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To determine the role of quantitative HBsAg levels in follow up of chronic HBV treatment and investigate the relationship between qHBsAg, HBV DNA levels and liver histopathology. 74 CHB patients with genotype D visited our Infectious Diseases outpatient clinic were included into the study. Patients were grouped according to treatment status; Group-I (patients new to treatment, 31 patients) and group-II (patients with long-term treatment history). All group-I patients had their serum HBsAg titers (qHBsAg) measured before treatment, at 3 and 6-month time periods after treatment. Group-II consisted of 43 CHB patients who had been on anti-viral treatment for at least 5 years. qHBsAg levels were measured and compared to that of patient in group II. Patients from group I were divided into two groups according to HBeAg positivity. The mean qHBsAg and HBVDNA levels and fibrosis scores were statistically higher (p=0.002, p =0.034, p=0.002) in HBeAg positive patients. For all patients in group-I, a positive correlation was found between qHBsAg and HBV DNA levels before treatment (p=0.003). Serum qHBsAg and HBVDNA levels that were measured before treatment, 3-month and 6-month after treatment were statistically different (p< 0.05) from each other. Group-II patients were classified according to YMDD mutations and virologic breakthrough during treatment. Serum qHBsAg levels of patients with YMDD mutations and virologic breakthrough were found to be statistically higher (p=0.010) than those who did not although these patients were receiving potent antivirals. Quantitative HBsAg levels may differ among chronic HBV patients according to their treatment protocols and duration. In patients who are new to treatment, HBeAg positive patients may have statistically higher levels of qHBsAg. Moreover, this difference was also observed when patient who are new to treatment were compared to those who had been under treatment for a longer time. For clinicians, qHBsAg levels should not be employed only in patients undergoing interferon therapy but also those undergoing antiviral therapy as well.. [Med-Science 2018; 7(3.000): 515-23]

We present a patient with severe hypophosphatemia related hypoxic respiratory failure resolving with phosphate replacement. [Med-Science 2016; 5(2.000): 747-50]

Subclinical hypothyroidism (SH) is a frequently seen clinical disorder, which needs to be managed strictly in the pregnant population. SH is closely related with newborn complications and also suggested to be risk factor for cardiovascular events. Mean platelet volume (MPV), a determinant of platelet function, is a newly emerging risk marker for cardiovascular events. The aim of this study was to evaluate how MPV values and other hematological parameters are influenced in pregnants with subclinical hypothyroidism. A total of 70 subclinical hypothyroidic pregnants and 40 euthyroid pregnant controls were enrolled in our study. Age, body mass index (BMI), erythrocyte and platelet parameters were all evaluated. Erytocyte parameters and thrombocyte parameters, including MPV, were not statistically significantly different between pregnants with SH and healthy pregnants (p>0.05). Mean free T3 and TSH levels of subclinical hypothyroidic pregnants were statistically significantly different from healthy pregnant (p=0.04 and p [Med-Science 2016; 5(1.000): 86-93]

Background/Aim: Increasing resistance of Helicobacter pylori to antimicrobials necessitated the development of new regimens and the modification of existing regimens. The present study aimed to compare the efficacy of two bismuth-containing quadruple regimens-one including clarithromycin (C) instead of metronidazole (M) and triple therapy. Patients and Methods: Patients with H. pylori infection given the following regimens were sequentially enrolled in this retrospective study: (1) Triple therapy: Lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., and amoxicillin 1 g b.i.d., (2) bismuth group C: Lansoprazole 30 mg b.i.d., clarithromycin 500 mg b.i.d., amoxicillin 1 g b.i.d., and bismuth subsalicylate 524 mg b.i.d., and (3) bismuth group M: Lansoprazole 30 mg b.i.d., amoxicillin 1 g b.i.d., metronidazole 500 mg t.i.d., and bismuth subsalicylate 524 mg b.i.d. for 14 days. Gastroscopy and 14 C-urea breath test were performed before enrollment, and urea breath test was repeated four weeks after the treatment. Results: At per-protocol analysis, the eradication rates were 64.7% (95% confidence interval 60.4-68.7) with the triple therapy (n = 504), 95.4% (95% confidence interval 91.5-99.4) with the bismuth group C (n = 501), and 93.9% (95% confidence interval 89.7-98.7) with the bismuth group M (n = 505). The eradication rates were similar between the two bismuth groups (P > 0.05) but significantly greater than that of the triple therapy (P < 0.05). Conclusion: In our study, both of the bismuth-containing quadruple therapies reached high eradication rates, whereas triple therapy was shown to be ineffective. Moreover, clarithromycin may also be a component of bismuth-containing quadruple therapy.

