The Hepatic Phase of Fascioliasis Complicated with Liver Bleeding: Presentation of Three Cases

Bleeding is a very rare complication of Fasciola species (F. hepatica or F. gigantica) infection. We present here three cases of subcapsular liver bleeding caused by the hepatic phase of Fasciola spp. infection in patients, two of whom were women, aged 22, 66, and 84 years in Diyarbakir Province, southeastern Turkey. They had symptoms of right upper quadrant pain (n = 3), nausea (n = 1), and vomiting (n = 2) for periods ranging from 6 hours to 15 days. All patients with clinical presentations ranging from moderate abdominal pain to hypovolemic shock and ischemic hepatitis were improved with supportive treatment without the need for surgery. They showed complete clinical and laboratory recovery after triclabendazole administration in their follow-up. In conclusion, Fasciola spp. infection should be considered in the etiology of bleeding from liver disease

Is tenofovir disoproxil nephrotoxic in all patients? side effects of tenofovir and entecavir on kidney

Background: Hepatit B virus (HBV) is one of the main causes of liver related morbidity and mortality in worldwide. This condition is also a significant healthcare problem in Turkey. Entecavir (ETV) and tenofovir (TDF) are potent nucleos(t)ide analogues (NAs) recommended for the treatment of chronic HBV (CHB) infection. The aim of the study was to determine the association of NAs and nephrotoxicity in our CHB cohort.Methods: Between the January 2011-February 2021, there were 294 patients treated with TDF (N=194) and ETV (N=100). Glomerular filtration rate (GFR) was calculated by the modification of diet in renal disease (MDRD) method. Kidney function tests were assessed at baseline and follow-up visits.Results: There were 294 patients in the total group. The mean follow-up period was 66±18 months. Age and sex distributions and baseline assessments including liver function tests, creatinine, GFR, HBV DNA values and pathology scores (HAI and fibrosis) were similar between TDF (N=194) and ETV (N=100) groups. Creatinin and GFR assessed at the last visit were 0.81±0.01 g/dl and 102.94±19.78 ml/min for TDF and 0.81±0.013 g/dl and 104.65±19.05 ml/min for ETV. These values were not significant between the both treatment groups. In terms of nephrotoxicity, none of the patients had significant changes in terms of creatinine and GFR that may require dose adjustment.Conclusions: We showed that the use of both drugs led to a decrease in GFR that was not clinically important in chronic hepatitis B patients with normal baseline renal tests and without co-morbidity

Epidemiological and clinical characteristics of malignant melanoma in Southeast Anatolia in Turkey

Introduction: The present study aimed to establish the epidemiological and clinical characteristics of patients who were histopathologically diagnosed with malignant melanoma (MM). Methods: The present study retrospectively analyzed the data of 78 patients who were histopathologically diagnosed with MM in Dicle University Medical Faculty, Dermatology and Medical Oncology departments between 2005 and 2014. Results: The study included 78 patients in total with 44 (56.4%) male and 34 (43.6%) female. Median age of the patients was 62.50 years (range: 27 - 84 years). Of the patients, 78.2% (n=61) had cutaneous melanoma, 8.9% had solid organ melanoma, and 2.5% had ocular and mucosal melanoma. The most common tumor localization among the patients was the lower extremities with 29.4% (n=23). The most common histopathological type was nodular malignant melanoma with 35.8% (n=28). Based on TNM, Clark and Breslow classifications, 26.9% (n=21) of the patients were stage 4, 26.9% (n=21) were Clark stage 4, and 37.1% (n=29) were Breslow stage 4. Median overall survival in all patients was 14.9 months (95% CI 10.9 - 18.8 months). In the multivariate Cox analysis, only stage statistically significantly affecting survival [odds ratio (OR): 0.54; (95% CI 0.16-1.82, p=0.02)]. Conclusion: Malignant melanoma data are also important for the optimal utilization of effective methods and healthcare resources to prevent the disease. In order to minimize MM mortality and morbidity, not only the society but also physicians from primary and secondary care hospitals should become familiar with melanoma.Pan African Medical Journal 2016; 2

Oxidative stress and the importance of H. pylori eradication in patients with functional dyspepsia

