Background: Studies have been conducted to evaluate changes in hemodynamics, postoperative bleeding, and pain in pediatric dental patients receiving general anesthesia (GA). However, a limited number of studies have evaluated the effects of local anesthetics (LA) on tooth extraction procedures during GA. There is no consensus in the literature regarding LA application in the perioperative period for dental treatments performed within the scope of GA. Aim: This study aimed to determine the retrospective physiologic effects of fluctuations in vital signs and postoperative bleeding in children who did or did not receive LA for tooth extraction under GA. Methods: A retrospective evaluation of 77 patients aged 5.16 ± 1.85 years who had the extraction of primary posterior teeth with or without LA under GA were reviewed in the post-anaesthesia care unit (PACU) for postoperative bleeding and the effects of intraoperative LA on fluctuations in postoperative parameters such as mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO2), respiratory rate (RR), and the end-tidal carbon dioxide (EtCO2). These were compiled from the patient records of the procedures. Results: Significant differences between the baseline and peak MAP (P < 0.001), HR (P = 0.011), and EtCO2 (P = 0.002) were noted in children without LA compared to those who had LA. In addition, substantial variations were observed between the baseline and peak values for MAP (P < 0.001) and HR (P = 0.037) in children who had tooth extraction in the mandibular region. Statistically significant differences were noted between the baseline and peak values for patients who did not receive LA before the extraction of the first primary molar in terms of MAP (P < 0.02) and EtCO2 (P = 0.032). Similarly, significant differences in MAP (P < 0.02) and EtCO2 (P = 0.034) were noted in the extraction of the second primary molar. In addition, there was a significant difference in bleeding based on the number of tooth extractions in those who did not receive LA (P = 0.020). Conclusion: This study showed that in children who underwent tooth extraction under GA, additional LA application minimized changes in HR, MAP, and EtCO2, whereas a lack of LA application produced significant fluctuations from baseline to peak values of HR, MAP, and EtCO2. In addition, LA application reduced postoperative bleeding.

ABSTRACTTo our knowledge, no study has been carried out to observe which subcortical basic affective systems are related to which defense styles. Such a perspective may have the potential to reveal how defenses may interact with subcortical primary emotional systems (PES) and how they contribute to affect regulation. We aimed to analyze the relationship of immature, neurotic, and mature defenses with basic subcortical affects (CARE, PLAY, SEEK, SADNESS, FEAR, ANGER) within an affective neuroscientific perspective. In addition, we sought to explore the effect of psychiatric disorders in relation to PES and defenses, and observe gender effects, if any. The sample consisted of 703 university students, recruited online. The materials included the Turkish translations of the Affective Neuroscience Personality Scales (ANPS) and the Defense Style Questionnaire (DSQ). The correlations between ANPS and DSQ showed that the immature defenses increase as all negative emotions increase, whereas mature defenses increase as all positive emotions (except CARE) increase and all negative affects decrease (except ANGER). On the other hand, as neurotic defenses increase, CARE, FEAR and SADNESS simultaneously increase. Subjects who reported the presence of psychiatric disorders also reported higher FEAR, SADNESS, ANGER accompanied by higher immature defenses. Finally, male subjects reported higher immature defenses, whereas the females reported higher neurotic defenses, accompanied by higher CARE, SEEK, SADNESS, FEAR, and slightly lower PLAY. Investigating defenses through the lens of affective neuroscience offers the opportunity to link the abstract concept of defenses to increasingly well-understood neurobiology.KEYWORDS: Basic affectsemotionsaffective neuroscience personality scaledefense mechanismsdefense style questionnaireaffect regulation AcknowledgementsThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.Disclosure statementNo potential conflict of interest was reported by the author(s).

