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Introduction: We aimed to evaluate access to diagnosis, treatment and follow-up in patients with viral hepatitis during the COVID-19 pandemic. Methodology: Patients who started treatment for hepatitis B and hepatitis C were included in the study and analyzed in two periods: before-pandemic and during-pandemic. Indication for treatment and frequency of laboratory follow-up was obtained from hospital records. A telephone survey was administered to evaluate treatment access and compliance. Results: Four centers with 258 patients were included in the study. Of these 161 (62.4%) were male, median age was 50 years. The number of patients, admitted to outpatient clinics was 134647 in the before-pandemic period and 106548 in the during-pandemic period. Number of patients who started treatment for hepatitis B were significantly high during-pandemic period compared with before-pandemic (78 (0.07%); 73 (0.05%) respectively; p = 0.04). The number who received treatment for hepatitis C was similar in both periods: 43 (0.04%); 64 (0.05%), respectively (p = 0.25). Prophylactic treatment for hepatitis B, due to immunosuppressive agents was significantly higher in during-pandemic period (p = 0.001). In the laboratory follow-ups at 4th, 12th and 24th weeks of treatment, worse adherence was detected in during-pandemic (for all p < 0.05). Access to treatment and compliance of all patients was over 90% and did not differ in the two periods. Conclusions: During-pandemic, hepatitis patients' access to diagnosis, treatment initiation and follow-up had worsened in Turkey. The health policy implemented during the pandemic had a positive impact on patients' access to and compliance to treatment.

Background: The treatment of solitary rectal ulcer (SRU) is challenging and controversial; generally, no response to conventional treatments can be obtained, particularly in patients with dyssynergic defecation (DD). We assessed the efficiency of biofeedback therapy (BFT) in patients who did not respond to conservative treatments and had coexistence of SRU and DD. Methods: BFT responses, as well as anorectal manometry and rectoscopy results of 20 patients with the coexistence of SRU and DD, were assessed. Results: Mean age was 32.5 years. Of the patients, 12 were female, and 8 of them were male. An average of 12 sessions of BFT was performed on the patients. Ulcer disappeared in 11 patients (55%) after BFT, and the ulcer size decreased in 3 patients (15%). However, ulcers healed in 9 (90%) of 10 patients whose DD pattern disappeared following BFT, and ulcers healed in only 20% of patients whose DD pattern continued (p = 0.005). The change in anal resting pressure after BFT was significant (p = 0.016). Ulcers were healed in 87.5% (7/8) of the patients whose anal resting pressure decreased after BFT and whose DD disappeared, while ulcers remained untreated in 85.7% of the patients whose anal resting pressure decreased, but the DD pattern continued (p = 0.005). Conclusions: SRU patients with DD are typically unresponsive to medical treatments. Ameliorating anorectal dyssynergia should be the priority of treatment in these patients. BFT is an effective treatment for DD. BFT enhances the healing of ulcers in patients with SRU by restoring coordination of the pelvic floor.

Objective: In this paper, it was tried to determine the incidence of COVID-19, course of the disease, and mortality rate in liver transplant patients by evaluating all patients operated on in our center. In addition, the results of liver transplantation performed in our center during the pandemic period were also presented. Material and Methods: All patients who had undergone liver transplantation in our liver transplant center were questioned about their history of COVID-19 either at their routine controls in the clinic or by phone interview. Results: Our liver transplant unit had 195 registered liver transplantation patients (2002-2020), and 142 of these were still alive and under follow-up. During the pandemic period, 80 patients referred to our outpatient clinic for follow-up, and their records were evaluated retrospectively in January 2021. Among 142 liver transplant patients, a total of 18 (12.6%) COVID-19 patients were identified. While 13 of these patients were males, mean age of the patients at the time of interviews was 48.8 years (22-65 years). Nine of the patients had living donor liver transplant, and the rest had cadaveric liver transplant. The most common COVID-19 associated symptom in the patients was fever. During the pandemic period, 12 liver transplant operations were performed in our center. Nine of them were living donor liver transplantation and the remainder were cadaveric liver transplantations. Two of our patients got COVID-19 positive during this period. One of them who was transplanted after COVID treatment was followed-up in intesive care for a long time and was lost not related to COVID-19. Conclusion: The incidence of COVID-19 is higher in liver transplant patients than in the general population. Nonetheless, mortality rates are low. During the pandemic period, liver transplantation can be continued by following general precautions.

