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

An unpredictable complication during percutaneous endoscopic tube placement: Esophageal perforation

WOS: 000343106300032PubMed ID: 25314168A percutaneous endoscopic gastrostomy (PEG) was performed to provide an enteral feeding route. Major and minor complications related to this procedure include, aspiration, wound infections, necrotizing fasciitis, peritonitis, abscess, peristomal leakage, pneumoperitoneum, ileus, portomesenteric venous gas, colon injury, gastrocolocutaneous fistulae, abdominal wall bleeding, intra-abdominal bleeding, gastric outlet obstruction, inadvertent gastrostomy tube removal, spleen trauma, clogged PEG tube, tumor implantation at PEG site, and buried bumper syndrome [1, 2]

Enteropathy-Associated T-cell Lymphoma: A diagnostically challenging complication of celiac disease

WOS: 000382751900019Enteropathy-associated T-cell Lymphoma (EATL) is a rare, but fatal complication of celiac disease. EATL may occasionally present simultaneously with celiac disease. In most cases, the clinical features of EATL are very similar to celiac disease in the initial stages, which usually leads to a late diagnosis. EATL is primarily observed during the sixth decade of life in patients with celiac disease who have no diet restrictions. In this article, we describe the diagnostic features of a case of EATL that was identified in a patient with celiac disease

Relationship of peripheral blood neutrophil to lymphocyte ratio and irritable bowel syndrome

WOS: 000408336600003PubMed ID: 29153264Background/aim: This study aimed to determine the relationship between the peripheral blood neutrophil to lymphocyte ratio (NLR) and irritable bowel syndrome (IBS). Materials and methods: A total of 107 patients suffering from constipation-predominant IBS, diagnosed in accordance with the ROMA III criteria and having complete blood count tests, were enrolled in this study. All patients underwent total colonoscopy in order to rule out any probable underlying organic colonic pathology. Results: The control group consisted of 106 healthy people with no medical complaints. The peripheral blood NLR was 2.80 +/- 2.52 on average in the IBS group. The NLR average was 2.37 +/- 1.65 in the control group, and the average NLR ratio in the patient group was statistically significant (P < 0.03) and higher than that of the control group when the patient and the control groups were compared. Conclusion: Peripheral blood NLR as a reliable, precise indicator of inflammation in constipation-predominant IBS patients, detected with a simple complete blood count, was slightly elevated but statistically significant compared to the control group

Acute temozolomide induced liver injury: Mixed type hepatocellular and cholestatic toxicity

Temozolomide (TMZ) is an oral imidazotetrazine methylating agent which is used for the treatment of glioblastoma multiforme (GBM). We report a case of acute hepatotoxicity in a 53-year old male patient after administration of TMZ for GBM. He had fatigue, nausea, anorexia and jaundice. His laboratory analysis showed alanine aminotransferase(ALT): 632 IU/L (normal range 0-40); aspartate aminotransferase(AST): 554 IU/L (normal range 5-34); alkaline phosphatase(ALP): 1143 IU/L (normal range 40- 150); -glutamyl transpeptidase(GGT): 514 IU/L (normal range 9-64 IU/L); total bilirubin: 15.1 mg/dL (normal range 0-1.2); direct bilirubin: 13.2 mg/dL and prothrombin time(PT): 13.5 s, with international normalized ratio (INR): 1.1 (normal range 0.8-1.2). His liver biopsy specimen showed mixed-type (both hepatocellular and cholestatic) hepatic injury, compatible with a diagnosis of drug-induced hepatitis. An objective causality assessment using the Naranjo probability scale suggested that TMZ was the probable cause of the acute hepatitis. His liver function tests gradually normalized in 2 months after discontinuation of the drug. In susceptible individuals, TMZ use may lead to acute mixed type liver toxicity. Complete recovery may be possible if the drug is discontinued before severe liver injury is established

Food impaction in older age: Think about an eosinophilic esophagitis

Eozinofilik özofajit özofagusun inşamatuvar hastalığıdır. Genellikle genç erişkin yaşta görülür. İleri yaşta nadiren görülmektedir. Eozinofilik özofajit, özofagusun yiyeceklere karşı esnemesini ve uyumunu azaltır. Bu nedenle esas semptom disfajidir. Özellikle gıdaların takılmasına neden olur. Bu yazıda, ileri yaşta gıda takılması ile gelen bir vaka sunduk. Özet olarak, ileri yaşta gıda takılması ile başvuran hastalarda nadir olmasına karşın eozinofilik özofajit akılda tutulmalıdır.Eosinophilic esophagitis is an inflammatory disease of esophagus. It is generally seen in childhood and young population. It is not common in 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). Therefore, food stuck in the esophageal lumen is the specific manifestation when swallowing. He- rein, we reported a patient in old age presented with food impaction. In conclusion, eosinophilic esophagitis is a rare entity that must be considered in elderly patients complaining food impaction

The prevalence of restless legs syndrome and comorbid condition among patient with type 2 diabetic mellitus visiting primary healthcare

