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Amaç: Akut pankreatitli (AP) hastalarda asit gelişimi üzerinde etkili olan faktörleri araştırmak ve asit gelişen AP’li hastalarda şiddetli pankreatit ve mortalite açısından fark olup olmadığını belirlemek. Gereç ve Yöntem: Mayıs 2018 ile Kasım 2021 tarihleri arasında AP tanısıyla hastaneye yatırılan 214 hasta asit gelişip, gelişmeme özelliğine göre gruplara ayrıldı. Hastaların klinik ve laboratuvar parametreleri istatistiksel olarak incelenerek predispozan faktörler belirlendi. Asit gelişiminin AP’li hastalarda pankreatitin seyrine olan etkisi, yatış gün sayısı, yoğun bakım ihtiyacı ve mortalite üzerine olan etkisini belirlemek için istatistiksel modeller kullanıldı. Bulgular: Çalışmaya alınan 214 hastanın 172’sinde (%80,4) asit gelişmez iken 42 hastada (%19,6) AP seyri sırasında asit gelişti. AP’li hastalarda şiddetli pankreatit gelişme oranı asit gelişen (%71,4) ve gelişmeyen (%17,5) hastalar arasında farklılık gösterdi (RR=4,09 p

© 2022 American Association for the Study of Liver Diseases.Background and Aims: A few case reports of autoimmune hepatitis–like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series. Approach and Results: We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18–79) years at presentation. Liver injury was diagnosed a median 15 (range: 3–65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3–4 liver injury than for grade 1–2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up. Conclusions: SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.

Background: Gastric polyps are often detected incidentally during endoscopic procedures performed for different reasons and may sometimes manifest by gastric bleeding, pyloric stenosis, iron deficiency anemia and abdominal pain. Our study aimed to investigate the demographic data of the cases found to have gastric polyps at the gastroenterology endoscopy unit, histologic type of the polyps, their localization and size, and their relationship with Helicobacter pylori. Material and Methods: Between September 2016 - September 2019, gastric polyps were detected in 255 of 9,771 cases who underwent upper gastrointestinal system endoscopy at the Gastroenterology Endoscopy Unit of our hospital. Demographic data, endoscopy reports and pathology results of these patients were retrospectively reviewed from the hospital registry system. Results: Of 255 cases included in the study, 160 (62.7%) were female, and 95 (37.3%) were male, with a mean age of 56.9 (min: 19, max: 95). A total of 336 polyps were detected in 255 cases, with 1.3 polyps per case. 36 (10.7%) of gastric polyps were found to be fundic gland polyps, 32 (9.5%) were found to be foveolar hyperplasia, 137 (40.8%) were found to be hyperplastic polyps, 5 (1.5%) were found to be xanthomas, and 6 (1.8%) were found to be neuroendocrine tumors. Conclusions: According to this study, 90% of gastric polyps detected endoscopically in southeast Turkey are smaller than 5 mm and located most commonly in the corpus; the most common histologic subtype is hyperplastic polyps.

Objectives: The long-term consequences of COVID-19 infection on the gastrointestinal tract remain unclear. Here, we aimed to evaluate the prevalence of gastrointestinal symptoms and post-COVID-19 disorders of gut-brain interaction after hospitalisation for SARS-CoV-2 infection. Design: GI-COVID-19 is a prospective, multicentre, controlled study. Patients with and without COVID-19 diagnosis were evaluated on hospital admission and after 1, 6 and 12 months post hospitalisation. Gastrointestinal symptoms, anxiety and depression were assessed using validated questionnaires. Results: The study included 2183 hospitalised patients. The primary analysis included a total of 883 patients (614 patients with COVID-19 and 269 controls) due to the exclusion of patients with pre-existing gastrointestinal symptoms and/or surgery. At enrolment, gastrointestinal symptoms were more frequent among patients with COVID-19 than in the control group (59.3% vs 39.7%, p, Fondazione Cassa di Risparmio in Bologna; Ministero dell’Istruzione, dell’Università e della Ricerca, MIUR; Korean Society of Neurogastroenterology and Mobility, KSNM; Fondazione del Monte di Bologna e Ravenna: H2020, SC1-BHC-01-2019; United European Gastroenterology, UEG; Fondazione Roma, GB’s contribution to this research was partly supported by funding from Fondazione Cassa di Risparmio in Bologna, the Italian Ministry of Education, University and Research; and Fondazione del Monte di Bologna e Ravenna and European Grant H2020, DISCOvERIE, SC1-BHC-01-2019, We thank the European Society of Neurogastroenterology and Motility, the United European Gastroenterology, and the Rome Foundation for supporting this study.

