Esophageal dysphagia (ED) is often underestimated in neuromuscular disorders (NMD) and it is impo... more Esophageal dysphagia (ED) is often underestimated in neuromuscular disorders (NMD) and it is important to evaluate the esophageal phase of swallowing with an easy and rapid screening test. We aimed both to assess the prevalence of ED in NMD and to perform validity and reliability study of the brief easophageal dysphagia questionnaire (BEDQ) screening test in NMD patients. This prospective cross-sectional clinical study was performed on NMD patients. Demographic features and disease characteristics were recorded. Endoscopic evaluation for oropharyngeal dysphagia (OD) and high-resolution esophageal manometry for ED were performed. In addition, the BEDQ and the 10-item eating assessment tool (EAT-10) were used to all subjects. Cronbach’s α and principle components factor analysis (PFCA) with varimax rotation were used for reliability. The Chicago Classification version 3 (CCv3) level (high-resolution esophageal manometry) and EAT-10 was used for validity. A total of 50 patients were included in the study. Thirty-four (68%) patients were diagnosed with myasthenia gravis and 16 (32%) patients were diagnosed with myopathy. Esophageal dysphagia according to the CCv3 was found in 33 (66%) of patients. While the Cronbach’s α was excellent as 0.937 for test overall the T-BEDQ scale. The PCFA included all scale items and resulted in a single factor (eigenvalue = 5.72, 71.5%). The all BEDQ scores were demonstrated good correlation with EAT-10 score and very good correlation with CCv3 level. Evaluation of swallowing in patients with NMD should include not only the oropharyngeal phase of swallowing, but also esophageal phase. For this purpose, the BEDQ can be used as a rapid, valid, and reliable test for the evaluation of ED.
Acute pancreatitis is a paranchymal inflamatory disease of the pancreas. According to the clinica... more Acute pancreatitis is a paranchymal inflamatory disease of the pancreas. According to the clinical presentation, pancreatitis is divided into two groups; mild (edematous) and severe (necrotizing) pancreatitis. Gall stones and alcohol use are the most common etiologic reasons. Hypertriglyceridemia is a rare etiological factor in non-biliary pancreatitis. Serum amylase levels may be at normal ranges in acute pancreatitis due to hypertriglyceridemia. Radiological screening and serum lipase levels are helpful for diagnosis. Herein we present a case of acute pancreatitis secondary
In this study, we aimed to define the predictive role of liver function tests at admission to the... more In this study, we aimed to define the predictive role of liver function tests at admission to the hospital in outcomes of hospitalised patients with COVID‐19.
INTRODUCTION: Pentraxin-3 (PTX-3) is a prototype of pentraxin proteins that have been shown to be... more INTRODUCTION: Pentraxin-3 (PTX-3) is a prototype of pentraxin proteins that have been shown to be involved in acute phase response. In this study, we aimed to investigate the relationship between PTX-3 levels and familial Mediterranean fever (FMF) disease, and to evaluate PTX-3 as a novel diagnostic marker of FMF. METHOD: Forty-three male patients diagnosed with FMF and 42 healthy individuals were included in the study. Patients with other infl ammatory diseases and patients who used drugs having anti-infl ammatory properties were excluded from the research. Blood samples were obtained during both attack and attack-free periods. RESULTS: Patient attack periods were confi rmed by combining physical examination and elevation of acute phase reactants. Acute phase reactants were signifi cantly higher in attack versus attack-free periods (p < 0.01), however PTX-3 levels were not signifi cantly different between the two periods. Additionally, PTX-3 levels in FMF patients were higher than in controls in both attack (917.29 ± 725.29 vs 451.83 ± 291.95, p < 0.01) and attackfree periods (748.23 ± 487.53 vs 451.83 ± 291.95, p < 0.01). CONCLUSION: In this study, we showed that PTX-3 levels, in both FMF attack and attack-free periods, were signifi cantly higher than in the control group. Finally, PTX-3 may be a promising biomarker for FMF diagnosis and may predict FMF attacks (Tab. 2, Fig. 2, Ref. 18).
Background Faecal microbiota transplantation (FMT) provides replacement of pathogenic bacteria wi... more Background Faecal microbiota transplantation (FMT) provides replacement of pathogenic bacteria with more favourable microbiomes in recipients with dysbiosis. The aim of the present study was to prospectively investigate the efficacy of FMT by assessing the clinical and endoscopic response in patients with ulcerative colitis (UC) who had failed anti-inflammatory, immunosuppressive and TNF-α inhibitors (Infliximab, Adalimumab, Vedolizumab) therapy. Methods In this prospective and uncontrolled study, 116 patients with UC were enrolled. All medications except mesalazine were discontinued 1 week before FMT. Colonoscopy was performed both before and after FMT. To assess the efficacy of FMT, Mayo scores were calculated at weeks 0, 24 and 48. A total of 400–600 ml of extracted fresh faecal suspension was administered into the 20 to 30 cm of terminal ileum of recipients. Results After 4.5 years of FMT experience with 116 patients, who have completed their 6 months after 236 procedures of FM...