Background: Inflammation plays an important role in the development of cardiovascular disease, including atherosclerosis and arrhythmia. The aim of this study was to evaluate atrial conduction times (ACTs) in patients with inflammatory bowel disease (IBD) in which systemic chronic inflammation is evident. Methods: In this cross-sectional, prospective, single-center study, 79 IBD patients (51 ulcerative colitis; 28 Crohn's disease) and 70 healthy controls were included. Atrial electromechanical properties were measured by recording simultaneous surface electrocardiography (ECG) with transthoracic echocardiography (ECHO) and tissue Doppler imaging methods. The relationship between age, disease duration, and ACT was evaluated. Results: There were significantly increased conduction durations of lateral-PA (time interval from the onset of the P-wave on surface ECG to the beginning of the late diastolic wave), septal-PA, tricuspid-PA, and interatrial-electromechanical delay (IA-EMD), right intraatrial EMD, and left intraatrial (LI-EMD) durations in IBD patients (P < 0.001). In IBD patients, there was a positive correlation with age, lateral PA, septal PA, tricuspid PA, IA-EMD, and LI-EMD (P < 0.05). A positive correlation was found between disease duration and only lateral PA and tricuspid PA (P < 0.05). Conclusion: In IBD patients, prolonged ACT consists a potential risk for severe atrial arrhythmias. ECG and ECHO screening can be useful in identifying risk groups in IBD patients and taking precautions for future cardiac complications. © 2021 Saudi Journal of Gastroenterology Published by Wolters Kluwer - Medknow.

Liver transplant recipients have been reported to be a high-risk population for severe disease from COVID-19 infection. In this crosssectional, single-center study, we investigated whether liver transplant increased the risk of death and severe disease in patients with SARS-CoV-2 infection.We collected data and serum anti-SARS-CoV-2 immunoglobulin M and immunoglobulin G results of 91 liver transplant recipients seen from September 2020 to March 2021. Liver transplant recipients were enrolled during presentation for scheduled routine follow-up visits. All patients who required serum anti-SARS-CoV-2 immunoglobulin M and immunoglobulin G tests completed a ques-tionnaire on clinical symptoms during the previous 6 months.Among the 91 patients with SARS-CoV-2 immunoglobulin M and G results, 7 patients had a known history of symptomatic COVID-19 during the previous 6 months. Of the 84 participants who completed the questionnaire, 21 (25%) had positive anti-SARS-CoV-2 immunoglobulin M and G results. These 21 patients also received COVID-19 polymerase chain reaction tests, which were negative in all 21 patients. Overall, only 7 patients stated that they experienced flu-like upper respiratory tract infection symptoms or diarrhea.We documented past SARS-CoV-2 infection in only 25% of our outpatient liver transplant recipients, and most were asymptomatic. We found no significant relationship between symptoms and seropositivity for SARS-CoV-2.

Background and Aim: The aim of the present study was to examine the etiology of hepatocellular carcinoma (HCC) by underlying cause and determine the characteristics and clinical features of patients with HCC. Materials and Methods: The study comprised 1802 HCC patients diagnosed and followed up by Liver Diseases Outpatient Clinics in 14 tertiary centers in Turkey between 2001 and 2020. Results: The mean age was 62.3 +/- 10.7 years, and 78% of them were males. Of the patients, 82% had cirrhosis. Hepatitis B virus (HBV) infection was the most common etiology (54%), followed by hepatitis C virus (HCV) infection (19%) and nonalcoholic fatty liver disease (NAFLD) (10%). Of the patients, 56% had a single lesion. Macrovascular invasion and extrahepatic spread were present in 15% and 12% of the patients, respectively. The median serum alpha-fetoprotein level was 25.4 ng/mL. In total, 39% of the patients fulfilled the Milan Criteria. When we compared the characteristics of patients diagnosed before and after January 2016, the proportion of NAFLD-related HCC cases increased after 2016, from 6.6% to 13.4%. Conclusion: Chronic HBV and HCV infections remain the main causes of HCC in Turkey. The importance of NAFLD as a cause of HCC is increasing.

Jackhammer özofagus, özofagus manometri incelemelerinin ortalama %4’ünde saptanan peristaltik hiperkontraktil motilite bozukluğudur. Tanısı çoğunlukla disfaji, bazen göğüs ağrısı veya gastroözofageal reflü şikayetleri ile başvuran hastalarda konur. Disfaji semptomu, alt özofageal sfinkterdeki güçlü kasılmalar, özofageal çıkış darlığı ve yüksek distal kontraktil integral ile ilişkilidir. Jackhammer özofagus tedavisi ile ilgili net bir konsensüs bulunmamaktadır. Asid maruziyetinin azaltılması semptom ve motor bozukluğunu azalttığı gösterilmiştir. Ağırlıklı semptomlar göğüs ağrısı ve disfaji için ise nöromodülatörler ile düz kas gevşeticileri verilebilir. Ağır refrakter olgularda özofageal Botulinum toksini enjeksiyonu ve POEM gibi endoskopik yöntemlerin yanında Heller myotomi gibi cerrahi seçenekler de düşünülebilir. Vakamızda Botulinum enjeksiyonu ve kalsiyum kanal blokeri ile klinik yanıt elde edilmiştir.