Purpose: Non-invasive tests used in the screening and follow-up of celiac disease (CD) are currently below expectations because they show false negatives/positives and are not always correlated with duodenal histology. We aimed to investigate the predictive value of intestinal free fatty acid binding protein (FABP-I) which can easily be released into the circulation in the presence of enterocyte damage in a short time in CD. Methods: This study included 59 patients with CD who were not on gluten free diet (GFD)(n=24) and who were on GFD(n=35) and 52 healthy controls. Demographic variables, complete blood count, ferritin, vitamin D, calcium, phosphorus, vitamin B12, prothrombin time, INR, and serum FABP-I levels were recorded for all groups. Results: There was no difference between the groups in terms of complete blood count, ferritin, calcium, phosphorus, vitamin B12, prothrombin time and INR (all p>0.05). Mean serum FABP-I was determined as 499.2±33.3 ng/L for patients with CD who were not on GFD and as 487.7±48.0 ng/L for who were on GFD, and these values were significantly higher when compared to the healthy controls 432.2±63.8 ng/L(p<0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of FABP-I for a cut-off value of 456.8 ng/L were 84.7%, 69.2%, 10.2% and 61.5%, respectively(AUC=0.785). Conclusion: This study has shown that FABP-I can serve as a non-invasive predictive marker for CD diagnosis. Overlooked diagnosis in serology-negative patients and false serology positivity for reasons other than CD will be prevented with its use in clinical practice since FABP-I directly reflects intestinal damage.

A 28-year-old female patient was admitted to our hospital with right upper quadrant pain and fever. The patient was diagnosed with acute cholangitis and choledocholithiasis. Stone removal was performed with Endoscopic retrograde cholangiopancreatography (ERCP) as it measured 1cm in size and a 10-Fr 10 cm straight plastic stent (Flexima™, Boston Scientific) was placed in the common bile duct. The patient was discharged after his symptoms subsided and was admitted to our hospital again two months later with abdominal pain, back pain, nausea and vomiting. On physical examination, mild tenderness was detected in the right upper quadrant. Laboratory tests showed a white blood cell (WBC) count of 6.82x109/L, hemoglobin 10.3 g/mL, alanine aminotransferase (ALT) 19 U/L, aspartate aminotransferase (AST) 18 U/L and total bilirubin (TB) 0.76 g/mL. All other laboratory parameters were normal. Abdominal computed tomography (CT) showed that the distal end of the plastic stent migrated to the lower wall of the third part of the duodenum and protruded into the peritoneal cavity. However, there was no evidence of perforation (Fig. 1A). During ERCP, it was observed that the proximal end of the plastic stent was in the bile duct and the distal end perforated the duodenal wall opposite the papilla (Fig. 1B). The plastic stent was held with rat-tooth forceps and removed with a slight upward movement towards the common bile duct and then a downward movement towards the lumen (Fig. 1C). Closure of the defect in the duodenum was performed with three hemostatic clips (Fig. 1D). Oral intake started a few days after the procedure and there were no complications. Duodenal perforation caused by migration of biliary stents is a rare complication. Abdominal CT scanning is usually preferred in these cases, and endoscopic intervention is an effective method for treatment.

A 61-year-old woman was admitted to the hospital because of persistent vomiting and diarrhea for the past year. In esophagogastroduodenoscopy performed for the etiology of these symptoms, a fistula was seen in the descending part of the duodenum without any erosion and ulceration. The fistula mouth was about 8mm wide, and endoscopy was used to view the transverse colon from the fistula mouth (▶Fig. 1). Colonoscopy revealed the fistula mouth in the hepatic flexure and diverticulum nearby (▶Fig. 2). No additional pathology such as tumors or ulcers was seen in the duodenum and colon. During esophagogastroduodenoscopy, the fistula on the descending part of the duodenum was closed by performing suction and using an over-thescope (OTS) clip (12/6/t; Ovesco Endoscopy AG, Tubingen, Germany) (▶Fig. 3; ▶Video 1). When the fistula mouth was checked with colonoscopy, it was observed to be closed (▶Fig. 4). Oral intake started the day after the procedure and there were no problems. As a result, in selected cases, an OTS clip is an effective and safe method in full-thickness closure of transmural defects such as duodenocolic fistula [1–4].