The Egyptian Journal of Critical Care Medicine, 2018
Objective: Synthetic cannabinoid drug abuse has been dramatically increasing among young individu... more 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-tolymphocyte 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. Results: All participants were male, and the mean age of the patients was 21.74 ± 1.57 and healthy controls was 22.62 ± 2.9 years (p > 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 Â 10 3 /mm 3 vs 7.05 ± 2.12 Â 10 3 /mm 3 (p < 0.001), mean platelet counts were 237.33 ± 60 Â 10 3 /mm 3 vs 263.90 ± 65.98 Â 10 3 /mm 3 (p = 0.022), NLR counts were 3.17 ± 1.95 vs 2.32 ± 1.27 (p = 0.003) and PLR values were 114.43 ± 36.39 vs 133.94 ± 45.27 (p = 0.008), in patients and controls, respectively. Cardiac side effects were observed among 36 patients but nobody was died. Conclusion: Our results exhibited a significant increase of NLR values and decrease of PLR counts among critical care patients with synthetic cannabinoid (bonzai) intoxication. After at least 24 h of intensive care stay without side effects, the patients might transfer out to inpatient clinic for ongoing follow up period and psychiatric consultation.
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2017
Acute pancreatitis (AP) is a disease that can cause local and systemic complications that may hav... more Acute pancreatitis (AP) is a disease that can cause local and systemic complications that may have high morbidity and mortality. Currently, there is not any specific treatment for AP. In this study, we created an experimental model of AP in rats, and we aimed to demonstrate the histological effectiveness of tocilizumab treatment that antagonizes interleukin-6 (IL-6), one of the key cytokines in the development of AP. Forty-eight rats were divided into six groups for this study. AP model was created by subcutaneous injections of cerulein (20 μg/kg) four times at 1-h intervals. Tocilizumab 4 mg/kg was administered to one of the treatment groups and 8 mg/kg to the other treatment group intraperitoneally. The effects of tocilizumab were revealed by examining pancreatic tissue of the rats histopathologically according to the Schonberg scoring system. A comparison between tocilizumab treatment group and AP control group provides statistically significant improvement in AP (p<0.0001). F...
Background and study aims: There is still a debate about the exact measurement of the oesophagoga... more Background and study aims: There is still a debate about the exact measurement of the oesophagogastric junction and the diaphragmatic hiatus among clinicians. The aim of this study was to investigate the differences between landmark readings of gastroscopy on intubation and extubation, and to correlate these readings with a gastro-oesophageal reflux questionnaire. Patients and methods: 116 cases who underwent diagnostic gastroscopy between January 2013 and June 2013 were included in this study. Landmark measurements were noted while withdrawing the endoscope and were also evaluated after the gastric air was fully emptied. We first used a frequency scale for the gastro-oesophageal reflux disease symptoms (FSSG) questionnaire in order to investigate dysmotility and acid reflux symptoms in the study population and correlated the FSSG questionnaire with intubation and extubation measurements at endoscopic examination. Results: Mean age of included subjects was 49.41 ± 17.7 (19-82) years. Males and females were equally represented. On FSSG scores, the total dysmotility score was 7.99 ± 5.06 and the total score was 15.18 ± 10.11. The difference between intubation and extubation measurements ranged from À3 cm to +2 cm (mean: À0.4). When an FSSG score of 30 was accepted as a cutoff value, we detected a significant difference between the measurements (p < 0.05; t: 0.048). Conclusion: Accuracy of landmark measurements during gastroscopy is clearly affected from insertion or withdrawal of the endoscope. When differences in measurements between insertion and withdrawal were evident, comparable with the FSSG scores, the results became significantly different. In conclusion, according to FSSG scores, these measurements should be performed at the end of the endoscopy.
Medicine Science | International Medical Journal, 2016
It is known that some foods improve health quality and prevent the formation of some common forms... more It is known that some foods improve health quality and prevent the formation of some common forms of cancer. To solve this nutrition problem, intensive researches are performing and training programs are organizing in all over the world especially in the developed countries. There is a balance between host and intestinal microbiota in the body and the causes which disrupt this equilibrium cause diseases. For a healthy and balanced diet, reducing the risk of diet related diseases are targeted by adding functional foods to diet. One of the functional foods is prebiotics. In this review, we aimed to describe the beneficial effects of prebiotics on human health.