Background and aims: Data on the soft tissue rheumatism, especially fibromyalgia syndrome is limited in inflammatory bowel disease. Our aim in our study is to determine the prevalence of fibromyalgia syndrome and to evaluate the impact of it on quality of life in inflammatory bowel disease. Methods: 60 ulcerative colitis and 34 Crohn's disease patients were included. 2010/2011 and 2016 American College of Rheumatology criteria were used for fibromyalgia syndrome diagnosis. Fibromyalgia impact survey was applied to the all patients. Results: According to the American Colloge of Rheumatology-2010/2011 criteria, fibromyalgia syndrome frequencies were determined as 29.8% in inflammatory bowel disease, 23.4% in Crohn’s disease and 33.3% in ulcerative colitis (P ˃ 0.05). The frequency of fibromyalgia syndrome was significantly higher in inflammatory bowel disease and especially more in female. There was no significant difference between ulcerative colitis and Crohn’s disease in terms of widespread-pain-index, somatic-symptom-severity and fibromyalgia syndrome scores. Fibromyalgia impact scores were found significantly higher in those with fibromyalgia syndrome in inflammatory bowel disease, ulcerative colitis and Crohn’s disease. Conclusions: This is the first study to show the frequency of fibromyalgia syndrome in patients with inflammatory bowel disease in Turkish population. Fibromyalgia syndrome has been shown to be increased in inflammatory bowel disease patients and more in ulcerative colitis and female. The quality of life is more affected in inflammatory bowel disease patients with fibromyalgia syndrome.

Objectives: To describe the prevalence of risk factors in patients infected with hepatitis C virus (HCV). Materials and Methods: Patients who were aged >18 years visiting outpatient clinics and diagnosed as having HCV infection were enrolled in this cross-sectional, multicenter study conducted in 71 cities. Patient data on socio-demographic and clinical characteristics and pre-defined risk factors were collected. Results: Among 1,018 patients, 53.0% were women. The mean age was 57.2 +/- 14.3 years and 34.8% had been diagnosed as having HCV infection >10 years before enrollment. Almost half of the patients (45.5%) were diagnosed during their regular check-up visits, and only 16.8% were diagnosed because of signs or symptoms of HCV. Genotype 1 and sub-genotype 1 b were detected in 87.9% and 73.7% of the patients, respectively. At least one risk factor was present in 94.8% of the patients. The most frequently reported risk factor was major dental procedures (79.2%), followed by major surgical operations (56.9%) and minor surgical interventions (42.3%). Conclusion: Our results revealed that most of the patients with HCV infection underwent major dental procedures., AbbVie Inc. (North Chicago, IL, USA); AbbVie, This study was funded in full by AbbVie Inc. (North Chicago, IL, USA). Statistical analysis, writing support, and editing services in the development of this manuscript were provided by MONITOR CRO (Istanbul, Turkey) and funded by AbbVie. The authors also acknowledge the other participants of the EPI-C Study (protocol number 10-989) Team.

Background and aim: this study aimed to compare carotid intima media (CIMT) and epicardial adipose tissue (EAT) measurements, which are considered as markers for the detection of early atherosclerosis in healthy controls and inflammatory bowel disease (IBD) cases. Methods: a total of 60 IBD patients (25 Crohn’s disease and 35 ulcerative colitis) and 60 healthy patients (as a control group) were included in the study. The measurements of CIMT and EAT were performed using echocardiography and ultrasonography, respectively. Statistical analysis was used to determine the relationship between the parameters. Results: the thickness of bilateral (right and left) CIMT and EAT were significantly higher in IBD than in the control group (p < 0.05). There was a positive correlation between EAT and bilateral (right and left) CIMT in IBD patients (p < 0.05). Conclusion: IBD is associated with an increased thickness of EAT and CIMT. Chronic inflammation in IBD may increase the risk of atherosclerotic heart disease. Thus, only measuring the thickness of EAT and CIMT can be used as an objective, easy, simple, affordable, non-invasive and accessible assessment method in order to screen for this risk. © Copyright 2021. SEPD y © ARÁN EDICIONES, S.L.