Introduction and objectives: Evaluation of liver fibrosis is important for treatment decisions, complications and to predict prognosis in patients with chronic hepatitis B (CHB). Our aim was to develop a new non-invasive fibrosis scoring method and prove its accuracy in the differentiation of no/low grade and advanced fibrosis in patients with CHB. Patients and methods: Our study included 273 chronic hepatitis B patients who underwent liver biopsy from February, 2007 to February, 2019 with medical records retrospectively reviewed. Preparations of these patients were divided into two groups as ≤ 3 no-low grade fibrosis (n=236) and ≥ 4 advanced fibrosis (n=37) according to histological ISHAK fibrosis scoring system. Results: The newly developed AGAP score and other non-invasive fibrosis scores; Fibrosis-4 index, Aspartate aminotransferase to platelets ratio, Gamma glutamyl transpeptidase to platelet ratio, Goteborg University Cirrhosis Index, King's score, Albumin-bilirubin index, Fibrosis cirrhosis index, Fibrosis index, Fibrosis quotient, Lok score and mean and/or median values of Fibroindex were significantly higher in the advanced fibrosis group compared to the no/low grade fibrosis group (p<0.001). However, there was no significant difference in AAR score among the groups (p=0.265). With cut-off value of 4.038, AUROC value of 0.803, sensitivity of 75.7%, specificity of 73.7% and accuracy of 0.740, AGAP score showed the best performance in advanced fibrosis differentiation compared to 12 other non-invasive fibrosis scoring methods. Conclusions: The newly developed AGAP score showed better performance in patients with CHB compared to 12 other non-invasive fibrosis scores in differentiation of no/low grade fibrosis and advanced fibrosis.

Objective: The majority of the liver function tests are not specific to the liver. The histological liver damage begins before patients are diagnosed with cirrhosis and continues afterwards. Therefore, there is an increasing demand for early and specific markers that are correlated with liver damage. This study aims to investigate if serum and urinary liver fatty acid-binding protein (L-FABP) levels could be used as an early diagnostic marker of liver cirrhosis. Material and Methods: This cross-sectional study included 30 patients with compensated liver cirrhosis, 27 patients with decompensated liver cirrhosis, and 30 healthy controls. The patients and healthy controls were tested for serum and urinary L-FABP levels. Results: The serum and urinary L-FABP levels were higher in patients with cirrhosis than the healthy controls (both p<0.001). The cut-off value of serum and urinary L-FABP was computed as 721.78 ng/ml and 621.25 ng/ml, respectively. The sensitivity of serum and urinary L-FABP to detect cirrhosis at this cut-off was 99.8% and 98.9%. The specificity, positive predictive value, and negative predictive value of serum and urinary L-FABP at these cut-off levels were 100 %. There was no difference in terms of serum and urinary L-FABP between compensated and decompensated cirrhosis patients. Accordingly, no correlation was determined between serum/urinary L-FABP levels and cirrhosis complications. Conclusion: L-FABP increases in serum and urine in response to hepatocyte damage that can result in liver fibrosis. We demonstrated that patients with liver cirrhosis had high L-FABP levels. L-FABP may be used as a predictive non-invasive marker of cirrhosis as it can be detected before the clinical symptoms of liver damage.

The Chanarin–Dorfman syndrome (CDS) is a rare, autosomal recessively inherited genetic disease. This syndrome is associated with a decrease in the lipolysis activity in multiple tissue cells because of recessive mutations in the abhydrolase domain containing 5 (ABHD5) gene, which leads to the accumulation of lipid droplets in multiple types of cells. Major clinical symptoms in patients with CDS include ichthyosis and intracytoplasmic lipid droplets. The variability of clinical symptoms in patients with CDS depends on a large number of mutations involved. In this syndrome, liver involvement is an important cause of mortality and morbidity. This review aims to summarize the demographic characteristic, clinical symptoms, liver involvement and mutations in CDS patients in the literature to date.

Background There are limited data about the mortality and morbidity of patients with HBV flare related to immunosuppressive treatments (IST) in the third-generation antivirals era. Herein, we performed a multi-centric study in patients treated with entecavir (ETV) or tenofovir disoproxil fumarate (TDF) and evaluated their clinical course. Methods The study group included patients who were referred to gastroenterology or infectious disease specialists at eight different hospitals in Turkey. HBV flare was defined as at least a threefold elevation in alanine aminotransferase (ALT) levels above the upper limit of normal range. The demographic data, IST protocol, virological markers, liver tests, international normalized ratio (INR), HBV DNA, reactivation risk profile according to AGA guideline, MELD and MELD-Na scores were retrospectively evaluated. The primary aim of the study was to determine the liver-related mortality, including transplantation, at 12 weeks and factors predicting it. Secondary aims were to compare ETV and TDF with respect to mortality and time to ALT, bilirubin normalization and HBV DNA undetectability. Results The study group included 40 patients (29 males, mean age: 57 ±12 years). Twenty-five patients (62.5%) had a high risk of reactivation. Twenty-six patients received TDF and 14 patients received ETV treatment. Eight (20%) patients developed acute liver failure and one patient (2.5%) underwent living donor liver transplantation. Seven patients died due to liver-related complications, revealing a mortality rate of 17.5%. In multivariate analysis, total bilirubin levels at the onset, ALT levels and delta-MELD score at the first week were the independent risk factors for liver related mortality (HR: 1.222, 1.003, 1.253 and 95% CI: 1.096, 1.362; 1.001, 1.004 and 1.065, 1.470, respectively). There was no significant difference between the TDF and ETV groups with respect to time to normalize ALT and bilirubin levels, HBV DNA undetectability and mortality rates (16% and 21.4%, respectively). Conclusions HBV flare associated with IST has a high mortality in the third-generation antivirals era. High total bilirubin at the onset and high ALT and delta-MELD score at the first week predict poor prognosis.

