The search for a common thrombophilic state during the active state of inflammatory bowel disease.

The clinical course of inflammatory bowel disease (IBD) is frequently associated with thromboembolic complications. The aim of this study was to investigate common thrombophilic markers in Turkish patients with active IBD. Twenty-seven consecutive patients with IBD who were followed-up at the Hacettepe University Hospital were recruited. All the patients were in the active disease state. International normalized ratio, activated partial thromboplastin time, lupus anticoagulant, anticardiolipin IgG, IgM antibodies, protein C, protein S, antithrombin-III, factor V, and factor II mutation of all the IBD patients and of a sex-matched and age-matched control group of non-IBD patients were measured. International normalized ratio, activated partial thromboplastin time, protein C, protein S, lupus anticoagulant, anticardiolipin IgG and IgM, and Proteins C and S mutations were comparable between the 2 groups, but antithrombin-III was significantly lower in the IBD group compared with healthy control group (P<0.0001). As a conclusion, it is reasonable to assume that there may be a subpopulation of the patients with IBD, in whom thrombophilic abnormalities might be important for either disease manifestation or for thrombotic complications. Those hemostatic abnormalities could be either inherited or secondary to the ongoing disease process. Routine screening for the common markers of thrombophilia does not seem to be warranted unless simultaneous arterial and venous thrombosis, major organ thrombosis, strong family history of thrombophilia, unusual and recurrent thrombosis resistant to standard anticoagulant therapy are present. Further studies are definitely required to clarify these complicated associations.

Invasive group A streptococcal infection with pancarditis caused by a new emm-type 12 allele of Streptococcus pyogenes.

Throughout the 1980s, a progressive increase in the incidence of Streptococcus pyogenes-related invasive infections has occurred. It has been suggested that a host-related immunogenetic background, as well as bacterial virulence factors may play an important role in the outcome of streptococcal infections. Here, we present the first case of pancarditis in the literature caused by direct bacterial invasion due to a new emm-type 12 allele of S. pyogenes in an immunocompetent patient. The pathogenesis of this invasive infection, as well as predictors of poor prognosis are discussed.

Evaluation of the Helicobacter pylori stool antigen test (HpSA) for the detection of Helicobacter pylori infection and comparison with other methods.

BACKGROUND/AIMS: Several invasive and non-invasive methods are available for the detection of H. pylori infection. The accuracy of anti-H. pylori antibodies in serum is low. There is a need for a quick, inexpensive and reliable non-invasive test to detect H. pylori. The aim of this study was to evaluate the enzyme immunoassay for the detection of H. pylori antigen in stool in the Turkish population and compare it to other methods. METHODOLOGY: 50 patients who were admitted to Hacettepe University Department of Internal Medicine, Division of Gastroenterology with the symptom of dyspepsia for whom the indication of upper gastrointestinal endoscopy was present were included in the study. With their permission stool samples were taken. The patients were evaluated with histology, culture, serology, rapid urease test and HpSA (Helicobacter pylori Stool Antigen test). Forty-one patients had gastritis and biopsies were taken from those. RESULTS: Excluding HpSA if three of the rest of four methods were positive, patients were accepted as H. pylori positive. Nineteen patients were positive for H. pylori, 22 were negative. HpSA was positive in 16 of 19. The sensitivity and specificity of the methods were as follows: histology 100% sensitive, and 86% specific, culture 63% and 100%, HpIgG 58% and 73%, rapid urease test 89% and 82%, respectively. The results were as 84% and 82% for HpSA. Comparing with the 'Gold Standard' histology using McNemar's test Kappa results were as 0.610, 0.181, 0.610, 0.708 for culture, HpIgG, Rapid Urease Test and HpSA, respectively. CONCLUSIONS: HpSA is a cheap, effective method for the diagnosis of H. pylori infection in the Turkish population.