A retrospective study of pregnant patients with acute pancreatitis.

OBJECTIVE: Acute pancreatitis is a rare disease in pregnant patients. Although it may have serious maternal and fetal consequences, morbidity and mortality rates have decreased recently due to appropriate and rapid treatment with earlier diagnosis. The aim of this study was to evaluate pregnant patients diagnosed with acute pancreatitis. METHODS: The study included pregnant patients diagnosed with acute pancreatitis who were admitted to Adana City Training and Research Hospital in Adana, Turkey, between January 2014 and January 2022. Patients' files were screened. Patients' demographics, acute pancreatitis etiology, severity, complications, and applied treatment, as well as maternal and fetal outcomes were evaluated. RESULTS: The study included 65 pregnant patients with acute pancreatitis. The mean age was 26.6±5 (19-41) years. Acute pancreatitis was observed in the third trimester. The most common cause of acute pancreatitis was gallstones, and its severity was often mild. Only two patients required endoscopic retrograde cholangiopancreatography, and the remaining patients were treated medically. Maternal and infant death developed in a patient with necrotizing acute pancreatitis secondary to hyperlipidemia. CONCLUSION: The most common etiology of acute pancreatitis in pregnancy was gallstones. Acute pancreatitis occurred in the third trimester. Most of the patients had mild acute pancreatitis. Maternal and fetal complications were rare. We think that the reasons for the low mortality rate were mild disease severity and biliary etiology, and most patients were in the third trimester, as well as early diagnosis and no delay in the intervention.

Predictors of 30-day mortality in patients diagnosed with hepatic encephalopathy on admission to the emergency department.

BACKGROUND: The aim of this study is to compare the laboratory findings and disease severity scores of patients diagnosed with hepatic encephalopathy (HE) in the emergency department (ED) to predict 30-day mortality. METHOD: The patients over 18 years old and diagnosed HE in the ED of a tertiary hospital were included in the study. Demographic and clinical characteristics, laboratory parameters, predisposing causes and outcomes of the patients included in the study were recorded in the data form. Severity of liver disease was assessed by Child Pugh Score (CPS), End-stage liver disease model (MELD), MELD-Na and MELD-Lactate scores. RESULTS: Two hundred fifty-four patients diagnosed with HE were included in the study. 59.1% of the patients were male. The mean age of the patients was 65.2 ±â€…12.6 years. The mortality rate of the patients was 47.2%. When the receiver operating characteristic (ROC) analysis, which determines the predictive properties of laboratory parameters and disease severity scores, was examined, the area under curve value of the MELD-Lactate score (0.858 95% CI 0.812-0.904, P  < 0.001) was the highest. Binary logistic regression analysis for the estimation of patients' 30-day mortality showed that CPS and MELD-Lactate scores and blood ammonia and B-type natriuretic peptide levels were independent predictors of mortality. CONCLUSION: According to the study data, MELD-Lactate and BNP levels in patients diagnosed with HE in the ED may help the clinician in the prediction of 30-day mortality in the early period.

Liver Stiffness Is Markedly Decreased After Chronic Hepatitis C Treatment.

AIM: The aim of the study was to demonstrate the liver stiffness (LS) change in chronic hepatitis C (CHC) patients obtained by elastography point quantification technique in before and after antiviral treatment (AVT). MATERIAL AND METHODS: This prospective study included 84 patients diagnosed with CHC who had not previously received treatment for CHC and who had an indication for using direct-acting AVT. Necessary measurements were recorded with noninvasive liver fibrosis (LF) examinations. Posttreatment control of patients was carried out (ombitasvir + paritaprevir + ritonavir) + 3 months after the start of treatment for those treated with dasabuvir and 6 months after the start of treatment for patients treated with sofosbuvir + ribavirin. Liver stiffness changed after AVT is accepted as (Δ-LS), LS before AVT-LS after AVT. RESULTS: Basal LS was found to decrease significantly after AVT (8.00 ± 2.56 kPa vs 6.95 ± 2.86 kPa, P < 0.05). Similar aspartate aminotransferase-to-platelet ratio index and platelet number fibrosis 4 indices were observed before and after AVT (P > 0.05). It was observed that Δ-LS value after AVT was lower in patients with Child-Pugh class A cirrhosis than patients without cirrhosis (P < 0.05). In the comparison between Δ-LS value after AVT and LF score determined by liver biopsy, it was seen that the greatest Δ-LS value was in patients with fibrosis score of 3. An independent relationship was found between Δ-LS after AVT and LF score determined by biopsy (P < 0.05). CONCLUSIONS: The LS value determined by the elastography point quantification technique is more effective than other noninvasive laboratory methods in demonstrating the CHC treatment response in clinical practice.