Giriş ve Amaç: Bu çalışmada, asit sodyum düzeyinin prognostik amaçlarla kullanılabilirliği ve iki yıllık mortalite, spontan bakteriyel peritonit, hepatik ensefalopati ve hepatorenal sendrom ile ilişkisi araştırıldı. Gereç ve Yöntem: Bu çalışma Temmuz ve Ekim 2018 tarihleri arasında karaciğer sirozu olup asit sodyum düzeyi çalışılan hastalarla yapıldı. Şiddetli kalp yetmezliği, nefrotik sendrom veya elektrolit bozukluğu olan hastalar; başvuru sırasında spontan bakteriyel peritonit, hepatik ensefalopati veya hepatorenal sendromu olan hastalar ve başka bir nedenden ötürü diüretik kullanan hastalar çalışma dışı bırakıldı. Bulgular: Çalışma 72 sirotik hasta ile yapıldı [32 kadın (%44.4) ve 40 erkek (%55.6)]. Hastalar iki yıl boyunca takip edildi ve 33 hastada mortalite gelişti (%45.8). 13 hastada hepatik ensefalopati (%18.1), 13 hastada hepatorenal sendrom (%18.1) ve 32 hastada spontan bakteriyel peritonit (%44.4) gelişti. Hepatik ensefalopati, hepatorenal sendrom ve spontan bakteriyel peritonit gelişme oranı derin hiponatremi grubunda diğer hiponatremi gruplarına göre daha yüksekti (p < 0.05). Ortalama Child-Pugh ve Model for End-Stage Liver Disease-Na skorları orta ve derin hiponatremi gruplarında diğer gruplara göre daha yüksekti (p < 0.05). Asit sıvısında hiponatremi mortalite için bağımsız bir prediktör olarak bulundu ve mortalite riski derin hiponatremisi olan hastalarda hiponatremi olmayan hastalara göre 29.55 kat daha fazla bulundu. Sonuç: Bu çalışmada asit sıvısında 125 mEq/L’den daha düşük sodyum düzeyi ile artmış sirotik komplikasyonlar ve mortalite arasında ilişki olduğu gösterilmiştir., Background and Aims: In this study, we investigated the usefulness of the ascites sodium level for prognostic purposes and its association with 2-year mortality, spontaneous bacterial peritonitis, hepatic encephalopathy, and hepatorenal syndrome. Material and Methods: This study was performed between July and October 2018 in patients with liver cirrhosis in whom the ascites sodium level was studied. Patients with severe heart failure, nephrotic syndrome, or electrolyte disturbance; patients who had spontaneous bacterial peritonitis, hepatic encephalopathy or hepatorenal syndrome at admission; and patients who used diuretics for another reason were excluded from the study. Results: The study population consisted of 72 cirrhotic patients [32 females (44.4%) and 40 males (55.6%)]. The patients were followed up for 2 years, and mortality developed in 33 patients (45.8%). During follow-up, hepatic encephalopathy developed in 13 patients (18.1%), hepatorenal syndrome in 13 patients (18.1%), and spontaneous bacterial peritonitis in 32 patients (44.4%). Hepatic encephalopathy, hepatorenal syndrome, and the spontaneous bacterial peritonitis ratio were higher in the deep hyponatremia group compared with other hyponatremia groups (p < 0.05). The mean Child-Pugh and Model for End-Stage Liver Disease-Na scores were similar in the moderate and deep hyponatremia groups, and they were higher than in the other groups (p < 0.05). The mortality rate was found to be higher in the deep hyponatremia group than in the other hyponatremia groups (p < 0.05). Hyponatremia in ascites was found to be an independent predictor of mortality, and patients in the deep hyponatremia group had a 29.55-fold increased risk of mortality compared with those patients without hyponatremia. Conclusion: In this study, it was shown that deep hyponatremia less than 125 mEq/L in ascites was associated with increased cirrhotic complications and mortality.

Crohn’s disease is a systemic, autoimmune disease affected whole the gastrointestinal system. hastaligi tum gastrointestinal sistemi tutan sistemik otoimmun bir hastaliktir. Drug-associated autoimmune diseases such as lupus-like syndrome are going to be seen related to antiTNF-alpha that is used frequently. This case is the Crohn’s disease that acut pancreatitis has developed after the usage of azathioprine, and then adalimumab has been started, lupus-like syndrome related to adalimumab has emerged. A little part of these side effects are related to autoimmunity. This autoimmunity is associated with the increase of Th2 cytokine response, and as a result, the production of autoantibody. Drug-associated lupus is the situation that is reversible after the stopping causative agent. It must be keep in mind that drug-associated lupus-like syndrome can emerge in the patients used antiTNF-alpha.

