Exploring the therapeutic potential of topical probiotics in dermatological diseases: a comprehensive review of clinical studies.

The gastrointestinal tract may contribute to the regulation of systemic inflammation and skin diseases due to the balance between the pathogenic, opportunistic, and beneficial bacterial species it contains. External supplementation of beneficial bacteria, besides its known positive effect in the treatment of digestive system diseases, also has different favorable effects such as accelerated wound healing, suppression of inflammation, lower infection risk, and reduced antibiotic requirement. It has been reported that oral use of probiotics may be effective in the treatment of skin diseases such as acne, psoriasis, and atopic dermatitis. Furthermore, topical administration of probiotics may create a positive bacterial balance, eliminate pathological conditions, and thus have a favorable impact on the management of skin diseases. Interest in the effect of the skin microbiome and topical probiotics in the treatment of skin diseases has increased recently. Herein, 21 clinical studies and a case report in the PubMed database on the use of topical probiotics in dermatological diseases were evaluated.

Early Cholecystectomy after Endoscopic Retrograde Cholangiopancreatography Is Feasible and Safe.

Laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) is the preferred treatment for cholelithiasis with common bile duct stones. However, the optimal timing of LC after ERCP remains controversial. This study aimed to identify the ideal time interval between ERCP and LC. Data from patients who underwent LC after ERCP between November 2016 and August 2022 were retrieved from the electronic medical information system. The patients were categorized into early cholecystectomy (within 72 h of ERCP) and delayed cholecystectomy (after 72 h). The impact of the time interval between ERCP and LC on perioperative outcomes was analyzed. A total of 197 patients were included in the study, with 45 undergoing early cholecystectomy and 152 undergoing delayed cholecystectomy. No significant differences in the preoperative characteristics or operative morbidity were observed between the groups (p = 0.286). However, a significant correlation was found between the time interval from ERCP to LC and the total length of stay (r = -350, p < 0.001). The findings suggest that early cholecystectomy after ERCP is feasible and safe, and performing LC within the first 72 h does not adversely affect postoperative outcomes.

Comparison of the recommendation of international autoimmune hepatitis pathology group 2022 and the simplified criteria for autoimmune hepatitis 2008: A preliminary study.

Background and Aim: The histological diagnosis of autoimmune hepatitis (AIH) is challenging. A new consensus recommendation was provided by the International AIH Pathology Group to address the problems in the histological diagnosis. The purpose of this study is to compare the 2008 'simplified' criteria for AIH with the 'consensus recommendation' of 2022 in terms of diagnostic sensitivity. Materials and Methods: A retrospective analysis was conducted on pathological specimens of patients diagnosed with Autoimmune Hepatitis (AIH) between 2010 and 2022. Out of 188 patients enlisted, 88 were selected based on exclusion criteria. The specimens were examined by two experienced hepatopathologists and a resident pathologist. All specimens were analyzed using both the "simplified" criteria and the new consensus recommendations. Results: Out of a total of 78 patients, the 2022 consensus recommendations raised the diagnostic category of 16 patients (20.5%) to a higher level. Six patients who were previously diagnosed as "atypical" were now considered "possible AIH", while 10 patients with a "compatible" diagnosis were elevated to "likely AIH" category. No patients were found to fall into a lower diagnostic category according to the new recommendations. A significant difference in diagnostic sensitivity was observed between the 2008 criteria and the 2022 consensus report (p<0.001). Conclusion: The 2022 consensus recommendation may be more sensitive in the diagnosis of AIH in comparison to the 2008 'simplified' histological criteria. More studies are needed both for the validation of the sensitivity of the new consensus recommendation and for the determination of the specificity.

Combination of Precut Techniques in Difficult Biliary Cannulation.