Turkiye Klinikleri Journal of Gastroenterohepatology, 2015
Endojen Kannabinoid Sistem ve Gastrointestinal Kanal Üzerine Etkileri Ö ÖZ ZE ET T Esrar (Cannabi... more Endojen Kannabinoid Sistem ve Gastrointestinal Kanal Üzerine Etkileri Ö ÖZ ZE ET T Esrar (Cannabis sativa) yüzyıllardır inflamatuar barsak hastalıkları, gastroenterit, anoreksi, motilite bozuklukları, diyare, diyabetik gastroparezi, kusma ve abdominal ağrı gibi sağlık problemlerinin tedavisinde kullanılmaktadır. Ancak kannabis ve sentetik kannabinoidlerin ciddi nöropsikiyatrik yan etkileri nedeni ile modern tıpta kullanımı sınırlıdır. Etken maddesi olan delta-9 tetrahidrokannabinol ve bu maddenin üzerinden etkili olduğu CB1 ve CB2 reseptörlerinin tanımlanmasından sonra endojen kannabinoid sistemin in vivo birçok etkisi olduğu gözlenmiştir. Bütün kannabinoid agonistler CB1 ve CB2 reseptörler üzerinden etki göstermektedir. İnsan vücudunda bu reseptörler üzerinden etki ederek memeli dokusunda endojen kannabinoid reseptörleri aktive eden anandamid ve 2-araşidonil gliserol gibi endokannabinoidler saptanmıştır. Lipid yapıdaki bu maddeler üretildikten hemen sonra hücrelerden salınırlar ve CB1 ve CB2 reseptörleri aktive ederek biyolojik yanıt oluştururlar. Kannabinoid sistemi oluşturan kannabinoid reseptörler, endokannabinoidler ve endokannabinoid sentez ve inaktivasyonunda rol oynayan enzimler özellikle enterik sinir sisteminde başta olmak üzere tüm gastrointestinal kanalda yaygın olarak saptanmıştır. Yapılan çalışmalarla kannabinoid sistemin gastrointestinal kanalda birçok farmakolojik etkisi olduğu gösterilmiştir. Kannabinoid sistem modülasyonunun hastalık fizyopatolojisi ve tedavisinde yer alabileceği hayvan çalışmalarında gösterilmiştir. Son yıllarda hayvan deneylerinde gözlenen bu faydalı etkileri nedeni ile, kannabinoid sistem üzerinde etkili ilaçlar insanlarda bazı hastalıkların tedavisinde denenmiştir ve hâlen denenmektedir. Bu çalışmada, endojen kannabinoid sistemin patofizyolojisini ve endojen kannabinoid sistem ile onun düzenleyicilerinin gastrointestinal kanalda oluşturduğu etkileri tanımlamak amaçlanmıştır. A An na ah ht ta ar r K Ke el li im me el le er r: : Kannabis; gastrointestinal hastalıklar; gastrointestinal kanal A AB BS ST TR RA AC CT T Cannabis sativa has been used to treat gastrointestinal diseases such as inflammatory bowel diseases, anorexia, motility disorders, diarrhea, gastroparesis, vomiting and abdominal pain for centuries. However, the use of cannabis is limited in modern medicine due to its neuropsychiatric side effects. After isolation of active ingredient delta-9 tetrahydrocannabinol and CB1 and CB2 receptors, the cannabinoid system and its various effects were determined. All of the cannabinoid agonists are acting on CB1 and CB2 receptors. Additionally, endocannabinoids such as anandamide and 2-arachyldonyl glycerol were defined in human body which activate endogenous cannabinoid receptors on mammalian tissue. Cannabinoid receptors, endocannabinoids and the enzymes which modulate synthesis and degradation of endocannabinoids were detected throughout the gastrointestinal canal, especially enteric nervous system. Many pharmacologic effects of cannabinoid system on gastrointestinal tract have been observed. At last decade, modulation of cannabinoid system was defined to modulate cannabinoid system in order to understand beneficial effects and neuropsychiatric side effects in animal studies. Due to these beneficial effects in animal studies, drugs which act on cannabinoid system were tried on some gastrointestinal diseases in humans. In this review, we aimed to describe the pathophysiology and effects of endogenous cannabinoid system and its modulators on the gastrointestinal tract. K Ke ey y W Wo or rd ds s: : Cannabis; gastrointestinal diseases; gastrointestinal tract T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J G Ga as st tr ro oe en nt te er ro oh he ep pa at to ol l 2 20 01 15 5; ;2 22 2((1 1
Eosinophilic esophagitis (EoE) is a chronic disease usually presenting with dysphagia and food im... more Eosinophilic esophagitis (EoE) is a chronic disease usually presenting with dysphagia and food impaction. Food allergy has been suggested as a causative trigger for some patients. Diagnosis of EoE is based on characteristic endoscopic and histological features. A ringed appearance referred to as “trachealization” is the classical endoscopic finding. Eosinophil-predominant inflammation is typical in histologic examination. The use of topical steroids is an effective and viable therapeutic option in the management of EoE in adults with relatively few side effects. Herein, we report a case of EoE presenting with severe dysphagia due to garlic impaction. Inhaled corticosteroid (budenoside) was prescribed for treatment due to the patient’s history of long-term proton-pump inhibitor use. Dysphagia complaints resolved after the prescribed treatment.
European Journal of Gastroenterology & Hepatology, 2016
We read with great interest the recent observational study/ review by Qi et al. [1] considering t... more We read with great interest the recent observational study/ review by Qi et al. [1] considering thrombotic risk factors in nonmalignant and noncirrhotic patients with portal vein thrombosis (PVT).
