How does disease location affect acute phase reactants in ulcerative colitis?

Background: We aimed to evaluate erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC), platelet (PLT) counts and albumin levels according to disease location in ulcerative colitis.Methods: The ESR, CRP, WBC, PLT counts and albumin levels of 206 ulcerative colitis patients with endoscopic activity were retrospectively evaluated. Endoscopic activity had been assessed using Rachmilewitz endoscopic activity index. Patients were grouped according to the extent of disease by Montreal classification, and they were evaluated regarding the location and severity of disease according to the laboratory test results.Results: Among 206 patients, 88 (42.7%) had extensive colitis, 89 (43.2%) of them had left sided colitis and 29 (14%) patients had proctitis. According to the endoscopic activity index, 32.04% of the patients had mild activity, 39.32% moderate activity and 28.64% had severe activity. As the disease extent progressed from the distal to the proximal intestine, CRP, ESR, WBC and PLT counts showed a significant increase while albumin levels showed a significant decrease. In our study, the test that yielded the best results in the assessment of disease activity was CRP, which was found to be high in 80% of patients with extensive colitis, followed by ESR, PLT and WBC counts. As the involved intestine shortened, the rate of patients with abnormal laboratory tests significantly decreasedConclusion: CRP, ESR, WBC, PLT counts and albumin levels are of limited value in determining disease activity in ulcerative colitis patients, especially in those with proctiti

Evaluation of the Effectiveness of Endoscopic Retrograde Cholangiopancreatography in Patients with Perihilar Cholangiocarcinoma and Its Effect on Development of Cholangitis

Objective. We aimed to determine the effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) in patients with inoperable perihilar cholangiocarcinoma and establish the incidence of cholangitis development following ERCP. Material and Method. This retrospective study enrolled patients diagnosed with inoperable perihilar cholangiocarcinoma who underwent endoscopic drainage (stenting) with ERCP. Patients were evaluated for development of cholangitis and the effectiveness of ERCP. The procedure was considered successful if bilirubin level fell more than 50% within 7 days after ERCP. Results. Post-ERCP cholangitis developed in 40.7% of patients. Cholangitis development was observed among 39.4% of patients with effective ERCP and in 60.6% of patients with ineffective ERCP. Development of cholangitis was significantly more common in the group with ineffective ERCP compared to the effective ERCP group (P=0.001). The average number of ERCP procedures was 2.33 ± 0.89 among patients developing cholangitis and 1.79 ± 0.97 in patients without cholangitis. The number of ERCP procedures was found to be significantly higher among patients developing cholangitis compared to those without cholangitis (P=0.012). Conclusion. ERCP may not provide adequate biliary drainage in some of the patients with perihilar cholangiocarcinoma and also it is a procedure associated an increased risk of cholangitis

Improvement of Work Productivity and Quality of Life with Anti-Tumor Necrosis Factor Treatment Used in Crohn's Disease in Routine Clinical Practice in Turkey

