Being a Female Gastroenterologist in Turkey.

BACKGROUND/AIMS: Our aim is to examine the representation of woman gastroenterologists in both work and social life in Turkey and to elucidate the difficulties they encounter during their career pathways or while actively practicing their profession. MATERIALS AND METHODS: A self-structured survey consisting of 25 questions was sent via email to all 152 female gastroenterologists. Survey results were received from 140 participants. RESULTS: Sixty percent of the woman gastroenterologists had marriage-career conflicts, and 74% of them stated that they could not manage work-life balance with their children. Among these woman gastroenterologists, 46.6% of them reported that they had faced carrier-related barriers and challenges while applying for an academic rise or expecting a promotion in their job, 58.5% were exposed to gender mobbing, and 35.6% were subjected to verbal or physical violence. On the other hand, woman gastroenterologists are found to be underrepresented in endoscopic interventions where only one-third of the participants perform invasive endoscopic procedures, and the percentage of those who perform advanced endoscopy such as endoscopic submucosal dissection and endoscopic mucosal resection remains even less as 8.9%. The number of women in leadership positions during their careers is found to be low, and only 2 women were selected as the president of the society since 1959, the establishment time of the Turkish Society of Gastroenterology. CONCLUSION: More effort is needed to keep a fair gender balance in Turkish gastroenterology society and to increase the women's representation in therapeutic endoscopy options and also in leadership positions.

Anxiety and Stress Levels Associated With COVID-19 Pandemic of University Students in Turkey: A Year After the Pandemic.

The outbreak of COVID-19 has been affecting the daily lives of almost everyone and puts huge psychological pressure on people worldwide, including Turkey. Anxiety and stress levels among university students were already a public health concern. Our study aims to demonstrate the anxiety and stress levels of university students in Turkey after the outbreak of COVID-19 according to the Coronavirus Anxiety Scale (CAS) and COVID Stress Scale (CSS). CAS is a brief mental health screener to identify probable cases of dysfunctional anxiety associated with the COVID-19 pandemic, and CSS was developed to understand and assess COVID-19-related distress. An online questionnaire was administered to active 1,265 university students in Turkey between February 27 and March 8, 2021, via Google forms. The questionnaire consists of three parts that assess participants' demographic information, anxiety, and stress levels related to the pandemic. According to CAS and CSS analysis, anxiety and stress levels were associated with each other and influenced university students during the COVID-19 pandemic. Both were associated with gender and family member loss. The academic year of students had a relationship with anxiety. It was observed that the danger factor was the highest stressor in university students in Turkey related to the novel coronavirus, followed by contamination fears. Both factors were shown as moderate stressors. As a result of the study, it was revealed that anxiety and stress associated with the COVID-19 pandemic are now included in the social, academic, and physical burdens of the university years, which are decisive and important in terms of mental development and psychological health of the person. It is essential to ascertain the long-term effects of COVID-19 and take effective precautions to support the physical and mental health of today's university students accordingly.

A Comparative Study Evaluating the Incidence of Colorectal Neoplasia(s) in Candidates for Bariatric Surgery by Screening Colonoscopy, 40-49 Versus 50-65 Years Old: a Preliminary Study.

INTRODUCTION: Obesity and metabolic syndrome (MetS) are associated with colorectal neoplasia (CRN) and carcinoma (CRC). Whether such subjects must undergo screening colonoscopy (SC) earlier, is unknown. Incidences of CRNs in 40-49- versus 50-65-year-old bariatric patients were compared by SC. No prospective data on SC is available in morbidly obese/MetS. MATERIAL AND METHODS: Surgical weight loss candidates over 39 years of age, asymptomatic, and average-risk for CRC offered SC. Those giving written informed consent were enrolled. Colonoscopies were done by the same surgeon. Smoking/drinking history, fasting blood glucose (FBG), insulin, C-peptide, triglyceride, high density lipoprotein, vitamin D, HbA1c, and insulin resistance parameters were recorded. CRN rate and the distribution of variables in patients 40-49 years of age were compared with 50-65. Student's t and Chi-square tests were used as appropriate. P < 0.05 was regarded as statistically significant. RESULTS: Among 168 SCs, 47 had CRNs (27.9%). Including carcinoma, 15 had an advanced CRN (aCRN) (8.9% aCRN and 0.6% CRC). CRN rate was 35.6% in ≥ 50 years old whereas 22.1% in 40-49 (p = 0.053). aCRN rates (8.4% in 40-49 versus 9.6% in 50-65) were similar (p = 0.792). Metabolic parameters and smoking-drinking history were equally distributed between the groups except FBG and HbA1c as their mean levels were slightly higher in the 50-65 age group (p < 0.05). CONCLUSIONS: Presented results warrant routine SC in the 40-49-year-old morbidly obese and/or MetS patient population with average risk, and in aged > 50, it certainly must be enforced and included in the preoperative check-list if not done before.

