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The COVID-19 pandemic has had a significant negative impact on the world in various ways. In an effort to mitigate the negative effects of the pandemic, this study proposes a deep learning approach for the automatic detection of COVID-19 from chest computed tomography (CT) images. This would enable healthcare professionals to more efficiently identify the presence of the virus and provide appropriate care and support to infected individuals. The proposed deep learning approach is based on binary classification and utilizes members of the pre-trained EfficientNet model family. These models were trained on a dataset of real patient images, called the EFSCH-19 dataset, to classify chest CT images as positive or negative for COVID-19. The results of the predictions made on the test images showed that all models achieved accuracy values of over 98%. Among these models, the EfficientNet-B2 model performed the best, with an accuracy of 99.75%, sensitivity of 99.50%, specificity of 100%, and an F1 score of 99.75%. In addition to the high accuracy achieved in the classification of chest CT images using the proposed pre-trained deep learning models, the gradient-weighted class activation mapping (Grad-CAM) method was also applied to further understand and interpret the model's predictions.

Amaç: Ranibizumab tedavisine dirençli tip 1 koroidal neovasküler membranlı olgularda intravitreal aflibercept tedavisinin etkinliğini araştırmak. Gereç ve Yöntemler: Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Göz Kliniği’ne Aralık 2012- Ocak 2016 tarihleri arasında başvurup, neovasküler tip yaşa bağlı makula dejenerasyonu (YBMD) tanısı alan, optik koherens tomografi (OKT) ve fundus floresein anjiografi (FFA) ile tip 1 koroidal neovasküler membranı (KNV) olduğu tespit edilen 22 hastanın 24 gözü geriye dönük olarak incelendi. Olguların ilk başvurularındaki ve ranibizumab tedavisi sonrasındaki en iyi düzeltilmiş görme keskinlikleri (EİDGK), fundus muayene bulguları ve OKT ile yapılan makula kalınlığı ölçümleri kaydedildi. İntravitreal aflibercept tedavisinin etkinliğini değerlendirmek için tedavi öncesi ve sonrasındaki EİDGK’leri, ortalama enjeksiyon sayıları ve ortalama makula kalınlıkları istatistiksel olarak karşılaştırıldı. İstatistiksel analizler için NCSS (Number Cruncher Statistical System) 2007 (Kaysville, Utah, USA) programı kullanıldı. Çalışma verileri değerlendirilirken tanımlayıcı istatistiksel metodların (Ortalama, Standart Sapma, Medyan, Frekans, Oran, Minimum, Maksimum) yanı sıra; niceliksel verilerin karşılaştırılmasında normal dağılım göstermeyen parametrelerin iki grup karşılaştırmalarında ise Mann Whitney U testi kullanıldı. Normal dağılım göstermeyen üç ve üzeri grupların karşılaştırmalarında ise Kruskal Wallis test kullanıldı. Normal dağılım göstermeyen parametrelerin grup içi karşılaştırmalarında ise Wilcoxon Signed Ranks test kullanıldı. Anlamlılık p0,05). Sonuç: Çalışmamızda ranibizumab tedavisine dirençli neovasküler YBMD’nin intravitreal aflibercept enjeksiyonu ile tedavisinde anatomik iyileşme sağlandı. Retinadaki sıvı lokasyonunun, PED mevcudiyetinin, tedaviye dirençli vakalarda aflibercept etkinliğinde belirleyici faktör olmayabileceği düşünüldü.