Meckel's diverticulum is a small bulge in the small intestine present at birth and is the most frequent malformation of the gastrointestinal tract. Although Meckel diverticulum is usually of no medical significance, tendency to gastrointestinal bleeding can require clinical attention. Despite the availability of modern imaging techniques, diagnosis is still challenging. We herein report three cases of undiagnosed gastrointestinal bleeding despite a number of imaging techniques. In all of these cases double balloon enteroscopy was successfully used and the diagnosis of Meckels diverticulum was established. We discuss the use of this successfully technique in obscure gastrointestinal (GI) bleeding caused by Meckel's diverticulum in relation to the pertinent literature. [Med-Science 2015; 4(3.000): 2528-35]

Ingestion of a sharp foreign object can lead to esophageal hemorrhage and perforation, which is related to high morbidity and mortality. To avoid such complications, early and adequate therapeutic management of these cases is crucial. Herein, we would like to present two cases of esophageal foreign bodies that were successfully managed with rigid bronchoscopy after failed attempts with upper gastrointestinal endoscopic intervention. [Med-Science 2015; 4(2.000): 2340-3]

In their relevant study, the authors demonstrated that ursodeoxycholic acid therapy significantly improvedliver function tests either when given alone or combined with silymarin. But, silymarin itself failed to improve liver function tests. We thank to the authors for their valuable contribution. However, there are some concerns that need to be explained in a detailed manner for a better understanding of the results presented in the manuscript. [Med-Science 2015; 4(4.000): 2986-8]

Background/Aims: It was aimed to investigate the biochemical and histopathological effects of resveratrol and melatonin, via histone H4 and β-defensin 1, in diabetic rats. Materials and Methods: Twenty-four Sprague–Dawley male rats were categorized into 4 groups, with 6 rats in each group (control, diabetes mellitus, melatonin – diabetes mellitus, and resveratrol+diabetes mellitus). Diabetes was formed by giving streptozotocin to all groups except the control group. Melatonin, 5 mg/kg/day, was given to the melatonin – diabetes mellitus group, and resveratrol, 5 mg/kg/day, was given to the resveratrol+diabetes mellitus group via intraperitoneally for 3 weeks. Interleukin-1 beta, tumor necrosis factor alpha, histone H4, and β-defensin 1 levels were measured in the blood of all rats. The lung, liver, and kidney tissue of all rats were performed as histopathological examinations. Results: Whereas there was no difference between the other groups (P > .05), interleukin-1 beta levels of the diabetes mellitus group were found to be significantly higher compared with the control group (5.02 ± 2.15 vs. 2.38 ± 0.72 ng/mL; P < .05). Whereas histone H4 levels of the diabetes mellitus group were higher compared with the control and resveratrol+diabetes mellitus groups (7.53 ± 3.30 vs. 2.97 ± 1.57 and 3.06 ± 1.57 ng/mL; P < .05), the β-defensin 1 levels of the diabetes mellitus group were lower compared with control and resveratrol+diabetes mellitus groups (7.6 ± 2.8 vs. 21.6 ± 5.5 and 18.8 ± 7.4 ng/mL; P < .05). β-Defensin 1 levels were moderately inversely correlated with interleukin-1 beta and histone H4 levels (rs > −0.50, P < .01). Histopathological changes found in favor of target cell damage in the diabetes mellitus group were not observed in resveratrol+diabetes mellitus group. Conclusion: Resveratrol may be used as a biotherapeutic agent, which significantly reduces diabetes-induced histone H4 and interleukin-1 beta-mediated liver and other target organ damage