Objective: Serum biomarkers are frequently used to assess disease activities in Ulcerative Colitis (UC) and Crohn disease (CD). But none of them are specific for intestinal inflammation. There are studies showing that hematological parameters predict inflammation in the body. Although previous studies have shown that the neutrophil / lymphocyte ratio (NLR) is associated with disease activity in UC, this relationship has not been shown in CD. In our study, the relationship of NLR and other hematological parameters to disease activity in UC and CD was evaluated. Material and Method: A total of 197 UC (107 active, 90 remissions), 97 CD (50 active, 47 remissions) and 26 age and sex matched healthy control groups were included in the study. The disease activity and CRP, ESR, hemogram parameters were recorded. NLR, Platelet/lymphocyte (PLR), MPV/platelet and RDW/platelet ratios were calculated. Parameters were compared between UC, CD and control groups according to activity status. Results: In UC, leukocyte, neutrophil, monocyte, platelet, platecrit (Pct), PLR, ESR, CRP values were found to increase significantly in the control, remission and active groups with a certain trend, respectively. Hemoglobin (Hb), hematocrit (HCT) and RDW/platelet were shown to decrease respectively. NLR and MPV/platelets were significantly different between the groups of active UC, UC in remission and control. Other parameters were not statistically significant. In CH, ESR, CRP, platelet, Pct, PLR were found to increase significantly with a certain trend in control, remission and active groups, respectively. Hb, HCT, MCV, MCH and RDW/platelets were found to decrease with a certain trend. Leukocyte, neutrophil, lymphocyte, monocyte count, MCHC, NLR and MPV/platelet were significantly different between the CD and control groups. In CD, eosinophil count and RDW were not statistically significant. ESR, CRP, NLR and PLR had acceptable sensitivity-specificity in predicting active patients in CD and UC. ESR, CRP, WBC, neutrophil, monocyte, platelet, Pct, NLR, PLR, MPV/platelet and RDW/platelet parameters were significant factors in predicting active disease in UC and CD. Conclusion: Many hemogram parameters change with activity in IBD. Although not specific for IBD, NLR and PLR are as effective as CRP and ESR in detecting active patients in IBD and can be used as markers to demonstrate activity.

Backgroundand Aims: In this study, we investigated the relationship between C-reaktiveprotein (CRP)/Albumin ratio (CAR) and hepatocellular carcinoma (HCC), hepaticencephalopathy (HES), mortality, Child-Pugh and MELD scores in newly diagnosedcirrhotic patients.Material and Methods: This study was performed retrospectively by examining newlydiagnosed cirrhotic patients records who applied to Gastroenterology andHepatology polyclinic between 2011 and 2017. Patients who diagnosed with HES, HCC or spontaneous bacterialperitonitis at admission and those younger than 18 years old were excluded fromthe study.Results:The study population was consisted of 118 patients,78 men (66.1%) and 40 women (33.9%). The meanage of the patients was 50.3±11.7 years. Themost common etiologic factors of cirrhosis were hepatitis B (37.3%),cryptogenic (17.8%) and hepatitis C (11.9%). Themean follow-up period of the patients was 48 months. In the multivariatestepwise Cox regression model in which risk factors were included; HESdevelopment (HR: 4,21; p=0,001), initial MELD score (HR: 1,17; p, Giriş ve Amaç: Bu çalışmada yeni tanı siroz hastalarında tanı anındaki C-reaktifprotein (CRP)/Albümin oranının (CAO) hepatosellüler karsinom (HCC), hepatikensefalopati (HES), mortalite, Child-Pugh ve MELD skorları ile ilişkisiniaraştırdık.Gereç ve Yöntem: Buçalışma 2011-2017 yılları arasında Gastroenteroloji ve Hepatoloji polikliniğebaşvuran yeni tanı siroz hastalarının hasta kayıtları incelenerek retrospektifolarak yapılmıştır. Çalışmaya alınma anında spontan bakteriyel peritonit, HESveya HCC tanısı olanlar ve 18 yaşından küçük olanlar çalışmadan dışlanmıştır.Bulgular: Araştırmapopülasyonu 78 erkek (%66,1) ve 40 kadın (%33,9) hasta olmak üzere 118 kişidenoluştu. Hastaların ortalama yaşı 50,3±11,7 yıldı. Hastalarda sirozun en sıketyolojik faktörleri hepatit B (%37,3), kriptojenik (%17,8) ve hepatit C(%11,9) idi. Hastaların ortalama takipsüresi 48 aydı. Risk faktörlerinin dahil edildiği çok değişkenli stepwise Coxregresyon modelinde; HES gelişmesi (HR:4,21; p=0,001), başlangıç MELD skoru(HR:1,17; p