We read the recently published article by Young et al. (1) with great interest. They aimed to eva... more We read the recently published article by Young et al. (1) with great interest. They aimed to evaluate whether unclassifiable groups can now be classified according to the recent Chicago Classification system, and they defined a group as variant achalasia. We thank Young et al for this valuable study; however we believe that some points require clarification.
Dear Editor, We read with great interest the recently published article by Fukuda et al. The auth... more Dear Editor, We read with great interest the recently published article by Fukuda et al. The authors indicate that there is significant correlation between serum telaprevir (TVR) level and bodyweight and suggest that adjustment of TVR dose according to bodyweight would avoid renal impairment during treatment. Herein, we want to present a case in which renal impairment completely reversed after discontinuation of TVR, and ribavirin dose reduction seemed to be important in improving renal impairment until therapy. A 51-year-old woman came to our clinic 4 months ago. She had chronic active hepatitis C, and had received peginterferon-α-2b and ribavirin treatment for 48 weeks after being diagnosed in 2010; but 6 months after remission, her condition relapsed. She had no history of renal failure until the dual treatment. After evaluation of the patient, we decided to administrate triple therapy, a combination of TVR 2250 mg/day, peginterferon-α-2a 180 μg/week and ribavirin 800 mg/day. At day 10, the patient’s serum creatinine (sCr) level rose to 1.3 mg/dL and glomerular filtration rate (GFR) was 48 mL/min (pretreatment: sCr, 0.8 mg/dL; GFR, 79 mL/min). We decided to reduce the ribavirin dose and not to reduce TVR therapy after evaluation of other causes of renal failure. We reduced the ribavirin dose 200 mg every 2 weeks until 200 mg/day and did not reduce TVR and peginterferon dose, and gave fluid resuscitation. Despite replacement therapy, her sCr level rose to 2.1 mg/dL. We decided to continue treatment despite low GFR (30 mL/min), because the urine output was sufficient. Also, with high fluid replacement, her sCr level remained constant at 1.5 mg/dL with GFR of 41 mL/ min until the 12th week. After the 12 weeks of therapy with triple treatment, we stopped TVR as scheduled. After finishing TVR treatment, and continuing dual treatment with peginterferon and ribavirin, her sCr level fell to a normal level (0.8 mg/dL). Despite this study, we did not observe irreversible renal damage in our patient. Mauss et al. showed in their study that renal impairment is reversible after discontinuation of the treatment. Instead of decreasing TVR dose, ribavirin dose reduction may be appropriate. In our patient, despite low GFR levels, our patient finished hepatitis C virus treatment successfully. In patients with renal impairment with high urine output, therapy could be completed with appropriate supportive treatment, and we believe that as well as the decrease in GFR, urine output should be taken into account.
Nonalcoholic fatty liver disease associated with increased risk of cardiovascular mortality. Caro... more Nonalcoholic fatty liver disease associated with increased risk of cardiovascular mortality. Carotid artery intima media thickness is a reliable index of subclinical atherosclerosis. There are contradictory reports about relationship between nonalcoholic fatty liver disease and carotid atherosclerosis. In this study, we aimed to investigate carotid artery intima media thickness levels and its association with histological findings in biopsy proven nonalcoholic fatty liver disease. 113 male patients and 57 healthy male controls were enrolled. Patients and control groups mean ages were 31.7± 5.7 and 30.1± 5.5 respectively. Body mass index, Waist circumference, glucose, lipids and insulin levels, and HOMA-IR were determined. Carotid atherosclerosis evaluated by carotid artery intima media thickness using high resolution carotid ultrasonography. Carotid artery intima media thickness levels were higher in patient group than the control group. This difference was disappeared when the findings were adjusted according to the body mass index, waist circumference, glucose and lipid levels, and HOMA-IR indexes. In addition, no significant association was observed between carotid artery intima media thickness and liver histology. However, there was a significant association between age and carotid artery intima media thickness in patients and controls. Our study does not support an association between carotid atherosclerosis and nonalcoholic fatty liver disease. Otherwise, it can be speculated that a longer exposure to the disease is required to determine significant differences in carotid atherosclerosis.
Özet Akut pankreatit, pankreas parankiminin inflamatuvar bir hastalığıdır. Klinik prezentasyona g... more Özet Akut pankreatit, pankreas parankiminin inflamatuvar bir hastalığıdır. Klinik prezentasyona göre hafif (ödematöz) ve şiddetli (nekrotizan) pankreatit olarak iki gruba ayrılmaktadır. En sık etyolojik nedenler safra taşı ve alkoldür. Hipertrigliseridemi, akut non-biliyer pankreatitte nadir görülen bir etyolojik faktördür. Hipertrigliseridemiye bağlı oluşan akut pankreatit tablosunda amilaz normal seviyede saptanabilir Görüntüleme tetkikleri ve serum lipaz düzeyi tanıda yardımcıdır. Biz burada hipertrigliseridemiye sekonder olarak gelişen ve amilaz değeri normal olan akut pankreatit olgusunu sunuyoruz.
