analizinde obezite, depresyon için bağımsız bir risk faktörü olarak bulundu (OR: 4,84, 2,1–10,7, p0,001).Çalışmamızın sonuçlarına göre, obezite depresyon için önemli ve bağımsız bir risk faktörüdür. Obezite tipi ve vücut kompozisyonu depresyonun şiddetini belirleyen önemli faktörlerdir.

Objective: Periampullary diverticulum (PAD) is an acquried luminal pathology that is located in the second segment of duodenum and Ampulla of Vater is located in or aside of it. We aimed to determine the frequency of periampullary diverticulum in endoscopic retrograde cholangiopancreatography (ERCP) and the effect of presence of periampullary diverticulum on ERCP success and complications. Material and Method: The ERCP procedures held in Gastroenterologic Endoscopy Unit of Sisli Hamidiye Etfal Training and Research Hospital between years 2011-2014 were retrospectively evaluated. Results: Periampullary diverticulum was found in 112 of (11.8%) 948 cases who underwent ERCP with various indications. A 1026 procedures were done to 836 patients without periampullary diverticulum and 136 procedures were done to 112 patients with periampullary diverticulum. No statistically significant difference was found in terms of number of ERCP procedure per patient between patients with and without periampullary diverticulum (1.21 vs. 1.23 p=0.838). Common bile duct cannulation failed in 8 (7%) of patients with periampullary diverticulum whereas this cannulation was unsuccessful in 54 (6.4%) of patients without periampullary diverticulum (p=0.859). The mean age of cases with periampullary diverticulum (72.7±12.2 years) was statistically significantly higher than the ones without periampullary diverticulum (56.8±16.4 years) (p

ST2, a specific ligand of interleukin 33, was described as a biomarker protein of inflammatory processes and overexpression of ST2 in ulcerative colitis (UC) was shown previously. We aimed to investigate the potential relationship of serum ST2 levels with the clinical, endoscopic and histopathological activity scores in UC and Crohn's disease (CD). Serum ST2 levels were determined in 143 patients with inflammatory bowel disease (IBD) (83 UC and 60 CD), in 50 healthy controls (HC), and in 32 patients with irritable bowel syndrome (IBS). Serum ST2 levels were elevated in IBD (56.8 (41.9–87.2) pg/mL) compared to HC and IBS (30.7 (20.2–54.3), p

Liver biopsy is the best method for detecting fibrosis grade of the liver in chronic hepatitis B. However, the invasiveness of liver biopsy complicates its routine use in follow-up of treatment. We planned to determine the usage of fibrosis predicting noninvasive scores in the follow-up of the treatment of patients with chronic hepatitis B treated with entecavir or tenofovir. Two hundred twenty-eight patients with hepatitis B with liver biopsy were included in the study. Fibrosis grade was determined by Ishak score. The laboratory data at months 0, 12, and 24 during treatment were collected and noninvasive fibrosis scores (aspartate aminotransferase to alanine aminotransferase ratio [AAR], aspartate aminotransferase to platelet ratio index [APRI], fibrosis index based on the 4 factors [FIB-4] and red cell distribution width to platelet ratio [RPR]) were calculated. Statistically significant increase in all scores and decrease in platelet count were observed as the fibrosis level increased. For differentiation of patients with fibrosis ≥grade 2, the highest sensitivity and specificity rates were shown by APRI score (sensitivity 67%, specificity 69%, and cutoff ≥0.5). FIB-4 was the most successful score for differentiation of patients with fibrosis ≥grade 3 (sensitivity 83%, specificity 74%, and cutoff ≥1.45). A significant decrease in all noninvasive fibrosis scores was observed at months 12 and 24 during treatment with both entecavir and tenofovir (P < 0.001). Among these, only the improvement in APRI score was found better in entecavir group with statistical significance (P < 0.05). APRI score was effective in demonstrating early-stage fibrosis. FIB-4, RPR, and platelet count were better in demonstrating advanced fibrosis. Although noninvasive scores cannot replace liver biopsy for diagnosis, they can be used for monitoring the response to treatment.