Background: Patients with Crohn's disease experience major deterioration in work productivity and quality of life. We aimed to provide the long-term effects of anti-tumor necrosis factor agents on work productivity and activity impairment and quality of life in patients with Crohn's disease using the Inflammatory Bowel Disease Questionnaire and the Short-Form Health Survey-36. Methods: Patients with Crohn's disease and initiated an anti-tumor necrosis factor treatment were included and followed up for 12 months in this observational study. Results: A total of 106 patients were included in this study, and 64.2% of the patients were males. Mean [+/- standard deviation] age was 36.8 [+/- 10.9] years. At baseline, mostly perianal fistulas [65.7%] were observed [n = 23]. Intestinal stenosis was detected in 34.9% of the patients [n = 37], and most of the stenosis was located in the ileum [70.6%] followed by the colon [20.6%]. Extraintestinal symptoms were observed in 24 patients [22.6%]. Most frequent extraintestinal symptom was arthritis with 71.4% [n = 15]. Mean time from first symptom to initiation of anti-tumor necrosis factor treatment was 6.3 [+/- 5.0] years. Improvements in work productivity and activity impairment scores throughout 12 months were -24.1% [P =.003] for work time missed, -18.0% [P =.006] for impairment at work, -8.5% [P =.160] for overall work impairment, and -17.0% [P <.001] for daily activity impairment. Similarly, significant improvements [P <.001] were detected in all components of the Inflammatory Bowel Disease Questionnaire when compared to baseline. Statistically significant improvements [P <.05] were detected for all components of Short-Form Health Survey-36 except for mental health [P =.095]. Conclusion: Our study indicates the significant improvement in work productivity and activity impairment and quality of life of patients with Crohn's disease who receive long-term anti-tumor necrosis factor treatment.AbbVie; Takeda; Genfit; Pfizer; Roche; Janssen; Gilead; Celltrion; UCBThe design, study conduct, and financial support for this study were provided by AbbVie. AbbVie participated in study design, research, analysis and data collection, interpretation of data, and review and approval of this manuscript. All authors received investigator fee payments from AbbVie for participating in this study. In addition, Dr. Murat Toruner has received no research grant, received consulting and/or speaker fee from AbbVie, Amgen, MSD, Takeda, Janssen. Dr. Metin Basaranoglu received research grant from Takeda and Genfit; received speaker and/or consulting fee from AbbVie, MSD, UCB, Bayer, and Santa Farma. Dr. Ozlen Atug received no research grant; received consulting and/or speaker fee from AbbVie, MSD, Takeda, and Eczacibasi. Dr. Filiz Akyuz received research grant from Pfizer and Genfit; consulting fee from Medtronic and speaker fee from AbbVie, Ferring, and Reckitt Benckiser. Dr. Cem Cekic received no research grant and received speaker and/or consultancy fee from AbbVie, Celltrion, and Ferring. Dr. Hulya Over Hamzaoglu received research grant from Roche and Janssen and speaker fee from AbbVie, MSD, Takeda, Ferring and consultancy fees from AbbVie, MSD, Takeda, and Ferring. Dr. Orhan Sezgin received research grant from AbbVie and Gilead and speaker and/or consultancy fees from AbbVie, Abdi Ibrahim, Bilim, Takeda, Ferring, UCB, and Drogsan. Dr. Hale Akpinar received research grant from AbbVie, Celltrion, and Janssen and speaker and/or consultancy fees from Abbvie, Ferring, MSD, Takeda, and UCB. Dr. Aykut Ferhat Celik received research grant from AbbVie, Pfizer, Janssen, UCB, and Takeda and speaker and/or consultancy fees from Abbvie, Ferring, Eczacibasi, Janssen, UCB, and Takeda. Dr. Ahmet Tezel received research grant from Lilly and Pfizer and speaker and/or consultancy fee from AbbVie, Ali Raif, Eczacibasi, Ferring, MSD, Takeda, and Pfizer. Dr. Fatih Tekin, Dr. Omer Senturk, Dr. Huseyin Savas Gokturk, and Dr. Taylan Kav have no additional disclosures to declare

Rationale, design, and methodology of the EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) study

Tasar, Onur/0000-0003-2030-3810;WOS: 000475438700008PubMed: 31311898Objective: The aim of this study is to assess the prevalence of polypharmacy, inappropriate drug use, and drug-drug interactions (DDIs) in elderly patients presenting at outpatient cardiology clinics in Turkey. Methods: The EPIC (Epidemiology of Polypharmacy and Potential Drug-Drug Interactions in Elderly Cardiac Outpatients) study will be an observational, real-world, multicenter study conducted to evaluate DDIs and polypharmacy in elderly cardiac outpatients. All consecutive patients (aged >= 65 years) admitted to outpatient cardiology clinics between July 30, 2018 and July 30, 2019 who provide written, informed consent will be enrolled. A total of approximately 5000 patients are to be enrolled in this non-interventional study. All of the data will be collected at one point in time and current clinical practice will be evaluated (ClinicalTrials.gov NCT03370523). Result: Patient demographics, comorbid disease characteristics, laboratory test results, and details of medication use will be collected using self-reports and medical records. The severity of comorbid disease will be recorded and scored according to Charlson Comorbidity Index (CCI) and patients will be divided into 3 groups: mild, those with a CCI score of 1-2; moderate, those with a CCI score of 3-4; and severe, those with a CCI score of >= 5. Polypharmacy will be defined as the use of 5 or more medications at one time. DDIs will be determined using the Lexicomp Online drug interaction screening tool and potentially inappropriate medications will be defined based on the 2015 update of the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Severe drug interactions will be defined as those in category D or X. Conclusion: EPIC will be the first large-scale study in Turkey to evaluate polypharmacy, potentially inappropriate medications, and DDIs in elderly cardiac outpatients in a real-world clinical setting