Background: Selective biliary cannulation (SBC) is a prerequisite for successful endoscopic retrograde cholangiopancreatography (ERCP). SBC has the potential to fail in as many as 20% of cases, even with skilled endoscopists. Precut incision techniques like needle-knife sphincterotomy (NKS) and transpancreatic septotomy (TPS) can be used in cases where standard cannulation techniques fail. However, these precut techniques may also fail in some cases. We aimed to evaluate the procedural success of the combined TPS + NKS technique in difficult biliary cannulation. Patients and methods: The study included 289 patients who underwent ERCP with precut techniques from 2017 to 2022. Patients were classified into the following three groups and evaluated retrospectively in terms of cannulation success, and ERCP-related adverse effects: Transpancreatic septotomy, NKS, and TPS + NKS; statistical package for the social sciences (SPSS), version 29.0, software was used to analyze the data. Results: The success rate of SBC was 69% in the TPS group, 75.3% in the NCS group, and 87% in the TPS + NCS group. There was no significant difference between the NKS and TPS + NKS groups. Cannulation success in both NKS group and NKS + TPS groups was significantly higher than in the TPS group (p < 0.001). Complication rates were similar. Conclusion: In cases where standard sphincterotomy and precut techniques fail, a second precut technique can be used. A previous TPS does not prevent NKS. How to cite this article: Abiyev A, Tuzcu B, Bilican G, et al. Combination of Precut Techniques in Difficult Biliary Cannulation. Euroasian J Hepato-Gastroenterol 2024;14(1):56-59.

Effect of COVID-19 Pandemic on Hepatocellular Carcinoma Diagnosis: Results from a Single Turkey Center Study.

BACKGROUND AND AIMS: Currently malignancies of the liver are the sixth most frequently diagnosed cancers worldwide. The admission of patients to hospitals decreased due to the restriction of the Coronavirus disease 2019 (COVID-19) pandemic, especially patients suspected with cancer were delayed in their diagnosis and treatment. With this study, we aimed to investigate whether the Covid-19 pandemic caused a decrease in the number of hepatocellular cancers (HCC) or a delay in its diagnosis. METHODS: The study, which included newly diagnosed HCC patients, was conducted as a retrospective cross sectional study, in a single Turkey medical center. The patients were divided into pre-COVID-19 and post- COVID-19 two-year periods and compared in terms of tumor size, biochemical parameters, clinical and demographic features. RESULTS: A total of 63 HCC patients, 46 (73%) patients before the COVID-19 pandemic and 17 (27%) patients diagnosed during the COVID-19 pandemic were included. Maximum diameter of lesions and serum alpha- fetoprotein levels showed a statistically significant difference between the groups. Maximum tumor size in the pre-COVID-19 period was 4.58±3.77 mm, while in the COVID-19 period was 7.42±6.88 mm, the difference between two groups being statistically significant (p<0.05). HCC in the pre-COVID-19 period were detected mostly at Barcelona Clinic for Liver Cancer (BCLC) stage A (45.7%, n=21), while in the COVID-19 period most of HCC were detected at stage B (35.3%, n=6). CONCLUSIONS: The COVID-19 pandemic limited the access of patients to screening programs for HCC. The significant disruption in screening cirrhotic patients for HCC has led to a delay in diagnosis.

Can neutrophil to lymphocyte ratio be a non-invasive indicator of the presence of duodenal ulcer related Helicobacter pylori in dyspeptic patients?

Background and aims: Neutrophil to lymphocyte ratio (NLR), a novel inflammatory marker, has been shown to increase in various systemic inflammatory conditions. In this way, we want to evaluate the relationship between the presence of H. pylori, duodenal ulcer related H. pylori and NLR in dyspeptic patients. Material and methods: The patients were divided into three groups after evaluating of the EGD and histopathology results. The groups were determined as follow; Group A: H. pylori positive and DU negative, Group B: H. pylori positive and DU positive, Group C: H. pylori negative and DU negative. Then, groups were compared with each other for demographic features, laboratory tests and NLR. Results: There were significant differences between groups for NLR when groups compared with each other. Significantly high NLR was seen in group A (H. pylori positive, DU negative) and group B (H. pylori positive, DU positive) when compared with group C (H. pylori negative, DU negative) (respectively p < 0.042, p < 0.001). Significantly higher NLR was determined in the group B when compared with group A and group C (respectively p < 0.021, p < 0.001). The cut-off value for NLR was 2,17 with a specificity of 61% and sensitivity of 66% for group B comparing with Group C (AUC:0,66). Conclusions: Significantly higher NLR was determined in patients with H. pylori and DU. As a result, NLR may be used as a non-invasive test for documenting the presence of H. pylori and H. pylori related DU.