Monocyte/High-Density Lipoprotein Ratio Is an Indicator of Activity in Patients with Ulcerative Colitis.

BACKGROUND: In patients with ulcerative colitis, endoscopic and clinical indices are used to assess the disease activity. In addition, stud- ies have been carried out for easier and cheaper markers in recent years. For this purpose, we evaluated the monocyte/high-density lipoprotein ratio of the disease activity. METHODS: According to clinical activity and partial Mayo scores, a total of 114 patients, 53 in the active ulcerative colitis group and 61 in the ulcerative colitis remission group were included in the study. Monocyte/high-density lipoprotein ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, C-reactive protein, and erythrocyte sedimentation rate measurements of these 2 groups were recorded. Ulcerative colitis remission group and active ulcerative colitis group were compared in terms of activity. RESULTS: The monocyte/high-density lipoprotein ratio value in the active ulcerative colitis group was significantly higher than that of the ulcerative colitis remission group (10.68 ± 3.39, 6.68 ± 1.39, P < .001, respectively). The monocyte/high-density lipoprotein ratio value for active ulcerative colitis at a cut-off value of 7.4 had 83% sensitivity and 81% specificity. In the active ulcerative colitis group, neutrophil/lymphocyte ratio, C-reactive protein, and erythrocyte sedimentation rate values were significantly higher than the ulcerative colitis remission group (P < .001, P < .001, P < .001, respectively). CONCLUSION: Monocyte/high-density lipoprotein ratio is an inexpensive and effective marker that can be used to determine the activity of ulcerative colitis.

Should lactate be added to Tokyo criteria for the evaluation of patients with acute cholangitis?

BACKGROUND: Tokyo guidelines (TG13/18) are used for the severity assessment of acute cholangitis (AC). Lactate is a clinical marker of tissue hypoxia and disease severity, independent from blood pressure. AIM: The aim of this study is to investigate the relationship between blood lactate level and TG13/18 criteria in patients diagnosed with AC. METHODS: One hundred fifteen patients with AC were included in this retrospective study. Demographic characteristics of the patients and laboratory data were scanned from their hospital medical records. According to TG13/18 guidelines, the patients were divided into 3 groups as mild (grade 1), moderate (grade 2), and severe (grade 3) AC. RESULTS: Sixty three (54.7%) of the patients were grade 1, 37 (32.1%) were grade 2, and 15 (13.0%) were grade 3. It was found that blood lactate level increased significantly from grade 1 to grade 3 (p < 0.001). In logistic regression analysis, white blood cell (WBC) count, total bilirubin and blood lactate levels independently determined the patients to be grade 2 or 3 AC. When the blood lactate cut-off value was taken as 16.5 mg/dL, we diagnosed grade 2 or 3 AC with a sensitivity of 78.8% and a specificity of 75.7%. From among lactate, WBC, and C reactive protein, lactate showed the highest value regarding the area under the curve, which is an index for predicting grade III upon ROC analysis. CONCLUSION: The blood lactate level is associated with the severity of AC. In addition to TG13/18 guidelines, blood lactate level can be a useful biomarker in the severity grading of AC.

Serum Elabela level is related to endoscopic activity index in patients with active ulcerative colitis.

BACKGROUND: In ulcerative colitis patients, Elabela levels and the relation of Elabela with laboratory parameters is unknown. AIM: The purpose of this study was to investigate the serum Elabela levels in UC patients and its relationship with other clinical and laboratory findings. METHODS: Forty-three patients with UC and 40 healthy controls (group I) similar in age and gender were included in the study. Routine patient history, physical examination, and laboratory tests were followed by analysis of serum Elabela levels. Endoscopic activity index (EAI) of patients with UC was calculated. There were two groups of patients: those in remission (group II) and with active disease (group III). RESULTS: Groups I, II, and III had 40, 22, and 21 participants, respectively. Serum Elabela levels were found to be 3.32 ± 1.25 ng/mL in group I, 3.38 ± 0.88 ng/mL in group II, and 5.48 ± 1.61 ng/mL in group III. Comparing the serum Elabela levels, a statistically significant difference was found between three groups (p < 0.001). Serum Elabela level showed a significant and positive correlation with EAI, leukocyte count, and hs-CRP, while a negative correlation was found with hemoglobin levels in univariate analysis (p < 0.001, for each). In linear regression analysis, these parameters were found to be associated with EAI and hs-CRP (p = 0.049, ß = 0.337, and p = 0.015, ß = 0.396, respectively). CONCLUSION: Elabela concentrations in patients with active UC was significantly higher and was associated with EAI and hs-CRP. Blood Elabela concentrations can be useful in the diagnosis and follow-up of patients with active UC.