Objective: Dyslipidemia play an important role in the development of coronary artery disease (CAD) which is the world’s leading cause of mortality. Diabetes mellitus and obesity can cause CAD by different ways; dyslipidemia is common in both of them, that can lead to CAD. We investigate the effect of obesity and poor glycemic control on lipid profile in diabetic patients, in our country. Material and Method: One hundred and sixty five patients (82 male) who admitted to Istanbul Education and Research Hospital Outpatient Diabetes department, whose known diabetes age was less than 5 years, not taking any anti-lipidemic medicine in the last 6 months, not having ischemic heart disease, diabetes controlled by only oral antidiabetics, non-smoker and not drinking alcohol, don’t having any endocrine disorder with possible affect on blood lipid levels, were enrolled to the study. The relationship between lipid levels and HbA1c, body mass index (BMI) and diabetes age were assessed. Student’s t test, ANOVA and Pearson correlation tests were used for comparisons. p

Background & Aims: Mild iron overload is frequently reported in patients with nonalcoholic fatty liver disease (NAFLD). Hepcidin is the master iron-regulatory peptide and hemojuvelin (HJV) is the key regulator of iron-dependent secretion of hepcidin. The aims of this study were to evaluate serum HJV and hepcidin levels in patients with biopsy-proven NAFLD with and without hepatic iron overload, and to identify potential associations of HJV and hepcidin with the clinical characteristics of the patients enrolled. Methods: Serum levels of HJV and hepcidin were measured in 66 NAFLD patients with (n=12) and without (n=54) iron overload, and controls (n=35) by enzyme-linked immunosorbent assay. Hemojuvelin and hepcidin levels were assessed in relation to clinical characteristics and liver histologic evaluation of the participants. Results: Significantly lower serum HJV (281.1 [239.2-353.6] vs. 584.8 [440.3-661] ng/ml, p

