Food impaction in older age: Think about an eosinophilic esophagitis

Eosinophilic esophagitis is an inflammatory condition of esophagus. It is generally seen in childhood and young population. Men are more commonly affected than women. However, it is not common in an advanced age. Eosinophilic esophagitis decreases the ability of the esophagus to stretch and accommodation against foods. Therefore, the major symptom in adults with eosinophilic esophagitis is difficulty in swallowing solid food (dysphagia). Specifically, the food gets stuck in the esophagus after it is swallowed. Less common symptoms include heartburn and chest pain. Because of this, it may be incorrectly diagnosed as a gastroesophageal reflux disease. Here, we reported a case presented with food impaction at advanced age. As a conclusion, eosinophilic esophagitis is a rare entity that must be remembered in advance aged patients presenting with food impaction

Situs inversus totalis and secondary biliary cirrhosis: a case report

Situs inversus totalis is is a congenital anomaly associated with various visceral abnormalities, but there is no data about the relationship between secondary biliary cirrhosis and that condition. We here present a case of a 58 year-old female with situs inversus totalis who was admitted to our clinic with extrahepatic cholestasis. After excluding all potential causes of biliary cirrhosis, secondary biliary cirrhosis was diagnosed based on the patient's history, imaging techniques, clinical and laboratory findings, besides histolopathological findings. After treatment with tauroursodeoxycholic acid, all biochemical parameters, including total/direct bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gama glutamyl transferase, returned to normal ranges at the second month of the treatment. We think that this is the first case in literature that may indicate the development of secondary biliary cirrhosis in a patient with situs inversus totalis. In conclusion, situs inversus should be considered as a rare cause of biliary cirrhosis in patients with situs inversus totalis which is presented with extrahepatic cholestasis

Efficiency of Direct Microscopy of Stool Samples Using an Antigen-Specific Adhesin Test for Entamoeba Histolytica

Background: E. histolytica is among the common causes of acute gastroenteritis. The pathogenic species E. histolytica and the nonpathogenic species E. dispar cannot be morphologically differentiated, although correct identification of these protozoans is important for treatment and public health. In many laboratories, the screening of leukocytes, erythrocytes, amoebic cysts, trophozoites and parasite eggs is performed using Native-Lugol’s iodine for pre-diagnosis. Aims: In this study, we aimed to investigate the frequency of E. histolytica in stool samples collected from 788 patients residing in the Anatolian region of İstanbul who presented with gastrointestinal complaints. We used the information obtained to evaluate the effectiveness of microscopic examinations when used in combination with the E. histolytica adhesin antigen test. Study Design: Retrospective cross-sectional study Methods: Preparations of stool samples stained with Native-Lugol’s iodine were evaluated using the E. histolytica adhesin test and examined using standard light microscopy at ×40 magnification. Pearson’s Chi-square and Fisher’s exact tests were used for statistical analysis. Logistic regression analysis was used for multivariate analysis. Results: Of 788 samples, 38 (4.8%) were positive for E. histolytica adhesin antigens. When evaluated together with the presences of erythrocytes, leukocytes, cysts, and trophozoites, respectively, using logistic regression analysis, leukocyte positivity was significantly higher. The odds ratio of leukocyte positivity increased adhesin test-positivity by 2,530-fold (95% CI=1.01–6.330). Adhesin test-positivity was significant (p=0.047). Conclusion: In line with these findings, the consistency between the presence of cysts and erythrocytes and adhesin test-positivity was found to be highly significant, but that of higher levels of leukocytes was found to be discordant. It was concluded that leukocytes and trophozoites were easily misjudged using direct microscopy. Although microscopic examination of samples stained with Native-Lugol’s iodine is a cheap and simple method, the confusion of trophozoites with leukocytes may direct the clinician toward an incorrect pre-diagnosis. Because trichrome staining is difficult and time consuming, and results may vary depending on the technician, this method is not preferred in most laboratories. Therefore, an enzyme-linked immunosorbent assay method, which is a more advanced method than polymerase chain reaction, should be used to distinguish between E. histolytica and E. dispar in order to achieve an accurate diagnosis

Yoğun bakım ünitesindeki hastalarda APACHE II, SAPS II, MODS, SOFA ve GKS gibi prognostik ve organ yetmezliği skorlama sistemleri ile serum amino asit düzeyleri arasındaki ilişki