Buried Bumper Syndrome: Early or Late?

Buried bumper syndrome (BBS) is a rare and serious complication of percutaneous endoscopic gastrostomy (PEG) tube placement. In the literature, BBS is considered to be a late complication of PEG procedure, but it may occur in the early period after PEG tube placement. Early diagnosis and proper treatment are important. Different treatment modalities may be used to treat BBS. The aim of this study was to evaluate patients with BBS. During a time frame between January 2015 and February 2020, a hospital medical database was screened for PEG placement and BBS. Buried bumper syndrome was found in 36 patients. Demographic and clinical characteristics of these patients were retrospectively investigated. Those who developed BBS in the first month were evaluated as early BBS. Those who developed BBS after more than a month were evaluated as late BBS. The median BBS development time was 135.9 ± 208.1 days (9-834 days). In 18 (50%) patients, BBS developed within the first month. Serious complications such as abscess and peritonitis were observed in 8 (22.2%) patients on admission. Thirty-two (88.9%) of 36 patients were treated with external traction and four patients were treated with surgery. No complications were observed in patients who were treated with traction. Five patients died, of whom three of them died because of BBS complications, whereas two of them died from other causes unrelated to BBS. Buried bumper syndrome is a complication that can be seen in the early period after gastrostomy. External traction is a reliable method for treating these patients. Proper education of patients' relatives and caregivers is very important to prevent BBS and related complications.

Lactate Level Predicts Mortality in Patients with Upper Gastrointestinal Bleeding.

BACKGROUND AND OBJECTIVES: The aim of this study was to show whether the level of lactate in venous blood compared with the Glasgow-Blatchford Bleeding Score (GBS), in patients diagnosed with upper gastrointestinal system (UGI) bleeding in the emergency department, will help to predict the need for transfusion and prognosis. MATERIALS AND METHODS: Patients with UGI bleeding who were admitted to the emergency department were included in the study. The parameters age, gender, referral complaints, comorbidities, lactate levels in venous blood, GBS, endoscopy findings, length of hospital stay, transfusion amount, and outcome of patients were recorded in the data collection form. RESULTS: A total of 139 patients were included in the study. The most common complaints were melena (38.1%) and hematemesis (32.4%). The most frequent endoscopic diagnosis was duodenal ulcer (40.3%). The cutoff value of the venous blood lactate level for the prediction of the need for red blood cell transfusion was 1.58 mmol/L, and the cutoff value for GBS was 9.5. While 124 patients were discharged, 15 patients died. The mean value of venous lactate in survived patients was 2.37 mmol/L and 4.80 in dead patients. This difference was statistically significant (p = 0.044). The cutoff value of lactate for the prediction of mortality was 2.32 mmol/L, and the cutoff value for GBS was 13.5. CONCLUSIONS: The venous blood lactate value of a patient who was admitted to the emergency department with UGI bleeding might be helpful in predicting the transfusion needs of the patient and predicting the mortality.

Update on the effect of age on acute pancreatitis morbidity: a retrospective, single-center study.

INTRODUCTION: Acute pancreatitis (AP) is one of the urgent diseases of gastroenterology. Due to the growth of the elderly population, the frequency of the disease in the elderly population is also increasing. AIM: To evaluate the contributing factors of mortality in geriatric patients (age ≥ 65 years) and non-geriatric (age < 65 years) patients. MATERIAL AND METHODS: We retrospectively analyzed data of consecutive patients with AP, in the Adana Numune Education and Research Hospital between March 2013 and September 2015. RESULTS: Of the 602 patients studied, 405 were female and 197 were male and their mean age was 55.2 ±19.5 years. The most common etiological factors were biliary stone, hyperlipidemia and alcohol, respectively. Two hundred and four patients were in the geriatric group and 394 patients were in the non-geriatric group. 84.4% of patients had mild AP, and 15.6% of patients had moderate to severe AP according to the revised Atlanta classification. 91.7% of non-geriatric patients had mild AP while 70.7% of geriatric patients had mild AP (p < 0.001). 29.4% of geriatric patients had moderate-to-severe AP while 8.4% of non-geriatric patients had moderate-severe AP. Duration of hospital stay was 6.2 ±3 days and 5.3 ±2.3 days in geriatric and non-geriatric groups respectively (p < 0.001). Mortality was higher in the geriatric group than the non-geriatric group (9.6% vs. 0.5%, respectively) (p < 0.001). CONCLUSIONS: Acute pancreatitis in the geriatric population shows a more severe course than the non-geriatric population. Geriatric patients have longer duration of hospital stay and higher mortality than non-geriatric patients.