Background/Aim: A liver biopsy is required for the reimbursement of antiviral therapy in Hepatitis B e-antigen (HBe-Ag) negative chronic hepatitis B patients. Liver biopsy is an invasive procedure with potential complications, such as bleeding, pain, pneumothorax, and even death. The study aimed to evaluate simple and non-invasive parameters that may help predict histological criteria that would be eligible for antiviral treatment reimbursement. Methods: HBeAg-negative chronic hepatitis B patients with alanine transaminase (ALT) levels > upper normal limit (40 IU/L) and HBV DNA viral load > 2000 IU/ml who underwent liver biopsy were enrolled in this retrospective cohort study. ALT, aspartate aminotransferase (AST), alpha-fetoprotein (AFP) values, hepatitis B virus (HBV) DNA levels, platelet count, and hepato-steatosis grade based on ultrasonography were used to predict the eligibility for antiviral therapy reimbursement. Eligibility for reimbursement of antiviral treatment regarding histological criteria defined by National Social Security Institution is based on the hepatitis activity index (HAI) score ≥ 6 and/or fibrosis score ≥ 2 according to Ishak’s scoring system. Results: One hundred and fifteen patients were included in the study; 79 patients (68.7%) were male. The mean age of patients was 46.51 (11.39). Sixty-two patients (53.9%) had a fibrosis score ≥ 2, and 80 (69.6%) patients had an HAI score ≥ 6. Ninety-two (80%) of the patients fulfilled histological criteria for antiviral treatment reimbursement. Multivariate analysis revealed that age and platelet count were independent predictors of eligibility for antiviral treatment reimbursement. The platelet count cut-off point was 198 x 109 /L for predicting eligibility for antiviral treatment reimbursement. Conclusion: Most patients (92/115, 80%) with high ALT and DNA viral load were eligible for antiviral treatment reimbursement. Platelet count and age may be used as simple non-invasive parameters for predicting the eligibility for antiviral treatment reimbursement in terms of histological findings.

Aim: Infective endocarditis (IE), infection of the endocardial surface of heart, may cause mortality up to 30% despite advancements in medical care. Epidemiology of IE and profile of causative organism has changed in the last years. We aimed to investigate the changing profile of IE over a 31-year period in a tertiary care hospital Material and Method: Medical records of 290 patients treated with the diagnosis of IE between 1974 and 2005 were re-evaluated according to Modified Duke criteria. Forty seven cases were classified as rejected cases. Results: Of the 243 patients 109 was female (44.8%) and 134 male (55.2%). The mean age of the patients was 38±16.4 years (Table). The mean age of the patients showed an increasing trend throughout the time (p< 0.001) ; it was 29 years between 1974- 1980 but increased to 54 years in 2001-2005 period. Rheumatic valvular disease (RVD) was the most frequent underlying heart disease (60%) but showed a declining trend especially in the last years. S. aureus was the most common pathogen in all the time periods (15.2%). Blood cultures were negative in 90 (43%) patients. But the percentage of blood culture negativitiy decreased significantly from 63% in 1981-1985 periods to 28% in 2001-2005 period. (p: 002). Mitral valve was the most common affected valve (52, 44%). Surgery was performed in 74 of the 243 cases (30.5%). In-hospital mortality rate was 30.6. Mortality rate was significantly lower in patients who underwent surgery compared to ones who did not (19.2% vs. 35.8%, p< 0.005). Mortality rate was also lower in patients with community acquired infection compared to ones with nosocomial infection (27% vs 45%). Embolic events, nosocomial infections and surgery were independent risk factors for mortality. Conclusion: The mean age of IE population is increasing, RVD disesase is less commonly seen as an underlying heart and S. aureus is the most common pathogen. These findings are compatible with the reports from developed countries. Surgery displays a protective effect on the prognosis of IE

Aim: Crohn's disease patients require life-long follow-up resulting in frequent hospital visits. The benefits of telehealth have been established in the remote management of Crohn’s disease but the role of mobile technology is missing. Our goal was to determine the feasibility and effectiveness of smartphone-based real-time video visits. Material and Method: We followed 139 patients with either traditional (FTF) or online clinics (OLV) at a university hospital between May 2020- December 2020. We measured patients' satisfaction, disease activity, visit outcomes, socioeconomic parameters, and travel expenses to assess the effectiveness and acceptance of OLV. Results: Satisfaction scores were significantly higher at OLV compared to FTF (89.58±9.93 vs 70.85±18.51, p