Per-Oral Endoscopic Myotomy in Achalasia: Experience From a Tertiary Reference Center in Turkey

WOS: 00020993160008

The last innovation in achalasia treatment; per-oral endoscopic myotomy

WOS: 000355104900005PubMed ID: 26006194Background/Aims: Per-oral endoscopic myotomy (POEM) is a minimally invasive endoscopic treatment option for patients with achalasia and has been performed since 2010. It is less invasive than Heller myotomy and its use is spreading rapidly worldwide. We present our results of POEM that, to the best of our knowledge, are the first cases in Turkey. Materials and Methods: We enrolled patients between May 2014 and September 2014; 8 patients with achalasia whose complaints recurred after pneumatic balloon dilatation underwent POEM. The procedure was performed under general anesthesia at the endoscopy unit of the gastroenterology clinic. Demographic data was recorded before the procedure, and the results of the procedure were recorded prospectively. Results: The median age of the patients was 42.5 (30-72) years. Preoperative and postoperative median Eckardt scores were 10 (8-12) and 1 (0-2), respectively. The median total duration of the procedure was 101 (71-158) min, and the median myotomy length was 13.5 (10-16) cm. Postoperative oral intake started on median day 1 (1-2) and the length of hospital stay was 4 (3-6) days. In 2 patients, capnoperitoneum developed during the procedure and was treated with a Veress needle. Conclusion: POEM is a safe endoscopic treatment modality for patients with achalasia in centers that are experienced in advanced endoscopic techniques

Improvement of Work Productivity and Quality of Life with Anti-Tumor Necrosis Factor Treatment Used in Crohn's Disease in Routine Clinical Practice in Turkey

Background: Patients with Crohn's disease experience major deterioration in work productivity and quality of life. We aimed to provide the long-term effects of anti-tumor necrosis factor agents on work productivity and activity impairment and quality of life in patients with Crohn's disease using the Inflammatory Bowel Disease Questionnaire and the Short-Form Health Survey-36

Cystic fibrosis in Turkey: First data from the national registry.

Background Cystic fibrosis (CF) care has been implemented in Turkey for a long time; however, there had been no patient registry. For this purpose, the Turkish National CF Registry was established. We present the first results of registry using data collected in 2017. Methods The data were collected using a data-entry software system, which was accessed from the internet. Demographic and annually recorded data consisted of 15 and 79 variables, respectively. Results There were 1170 patients registered from 23 centers; the estimated coverage rate was 30%. The median age at diagnosis was 1.7 years (median current age: 7.3 years); 51 (4.6%) patients were aged over 18 years. Among 293 patients who were under 3 years of age, 240 patients (81.9%) were diagnosed through newborn screening. Meconium ileus was detected in 65 (5.5%) patients. Genotyping was performed in 978 (87.4%) patients and 246 (25.2%) patients' mutations were unidentified. The most common mutation was deltaF508 with an allelic frequency of 28%, followed by N1303K (4.9%). The median FEV1% predicted was 86. Chronic colonization with Pseudomonas aeruginosa was seen in 245 patients. The most common complication was pseudo-Bartter syndrome in 120 patients. The median age of death was 13.5 years in a total of 15 patients. Conclusions Low coverage rate, lack of genotyping, unidentified mutations, and missing data of lung functions are some of our greatest challenges. Including data of all centers and reducing missing data will provide more accurate data and help to improve the CF care in Turkey in the future