What is the impact of capsule endoscopy in the long term period?

AIM: To assess the clinical impact of capsule endoscopy(CE) in the long-term follow-up period in patients with obscure gastrointestinal bleeding(OGIB). METHODS: One hundred and forty-one patients who applied CE for OGIB between 2009 and 2012 were retrospectively analyzed, and this cohort was then questioned prospectively. Demographic data of the patients were determined via the presence of comorbid diseases, use of non-steroidal anti-inflammatory drugs anticoagulant-antiaggregant agents, previous diagnostic tests for bleeding episodes, CE findings, laboratory tests and outcomes.RESULTS: CE was performed on 141 patients becauseof OGIB. The capsule was retained in the upper gastrointestinal(GI) system in two of the patients, thus video monitoring was not achieved. There were 139 patients [62% male, median age: 72 years(range: 13-93 years) and a median follow-up duration: 32 mo(range: 6-82 mo)]. The overall diagnostic yield of CE was 84.9%. Rebleeding was determined in 40.3%(56/139) of the patients. The rebleeding rates of patients with positive and negative capsule results at the end of the follow-up were 46.6%(55/118) and 4.8%(1/21), respectively. In the multivariate analysis, usage of NSAIDs, anticoagulant-antiaggregant therapies(OR = 5.8; 95%CI: 1.86-18.27) and vascular ectasia(OR = 6.02; 95%CI: 2.568-14.146) in CE were detected as independent predictors of rebleeding. In the univariate analysis, advanced age, comorbidity, and overt bleeding were detected as predictors of rebleeding.CONCLUSION: CE is a reliable method in the diagnosis of obscure GI bleeding. Negative CE correlated with a significantly lower rebleeding risk in the long-term follow-up period.

Is There a Link between Circadian Clock Protein PERIOD 3 (PER3) (rs57875989) Variant and the Severity of COVID-19 Infection?

Objective:Corona Virus Disease-2019(COVID-19)has been among the major infectious events of the century.In today’s literature where COVID-19 and host factor effects are frequently examined,we aimed to examine another factor:Circadian Clock Protein PERIOD 3(PER3).There is a significant correlation between PER3 gene polymorphism and circadian rhythm disturbances and immune system dysregulation.Methods:In our study,we recruited 200 patients diagnosed with COVID-19 in our hospital between April-June 2020,and 100 volunteers without known comorbidities to create a healthy control group.After comparing the initial gene polymorphisms of the patients with healthy controls,three separate clinical subgroups were formed.Gene polymorphism distribution and statistical significance were examined in the formed patient groups.Results:No significant difference was found between the patient group and the healthy controls(P>0.05,for all).When patients were divided into two separate clinical subgroups as exitus/alive according to their last condition during their 28-day follow-up,the 4R/5R genotype was significantly more common in patients with a mortal course(P=0.007).The PER34R75R genotype was found at a significantly higher rate in the group of patients with the need for intensive care(P=0.034).Conclusion:The 4R/5R genotype may be associated with the need for intensive care and mortality in COVID-19 patients.These important results will be a guide for future studies.

Marked elevation of troponin I without wall motion abnormality in a patient with myocarditis: Cardiac enzymes may not predict the outcome in myocarditis

A seventeen-year-old male presented with severe substernal chest pain after an episode of upper respiratory tract infection. On clinical grounds, a diagnosis of myocarditis was established. He had a peak troponin I level as high as 40.4 ng/dl but interestingly with no abnormal wall motion and normal ejection fraction in echocardiography. Coronary artery disease was excluded with normal coronary angiography. Diagnosis of myocarditis was confirmed with cardiac MRI. After one month, patient had no complaint and ejection fraction were still normal. Our case emphasizes that the troponin levels predict neither the early nor the late outcome of the left ventricular functions in myocarditis, therefore serum troponin I may not be helpful in determining the prognosis of patients with myocarditis.

Gastroesophageal reflux in asymptomatic obese subjects:An esophageal impedance-pH study

AIM:To investigate the relationship between reflux and body mass index(BMI) in the asymptomatic obese population using the impedance-p H technique.METHODS:Gastroesophageal reflux is frequent in the obese population.However,the relationship between acid reflux and BMI in asymptomatic obese people is unclear.Forty-six obese(BMI > 25 kg/m2) people were enrolled in this prospective study.We evaluated the demographic findings and 24-h impedance p H values of the whole group.Gas,acid(p H < 4),weak acid(p H = 4-7) and weak alkaline(p H ≥ 7) reflux parameters were analyzed.RESULTS:The mean age of patients was 49.47±12.24 years,and half of them were men.The mean BMI was 30.64±3.95 kg/m2(25.14-45.58 kg/m2).BMI of 23 was over 30 kg/m2.Seventeen patients had a comorbidity(hypertension,diabetes mellitus,or ischemic heart disease).Endoscopic examination revealed esophagitis in 13 of the 28 subjects(10Grade A,3 Grade B).The subjects were divided into two groups according to BMI(<30 and>30 kg/m2).Demographic and endoscopic findings,and impedance results were similar in these two groups.However,there was a positive correlation between BMI and total and supine p H<4 episodes(P=0.002,r=0.414;P=0.000,r=0.542),p H<4 reflux time(P=0.015,r=0.319;P=0.003,r=0.403),and De Meester score(P=0.012,r=0.333).CONCLUSION:Acid reflux is correlated with BMI in asymptomatic obese individuals.