BACKGROUND/AIM Plastic biliary stents that remain in situ for more than 12 months, termed forgotten biliary stents (FBSs), can cause complications such as cholangitis, stent migration, stent occlusion and perforation. We evaluated the incidence, complications, and management of FBSs in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). MATERIALS AND METHODS The medical records of patients who underwent ERCP procedures at the Gastroenterology Endoscopy Department of Kocaeli University Medical Faculty from December 2016 to December 2020 were analysed retrospectively. Data on patient characteristics, indications for ERCP and stenting, stent types, stenting duration, and complications were obtained from the hospital?s database. RESULTS A total of 48 cases with FBSs were analysed. The mean age (SD) of the patients was 71.23 years (12.165), the male to female ratio was 23/25 (0.92), and the mean stenting duration was 27.12 (range: 12?84) months. The most common indication for biliary stenting was irretrievable choledochal stones (40/48). Among the FBS patients in whom ERCP was performed, the most common presenting condition was cholangitis (22/34). Stone formation (79%) and proximal stent migration (26.4%) were the most frequent complications. The patients in the FBS group were significantly older than those in whom stents were removed in a timely manner (71.23 vs. 62.43 years, p < 0.001). Endoscopic treatment was possible in all cases; surgery was not required in any case. The most common cause of FBSs cited by patients was not having been informed about the need for long-term management of their stents (n = 14, 29.2%) Conclusion: FBSs are potentially problematic, particularly in older patients. Communication with the patient to remind them of the need for stent management is important for preventing FBSs.

This study presents a thorough review of the literature on intergenerational income mobility with a focus on the issues regarding consistent estimation of mobility correlations. In the light of the discussions, the intergenerational income association in Turkey is analyzed using OLS and IV estimation strategies. The sample is extracted from Household Budget Surveys and includes father-son and father-daughter pairs with either non-zero wages or non-zero earnings living in the same household in any of the years between 2003 and 2011. OLS and IV estimation strategies are shown to bound the true population mobility correlation from below and above; hence, resulting in a consistent interval estimate of intergenerational mobility. The true mobility correlations in the population are estimated to be in the range of (0.10, 0.51) for sons and (0.17, 1.00) for daughters. The large mobility correlations may call for government intervention to break the harmful income link across generations., Bu çalışma, hareketlilik korelasyonlarının tutarlı tahminine ilişkin konulara odaklanarak kuşaklar arası gelir hareketliliği literatürünün kapsamlı bir incelemesini sunmaktadır. Tartışmalar ışığında, Türkiye'deki kuşaklar arası gelir hareketliliği “En Küçük Kareler” ve “Araç Değişken” tahmin stratejileri kullanılarak analiz edilmiştir. Örneklem Hanehalkı Bütçe Anketlerinden alınmıştır ve 2003 ile 2011 arasındaki yılların herhangi birinde aynı hanede yaşayan pozitif bir ücret veya kazanç belirten baba-oğul ve baba-kız çiftlerini içerir. En Küçük Kareler ve Araç Değişken tahmin stratejilerinin gerçek popülasyon hareketliliği korelasyonunu aşağıdan ve yukarıdan bağladığı gösterilmiştir; bu nedenle, kuşaklar arası hareketliliğin tutarlı bir aralık tahmini ile sonuçlanır. Popülasyondaki gerçek hareketlilik korelasyonlarının erkek çocuklar için (0,10, 0,51) ve kız çocuklar için (0,17, 1,00) aralığında olduğu tahmin edilmektedir. Bulunan büyük hareketlilik korelasyonları, iki nesil arasında yer alanzararlı gelir bağını kırmak için devlet müdahalesini gerektirebilir.

Objective: Guidelines recommend endoscopic surveillance for patients with extensive atrophy/intestinal metaplasia (IM), but follow-up is not recommended for patients with atrophy/IM restricted to the antrum. We evaluated the risk of neoplastic lesions in patients with antrum-restricted IM to determine whether surveillance endoscopy is necessary. Methods: Overall, 117 patients with antrum-restricted IM diagnosed within the past 10 years underwent surveillance endoscopy. The gastric biopsy specimens were evaluated for atrophy, IM, and dysplasia. Results: We enrolled 117 patients. Surveillance endoscopy was performed at a median (interquartile range) of 7.2 years (5.9-8.7 years) after the initial diagnosis of IM. On surveillance endoscopy, 27.4% of patients exhibited progression in their IM grade, whereas 25.6% had atrophy progression, and 33.3% had dysplasia progression. High-grade dysplasia and gastric cancer (GC) were detected in four and two patients, respectively. The annual incidence of GC in patients with antrum-restricted IM was 0.17%. IM grade and type regressed in 29.9% and 38.5% of patients, respectively. Most patients with progressive IM grade, IM type, and dysplasia on surveillance endoscopy had Operative Link on Gastritis Assessment (OLGA) stage 3-4 (p=0.0001, p=0.008, and p=0.0001, respectively), and most patients with progressive atrophy and dysplasia had Operative Link on Gastric IM (OLGIM) stage 3-4 (both p=0.001). Conclusion: Patients with IM restricted to the antrum are at risk for neoplastic lesions and require endoscopic surveillance, contrary to existing recommendations. Premalignant lesions can exhibit both progression and regression. Therefore, a patient-specific surveillance program based on OLGA and OLGIM might be appropriate. WOS:000604280800012