Background: To investigage the thiol and disulphide levels in Helicobacter pylori-positive patients with non-ulcer dyspepsia and investigate the change in these levels with eradication therapy. Methods: This is a prospective observational study. A total of 320 patients diagnosed with dyspepsia according to Rome IV criteria were included in the study. First, blood samples were drawn from patients to determine their serum thiol and disulphide levels. Endoscopic biopsy was performed on all patients and the biopsy specimens obtained were examined pathologically. Patients positive for H. pylori were administered eradication therapy. Blood samples were drawn from these patients for the second time, and their serum thiol and disulphide levels were measured. The thiol–disulfide levels of the patients who were successful in H. pylori eradication treatment, with those who were not, were compared before and after the treatment. Results: The mean plasma disulphide level decreased significantly from 14.0 ± 6.6 to 10.9 ± 5.9 µmol/L in H. pylori-positive patients that responded to the H. pylori eradication treatment (P = 0.033). On the other hand, there was an insignificant increase in the mean serum thiol level (341.4 ± 30.5 vs. 342.6 ± 29.8 µmol/L; P = 0.273) and an insignificant decrease in the mean serum disulphide level (15.2 ± 2.5 vs. 14.8 ± 2.3 µmol/L; P = 0.163) in H. pylori-positive patients that did not respond to the H. pylori eradication treatment. Conclusion: The inflammation caused by H. pylori shifted the thiol–disulphide equilibrium in the cell redox system towards the direction of disulphide. The study findings suggest that the restoration of the said hemostatic balance with eradication therapy relieved the organism from oxidative stress

The results of the percutaneous endoscopic gastrostomy insertion: Analysis of 113 cases

Objective: In this study, we aimed to evaluate the results and experiences of the patients who received percutaneous endoscopic gastrostomy (PEG). Methods: A total of 113 patients who admitted to the Dicle University Medical Faculty , Department of Gastroenterology between January 2012 and December 2014 and in whom received PEG was performed. The patients were assessed in terms of indications, complications and results. Results: Among these patients, 70 (61.9%) were male and 40 (38.1%) were female. Though 8 (7%) patients had head, neck and esophageal cancer; 105 (93%) patients had primer or seconder neurological disorders. After the PEG, any serious complication was seen in patients. Wound infections were encountered in five patients (4.4%) and the rate of minor complications was found to be 9.7%. The risk of complications was higher in patients over sixty years and men (p values of 0.049 and 0.022). Conclusion: Percutaneous endoscopic gastrostomy, a simple and safe method of enteral nutrition with a low complication rate, should be the first choice when extended period enteral nutrition is required. There is increased risk of complications in elderly males

Incidence and Characteristics of Colon Polyps in Southeast Anatolian Region: A 5-Year Evaluation

Aim: Polyps are one of the most common pathologic indications observed in the lower gastrointestinal system. Colonoscopic polypectomy ensures both the treatment of such lesions and identification of their histopathologic features. The purpose of this study was to evaluate the results of polypectomies performed in our clinic. Method: Colonoscopy reports produced and archived in the Endoscopy Unit of the Faculty of Medicine of Dicle University between January 2010 and December 2014 were retrospectively examined. Demographic, colonoscopic and histopathologic data of 470 patients who underwent polypectomy were recorded. Results: In five years (between January 2010 and December 2014) a total of 3514 patients underwent colonoscopy and 470 of them were found to have at least one polyp (13.3%). The patients’ mean age was 56.9±16.0 years (15-100, range) and 270 of them (61.7%) were male. A total of 980 polypectomies (polyp numbers; median=2, minimum-maximum=1-15) were performed for polyps varying between 2-40 mm in size (mean 6.24±5.0 mm). 31.3% of the patients had polyps in multiple locations, however the most frequent location of the polyps was the rectum (44.9%). The polyps were grouped according to their histopathologic features: adenomatous (53.6%), hyperplastic (31.7%), cancerous (6.6%), dysplastic (5.1%) and others (3%). The histopathologic malignancy risk was found to correlate with having polyps larger than 20 mm in diameter, having pedunculated polyps and having polyps in multiple locations (p<0.001, p<0.001, and p=0.011, respectively). In addition, a correlation was found between the histopathologic dysplasia risk and polyps located on the right side of the colon (p=0.033). Conclusion: Polyp was observed for significant portion of our patient who underwent colonoscopy. The most common of these polyps were the adenomatous type which has the potential of malignancy

Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi

Amaç: Toksik hepatit birçok ilaç ve bitkisel ürünün alınmasıyla ortaya çıkan klinik tablodur. Çok sayıda ilaç değişik mekanizmalarla toksik hepatite neden olmaktadır. Hastalığın görülme sıklığı ve sebepleri bölgesel farklılıklar gösterebilmektedir. Çalışmadaki amacımız kliniğimize başvuran toksik hepatitli olguların demografik, klinik ve laboratuar özelliklerini sunmaktır. Yöntemler: Ağustos 2014-Haziran 2016 tarihleri arasında kliniğimize anormal karaciğer fonksiyon testleri nedeniyle yatırılan, klinik ve laboratuar değerlendirme sonrası TH tanısı konulan hastalar alındı. Hastaların demografik özellikleri, toksik hepatitin muhtemel etiyolojisi, klinik özellikleri, biyokimya ve tam kan değerleri, klinik seyirleri kaydedildi. Bulgular: Çalışmaya yaş ortalaması 41.4±16.8 olan 56 (34 kadın) hasta alındı. Hastaların 31 (%55.6)’inde ilaçlar, 11 (%20.4)’inde bitkisel maddeler, 6 (%9,3)’ında narkotik madde ve 8 (%14,8)’inde bitkisel madde, ilaç ve narkotik kullanımına bağlı toksik hepatit geliştiği saptandı. İlaçlar içinde en çok antibiyotik (birinci sırada amoksisilin+ klavulanik asit) ve non-steroid anti inflamatuvar ilaç (birinci sırada diklofenak sodyum) kullanımı hikayesi saptandı. Bitkisel madde kullanımı olan hastalarda en sık meryem otu, lavanta çayı ve atom çayı kullanım hikayesi mevcuttu. Narkotik madde olarak en sık ekstazi (5 hasta) kullanımı saptandı. Otuz yaş altı (RR:1.545, p<0.001) ve erkek cinsiyet (RR:11.0, p=0.013) narkotik madde kullanımı için risk faktörü olarak saptandı. Sonuç: Bölgemizde ilaç ve bitkisel madde kullanımına bağlı gelişen TH anormal karaciğer fonksiyon testlerinin önemli bir sebebi olarak dikkate alınmalıdır. Özellikle genç erkeklerde narkotik kullanımı toksik hepatit etiyolojisinde önemli yer tutmaktadır

What does the procalcitonin level tell us in patients with acute pancreatitis?

Objective: To determine the factors affecting the procalcitonin level, and its association with the severity of pancreatitis in patients with acute pancreatitis (AP). Study Design: Cross-sectional analytical study. Place and Duration of Study: Division of Gastroenterology, University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital and Department of Gastroenterology, Dicle University School of Medicine, Diyarbakır, Turkey, between April 2017 and June 2021. Methodology: The study included 214 patients diagnosed with AP according to Atlanta criteria. By checking the PCT and CRP values of the patients in the first 12 hours, the relationship with these scales that predict the severity of pancreatitis was statistically examined. Results: Hundred and fifty-two patients (71.0%) had mild, while 62 patients (29.0%) had severe pancreatitis. According to the Atlanta criteria, the mean PCT level of patients with mild pancreatitis was 1.4±0.7 ng/mL, while the mean PCT level of patients with severe pancreatitis was 9.0±12.3 ng/mL (p<0.001). The diagnostic performance of PCT was better for predicting severe AP. For the 0.94 ng/mL cut-off, PCT had 86.9% sensitivity and 50.7% specificity. (AUC=0.731[95% CI: 0.669-0.811]; p<0.001; LR: 1.7). In patients with severe pancreatitis, the PCT level was 4.7±18.5 ng/mL in patients without concomitant infection and 15.8±8.1 ng/mL in patients with concomitant infection (p<0.001). Conclusion: High PCT value measured at the time of the first admission to the hospital may predict severe pancreatitis. In addition, a high PCT value at the time of admission to the hospital in patients with pancreatitis may indicate another concomitant infection

BİLATERAL HİDROÜRETERONEFROZ VE FROZEN PELVİS NEDENİYLE OPERE EDİLEN BİR PELVİK AKTİNOMİKOZ OLGUSU

Pelvik aktinomikoz, oldukça nadir görülen bir durumdur