Several studies have suggested that treatment with direct-acting antivirals (DAAs) in patients with chronic hepatitis C virus (HCV) may be associated with an increased risk of developing hepatocellular carcinoma (HCC). We investigated the incidence and risk factors of HCC in HCV patients who achieved a sustained virologic response (SVR) following DAA therapies.The medical data of patients who were diagnosed with HCV and received DAA therapy in two tertiary centers in Turkey were retrospectively collected.Among them, 75 patients (52.4%) were noncirrhotic and 68 patients (47.6%) were cirrhotic. The overall SVR rate was 97.2% (139/143). It was 100% in noncirrhotic and 94.1% in cirrhotic patients. HCC was developed in 5 (7.4%) patients, all of whom had baseline cirrhosis. The annual rate of HCC occurrence was 2.94%, and the 5-year cumulative incidence of HCC was 7.3%. The mean Child-Pugh score (CPS) and Model for End-Stage Liver Disease (MELD) score significantly decreased after DAA treatment (CPS 7.0 vs 5.9, p=0.001; MELD 10.8 vs 9.5, p=0.003).There was no significant increase in the rate of HCC in cirrhotic HCV patients treated with DAAs. This treatment led to a remarkably high SVR rate and lowered CPS and MELD scores in cirrhotic HCV patients.

Objective: Our working purpose; was to examine the effect of drugs used in the treatment of COVID-19 on liver function tests and to investigate the frequency of development of DILI (drug-induced liver damage) during treatment in patients. In addition, there is not much data in the literature regarding the effect of favipravir on the liver; liver function disorders caused by the widespread use in the treatment of COVID-19; to investigate its relationship with favipravir. Methods: We included 1301 patients who were diagnosed with COVID-19 by PCR test and were hospitalized in our study between April-September -2020. We did not include patients with previously known chronic liver disease, those who developed cytokine release syndrome during COVID-19, and patients who developed sepsis and ischemic hepatitis. We divided the patients into groups according to the medication they used. We examined whether there was a difference in the number of cases with liver dysfunction and DILI between the groups. Results: ALT-AST elevation developed in 50.2% of the 1301 patients we included in the study during the treatment. 45.3% of this increase was mild and moderate enzyme elevation. DILI developed in 4.9% of the patients. DILI developed in 1.1% of the patients who received only favipravir, while the rate of DILI development was found to be 8.7% in patients who received favipravir + antibiotics. (p

Amaç: Çalışma amacımız; COVID-19 tedavisinde kullanılan ilaçların karaciğer fonksiyon testleri üzerindeki etkisini incelemek ve hastalarda tedavi sırasında ilaca bağlı karaciğer hasarı (İBKH) gelişim sıklığını araştırmaktır. Ayrıca literatürde karaciğer üzerindeki etkisiyle ilgili çok fazla veri olmayan favipravirin; COVID-19 tedavisinde yaygın bir şekilde kullanılmaya başlanmasıyla gelişen karaciğer fonksiyon bozukluklarının favipravir ile ilişkisini araştırmaktır. Yöntemler: Çalışmamıza 2020 Nisan-Eylül döneminde PZR (polimeraz zincir reaksiyonu) testi ile COVID 19 tanısı konulan ve hastanede yatarak tedavi gören 1301 hasta aldık. Önceden bilinen kronik karaciğer hastalığı olanları, COVID-19 sırasında sitokin fırtınası, sepsis ve iskemik hepatit gelişen hastaları çalışmaya almadık. Hastaları kullandıkları ilaç tedavisine göre gruplara ayırdık. Gruplar arasında, karaciğer fonksiyon bozukluğu ve İBKH gelişen vaka sayısında fark olup olmadığını inceledik. Bulgular: Çalışmaya aldığımız 1301 hastanın %50.2 sinde tedavi sırasında ALT-AST yüksekliği gelişmesine rağmen bu yüksekliklerin %45.3’ünün hafif ve orta düzeyde enzim artışı olduğu görüldü. Hastaların %4,9’unda İBKH gelişti. Sadece favipravir alan hastaların %1,1’inde İBKH gelişmesine karşın; favipravir+antibiyotik alan hastalarda bu oran %8,7 idi.(p