Esophageal dysphagia (ED) is often underestimated in neuromuscular disorders (NMD) and it is impo... more Esophageal dysphagia (ED) is often underestimated in neuromuscular disorders (NMD) and it is important to evaluate the esophageal phase of swallowing with an easy and rapid screening test. We aimed both to assess the prevalence of ED in NMD and to perform validity and reliability study of the brief easophageal dysphagia questionnaire (BEDQ) screening test in NMD patients. This prospective cross-sectional clinical study was performed on NMD patients. Demographic features and disease characteristics were recorded. Endoscopic evaluation for oropharyngeal dysphagia (OD) and high-resolution esophageal manometry for ED were performed. In addition, the BEDQ and the 10-item eating assessment tool (EAT-10) were used to all subjects. Cronbach’s α and principle components factor analysis (PFCA) with varimax rotation were used for reliability. The Chicago Classification version 3 (CCv3) level (high-resolution esophageal manometry) and EAT-10 was used for validity. A total of 50 patients were included in the study. Thirty-four (68%) patients were diagnosed with myasthenia gravis and 16 (32%) patients were diagnosed with myopathy. Esophageal dysphagia according to the CCv3 was found in 33 (66%) of patients. While the Cronbach’s α was excellent as 0.937 for test overall the T-BEDQ scale. The PCFA included all scale items and resulted in a single factor (eigenvalue = 5.72, 71.5%). The all BEDQ scores were demonstrated good correlation with EAT-10 score and very good correlation with CCv3 level. Evaluation of swallowing in patients with NMD should include not only the oropharyngeal phase of swallowing, but also esophageal phase. For this purpose, the BEDQ can be used as a rapid, valid, and reliable test for the evaluation of ED.
Acute pancreatitis is a paranchymal inflamatory disease of the pancreas. According to the clinica... more Acute pancreatitis is a paranchymal inflamatory disease of the pancreas. According to the clinical presentation, pancreatitis is divided into two groups; mild (edematous) and severe (necrotizing) pancreatitis. Gall stones and alcohol use are the most common etiologic reasons. Hypertriglyceridemia is a rare etiological factor in non-biliary pancreatitis. Serum amylase levels may be at normal ranges in acute pancreatitis due to hypertriglyceridemia. Radiological screening and serum lipase levels are helpful for diagnosis. Herein we present a case of acute pancreatitis secondary
In this study, we aimed to define the predictive role of liver function tests at admission to the... more In this study, we aimed to define the predictive role of liver function tests at admission to the hospital in outcomes of hospitalised patients with COVID‐19.
INTRODUCTION: Pentraxin-3 (PTX-3) is a prototype of pentraxin proteins that have been shown to be... more INTRODUCTION: Pentraxin-3 (PTX-3) is a prototype of pentraxin proteins that have been shown to be involved in acute phase response. In this study, we aimed to investigate the relationship between PTX-3 levels and familial Mediterranean fever (FMF) disease, and to evaluate PTX-3 as a novel diagnostic marker of FMF. METHOD: Forty-three male patients diagnosed with FMF and 42 healthy individuals were included in the study. Patients with other infl ammatory diseases and patients who used drugs having anti-infl ammatory properties were excluded from the research. Blood samples were obtained during both attack and attack-free periods. RESULTS: Patient attack periods were confi rmed by combining physical examination and elevation of acute phase reactants. Acute phase reactants were signifi cantly higher in attack versus attack-free periods (p < 0.01), however PTX-3 levels were not signifi cantly different between the two periods. Additionally, PTX-3 levels in FMF patients were higher than in controls in both attack (917.29 ± 725.29 vs 451.83 ± 291.95, p < 0.01) and attackfree periods (748.23 ± 487.53 vs 451.83 ± 291.95, p < 0.01). CONCLUSION: In this study, we showed that PTX-3 levels, in both FMF attack and attack-free periods, were signifi cantly higher than in the control group. Finally, PTX-3 may be a promising biomarker for FMF diagnosis and may predict FMF attacks (Tab. 2, Fig. 2, Ref. 18).
Background Faecal microbiota transplantation (FMT) provides replacement of pathogenic bacteria wi... more Background Faecal microbiota transplantation (FMT) provides replacement of pathogenic bacteria with more favourable microbiomes in recipients with dysbiosis. The aim of the present study was to prospectively investigate the efficacy of FMT by assessing the clinical and endoscopic response in patients with ulcerative colitis (UC) who had failed anti-inflammatory, immunosuppressive and TNF-α inhibitors (Infliximab, Adalimumab, Vedolizumab) therapy. Methods In this prospective and uncontrolled study, 116 patients with UC were enrolled. All medications except mesalazine were discontinued 1 week before FMT. Colonoscopy was performed both before and after FMT. To assess the efficacy of FMT, Mayo scores were calculated at weeks 0, 24 and 48. A total of 400–600 ml of extracted fresh faecal suspension was administered into the 20 to 30 cm of terminal ileum of recipients. Results After 4.5 years of FMT experience with 116 patients, who have completed their 6 months after 236 procedures of FM...