Endoscopic retrograde cholangiopancreatography-oriented surgery for accomplished treatment of Mirizzi syndrome: a single-center experience.

BACKGROUND: Mirizzi syndrome is a gallstone disease characterized by compression of extrahepatic biliary duct with an impacted stone. Our aim is to identify and describe the incidence, clinical presentation, operative details and the association postoperative complication of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS: The ERCP procedures were held in Gastroenterology Endoscopy Unit and retrospectively evaluated. The patients were divided into two groups, the cholelithiasis + common bile duct (CBD) stone group and the Mirizzi syndrome group. These groups were compared with the demographic characteristics, ERCP procedures, types of Mirizzi syndrome and surgical technique. RESULTS: A total of 1018 consecutive patients who underwent ERCP were scanned retrospectively. Of the 515 patients fulfilling the criteria for ERCP, 12 had Mirizzi syndrome and 503 had cholelithiasis and CBD stones. Half of the Mirizzi syndrome patients were diagnosed with pre-ERCP ultrasonography. The mean diameter of choledoc was found to be 10 mm in ERCP. ERCP-related complication rates (pancreatitis, bleeding and perforation) were the same in the two groups; 66.6% of the Mirizzi syndrome patients applied cholecystectomy and placement of T-tube surgical procedures, and there were no postoperative complications. CONCLUSION: Surgery is the definitive treatment of Mirizzi syndrome. Thus patients should have a correct preoperative diagnosis for an appropriate and safe surgery. We think that ERCP could be the best guide for this. Also, we believe that intraoperative cholangiography with ERCP and hybrid procedures for guiding surgical treatment may become an advanced treatment option in the future.

MONOCYTE/HDL RATIO IN NON-ALCOHOLIC HEPATIC STEATOSIS.

BACKGROUND: Non-alcoholic hepatic steatosis (NAS) is characterized by excess fat accumulation in hepatocytes, causing portal and lobular inflammation and hepatocyte injury. OBJECTIVE: We aimed to evaluate the alterations in monocyte count to high-density lipoprotein cholesterol ratio (MHR) in patients with grade 2 or 3 fatty liver disease and the association of this marker with liver function tests and insulin resistance. METHODS: In this retrospective analysis; patients diagnosed and followed for the grade 2 or 3 fatty liver disease were included in the patient group and the patients who had undergone abdominal ultrasound for any reason and who were not having any fatty liver disease were included in the control group. RESULTS: Totally 409 cases were included in the study. Among participants, 201 were in the control group, and 208 were in the NAS group (111 were having grade 2 and 97 were having grade 3 steatosis). The monocyte/HDL ratio was significantly higher in the NAS group compared with the healthy controls (P=0.001). There was a significant positive correlation between the monocyte/HDL ratio and age (r=0.109; P=0.028), ALT (r=0.123, P=0.014) and HOMA-IR (r=0.325, P=0.001) values. CONCLUSION: In conclusion, the monocyte to high-density lipoprotein ratio significantly increases in fatty liver disease and correlates with insulin resistance. Since it was suggested as a prognostic marker in atherosclerotic diseases, elevated MHR values in fatty liver disease should be evaluated cautiously.

Time to give up traditional methods for the management of gastrointestinal neuroendocrine tumours.