Amaç: Bu çalışmadaki amacımız en sık kullanılan Helikobakter pylori (Hp) tedavi rejimlerinin HP eradikasyon başarı oranlarını saptamaktır.Materyal ve Metod: 2016 – 2020 yılları arasında üst gastrointestinal sistem endoskopisi sırasında Helikobakter pylori pozitif saptanan ve eradikasyon tedavisi sonrası kontrol endoskopik biyopsi alınan hastalar geriye dönük olarak değerlendirildi. Hastalar tedavi rejimlerine göre 3 gruba ayrıldı; lansoprazol 30 mg 2x1, klaritromisin 500 mg 2x1, amoksisilin 1000 mg 2x1 14 gün alanlar (grup 1, n=20), lansoprazol 30 mg 2x1, bizmut subsalisilat 262 mg 4x1, klaritromisin 500 mg 2x1, amoksisilin 1000 mg 2x1 14 gün alanlar (grup 2, n = 23) ve lansoprazol 30 mg 2x1, bizmut subsalisilat 262 mg 4x1, metronidazol 500 mg 3x1, tetrasiklin 500 mg 4x1 14 gün alanlar (grup 3, n = 17). Bu üç grubun tedavi başarıları değerlendirildi.Bulgular: Çalışmaya, ortalama yaşı 42.8±15.17 olan 60 hasta dahil edildi. Grup 1,2 ve 3’ün yaş ortalamaları sırasıyla 40.05±15.33, 42.86±15.90 ve 46.23±14.14 olup gruplar arasında istatiksel olarak anlamlı farklılık yoktu. Çalışmaya alınan hastaların %57.6’sında (34/60) eradikasyon tedavisi sonrası Hp eradikasyonu sağlandı. Grup 1, 2 ve 3'teki HP eradikasyon oranları sırasıyla %50, %52.2 ve %66.7 idi. Gruplar arasında başarı oranları açısından istatiksel olarak anlamlı farklılık yoktu.Sonuç: Bu çalışmada, yüksek antibiyotik direnci ve hedeflenen eradikasyon oranlarından daha düşük eradikasyon oranları nedeniyle klasik üçlü tedavi, bizmut eklenmiş klasik üçlü tedavi ve bizmutlu dörtlü tedavinin Türkiye’de kullanılmasının uygun olmayabileceği sonucuna vardık. Helikobakter pylori tedavisinde yeni tedavi rejimlerinin geliştirilmesi gerekmektedir.

The aim of the study was to evaluate the relationship among lower esophageal sphincter pressure (LESP),The retrospective study included patients with isolated hypertensive or hypotensive lower esophageal sphincter (LES) who underwent esophageal manometry in our gastroenterology motility laboratory and had normal manometry results. Demographic characteristics, complaints on admission, upper endoscopy findings, 24-h esophageal pH monitoring results, and presence of Hp in gastric biopsy were evaluated.A total of 1226 patients were included in the study, among whom women comprised 54% of all patients. Mean age was 45.4±13.4 years. Most common presenting complaint was pyrosis (85.4%). Pathological reflux was detected in 61.4% of the patients in 24-h esophageal pH monitoring. Reflux esophagitis was detected in 22.9% and LES laxity was present in 17.4% of the patients. In gastric biopsy, Hp was positive in 40% of the patients. The age of patients with hypertensive LES was significantly higher and female gender and body mass index (BMI) were associated with hypertensive LES. Pyrosis was significantly less prevalent in patients with hypertensive LESP. Esophagitis and LES laxity were significantly more prevalent in patients with hypotensive LES. No significant difference was found among the three groups with regard to reflux and Hp positivity. No significant difference was found between Hp-positive and Hp-negative groups with regard to reflux and reflux esophagitis.No clear relationship was found among LES disorders, GER, and Hp. Moreover, no significant difference was found among LES disorders with regard to GER, while the presence of hypotensive LESP, rather than Hp, was found to be an important factor in the development of reflux esophagitis.

Background We investigated associations between baseline use of immunosuppressive drugs and severity of Coronavirus Disease 2019 (COVID-19) in autoimmune hepatitis (AIH). Patients and methods Data of AIH patients with laboratory confirmed COVID-19 were retrospectively collected from 15 countries. The outcomes of AIH patients who were on immunosuppression at the time of COVID-19 were compared to patients who were not on AIH medication. The clinical courses of COVID-19 were classified as (i)-no hospitalization, (ii)-hospitalization without oxygen supplementation, (iii)-hospitalization with oxygen supplementation by nasal cannula or mask, (iv)-intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v)-ICU admission with invasive mechanical ventilation or (vi)-death and analysed using ordinal logistic regression. Results We included 254 AIH patients (79.5%, female) with a median age of 50 (range, 17-85) years. At the onset of COVID-19, 234 patients (92.1%) were on treatment with glucocorticoids (n = 156), thiopurines (n = 151), mycophenolate mofetil (n = 22) or tacrolimus (n = 16), alone or in combinations. Overall, 94 (37%) patients were hospitalized and 18 (7.1%) patients died. Use of systemic glucocorticoids (adjusted odds ratio [aOR] 4.73, 95% CI 1.12-25.89) and thiopurines (aOR 4.78, 95% CI 1.33-23.50) for AIH was associated with worse COVID-19 severity, after adjusting for age-sex, comorbidities and presence of cirrhosis. Baseline treatment with mycophenolate mofetil (aOR 3.56, 95% CI 0.76-20.56) and tacrolimus (aOR 4.09, 95% CI 0.69-27.00) were also associated with more severe COVID-19 courses in a smaller subset of treated patients. Conclusion Baseline treatment with systemic glucocorticoids or thiopurines prior to the onset of COVID-19 was significantly associated with COVID-19 severity in patients with AIH., Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic), A. Gerussi, L. Cristoferi, and P. Invernizzi acknowledge that this research was partially supported by the Italian Ministry of University and Research (MIUR)-Department of Excellence project PREMIA (PREcision MedIcine Approach: bringing biomarker research to clinic).