Objetivo: Evaluar parámetros inflamatorios como posibles marcadores de malignidad en individuos con nódulos tiroideos. Método: Se incluyeron 991 pacientes con nódulos tiroideos que se sometieron a biopsia por aspiración con aguja fina y se clasificaron según el sistema de Bethesda. Se determinaron los valores de la relación neutrófilo-linfocito (NLR) y el índice de inflamación inmunitaria sistémica (SII). El estudio exploró la correlación entre la clasificación de Bethesda y los valores de NLR/SII, y comparó los parámetros inflamatorios de los grupos benignos y malignos de Bethesda. Resultados: Se clasificaron 573 pacientes como Bethesda 2 (benigno) y 34 como Bethesda 6 (maligno). Se observó una correlación entre la clasificación de Bethesda y los valores de NLR y SII (r: 0.230; r: 0.207). Los valores de NLR y SII fueron mayores en el grupo maligno (p < 0.001). El valor de corte para SII en la predicción de nódulos tiroideos benignos y malignos fue de 489.86 × 103/mm3, con una sensibilidad del 88.2% y una especificidad del 63.7%; para NLR fue de 2.06, con una sensibilidad del 82.4% y una especificidad del 83.4%. Conclusiones: El SII y el NLR pueden ser valiosos marcadores pronósticos para predecir la malignidad de los nódulos tiroideos.

Abstract Objective Gilbert’s syndrome (GS) is a benign genetic disorder that is characterized by intermittent mild jaundice in which the liver doesn’t process bilirubin properly. The aim of this study was to determine whether GS patients have a different personality structure and if there are associations between properties of temperament and character and total bilirubin levels. Methods A total of 1665 young male individuals aged from 19 to 30 who were admitted for occupational examinations were included in this study. Careful patient history was taken, a detailed physical examination was conducted, and hematologic and biochemical tests and abdominal ultrasonography were performed. The Turkish version of the Temperament and Character Inventory (TCI) was administered to all participants. 81 patients diagnosed with GS and 150 randomly chosen healthy individuals (control group) were investigated with comparison and correlation analyses. Results GS patients had higher scores than healthy controls for disorderliness (NS4) (p = 0.018), sentimentality (RD1) (p = 0.042), and fatigability (HA4) (p = 0.03). Moreover, Gilbert syndrome patients scored lower than controls for empathy (C2) (p = 0.041) and transpersonal identification (ST2) (p = 0.044). Bilirubin levels were positively associated with disorderliness (NS4) (r = 0.141, p = 0.032) and fatigability (HA4) (r = 0.14, p = 0.033). Conclusions GS patients may have some different personality characteristics from healthy individuals. This study is an initial exploration of the personality structure of GS patients and the findings should be interpreted with caution. Further prospective studies are needed to identify the relationship between Gilbert disease and personality characteristics.

Abstract It was aimed to evaluate long non-coding RNAs (lncRNAs) in terms of diagnosis and prognosis in colorectal cancer (CRC) cases with peritoneal metastasis who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Paraffinized 32 CRC tissue and 32 adjacent normal colon tissue of 32 cases, and paraffinized metastatic 10 peritoneal tumor tissue and 10 adjacent normal peritoneal tissues of 10 cases were included in. Expression levels of lncRNAs GAS5, MALAT1, CCAT2, HOTAIR and H19 were measured by qRT-PCR, clinicopathological and demographic characteristics of the patients were also recorded. 11 (34%) patients were female and 21 (66%) were male. The mean age was 54.59±11.97 (24-73 years). Expression levels of GAS5 decreased significantly in colon tumor tissues compared to normal colon tissues (p

