Aim: The incidence of hepatitis A (HepA) has decreased due to vaccination and improved hygiene conditions. However, the age of onset of the disease has shifted from childhood to adulthood. Children with HepA are mildly symptomatic, whereas the course of the disease in adults may be severe. The aim of this study was to examine the change in HepA seroprevalence and identify the population susceptible to HepA. Material and Methods: A total of 10132 patients who were tested anti-Hepatitis A virus immunoglobulin G (anti-HAV IgG) between 2016 and 2019 were reviewed retrospectively, and included in this study. The patients were divided into five groups according to their age, and seropositivity rates were compared between age groups. The relevant data of the healthcare professionals were also evaluated separately. Results: The overall seropositivity rate was 60.1% (n=6088). The seropositivity rate was found 29.0% (n=944) in the 18 to 24 years range, 49.7% (n=837) in the 25 to 29 years range, 60.6% (n=689) in the 30 to 34 years range, 76.6% (n=784) in the 35 to 39 years range, and 93.3% (n=2834) in the ≥40 years groups. The seropositivity rate was found 36.1% (n=1781) and 82.9% (n=4307) in patients <30 and ≥30 years groups, respectively (p<0.001). Conclusion: In recent decades, there has been a significant change in HepA seroprevalence. This change has resulted in the emergence of a young adult population susceptible to possible HepA outbreaks. Thus, seronegative young adults may be considered at risk for HepA and routine vaccination may be considered.

Excessive daytime sleepiness (EDS) is a common complaint encountered in clinical practice with serious consequences both for individual and society since it can increase the ratio of motor vehicle accidents, work- related incidents, and deaths. Moreover, it also manifests less serious individual consequences. This study aimed to investigate the potential role of PER3-VNTR, 5-HTT-LPR, and 5-HTT-VNTR in terms of constituting liability to EDS. Two hundred eighteen participants (93 complaining about daytime sleepiness and 125 individuals with no serious complaint) were recruited in the study. General daytime of sleepiness was quantified with Epworth sleepiness scale (ESS). DNA extractions were performed from collected blood samples with standart salting-out procedure and genotyped. ESS scores displayed difference between individuals suffering from sleep disturbances and other individuals with values of 12.75±4.55 and 6.34±4.26, respectively. PER3- VNTR and 5-HTT-LPR genotypes did not display association with mean ESS scores. However, 5-HTT-VNTR genotypes showed significant association with mean ESS scores; individuals with 10/10 genotypes had the highest ESS score reflecting this genotype as a liability factor for EDS. We strongly recommend further studies based on circadian/serotonin pathway genes in different populations to reach to a consensus and highlight sleep genetic marker genes which then can be the future targets of pharmacological treatment studies for sleep problems.

Aim: The incidence of hepatitis A (HepA) has decreased due to vaccination and improved hygiene conditions. However, the age of onset of the disease has shifted from childhood to adulthood. Children with HepA are mildly symptomatic, whereas the course of the disease in adults may be severe. The aim of this study was to examine the change in HepA seroprevalence and identify the population susceptible to HepA. Material and Methods: A total of 10132 patients who were tested anti-Hepatitis A virus immunoglobulin G (anti-HAV IgG) between 2016 and 2019 were reviewed retrospectively, and included in this study. The patients were divided into five groups according to their age, and seropositivity rates were compared between age groups. The relevant data of the healthcare professionals were also evaluated separately. Results: The overall seropositivity rate was 60.1% (n=6088). The seropositivity rate was found 29.0% (n=944) in the 18 to 24 years range, 49.7% (n=837) in the 25 to 29 years range, 60.6% (n=689) in the 30 to 34 years range, 76.6% (n=784) in the 35 to 39 years range, and 93.3% (n=2834) in the ≥40 years groups. The seropositivity rate was found 36.1% (n=1781) and 82.9% (n=4307) in patients <30 and ≥30 years groups, respectively (p<0.001). Conclusion: In recent decades, there has been a significant change in HepA seroprevalence. This change has resulted in the emergence of a young adult population susceptible to possible HepA outbreaks. Thus, seronegative young adults may be considered at risk for HepA and routine vaccination may be considered.