Background: Data regarding outcome of Coronavirus disease 2019 (COVID-19) in vaccinated patients with autoimmune hepatitis (AIH) are lacking. We evaluated the outcome of COVID-19 in AIH patients who received at least one dose of Pfizer- BioNTech (BNT162b2), Moderna (mRNA-1273) or AstraZeneca (ChAdOx1-S) vaccine. Patients and methods: We performed a retrospective study on AIH patients with COVID-19. The outcomes of AIH patients who had acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection after at least one dose of COVID-19 vaccine were compared to unvaccinated patients with AIH. COVID-19 outcome was classified according to clinical state during the disease course as: (i) no hospitalization, (ii) hospitalization without oxygen supplementation, (iii) hospitalization with oxygen supplementation by nasal cannula or mask, (iv) intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v) ICU admission with invasive mechanical ventilation or (vi) death, and data was analyzed using ordinal logistic regression. Results: We included 413 (258 unvaccinated and 155 vaccinated) patients (81\%, female) with a median age of 52 (range: 17-85) years at COVID-19 diagnosis. The rates of hospitalization were (36.4\% vs. 14.2\%), need for any supplemental oxygen (29.5\% vs. 9\%) and mortality (7\% vs. 0.6\%) in unvaccinated and vaccinated AIH patients with COVID-19. Having received at least one dose of SARS-CoV-2 vaccine was associated with a significantly lower risk of worse COVID-19 severity, after adjusting for age, sex, comorbidities and presence of cirrhosis (adjusted odds ratio {[}aOR] 0.18, 95\% confidence interval {[}CI], 0.10-0.31). Overall, vaccination against SARSCoV-2 was associated with a significantly lower risk of mortality from COVID-19 (aOR 0.20, 95\% CI 0.11-0.35). Conclusions: SARS-CoV-2 vaccination significantly reduced the risk of COVID-19 severity and mortality in patients with AIH.

Object We aimed to evaluate the elevation of amylase and lipase enzymes in coronavirus disease 2019 (COVID‐19) patients and their relationship with the severity of COVID‐19. Method In this study, 1378 patients with COVID‐19 infection were included. Relation of elevated amylase and lipase levels and comorbidities with the severity of COVID‐19 was analysed. The effects of haemodynamic parameters and organ failure on pancreatic enzymes and their relations with prognosis were statistically analysed. Results The 1378 patients comprised of 700 (51.8%) men and 678 (%49.2) women. Of all patients, 687 (49.9%) had mild and 691 (50.1%) patients had severe COVID‐19 infection. Amylase elevation at different levels occurred in 316 (%23) out of 1378 patients. In these patients, the amylase levels increased one to three times in 261 and three times in 55 patients. Pancreatitis was detected in only six (%1.89) of these patients according to the Atlanta criteria. According to univariate and multivariate analyses, elevated amylase levels were significantly associated with the severity of COVID‐19 (odds ratio [OR]: 4.37; P

Aim: The aim of this study; to investigate the clinical course and mortality of COVID-19 in chronic liver patients with and without cirrhosis and to determine decompensation rates during COVID'19 in cirrhotic patients.Materials and Methods: 96 patients with chronic liver disease (30 of them cirrhosis) and 153 patients without any comorbid disease were included in this study. It was examined whether there was a difference among these patient groups in terms of severity and mortality of COVID-19.Results: Severe COVID-19 developed in 46.6% (14/30) cirrhotic patients, in 15.1% (10/66) non-cirrhotic patients, and in 12.4% (19/153) patients with no chronic liver disease (p, Amaç: Sirozu olan ve olmayan kronik karaciğer hastalarında COVID-19’un klinik seyrini ve mortalitesini araştırmak ve sirotik hastalarda COVID’19 sırasında kompansasyon oranlarını belirlemek.Gereç ve Yöntem: Bu çalışmaya, kronik karaciğer hastalığı olan 96 hasta ile (30 tanesi sirotik) herhangi bir komorbid hastalığı bulunmayan 153 hasta alındı. Bu hasta grupları arasında COVID-19’un şiddeti ve mortalitesi açısından fark olup olmadığı incelendi.Bulgular: Sirotik hastaların %46,6’sında (14/30) non-sirotik hastaların %15,1’inde (10/66), kronik karaciğer hastalığı olmayan hastaların %12,4’ünde (19/153)’ünde ağır COVID-19 gelişti (p