AIM: The aim of this study was to determine the prevalence of restless legs syndrome (RLS) and Pittsburgh Sleep Quality Index (PSQI) in patients with type 2 diabetes mellitus (T2DM) attending primary healthcare. SUBJECTS AND METHODS: This is a cross-sectional study and participants were between 25 and 70 years old who visited the diabetes and endocrinology department of Mega Medipol University Teaching Hospital, Istanbul. The diagnosis of RLS was performed according to the International Restless Legs Syndrome Study Group consensus criteria. The RLS and PSQI instruments were conducted on 871 patients with T2DM. Good sleep quality was defined as PSQI score <5. RLS severity was assessed by the Restless Legs Syndrome-6 Scales (RLS-6). The scale development and validation was carried out using Rasch measurement model. RESULTS: The prevalence of RLS was 22.8% including 60.3% of females and 39.7% of males. This study showed significant differences between RLS and no RLS patients with respect to their age (years), body mass index (BMI) (kg/m2), physical activity, smoking habit, sheesha smoking, income, and sleeping quality with PSQI. Also, the analysis presented that statistically significant differences between both RLS and no RLS reported sleep complaints including difficulty falling asleep, inadequate sleep, anytime fatigue, and leg discomfort. There were statistically significant differences between RLS and no RLS patients regarding hypoglycemia, numbness in legs, retinopathy, neuropathy, nephropathy high blood pressure, depression, stroke, anemia, diabetic foot, ulcer, arthritis, respiratory disease, metabolic syndrome, and coronary heart disease. Furthermore, there were statistically significant differences between RLS and no RLS concerning the number of sleeping hours, wake-up time (AM), sleeping time (PM), BMI (kg/m2), HbA1c, vitamin D, calcium, creatinine, fasting blood glucose, low-density lipoprotein, triglyceride, uric acid, and systolic and diastolic blood pressure (mmHg). CONCLUSION: This study confirms positive relation and high prevalence of RLS among patients with T2DM visiting primary healthcare. The results suggest that physical activity is associated with a better perception of functional capacity and pain in diabetic patients with RLS, and thus a more active lifestyle should be encouraged

Acute temozolomide induced liver injury: Mixed type hepatocellular and cholestatic toxicity

Temozolomide (TMZ) is an oral imidazotetrazine methylating agent which is used for the treatment of glioblastoma multiforme (GBM). We report a case of acute hepatotoxicity in a 53-year old male patient after administration of TMZ for GBM. He had fatigue, nausea, anorexia and jaundice. His laboratory analysis showed alanine aminotransferase(ALT): 632 IU/L (normal range 0-40); aspartate aminotransferase(AST): 554 IU/L (normal range 5-34); alkaline phosphatase(ALP): 1143 IU/L (normal range 40-150); ?-glutamyl transpeptidase(GGT): 514 IU/L (normal range 9-64 IU/L); total bilirubin: 15.1 mg/dL (normal range 0-1.2); direct bilirubin: 13.2 mg/dL and prothrombin time(PT): 13.5 s, with international normalized ratio (INR): 1.1 (normal range 0.8-1.2). His liver biopsy specimen showed mixed-type (both hepatocellular and cholestatic) hepatic injury, compatible with a diagnosis of drug-induced hepatitis. An objective causality assessment using the Naranjo probability scale suggested that TMZ was the probable cause of the acute hepatitis. His liver function tests gradually normalized in 6 months after discontinuation of the drug. In susceptible individuals, TMZ use may lead to acute mixed type liver toxicity. Complete recovery may be possible if the drug is discontinued before severe liver injury is established

Effect of pre-operative red blood cell distribution on cancer stage and morbidity rate in patients with pancreatic cancer

WOS: 000345121000092PubMed ID: 25356183Background: The red blood cell distribution (RDW) is a test measure of erythrocyte variation and the volume level which shows the heterogeneity and it is a proven test in literature for the determination of survival on cardiovascular diseases. The main purpose of this research is to investigate the relationship between the RDW level and postoperative morbidity as well as its stages in diagnosed pancreatic cancer patients. Methods: In this study we covered 104 diagnosed pancreatic cancer patients who have been operated in 2011-2014. The RDW levels were separated into two groups. Group 1 contains higher level RDW patients (> 14) whereas group 2 contains only lower level RDW patients. We compared both groups in terms of the patients' demographic data, duration of hospitalization, ratio of pancreatic fistula, disease period, and the mortality rates. Results: In group 1 contains 39 patients whereas group 2 contains only 65 patients. We determined the positive correlation between stages of disease with RDW levels as well as the correlation between low level of blood albumin and Ca 19.9 levels (p = 0001). However we did not observe statistically important difference in postoperative morbidity. Conclusions: Based on this study we report that RDW levels can be use as a marker to show the stages of pancreatic cancer in diagnosed patients

Prevalence of helicobacter pylori infection among type 2 diabetes mellitus

Background: Several conducted studies have reported a higher and more frequent Helicobacter pylori infection rate in type 2 diabetes mellitus (T2DM). The aim of this study was to investigate the prevalence and its association between H. pylori infection and T2DM.Materials and methods: A case and control study was conducted based on 529 T2DM patients and 529 control. H. pylori was assessed by Serum anti-H. pylori immunoglobulin G (IgG) and IgA. Furthermore, patients were investigated for fasting blood glucose (FBG) levels, glycosylated hemoglobin (HbA1c), serum cholesterol, and other biochemistry parameters.Results: The findings showed a positive significantly higher antibody titer for H. pylori infection (IgA > 250) in diabetic patients (50.7%) compared to controls (38.2%) (P 300 titer was higher in T2DM patients (73.5%) compared to controls 61.8%) (P 300 titer and IgA > 250 titer, regarding Vitamin D, HbA1C (P < 0.001), FBG, calcium, creatinine, total cholesterol, LHDL, triglyceride levels, uric acid, bilirubin, thyroid-stimulating hormone (TSH), and systolic and diastolic blood pressure. The diabetic patients showed higher prevalence rate of symptoms than controls included: hypertension (14.3%), vomiting (15.5%), muscular symptoms (35.2%), bloating/distension (13.2%), abdominal pain (17%), nausea (9.6%), anemia (17%), kidneys (20.8%), chronic bronchitis (14.7%), gastrointestinal (23.8%), and diarrhea (20.4%).Conclusions: The current study revealed that H. pylori infections were significantly higher in diabetic patients compared to controls. Furthermore, T2DM patients infected with H. pylori positive reported a higher prevalence rate of symptoms than H. pylori negative