Background and Aims:Biopsy of the papilla taken during ERCP is widely used in the diagnosis of periampullary tumors. In this study, we aimed to evaluate the biopsy results taken from the papilla with the suspicion of tumor. and determine their predictive value after confirming the final the diagnosis. Materials and Methods:A total of 48 patients whom biopsies were taken from papilla during ERCP done between January 2013 and December 2014 in our clinic were taken to the study. ERCP and pathology reports, post-ERCP operative/EUS/or other guided biopsy results were collected retrospectively from computer database. According to these results final diagnosis of the patients were determined. Results:The mean age ot the patients was 69.4±13.3 years. Twenty-two of the cases wer male and 26 were female. According to the pathology reports in 12 (25%) of the patients malignancy were positive, in 7 (14.6%) of the patients adenomatous changes were present, in 23 (47.9%) of the patients malignancy were negative and in 6 of the patients the distinction between malign or benign changes could not be done. With these biopsy results 6 patients underwent to Whipple operation and ampullectomy was done in 1 patient. According to final diagnosis 19 (39.6%) of the patients were found malign, 5 (10.4%) of the patients were found to have adenomas and the remaining 24 (50%)patients were found negative for malignancy. The sensitivity of the biopsy of papilla for prediciting malignancy was found 66.6% and specificity was 100%, PPV was 100%, NPV 80% and diagnostic accuracy was 85%. In the malignancy positive group, pre-procedural ALP, ALT, AST, total bilirubin and CA 19-9 levels and number of the biopsies were found statistically significantly higher. In 3 patients with malignancy negative or indiscriminant biopsy results final diagnosis were obtained with second biopsy of the papilla. One of these patients were found to have adenocarcinoma. Conclusion:In patients with suspicion of ampullary region tumors the contribution of the biopsy of the papilla to the diagnosis was significant. Even if the first biopsy was negative, in the presence of clinical suspicion, the second biopsy may be helpful for definitive diagnosis. Papilla biopsy should be performed especially in patients with elevated AST, ALT, ALP, total bilirubin and CA 19-9 levels when there is clinical suspicion of malignancy., Giriş ve Amaç:Endoskopik retrograd koloanjiopankreatografi esnasında alınan papilla biyopsisi periampuller bölge tümörlerinin tanısında yaygın olarak kullanılmaktadır. Bu çalışmada, tümörden şüphelenilen olgularda alı-nan papilla biyopsi sonuçlarını değerlendirmeyi amaçladık. Gereç ve Yöntem:Çalışmaya kliniğimizde Ocak 2013 ile Aralık 2014 tarihleri arasında yapılan endoskopik retrograd kolanjiopankreatografi sırasında papilladan biyopsi alınan toplam 48 vaka alındı. Endoskopik retrograd kolanjiopankreatografi ve patoloji raporları, endoskopik retrograd kolanjiopankreatografi sonrası ameliyat/görüntüleme/endoskopik ultrasonografi eşliğinde biyopsi bulguları, bilgisayar veri tabanından retrospektif olarak toplandı. Bu sonuçlara göre hastaların nihai tanıları tespit edildi. Bulgular:Hastaların ortalama yaşı 69.4±13.3 yıl idi. Vakaların 22’si erkek, 26’si kadındı. Patoloji sonuçları-na göre hastaların 12’si (%25) malignite pozitifti, 7’sinde (%14.6) adenomatöz değişiklikler saptanmıştı, 23’ünde (%47.9) malignite negatifti ve 6’sında (%12.5) malign/benign ayrımı yapılamamıştı. Papilla biyopsisi sonuçlarına göre 1 hastaya ampullektomi ve 6 hastaya Whipple operasyonu uygulandı. Nihai tanılara göre hastaların 19’unun (%39.6) malign, 5’inin (%10.4) adenom, 24’ünün (%50) malignite negatif olduğuna karar verildi. Papilla biyopsisinin malignite tanısını öngörmede sensitivitesi %66.6, spesifitesi %100, pozitif prediktif değer %100, negatif prediktif değer %80 ve tanısal doğruluk oranı %85 olarak bulundu. İşlem öncesi alkalen fosfataz, aspartat aminotransferaz, alanin aminotransferaz, total bilirubin ve CA 19-9 düzeyleri ve işlem sırasında alınan parça sayısı malign grupta istatistiksel olarak anlamlı biçimde yüksekti. İlk biyopsileri negatif veya ayrım yapılamayan şeklinde rapor edilen ve papilla biyopsisi tekrarlanan 3 olguda da ikinci biyopsi ile nihai tanıya ulaşıldı. Bu olgulardan biri adenokarsinomdu. Sonuç:Ampüller bölge tümörü düşünülen olgularda papilla biyopsisinin tanıya katkısı yüksektir. İlk biyopsi negatif gelse de klinik bulgular varsa, ikinci biyopsinin yapılması yararlı olabilir. Özellikle aspartat aminotransferaz, alanin aminotransferaz, alkalen fosfataz, total bilirubin ve CA 19-9 değerleri yüksek olgularda klinik şüphe varlığında biyopsi yapılmalıdır.