Giriş ve Amaç: Mallory-Weiss sendromu üst gastrointestinal sistem kanamalarının %1-4 kadarından sorumludur. Çoğu Mallory-Weiss sendromu spesifik endoskopik tedavi gerektirmeyen bir şekilde hafif kanama ile seyreder; bununla beraber bazı olgularda kanama abondan olabilir. Ülser kanamalarından farklı olarak Mallory-Weiss sendromunda endoskopik tedavi çok iyi standartize edilmemiştir. Biz bu çalışmamızda kendi olgularımızın demografik özelliklerini, uygulanılan endoskopik tedavileri ve hastaların klinik seyirlerini karşılaştırmayı hedefledik. Gereç ve Yöntem: Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Endoskopi ünitesinde 2010-2017 tarihleri arasında Mallory-Weiss sendromu tanısı almış hastalar retrospektif olarak incelendi. Bulgular: Çalışmaya toplam 37 hasta (erkek/kadın: 29/8, yaş ortalaması: 63,4±19,4) dahil edildi. Bu hastaların Mallory-Weiss laserasyonu endoskopi esnasında oluşan hasta sayısı 15 olup hastaların 27 tanesinde aktif kanama belirtisi vardı. Primer hemostaz 25 hastada %92,5 sıklıkta izlendi. Aktif kanama belirtisi olan hastalara uygulanılan endoskopik tedaviler adrenalin enjeksiyonu, klips uygulaması, heater prob idi. Mallory-Weiss sendromu oluşumuna göre hastalar iatrojenik Mallory-Weiss sendromu olan ve olmayan hastalar olarak iki gruba ayrıldı. Hastanede yatış varlığı, eritrosit süspansiyonu verilme ihtiyacı, aktif kanama belirtisi varlığı, hiatal herni varlığı ve uygulanılan endoskopik tedaviler karşılaştırıldığında bu parametreler açısından gruplar arasında fark yoktu. Toplam 27 hastaya klips uygulaması yapılmıştı; bu hastaların 19 tanesine sadece klips uygulanırken 8 tanesine ise klips ile beraber adrenalin uygulaması yapıldı. Hastalarımızda mortalite izlenmedi. Sonuç: Mallory-Weiss sendromlu çoğu hasta klinik olarak benign seyir gösterse de bu hastaların şiddetli kanama ile beraber olacakları akılda tutulmalıdır. Hemoklipsler tedavide etkin ve güvenli bir endoskopik tedavi yöntemidir.

Background/aims Lipoxin A4 (LXA4), an anti-inflammatory lipid mediator, regulates leukocyte cellular activity and activates gene transcription. The therapeutic effect of LXA4 on liver fibrosis and its mechanism on the immune system are largely unknown. Because the regenerative capacity of hepatocytes in acute and chronic liver failure models of mouse increases by silencing MKK4, we aimed to investigate the effect of parenteral administration of LXA4 on the genes responsible for regeneration of liver, namely MKK4, MKK7, and ATF2, and visualize the therapeutic effects in an experimental model. Materials and methods Fibrosis was induced in mice by administration of thioacetamide (TAA). LXA4 was administered during the last two weeks of fibrosis induction. The fibrosis level was measured by Knodell scoring. The liver function was measured by analyzing serum ALT, AST, and AP levels. Expression levels of genes responsible for liver fibrosis (TGF-α) and cell regeneration (MKK4, MKK7, and ATF2) have been measured by RT-PCR analysis. Inflammatory and anti-inflammatory cytokine levels were measured in serum samples and liver homogenates by Enzyme Linked Immunosorbent Assay (ELISA). Ultrathin sections were examined using a transmission electron microscope and analyzed. Results We observed significant healing in liver of the LXA4-treated group, histologically. This finding was in parallel with reduction of serum ALT, AST, but not AP levels. TGF-α and MKK4 expressions were significantly reduced in the LXA4-treated group. Administration of LXA4 caused significant elevation of IL-10 in systemic circulation; however, that elevation was not detected in liver homogenates. Nevertheless, significant reductions in TNF-α and IL-17 have been observed. Conclusion The anti-inflammatory effect of LXA4 maintains the regenerative capacity of liver during fibrosis in an experimental liver fibrosis model. LXA4 may be therapeutically beneficial in liver fibrosis.