Background Viral infections can cause acute pancreatitis. Idiopathic pancreatitis has an important proportion in the etiology of acute pancreatitis. Objective To investigate the rate of development of acute pancreatitis (AP) in COVID-19 patients and to determine the rate of idiopathic pancreatitis in the etiology of this pancreatitis. Methods A total of 6.467 patients hospitalized with the COVID-19 diagnosis were included in the study. Patients diagnosed with AP based on the Atlanta criteria were identified. Etiological factors were determined in patients who developed acute pancreatitis and compared with the etiological factors in 315 patients with non-COVID-19, hospitalized with the diagnosis of AP before the COVID-19 pandemic. AP was detected in 0.1% of patients with COVID-19. While gallstone was the etiologic factor in 2 (28.6%) of seven patients who developed acute pancreatitis during COVID-19, hyperlipidemia was the factor for 1 (14.3%) patient. Moreover, the etiologic factor could not be determined in 4 (57.1%) patients, and they were regarded as idiopathic pancreatitis patients. Biliary pancreatitis was the most common etiologic factor in 315 (78.4%) patients admitted to the hospital for AP before the COVID-19 pandemic. Idiopathic pancreatitis was ranked second with 16.8%. Conclusion It was observed that there was a significant difference in the incidence of idiopathic pancreatitis between patients with COVID-19 and non-COVID-19 (P=0.015). Results suggest that the SARS-Cov-2 virus may be among the factors leading to AP.

Background: In this study, our aim was to draw attention to the vaccine hesitation as a cause of unvaccination and evaluate the vaccinated and unvaccinated patients in the intensive care unit in terms of morbidity and mortality.Methods: A hundred and ninety-nine patients between the May 2021-September 2021 admitted to the intensive care units in our hospital were included in this study. We included the patients with COVID-19 infection as assessed by reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assay.Results: Despite the availability of eligible vaccines in our region, the most of included patients in this study were unvaccinated (n:119). Eighty patients were vaccinated. The vaccinated patients were divided into six groups according to their vaccination status such as subgroup 1: one-dose Coronavac, subgroup 2: two-doses Coronavac, subgroup 3: three-doses Coronavac, subgroup 4: 2-doses Coronavac+ One-dose BNT162b2, subgroup 5: one-dose BNT162b2, subgroup 6: two-doses BNT162b2 (Numbers of patients: 7-61-3-1-10-0 respectively for each group). Between the vaccinated and unvaccinated groups, there was no significant difference in terms of mortality (p>0,05). The majority of patients in the vaccinated group were the patients vaccinated with Coronavac (subgroup 2:59), and there was no full dose vaccinated patient with BNT162b2.Conclusions: While both vaccines are effective to reduce the morbidities and mortality related to COVID-19, there might not be efficacy in these vaccines, particularly Coronavac, following the admission to the intensive care unite in the more vulnerable population. And despite the availability of vaccines, vaccine-hesitancy may be one of the significant reasons for the hospitalization process.

Background: Hepatit B virus (HBV) is one of the main causes of liver related morbidity and mortality in worldwide. This condition is also a significant healthcare problem in Turkey. Entecavir (ETV) and tenofovir (TDF) are potent nucleos(t)ide analogues (NAs) recommended for the treatment of chronic HBV (CHB) infection. The aim of the study was to determine the association of NAs and nephrotoxicity in our CHB cohort.Methods: Between the January 2011-February 2021, there were 294 patients treated with TDF (N=194) and ETV (N=100). Glomerular filtration rate (GFR) was calculated by the modification of diet in renal disease (MDRD) method. Kidney function tests were assessed at baseline and follow-up visits.Results: There were 294 patients in the total group. The mean follow-up period was 66±18 months. Age and sex distributions and baseline assessments including liver function tests, creatinine, GFR, HBV DNA values and pathology scores (HAI and fibrosis) were similar between TDF (N=194) and ETV (N=100) groups. Creatinin and GFR assessed at the last visit were 0.81±0.01 g/dl and 102.94±19.78 ml/min for TDF and 0.81±0.013 g/dl and 104.65±19.05 ml/min for ETV. These values were not significant between the both treatment groups. In terms of nephrotoxicity, none of the patients had significant changes in terms of creatinine and GFR that may require dose adjustment.Conclusions: We showed that the use of both drugs led to a decrease in GFR that was not clinically important in chronic hepatitis B patients with normal baseline renal tests and without co-morbidity.

Aim: The present study aimed to examine the prevalence of liver dysfunction in patients hospitalized due to coronavirus disease 2019 (COVID-19) and to investigate the role of liver dysfunction in predicting intensive care unit admission and mortality.Material and Methods: A total of 2168 patients who had no previously known chronic liver disease and were found to be COVID-19 positive on polymerase chain reaction test were divided into mild and severe COVID-19 groups. The effect of the development of liver damage on the course and prognosis of COVID-19 was investigated.Results: Elevated liver enzymes developed in 26.3% (n=461) of the patients with mild COVID-19 and in 45.3% (n=189) of the patients with severe COVID-19. The highest ALT and AST elevation was detected in patients using more than one drug with antibiotics (p, Amaç: Bu çalışma, koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) nedeniyle hastaneye yatırılan hastalarda karaciğer fonksiyon bozukluğu prevalansını incelemeyi ve yoğun bakım ünitesine yatış ve mortaliteyi öngörmede karaciğer fonksiyon bozukluğunun rolünü araştırmayı amaçlamaktadır.Gereç ve Yöntemler: Önceden bilinen bir kronik karaciğer hastalığı olmayan ve polimeraz zincir reaksiyonu testi ile doğrulanmış COVID-19 pozitif olan toplam 2168 hasta, hafif ve şiddetli COVID-19 olarak gruplara ayrıldı. Karaciğer hasarı gelişiminin COVID-19’un seyrine ve prognozuna etkisi araştırıldı.Bulgular: Hafif COVID-19’lu hastaların %26,3’ünde (n=461) ve şiddetli COVID-19’lu hastaların %45,3’ünde (n=189) karaciğer enzimlerinde yükselme meydana geldi. En yüksek ALT ve AST artışları, antibiyotikler ile birlikte birden fazla ilaç kullanan hastalarda tespit edildi (p