Background: Updated Sydney system (USS) recommends taking biopsies from certain areas of the stomach for the diagnosis of precancerous lesions associated with Helicobacter pylori. Our aim was to evaluate the contribution of each of the biopsy sites to the diagnosis. Methods: This prospective study included 97 patients aged 40 and over with dyspeptic complaints. Biopsies were taken from five regions: the lesser curvature of the antrum (LCA), the lesser curvature of the corpus (LCC), incisura angularis (IA), the greater curvature of the antrum (GCA), and the greater curvature of the corpus (GCC). Biopsy specimens were stained with hematoxylin–eosin stain, periodic acid Schiff–alcian blue, and Giemsa histochemical stain and evaluated according to the Sydney classification. Results: Thirty-seven (38%) patients were positive for H. pylori in at least one biopsy site. Atrophic gastritis without intestinal metaplasia (IM) was found in 17 (17.5%) of the patients (6.2% in IA, 5.2% in each of LCA, GCA, and LCC, and 2% in GCC). The prevalence of atrophic gastritis with IM was 42.3% (21.6% in LCA, 20.6% in GCA, 20.6% in IA, 14.4% in LCC, and 5.2% in GCC). Endoscopic follow-up was planned in 21 (22%) patients due to the presence of extensive atrophy or incomplete IM. If a single biopsy of the LCA or a biopsy of both LCA and GCA was taken, endoscopic follow-up would have been missed in 12 (57%) or 6 (29%) patients, respectively. Conclusion: Taking biopsies in accordance with the USS had higher sensitivity in detecting atrophic gastritis with or without IM compared to single biopsy. One or two biopsies is not sufficient to identify patients for whom endoscopic follow-up is recommended.

PURPOSE The main aim of the study was to evaluate the potential roles of KRAS/NRAS proto-oncogenes, IL-4 VNTR variants and HPV prevalence in colorectal cancer metastasis. As the second aim, the interactions of the analyzed genes and viral sequences with both clinicopathological variables and each other were targeted. METHODS DNA was extracted using AmoyDx FFPE DNA Extraction kit from paraffin-embedded colorectal tumor tissue samples (n = 60). NRAS/KRAS mutational profiles were determined with real-time polymerase chain reaction using AmoyDx KRAS/NRAS Mutation Detection Kit. Genotyping of IL-4 VNTR was made with PCR. HPV detection was analyzed by PCR with both GP5+/GP6+ consensus primers and type-specific primers for HPV-16 and HPV-18. SPSS v22 (IBM) statistics software was used for all statistical analyses. RESULTS From the demographical/clinicopathological parameters, age and biopsy specimens revealed an association with metastasis. KRAS mutation rate was as high as 65 % in the patients and the most prevalent mutation type was G12D. Metastasis risk was 3.19-fold increased in KRAS-mutated patients compared to KRAS-negative ones. IL-4 VNTR genotypes/alleles were not associated with metastasis in our analysis.  The frequency of HPVs in our colorectal cancer cohort was 36.7 %, but HPV positivity was not found to be associated with metastasis.  A significant association was found between HPV and NRAS mutations; NRAS wild-type status acted as a protective factor by 7.5-fold for HPV negativity. CONCLUSION Our study comprehensively and concomitantly evaluated several potential molecular risk factors. Future studies designed in such combined approaches will substantially contribute to better manage colorectal cancer tumorigenesis from molecular biological perspective (Tab. 6, Fig. 2, Ref. 40).

In this study, we aimed to evaluate the relationship between the repetitive thinking styles and anxiety and depression in patients with inflammatory bowel disease (IBD). One hundred IBD outpatients (39 active and 61 remission) attending the gastroenterology clinic and 100 healthy controls were included.The rumination and worry scores of IBD patients, particularly in their active period, were significantly higher than controls. Additionally, the correlation of rumination and worry with anxiety and depression was statistically significant. Our results suggest that psychological interventions targeting repetitive thinking would alleviate depression and anxiety as well as GI symptoms in people with IBD which should be confirmed by further studies.