Predicting which patients will need the intensive care unit (ICU) due to severe COVID-19 is critical in terms of disease treatment. In this study, the use of the derived isohemagglutinin (dIH) parameter calculated from isohemagglutinin (IH) values and neutrophil to lymphocyte ratios for prediction of clinical care (CLC), ICU admission and mortality status was investigated for the morbidity and mortality of COVID-19. The data of approximately 21,500 patients admitted to the hospital with the suspicion of COVID-19 were scanned retrospectively. A total of 352 patients with IH results were divided into three groups according to CLC, ICU admission and mortality. Isohemagglutinin, hemogram and biochemistry test results, demographic characteristics, chronic diseases, length of stay, treatments, ICU admission and mortality records were reviewed for all patients. The relationship between test results, demographic characteristics, clinical status and mortality was investigated using statistical methods. The dIH values of patients with ICU admission and mortality were much lower than those of CLC patients [median (min-max): 3.34 (0.14-95.8) and 0.82 (0.05-42.3) vs. 0.18 (0.01-20.6) titers, p < 0.01, respectively]. In the ROC analysis for the power of dIH to discriminate ICU admission, the cutoff was ≤ 0.68 with sensitivity 88.9%, and specificity 79.6%. It was determined that a 1-unit increase in dIH values decreased the need for ICU by 2.09 times and the mortality of those receiving ICU treatment by 2.02 times. dIH values calculated in the early stages of the disease in patients with COVID-19 can be used to estimate the clinical progression associated with ICU admission and mortality.

Colonoscopy is a widely used modality for detecting colonic pathologies nearly all over the world. In this retrospective analysis, we aimed to determine the prevalence of colonic polyps and their histopathological results based on colonoscopies performed in the gastroenterology unit in Canakkale Onsekiz Mart University Health Practice and Research Hospital and Istanbul Sultan Abdulhamidhan Training and Research Hospital. Patients underwent colonoscopic examination due to lower gastrointestinal system complaints between 01/01/2014 and 01/12/2019 were evaluated. Patient age, gender, indications, colonoscopic findings, polyp number, size and histopathologic results of the lesions were recorded. A total of 1040 polyps were detected from 839 polypectomy operations performed according to the colonoscopic evaluation of 9044 patients between January 2014 and January 2019. Bleeding after polypectomy was observed in 8 (0.95%) patients and all of the bleedings were controlled with sclerotherapy and/or heater probe coagulation. According to the polyp detection sites, rectosigmoid region (49.7%) was followed by transverse colon (17.3%), descending colon (17.5%), ascending colon (10.5%) and caecum (5%). Adenomatous polyps were the most encountered histopathologic type followed by hyperplastic polyps (19.6%). Thirteen (1.25%) polyps were reported as adenocarcinoma. Polypectomy is an effective procedure of colonoscopy when performed by expert hands. In this retrospective analysis, our results was found to be consistent with those of the literature in terms of polyp number, size and histopathologic characteristics. [Med-Science 2020; 9(2.000): 473-7]

According to the TURHEP study, the prevalence of Helicobacter pylori in Turkey is 82.5%. After FDA approval in 1995, many countries have used standard triple therapy (proton pump inhibitor 40 mg b.i.d clarithromycin 500 mg b.i.d and amoxicillin 1 gr b.i.d) for Helicobacter pylori treatment. In the beginning, eradication rates were above 90% in many countries; however, current studies have demonstrated a prominent decrease in successful treatment rates, even down to 60%. This unfavorable reduction stimulated searches for new treatment protocols. Treatment protocols differ according to country, prevalence, cost-effectiveness, antibiotic resistance, CYP2C19 polymorphism and eradication rates. Thus, each country/region needs to revise its own therapeutic results and the efficacy of various eradication regimens in the treatment of Helicobacter pylori. This report aims to review the current status of Helicobacter pylori treatment in Turkey and to provide recommendations for rational therapeutic considerations for the eradication of the bacterium. (NCI-2019-0024.R1)