With the developments in computer hardware technology, studies in the fields of computer vision and artificial intelligence has accelerated. However, the number of areas where autonomous systems are used has also increased. Among these areas are unmanned aerial vehicles, which are one of the most important parameters of today's military technology. In this study, which includes two different scenarios, we aimed to improve the vision capabilities of unmanned aerial vehicles based on artificial intelligence. Within the scope of Scenario-1, the U-Net model suitable for binary semantic segmentation method was trained with the help of images taken by unmanned aerial vehicle camera. Within the scope of Scenario-2, which is designed for moving or stationary vehicle detection, the U-Net model is trained in accordance with multi-class semantic segmentation method. In all these training processes, a publicly available dataset was used. The model trained for Scenario-1 reached mean Intersection over Union (mIoU) value of 84.3%, while the model trained for Scenario-2 reached 79.7% mIoU. In this study, approaches were shared about the use of high-resolution images in model training and testing stages. Applying such studies in the field can help improve precision and reliability in arms industry., Bilgisayar donanımı teknolojisindeki gelişmelerle birlikte bilgisayar görmesi ve yapay zeka alanlarındaki çalışmalar hız kazanmıştır. Bununla birlikte otonom sistemlerin kullanıldığı alanların sayısı da artmıştır. Bu alanlar arasında günümüz askeri teknolojisinin en önemli parametrelerinden biri olan insansız hava araçları yer almaktadır. İki farklı senaryoyu içeren bu çalışmamızda insansız hava araçlarının görüş yeteneklerini yapay zeka tabanlı olarak geliştirmeyi hedefledik. Senaryo-1 kapsamında ikili anlamsal bölütleme yöntemine uygun U-Net modeli sadece araç objesinin tespitini yapabilmek için insansız hava aracı kamerasıyla çekilen görüntüler yardımıyla eğitilmiştir. Hareketli veya durağan araç tespiti için tasarlanan Senaryo-2 kapsamında, U-Net modeli çok sınıflı anlamsal bölütlemeye uygun olarak eğitilmiştir. Tüm bu eğitim süreçlerinde kamuya açık veri seti kullanılmıştır. Senaryo-1 kapsamında eğitilen model %84,3 ortalama birleşim üzerinden kesişme (mIoU) değerine ulaşırken, Senaryo-2 kapsamında eğitilen model %79,7 mIoU değerine ulaşmıştır. Bu çalışmada yüksek çözünürlüklü görüntülerin model eğitiminde ve test aşamalarında kullanılabilmesi hakkında yaklaşımlar paylaşıldı. Bu tür çalışmaların sahada uygulanması, savunma sanayisinde hassaslığı ve güvenirliği iyileştirmeye yardımcı olabilir.