The Egyptian Journal of Critical Care Medicine, 2018
Objective: Synthetic cannabinoid drug abuse has been dramatically increasing among young individu... more 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-tolymphocyte 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. Results: All participants were male, and the mean age of the patients was 21.74 ± 1.57 and healthy controls was 22.62 ± 2.9 years (p > 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 Â 10 3 /mm 3 vs 7.05 ± 2.12 Â 10 3 /mm 3 (p < 0.001), mean platelet counts were 237.33 ± 60 Â 10 3 /mm 3 vs 263.90 ± 65.98 Â 10 3 /mm 3 (p = 0.022), NLR counts were 3.17 ± 1.95 vs 2.32 ± 1.27 (p = 0.003) and PLR values were 114.43 ± 36.39 vs 133.94 ± 45.27 (p = 0.008), in patients and controls, respectively. Cardiac side effects were observed among 36 patients but nobody was died. Conclusion: Our results exhibited a significant increase of NLR values and decrease of PLR counts among critical care patients with synthetic cannabinoid (bonzai) intoxication. After at least 24 h of intensive care stay without side effects, the patients might transfer out to inpatient clinic for ongoing follow up period and psychiatric consultation.
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2017
Acute pancreatitis (AP) is a disease that can cause local and systemic complications that may hav... more Acute pancreatitis (AP) is a disease that can cause local and systemic complications that may have high morbidity and mortality. Currently, there is not any specific treatment for AP. In this study, we created an experimental model of AP in rats, and we aimed to demonstrate the histological effectiveness of tocilizumab treatment that antagonizes interleukin-6 (IL-6), one of the key cytokines in the development of AP. Forty-eight rats were divided into six groups for this study. AP model was created by subcutaneous injections of cerulein (20 μg/kg) four times at 1-h intervals. Tocilizumab 4 mg/kg was administered to one of the treatment groups and 8 mg/kg to the other treatment group intraperitoneally. The effects of tocilizumab were revealed by examining pancreatic tissue of the rats histopathologically according to the Schonberg scoring system. A comparison between tocilizumab treatment group and AP control group provides statistically significant improvement in AP (p<0.0001). F...
Background and study aims: There is still a debate about the exact measurement of the oesophagoga... more Background and study aims: There is still a debate about the exact measurement of the oesophagogastric junction and the diaphragmatic hiatus among clinicians. The aim of this study was to investigate the differences between landmark readings of gastroscopy on intubation and extubation, and to correlate these readings with a gastro-oesophageal reflux questionnaire. Patients and methods: 116 cases who underwent diagnostic gastroscopy between January 2013 and June 2013 were included in this study. Landmark measurements were noted while withdrawing the endoscope and were also evaluated after the gastric air was fully emptied. We first used a frequency scale for the gastro-oesophageal reflux disease symptoms (FSSG) questionnaire in order to investigate dysmotility and acid reflux symptoms in the study population and correlated the FSSG questionnaire with intubation and extubation measurements at endoscopic examination. Results: Mean age of included subjects was 49.41 ± 17.7 (19-82) years. Males and females were equally represented. On FSSG scores, the total dysmotility score was 7.99 ± 5.06 and the total score was 15.18 ± 10.11. The difference between intubation and extubation measurements ranged from À3 cm to +2 cm (mean: À0.4). When an FSSG score of 30 was accepted as a cutoff value, we detected a significant difference between the measurements (p < 0.05; t: 0.048). Conclusion: Accuracy of landmark measurements during gastroscopy is clearly affected from insertion or withdrawal of the endoscope. When differences in measurements between insertion and withdrawal were evident, comparable with the FSSG scores, the results became significantly different. In conclusion, according to FSSG scores, these measurements should be performed at the end of the endoscopy.
Medicine Science | International Medical Journal, 2016
It is known that some foods improve health quality and prevent the formation of some common forms... more It is known that some foods improve health quality and prevent the formation of some common forms of cancer. To solve this nutrition problem, intensive researches are performing and training programs are organizing in all over the world especially in the developed countries. There is a balance between host and intestinal microbiota in the body and the causes which disrupt this equilibrium cause diseases. For a healthy and balanced diet, reducing the risk of diet related diseases are targeted by adding functional foods to diet. One of the functional foods is prebiotics. In this review, we aimed to describe the beneficial effects of prebiotics on human health.