Neuroendocrine tumors (NETs) are a rare and heterogeneous disease group and constitute 0.5% of all malignancies. The annual incidence of NETs is increasing worldwide. The reason for the increase in the incidence of NETs is the detection of benign lesions, incidental detection due to the highest use of endoscopic and imaging procedures, and higher recognition rates of pathologists. There have been exciting developments regarding NET biology in recent years. Among these, first of all, somatostatin receptors and downstream pathways in neuroendocrine cells have been found to be important regulatory mechanisms for protein synthesis, hormone secretion, and proliferation. Subsequently, activation of the mammalian target of rapamycin pathway was found to be an important mechanism in angiogenesis and tumor survival and cell metabolism. Finally, the importance of proangiogenic factors (platelet-derived growth factor, vascular endothelial growth factor, fibroblastic growth factor, angiopoietin, and semaphorins) in the progression of NET has been determined. Using the combination of biomarkers and imaging methods allows early evaluation of the appropriateness of treatment and response to treatment.

Gamma-glutamyl-transferase may predict COVID-19 outcomes in hospitalised patients.

AIM: In this study, we aimed to define the predictive role of liver function tests at admission to the hospital in outcomes of hospitalised patients with COVID-19. MATERIAL AND METHOD: In this multicentric retrospective study, a total of 269 adult patients (≥18 years of age) with confirmed COVID-19 who were hospitalised for the treatment were enrolled. Demographic features, complete medical history and laboratory findings of the study participants at admission were obtained from the medical records. Patients were grouped regarding their intensive care unit (ICU) requirements during their hospitalisation periods. RESULTS: Among all 269 participants, 106 were hospitalised in the ICU and 66 died. The patients hospitalised in ICU were older than patients hospitalised in wards (P = .001) and expired patients were older than alive patients (P = .001). Age, elevated serum D-dimer, creatinine and gamma-glutamyl transferase (GGT) levels at admission were independent factors predicting ICU hospitalisation and mortality in COVID-19 patients. CONCLUSION: In conclusion, in hospitalised patients with COVID-19, laboratory data on admission, including serum, creatinine, GGT and d-dimer levels have an important predictive role for the ICU requirement and mortality. Since these tests are readily available in all hospitals and inexpensive, some predictive formulas may be calculated with these parameters at admission, to define the patients requiring intensive care.

Relação monócito/HDL em esteatose não hepática / Monocyte/hdl ratio in non-alcoholic hepatic steatosis

ABSTRACT BACKGROUND: Non-alcoholic hepatic steatosis (NAS) is characterized by excess fat accumulation in hepatocytes, causing portal and lobular inflammation and hepatocyte injury. OBJECTIVE: We aimed to evaluate the alterations in monocyte count to high-density lipoprotein cholesterol ratio (MHR) in patients with grade 2 or 3 fatty liver disease and the association of this marker with liver function tests and insulin resistance. METHODS: In this retrospective analysis; patients diagnosed and followed for the grade 2 or 3 fatty liver disease were included in the patient group and the patients who had undergone abdominal ultrasound for any reason and who were not having any fatty liver disease were included in the control group. RESULTS: Totally 409 cases were included in the study. Among participants, 201 were in the control group, and 208 were in the NAS group (111 were having grade 2 and 97 were having grade 3 steatosis). The monocyte/HDL ratio was significantly higher in the NAS group compared with the healthy controls (P=0.001). There was a significant positive correlation between the monocyte/HDL ratio and age (r=0.109; P=0.028), ALT (r=0.123, P=0.014) and HOMA-IR (r=0.325, P=0.001) values. CONCLUSION: In conclusion, the monocyte to high-density lipoprotein ratio significantly increases in fatty liver disease and correlates with insulin resistance. Since it was suggested as a prognostic marker in atherosclerotic diseases, elevated MHR values in fatty liver disease should be evaluated cautiously.