Abstract Deregulation of miRNA expressions was identified as a novel feature of tumor biology in Ewing sarcoma (EWS). The aim was to evaluate the regulatory role of miR-129-2-3p in EWS cell lines and human EWS tissue samples. EWS cell lines TC-71, TC-106, and CHLA-99 were used in the study and real-time PCR was utilized to investigate the functional role of tumor suppressor mir-129-2-3p and miR-129-2-3p levels in the cells. Proliferation, migration, invasion and apoptosis assays were carried out within the scope of functional in vitro studies. Expression levels of CDK6 and SOX4, which are miR-129-2-3p target genes, were examined. Moreover, the change in expression levels of miR-129-2-3p in EWS tumor tissues was also examined. It was determined that miR-129-2-3p expression markedly diminished in all the studied cell lines. In addition, miR-129-3p was found to decrease in proliferation, migration, invasion and apoptosis assays in all EWS cell lines. CDK6 and SOX4 levels were also decreased in miR-129-2-3p transfected cell lines. It was found that miR-129-2-3p levels were significantly decreased in EWS tumor tissue samples compared to the corresponding adjacent normal tissue samples. In line with the results of our current study, where the possible function of miR‐129-2-3p in EWS cell lines was examined, for the first time in the literature miR-129-2-3p was shown to have low expression level in EWS lines and EWS tumor tissue samples, and to provide a tumor suppressor effect.

Ulcerative colitis is a chronic inflammatory disease affecting mainly the colon and presenting with diarrhea, bloody defecation andabdominal pain. Although cardiac and/or pulmonary involvement has been reported in patients with ulcerative colitis, it rarelyinvolves both the pleura and pericardium at the same time. Also, it is difficult to determine whether pulmonary or cardiac diseaseis secondary to the ulcerative colitis drugs or to the underlying disease process. Here we present a rare case of pleuropericardialeffusion in a patient newly diagnosed with ulcerative colitis. In ulcerative colitis, the simultaneous involvement of the respiratoryand cardiovascular systems is uncommon yet potentially dangerous.

Abstract We aimed to analyze the expression profile of ACE2 and similar genes with ACE2, predict the number of variations in ACE2, detect the suspected SNPs on ACE2 gene, and perform the pathway analysis of renin-angiotensin system (RAS) and protein absorption-digestion. Moreover, we have predicted the gene-related diseases with ACE2. STRING was used to analyze functionally similar genes with ACE2. Exome Variant Server, SIFT, Polyphen2 were used to predict the number of variations in ACE2 and detect the suspected SNPs on ACE2. KEGG database and STRING were used to draw pathway of ACE2. Then, DISEASES resource, FitSNPs, UniProt, BioXpress, IGV Browser, Ensembl Genome Browser, and UCSC Genome Browser were used to predict the ACE2 gene-related diseases and expression profile in human normal and cancer tissues. We have shown that expression of ACE2 was correlated with AGT, REN, AGTR1, AGRT2, MME2, DPP4, PRCP, MEP1A, XPNPEP2, MEP1BandACE2 is expressed in testis, kidney, heart, thyroid, colon, esophagus, breast, minor salivary gland, pancreas, lung, liver, bladder, cervix, and muscle tissues. We found 99 variations in ACE2 gene, in which no previous study has been performed. In the future, this in silico analysis should be combined with other pieces of evidence including experimental data to assign function.

Objective: Synthetic cannabinoid drug abuse has been dramatically increasing among young individuals in many countries. There have been reports of serious side effects with SC abuse in these patients. Previous researches have exhibited that neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with mortality and morbidity in many chronic diseases. The aim of this study was to evaluate PLR and NLR in critical care patients with synthetic cannabinoid (bonzai) intoxication. Materials and methods: One hundred and seven synthetic cannabinoid intoxication patients requiring intensive care and 40 healthy controls were included in the study. Patients characteristics and the complete blood count (CBC) variables, including white blood cell (WBC), hemoglobin (Hb), platelet count, NLR, PLR as well as AST, ALT, albumin total bilirubin, and other routine biochemical parameters were tested. Data analyses were conducted with SPSS-15 software (SPSS Inc., Chicago, Illinois, USA). Statistical significance was set at a p-value of 0.05). All the routine laboratory tests and inflammatory markers (Erythrocyte sedimentation rate and C-reactive protein) were similar between groups. As complete blood cell count; mean WBC values were 9.43 ± 3.27 × 103/mm3 vs 7.05 ± 2.12 × 103/mm3 (p