Turkiye Klinikleri Journal of Gastroenterohepatology, 2015
Endojen Kannabinoid Sistem ve Gastrointestinal Kanal Üzerine Etkileri Ö ÖZ ZE ET T Esrar (Cannabi... more Endojen Kannabinoid Sistem ve Gastrointestinal Kanal Üzerine Etkileri Ö ÖZ ZE ET T Esrar (Cannabis sativa) yüzyıllardır inflamatuar barsak hastalıkları, gastroenterit, anoreksi, motilite bozuklukları, diyare, diyabetik gastroparezi, kusma ve abdominal ağrı gibi sağlık problemlerinin tedavisinde kullanılmaktadır. Ancak kannabis ve sentetik kannabinoidlerin ciddi nöropsikiyatrik yan etkileri nedeni ile modern tıpta kullanımı sınırlıdır. Etken maddesi olan delta-9 tetrahidrokannabinol ve bu maddenin üzerinden etkili olduğu CB1 ve CB2 reseptörlerinin tanımlanmasından sonra endojen kannabinoid sistemin in vivo birçok etkisi olduğu gözlenmiştir. Bütün kannabinoid agonistler CB1 ve CB2 reseptörler üzerinden etki göstermektedir. İnsan vücudunda bu reseptörler üzerinden etki ederek memeli dokusunda endojen kannabinoid reseptörleri aktive eden anandamid ve 2-araşidonil gliserol gibi endokannabinoidler saptanmıştır. Lipid yapıdaki bu maddeler üretildikten hemen sonra hücrelerden salınırlar ve CB1 ve CB2 reseptörleri aktive ederek biyolojik yanıt oluştururlar. Kannabinoid sistemi oluşturan kannabinoid reseptörler, endokannabinoidler ve endokannabinoid sentez ve inaktivasyonunda rol oynayan enzimler özellikle enterik sinir sisteminde başta olmak üzere tüm gastrointestinal kanalda yaygın olarak saptanmıştır. Yapılan çalışmalarla kannabinoid sistemin gastrointestinal kanalda birçok farmakolojik etkisi olduğu gösterilmiştir. Kannabinoid sistem modülasyonunun hastalık fizyopatolojisi ve tedavisinde yer alabileceği hayvan çalışmalarında gösterilmiştir. Son yıllarda hayvan deneylerinde gözlenen bu faydalı etkileri nedeni ile, kannabinoid sistem üzerinde etkili ilaçlar insanlarda bazı hastalıkların tedavisinde denenmiştir ve hâlen denenmektedir. Bu çalışmada, endojen kannabinoid sistemin patofizyolojisini ve endojen kannabinoid sistem ile onun düzenleyicilerinin gastrointestinal kanalda oluşturduğu etkileri tanımlamak amaçlanmıştır. A An na ah ht ta ar r K Ke el li im me el le er r: : Kannabis; gastrointestinal hastalıklar; gastrointestinal kanal A AB BS ST TR RA AC CT T Cannabis sativa has been used to treat gastrointestinal diseases such as inflammatory bowel diseases, anorexia, motility disorders, diarrhea, gastroparesis, vomiting and abdominal pain for centuries. However, the use of cannabis is limited in modern medicine due to its neuropsychiatric side effects. After isolation of active ingredient delta-9 tetrahydrocannabinol and CB1 and CB2 receptors, the cannabinoid system and its various effects were determined. All of the cannabinoid agonists are acting on CB1 and CB2 receptors. Additionally, endocannabinoids such as anandamide and 2-arachyldonyl glycerol were defined in human body which activate endogenous cannabinoid receptors on mammalian tissue. Cannabinoid receptors, endocannabinoids and the enzymes which modulate synthesis and degradation of endocannabinoids were detected throughout the gastrointestinal canal, especially enteric nervous system. Many pharmacologic effects of cannabinoid system on gastrointestinal tract have been observed. At last decade, modulation of cannabinoid system was defined to modulate cannabinoid system in order to understand beneficial effects and neuropsychiatric side effects in animal studies. Due to these beneficial effects in animal studies, drugs which act on cannabinoid system were tried on some gastrointestinal diseases in humans. In this review, we aimed to describe the pathophysiology and effects of endogenous cannabinoid system and its modulators on the gastrointestinal tract. K Ke ey y W Wo or rd ds s: : Cannabis; gastrointestinal diseases; gastrointestinal tract T Tu ur rk ki iy ye e K Kl li in ni ik kl le er ri i J J G Ga as st tr ro oe en nt te er ro oh he ep pa at to ol l 2 20 01 15 5; ;2 22 2((1 1
Eosinophilic esophagitis (EoE) is a chronic disease usually presenting with dysphagia and food im... more Eosinophilic esophagitis (EoE) is a chronic disease usually presenting with dysphagia and food impaction. Food allergy has been suggested as a causative trigger for some patients. Diagnosis of EoE is based on characteristic endoscopic and histological features. A ringed appearance referred to as “trachealization” is the classical endoscopic finding. Eosinophil-predominant inflammation is typical in histologic examination. The use of topical steroids is an effective and viable therapeutic option in the management of EoE in adults with relatively few side effects. Herein, we report a case of EoE presenting with severe dysphagia due to garlic impaction. Inhaled corticosteroid (budenoside) was prescribed for treatment due to the patient’s history of long-term proton-pump inhibitor use. Dysphagia complaints resolved after the prescribed treatment.
European Journal of Gastroenterology & Hepatology, 2016
We read with great interest the recent observational study/ review by Qi et al. [1] considering t... more We read with great interest the recent observational study/ review by Qi et al. [1] considering thrombotic risk factors in nonmalignant and noncirrhotic patients with portal vein thrombosis (PVT).