Objectives: To evaluate the post-treatment upto fourth-year kinetics of alpha-fetoprotein (AFP) in patients with chronic hepatitis C (CHC) treated with direct-acting antiviral (DAA) drugs. Materials and Methods: In this retrospective, single-center study, 182 patients (124 female, 58 male) with CHC treated with DAA were included in the study. Biochemistry and AFP were recruited from the hospital database. The data at pre-treatment, 3rd and 48th month after the end of treatment were evaluated. Results: Of the 182 patients, mean age was 58 +/- 12 (28-76), and forty-nine (27%) had cirrhosis. At month 3, the average decline of AFP was 35.6% (0.4-97.0). Early decline of AFP <8.7% was found to be a predictor for HCC development. Mean AFP was 7.7 +/- 9.2 ng/mL at pre-treatment and 3.8 +/- 2.7 at third month (p<0.001). The decline persisted at 48th month (3.6 +/- 2.4 ng/mL). Conclusion: Early decline of AFP and persistence at fourth-year after DAA treatment was observed, except five cases developing HCC. Inadequate decline in AFP level found to be a possible predictor for HCC development. However, these results needs to be confirmed in large-scale multicenter cohorts. This study highlights the importance of AFP response to DAA treatment in identifying HCC risk, especially in patients with cirrhosis.

Surgeries for obesity can lead to complications. Dumping syndrome is one such complication caused by the quick passage of hyperosmolar chyme from the stomach to the duodenum. Mild cases can be cured with dietary modification and medical treatment. However, refractory cases may need invasive treatment options, such as transoral outlet reduction or surgery. We successfully treated a 48-year-old female with dumping syndrome, using a combination of argon plasma coagulation and hemoclips to narrow the pyloric lumen. We suggest that this new technique could be a cheap and easily accessible alternative to surgery, especially in countries where the specialised devices needed to treat such cases are unavailable.

Small bowel adenocarcinoma (SBA) is a rare disease and presents with intermittent abdominal pain, weight loss, nausea, vomiting, and gastrointestinal bleeding. In cases with delayed diagnosis, intestinal obstruction or bowel perforation can also be observed. In our case, the patient presented with ileus after an operation that was diagnosed with SBA. After six cycles of chemotherapy, the patient went into complete remission.

Objective: Current study evaluated the utility of total antioxidant status (TAS), oxidative stress index (OSI), total oxidant status (TOS), ischemia-modified albumin (IMA), and ischemia-modified albumin ratio (IMAR) as markers in autoimmune liver disease (AILD). Material and Methods: The study included a total of 66 AILD patients, 22 with autoimmune hepatitis (AIH), 32 with primary biliary cholangitis (PBC), and 12 with AIH/PBC overlap syndrome, and 49 healthy controls. Serum TAS, TOS, IMA, albumin (Alb), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), direct bilirubin (DBil), and 25-hydroxyvitamin D (25[OH]D) were analyzed. OSI was calculated as TOS/TAS and IMAR was derived from IMA and Alb. Results: Serum TAS, OSI, TOS, IMA, and IMAR values were found to be significantly higher in the AILD group compared to controls (p=0.004,

Objective: This review aims to raise the awareness and importance of HBV reactivation (HBVr) related to immunosuppressive treatment and chemotherapy. Besides a useful quick algorithm and recommendations for adequate viral serology, avoidance of unnecessary serological testing is also targeted. Introduction: During and after immunosuppressive treatment and chemotherapy, hepatitic exacerbations of various degrees of severity and even death can occur in patients who have previously been exposed to hepatitis B virus. In parallel, with the increase in the prevalence of autoimmune diseases and malignancies requiring IST, the variety of numerous biopharmaceutical and chemotherapeutic drugs is also multiplying. However, due to immunosuppression by these drugs, "de novo", latent, or resolved infections such as tuberculosis, listeriosis, pneumocystis jirovecii, histoplasma capsulatum, candidiasis, aspergillosis, herpes, cytomegalovirus, hepatitis B, and hepatitis C can reactivate. Materials and methods: The literature regarding the HBVr during and after the immunosuppressive treatment and chemotherapy were analysed and a pathway in clinical practice was formed. Results: HBsAg, antiHBc, antiHBs, Anti HCV and Anti HIV testing should be done for all candidates of immunosuppressive treatment or chemotherapy prior. Conclusion: A practical algorithm for physicians of all specialties for preventive measures to avoid HBV reactivation in patients receiving immunosuppressive treatment and chemotherapy who had previous exposure to hepatitis B virus is presented.