WOS:000623281200098 Aquagenic syringeal acrokeratoderma (ASA) is a rare, acquired disease affecting predominantly young women. It is characterised by the development of hypopigmented, translucent, flat‐topped, oedematous papules and plaques that form hyperwrinkling or keratoderma.1 It occurs after 3‐5 minutes of contact with water and resolves when the hand dries.1 Although its aetiology is not known exactly, it has been suggested that the disease may develop due to genetic predisposition or diseases such as cystic fibrosis, focal hyperhidrosis and Raynaud's phenomenon.2, 3 However, increased personal hygiene measures such as wearing personal protective equipment, excessive hand washing and disinfection in the COVID‐19 epidemic may play a role in the aetiology of ASA.5 Here we present ten cases with a very short history of ASA where lesions were first seen after the COVID‐19 outbreak.

Background: data regarding outcome of Coronavirus disease 2019 (COVID-19) in patients with autoimmune hepatitis (AIH) are lacking. Patients and methods: we performed a retrospective study on AIH patients with COVID-19 from 34 centres in Europe and the Americas. We analyzed factors associated with severe COVID-19 outcomes defined as the need for mechanical ventilation, intensive care admission, and/or death. The outcomes of patients with AIH were compared to a propensity-score matched cohort of non-AIH patients with chronic liver diseases (CLD) and COVID-19. The frequency and clinical significance of new-onset liver injury (alanine aminotransferase>2xupper limit of normal) during COVID-19 was also evaluated. Results: we included 110 AIH patients (80%,female) with a median age of 49 (range:18-85) years at COVID-19 diagnosis. New-onset liver injury was observed in 37.1% (33/89) of the patients. Use of antivirals was associated with liver injury (p=0.041; odds ratio (OR) 3.36[1.05-10.78]) while continued immunosuppression during COVID-19 was associated with a lower rate of liver injury (p=0.009; OR 0.26[0.09-0.71]). The rates of severe COVID-19 (15.5% vs 20.2% p=0.231) and all-cause mortality (10% vs 11.5%; p=0.852) were not different between AIH and non-AIH CLD. Cirrhosis was an independent predictor of severe COVID-19 in patients with AIH (p, Italian Ministry of University; Research (MIUR)-Department of Excellence Project PREMIA; AMAF Monza ONLUS; AIRCS

Background/Aims: Gastric polyps are often detected incidentally during endoscopic procedures performed for different reasons and may sometimes be manifested by gastric bleeding, pyloric stenosis, iron deficiency anemia and abdominal pain. In our study, we aimed to investigate the demographic data of the cases who were found to have gastric polyps at the gastroenterology endoscopy unit, histologic type of the polyps, their localization and size, and their relationship with Helicobacter Pylori. Materials and Methods: Between September 2016 - September 2019, gastric polyps were detected in 255 of 9771 cases who underwent upper gastrointestinal system endoscopy at the Gastroenterology Endoscopy Unit of …….. Training and Research Hospital. Demographic data, endoscopy reports and pathology results of these patients were retrospectively reviewed from the hospital registry system. Results: Of 255 cases included in the study, 160 (62.7%) were female and 95 (37.3%) were male, with a mean age of 56.9 (min: 19, max: 95). A total of 336 polyps were detected in 255 cases, with 1.3 polyps per case. 36 (10.7%) of gastric polyps were found to be fundic gland polyps, 32 (9.5%) were found to be foveolar hyperplasia, 137 (40.8%) were found to be hyperplastic polyps, 5 (1.5%) were found to be xanthomas, and 6 (1.8%) were found to be neuroendocrine tumors. Conclusion: According to this study, 90% of gastric polyps detected endoscopically in southeast Turkey are smaller than 5 mm and located most commonly in the corpus; the most common histologic subtype is hyperplastic polyps.

Isotretinoin is a first-generation retinoid initially approved for the treatment of severe cases of acne vulgaris (nodulocystic acne). Because of its broad anti-inflammatory and immunomodulatory properties, it has been used beyond its initial approval in a myriad of other indications. Adverse effects of isotretinoin vary from xerosis to teratogenicity. Herein, we reviewed the literature, through date-unlimited PubMed search, from inception till December 2019, using the following search terms: "low-dose isotretinoin" and "dermatology," "isotretinoin and safety," "isotretinoin, off-label uses," "isotretinoin and male fertility," "isotretinoin, iPLEDGE system," aiming to deliver a therapeutic update relevant to clinical practice. All English-language articles were considered with no limitation based on the articles' type. Low-dose isotretinoin is not limited to old and novel dermatological conditions, but also showed promising results in the field of infertility and safety in the field of gastroenterology. We also highlight on the safety profile of the drug and experts' recommendations to enhance safety measures to decrease fetal risk while on isotretinoin.