Aim: The majority of studies on cardiac dysfunction in patients with cirrhosis are associated with left ventricular (LV) myocardial dysfunction, with fewer studies on right ventricular (RV) function. The aims of this study were to evaluate biventricular function, particularly RV function, in patients with cirrhosis and investigate its relationship with disease severity.Methods: We included 50 hospitalized and ambulatory patients with cirrhosis and 33 healthy controls. Echocardiographic evaluation was performed with speckle-tracking analysis. Liver disease was graded according to Child-Pugh and Model for End-Stage Liver Disease (MELD) scores.Results: In our study, the most prevalent etiology of cirrhosis was viral hepatitis (60%), followed by non-alcoholic fatty liver disease (24%). RV-global longitudinal strain (GLS) and LV ejection fraction (EF) values were lower in patients with cirrhosis compared to the control group (both, P=0.001). LVEF was, Amaç: Sirozlu hastalarda kardiyak disfonksiyon üzerine yapılan çalışmaların çoğu, sol ventriküler (LV) miyokardiyal disfonksiyon ile ilişkilidir ve sağ ventrikül (RV) fonksiyonu üzerine daha az çalışma vardır. Bu çalışmanın amacı sirozlu hastalarda özellikle RV fonksiyonu olmak üzere, biventriküler fonksiyonu değerlendirmek ve hastalık şiddeti ile ilişkisini araştırmaktır.Yöntemler: Hastanede yatan ve ayakta tedavi gören 50 siroz hastası ve 33 sağlıklı kontrol çalışmamıza dahil edildi. Ekokardiyografik değerlendirme speckle-tracking analizi ile yapıldı. Karaciğer hastalığı Child-Pugh ve Son Evre Karaciğer Hastalığı Modeli (MELD) puanlarına göre derecelendirildi.Bulgular: Çalışmamızda sirozun en yaygın etiyolojisi viral hepatit (%60), ardından non-alkolik yağlı karaciğer hastalığı (%24) idi. Sirozlu hastalarda RV-global longitudinal strain (GLS) ve LV ejeksiyon fraksiyonu (EF) değerleri kontrol grubuna göre daha düşüktü (her ikisi de P=0.001). LVEF, 19 (% 38) hastada < %55 idi. Asitli hastalarda RV-GLS ve LVEF değerlerindeki düşüşler daha sıktı (her ikisi de, P=0,001). Bununla birlikte, RV-GLS ve LVEF ölçümleri, Child-Pugh ve MELD skorlarına göre karaciğer hastalığının şiddet derecesini ayırt etmedi. Sirozlu hastalar ile kontrol grubu arasındaki LV-GLS değerleri benzerdi (P=0.896).Sonuç: Bu çalışma, RV fonksiyonunun sirozlu hastalarda ve daha sık olarak asitli hastalarda bozulduğunu göstermiştir. Bununla birlikte, RV-GLS değerleri, karaciğer hastalığının şiddet derecesini ayırt etmedi. Ayrıca sirozlu hastalarda LVEF düşüktü ve LV-GLS normaldi.

BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians. (J Am Coll Cardiol 2021;78:2131-2143) (c) 2021 by the American College of Cardiology Foundation.

In this study, the performance of popular convolution architectures against an imbalanced dataset is analyzed in detail with a multi-classing medical image processing application. Our selection for dermoscopic images is a large-scale and imbalanced dataset consisting of 10,015 colored lesion images belonging to 7 different skin diseases, was used as a benchmark. Images without pathological testing are labeled by specialist dermatologists who are members of International Skin Imaging Association. The f1-score was preferred as the measurement metric during the training phase of the convolution networks, which were trained with imbalanced dataset, and the area under the receiver operating characteristic curve and the confusion matrix of each model were calculated at the test phase. In the validation phase of convolution networks, k-fold cross validation technique was used. In addition, the filters obtained from the ImageNet dataset have been imported with the Transfer-Learning option. Fine-tuning was applied to the deepest convolution layers in order for these pre-trained models to develop themselves specific to our application. In order to prevent the overfit problem, the feature extraction outputs of the models were drop-out at a rate of 50% after flattening, and L2-regularization (weigh decay) was applied during the update phase of the weights. Although it is not the main purpose of the study, in order to partially improve the performance of convolution architectures, synthetic lesion images created with data-augmentation for the minor classes in the imbalanced dataset were included in the training process in a way that does not cause information leakage., Bu çalışmada, dengeli dağılım sergilemeyen bir veri seti karşısında popüler evrişimsel sinir ağı mimarilerinin nasıl bir performans sergileyebilecekleri çok-sınıflı bir medikal görüntü işleme uygulaması ile detaylı bir şekilde analiz edilmiştir. 7 farklı deri hastalığına ait 10.015 tane renkli lezyon resimlerinden oluşan büyük ölçekli ve dengesiz bir veri seti olan HAM10000(İnsan-Makineye Karşı-10000), test aracı olarak kullanılmıştır. Bu veri seti ile eğitilip performans karşılaştırması yapılan evrişimsel sinir ağı modellerinin eğitim aşamasında ölçüm metriği olarak f1-score değerleri ve test aşamasında ise her bir modelin hem hata matrisi hem de ROC eğrileri altında kalan AUC alanları hesaplanmıştır. Evrişimsel sinir ağı modellerinin eğitim süreçleri, k-fold çapraz doğrulama ile analiz edilmiştir. Ayrıca imagenet veri setindeki filtreler, Eğitim-Transferi seçeneği ile içe aktarılmıştır. Ön-eğitimli bu modellerin uygulamaya özgü kendilerini geliştirebilmeleri için ise en derindeki evrişim katmanlarına ince-ayar işlemi uygulanmıştır. Ezber yapma problemini engellemek amacı ile modellerin çıkardıkları özellikler, tek sütunlu vektör haline getirildikten sonra 50% oranında silme işlemi ve ağırlıkların güncelleme aşamasında ise L2-düzenleme(weigh decay) işlemi uygulanmıştır. Çalışmanın asıl amacı olmamak ile birlikte evrişim mimarilerin performanslarını kısmen de olsa iyileştirebilmek için HAM10000 sınıfındaki azınlık sınıfları için veri çeşitlendirme ile oluşturulan sentetik lezyon görüntüleri, bilgi sızıntısına neden olmayacak şekilde eğitim sürecine dâhil edilmiştir.