Background and Aims:Common bile duct stones were successfully extracted in 85-90% of cases using endoscopic retrograde cholangiopancreatography procedures with balloons and basket catheters. However, endoscopic stone removal becomes challenging and sometimes impossible in the presence of a large, angled or multiple stones. The mechanical lithotripsy method is a procedure used to crush difficult to treat common bile duct stones. We retrospectively analyzed efficacy and safety of mechanical lithotripsy at our single center. Materials and Methods:Between August 2011 and August 2014, mechanical lithotripsy procedures were performed in 18 cases in the Sisli Etfal Education and Training Hospital Gastroenterology Department. Demographic features, laboratory tests, clinical course, procedure type and complications were retrospectively analyzed. Results:Mechanical lithotripsy was performed in 18 patients (Age: 22-68; 11 females, 7 males). In 16 patients, an endoscopic sphincterotomy was performed and the common bile duct was swept with a balloon catheter. While stone fragmentation was being performed with a basket catheter, the entrapped stone was impacted within the mid- common bile duct. A mechanical lithotripteur was used to crush the stone. In two patients with large stones, mechanical lithotripteur was performed after sphincterotomy. Mechanical lithotripsy was successful in 15 (83%) patients; however, in two patients the wire of the mechanical lithotriptor snapped. Unfortunately, an esophageal perforation occurred in one patient. A metallic esophageal stent was placed and the patient recovered in one month. There were no mortalities in our mechanical lithotripsy cases. Conclusion:Mechanical lithotripsy is useful to crush difficult common bile duct stones in routine endoscopic retrograde cholangiopancreatography exams and also as a rescue procedure. It is a difficult procedure that requires considerable technical expertise. The success rate was 70-80% for cases performed by those with experience; it is widely available in many parts of the world. The success rate was 81% in our series, despite some complications., Giriş ve Amaç:Endoskopik sfinkterotomi, balon ve basket kateterler yardımıyla koledok taşlarının %85-90’ı temizlenebilmektedir. Büyük taşlarda, impakte taşlarda, çok sayıda taşı olan hastalarda standart tedavi ile başarı güçtür. Zor taşlar için kullanılan metodlardan biri de mekanik litotripsi yöntemidir. Biz de kliniğimizde mekanik litotripsi yönteminin etkinliği ve güvenilirliğini retrospektif olarak incelemeyi amaçladık. Gereç ve Yöntem: Çalışmaya Ağustos 2011 ile Ağustos 2014 arasında Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi Gastroenteroloji Endoskopi ünitesinde mekanik litotripsi yapılmış olan 18 hasta alındı. Hastaların demografik özellikleri, laboratuvar değerleri, hastalara yapılan işlemler, işlem sonrası klinik seyir ve işlem komplikasyonları retrospektif olarak değerlendirildi. Bulgular:Mekanik litoripsi işlemi 22-68 yaş arası 18 hastaya (11’i kadın) uygulanmıştır. Hastaların 16’sında endoskopik sfinkterotomi yapılmış, balonla koledok temizlenmiş, basket kateterle taş parçalanmaya çalışılırken basket kateter koledokta sıkışmış ve mekanik litotripsi işlemine geçilmiştir. 2 hastada ise köşeli ve büyük taşlar bilindiğinden direkt olarak through the scope mekanik litotriptör ile taşlar kırılmıştır. Skop dışından mekanik litotripsi yapılan hastaların 15’ünde (%83) litotripsi işlemi başarıyla gerçekleştirilirken, 2 hastada baskette kırılma meydana gelmiştir. Bir hastada ise mekanik litotripsiyi takiben özofagus alt uçta perforasyon saptanmıştır. Endoskopik retrograd kolanjiopankreatikografi işlemi, mekanik litotripsi ve anesteziye bağlı mortalite görülmemiştir. Sonuç:Mekanik litotripsi, papilladan çıkmayacak kadar büyük taşların kırılarak küçültülmesi amacıyla planlı veya basketle koledok taşlarının temizlenmesi esnasında, basketin koledok içinde sıkışması nedeniyle plansız ve zorunlu olarak taşı kırmak maksadıyla kullanılır. Zor, deneyim gerektiren, literatürde başarı oranı %70-80 olarak bildirilen bir iş-lemdir. Bizim olgularımızda da %83 tedavi başarısı etkin bir metod olduğunu göstermekte ancak riskleri de beraberinde getirmektedir.

The close relationship between inflammation and thrombosis affects the progression and severity of inflammatory bowel disease (IBD). The prevalence of venous thromboembolism (VTE) varies between 1% and 7% among patients with IBD. The VTE risk in patients with IBD is at least 3 times higher than that in the normal general population. The absolute risk is very high during hospitalization, active disease, and surgery. The IBD-related VTE occurs at younger ages and recurs more frequently. The development of thrombosis in IBD is due to the interaction of many hereditary and acquired risk factors. Each patient diagnosed with IBD should be evaluated for a personal and family history of thrombosis and for prothrombotic drug use. Although procoagulant factors are increased during the natural course of inflammation, natural anticoagulants and fibrinolytic activity are decreased. Although IBD is accepted as a prothrombotic condition, there is no treatment that can remove this risk from daily practice. Patient training is required to control important factors, such as long-term immobilization and smoking. Oral contraceptives and hormone replacement therapy should be avoided. Inducing permanent disease remission must be the key approach for the prevention of thrombosis. Low-molecular-weight heparin (LMWH) is the basis of prophylactic treatment, which reduces the thrombosis risk by 50%. Prophylaxis with LMWH should be administered to all patients with IBD hospitalized due to disease attack or surgery. Long-term or even life-long anticoagulation therapy should be planned if there is insufficient disease control, recurrent VTE attacks, positive thrombophilia tests, or thrombosis in vital veins.