Purpose To identify the correlation of nonalcoholic pancreatic steatosis (NAPS) with nonalcoholic fatty liver disease (NAFLD) in an outpatient group. Based on its metabolic and imaging properties, NAPS has been increasingly recognized in recent years; however, its interaction with NAFLD is still not clear. Patients and Methods In this cross-sectional observational study, 345 consecutive patients without any chronic illness who were referred to the senior radiologist for abdominal ultrasound (US) were included. The US report showed hepatic and pancreatic echogenicity. The patients’ demographic, anthropometric, and laboratory data were collected from medical records. Results Overall, NAPS and NAFLD were seen in 227 (65.8%) and 219 (63.5%) patients, respectively. Normal echogenicity was noted in 74 (21.4%) patients. Forty-four patients (12.8%) had steatotic liver without NAPS, 52 (15.1%) had steatotic pancreas without NAFLD, and 175 (50.7%) had steatosis in both organs. The discordance in steatosis grading between NAPS and NAFLD was 55.1%. Insulin resistance was present in 8.7, 26.7, 19, and 61.3% of patients with no steatosis, only NAFLD, only NAPS, and steatosis in both organs, respectively. Evident NAFLD and NAPS having grade 2 and 3 steatosis were present in 15.3% and 29.0% of the study group, respectively. Cholecystolithiasis was present in 6.8, 13.6, and 28.8% of patients with normal echogenic pancreas, only NAFLD, and only NAPS, respectively (p=0.01). Conclusion Based on the ultrasonographic, clinical, demographic, and anthropometric features of the included patients, we found that NAPS did not fully accompany nonalcoholic fatty liver. Despite severe pancreatic steatosis, more than a quarter of cases had normal liver echogenicity. Insulin resistance frequency was insignificantly higher in NAFLD than NAPS (p=0.694). The significantly higher frequency of cholecystolithiasis in NAPS needs further large-scale studies. The inconsistency of steatosis degree in NAPS and NAFLD in >50% cases may reflect differences in the pathophysiology of these two clinical entities.

Ocular discomfort is a common symptom in central sensitization syndromes. The aim of this study was to evaluate ocular surface discomfort and related corneal changes in patients with irritable bowel syndrome. Twenty-nine patients with IBS (20 female, 9 male, mean age: 45.3 ± 10.1 years) and 37 healthy control subjects (25 female, 12 male, mean age: 44.95 ± 9.76 years) were included. A detailed ophthalmological examination was performed to all participants including tear break-up time (TBUT) and Schirmer test I with anesthetic (SIT). Ocular discomfort was evaluated using the ocular surface disease index (OSDI) questionnaire and corneal sensation was evaluated with Cochet-Bonnet esthesiometer. Corneal subbasal nerve plexus was evaluated with in vivo corneal confocal microscopy (IVCM). There was no significant difference between the groups for age, gender distribution, and visual acuity. OSDI scores were significantly higher (p = 0.008) and TBUT was significantly reduced in patients with IBS compared to controls (p = 0.001 for right eye, p = 0.014 for left eye). However, there was no significant difference in corneal touch sensation and SIT results between the groups. IVCM revealed that corneal nerve fiber density, corneal nerve branch density, and corneal nerve fiber length were significantly reduced in patients with IBS (p < 0.001, p < 0.001, and p = 0.023, respectively). Patients with IBS have increased dry eye-associated ocular surface complaints and nerve fiber loss in corneal subbasal nerve plexus. IBS should be remembered in the differential diagnosis, when there is discordance between the level of ocular surface discomfort and dry eye disease associated corneal findings.