BackgroundCrohn’s Disease patients require life-long follow-up resulting frequent hospital visits. Usefulness of telehealth has been established in remote management of Crohn’s disease but mobile technology’s role is missing. We aimed to determine the feasibility and effectiveness of smartphone-based real-time video visits.MethodsWe prospectively studied 139 patients either at a traditional (FTF) or online clinic (OLV) in a university hospital between March 2020-September 2020. We measured patients’ satisfactions, disease activity, visit outcomes, socioeconomic parameters, and travel expenses to assess the effectiveness and acceptance of OLV.ResultsSatisfaction scores were significantly higher at OLV compared to FTF (89.58±9.93 vs 70.85±18.51, pConclusionsSmartphone-based real-time video visit telehealth model for distant management of Crohn’ disease had high acceptance. The model was easy to implement, effective and saved travel cost and time.

Giriş ve Amaç: Kliniğimizde Dieulafoy lezyonu tanısı konulan hastalar için yapılan endoskopik tedavileri, bu endoskopik tedavilerin başarı ve komplikasyon oranlarını ve işlem sonrası takip döneminde gelişen yeniden kanama ve hastaneye yatış oranlarını tespit etmeyi amaçladık. Gereç ve Yöntem: Haziran 2015 - Haziran 2020 tarihleri arasında,Kliniğimiz Endoskopi Ünitesi’nde, gastrointestinal sistem kanaması nedeniyle, endoskopik inceleme yapılmış hastaların dosyaları ve endoskopi raporları geriye dönük olarak değerlendirildi. Dieulafoy lezyonu tanısı doğrulanmış hastaların demografik özellikleri, başvuru öncesi şikayetleri, yapılmış tetkik ve endoskopik işlemlerin sonuçları, endoskopik müdahalenin içeriği ve işlem başarısı, işlem sonrası erken veya geç komplikasyon ya da yeniden kanama olup olmadığı analiz edildi. Bulgular: Toplam 48 hasta çalışmaya alındı. Hastaların 16’sında lezyonun jejenumda bulunduğu görüldü (%33.3). Mortalite hastaların ikisinde (%4.2) gerçekleşti. En sık kullanılan endoskopik tedavi yöntemi kombine teknik olup (n=30), 31 hastada hemoklips tek başına veya kombinasyon tedavisi olarak uygulanmıştı. On hastada, endoskopik müdahale sonrası erken (n=6) veya geç (n=4) dönemde yeniden kanama gelişti. Kombine teknik uygulanan hastalarda, tek bir teknik uygulanan hastalara göre yeniden kanama oranının daha düşük olduğu görüldü (p=0.027). Hemoklips içeren kombine tedaviler sadece hemoklips uygulamasıyla ya da argon plazma koagülasyon içeren kombine tedaviler sadece argon plazma koagülasyon uygulamasıyla karşılaştırıldığında ise anlamlı farklılık görülmedi (sırasıyla, p=0.300 ve p=0.550). Sonuç: Dieulafoy lezyonları, standart endoskopik yöntemler kullanılarak kanama odağı tespit edilemeyen tüm hastalarda, ayırıcı tanı seçenekleri arasında bulunmalı ve ince bağırsaklar, mutlaka olası tutulum açısından endoskopik olarak incelenmelidir. Mekanik ve termal yöntemleri içeren kombine uygulamaların kullanılması yeniden kanama oranlarını azaltabilir., Background and Objective: The goal of this study was to determine the endoscopic treatments performed in patients diagnosed with Dieulafoy lesion in our clinic, the effectiveness and complication rates of these endoscopic treatments, and the rates of re-bleeding and hospitalization during the post-procedure follow-up period.Material and Methods: Files and endoscopy records of patients who underwent endoscopy at our clinic’s endoscopy unit due to gastrointestinal system bleeding were evaluated retrospectively between June 2015 and June 2020. [A1]Furthermore, demographic characteristics, complaints or examinations conducted for bleeding prior to application, and content and success of the endoscopic procedures, whether there are early or late complications or re-bleeding, were also analyzed in patients with established diagnoses of Dieulafoy lesion.[A2]Results: A total of 48 patients were included in the study. The lesion was observed in the jejunum of 16 patients (33.3%). Further, mortality occurred in two (4.2%) patients. The most widely used endoscopic treatment method was the combined technique (n = 30), and hemoclips were administered alone or as a combination therapy in 31 patients. In ten patients, re-bleeding occurred early (n = 6) or late (n = 4) period after endoscopic intervention. The rate of re-bleeding was found to be lower in patients who underwent the combined technique compared to patients who underwent a single technique (p = 0.027). There was no substantial difference (p = 0.300 and p = 0.550, respectively) when combined therapies containing hemoclips were compared either with hemoclip application or combined treatments containing APC with only APC application.[A3]Conclusion: Dieulafoy lesions should be among the differential diagnostic options for all patients whose bleeding focus cannot be identified using standard endoscopic methods, and the small intestines should be endoscopically examined for possible involvement. Moreover, the use of combined applications involving mechanical and thermal methods may reduce the rate of re-bleeding.Key words: , ,