RESUMO CONTEXTO: A esteatose não hepática (ENH) é caracterizada pelo acúmulo de gordura nos hepatócitos, causando inflamação portal e lobular e lesões ao hepatócito. OBJETIVO: Avaliar as alterações na contagem de monócitos em relação à proporção de lipoproteína de colesterol de alta densidade (MHR) em doentes com doença hepática gordurosa de grau 2 ou 3 e a associação deste marcador com testes de função hepática e de resistência à insulina. MÉTODOS: Nesta análise retrospectiva os pacientes diagnosticados e seguidos para a doença hepática gordurosa de grau 2 ou 3, foram incluídos no grupo de doentes e os indivíduos que tinham sido submetidos a ecografia abdominal por qualquer motivo e que não tinham qualquer doença hepática gordurosa foram incluídos no de controle. RESULTADOS: Foram incluídos 409 pacientes no estudo. Entre os participantes, 201 estavam no grupo controle e 208 estavam no grupo ENH (111 caracterizados como grau 2 e 97 com esteatose de grau 3). A relação monócito/HDL foi significativamente maior no grupo ENH em comparação com os controles saudáveis (P=0,001). Verificou-se correlação positiva significativa entre a relação monócitos/HDL e a idade (r=0,109; P=0,028), e valores de ALT (r=0,123; P=0,014) e HOMA-IR (r=0,325; P=0,001). CONCLUSÃO: A razão entre monócitos e a lipoproteína de alta densidade aumenta significativamente na doença hepática gordurosa e correlaciona-se com a resistência à insulina. Uma vez que foi sugerido como um marcador prognóstico em doenças ateroscleróticas, os valores elevados de MHR na doença hepática gordurosa devem ser avaliados com cautela.

Serum chitotriosidase and YKL-40 in acute pancreatitis: Reliability as prognostic marker for disease severity and correlation with inflammatory markers

Background/aim: Chitotriosidase and YKL-40, also called chitinase 3-like protein 1, are homologs of family 18 glycosyl hydrolases, secreted by human macrophages and granulocytes under inflammatory conditions. Although increased levels of chitotriosidase and YKL-40 are linked with several inflammatory diseases, the physiological utility of these two enzymes is still not fully characterized. This study aims to analyse the serum YKL-40 and chitotriosidase levels of acute pancreatitis patients to assess whether their activity correlates with acute pancreatitis and its severity. Materials and methods: Chitotriosidase and YKL-40 levels, along with routine laboratory parameters, were determined from the serum samples of 41 acute pancreatitis patients, at both onset and remission (male/female: 22/19), and 39 healthy subjects (male/female: 19/20). The Modified Glasgow Prognostic Score was used to predict the severity of the disease, and a correlation analysis was performed between study variables. Results: A statistically significant increase in both chitotriosidase and YKL-40 levels was observed in acute pancreatitis patients compared to healthy controls (P < 0.001). Higher levels of YKL-40, chitotriosidase and C-reactive protein were found in patients with acute pancreatitis at onset than in remission. The correlation analysis showed a statistically significant association between YKL-40 and chitotriosidase (p = 0.039, r = 0.323). The cut-off point for YKL-40, for detecting acute pancreatitis, was 60.3 with a sensitivity and specificity of 84.9% and 84.6% (AUC: 0.890). The optimum cut-off points for chitotriosidase, for detecting acute pancreatitis, was 33.5 with a sensitivity and specificity of 79.5% and 78.4% (AUC: 0.899). Conclusion: Elevated YKL-40 and chitotriosidase levels in acute pancreatitis patients demonstrate the importance of possible macrophage involvement in the pancreatic microenvironment during acute pancreatitis progression.