Individuals with increased visceral adiposity are considered to be more sensitive and more prone to severe acute pancreatitis because of the inflammatory microenvironment they have. We hypothesized that insulin resistance, adipokines, and proinflammatory cytokines that markedly affect the course of pancreatitis can contribute toward development of postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) and aimed to investigate the association between PEP risk and preprocedural serum vaspin, chemerin, tumor necrosis factor α, interleukin-6 (IL-6) levels, and homeostasis model assessment of insulin resistance.Eighty-two patients with a diagnosis of choledocholithiasis and 30 controls were enrolled. Preprocedural chemerin, vaspin, IL-6, and well-known PEP risk factors were compared between PEP and non-PEP groups.The mean age of the patients was 56.3±14.4 years; 52 patients were women. Adipocytokine levels, BMIs, and waist circumferences of the patient group were found to be higher than those of the controls. Total cannulation success and the mean procedure time were 82.9% and 28.7±8.8 min, respectively. PEP developed in 12 (14.6%) patients. Chemerin levels in the PEP group were higher than those in the non-PEP group (580.2±172.5 vs. 392.2±168.2 ng/ml, P0.01). Insulin resistance was higher in the PEP group than the non-PEP group (P=0.001), but there was no significant difference between PEP and non-PEP groups in terms of preprocedural vaspin, tumor necrosis factor α, IL-6, and C-reactive protein levels. According to logistic regression analysis, increased chemerin levels, homeostasis model assessment of insulin resistance 2.5 or greater, and pancreatic duct cannulation were found to be independent risk factors for PEP [odds ratio (OR)=1.006, P=0.006; OR=4.57, P=0.05; OR=6.54, P=0.02].Elevated serum chemerin levels and insulin resistance are independent risk factors of PEP development.

The relationship between insulin resistance and post-ERCP pancreatitis (PEP) is not known. We aimed to determine the relation between pre-ERCP insulin resistance and risk of PEP, and to evaluate the relationship of insulin resistance with well-established risk factors for PEP. Consecutive patients who underwent ERCP with the diagnosis of choledocolithiasis between January and December 2013 were enrolled in this prospective study. Pre-procedural insulin resistance state and other risk factors were evaluated according to PEP development. Pancreatitis developed in 16 (11.3 %) of 141 ERCP procedure. Homeostasis model assessment of insulin resistance (HOMA-IR) levels was found statistically significantly higher in patients who developed PEP than the ones who did not (3.37 ± 0.8 vs. 2.38 ± 1.4, p

Background and Aim Cardiovascular disease (CVD) is the most frequent cause of death in nonalcoholic fatty liver disease (NAFLD). Insulin resistance, hepatic dysfunction, and chronic inflammation are factors interacting in explaining the increased CVD incidence in NAFLD. We aimed to evaluate the effects of insulin resistance and inflammatory biomarkers on asymmetric dimethylarginine (ADMA) levels, a predictor of CVD. We also investigated relationship between these markers and histological findings in patients with NAFLD. Patients and Methods Plasma ADMA, high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and homeostasis model assessment of insulin resistance (HOMA-IR) were measured in 70 patients with histologically verified NAFLD (53 with nonalcoholic steatohepatitis [NASH], 17 with non-NASH) and 12 controls. Results The HOMA-IR (5.3 [3.9] vs 1.9 [1], P < 0.001), hs-CRP (5.6 [4.2] vs 2.2 [2.3] mg/L, P < 0.001), ADMA (0.81 [0.25] vs 0.48 [0.24] μmol/L, P = 0.005), and IL-6 (4.1 [1.2] vs 1.0 [0.4] pg/mL, P < 0.001) levels were all found higher in the NAFLD group than the control group. The ADMA levels were significantly higher in patients with NAFLD independent from HOMA-IR and body composition ( P = 0.02). The IL-6 and HOMA-IR levels of the NASH group were found significantly higher than those of the non-NASH group. The only determinant significantly correlated to ADMA was HOMA-IR. Conclusions Our data suggested that although ADMA levels are independently higher in NAFLD, the only determinant correlated to ADMA is HOMA-IR and not inflammatory biomarkers (hs-CRP, IL-6) or presence/absence of NASH.