Amaç: Toksik hepatit birçok ilaç ve bitkisel ürünün alınmasıyla ortaya çıkan klinik tablodur. Çok sayıda ilaç değişik mekanizmalarla toksik hepatite neden olmaktadır. Hastalığın görülme sıklığı ve sebepleri bölgesel farklılıklar gösterebilmektedir. Çalışmadaki amacımız kliniğimize başvuran toksik hepatitli olguların demografik, klinik ve laboratuar özelliklerini sunmaktır. Yöntemler: Ağustos 2014-Haziran 2016 tarihleri arasında kliniğimize anormal karaciğer fonksiyon testleri nedeniyle yatırılan, klinik ve laboratuar değerlendirme sonrası TH tanısı konulan hastalar alındı. Hastaların demografik özellikleri, toksik hepatitin muhtemel etiyolojisi, klinik özellikleri, biyokimya ve tam kan değerleri, klinik seyirleri kaydedildi. Bulgular: Çalışmaya yaş ortalaması 41.4±16.8 olan 56 (34 kadın) hasta alındı. Hastaların 31 (%55.6)’inde ilaçlar, 11 (%20.4)’inde bitkisel maddeler, 6 (%9,3)’ında narkotik madde ve 8 (%14,8)’inde bitkisel madde, ilaç ve narkotik kullanımına bağlı toksik hepatit geliştiği saptandı. İlaçlar içinde en çok antibiyotik (birinci sırada amoksisilin+ klavulanik asit) ve non-steroid anti inflamatuvar ilaç (birinci sırada diklofenak sodyum) kullanımı hikayesi saptandı. Bitkisel madde kullanımı olan hastalarda en sık meryem otu, lavanta çayı ve atom çayı kullanım hikayesi mevcuttu. Narkotik madde olarak en sık ekstazi (5 hasta) kullanımı saptandı. Otuz yaş altı (RR:1.545, p

İnsan fasioliazisi, Fasciola hepatica ve Fasciola gigantica’nın neden olduğu, dünya genelinde nadir görülen zoonotik bir hastalıktır. Genellikle çiftlik hayvanlarını etkileyen bir trematod olup insan rastlantısal ara konakçıdır. Spesifik olmayan semptom ve bulgularının birçok hepatobiliyer hastalıkta izlenebilmesi nedeniyle fasioliazisin tanı ve tedavisi gecikebilmektedir. Elli üç yaşında kadın hasta 18-Florodeoksi-glukoz pozitron emisyon bilgisayaralı tomo-grafi incelemesinde ekstrahepatik safra yollarında yüksek florodeoksi-glukoz tutulumu nedeniyle kliniğimize başvurdu. Hastada son 3 aydır süren karın ağrısı, kaşıntı ve halsizlik yakınmaları mevcuttu. Kolanjiyosellüler kanseri taklit eden ve serolojik olarak tanısı konan biliyer fasioliazisli bu vakayı sunacağız., Human fascioliasis is a rare zoonotic disease caused by Fasciola hepatica and Fasciola gi-gantica. Humans may be coincidental intermediate hosts of these trematodes that usually affect livestock. Nonspecific signs and symptoms of this disease may also occur in several other hepatobiliary diseases, which potentially leads to a delay in diagnosis and treatment. A 53-year-old female patient was admitted to our clinic due to high fluorodeoxyglucose uptake in the extrahepatic bile ducts on the (18) F-fluoro-2-deoxy-D-glucose positron emission tomog-raphy scan. She had symptoms including abdominal pain, pruritus, and malaise lasting for the last 3 months. We present the case of this patient with biliary fascioliasis that mimicked chol-angiocellular carcinoma and was diagnosed serologically.

Laurence Moon Bardet Biedl Sendromu (LMBBS); otozomal resesif geçişli, obezite, mental retardasyon, polidaktili, hipogonadizm ve retinitis pigmentoza ile karakterize nadir görülen bir bozukluktur. Hastalığın tanı kriterleri arasında yer almasa da bu hastalarda, böbreklerde yapısal anomali ve fonksiyon bozukluğu, diabetes mellitus, insülin direnci, hipertansiyon ve karaciğerde fibrozis de görülebilmektedir. Renal fonksiyonlarda progresif bozulma sonucu gelişen son dönem böbrek yetersizliği en sık ölüm nedenidir. Bu olgu sunumunda, boyun apsesi, üre, kreatinin değerlerinde yükseklik ve metabolik asidozla başvuran 17 yaşında bir Laurence Moon Bardet Biedl sendromu olgusunun paylaşması amaçlandı. The Laurence Moon Bardet Biedl syndrome (LMBBS), is a rare autosomal recessive disorder characterized by obesity, mental retardation, polydactly, hypogonadism and retinitis pigmentosa. Kidney failure, diabetes mellitus, insulin resistance, hypertension and liver fibrosis which are not included among the criteria for the diagnosis of the disease can also be seen in these patients. End stage renal disease that develops as a result of progressive deterioration in renal function is the most frequent cause of death. In this case report, a 17-year-old male patient with LMBBS who had a neck abscess, high urea- creatinine levels and metabolic acidosis is reported.