Background: We evaluated ocular hemodynamic changes, malondialdehyde(MDA) and vascular endothelial growth factor (VEGF) levels in patients with IBD.Methods: We used ocular color Doppler ultrasonogr...

Background/aims The use of cholangioscopy for the diagnosis and treatment of hepatobiliary diseases is gradually becoming more common. We aimed to review our peroral cholangioscopy interventions, using the first-generation SpyGlass Direct Visualization System (SDVS) and summarize our experience in terms of procedures and results. Materials and methods Forty-one patients who underwent this procedure at our Gastroenterology Clinic between February 2010 and October 2014 were included in this study. Patients were monitored for a median (IQR) of 44 (range 38-72) months. Demographic characteristics of these patients, results of the radiological and biochemical evaluation performed prior to the procedure, cholangioscopy findings together with the data relating to the procedure, histopathological diagnosis, clinical findings and results, and their effects on patient prognosis were assessed. Results In total, 41 patients underwent 46 cholangioscopy procedures. Of them, 21 (51.2%) were male. The most frequent clinical indications for cholangioscopy was the need to further investigate indeterminate stricture (n=16; 39%) and indeterminate filling defect (n=7; 17.1%). The procedure was considered successful in 39 patients with 41 (95.1%) receiving diagnostic and 33 (80.5%) receiving therapeutic benefits. The sensitivity and specificity for SVDS-guided biopsies and brush cytology were 80% and 87.5%; 26.6% and 75%, respectively. Complications related to the procedure occurred in a total of three patients (7.3%), two with cholangitis and one with perforation of gall bladder. Conclusion Our experience shows that cholangioscopy procedures, performed with SDVS, are clinically applicable and safe in the diagnosis and treatment of hepatobiliary diseases.