Background and Aims: Oesophagogastroduodenoscopy (gastroscopy) andcolonoscopy are examinations required for the evaluation of the etiology ofanemia. We aimed to retrospectively evaluate results of gastroscopic andcolonoscopic examinations done in our endoscopy unit for the investigationof anemia. Materials and Methods: Retrospective data from 545 gastroscopyand 398 colonoscopy examinations done in the Endoscopy Unit ofŞişli Hamidiye Etfal Training and Research Hospital Gastroenterology Departmentbetween January 2012 and December 2013 with an indication ofanemia were obtained from our computer database. Results: Gastroscopywas performed on 545 patients because of anemia, of whom 214 (39%)were male and 331 (61%) were female. The average age of the patients was53.8±17.2 years. In 27.2% of these patients, diseases such as oesophagealvarices, gastric cancer, gastroduodenal ulcer, angiodisplasia and previousgastric surgery that could explain anemia were detected. This ratio was 20%in female patients, 39% in male patients, 19% in patients younger than 50years and 34% in patients 50 years and over. Colonoscopy was done in 398patients because of anemia, of whom 171 (43%) were male and 227 (57%)were female. The average patient age was 56.9±15.7 years. In 40.5% of patientsundergoing colonoscopy, a pathology that may cause anemia was detected.This ratio was 33.5% in female patients, 49.7% in male patients, 22%in patients younger than 50 years and 49.1% in patients 50 years or over.While malignancy was detected in 1.8% of patients undergoing gastroscopydue to anemia, 3.3 % malignancy and 21.6 % polyp were detected in patientsundergoing colonoscopy. Conclusion: In the upper and lower gastrointestinalsystem, endoscopic examinations done for the investigation of irondeficiency anemia etioogy and the detection rate of a pathology that couldexplain anemia was higher in patients 50 years or older and in male patients., Giriş ve Amaç: Anemi etiyolojisini araştırmada özofagogastroduodenoskopi(gastroskopi) ve kolonoskopi yapılması gerekli olan tetkiklerdir. Endoskopiünitemizde anemi nedeniyle yapılan gastroskopi ve kolonoskopi işlemlerininsonuçlarını retrospektif olarak değerlendirmeyi amaçladık. Gereç ve Yöntem:Ocak 2012-Aralık 2013 tarihleri arasında Şişli Hamidiye Etfal Eğitimve Araştırma Hastanesi Gastroenteroloji Kliniği endoskopi ünitesinde anemiendikasyonu ile yapılmış olan 545 gastroskopi ve 398 kolonoskopi işlemininsonuçları retrospektif olarak bilgisayar veri tabanından elde edildi. Bulgular:Anemi nedeniyle gastroskopi istenen 545 hastanın 214’ü (%39) erkek ve331’i (%61) kadındı. Hastaların ortalama yaşı 53.8±17.2 yıl olarak bulundu.Bu hastaların toplam %27.2’sinde özofagus varisi, mide kanseri, gastroduodenalülser, angiodisplazi ve geçirilmiş mide ameliyatı gibi anemiyi açıklayabilecekpatoloji saptandı. Bu oran kadın hastalarda %20, erkek hastalarda%39 olarak; 50 yaş altı hastalarda %19, 50 yaş üstü hastalarda %34 olarakbulundu. Anemi nedeniyle kolonoskopi yapılan 398 hastanın 171’i (%43)erkek ve 227’si (%57) kadındı. Hastaların ortalama yaşı 56.9±15.7 yıl idi.Kolonoskopi yapılan hastaların %40.5’inde anemiye sebep olabilecek patolojisaptandı. Bu oran kadın hastalarda %33.5, erkek hastalarda %49.7 olarak;50 yaş altı hastalarda %22, 50 yaş üstü hastalarda %49.1 olarak bulundu.Anemi nedeniyle gastroskopi yapılan hastaların %1.8’inde malignite saptanırken,kolonoskopi yapılan hastaların ise %3.3’ünde malignite, %21.6’sındapolip saptandı. Sonuç: Demir eksikliği anemisi etiyolojisi araştırmak içinyapılan alt ve üst gastrointestinal sistem endoskopik incelemeleri ile 50 yaşüstü ve erkek hasta grubunda anemiyi açıklayacak patoloji saptama oranıdaha yüksektir.

