The Effect of Direct Oral Anticoagulants on Gastric Mucosa and Helicobacter Pylori Prevalence in Dyspeptic Patients: A Retrospective Cross-Sectional Study.

Background and aim Although direct oral anticoagulants (DOACs) are widely used and their side effects related to bleeding at various body sites have been well studied in the literature, less is known about their local impact on gastric mucosa. Some studies suggest that the higher risk of gastrointestinal (GI) bleeding associated with DOACs may be due to their direct local anticoagulant effects on the gastric mucosa. In this study, we aim to evaluate whether this potential local effect has a favorable outcome on the gastric mucosa and the prevalence of Helicobacter pylori (HP).  Materials and methods A total of 125 patients with dyspepsia were included in the study. Sixty patients who had been using a DOAC for at least one month were classified as the "DOAC group," while 65 patients who had not used DOACs were designated as the "control group." Demographic, laboratory, and pathological findings for these patients were retrospectively analyzed from their medical files. Results Patients in the DOAC group were significantly less likely to have antral gastritis (AnG) (p = 0.028), while the frequencies of HP and atrophic gastritis (AtG) were similar between the two groups. Although not statistically significant, the DOAC group showed fewer instances of intestinal metaplasia (IM) and a higher number of upper GI ulcers. Patients who had been using DOACs for more than 12 months had increased incidences of IM, upper GI ulcers, AnG, and HP compared to those who had been using DOACs for 12 months or less. The Rivaroxaban subgroup showed significantly lower HP positivity compared to patients using other DOACs (p = 0.042). Among all subgroups, the Rivaroxaban group had the lowest frequency of AnG (p = 0.024). Conclusion While DOACs seem to prevent AnG, HP, and IM at their early use stages, unfavorable gastric mucosa manifestations might increase with prolonged use. Higher upper GI ulcer prevalence is another controversial result of this issue. Rivaroxaban shines amongst other DOACs with its lesser HP and AnG association. These exciting findings should be supported by randomized controlled trials with large patient populations.

The Relationship Between Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) Levels and Treatment Response in Patients With Glomerulonephritis: A Single-Center Experience.

Aim Soluble urokinase-type plasminogen activator receptor (suPAR) is an important protein that is reported to increase in a broad range of inflammatory processes. We aimed to determine whether suPAR is a significant biomarker in glomerulonephritis for distinguishing patients with treatment response from patients without treatment response in our study. Materials and methods This was a prospective study in which 117 patients with biopsy-proven glomerulonephritis and 54 healthy individuals without a known chronic disease (control group) were enrolled. A total of 117 patients were divided into two groups: "treatment responsive" and "treatment nonresponsive." Blood samples were collected from the patients upon their outpatient clinic visits, and the demographical and lab parameters were compared between the groups. Results For the patient group consisting of 117 individuals, 56.4% were male, the mean age was 49.6 years, and the mean follow-up duration was 32.2 months. The most commonly diagnosed glomerular disease was focal segmental glomerulosclerosis (FSGS), followed by IgA nephropathy and membranoproliferative glomerulonephritis, respectively. While suPAR levels were significantly higher in the patient group (166.06 ± 127.66 vs. 119.67 ± 70.53 pg/ml, p = 0.001) (suPAR level ± standard deviation), no significant relationship was found between suPAR levels, treatment response status, and disease severity. Besides, there was no significant relationship between suPAR levels and proteinuria levels, BMI of the patients, and the type of immunosuppressive agent used in the treatment and BMI. Conclusion Our study showed that suPAR levels could distinguish a patient with glomerulonephritis from a healthy individual, whereas it has no value in predicting the disease progression and treatment responsiveness.

First report of human infection with Leptospira interrogans serovar Bratislava in the Eastern Black Sea region of Turkey.

Leptospirosis is one of the most common zoonotic bacterial infections worldwide. It is an infection that usually affects people with low socioeconomic status, with morbidity and mortality risk. The clinical course of the disease may range from mild, featuring nonspecific clinical signs and symptoms, to severe, resulting in death. The respective studies conducted in Turkey indicate that leptospirosis seropositivity in animals and humans is higher in coastal and rural areas. Turkey's Eastern Black Sea Region has a humid climate with heavy rainfalls and a large population of mice and other rodents. However, a Leptospira interrogans serovar Bratislava case is yet to be reported in this region. This article reports the case of a 38-year-old patient who presented fever and acute renal failure and was diagnosed with Leptospira interrogans serovar Bratislava after hospitalization.

Helicobacter Pylori and Celiac Disease Antibody Positivity Have a Higher Prevalence in Patients With Distal Gastrectomy: A Cross-Sectional Retrospective Study.