Introduction This study aims to assess the predictive value of indices as systemic immune-inflammation index (SII), neutrophil-lymphocyte ratio (NLR) and monocyte/lymphocyte ratio (MLR) on presence of active CMV infection in UC patient. Methods We retrospectively reviewed colonoscopy reports of UC patients between January 2011 and January 2021. These indices are derived from the CBC parameters. CMV colitis was diagnosed from PCR of colonic tissue. The patients with CMV colitis were treated with gancyclovir for 21 days. Statistical analyses were performed using SPSS. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off values for predicting CMV colitis. Results A total of 269 UC patients were involved. 19 (7.1%) patients had documented CMV colitis. CMV patients had pancolitis (n=11, 57.9%) and left-sided colitis in 8(42.1%). The drugs used were mesalazine monotherapy (n=9), azathioprine (n=6) and anti-TNF therapy (n=4). The control group consisted of 250 UC patients without active CMV. This group mostly had left-sided colitis (n=128), while the number of proctitis was 40 and pancolitis in 82. There were significant differences between CMV PCR(+) and CMV PCR (-) cases by means of SII (p=0,037), NLR (p=0,040) and MLR (p=0,016) indices. Moreover, there was no significant superiority between SII, NLR, and MLR. According to the ROC curve analysis, the best cut-off MLR value to differentiate between patients with CMV colitis from UC was >0.43 (Sens:36.8 ;Spec:89.1 ; PPV:21.2 ; NPV:94.7), best cut-off NLR value was >3.1(Sens:68.4 ;Spec:57.7 ; PPV:11.4 ; NPV:95.8), and best cut-off SII value was >900 (Sens:68.4 ;Spec:52.3 ; PPV:11.1 ; NPV:95.7) (Table 1). Conclusions This is the first report to demonstrate that SII, NLR, MLR may predict superinfection of CMV colitis in UC patients. The cut-off values were 900, 3.1 and 0.43 for systemic inflammation index, NLR and MLR, respectively. Thus, CMV complicating UC seems to result with higher inflammatory indices. Large scale, prospective studies are needed for further conclusion.

Pain can be considered an early sign of COVID-19 infection. There are no studies that specifically investigate the frequency, characteristics, and presentation patterns of pain in COVID-19 infection. Our aim is to evaluate the frequency, localization, and severity of pain among the presenting signs and symptoms in patients with COVID-19. Patients with the diagnosis of COVID-19 who were admitted to our hospital between March and June 2020 were retrospectively analyzed. Patients’ general symptoms at the first admission to the hospital, presence of pain at admission, localization, severity, and persistence of pain were queried by phone call. A total of 210 inpatients diagnosed with COVID-19 were recruited from the hospitals database. Complaints of the patients were 76.6% fatigue, 69.3% pain, 62% fever, 45.3% cough, 43.5% loss of taste and/or smell, 25% diarrhea, and 0.5% skin lesions respectively. Pain was the chief complaint in of 46.61% of the patients. Pain complaints had started on average 2.2 (± 2.8) days before admission. Among 133 patients reporting pain, the distribution of site was 92 (69.2%) myalgia/arthralgia; 67 (50.4%) headache; 58 (43.6%) back pain; 44 (33.1%) low back pain; 33 (25.0%) chest pain; 28 (21.1%) sore throat; and 18 (13.6%) abdominal pain. The most common pain symptoms were myalgia/arthralgia and headache (69.17% and 50.37%) and found to be much higher than previously reported. Pain is one of the most common complaints of admission to the hospital in patients with COVID-19. Patients who apply to health institutions with pain complaints should be evaluated and questioned in suspicion of COVID-19 infection.

Budd-Chiari syndrome (BCS) is a clinical state with thrombosis in major hepatic veins which may be related with myeloproliferative diseases, hypercoagulopathy states, oral contraceptives and secondary to compressing tumors. As a rare etiology, Behçet's disease may be responsible from this thrombotic cascade. Behçet's disease-related BCs has a number of treatment modalities including anticoagulants, immunosupressives, immunomodulators, biological agents and alkylating anti-neoplastic agents such as cyclophosphamide. In this case report, we aimed to emphasize the importance of early initiation of immunosupressives and anticoagulant treatment with a combination of cyclophosphamide, corticosteroids and rivaroxaban in a Behçet's disease-related BCS case with multiple thrombotic venous vessels.