Objective: We aimed to revise the pregnancy and portal hypertension approach which is rarely seen together and may cause bleeding in esophageal varices. Case Report: A 35-year-old patient with portal hypertension at 38 weeks of gestation according to first trimestr ultrasonography (USG) was admitted to our clinic. At the age of 16, she was diagnosed with liver biopsy. She had had two vaginal births before. The patient did not have 2nd and 3rd trimester screening tests. The detailed USG was normal. The abdominal USG had a liver size of 14.5 cm. Hepatic venules and portal venous diameter were 8.2 mm at the level of the liver hilus. Spleen size was 14.5 cm. In the vicinity of the splenic hilus, the widest 13 mm diameter tortuous veins were observed. A council consisting of Gynecology, Gastroenterology and Neonatology team at 32nd week of pregnancy it was suggested that clinical and laboratory findings were closely followed and vaginal delivery was recommended unless there was an obstetric problem. The pregnancy was terminated by cesarean section because acute fetal distress developed when she was followed on the travay when she applied at 38th gestational week. Meconium 2420 gr 48 cm Apgar score 6/8 male baby was born. Conclusions: Portal hypertension is defined as elevation of blood pressure in the portal vein and its branches over 200-230 mmH2O. Portal hypertension and pregnancy can rarely be confronted. It increases the mortality and morbidity of the baby and the mother. Portal hypertension does not constitute a contraindication to pregnancy. During pregnancy, esophageal variceal bleeding, premature delivery, intrauterine growth restriction and fetal death can occur. In our case, we had a baby born with low birth weight who had cesarean section for an obstetric cause. As a result, the management of complications caused by portal hypertension during pregnancy is similar to that in non-pregnant patients, but a more intensive monitoring and follow-up is necessary.

Background: Using a relaxant agent before an endoscopic retrograde cholangiopancreatography (ERCP) might reduce complications. Study Aims: We aimed to investigate the relaxant effects of proton pump inhibitors (PPIs) on sheep sphincter of Oddi (SO) and the mechanisms that might take part in this relaxant effect. Patients and Methods: The sheep SO was mounted in an organ bath filled with Krebs-Ringer bicarbonate solution under 1.5 g tension and the relaxant effects of PPIs were evaluated in the tissues precontracted by carbachol (10(-6) mol/l). The relaxant responses to the PPIs were tested in the presence of various blockers to enlighten the underlying mechanism by the PPIs. Results: The PPIs exerted relaxant responses in a concentration-dependent manner in the sheep SO (P < 0.05). Esomeprazole produced the strongest relaxation. The administration of atropine, indomethacin, L-NAME, methylene blue, clotrimazole, glibenclamide, and 4-aminopyridine into the organ baths did not change the relaxations induced by PPIs in vitro (P> 0.05). On the other hand, Ca+2-activated potassium channel blocker tetraethylammonium (TEA) reduced the relaxation responses created by PPIs (P < 0.05). Conclusions: The present study suggests that PPIs create relaxation on SO partially via Ca+2-activated potassium channels. PPIs, especially esomeprazole, may be beneficial during the ERCP procedure. Further clinical studies are needed to confirm our results.

1 Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, Sivas, Turkey 2 Department of Obstetrics and Gynecology, Sivas State Hospital, Sivas, Turkey 3 Department of Gastroenterology, Cumhuriyet University School of Medicine, Sivas, Turkey Corresponding author: Savaş Karakuş, MD, Department of Obstetrics and Gynecology, Cumhuriyet University School of Medicine, 58140 Sivas, Turkey E-mail: karakussavas@yahoo.com Received/Accepted: April 13, 2018 / June 29, 2019 Conflict of interest: There is not a conflict of interest.