Aims and objectives Distal gastrectomy was a widely used therapeutic option for peptic ulcer and gastroesophageal reflux disease until quite recently. The consequences of anatomical and physiological changes following surgery in the gastric mucosa have been the object of interest for the scientist. In this study, we aimed to determine whether Helicobacter pylori (HP) infection and celiac disease were more common in patients with a history of distal gastrectomy. Materials and methods This is an observational retrospective study conducted at Giresun University Faculty of Medicine. The medical files of 35 patients with dyspepsia who had a history of distal gastrectomy for benign etiologies (antrectomy group) and 50 patients with dyspepsia (control group) were retrospectively analyzed. Results There were more males and older patients in the antrectomy group. Concerning the lab parameters, platelets, lymphocyte, and albumin levels were significantly lower, and urea, creatinine, anti-Endomisium Ig A (anti-EMA), and anti-tissue transglutaminase IgA (anti-tTGA) antibody positivity were significantly higher in the antrectomy group. Gastric biopsy results revealed a higher positivity of HP, atrophy, neutrophil, and lymphocytes in the antrectomy group. Correlation analysis revealed an inverse correlation between albumin and anti-EMA/atrophy positivity whereas a positive correlation between anti-EMA and HP/atrophy positivity. Conclusions HP infection and coeliac disease (CD) could be the problems that distal gastrectomy patients with dyspepsia can face during their follow-up. Concerning the pre-malignant potential of HP, its screening and eradication should be performed to prevent the malignant transformation of the remnant gastric tissue.

Leptospirosis during the COVID-19 pandemic: a case report.

Since SARS-CoV-2 disease (COVID-19) has been labeled as a pandemic, it took the spotlight in the differential diagnosis for patients presenting with acute respiratory and systemic symptoms. Leptospirosis is one of the most common zoonoses in the world, yet it is mainly a disease of differential diagnosis for places that do not have it as an endemic. Due to the high burden of COVID-19 on the healthcare field, patients suffering from other infections may have been inadvertently neglected. COVID-19 infection can mimic other infectious diseases and can confuse physicians in their search for a confirmatory diagnosis. Nonetheless, it is very crucial to broaden the differential diagnosis and keep diseases like leptospirosis within the differential diagnosis despite its rarity, especially in patients presenting with unexplained systemic infectious symptoms. This is a unique case of a patient who presented with dyspnea, jaundice and change in urine color who was suspected to be COVID-19 positive. After a detailed investigation, the patient was diagnosed with leptospirosis instead of COVID-19 and was treated with plasmapheresis and antibiotics accordingly.

First report of human infection with Leptospira interrogans serovar Bratislava in the Eastern Black Sea region of Turkey

ABSTRACT Leptospirosis is one of the most common zoonotic bacterial infections worldwide. It is an infection that usually affects people with low socioeconomic status, with morbidity and mortality risk. The clinical course of the disease may range from mild, featuring nonspecific clinical signs and symptoms, to severe, resulting in death. The respective studies conducted in Turkey indicate that leptospirosis seropositivity in animals and humans is higher in coastal and rural areas. Turkey's Eastern Black Sea Region has a humid climate with heavy rainfalls and a large population of mice and other rodents. However, a Leptospira interrogans serovar Bratislava case is yet to be reported in this region. This article reports the case of a 38-year-old patient who presented fever and acute renal failure and was diagnosed with Leptospira interrogans serovar Bratislava after hospitalization.

Leptospirosis during the COVID-19 pandemic: a case report

ABSTRACT Since SARS-CoV-2 disease (COVID-19) has been labeled as a pandemic, it took the spotlight in the differential diagnosis for patients presenting with acute respiratory and systemic symptoms. Leptospirosis is one of the most common zoonoses in the world, yet it is mainly a disease of differential diagnosis for places that do not have it as an endemic. Due to the high burden of COVID-19 on the healthcare field, patients suffering from other infections may have been inadvertently neglected. COVID-19 infection can mimic other infectious diseases and can confuse physicians in their search for a confirmatory diagnosis. Nonetheless, it is very crucial to broaden the differential diagnosis and keep diseases like leptospirosis within the differential diagnosis despite its rarity, especially in patients presenting with unexplained systemic infectious symptoms. This is a unique case of a patient who presented with dyspnea, jaundice and change in urine color who was suspected to be COVID-19 positive. After a detailed investigation, the patient was diagnosed with leptospirosis instead of COVID-19 and was treated with plasmapheresis and antibiotics accordingly.