Background and Aims: Nasobiliary drainage is an established mode of treatment for acute suppurative cholangitis, bile leakage and biliary fistula. We retrospectively analyzed the safety and efficacy of nasobiliary drainage placement for biliary drainage in patients with acute cholangitis. Materials and Methods: Between January 2011 and December 2012, nasobiliary drainage was performed in 22 patients at Sisli Etfal Training and Education Hospital. The clinical characteristics, laboratory results, clinical outcomes, and complications were analyzed retrospectively. Results:Nasobiliary drainage was performed in 22 patients (11 female), and the mean age was 54,3±24,4 years (range, 12-84). Acute suppurative cholangitis (n=11), hydatid cyst with biliary communication (n=4), postoperative biliary leak (n=3), external biliary leakage (n=2), and hemobilia (n=2) were the main indications of nasobiliary drainage. The catheter was removed in 8,4±6,2 days, and time elapsed to normalization of total serum bilirubin levels was 4±0,6 days. There were no endoscopic retrograde cholangiopancreatography -related complications. Although it is not a comfortable treatment modality, there were no instances of displacement or kinking of the nasobiliary drainage.Conclusions: Biliary drainage by nasobiliary drainage is a safe and effective treatment in patients with severe cholangitis, postoperative bile leakage and bile fistula.

An increase in the prevalence of colorectal polyps and cancer is reported in patients with acromegaly. This trial is designed to determine whether there is an increase in the prevalence of colorectal polyps/cancer in Turkish acromegaly patients. Sixty-six patients, who were under follow-up with the diagnosis of acromegaly and underwent total colonoscopic examination, were enrolled in the study. Sixty-five age- and gender-matched patients with nonspecific complaints were selected as control. The mean age of acromegalic patients was 51.5±12.8 years of whom 27 (40.9%) were females. In 20 (30.3%) of the patients with acromegaly a total of 65 colorectal polyps were detected. Forty-seven (72.3%) of the polyps were detected at the rectosigmoid region. In 8 (12.3%) of the 65 control patients a total of 17 polyps were found. There was a statistically significant difference between the groups (P=0.018). At the logistic regression analysis we found that the risk for colon polyps increased 3.2-fold in the presence of acromegaly, irrespective of age and gender (OR: 3.191, 95% CI: 1.25–8.13). In conclusion, patients who were followed up with the diagnosis of acromegaly should be taken to the colonoscopic surveillance program and all polyps detected should be excised in order to protect them from colorectal cancer.

Background: Terminal ileum endoscopy and biopsy are the diagnostic tools of diseases attacking the ileum. However, abnormal histological findings can be found in endoscopically normal terminal ileum. Objective: This study was performed to evaluate the histopathological results of biopsies from endoscopically normal terminal ileum in order to determine pre-procedure clinical and laboratory factors predicting abnormal histopathological results, if any. Methods: A total of 297 patients who underwent colonoscopy and terminal ileum biopsy and had normal terminal ileum or a few aphthous ulcers in the terminal ileum together with completely normal colon mucosa were included in the study. The patients were grouped into two arms as normal cases and cases with aphthous ulcers. Histopathological and pre-procedural laboratory results of patients were analyzed according to their indications. Results : The terminal ileum was endoscopically normal in 200 patients, and 97 patients had aphthous ulcers. Chronic ileitis rate was present in 5.5% of those with endoscopically normal terminal ileum and in 39.2% of the patients with aphthous ulcers. In both groups, the highest rate of chronic ileitis was detected in the patients with known inflammatory bowel disease (IBD) (15.4 and 50%, respectively), anemia (9.5 and 43.5%, respectively), and in the patients having chronic diarrhea together with abdominal pain (7.7 and 44.8%, respectively). We found that the sensitivity of mean platelet volume for predicting chronic ileitis was 87% and the specificity was 45% at a cut-off value lower than 9.35 fl. Conclusion: In anemia indication or chronic diarrhea together with abdominal pain, the frequency of aphthous ulcers detected by ileoscopy and the frequency of chronic ileitis detected histopathologically despite a normal-appearing ileum were elevated. Keywords: Terminal ileum; ileoscopy; chronic ileitis; inflammatory bowel disease (Published: 19 February 2014) Citation: Libyan J Med 2014, 9 : 23441 - http://dx.doi.org/10.3402/ljm.v9.23441