BACKGROUND This study aimed to investigate ovarian reserve in patients of reproductive age with Celiac disease (CD) using anti-Müllerian hormone (AMH) levels, antral follicle counts (AFCs), and ovarian volume. MATERIAL AND METHODS We included into this study 46 CD female patients and 40 healthy female subjects of reproductive age, ages 18-45 years. Venous blood samples were taken from both groups on days 2-4 of the menstrual cycle, and follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), and AMH levels were measured. On the same day, AFCs and ovarian volumes were determined. Data on body mass index (BMI), gravidity/parity/abortions/alive counts, disease duration, and Marsh histological classification were recorded. RESULTS There were no statistically significant differences between CD and control groups in terms of mean age, BMI, or median gravidity/parity/abortions/alive counts (p>0.05). Also, there were no statistically significant differences between the 2 groups in terms of mean FSH, LH, E2, PRL levels, right and left ovarian volumes, and median right and left ovarian AFCs (p>0.05). However, AMH level was significantly lower in the CD group (p=0.032). No statistically significant correlation was found between AMH levels and age, BMI, FSH, LH, E2, PRL levels, right and left ovarian volumes, right and left ovarian AFCs, or Marsh histological classification using the Spearman correlation test (p>0.05). However, an inverse correlation was detected showing that AMH levels decrease with increasing CD duration (r=-0.054, p=0.001). CONCLUSIONS We found that AMH level and ovarian reserve was decreased in CD patients of reproductive age compared to healthy controls, and that AMH level and ovarian reserve decreased with increasing disease duration in CD patients.

Paraneoplastic syndromes are functional clinical disorders caused by the direct effect of the primary tumor or metastasis. The initial presenting symptom of the patients may be associated with paraneoplastic manifestations. Paraneoplastic cholestasis is most frequently defined in association with renal cell carcinoma (Stauffer's syndrome), but it is an extremely rare clinical entity seen in association with prostate cancer. Etiology of cholestasis was investigated in the case diagnosed as metastatic prostate cancer who applied to the gastroenterology outpatient clinic due to complaints of ascites and jaundice that established the diagnosis of paraneoplastic hyperbilirubinemia. We observed improvement of his cholestasis with hormonotherapy used for prostate cancer.

Objective: This study aimed to determine the frequency of HBV reactivation and the potential predictive factors in resolved hepatitis B virus (HBV) patients [hepatitis B surface antigen (HBsAg)-negative and antibody to hepatitis B core antigen (antiHBc)-positive patients] who received rituximab-containing chemotherapy for B-cell lymphoma. Materials and Methods: A retrospective examination was performed for HBV-related markers in 106 patients before and after receiving rituximab-containing chemotherapy for CD20-positive B-cell lymphoma. Results: Of the 106 patients with CD20-positive B-cell lymphoma who received rituximab-containing chemotherapy, 98 were HBsAg negative and 8 were HBsAg positive; among the 98 patients, 64 (65.7%) were anti-HBc negative and 34 (34.7%) were anti-HBc positive. Of the 34 CD20-positive B-cell lymphoma patients with resolved HBV infection who received rituximab-containing chemotherapy, 26 (76.5%) were anti-HBsAg antibody (anti-HBs) positive and 8 (23.5%) were anti-HBs negative. Of these 8 anti-HBs-negative patients, HBV reactivation occurred in 4 (50%) patients; no HBV reactivation was observed in any of the 26 anti-HBs-positive patients. Compared with the anti-HBs-positive patients, the rate of HBV reactivation in B-cell lymphoma patients who were anti-HBs negative and had resolved HBV infection revealed a highly significant relationship (p<0.001). Conclusion: HBV reactivation occurred in 50% of the CD20-positive B-cell lymphoma anti-HBs-negative patients with resolved HBV infection who had received rituximab-containing chemotherapy and in none of the anti-HBs-positive patients. This indicates that anti-HBs negativity in the patients with resolved HBV infection is an important risk factor, and the antiviral prophylaxis should certainly be administered to such patients.