In this study, we aimed to determine the clinical significance of the neutrophil to lymphocyte (NLR) ratio, mean platelet volume (MPV) and other biochemical parameters for predicting the degree of liver fibrosis in patients with chronic hepatitis B (CHB) infection. A total of 95 biopsy-proven naïve CHB cases patients were included in the study. The complete blood count variables including white blood cell, hemoglobin, hematocrit, platelet count, neutrophil, lymphocyte, MPV, and other routine biochemical parameters were tested. Liver biopsy samples were examined using the Ishak scoring system. Individuals with a fibrosis score of 0, 1 and 2 were included in Group 1 and 3,4,5 and 6 were included in Group 2. Data analyses were carried out using SPSS 15 software. Statistical significance was set at a p-value of less than 0.05.Of the 95 cases, 76 (80%) were men and 19 (20%) were women. The mean age of the patients was 39.91±18.6 years, and 30 cases (31.5%) had HBeAg positivity. Fibrosis scores of 36 cases (37.8%) were greater than or equal to 3, whereas 59 cases (62.2%) had fibrosis scores less than 3. There was a significant difference between these two groups for NLR (Group 1; 2.38± 0.96, Group 2; 1.64 ± 0.60, p [Med-Science 2016; 5(1.000): 147-59]

So far, spiramycin-associated acute pancreatitis has not been reported in literature. In this letter, it was presented that A 63-year-old female subject was experienced acute pancreatitis 4 days after taking spiramycin for therapy of dental infection, as an unusual approach. She was prescribed spiramycin tablet for dental infection, and in 4th day, she admitted to emergency service with severe epigastric pain with radiation to the flank and back. Her magnetic resonance (MR) cholangiography and upper abdominal MR imaging revealed acute edematous pancreatitis without any gallstone. As a macrolide antibiotic, clinicians should be aware of potential side effects of spiramycin including acute pancreatitis. [Med-Science 2015; 4(2.000): 2352-5]

We report the case of a 24-year-old male patient admitted for recent ascites and splenomegaly of unknown origin. The patient was referred to our institution with complaints of diarrhea, epigastric pain, abdominal cramping and weight loss over the past three weeks. The acute onset presented with colicky abdominal pain and peritoneal effusion. History revealed reduced appetite and weight gain of 7 kg over the last one month. His past medical history and family history was negative. He had no history of alcohol abuse or viral hepatitis infection. Laboratory data revealed normal transaminases and bilirubin levels, and alkaline phosphatase and gammaglutamyltransferase were within normal range. A diagnostic laparoscopy was performed which showed free peritoneal fluid and normal abdominal viscera. Upper gastrointestinal system endoscopy performed a few days later revealed diffuse severe erythematous pangastritis and gastroduodenal gastric reflux. Duodenal biopsies showed chronic nonspecific duodenitis. Antrum and corpus biopsies showed chronic gastritis. The ascitic fluid was straw-colored and sterile with 80% eosinophils. Stool exam was negative for parasitic infection. Treatment with albendazole 400 mg twice daily for 5 days led to the disappearance of ascites and other signs and symptoms. Three months after albendazole treatment the eosinophilic cell count was normal. The final diagnosis was consistent with parasitic infection while the clinical, sonographic and histological findings suggested an eosinophilic ascites. We emphasize the importance of excluding parasitic infection in all patients with eosinophilic ascites. We chose an alternative way (albendazole treatment) to resolve this clinical picture. With our alternative way for excluding this parasitic infection, we treated the patient and then found the cause.

LETTER TO THE EDITOR

Introduction Mucosa-associated lymphoid tissue (MALT) lymphoma most commonly involves the stomach and its treatment is surgery, antibiotic therapy or radiotherapy. Rectal MALT is not only so rare but treatment is not as clear as gastric MALT. Case Presentation Our patient was a 66 year-old man presenting with 5-6 months abdominal pain and anemia. In colonoscopy, a rectal ulcer was found and biopsy revealed MALT lymphoma. Physical examination and staging evaluations were normal. Radiotherapy was started for him but he did not tolerate radiotherapy and instead received chemotherapy. After 38 months, he is fine. Conclusions The incidence of rectal MALT is rare and treatment is not so clear. The results on H. pylori eradication, radiotherapy and chemotherapy are more controversial.