Retrospective analysis of cases with an ectopic opening of the common bile duct into duodenal bulb.

BACKGROUND: Ectopic opening of the common bile duct (EOCBD) is a very rare entity. It has been reported in the 3rd or 4th portion of the duodenum, pyloric canal, duodenal bulb, and the stomach. OBJECTIVES: The aim of this study was to evaluate the clinical characteristics, laboratory values and imaging studies of patients with EOCBD into the duodenal bulb retrospectively. MATERIAL AND METHODS: The files of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2003 and November 2015 were reviewed. The demographic data, presentations, abdominal ultrasonography, computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and ERCP findings of patients with EOCBD into the duodenal bulb were evaluated retrospectively. RESULTS: Ectopic openings of the CBD into the duodenal bulb were found in 20 out of 3,270 patients who had undergone ERCP. Twenty patients (15 males and 5 females) with a median age of 59 (40-88) years were included in the study. Ectopic opening of the CBD into the duodenal bulb were found in 20 patients (0.61%). Laboratory test abnormalities included: hyperbilirubinemia in 20 (100%) patients, leukocytosis in 14 (70%) patients, an elevated serum alkaline phosphatase and gamma-glutamyl transferase level in 20 (100%) patients. Indications for ERCP were CBD dilatation and extrahepatic cholestasis (n = 20), cholangitis (n = 12), only choledocholithiasis (n = 7), and acute pancreatitis (n = 2). CONCLUSIONS: In patients with recurrent duodenal ulcers and/or apical stricture with accompanying CBD dilatation, extrahepatic cholestasis and cholangitis, EOCBD into the duodenal bulb should be considered.

Comparison of prognostic systems in cirrhotic patients with hepatic encephalopathy

Background/aim: There are various scoring systems for evaluating prognosis in patients hospitalized in intensive care units (ICUs) with hepatic encephalopathy. These include the Child-Turcotte-Pugh (CTP) classification, Model for End-stage Liver Disease (MELD), chronic liver failure-sequential organ failure assessment (CLIF-SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). In this study, we aimed to compare the various scoring systems to determine the best system for showing the prognosis of patients with a prior diagnosis of cirrhosis who were hospitalized for hepatic encephalopathy. Materials and methods: Patients with known cirrhosis hospitalized in the internal medicine ICU of the Adana Numune Education and Research Hospital with a diagnosis of hepatic encephalopathy were included in the study. Diagnosis and classification of hepatic encephalopathy were done according to the West Haven criteria. The etiology of hepatic encephalopathy was recorded for all patients. APACHE II, CLIF-SOFA, MELD, and CTP scores were calculated for all patients within the first 24 h. Outcomes of patients were recorded as either discharged or deceased. Demographic and biochemical data, duration of hospitalization, and prognostic factors were compared for both groups. Area under the receiver operating characteristic curve (AUROC) values were calculated for each scoring system. Results: A total of 84 patients were included in the study. The etiologies of encephalopathy were infection (n = 35, 41.7%), variceal bleeding (n = 19, 22.6%), constipation (n = 15, 17.9%), consuming excessive protein (n = 8, 9.5%), hypokalemia (n = 6, 7.1%), and hepatocellular carcinoma (n = 1, 1.2%). Nine patients had grade 1 encephalopathy, 34 patients had grade 2, 27 patients had grade 3, and 14 patients had grade 4. AUROC values were 0.986 (0.970-1.003), 0.974 (0.945-1.003), 0.955 (0.915-0.996), and 0.880 (0.800-0.959) for CLIF-SOFA, APACHE II, CTP, and MELD scores, respectively. Conclusion: We found the best prognostic model for patients who were hospitalized in the ICU for hepatic encephalopathy to be CLIFSOFA, followed by APACHE II, CTP, and MELD scores.

New predictor of acute necrotizing pancreatitis: Red cell distribution width.