Association of C-reactive Protein/Albumin, Procalcitonin/Albumin, Platelet/Lymphocyte, and Lymphocyte/Monocyte Ratio with Mortality in Hospitalised COVID-19 Patients.

OBJECTIVE: To investigate and compare complete blood count and biochemistry parameters such as c-reactive protein/albumin (CRP/ALB) ratio, procalcitonin/albumin (PRO/ALB) ratio, lymphocyte/monocyte (LYM/MON) ratio, platelet/lymphocyte (PLT/LYM) ratio of the recovered/deceased, and ICU (intensive care unit) /ward patients with COVID-19. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Internal Medicine, Sakarya University Training and Research Hospital, Turkey, from April 2020 to January 2021. METHODOLOGY: The study was conducted with 590 diagnosed patients with COVID-19. The patients were divided into 2 groups as deceased (n = 294) /survivor (n = 296) and those in need of ICU (n= 418) /ward (n = 172). The information was obtained from the hospital information system and analysed retrospectively. The relationships of crp/alb, pro/alb, lym/mon, and PLT/LYM ratios with patient groups were investigated. RESULTS: Of the total 590 patients in the study, 358 (60.6%) were males. The total mean age was 65.63 ±14.9 years. The mean age of survivor and deceased groups was 71.32±10.9 and 59.97±16.2 years, respectively (p.

Depression and Anxiety Disorders in COVID-19 Survivors: Role of Inflammatory Predictors.

Introduction: Infection-triggered perturbation of the immune system, which was observed after previous coronavirus outbreaks, could induce psychiatric sequelae. The spreading of the Coronavirus-19 (COVID-19) pandemic could be associated with psychiatric implications. In this study, we aimed to evaluate the association between inflammatory biomarkers and the levels of depression and anxiety in patients who recovered from COVID-19. Methods: We screened 109 COVID-19 survivor adults for psychiatric symptoms on the 15th day of follow-up after discharge from the hospital. The patients were split into two groups, the ones with depression and anxiety, and the ones without depression or anxiety, after the psychiatric interview. Self-rating Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were applied to assess the levels in patients with depression and anxiety. We collected and recorded the sociodemographic information, clinical data, and baseline inflammatory markers. Results: Higher baseline neutrophil/lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) were found in patients with depression and anxiety. Higher levels of depression and anxiety were found in younger and female patients. Besides, a significant correlation was found between BAI and ferritin levels in patients with anxiety, while no association was found between BAI and other inflammatory biomarkers. Moreover, no significant relationship was found between BDI scores and inflammatory biomarkers in patients with depression. Conclusion: COVID-19 primarily affects the respiratory and cardiovascular systems. Nonetheless, psychiatric involvement is not uncommon and can lead to severe problems if not detected and managed at an early stage. It is recommended that clinicians should be vigilant in terms of psychiatric involvement in COVID-19 patients presenting with high inflammatory parameters.

The association between post-progression survival and clinical characteristics of patients with metastatic colon cancer: A single center experience.

PURPOSE: In this study, we aimed to determine the factors which affect post-progression survival (PPS) and overall survival (OS) in patients with metastatic colorectal cancer. METHODS: 87 patients with metastatic colorectal cancer had been followed up with palliative care due to disease progression or ECOG performance status after receiving at least two cycles of chemotherapy. PPS was estimated as the time between the last progression date and last control or death date in patients who were followed up with palliative care. RESULTS: 87 patients with metastatic colorectal cancer were included in the study. Evaluation with multivariate analysis of factors affecting PPS revealed a significantly longer PPS (10.8 weeks) in patients with ECOG score 0 or 1 than the PPS of patients with ECOG score 2-5 (3 weeks) (p=0.01). It was also found that PPS was 14.4 weeks in patients with CEA levels <5ng/ml,while it was 6.7 weeks in patients with CEA levels ≥5 ng/ml (p=0.001) and PPS was 13.7 weeks in patients with controlled disease after first-line chemotherapy while it was 8 weeks in patients with progression (p=0.03); both were statistically significant. No significant association was found between PPS and age, gender, tumor location, sites of metastasis, and RAS status. CONCLUSION: ECOG performance status score of 0-1, CEA levels below 5 ng/ml, and disease control with first-line chemotherapy are related to longer PPS in patients with metastatic colorectal cancer.

Predictive role of FAR ratio in COVID-19 patients.