We read the recently published article by Young et al. (1) with great interest. They aimed to eva... more We read the recently published article by Young et al. (1) with great interest. They aimed to evaluate whether unclassifiable groups can now be classified according to the recent Chicago Classification system, and they defined a group as variant achalasia. We thank Young et al for this valuable study; however we believe that some points require clarification.
Dear Editor, We read with great interest the recently published article by Fukuda et al. The auth... more Dear Editor, We read with great interest the recently published article by Fukuda et al. The authors indicate that there is significant correlation between serum telaprevir (TVR) level and bodyweight and suggest that adjustment of TVR dose according to bodyweight would avoid renal impairment during treatment. Herein, we want to present a case in which renal impairment completely reversed after discontinuation of TVR, and ribavirin dose reduction seemed to be important in improving renal impairment until therapy. A 51-year-old woman came to our clinic 4 months ago. She had chronic active hepatitis C, and had received peginterferon-α-2b and ribavirin treatment for 48 weeks after being diagnosed in 2010; but 6 months after remission, her condition relapsed. She had no history of renal failure until the dual treatment. After evaluation of the patient, we decided to administrate triple therapy, a combination of TVR 2250 mg/day, peginterferon-α-2a 180 μg/week and ribavirin 800 mg/day. At day 10, the patient’s serum creatinine (sCr) level rose to 1.3 mg/dL and glomerular filtration rate (GFR) was 48 mL/min (pretreatment: sCr, 0.8 mg/dL; GFR, 79 mL/min). We decided to reduce the ribavirin dose and not to reduce TVR therapy after evaluation of other causes of renal failure. We reduced the ribavirin dose 200 mg every 2 weeks until 200 mg/day and did not reduce TVR and peginterferon dose, and gave fluid resuscitation. Despite replacement therapy, her sCr level rose to 2.1 mg/dL. We decided to continue treatment despite low GFR (30 mL/min), because the urine output was sufficient. Also, with high fluid replacement, her sCr level remained constant at 1.5 mg/dL with GFR of 41 mL/ min until the 12th week. After the 12 weeks of therapy with triple treatment, we stopped TVR as scheduled. After finishing TVR treatment, and continuing dual treatment with peginterferon and ribavirin, her sCr level fell to a normal level (0.8 mg/dL). Despite this study, we did not observe irreversible renal damage in our patient. Mauss et al. showed in their study that renal impairment is reversible after discontinuation of the treatment. Instead of decreasing TVR dose, ribavirin dose reduction may be appropriate. In our patient, despite low GFR levels, our patient finished hepatitis C virus treatment successfully. In patients with renal impairment with high urine output, therapy could be completed with appropriate supportive treatment, and we believe that as well as the decrease in GFR, urine output should be taken into account.
Nonalcoholic fatty liver disease associated with increased risk of cardiovascular mortality. Caro... more Nonalcoholic fatty liver disease associated with increased risk of cardiovascular mortality. Carotid artery intima media thickness is a reliable index of subclinical atherosclerosis. There are contradictory reports about relationship between nonalcoholic fatty liver disease and carotid atherosclerosis. In this study, we aimed to investigate carotid artery intima media thickness levels and its association with histological findings in biopsy proven nonalcoholic fatty liver disease. 113 male patients and 57 healthy male controls were enrolled. Patients and control groups mean ages were 31.7± 5.7 and 30.1± 5.5 respectively. Body mass index, Waist circumference, glucose, lipids and insulin levels, and HOMA-IR were determined. Carotid atherosclerosis evaluated by carotid artery intima media thickness using high resolution carotid ultrasonography. Carotid artery intima media thickness levels were higher in patient group than the control group. This difference was disappeared when the findings were adjusted according to the body mass index, waist circumference, glucose and lipid levels, and HOMA-IR indexes. In addition, no significant association was observed between carotid artery intima media thickness and liver histology. However, there was a significant association between age and carotid artery intima media thickness in patients and controls. Our study does not support an association between carotid atherosclerosis and nonalcoholic fatty liver disease. Otherwise, it can be speculated that a longer exposure to the disease is required to determine significant differences in carotid atherosclerosis.
Özet Akut pankreatit, pankreas parankiminin inflamatuvar bir hastalığıdır. Klinik prezentasyona g... more Özet Akut pankreatit, pankreas parankiminin inflamatuvar bir hastalığıdır. Klinik prezentasyona göre hafif (ödematöz) ve şiddetli (nekrotizan) pankreatit olarak iki gruba ayrılmaktadır. En sık etyolojik nedenler safra taşı ve alkoldür. Hipertrigliseridemi, akut non-biliyer pankreatitte nadir görülen bir etyolojik faktördür. Hipertrigliseridemiye bağlı oluşan akut pankreatit tablosunda amilaz normal seviyede saptanabilir Görüntüleme tetkikleri ve serum lipaz düzeyi tanıda yardımcıdır. Biz burada hipertrigliseridemiye sekonder olarak gelişen ve amilaz değeri normal olan akut pankreatit olgusunu sunuyoruz.
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