Long-term proton pump inhibitor use is a risk factor for mortality in patients hospitalized for COVID-19

Background and aim: The aim of this study is to evaluate whether the long-term (≥4 weeks) use of proton pump inhibitors (PPIs) is a risk factor for intubation requirement and mortality in patients hospitalized for COVID-19. Materials and methods: In this multicentric retrospective study, a total of 382 adult patients (≥18 years of age) with confirmed COVID-19 who were hospitalized for treatment were enrolled. The patients were divided into two groups according to the periods during which they used PPIs: the first group included patients who were not on PPI treatment, and the second group included those who have used PPIs for more than 4 weeks. Results: The study participants were grouped according to their PPI usage history over the last 6 months. In total, 291 patients did not use any type of PPI over the last 6 months, and 91 patients used PPIs for more than 4 weeks. Older age (HR: 1.047, 95% CI: 1.026­1.068), current smoking (HR: 2.590, 95% CI: 1.334­5.025), and PPI therapy for more than 4 weeks (HR: 1.83, 95% CI: 1.06­2.41) were found to be independent risk factors for mortality. Conclusion: The results obtained in this study show that using PPIs for more than 4 weeks is associated with negative outcomes for patients with COVID-19. Patients receiving PPI therapy should be evaluated more carefully if they are hospitalized for COVID-19 treatment.

Social stigmatization in Turkish patients with chronic hepatitis B and C / Estigmatización social en pacientes turcos con hepatitis crónica B y C

Background and aim: Viral hepatitis is the most important cause of chronic hepatitis worldwide. Stigmatization is defined as a feeling of rejection and isolation of patients by society due to illness. There are no studies on chronic viral hepatitis in the literature in English, which has its own religious and socio-cultural structure. In our study, we aimed to investigate the presence of social stigmatism and psychosocial effects on patients with different stages of chronic viral hepatitis B and C. Methods: Forty-five patients with chronic hepatitis C and 114 patients with chronic hepatitis B were enrolled in the study. Berger's scale was used for stigmatization, composed of 40 four-point Likert items that have four subscales: personalized stigma, disclosure, negative self-image, and public attitude. Stigma score ranges between one and four. Stigma is accepted as present if the overall score is above two. Results: Overall the mean stigma scores were 1.97±0.58 and 2.14±0.57 for chronic hepatitis B and C, respectively. There was stigma in 47.4% of the patients with chronic hepatitis B, and 60% of the patients with chronic hepatitis C. Being male was the risk factor on overall stigma, disclosure and public attitude in chronic hepatitis C. Living in an urban setting was the risk factor on negative self-image in chronic hepatitis C and on personalized stigma and disclosure in chronic hepatitis B. Conclusions: To the best of our knowledge, this is the first study that provides qualitative information about chronic hepatitis-related stigma. Stigmatization is a major problem in Turkey and worldwide. We believe that increasing the knowledge of the patients and society by teaching about the transmission routes of the disease and focusing on vaccination studies will prevent stigmatization.(AU)

Antecedentes y objetivo: La hepatitis viral es la causa más importante de hepatitis crónica en todo el mundo. La estigmatización se define como un sentimiento de rechazo y aislamiento de los pacientes, por parte de la sociedad debido a su enfermedad. No hay estudios sobre la hepatitis viral crónica en la literatura inglesa, que tiene su propia estructura religiosa y sociocultural. En nuestro estudio, nos propusimos investigar la presencia del estigma social y los efectos psicosociales en los pacientes con diferentes fases de hepatitis viral crónica B y C. Métodos: Se incluyó en el estudio a 45 pacientes con hepatitis crónica C y 114 pacientes con hepatitis crónica B. Se utilizó la escala de Berger para la estigmatización, compuesta por 40 ítems Likert de cuatro puntos, con cuatro subescalas cada uno: estigma personalizado, revelación, imagen negativa de sí mismo y actitud pública. La puntuación del estigma oscila entre uno y cuatro. El estigma se acepta como presente si la puntuación general es superior a dos. Resultados: En general, la media de las puntuaciones de estigmatización fue de 1,97 ± 0,58 y 2,14 ± 0,57 para la hepatitis crónica B y C, respectivamente. El 47,4% de los pacientes con hepatitis crónica B y el 60% de los pacientes con hepatitis crónica C sufrieron estigmatización. El hecho de ser varón fue el factor de riesgo del estigma general, la revelación y la actitud pública en la hepatitis crónica C. Vivir en un entorno urbano fue el factor de riesgo de la imagen negativa de sí mismo en la hepatitis crónica C y el estigma personalizado y la revelación en la hepatitis crónica B. Conclusiones: Hasta donde sabemos, este es el primer estudio que proporciona información cualitativa sobre el estigma relacionado con la hepatitis crónica. La estigmatización es un problema importante en Turquía y en todo el mundo...(AU)

Social stigmatization in Turkish patients with chronic hepatitis B and C.