To the Editor, Leptospirosis is a self-limited zoonotic disease in mild cases, but the more severe form, known as Weil disease, can progress to multi-organ failure (1). Clinical signs and routine laboratory tests are non-specific. Therefore, in clinically suspected cases, antibiotic treatment must be immediately initiated. However, the antibiotic treatment may not be sufficient in Weil disease. Supportive treatment may be life-saving at this point. A 19 year-old male presented with fever, nausea, vomiting, generalized jaundice, and reduced urinary output. Laboratory investigations revealed severe thrombocytopenia, elevated total bilirubin, and increased urea and creatinine levels. The history revealed that he had worked in a wooden fruit crate production facility. He resigned from his job and returned to his city 15 days before the clinical onset. He frequently scratched his hands and there were mice infestations where he used to work. He was initially diagnosed with Weil disease and treatment with ampicillinsulbactam (Ampisid, Mustafa Nevzat Medical; Istanbul, Turkey) was initiated at 3gr/day. On the third day of the follow-up, his platelet count decreased to 19,000 and his total bilirubin level rose to 14.7 mg/dL; he had epistaxis. Since we could not perform plasmapheresis, prednisolone (Prednisolon, Actavis Medical; Istanbul, Turkey) was initiated at 1 mg/kg on the third day of admission. With the initiation of prednisolone, his platelet count began to rise and epistaxis regressed. Prednisolone was stopped on the fifth day and ampicillin-sulbactam course was completed after 14 days. At his outpatients’ control after 15 days, total biliruin level regressed to 6.0 mg/dL and all other laboratory results normalized (Table 1). Microagglutination test (MAT) for serodiagnosis was later determined to be positive (L. icterohaemorrhagiae, titer: 1:200; serum was taken on the first day). TABLE 1. Laboratory results before and after prednisolone therapy (The prednisolone was started on Day 3) Our patient had a history of highly probable contact with mouse urine. He was initially diagnosed with Weil disease and antibiotic treatment was initiated immediately. His renal functions partially improved following intensive hydration and antibiotic treatment; however, thrombocytopenia worsened and total bilirubin level increased further. It has been reported that 50–80% of leptospirosis patients had thrombocytopenia, frequently accompanying renal failure (1,2). Although its pathophysiology is not exactly clear, the following explanations were asserted: 1- direct toxicity of leptospira on the bone marrow, 2- thrombocyte consumption caused by DIC, 3- immune-mediated thrombocyte destruction due to capillary vasculitis and inflammation (most favored mechanism), and 4- increased thrombocyte consumption secondary to vascular endothelial activation (3,4). The presence of thrombocytopenia indicates severe disease; therefore, it should be closely monitored with regard to bleeding. After the addition of prednisolone, the platelet count rise and epistaxis regressed, supporting the idea that thrombocytopenia in leptospirosis appears secondary to vasculitis and inflammation. There are limited data evaluating the use of prednisolone in Weil disease (2,5,6). These reports showed that anti-inflammatory drugs like corticosteroids can reverse vasculitis by suppressing inflammation triggered by the disease and, as a result, reduce mortality. Similarly, we also found an effective response to corticosteroid therapy in a short period of time in our case. Based on this, we would like to emphasize that considering Weil disease in differential diagnosis of patients with fever, icterus, azotemia or hematological abnormalities is of significance. Antibiotic treatment should be initiated immediately upon suspicion of Weil disease in order to prevent mortality. Early administration of steroids helps to improve renal functions and prevents mortality in cases with thrombocytopenia. This approach could be important for centers where resources and patient transfer chances are limited.

We present a case of Fasciola gigantica-induced biliary obstruction and cholestasis diagnosed and treated via endoscopy and trichlorobendazole treatment. This is the first case of Fasciola gigantica treated via endoscopic biliary extraction during ERCP and drug treatment reported from Turkey.

A case of Fasciola gigantica-induced biliary obstruction and cholestasis is reported in Turkey. The patient was a 37- year-old woman, and suffered from icterus, ascites, and pain in her right upper abdominal region. A total of 7 living adult flukes were recovered during endoscopic retrograde cholangiopancreatography (ERCP). A single dose of triclabendazole was administered to treat possible remaining worms. She was living in a village of southeast of Anatolia region and had sheeps and cows. She had the history of eating lettuce, mallow, dill, and parsley without washing. This is the first case of fascioliasis which was treated via endoscopic biliary extraction during ERCP in Turkey.