Interferon tedavisi antiviral etkisi yaninda, hucre proliferasyonunu baskilamak, immun sistemi duzenlemek gibi degisik nedenlerle kulanilmaktadir. BU ilaclarin neoplastik hastaliklar, kronik viral hepatit tedavisi yaninda vaskuler endotelyal hucre proliferasyonu ve anjiogenezi baskilama gibi etkileri de vardir. Interferon tedavisinin degisik yan etkileri bulunmaktadir. Retinopati, konjunktiva alti kanamalari gibi okuler toksisiteleri de bilinir. Biz burada; kronik hepatit C tanisi alan ve interferon +ribavirin tedavisi sonrasi retinopati gelisen bir vakayi sunacagiz. Hastanin okuler yan etkilerden dolayi interfeon tedavisinin kesilmesine ragmen okuler bulgular uzun sure sebat etmistir.

Background/aims We aimed to investigate the association of bezoar with endoscopic findings, risk factors for bezoar occurrence, and the success of endoscopic treatment in a tertiary center. Materials and methods This retrospective study was conducted between January 2012 and December 2015. Overall, 8200 endoscopy records were examined and 66 patients with bezoar were included in the study. Results We enrolled 29 (44%) female and 37 (56%) male patients in this study. The mean age of the patients was 63±9.4 years. The most frequent risk factors were history of gastrointestinal surgery (23%), diabetes mellitus (17%), trichophagia (9%), and anxiety disorder (6%). Gastric ulcer, duodenal ulcer, erosive gastritis, and reflux esophagitis were present in 27%, 11%, 20%, and 23% of the patients, respectively. While bezoars were most commonly observed in the stomach (70%), the majority of them were phytobezoars (91%). The mean number of interventions for each patient was 1.5 (range, 1-6). Endoscopy was successful in removing bezoars in 86.5% of the patients. Among those referred to surgery, seven patients underwent gastrostomy (10.5%); one (1.5%) patient underwent gastroenterostomy because of concomitant pyloric stenosis; and one (1.5%) patient underwent fistula repair surgery due to the development of duodenal fistula caused by bezoar. Conclusion The findings of this study indicated that bezoars are more common among subjects with history of gastrointestinal surgery, diabetes mellitus, or psychiatric disorders; bezoars are closely related to peptic ulcer and reflux esophagitis; and they can be successfully treated with endoscopy.

Giriş:Elektrokardiyografide (EKG) ventriküler repolarizasyon Tp-eintervali ve kalp hızına göre düzeltilmiş QT (QTc) aralığıkullanılarak değerlendirilir. Uzamış Tp-e/QTc oranı aritmiler vekardiyak mortalite riskinde artışla ilişkilidir. NASH(nonalkolik steatohepatit)’in ventriküler repolarizasyon üzerine etkileriyle ilgili az sayıdaçalışma olduğu için, NASHhastalarında Tp-einterval ölçümlerini ve Tp-e/QT oranını değerlendirmeyiamaçladık. Gereçve Yöntemler: Çalışmamıza toplam97 NASHhastası ile 77 kişilik kontrol grubu dahil edildi. Tp-e intervali,Tp-e/QT ve Tp-e/QTc oranları 12-lead elektrokardiyogram ileölçüldü.Bulgular:Kalp hızı her iki grupta da benzerdi (74.8± 10.1 vs.75.7± 11.7;p=0.598). QT interval (396.0± 34.2 vs.384.6± 30.7;p=0.023) ve QTc interval (403.6± 34.8 vs.399.9± 36.3;p=0.027), Tp-e interval (100.4± 13.6 vs.91.4± 13.4;p, Aim: Ventricular repolarization is assessed usingthe Tp-e interval and QT interval corrected by the heart rate (QTc) via anelectrocardiogram (ECG). Prolonged Tp-e/QTc is related with an increased riskof arrhythmias and cardiac mortality. As there have been few reports regardingthe effects of NAFLD on ventricular repolarization, we aimedto appraise the assessment of Tp-einterval and Tp-e/QT ratio in patients with NAFLD. Materialand Methods: Totally 97 patients with NAFLD and 77 control subjects were enrolled in our study. Tp-e interval, Tp-e/QT and Tp-e/QTcratios were measured from the 12-lead electrocardiogram. Results:Heart rate was similar between groups (74.8 ± 10.1 vs. 75.7 ± 11.7; p=0.598). QT interval(396.0 ± 34.2 vs.384.6 ± 30.7;p=0.023) and QTc interval (403.6 ± 34.8 vs. 399.9 ± 36.3; p=0.027), Tp-einterval (100.4 ± 13.6 vs.91.4 ± 13.4;p