BACKGROUND: Acute pancreatitis (AP) is inflammation of the pancreas of various severity ranging from mild abdominal pain to mortality. AP may be classified as acute interstitial edematous pancreatitis (AEP) or acute necrotizing pancreatitis (ANP), according to the revised Atlanta criteria. Most of the patients with AP are AEP (75-85% of patients), while 15-25% of patients have ANP. The mortality rate is 3% in AEP and 15% in ANP. Thus, it is important to predict the severity of AP to decrease the morbidity and mortality. OBJECTIVES: The aim of the study was to evaluate the relationship between red cell distribution width (RDW) and the severity of AP on admission to hospital. MATERIAL AND METHODS: Patients admitted to Adana Numune Research and Educational Hospital with a diagnosis of AP through the time frame of January 2014-May 2016 were included in our study. Diagnosis of AP was made according to the revised Atlanta classification. Patients' age, sex, etiology of AP, and RDW values were recorded on admission to the hospital. RESULTS: A total of 180 patients were included in the study. Eighty patients (44%) were male and 100 patients were female. Mean age was 56.25 ±18.3 years (52.66 ±14.4 in males; 59.84 ±20.2 in females). There was no statistically significant difference between patients' age. The most frequently observed etiologic factor was gallstone disease followed by alcohol intake and the use of pharmaceuticals. Drug-related AP was associated with azathioprine, furosemide, and thiazide diuretics. One hundred forty-four (80%) patients had AEP and 36 (20%) patients had ANP. RDW values showed a statistically significant difference between patients with AEP and ANP (p = 0.011). The cut-off value of RDW was 16.4 and the area under curve (AUC) value was 0.591 (p = 0.0227) with a sensitivity of 29.2% and specificity of 89.83%. CONCLUSIONS: Red cell distribution width could be used to evaluate the prognosis of acute pancreatitis.

Plasma Thrombin-activatable Fibrinolysis Inhibitor Levels Correlate with the Disease Activity of Ulcerative Colitis.

Objective Patients with ulcerative colitis (UC) are at an increased risk for thromboembolic events, particularly in patients with extensive and active disease. To date, a few studies have been published on the role of thrombin-activatable fibrinolysis inhibitor (TAFI) in UC. However, there are no reports in the literature investigating the effect of UC treatment on plasma TAFI levels. Methods The plasma TAFI antigen levels were quantitatively determined using ELISA kits for 20 UC patients at activation and remission, along with 17 healthy controls. The association between the TAFI levels and inflammatory markers was assessed to determine UC activation. To predict and determine the activation of UC, the Truelove-Witts index and the endoscopic activation index (EAI) were used for each subject. Results The plasma TAFI levels were higher in UC patients at activation of the disease compared with the remission state and in healthy controls. Spearman's correlation analyses revealed that the WBC (r: 0.586, p<0.001), hsCRP (r: 0.593, p<0.001) and EAI (r: 0.721, p<0.001) were significantly correlated with the TAFI levels. The overall accuracy of TAFI in determining UC activation was 82.5% with a sensitivity, specificity, NPV and PPV of 80%, 85%, 81% and 84.2%, respectively (cut-off value: 156.2% and AUC: 0.879). Conclusion The present study demonstrates that the TAFI levels are elevated in the active state of UC. The assessment of TAFI levels in patients with UC in conjunction with other markers of inflammation may provide additional information for estimating UC activation and severity.

Evaluation of Stump Pressure in Three Types of Appendectomy: Harmonic Scalpel, LigaSure, and Conventional Technique.

INTRODUCTION AND OBJECTIVE: Appendectomy is one of the most common operations carried out by general surgeons. The recent introduction of the alternative energy-based devices in surgery and their use in the laparoscopic appendectomy shortened the duration of operations, but these devices are used generally for meso dissection. These devices did not receive wide acceptance among surgeons as there is not enough evidence confirming their use in appendicular lumen operations. Our objective in this study was to test the safety of three types of appendectomy. MATERIALS AND METHODS: Twenty-four cases with right hemicolectomy or subtotal colectomy were enrolled into this study. The patients were distributed in three groups. After the colectomy specimen was removed, in Group 1 conventional appendectomy (it was dissected with mesoappendiceal fixation and with electro cauterization) was performed in the operating room, the appendicular stump was ligated with a silk suture; in Group 2 appendectomy was performed with LigaSure™ and the stump was closed also with LigaSure; in Group 3 appendectomy was performed with Harmonic Scalpel™ and the stump was closed also with Harmonic Scalpel. Stump opening pressures were measured in all patients in the groups. RESULTS: Three groups were compared in terms of age, gender, concomitant diseases, clinical diagnosis, previous operations, pathological findings, and applied maximum pressure levels. No statistical difference was detected among the groups. CONCLUSION: Appendectomies carried out with LigaSure and Harmonic Scalpel are as safe as appendectomies carried out with the conventional methods.