Validity and reliability of the measure yourself medical outcome profile 2 (MYMOP2) questionnaire among Turkish patients having anorectal disorders.

BACKGROUND/AIMS: Measure Yourself Medical Outcome Profile 2 (MYMOP2) is a patient-generated outcome measure allowing patients to select the problems that are the most important to them and that they want to address, and it measures the effects of the problem from a wide range of health care interventions. This study aimed to translate the questionnaire into Turkish language (Turkish MYMOP-TMYMOP) and add this clinically useful measure to Turkish medical practice by assessing its validity and reliability. MATERIALS AND METHODS: Fifty volunteers with anorectal disorders were prospectively included into the study. Each patient was enrolled into a pelvic floor training biofeedback program, specific to their anorectal symptomatology. The subjects were administered both the Nottingham Health Profile and the TMYMOP2 questionnaires before the treatment session (initial visit) and at the control follow-up visits (the first and second months, via e-mail or telephone calls). RESULTS: The TMYMOP2 questionnaire was shown to be moderately valid (the Pearson correlation coefficient score between the total scores of the subgroups of the two questionnaires were 0.335 and 0.642, respectively, p<0.05) and highly reliable (the Cronbach's alfa coefficient score between the total scores of the subgroups of the two questionnaires were 0.77, 0.82, and 0.88 in the beginning and at the first and second month follow-up visits, respectively). CONCLUSION: The TMYMOP2 was shown to be a low-to-moderately valid and a highly reliable scale. Because it is brief and short to complete, it might be an important and free-to-use tool to measure the diseases, and it can enhance the patient-centered care within the Turkish health care context.

Analyzing esophageal squamous cell papillomas for the presence of human papilloma virüs.

BACKGROUND/AIMS: Human Papilloma Virus (HPV) infection can be a predisposing condition for the development of squamous cell papilloma (SCP) of the esophagus, which can progress to dysplasia and to carcinoma as a result of chronic infection. The aim of the present study was to search for the presence of HPV in the esophageal SCP, and to genotype the detected HPV. MATERIALS AND METHODS: Data from patients with definite diagnosis of SCP of the esophagus were identified from pathology records for two years period at different Hospitals. Slides from each patient were reviewed and samples with satisfactory papilloma tissues were submitted to molecular analysis. DNA has been isolated. DNA sequencing has been performed for genotyping HPV for all types. RESULTS: Our study group consisted of 21 women and 17 men (a total of 38 patients), mean age was 41 years (range 17-67 years). Most of the papillomas were located at mid-esophagus (68%). Eight out of 38 patients (21%) had associated erosive esophagitis, and fourteen patients (36.8%) had Helicobacter Pylori (H. pylori). Of the 38 SCP analyzed, seven (19%) were positive for HPV DNA. Three of them were of genotype 6, whereas four were of genotype 16, 18, 31, 81 that are known as highly oncogenic. There were no correlations between the presence of HPV and the patient's age, the presence of reflux esophagitis or H. pylori, smoking habit and the location of the papillomas. CONCLUSION: The presence of high-risk type HPV in esophageal SCP may implicate a role of the virus in the pathogenesis of the esophageal tumor.

Ki67 as a prognostic factor for long-term outcome following surgery in gastrointestinal stromal tumors.