Girişve Amaç: Etat mamillone endoskopikolarak gözlenen ve Helicobacter pylori pozitifolan hastalarda mukozal nodüler tutulum ile karakterizekolaylıkla tanınabilen karakteristik bir bulgudur. Bizbu çalışmada etat mamillone görüntüsü nedeniyle endoskopik biyopsi alınanhastalarda bu görüntünün histopatolojik tanıya göre doğruluğunu araştırdık. Gereç ve Yöntem: Bu çalışma Ocak2016-Aralık 2017 tarihleri arasında hastanemiz gastroenteroloji kliniğindeçeşitli sebeplerle endoskopi yapılan hastaların hasta kayıtları incelenerekretrospektif olarak yapılmıştır. Toplamda 5200 endoskopi kaydı incelenmiş, etatmamillion veya etat mamillone tabiri geçen 53 hasta çalışmaya dahil edilmiştir.Bulgular: Araştırma popülasyonu 41kadın (%77) ve 12 erkek (%23) erkekhasta olmak üzere 53 kişiden oluştu. Hastaların ortalama yaşı 29±11.2 (18-56)yıldı. Hastaların endoskopik biyopsi sonuçlarına bakıldığında 4 (%8) hastadaatrofik gastrit mevcut iken 49 (%92) hastada atrofi yoktu. Hastaların biyopsiörnekleri incelendiğinde 53 hastanın 45’inde Helicobacter pylori pozitifsaptandığı görüldü (%85). Bu hastaların Sydney sınıflamasına göre 12’sinde 1+ Helicobacterpylori (%23),17’sinde 2+ Helicobacter pylori (%32) ve 16’sında 3+ Helicobacter pylori (%30) saptanmıştır. Endoskopik etat mamillonegörüntüsü ile biyopsi sonuçları arasında %85 oranında korelasyon olduğu görülmüştür.Sonuç:Endoskopikolarak tanımlanan etat mamillone görünümü Helicobacter pylori gastrititanısı için kullanılabilecek non-invaziv ve yüksek doğruluk oranına sahip biryöntemdir., Background and Aims: Etat mamilloneis an endoscopic appearance characterized by mucosal nodular involvement inpatients with Helicobacter pylorigastritis. In the present study, we investigated the accuracy of this appearanceon the basis of histopathological diagnosis in patients who underwentendoscopic biopsy for etat mamillone. Materialand Methods: The present study was performed retrospectively betweenJanuary 2016 and December 2017 in the gastroenterology clinic of our hospital.A total of 5200 endoscopy records were examined, and 53 patients with etatmamillion or etat mamillone were included in the study. Results: The study population consisted of 53 patients, 41 of whomwere female (77%) and 12 male (23%). The mean age of the patients was 29±11.2years (range: 18–56 years). Atrophic gastritis was observed in four patients (8%),while 49 patients (92%) had no atrophy. Upon biopsy, 45 of the 53 patients(85%) were found to be Helicobacter pylori positive.According to the Sydney classification, 12 patients had 1+ Helicobacterpylori (23%),17 had 2+ Helicobacter pylori (32%),and 16 had 3+ Helicobacter pylori (30%).There was 85% correlation between the endoscopic etat mamillone appearance andbiopsy results. Conclusion: Endoscopic etat mamillone appearance is anon-invasive and highly accurate method for diagnosis of Helicobacterpylori gastritis.

Giris ve Amac: Calismamizda klinigimizde Dieulafoy Lezyonu tanisi konulan hastalari, yapilan endoskopik tedavileri ve bu tedavilerin basari oranlarini ortaya koymayi hedefledik. Gerec ve Yontem: Klinigimizde 2008-2016 tarihleri arasinda endoskopileri yapilan hastalar ‘Dieulafoy Lezyonu’ tanisi icin retrospektif olarak tarandi. Endoskopik tanisi Dieulafoy lezyonu olan hastalarin servis yatislari, laboratuvar degerleri, kac gun yattiklari, hastaliklarinin nihai sonucu tespit edildi. Bulgular: 18 hasta calismaya alindi. En sik basvuru sikayeti melenaydi. Hastalarin yedi tanesinde mortalite gerceklesti. Klips, tek basina veya kombine olmak uzere en sik basvurulan endoskopik tedavi yontemiydi. Klipsin tek basina uygulandigi hastalarla, klipsle beraber veya klips olmadan kombine tedavi uygulanan hastalar arasinda mortalite acisindan fark yoktu (p=0,9). Adrenalinle beraber heater yapilan olgular dislanarak yapilan subgrup analizinde klips uygulanan hastalarla klipsle beraber diger yontemlerin yapildigi hastalar arasinda mortalite karsilastirildi. Iki grup arasinda yine mortalite acisindan bir fark yoktu (p=0,6). Sonuc: Calismamiz klips tedavisine eklenecek adrenalin ve/veya heater koagu- lasyon gibi yontemlerle yapilan kombine tedavinin mortaliteyi azaltmada klips monoterapisine kiyasla herhangi bir ustunluklerinin olmadigini gostermistir.