Background/aims Glycoprotein 2 (GP2), the major autoantigen of Crohn's disease (CD)-specific pancreatic autoantibodies, is reportedly correlated with several characteristics of CD. We investigated this serological marker in Turkish patients with CD and assessed its utility in combination with anti-Saccharomyces cerevisiae antibodies (ASCAs) for differential diagnosis of CD. Materials and methods A total of 60 patients with CD, 62 patients with ulcerative colitis (UC), and 46 healthy controls with a definite diagnosis who were similar in age and sex were enrolled in the study conducted from November 2011 to October 2012. ASCA and anti-GP2 levels were measured using commercially available kits. Results Anti-GP2 IgA and IgG levels were higher in patients with CD (25%) than in those with UC (5%) and controls (2%). The seroprevalence of anti-GP2 IgA was markedly higher than that of IgG in patients with CD in contrast to previous studies. The specificity and positive predictive value of seropositivity for both ASCA and anti-GP2 were 100%. ASCA IgA seropositivity was correlated with a complicated disease course and a history of surgery. There was no correlation between anti-GP2 seropositivity and disease location, disease behavior, or a history of surgery. Conclusion The combination of ASCA and anti-GP2 may enable differentiation of CD from UC. As ASCA seropositivity is associated with a more complicated disease course, patients seropositive for ASCA at the initial diagnosis should undergo more intense therapy.

TAFRO syndrome is a rare subtype of the Castleman’s disease which has been described over the last years. The name of TAFRO syndrome comes from thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly. We report a young Turkish male patient presented with fever, night sweats, fatigue, nausea, bilateral pretibial pitting edema, abdominal pain and watery diarrhea. PET/CT revealed multiple lymphadenopathies in cervical, axillary, mediastinal, paraaortic, mesenteric and inguinal lymph nodes. Excisional lymph node biopsy showed atretic germinal centers and expanded interfollicular areas, containing sheets of plasma cells. The R-CHOP regimen was started, and his signs and symptoms improved after the treatment. The current case confirms the unique presentation of this syndrome, helping to understand its clinical course and treatment strategy.

Eosinophilic gastroenteritis is a disease of unknown etiology presenting with different clinical pictures due to eosinophilic infiltration of different areas in gastrointestinal tractus. Eosinophilia is the sole hematologic finding seen in the course of eosinophilic gastroenteritis. We presented a case evaluated for eosinophilic ascites and diagnosed as eosinophilic gastroenteritis in which cyclic neutropenia was seen. Although cyclic neutropenia suggests solid organ or hematologic malignancy no sign of malignancy on investigations, improvement in ascites, peripheral eosinophilia and neutropenia with steroid therapy confirmed that this picture was completely due to eosinophilic gastroenteritis. It should be kept in mind that cyclic neutropenia may be seen during the course of eosinophilic gastroenteritis., Eozinofilik gastroenterit gastrointestinal kanalın farklı alanlarının eozinofilik infiltrasyonuna bağlı olarak farklı klinik tabloların görüldüğü nedeni bilinmeyen bir hastalıktır. Eozinofilik gastroenteritin seyrinde görülen hematolojik bulgu sadece eozinofilidir. Biz eozinofilik gastroenterit ve eozinofilik asit nedeniyle değerlendirilen ve siklik nötropeni görülen bir hastayı sunduk. Her ne kadar siklik nötropeni solid organ veya hematolojik malignensileri desteklerse de steroid tedavisi ile asit, nötropeni ve periferal eozinofilide düzelme olması tablonun eozinofilik gastroenterite bağlı olduğunu doğrulamıştır. Eozinofilik gastroenteritin seyrinde siklik nötropeni görülebileceği akılda tutulmalıdır.

Background To evaluate the clinical outcomes after the implantation of a new trifocal diffractive intraocular lens (IOL) combined with Enhanced depth of focus (EDOF) technology. Methods The study enrolled 80 eyes of 40 patients who underwent cataract surgery with bilateral implantation of a diffractive trifocal IOL (Reviol Tri-ED) designed with a combination of enhanced depth of focus. Mean age was 52.09 ± 11.32 years (range from 45 to 70 years). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), corrected intermediate visual acuity (CIVA), uncorrected near visual acuity (UNVA), corrected near visual acuity (CNVA), keratometry (K), and manifest refraction spherical equivalent (MRSE) were evaluated pre- and postoperatively. The contrast sensitivity, defocus curves, and a questionnaire evaluating individual satisfaction were also estimated. Results There was a significant improvement in UDVA, CDVA, UNVA, CNVA, CIVA postoperatively. The defocus curve confirmed good visual acuity also in the intermediate distance. The postoperative MRSE was ranged from −0.75 to 0.75 diopters. Contrast sensitivity also significantly improved postoperatively. The patient satisfaction was high. Conclusion The new trifocal EDOF IOL provides visual improvement for far, intermediate, and near distances with a high level of visual quality and patient satisfaction.