Objective: The aim of this study was to investigate the real-world efficacy and safety in Turkey of the paritaprevir/ritonavir, ombitasvir, dasabuvir (PrOD) ± ribavirin (RBV) and ledipasvir/sofosbuvir (LDV/SOF) ± RBV combination regimens used for chronic hepatits C virus (HCV) genotype 1 patients, which is the most common form of this disease seen both in Turkey and worldwide. Method: The study included a total of 81 HCV genotype 1 patients receiving PrOD ± RBV or LDV/SOF ± RBV treatment regimens between June 2016 and October 2017. The patients were evaluated in respect of demographic, clinical and virological data, sustained virologic response (SVR) and detailed adverse events (AE). Results: The 81 HCV patients comprised 35 (43.2%) males and 46 (56.8%) females with a mean age of 62 years. All the patients were genotype 1, which is the most commonly seen genotype in Turkey, and the sub-genotypes were HCV genotype 1a in 12.3% and genotype 1b in 87.7%. The SVR12 rate of all the chronic HCV genotype 1 patients was 79 (96.4%), 98.2% in the PrOD ± RBV patients and 96% in SOF/LDV ± RBV. AEs were reported in 46 (56.8%) of the total patient group. The most common AEs were pruritus in 18 (22.2%) patients, fatigue in 17 (21%) and headache in 16 (19.8%). Conclusions: According to the real-world data obtained in this study from a single centre in our region, a high rate of SVR12 response was obtained direct-acting oral viral treatment regimens in patients with chronic HCV genotype 1 and there was seen to be excellent tolerability.

BACKGROUND:Intestinal ischemia-reperfusion (I/R) injury can lead to multiple organ failure and death. The aim of this study was to investigate the effects of pentoxifylline and iloprost administered before reperfusion in intestinal ischemia.METHODS:In total, 25 male Wistar Albino rats weighing 250-300 g were divided into five groups each comprising five subjects: control group (n=5), sham group (n=5, no I/R), I/R group (n=5, 45 min ischemia, and 120 min reperfusion), I/R + pentoxifylline group (n=5, 45 min ischemia following intraperitoneal 50 mg/kg pentoxifylline and 120 min reperfusion), and I/R + iloprast group (n=5, 45 min ischemia followed by intraperitoneal 2 mcg /kg iloprost and 120 min reperfusion). At the end of the experiment, ileum specimens were stained using hematoxylin-eosin and histopathologically evaluated using the Chiu score. Isometric contraction-relaxation responses were recorded using organ baths for contraction-relaxation responses.RESULTS:Pentoxifylline provided a significant improvement in response to histopathological and contraction-relaxation responses. Although iloprost provided recovery in reperfusion injury, it was not statistically significant.CONCLUSION:Our findings demonstrate that pentoxifylline may be promising in preventing small bowel ischemia-reperfusion injury. We concluded that further clinical and experimental studies for iloprost are needed.

Giriş ve Amaç: Polikistik over sendromu reprodüktif çağdaki kadınlarda en sık görülen endokrin hastalıktır. Fonksiyonel dispepsi, genel popülasyonda yaygın görülen organik neden olmaksızın dispeptik semptomların eşlik ettiği fonksiyonel gastrointestinal bozukluktur. Daha önceki çalışmalarda polikistik over sendromlu hastalarda fonksiyonel dispepsi sıklığı ve aralarındaki ilişki araştırılmamıştır. Biz bu çalışmada polikistik over sendromlu hastalarda fonksiyonel dispepsi sıklığını ve aralarındaki ilişkiyi araştırmayı amaçladık. Gereç ve Yöntem: Çalışmamız prospektif olarak planlandı ve reprodüktif çağdaki 73 polikistik over sendromlu hasta ve 67 sağlıklı kontrol denek alındı. Bu deneklerin gastrointestinal semptomları anketle saptandı. Deneklerin boy, kilo değerleri kayıt edildi ve serum açlık glukoz, insülin, kortizol, prolaktin, troid uyarıcı hormon, folikül uyarıcı hormon, luteinleştirici hormon, total testosteron, dehidroepiandrosteron sülfat düzeylerine bakıldı. Deneklerin insülin direnci ve vücut kitle indeksi değerleri hesaplandı. Bulgular: Çalışmaya alınan polikistik over sendromu ve sağlıklı kontrol grubu arasında yaş açısından anlamlı fark bulunamadı (22.1±4.1 vs. 23.5±5.1 yıl,sırasıyla p > 0.05). Gruplar serum total testosteron, dehidroepiandrosteron sülfat ve luteinleştirici hormon düzeyleri açısından karşılaştırıldığında aradaki fark önemli bulundu (p=0.001, p=0.001, p= 0.038, sırasıyla). Polikistik over sendromlu 73 hastanın 38’inde (%52.1) ve kontrol grubunda 67 deneğin 16’sında (%23.9) fonksiyonel dispepsi mevcut idi. Fonksiyonel dispepsi sıklığı polikistik over sendromu hastalarında sağlıklı kontrol deneklerden daha yüksek bulundu (p=0,006). Fonksiyonel dispepsisi olan polikistik over sendromlu hastalar, fonksiyonel dispepsi subgrupları açısından karşılaştırıldığında postprandiyal distres sendromu sağlıklı kontrol grubuna kıyasla sık (p<0.05) iken epigastrik ağrı sendromu için sağlıklı kontrol grubu ile arasında istatistiksel fark yok idi (p>0.05). Polikistik over sendromu hastalarında vücut kitle indeksi, serum açlık kan glukozu, insülin, kortizol, prolaktin, troid uyarıcı hormon, folikül uyarıcı hormon ve insülin direnci indeksi sağlıklı kontrol grubu ile karşılaştırıldığında aralarında fark bulunamadı (p>0.05). Sonuç: Polikistik over sendromlu hastalarda, fonksiyonel dispepsi ve dispepsi subgrubu olan postprandial distress sendromu sıklığı sağlıklı kontrol grubu ile karşılaştırıldığında yüksek saptandı. Polikistik over sendromlu hastalarda, fonksiyonel dispepsi ve subgrubu olan postprandial distress sendromun sık görülmesinin hiperandojenizm ile ilişkili olduğu düşünüldü.