BACKGROUND AND AIM: Viral hepatitis is the most important cause of chronic hepatitis worldwide. Stigmatization is defined as a feeling of rejection and isolation of patients by society due to illness. There are no studies on chronic viral hepatitis in the literature in English, which has its own religious and socio-cultural structure. In our study, we aimed to investigate the presence of social stigmatism and psychosocial effects on patients with different stages of chronic viral hepatitis B and C. METHODS: Forty-five patients with chronic hepatitis C and 114 patients with chronic hepatitis B were enrolled in the study. Berger's scale was used for stigmatization, composed of 40 four-point Likert items that have four subscales: personalized stigma, disclosure, negative self-image, and public attitude. Stigma score ranges between one and four. Stigma is accepted as present if the overall score is above two. RESULTS: Overall the mean stigma scores were 1.97±0.58 and 2.14±0.57 for chronic hepatitis B and C, respectively. There was stigma in 47.4% of the patients with chronic hepatitis B, and 60% of the patients with chronic hepatitis C. Being male was the risk factor on overall stigma, disclosure and public attitude in chronic hepatitis C. Living in an urban setting was the risk factor on negative self-image in chronic hepatitis C and on personalized stigma and disclosure in chronic hepatitis B. CONCLUSIONS: To the best of our knowledge, this is the first study that provides qualitative information about chronic hepatitis-related stigma. Stigmatization is a major problem in Turkey and worldwide. We believe that increasing the knowledge of the patients and society by teaching about the transmission routes of the disease and focusing on vaccination studies will prevent stigmatization.

Relationship between helicobacter pylori infection and pityriasis versicolor: can helicobacter pylori infection be a new etiologic factor for pityriasis versicolor?

Background/aim: H. pylori has been found to be related to certain dermatological diseases. However, there is no data as yet to propose an association between H. pylori and pityriasis versicolor. In this study, we aimed to evaluate the association between H. pylori and pityriasis versicolor. Materials and methods: This was a prospective study performed in the Gastroenterology and Dermatology and Venereology departments of the Health Sciences University, Ankara Training and Research Centre. A total of 57 consecutive patients (27 pityriasis versicolor, 30 telogen effluvium) were enrolled from the Department of Dermatology and Venereology. All patients were screened for H. pylori IgG and CagA. In addition, urea breath test was carried out to detect the existence of H. pylori infection. Results: There were significantly higher rates of H. pylori positivity, H. pylori IgG in serum in the pityriasis versicolor group compared to the telogen effluvium group (P < 0.05). In addition, the number of patients with dyspeptic complaints was higher in the pityriasis versicolor group than in the telogen effluvium group. The odds ratio for dyspepsia, H. pylori positivity, and H. pylori IgG were 2.48, 1.67, and 1.78, respectively. Conclusion: In this study, we found a statistically significant relationship between H. pylori infection and pityriasis versicolor. Therefore, H. pylori eradication could be considered in recurrent pityriasis versicolor patients with dyspepsia. New studies are required to clarify the effect of eradication treatment on the clinical course of pityriasis versicolor.