OBJECTIVE: This study aimed to examine the value of Ki67 expression along with other potential prognostic factors for predicting overall survival and disease-free survival in patients with gastrointestinal stromal tumors who underwent curative resection. PATIENTS AND METHODS: Sixty-eight histologically confirmed and operated patients with gastrointestinal stromal tumors were included. Clinical and follow-up data were retrieved from medical records and patients were contacted at the end of the study. The effects of certain clinical and histopathological parameters on survival outcomes were examined. RESULTS: Sixty-eight patients were followed for a mean duration of follow-up of 2923.3 patient-months. Twelve deaths (17.6%), seven metastasis (10.3%), and two local recurrences (2.9%) occurred. Overall survival was 102.5 months [95% confidence interval (CI), 88.3-116.8] and disease-free survival was 91.8 months (95% CI, 76.5-107.2). Multivariate analyses identified a high Ki67 index (≥ 10%) as an independent predictor of both poor overall survival (hazard ratio, 4.8; 95% CI 1.2-19.2; P=0.027) and poor disease-free survival (hazard ratio, 15.3; 95% CI, 4.7-50.2). CONCLUSION: A high Ki67 expression seems to be a useful prognostic factor that would aid in predicting disease course in gastrointestinal stromal tumors. These findings deserve further investigation in larger studies.

A rare cause of Fatty liver and elevated aminotransferase levels: chanarin-dorfman syndrome: a case report.

Chanarin-Dorfman syndrome is a rare, inherited metabolic disorder of neutral lipid storage characterized by ichthyosis, lipid vacuoles in leukocytes, and involvement of several internal organs, mostly the liver. Since the initial case was reported by Dorfman in 1974, nearly 50 cases have been reported, and the majority were from Middle East countries. Here, we report a 20-year-old patient with ichthyosis from Turkey, diagnosed as Chanarin-Dorfman syndrome presented with asypmtomatic elevated transaminases and hepatosteatosis, and also briefly review the updated clinical implications and management of this rarely seen syndrome. Prompt diagnosis of this syndrome avoids further unnecessary investigations in patients with ichthyosis.

Anti-pancreatic antibody in Turkish patients with inflammatory bowel disease and first-degree relatives.

AIM: To identify the role of anti-pancreatic antibody (PAB) in the diagnosis of inflammatory bowel diseases (IBD) among Turkish patients, and its frequency in first-degree relatives. METHODS: PAB and anti-Saccharomyces cerevisiae (ASCA) were examined in serum samples of 214 subjects including patients with Crohn's disease (CD, n = 64), ulcerative colitis (UC, n = 63), first-degree relatives of patients with CD (n = 25), first-degree relatives of patients with UC (n = 28),and a control group with gastrointestinal symptoms other than (IBD) (n = 34) by indirect immunofluorescence Positivity of PAB and ASCA was compared in terms of Vienna classification, disease activity and medications used. RESULTS: In terms of PAB positivity, no difference was found between patients with CD (14.1%) and UC (7.9%) however, significant difference was observed between patients with CD and subjects in the control group (P < 0.05). No difference was found between patients with CD and their relatives in terms of ASCA positivity, whereas a significant difference was found between other groups (P < 0.001). Compared to ASCA, the sensitivity of the PAB was 19% (7/37), its specificity was 93% (25/27), positive predictive value was 77% (7/9) and negative predictive value was 45% (25/55). ASCA was found with significantly higher prevalence in patients with CD activity index > 150 (P < 0.05). CONCLUSION: PAB is valuable in the diagnosis of IBD rather than CD, but cannot be used alone for diagnostic purposes. PAB is not superior to ASCA in CD diagnosis and in detecting CD among relatives of patients with CD.

Association of gluten enteropathy and irritable bowel syndrome in adult Turkish population.