Rare pancreas tumor mimicking adenocarcinoma: Extramedullary plasmacytoma

Neoplastic proliferation of plasma cells is called plasma cell dyscrasias, and these neoplasms can present as a solitary neoplasm or multiple myeloma. Extramedullary plasmacytoma, in particular pancreatic plasmacytoma, is a rare manifestation of multiple myeloma. Although computerized tomography is useful for the diagnosis of extramedullary plasmacytoma, there are no specific radiologic markers that distinguish it from adenocarcinoma. Histological confirmation by biopsy is necessary for accurate diagnosis and management of the tumor. Endosonography is the most sensitive method for the diagnosis of pancreatic tumors, and the use of fine needle aspiration by endosonography is associated with a lower risk for malignant seeding and complications. Here, we report a case of pancreatic plasmacytoma in newly identified multiple myeloma as diagnosed by endosonography. Endosonography is a reliable and rapid method for the diagnosis of extramedullary plasmacytoma. Therefore, endosonographic fine needle aspiration should be the first choice for histological evaluation when pancreatic plasmacytoma is suspected. Ideally, the pathology would be performed at the same site as endosonographic biopsy.

A case of isolated hepatic actinomycosis causing right pulmonary empyema

The clinical picture of actinomycosis was first described in 1878.Actinomycosis agents are found in the natural flora of the oral cavity, upper gastrointestinal system and female genital systems. Actinomyces israelii is usually responsible for the infections and causes chronic suppurative and granulomatous infections. The most common disease form is cervicofascial infection. Liver is involved in 5% of all actinomycosis infections. Liver involvement secondary to any primary infection site in the abdomen frequently occurs. In 15% of abdominal infections the liver is also involved. However, in very rare cases, a primary focus cannot be found, and these cases are called primary or isolated hepatic actinomycosis （IHA）. IHA which is frequently seen as a solitary abscess can be confused with a malignancy both clinically and radiologically.

Current state and clinical outcome in Turkish patients with hepatocellular carcinoma

AIM To investigate clinical, etiological, and prognostic features in patients with hepatocellular carcinoma.METHODS Patients with hepatocellular carcinoma who were followed-up from 2001 to 2011 were included in the study. The diagnosis was established by histopathological and/or radiological criteria. We retrospectively reviewed clinical and laboratory data, etiology of primary liver disease, imaging characteristics and treatments. ChildPugh and Barcelona Clinic Liver Cancer stage was determined at initial diagnosis. Kaplan-Meier survival analysis was done to find out treatment effect on survival. Risk factors for vascular invasion and overall survival were investigated by multivariate Cox regression analyses. RESULTS Five hundred and forty-five patients with hepatocellular carcinoma were included in the study. Viral hepatitis was prevalent and 68 patients either had normal liver or were non-cirrhotic. Overall median survival was 16(13-19) mo. Presence of extrahepatic metastasis was associated with larger tumor size(OR = 3.19, 95%CI: 1.14-10.6). Independent predictor variables of vascular invasion were AFP(OR = 2.95, 95%CI: 1.38-6.31), total tumor diameter(OR = 3.14, 95%CI: 1.01-9.77), and hepatitis B infection( OR = 5.37, 95 % CI : 1.23-23.39). Liver functional reserve, tumor size/extension, AFP level and primary treatment modality were independent predictors of overall survival. Transarterial chemoembolization(HR = 0.38, 95%CI: 0.28-0.51) and radioembolization(HR = 0.36, 95%CI: 0.18-0.74) provided a comparable survival benefit in the real life setting. Surgical treatments as resection and transplantation were found to be associated with the best survival compared with loco-regional treatments(log-rank, P < 0.001).CONCLUSION Baseline liver function, oncologic features including AFP level and primary treatment modality determines overall survival in patients with hepatocellular carcinoma.

A mysterious cause of recurrent acute liver dysfunction for over a decade

Introduction Acute liver failure(ALF)is an uncommon disease in pediatric cases.Etiology includes infections,autoimmune diseases,inborn errors of metabolism,and intoxications.Metabolic disorders account for 25%of resolved cases.However,the etiology remains unknown in half of pediatric ALF[1].The recognition of molecular etiopathogenesis has been facilitated after the common use of next-generation sequencing techniques.Recently,biallelic variants in neuroblastoma-amplified sequence(NBAS),Leucyl-tRNA synthetase 1(LARS1),and RAD50-interacting protein(RINT1)were identified in recurrent ALF(RALF)[2–4].

Mortal neutropenic enterocolitis in acute lymphoblastic leukemia

Neutropenic enterocolitis (NE) or typhlitis is a serious complication of anticancer therapy, especially in he- matological malignancies. We describe a case of acute lymphoid leukemia presenting the early onset of a syndrome with the clinical features and specific radiological findings of NE during the neutropenic phase.