The use of prealbumin as a predictor of malnutrition in cirrhotic patients and the effect of nutritional support in patients with low prealbumin levels

Background/aim: Malnutrition is an important and commonly seen prognostic factor in patients with cirrhosis. The diagnosis of malnutrition in cirrhosis patients may be challenging, and an easily measured and widely usable marker is lacking. Prealbumin, however, is an easily measured marker. In the current study we measured prealbumin levels in cirrhotic patients with no clinically apparent malnutrition and used it as a malnutrition marker. Another aim of this study was to evaluate the effect of nutritional support on patient with low prealbumin levels. Materials and methods: Fifty-two patients with Child A and Child B cirrhosis were selected for the study. Prealbumin levels were studied, and Child and MELD scores were calculated. Patients with prealbumin levels ˂180 mg/L were considered to have malnutrition, and two different types of nutritional products were given to these patients. The patients given nutritional support were investigated a month later, and parameters were compared. Results: According to the prealbumin threshold of 180 mg/L, malnutrition frequencies were 59.3% for Child A and 95% for Child B cirrhosis. After the provision of nutritional support statistically significant improvements in albumin and INR levels were detected. In addition, the MELD score decreased; however, it was not statistically significant (P: 0.088). A statistically significant decrease in the MELD score was only obtained in patients with Child B cirrhosis (P: 0.033). When the oral replacement therapies were investigated separately, a statistically significant decrease in MELD scores was detected with product 1 (P: 0.043). Conclusion: Prealbumin can be used as an easily measured parameter for earlier detection of malnutrition in patients with cirrhosis and without clinically apparent malnutrition. Oral nutritional support, especially with products containing relatively high carbohydrate levels and low protein, may have a favorable effect on MELD scores.

Effect of sevoflurane anaesthesia on nasal mask in endoscopic retrograde cholangiopancreatography: is it a preferred alternative?

Background/aim: Endoscopic retrograde cholangiopancreatography (ERCP) often requires deep sedation. Propofol provides adequate sedation and amnesia at subhypnotic doses, but safe guarding the patient's airway is important for preventing respiratory depression or hypoxic events. This study compared sedation levels, operator satisfaction, intraoperative and recovery characteristics using sevoflurane with nasal mask and propofol in ERCP. Material and methods: Sixty-one patients underwent ERCP (Group I: propofol, n = 31; Group II, sevoflurane, n = 30), with sedation controlled by the Ramsay sedation scale (RSS). The patients' demographic data, procedure length, overall drug dose, hemodynamic changes, duration of recovery and Aldrete scores during recovery were evaluated. In addition, satisfaction of the gastroenterologist was evaluated. Results: The mean sphincterotomy satisfaction scores were statistically significant (P= 0.043). The Aldrete scores and RSS of the groups were similar; there was a significant difference between groups at the beginning of the procedure regarding peripheric oxygen saturations and Group II's saturation levels increased during sedation. Conclusion: In ERCP, propofol infusion provides shorter recovery duration and adequate sedation levels. Sevoflurane and oxygen with a nasal mask can be chosen to generate specific anaesthesia in patients, especially for strong airway support and safety treating hypoxemic patients.

Midkine level may be used as a noninvasive biomarker in Crohn's disease

Background/aim: Crohn's disease (CD) is a kind of inflammatory bowel disease. Midkine (MDK) is an endogenous inflammatory marker. We aimed to investigate the relationship between MDK levels and inflammation and hence determine whether MDK can be used as a noninvasive biomarker in active CD. Materials and methods: Sixty-five consecutive patients over the age of 18 with CD and 36 healthy controls were included in this study. CD patients' venous blood samples were taken before treatment. Serum MDK levels were determined in human plasma samples by enzyme-linked immunosorbent assay (ELISA) method. Results: The mean age of the study patients was 44.8 ± 12.5 years, 35 patients were female, and 30 were male. Of these 65 patients, 37 had active CD and 28 were in the remission phase. MDK levels were significantly higher in active and remission CD than in healthy controls (P = 0.01, P = 0.038, respectively). Conclusion: e report that there is an association between MDK levels and CD activation, and therefore with enhanced inflammation. MDK levels were significantly correlated with inflammatory indices. In line with our findings, we suggest the theory that MDK inhibitors may be useful in treating Crohn's disease.