Atypical clinical forms of familial Mediterranean fever (FMF) can be misdiagnosed as therapy-resistant epigastric pain syndrome (EPS) for they share many of the same clinical features, such as abdominal pain. Thus, we aimed to determined the frequency of FMF in patients who were followed with a diagnosis of therapy-resistant EPS. Seventy-five patients with therapy-resistant EPS and 20 controls were involved in the study. To detect the FMF in patients with therapy-resistant EPS, Tel-Hashomer criteria, family history of FMF were researched and recorded. We performed performed MEFV gene analysis on all patients. Forty-three patients with EPS (57.3%) had MEFV gene mutations and the carrier rate was 30.0%. The most common MEFV gene alteration was R202Q (55.8%), followed by E148Q (16.2%), R761H (16.2%), V726A (9.3%), M680I (9.3%) and M694V (4.6%). Rarely seen mutations in the Turkish population were also identified: K695R (2.3%), L110P (2.3%) and G304R (2.3%). Eight patients with EPS were diagnosed with FMF and started on colchicine therapy. Three patients with compound heterozygosities for three mutations, two patients with compound heterozygosities for two mutations (K695R/ V726A and R202Q/ R761H), one patient with homozygous R202Q, one patient with heterozygous R202Q mutation and one patient with non- R202Q heterozygous mutation (G304R/-) had clinical FMF symptoms and were started on colchicine therapy. Patients who have therapy-resistant EPS should also be questioned about FMF, especially in high risk populations.

Objective: The incidence of colorectal cancer in developed countries has been found to increase with age. Early diagnosis and screening decrease the mortality rates in colorectal cancer. This study aimed to use inflammatory markers neutrophil-tolymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red blood cell distribution width (RDW) as new biomarkers for early diagnosis and screening in patients with colorectal cancer. Materials and Methods: A total of 59 patients with colorectal cancer and 59 ageand sex-matched healthy participants were included in the study. Localization, tumor node metastasis (TNM) stage, and preoperative hemoglobin levels, neutrophil counts, lymphocyte counts, platelet counts, and RDW values were obtained from medical records. Using the receiver operating characteristic (ROC) curve, the optimal cutoff levels of the biomarkers were determined. Results: NLR, PLR, and RDW were significantly higher in patients with colorectal cancer than in healthy participants (p<0.001). According to ROC analysis, the cutoff value for NLR was 2.05 [area under the curve (AUC): 0.740, sensitivity: 78%, specificity: 66%]; the cutoff value for PLR was 130 (AUC: 0.702, sensitivity: 65%, specificity: 72%); and the cutoff value for RDW was 14 (AUC: 0.774, sensitivity: 68%, specificity: 73%). Conclusions: NLR, PLR, and RDW were found to be significantly higher in patients with colorectal cancer than in healthy participants. Therefore, it is recommended that these additional biomarkers can be used for early diagnosis and screening of colorectal cancer.