Purpose: A completely satisfactory biomarker has yet to be identified for the diagnosis and characterization of inflammatory bowel disease (IBD). This study evaluated the utility of fetuin A and secreted phosphoprotein 24 kDa (Spp24) as novel biomarkers in IBD. Methods: Ninety IBD patients, 54 with ulcerative colitis (UC) and 36 with Crohn's disease (CD), and 41 healthy controls (HC) were included. Serum fetuin A, Spp24, TNF-alpha, and IFN-gamma levels were analyzed by ELISA. Serum C-reactive protein (CRP) levels were determined turbidimetrically by an automated procedure. Results: There were no significant differences in serum Spp24 levels among the UC (17.15 pg/mL, mean), CD (18.88 pg/mL), and HC (14.77 pg/mL) groups (P>0.05). Median fetuin A levels were significantly lower in the UC (249 mg/L) and CD (254 mg/L) groups compared to HC (352 mg/L) (UC vs. HC P<0.001, CD vs. HC P<0.001). Fetuin A levels were not associated with disease activity, extent, or localization in UC or CD. In ROC curve analysis, a fetuin A cut-off value of 304 mg/L predicted IBD with better area under curve, sensitivity, and specificity (0.770, 76.1%, and 70.0%, respectively) compared to CRP (0.645, 32.2%, and 90.2%, respectively). TNF-alpha levels in IBD patients were not differ compared to HC (P>0.05), whereas IFN-gamma levels were statistically significant between UC (3.94 pg/mL, median) and HC (2.65 pg/mL) groups (P=0.037). Conclusion: Fetuin A may have an anti-inflammatory function in IBD and may be used as a potential biomarker for the discrimination of IBD patients from healthy individuals.

INTRODUCTION: Ophtalmic pathologies may be seen in various liver diseases related to autoimmunity, complications, drugs and other treatment modalities. In this study we aimed to assess the ophtalmic findings in autoimmune liver diseases (AILD) including Autoimmune Hepatitis (AIH), Primary Biliary Cholangitis (PBC), Overlap Syndromes and Primary Sclerosing Cholangitis (PSC). METHODS: Patients with AILD under follow-up in gastroenterology department in a tertiary hospital (Istanbul Medeniyet University, Goztepe Education and Research Hospital) were examined by an ophtalmologist blind to the diagnosis. A detailed ophthalmic examination, including external inspection of eye and eye lids, visual acuity, pupillary reaction, ocular movements, and ophthalmoscopy were performed. The demographic data and ocular findings were statistically analysed. RESULTS: The total registered patients in a single center with AILD were 111 (101 female and 10 male; 55 PBC, 44 AIH, 10 Overlap and 2 PSC) fulfilling relevant criteria for diagnosis. The mean age of the patients were 56,4±13,6 (23-84). Of these 13 patients had died related to liver problems. Ophtalmic examination could be done in 156 eyes of 78 patients. with AILD. The prominent ocular findings of 156 eyes of 78 patients were cataract (12,8%) and dry eye (11,5%). corneal sensitivity, uveitis, diabetic retinopathy (2,56% each), corneal lesions, episcleritis, macular degeneration, blepharitis, arcus senilis, conjunctival nevi and floating specks (1,28% each). xanthelasma was present on eyelids only in 3 patients (3,8%) and all were female PBC patients. All cataract patients were female and the ages were less than 60 in 5 of them and the youngest was 38 years old. Remaining 90 eyes of 45 patients (57.6%) had no distinct pathological ocular finding. Also, no glaucoma was assessed in this cohort. CONCLUSION: In our AILD patients, ophtalmic findings were primarily cataract and dry eye. Xanthelasma which is closely related with high total cholesterol level was infrequent in our patients than some reports indicating it as 15-33% of PBC patients. Other findings were not seen in a high majority of AILD patients than other autoimmune diseases as rheumatoid arthritis, Reiters or SLE.