Gastrointestinal tract is the most common site of extranodal non-Hodgkin’s lymphoma. Small bowel involvement accounts for 2030% of all gastrointestinal lymphomas. Among all intestinal lymphomas, the ileum is the most common involved area, with duodenal involvement only accounting for a small proportion. The most frequent histological type is diffuse large B-cell lymphoma (DLBCL). T-cell/ histiocyte-rich-large B-cell lymphoma (TCHRBCL) is an uncommon morphologic variant of B-cell lymphoma. Duodenal involvement of TCHRBCL has not been reported previously. We hereby report this first case of TCHRBCL of the duodenum. (Published: 16 December 2013) Citation: Libyan J Med 2013, 8 : 22955 - http://dx.doi.org/10.3402/ljm.v8i0.22955

A 25-year-old female patient with Crohn's disease had been using azathioprine and metronidazole for an extended period because of recurrent perianal and rectovaginal fistulae. Infliximab was added to the treatment regimen following postoperative recurrence of a rectovaginal fistula. Upon the development of severe neutropenia and thrombocytopenia after the third dose of infliximab, azathioprine and infliximab were stopped. Neutropenia work-up did not reveal any other cause. Neutropenia was ameliorated with use of granulocyte colony-stimulating factor. Treatment was restarted with infliximab alone upon leakage from the rectovaginal fistula with no hematologic toxicity. This case was considered as a serious adverse effect of infliximab and azathioprine combination therapy.

Koksal, Ali Riza/0000-0002-5693-5951; Cakar, Burcu/0000-0003-3790-791X; ADIBELLI, ZELAL/0000-0001-7091-5204 WOS: 000255168800005 PubMed: 18568690 Self-measurement of blood pressure (BP) at home is more common than 10 years ago and encouraged by current guidelines to increase patient adherence to treatment and reach the goal of target BP. The aims of this study are to evaluate the accuracy of home sphygmomanometers and to investigate behavior/knowledge of the sphygmomanometer owners. A campaign was planned to determine the accuracy of home sphygmomanometers in 2006. Seven hundred and twenty-three home sphygmomanometers were brought by individuals to the University Hospital Hypertension Clinic within 1 year and 693 (96%) of the devices were in adequate working condition and suitable for analysis. Four hundred and thirty-nine (63%) of the sphygmomanometers were automatic. Four hundred and eleven (59.3%) of the 693 sphygmomanometer were inaccurate. About 80% (256/320) of the wrist devices were inaccurate. Most studies evaluating the accuracy of sphygmomanometers are conducted in hospital or primary care settings; studies investigating home sphygmomanometers are rare. High frequency of inaccurate home devices is a major public health problem. In conclusion, inaccurate devices have been used in home BP measurements frequently and frequency of device-related errors can be decreased by awareness and training of the patients. Physicians and healthcare providers should advise the patients to check the accuracy of their home sphygmomanometers regularly.

A 31-year-old non-smoking man presented with a 2 month history of dry cough, rhinorrhea and postnasal drip. He had been seen at an Otorhinolaryngology clinic which prescribed standard sinusitis therapy. Due to lack of relief, he then presented to our clinic. The patient had no symptoms related to other systems. His vital signs were normal and physical examination was unremarkable. Basic laboratory tests were normal, as were his spirometry results. The chest X-ray was normal.

A 56-year-old man was referred for digital subtraction angiography (DSA) with an ultrasound diagnosis of right proximal internal carotid artery (ICA) stenosis for possible carotid artery stenting. DSA revealed total occlusion of the ICA and an occipital artery arising from the stump and simulating continuation of the ICA. An ascending pharyngeal artery also arose from the same occipital artery. This case is of interest because this is a rare variation besides being a cause of misdiagnosis at carotid ultrasound.