OBJECTIVE: No effective treatment has yet been found for SARS-Cov-2, which caused a pandemic outbreak in 2019. It is crucial to detect the progression of COVID-19 in patients as early as possible. Fibrinogen to albumin ratio (FAR) has been used as a new inflammatory marker. We aimed to find out whether the use of the FAR as a predictor of mortality in COVID-19 patients provides clinical benefit. MATERIALS AND METHODS: Data from 590 patients with COVID-19 from March 15, 2020 to January 15, 2021 in medicine wards and intensive care units (ICU) were retrospectively analysed. Demographic data and other laboratory markers were collected from the electronic medical records. Relationship between FAR was investigated between patients in the survivor/non-survivor patients. FINDINGS: The mean FAR levels in patients who were non-survivor was 24.44 ± 30.3 (n = 272 and 11.29 ± 6.29 (n = 275) (P = .000) in patients survivor COVID-19 infection. In ROC curve for FAR, the threshold FAR that may pose a risk for mortality was determined as 13.84 ((AUC: 0.808 (0.771-0.844)); 74.9% sensitivity, 74.6% specificity; P = .000)). RESULT: As a result of this study, increased FAR were found to be important markers in determining the mortality levels in COVID-19 patients.

Psoas muscle mass, nutritional status, inflammation, and their relationship with prognosis in patients with pancreatic adenocarcinoma.

INTRODUCTION: Introduction: some factors have been shown to be associated with survival in patients with pancreatic adenocarcinoma. Recently, some studies suggested that malnutrition, muscle mass, and inflammation might have an effect on survival in patients with pancreatic malignancy. Objectives: to investigate the association between psoas muscle mass, inflammation, nutritional status at the time of diagnosis, and survival in patients with pancreatic adenocarcinoma. Methods: this retrospective study included 219 patients diagnosed with pancreatic carcinoma. The nutritional status, inflammation, and psoas muscle mass of the patients at the time of diagnosis were evaluated. Nutritional status was assessed using the Prognostic Nutritional Index (PNI). Leucocyte count and neutrophil/lymphocyte ratio (NLR) were used for inflammation assessment. Psoas muscle mass was calculated by using abdominal computed tomography images of the patients. Results: the mean age of patients (80 female and 139 male) was 66.6 ± 11.7 years. According to the PNI results, 155 patients had a normal nutritional status (70 %), whereas 64 patients were malnourished (30 %). The survival of the patients with normal nutritional status was significantly longer than that of those who were malnourished (p < 0.001). There was no significant relationship between psoas muscle area, leucocyte count, NLR, and survival time. Conclusion: the survival of pancreatic adenocarcinoma patients with malnutrition at the time of diagnosis was significantly shorter than for patients without malnutrition.

INTRODUCCIÓN: Introducción: se ha demostrado que algunos factores se asocian a la supervivencia en los pacientes con adenocarcinoma de páncreas. Recientemente, algunos estudios sugirieron que la desnutrición, la masa muscular y la inflamación podrían afectar a la supervivencia de los pacientes con neoplasias malignas pancreáticas. Objetivo: investigar la asociación entre masa muscular del psoas, inflamación, estado nutricional en el momento del diagnóstico y supervivencia en pacientes con adenocarcinoma de páncreas. Métodos: este estudio retrospectivo incluyó a 219 pacientes diagnosticados de carcinoma de páncreas. Se evaluaron el estado nutricional, la inflamación y la masa del músculo psoas de los pacientes en el momento del diagnóstico. El estado nutricional de los pacientes se evaluó con el Índice Nutricional Pronóstico (PNI). El recuento de leucocitos y el cociente de neutrófilos/linfocitos (NLR) se emplearon para la evaluación de la inflamación. La masa del músculo psoas se calculó utilizando las imágenes de tomografía computarizada abdominal de los pacientes. Resultados: la edad media de los pacientes (80 mujeres y 139 hombres) fue de 66,6 ± 11,7 años. Según los resultados del PNI, 155 pacientes tenían un estado nutricional normal (70 %) mientras que 64 pacientes estaban desnutridos (30 %). La supervivencia de los pacientes con estado nutricional normal fue significativamente mayor que la de los pacientes desnutridos (p < 0,001). No hubo ninguna relación significativa entre el área del músculo psoas, el recuento de leucocitos, el NLR y el tiempo de supervivencia. Conclusión: la supervivencia de los pacientes con adenocarcinoma de páncreas con desnutrición en el momento del diagnóstico fue significativamente menor que la de los pacientes sin desnutrición.

Prealbumin: A New Biomarker for Predicting Prognosis in Patients with Severe COVID-19.