Objective: This study aimed to investigate the relationship between the prognostic and organ failure scoring systems and quantitative amino acid levels in patients in the intensive care unit (ICU). Methods: A total of 45 patients over 45 years old, who were admitted to the ICU, were included in the study. Physical examinations of all patients were performed, and blood tests (including serum amino acids) were analyzed. Sequential organ failure assessment (SOFA), multiple organ dysfunction score (MODS), simplified acute physiology score II (SAPS II), acute physiology and chronic health evaluation II (APACHE II), and glasgow coma scale (GCS) scores of patients were calculated. Risk ratios were determined according to the mortality and organ failure scores of patients, and patients were grouped as high-risk and low risk. All these parameters were compared between these groups, and the relationship between amino acid levels and risk scores was evaluated. Statistical significance level was determined as a p-value of <0.05. Results: This study was carried out on 45 patients, 23 females and 22 males. The mean age of the patients was 74 +/- 11 years. In high-risk patients compared to low-risk group; methionine, ornithine, and phenylalanine levels according to APACHE II; beta-alanine, cystine, 3-methyl histidine, phenylalanine, and proline levels according to SAPS II; alanine, beta-alanine, phenylalanine, glycine, histidine, methionine, and ornithine levels according to GCS were significant different (p<0.05 for all). We found a significant positive correlation between the APACHE II score and beta alanine (r=0.466; p=0.001), citrulline (r=0.394; p=0.007), ethanolamine (r=0.366; p=0.013), histidine (r=0.353; p=0.017), 3-methyl histidine (r=0.450; p=0.002), ornithine (r=0.445; p=0.002), phenylalanine (r=0.548; p<0.001). There was a significant positive correlation between the SAPS II score and beta alanine (r=0.403; p=0.006), cystathionine (r=0.341; p=0.022), ethanolamine (r=0.356; p=0.017), 3-methyl histidine (r=0.402; p=0.006), ornithine (r=0.349; p=0.019), phenylalanine (r=0.525; p<0.001) and between the MODS score and alanine (r=0.340; p=0.022), beta alanine (r=0.407; p=0.006), cystathionine (r=0.352; p=0.018), ethanolamine (r=0.358; p=0.0169), histidine (r=0.495; p=0.001), 3-methyl histidine (r=0.407; p=0.006), methionine (r=0.462; p=0.001), ornithine (r=0.360; p=0.015), phenylalanine (r=0.621; p<0.001), proline (r=0.445; p=0.002). We found a significant positive correlation between the SOFA score and alanine (r=0.547; p<0.0019), beta-alanine (r=0.354; p=0.0179), arginine (r=0.423; p=0.004), cystathionine (r=0.423; p=0.004), ethanolamine (r=0.437; p=0.003), glycine (r=0.399; p=0.007), histidine (r=0.512; p<0.001), 3-methyl histidine (r=0.327; p=0.028), leucine (r=0.376; p=0.011), methionine (r=0.585; p<0.001), ornithine (r=0.467; p=0.001), phenylalanine (r=0.644; p<0.001), proline (r=0.523; p<0.001), threonine (r=0.371; p=0.012). Also, there was a significant negative correlation between GCS score and beta alanine (r=-0.390; p=0.008), ethanolamine (r=-0.364; p=0.014), glycine (r=-0.360; p=0.015), ornithine (r=-0.510; p=0.000), phenylalanine (r=-0.433; p=0.003). Conclusion: This study found significantly higher methionine, ornithine, phenylalanine, beta-alanine, cystine, 3-methyl histidine, proline, alanine, glycine, and histidine levels in patients with high-risk scores.Amaç: Bu çalışmada yoğun bakım ünitesindeki (YBÜ) hastalarda prognostik ve organ yetmezliği skorlama sistemleri ile serum aminoasit düzeyleri arasındaki ilişki araştırıldı. Gereç ve Yöntem: Çalışmaya 45 yaş üstü herhangi bir nedenden dolayı dahiliye YBÜ’ye interne edilen 45 hasta dahil edildi. Tüm hastaların fizik muayeneleri yapıldı ve kan tetkikleri (kantitatif amino asitler dahil) analiz edildi. Hastaların sıralı organ yetmezliği değerlendirmesi (SOFA), çoklu organ disfonksiyon skoru (MODS), Basitleştirilmiş akut fizyoloji skoru II (SAPS II), akut fizyoloji ve kronik sağlık değerlendirmesi II (APACHE II), ve glasgow koma skalası (GCS) skorları hesaplandı. Kantitatif aminoasit düzeyleri ölçüldü. Hastaların mortalite ve organ yetmezliği skorlarına göre risk oranları belirlendi ve hastalar yüksek riskli ve düşük riskli olarak gruplandırıldı. Tüm parametreler bu gruplar arasında karşılaştırıldı ve amino asit seviyeleri ile risk skorları arasındaki ilişki değerlendirildi. İstatistiksel analizde p40 puan) diye iki gruba ayrıldığında beta-alanin (p=0,038), sistin (p=0,038), 3-metil histidin (p=0,024), fenilalanin (p=0,011) ve prolin (p=0,027); GKS skoruna göre yüksek riskli (≤8 puan), orta riskli (8-13 puan) ve düşük riskli (≥13 puan) diye üç gruba ayrıldığında alanin (p=0,031), beta-alanin (p=0,035), fenilalanin (p=0,006), glisin (p=0,005), histidin (p=0,007), metiyonin (p=0,044) ve ornitin (p=0,007) düzeyleri arasında anlamlı farklılık saptandı. APACHE II skoru ile beta alanin (r=0,466; p=0,001), sitrulin (r=0,394; p=0,007), etanolamin (r=0,366; p=0,013), histidin (r=0,353; p=0,017), 3-metil histidin (r=0,450; p=0,002), ornitin (r=0,445; p=0,002), fenilalanin (r=0,548; p<0,001) arasında pozitif yönlü orta düzeyde; SAPS II skoru ile beta alanin (r=0,403; p=0,006), sistatyonin (r=0,341; p=0,022), etanolamin (r=0,356; p=0,017), 3-metil histidin (r=0,402; p=0,006), ornitin (r=0,349; p=0,019), fenilalanin (r=0,525; p<0,001) arasında pozitif yönlü orta düzeyde, glisin, valin arasında pozitif yönlü zayıf düzeyde; MODS skoru ile alanin (r=0,340; p=0,022), beta alanin (r=0,407; p=0,006), sistatyonin (r=0,352; p=0,018), etanolamin (r=0,358; p=0,0169), histidin (r=0.495; p=0,001), 3-metil histidin (r=0,407; p=0,006), metiyonin (r=0,462; p=0,001), ornitin (r=0,360; p=0,015), fenilalanin (r=0,621; p<0,001), prolin (r=0,445; p=0,002) arasında pozitif yönlü orta düzeyde; SOFA skoru ile alanin (r=0,547; p<0,0019), beta-alanin (r=0,354; p=0,0179), arginin (r=0,423; p=0,004), sistatyonin (r=0,423; p=0,004), etanolamin (r=0,437; p=0,003), glisin (r=0,399; p=0,007), histidin (r=0,512; p<0,001), 3-metil histidin (r=0,327; p=0,028), lösin (r=0,376; p=0,011), metyonin (r=0,585; p<0,001), ornitin (r=0,467; p=0,001), fenilalanin (r=0,644; p<0,001), prolin (r=0,523; p<0,001), treonin (r=0,371; p=0,012) arasında pozitif yönlü orta düzeyde, GKS skoru ile beta alanin (r=-0,390; p=0,008), etanolamin (r=-0,364; p=0,014), glisin (r=-0,360; p=0,015), ornitin (r=-0,510; p=0,000), fenilalanin (r=-0,433; p=0,003) arasında negatif yönlü orta düzeyde anlamlı korelasyon saptadık. Sonuç: Bu çalışmada risk skoru yüksek ve prognozu kötü olan hastalarda metiyonin, ornitin, fenilalanin, beta-alanin, sistin, 3-metil histidin, prolin, alanin, glisin, histidin düzeylerinin yüksek olduğunu saptadık. Sonuçlarımız, kritik hastalarda bozulmuş enerji metabolizması ile kas proteini yıkımı arasında yakın ve anlamlı bir ilişki olduğunu düşündürtmektedir

