Cytomegalovirus ileocolitis in a rheumatoid arthritis patient: case report and literature review.

Rheumatoid arthritis (RA) is an autoimmune, systemic, chronic, inflammatory disease generally treated with various immunosuppressive drugs. Cytomegalovirus (CMV) is an opportunistic, viral infection that is commonly seen in immunosuppressed patients. A sixty-four-year old female diagnosed with RA and treated with immunosuppressive agents was admitted to our rheumatology outpatient service with complaints of diarrhea and abdominal pain, which had lasted longer than four weeks. The patient's colonoscopy revealed inflamed and ulcerated areas in the colon and in the terminal ileum. A biopsy showed intra-nuclear inclusion particles consistent with CMV. We started an oral valganciclovir therapy in this serum-CMV-polymerase chain reaction-positive patient. The concomitant use of immunosuppressive agents and anti-viral drugs eased the patient's complaints, and the endoscopic picture improved. Consequently, cytomegalovirus ileocolitis in immunosuppressed patients admitted with severe diarrhea must be considered in the differential diagnosis.

Unsedated transnasal versus conventional oral endoscopy in endoscopy naïve patients.

BACKGROUND AND STUDY AIMS: Unsedated transnasal upper endoscopy (TNE) has been suggested as a more comfortable and safer method than unsedated transoral endoscopy (TOE). However, the numbers of comparative trials are limited. The current study aimed to assess the tolerability, safety, and efficacy of TNE in endoscopy naïve patients. PATIENTS AND METHODS: The current study was designed as a randomized, prospective, parallel arm trial including all eligible patients referred for upper endoscopy. Patients were randomized with a 1:1 ratio to undergo either unsedated TOE using a standard endoscope or unsedated TNE using an ultrathin endoscope. Postprocedure, all patients were asked to complete a questionnaire to assess pain, discomfort, distress and tolerability using a 10 cm visual analog scale (VAS). Patients' expectations and future preferences were also determined by multiple choice questions. Endoscope insertion rate, procedure duration, and side-effects were recorded for each patient. RESULTS: Each group included 200 patients. With the exception of nasal pain, mean VAS scores were significantly lower in TNE patients when compared to TOE patients (p = 0.0001). 85% and 54.5% of patients in TNE and TOE groups, respectively, found the procedure better than expected (p = 0001). A repeat procedure was significantly more acceptable for TNE than TOE (82.4% and 60.5%, respectively). Endoscope insertion failed in 3.5% of TNE patients. Mild epistaxis was observed in 4% of TNE patients. CONCLUSION: Unsedated TNE was tolerated better in endoscopy naive patients than unsedated TOE in a large parallel arm trial.

Could platelet indices be new biomarkers for inflammatory bowel diseases?

BACKGROUND AND AIM: Ulcerative colitis (UC) and Crohn's disease (CD) are chronic inflammatory diseases. Many serum biomarkers have been studied for diagnosis and monitoring of disease activity in inflammatory bowel diseases (IBD). Platelets play an important role in inflammation. The aim of the present study is to determine whether platelet indices; mean platelet volume (MPV), platelet distribution width (PDW) and platelet-crit (PCT) would be useful, cheap, non-invasive biomarkers for following up and determining severity of IBD. MATERIALS AND METHODS: The study group consisted of 175 patients with IBD (UC n: 103 and CD n: 72) and the control group included 40 healthy subjects. Disease activity was evaluated both by endoscope and clinically. Platelet indices and inflammatory parameters were measured for all study participants. Patients were checked in both active and remission phase of the diseases. RESULTS: In patients with active UC and CD, there was a statistically significant decrease in MPV, PDW levels and increase in PCT levels when compared to healthy controls. In remission phase of IBD while MPV levels were lower, PDW and PCT levels were higher than control group. Both PDW (r: -0.271 p: 0.032) and PCT (r: 0.295 p: 0.027) had a significant correlation with UC disease activity. There was statistically significant change in all platelet indices during diseases follow-up. CONCLUSIONS: The present report revealed that changes of platelet indices in IBD are noteworthy. They can be added to other inflammatory markers especially to monitor disease from active phase to remission phase.