OBJECTIVE: To analyse whether prealbumin could be a new biomarker for predicting mortality in severe COVID-19 patients. STUDY DESIGN: An observation study. PLACE AND DURATION OF STUDY: Intensive care units (ICU) of Sakarya University Training and Research Hospital, Sakarya, Turkey, from October 2020 to December 2020. METHODOLOGY: The data of 149 patients, who were admitted to the ICU were collected and analysed retrospectively. Routine blood samples were collected from all patients at the time of admission to the ICU; and 102 patients with the mortal course and 47 patients with the non-mortal course were included in the study. The data obtained from these patients were analyzed in the biostatistics programme.  Results: The median age of all patients was 68 years; while 94 of them were males (63.1%) and 55 of them were females (36.9%). Median levels of potassium (K) (p=0.04), uric acid (p=0.001), C-reactive protein (CRP) (p=0.004), and procalcitonin (PCT) (p<0.001) were significantly higher and median level of prealbumin (p=0.002) was significantly lower in the deceased group. The cut-off level of prealbumin for mortality was found as 0.085 g/L (p=0.002). Further analysis revealed that the risk of mortality was found as 2.193 times more in patients with prealbumin levels of <0.085 g/L (Odds Ratio (OR): 2.193, 95% CI: 1.084-4.434). CONCLUSION: As a result of this study, it was found that patients with lower levels of prealbumin at the time of admission to the ICU have a higher risk for mortality. It was showed that prealbumin can be a useful biomarker for predicting mortality in patients with severe COVID-19. Key Words: Prealbumin, COVID-19, Mortality, Prognostic biomarkers, Severe disease.

The predictive and diagnostic accuracy of long pentraxin-3 in COVID-19 pneumonia

Background/aim: The purpose of this study is to evaluate serum pentraxin-3 (PTX-3) levels in Sars-CoV-2 virus infection (COVID-19) patients and to investigate whether PTX-3 predicts the disease prognosis. Materials and methods: This study was conducted on 88 confirmed COVID-19 patients who were hospitalized due to symptomatic pneumonia between April 15 and August 15, 2020. The patients were divided into two groups as survived patients and non-survived patients. Both groups were compared according to demographic features, comorbid conditions and measurement of the PTX-3 and other laboratory parameters of the patients. Results: Of 88 patients with COVID-19, 59 (67%) were discharged with complete cure and 29 (33%) resulted in death. 46 (52.3%) of the patients were men. PTX-3 median value (IQR) was 3.66 ng/mL (0.9­27.9) in all patients, 3.3 ng/mL (0.9­27.9) in survivors and 3.91 ng/mL (1.9­23.2) in nonsurvivors which was significantly higher (P = 0.045). As a receiver operating characteristic curve analysis the cut-off value of PTX-3 for predicting mortality in patients was 3.73 with 65% sensitivity and 65% specificity (AUC: 0.646, 95% CI: 0.525­ 0.767, P = 0.045). Also, we found significant cut-off values with respect to D-dimer, D-dimer/PTX-3, high-sensitivity troponin, high- sensitivity troponin/PTX-3, lymphocyte, PTX-3/lymphocyte, procalcitonin, procalcitonin/PTX-3, CRP, and CRP/PTX-3 (P < 0.05). Conclusion: In this study, as far as we know, for the first time, we have shown PTX-3 as the new mortality biomarker for COVID-19 disease.

The effect of abo and rh blood group antigens on admission to intensive care unit and mortality in patients with COVID-19 infection.

AIM: The aim of this study is to analyze the prognostic significance of ABO and Rh blood group antigens along with various parameters in patients followed-up with the diagnosis of COVID-19. METHODS: We evaluated 397 patients who were follow-up and treated due to COVID-19 infections. The ages, genders, chronic diseases, ABO and Rh blood group antigens, admission rates to Intensive Care Units (ICU), and mortality rates of the patients were analyzed. FINDINGS: The mean age of the 397 patients with COVID-19 was 47±17 years. In the blood group analysis of the patients, A Rh-positive (A +) was the most frequently seen blood type (176 patients, 44.3%) followed by O Rh-positive (0 +) (109 patients, 27,5%); 38 patients were Rh negative (Rh -) (9,6%). 53 of the patients (13,4%) were followed in ICU and 29 patients died (7,3%). Neither mortality nor admission to ICU was seen for Rh - group. The comparison of Rh groups concerning the need for ICU admission revealed a significantly high rate of ICU admission in the Rh + group (p=0,011), while no significant relationship was found between mortality and Rh antigen (p=0,069). CONCLUSION: The most frequently seen blood type among COVID-19 patients was A +. The Rh + blood group was found in all cases who were admitted to ICU and had a death outcome. The Rh + blood group was found in a significantly high number of patients who were admitted to ICU, while no significant relationship was found between mortality and Rh blood group.