Effect of physician-provided education on the quality of bowel preparation.

BACKGROUND AND STUDY AIMS: Inadequate bowel preparation in patients scheduled for colonoscopy is an important problem. In our study, we aimed to investigate the effect of physician-provided bowel preparation education on the quality of bowel preparation and process. PATIENTS AND METHODS: A total of 150 outpatients who were referred to Kocaeli University Medical Faculty Hospital Gastroenterology Unit for colonoscopy between May 2019 and October 2019 were enrolled in our prospective, endoscopist-blinded study. Patients were divided into two groups. Group 1 (education group) included 73 patients who received 10 minutes of verbal information from a physician in addition to a written information form. Group 2 (control group) included 75 patients who received information from a medical secretary in addition to a written information form. During colonoscopy, the quality of bowel preparation was assessed using the Boston bowel preparation scale (BBPS). A BBPS score = 5 was considered adequate bowel preparation. The mean BBPS score, polyp detection rate, cecal intubation rate and time, and procedure time were also evaluated. RESULTS: The rate of adequate bowel preparation (BBPS score = 5) was 90.4% and 74.7% in groups 1 and 2, respectively (p = 0.021). The odds ratio for having a BBPS score = 5 in the education group was 3.199 compared with the control group (95% confidence interval = 1.254-8.164; p = 0.015). The cecal intubation rates were 91.8% and 88% in groups 1 and 2, respectively (p > 0.05). The cecal intubation time, procedure time, and adenoma detection rates were similar between the groups. The relationships of age, education level, sex, diabetes mellitus, medicine use, procedure time, and intraabdominal surgery with inadequate bowel preparation were analysed using a logistic regression model. Univariate and multivariate analyses revealed no significant factors associated with inadequate bowel preparation. CONCLUSIONS: Patient education on the bowel preparation process via a physician improved the quality of bowel preparation.

The relationship between neutrophil/lymphocyte and platelet/lymphocyte ratios with oxidative stress in active Crohn's disease patients.

BACKGROUND: This study investigated the relationship between the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) values with oxidative stress in active Crohn's disease (CD) patients. We investigated whether these parameters were useful for follow-up assessments of CD activity. METHODS: Forty-nine patients with a confirmed diagnosis of CD (24 active and 25 inactive) and 38 control subjects were enrolled in the study. We measured serum activity of superoxide dismutase (SOD) using an enzyme-linked immunosorbent assay (ELISA) and malondialdehyde (MDA) levels using a spectrophotometric method. Neutrophil, lymphocyte and platelet counts were recorded, and the NLR and PLR values were calculated from these parameters. RESULTS: Patients with active CD exhibited significantly higher serum levels of MDA (p =0.007), NLR (p =0.034), and PLR (p =0.026) than inactive CD patients. Receiver operating characteristic (ROC) curve analysis demonstrated that the optimum cut-off values of MDA, NLR, and PLR based on the differences between active and inactive patients were 0.14 µmol/L, 2.58, and 192.26, respectively. The NLR value increased in active patients with elevated MDA levels as a dependent variable (B: 0.422, p =0.029). CONCLUSIONS: We suggest the use of MDA, PLR, and NLR values as a noninvasive test to evaluate disease activity in CD patients. NLR values may also reflect the presence of oxidative stress, and this value may be efficient and useful in determining CD activity. Hippokratia 2016, 20(4): 268-273.

A new technique for endoscopic treatment of gastric phytobezoars: fragmentation using guidewire.

BACKGROUND AND STUDY AIMS: Bezoars result from accumulation of indigestible materials in the gastrointestinal tract and often occur in the stomach. In this study, we evaluated the use of guidewires in patients with gastric phytobezoars (PBs) as a new method for PB removal and examined the safety of the procedure. PATIENTS AND METHODS: Between February 2009 and January 2013, we analyzed data from 11 patients with gastric PBs. We fitted a transparent cap to a standard endoscope (EG450WR5, Fujinon), and a 0.025 inch guidewire was passed through the standart endoscope. PBs were surrounded by a loop in the guidewire and destroyed. After 2 weeks of treatment, patients were re-evaluated for effectiveness. RESULTS: PB fragmentation time was 5-11 minutes. In five patients with a history of gastric surgery, we needed an additional 16-28 minutes for removal of the fragments. In six patients additionally treated with enzymatic degradation after the breaking procedure, PBs completely disappeared within 2 weeks. There were no complications during the procedure. CONCLUSIONS: The guidewire and fragmentation procedure for PBs is an efficient and reliable method. When combined with enzymatic degradation, PBs can be managed quickly and effectively.

Successful treatment of myelodysplastic syndrome-induced pyoderma gangrenosum.

We report successful treatment of a refractory myelodysplastic syndrome-associated pyoderma gangrenosum with the combination of thalidomide and interferon-alpha2a in a single patient. A non-healing wound developed on a 40-year-old woman's left thumb after minor trauma. Massive ulcerovegetative lesions developed after reconstruction surgery. Histopathological examination of the bone marrow and cytogenetic studies revealed an atypical myeloproliferative/myelodysplastic syndrome. The skin lesions resolved dramatically after two months of thalidomide and interferon-alpha2a combination therapy and the haematological status improved.