Integrating personalized genomics into Turkish healthcare system: A cancer-oriented pilot activity of Istanbul Northern Anatolian Public Hospitals with GLAB

WOS: 000408984000001PubMed ID: 28752136

Are adipocytokines inflammatory or metabolic mediators in patients with inflammatory bowel disease?

This study examined the adiponectin and leptin levels and insulin resistance (IR) in patients with inflammatory bowel disease (IBD) and the associations between these factors and IBD characteristics. Fasting serum leptin, adiponectin, glucose, and insulin levels, as well as inflammatory parameters, were measured in 105 patients with IBD (49 patients with Crohn's disease [CD], 56 patients with ulcerative colitis [UC]) and 98 healthy controls [HC]. IR was evaluated using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Disease activity and severity in patients with UC were evaluated using the Truelove-Witts index, and patients with CD were evaluated using the Crohn's Disease Activity Index. Serum adiponectin levels were found to be significantly lower in patients with CD and UC (p < 0.001). Serum leptin levels were also found to be significantly higher in both the UC and CD groups (p < 0.001). When HOMA-IR levels were compared, no significant difference was detected for either the CD or UC groups compared with the controls. In conclusion, it was shown that leptin levels increased and adiponectin levels decreased in patients with IBD, which is thought to be related to chronic inflammation. The effects of adipocytokines in patients with IBD with inflammatory and metabolic processes need to be investigated in further broader studies