PURPOSE: Irritable bowel syndrome is generally diagnosed according to the symptoms of the patient, and gluten enteropathy can also be presented with similar symptoms (diarrhea and/or constipation) of irritable bowel syndrome. Aimed to assess the association and the frequency of gluten enteropathy in a group of Turkish patients diagnosed as irritable bowel syndrome. RESULTS: Found anti-gliadin IgA positivity only in four patients among patients with irritable bowel syndrome. However, none of these four patients had anti-endomycium positivity or any histopathological findings specific for gluten enteropathy. All these four patients had normal histology in their small bowel biopsies. CONCLUSION: Irritable bowel syndrome is a common problem in the population, but gluten enteropathy is not associated with the vast majority of subjects with irritable bowel syndrome as expected. The need for screening gluten enteropathy among these patients is still unclear, and screening with serology only without small bowel biopsy may lead to false positive results.

Paraneoplastic porphyria cutanea tarda associated with cholangiocarcinoma: case report.

The porphyrias are a group of disorders of the heme biosynthesis pathway that present with acute neurovisceral symptoms, skin lesions or both. Porphyria cutanea tarda, presenting as a non-acute form, is the most common type of porphyria that encompasses a group of related disorders, all of which arise from deficient activity of the heme synthetic enzyme, uroporphyrinogen decarboxylase, in the liver. In the literature, concomitant presentation of porphyria with hepatocellular carcinoma is common; however, no case of porphyria cutanea tarda associated with cholangiocarcinoma has been seen. Here, we present a case of porphyria cutanea tarda seen in the course of cholangiocarcinoma, which can be attributed to a paraneoplastic syndrome. Our case is of interest because of its rarity. We also give a brief review of the literature regarding porphyria and cholangiocarcinoma.

Distribution of gastric lymphoid follicles in Helicobacter pylori-associated gastritis.

BACKGROUND/AIMS: Lymphoid follicles and the satellite lesions (intestinal metaplasia, atrophy and dysplasia) are known as precursor lesions of mucosa associated lymphoid tissue lymphomas in gastritis. Little is known about their prevalence in different distributions and types of Helicobacter pylori-associated gastritis. The aim of the study was to estimate the topographic prevalence of these lesions in gastritis related with Helicobacter pylori and to associate them with the density of bacteria. METHODOLOGY: Histology for the type of gastritis and for lymphoid follicles and Helicobacter pylori density were studied in antrum and/or corpus biopsies taken from 107 consecutive patients with clinical diagnosis of peptic ulcer. RESULTS: Lymphoid follicles, panmucosal and superficial gastritis were seen in 31 (31.9%), 84 (86.6%) and 13 (13.4%) out of 97 antrum biopsies, respectively. In the corresponding 28 corpus biopsies, these lesions were seen in 8 (28%), 15 (54%), 13 (46%), respectively. Lymphoid follicles were found more in panmucosal than superficial gastritis in the antrum, however in the same ratios in the corpus. In association with lymphoid follicles, Helicobacterpylori was positive in 7 (87%) of 8 corpus biopsies and in all (100%) of 31 antrum biopsies. No relation was observed between lymphoid follicles and Helicobacter pylori density. CONCLUSIONS: Examination of antrum biopsies rather than corpus biopsies would be sufficient to screen precarcinogenic lymphoid follicles in Helicobacterpylori associated gastritis.

Very high alpha-fetoprotein in a young man due to concomitant presentation of hepatocellular carcinoma and Sertoli cell testis tumor.

Studies reported that there is a close relationship between hepatocellular carcinoma (HCC) and testis carcinoma. Both tumors can be presented as synchronal tumors, or as testicular metastases of HCC or as hepatic metastases of testicular tumor( [7] ). HCC is one of the most common malignancies worldwide and the incidence of HCC increases with age( [8] ). The relationship between hepatitis B incidence and HCC rates is also well recognized. Alpha fetoprotein (AFP) is produced by 70% of HCC. Though a level of AFP >400 ng/mL is diagnostic for HCC, in the presence of active hepatitis B infection, the cut-off level should be considered to be at least 1 000-4 000 ng/mL. Like HCC, germ cell tumors of the testis also release AFP; but it is shown that some of Sertoli cell tumors of testis can also release AFP( [10] ). Herein we have reported about the first case of HCC in the literature which is presented concomitantly with Sertoli-Leydig tumor of testis, leading to extremely high level of AFP in a 21-year-old man.