Galectin-3 levels in school aged children with autism spectrum disorder.

Objective: Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders with underlying pathogenesis and etiological factors not fully understood. We assumed that galectin-3, which is also linked with inflammatory responses, may be central to the ethiopathogenesis of ASD. Method: The current study consisted of 33 psychotropic medication-naive children with ASD and 32 control subjects. The Schedule for Affective Disorders and Schizophrenia for School-Aged Children, Present and Lifetime Version-DSM-5 (K-SADS-PL-DSM-5) was used to screen healthy controls for psychiatric disorders by a psychiatrist after a physical examination by a pediatrician. The clinical severity of the ASD symptoms has been assessed by the Childhood Autism Rating Scale (CARS). Venous blood samples were collected and serum galectin-3 levels were measured. Results: When the ASD and control groups are compared, the mean galectin-3 level is 417.77 (SD = 200.20) in the ASD group and 243.08 (SD = 64.65) in the control group, and there is a statistically significant difference between the groups (p < 0.001). When examining whether there is a correlation between galectin-3 levels and CARS total scores, no statistically significant correlation was found between them (r = 0.015, p = 0.933). Discussion: In this study, we examined whether serum galectin-3 levels have a relation with ASD in childhood or not. Our findings have indicated that the children with ASD have higher serum galectin-3 levels compared to the controls. However, no significant relationship has been found between serum galectin-3 levels and ASD symptom severity.

Comparison of the effects of esomeprazole 40 mg, rabeprazole 20 mg, lansoprazole 30 mg, and pantoprazole 40 mg on intragastric pH in extensive metabolizer patients with gastroesophageal reflux disease.

BACKGROUND/AIMS: Studies on the therapeutic efficacy of proton pump inhibitors (PPIs) in patients with gastroesophageal reflux disease (GERD) have been recently published. In most of these studies, comparison of only two PPIs have been made. There are few studies on the comparison of four or more PPIs. We aimed to compare the acid inhibitory effects of esomeprazole 40 mg, rabeprazole 20 mg, lansoprazole 30 mg, and pantoprazole 40 mg on days 1 and 5 of treatment in patients with GERD, who were extensive metabolizers in regard to the CYP2C19 genotype. MATERIALS AND METHODS: Helicobacter pylori-negative with typical symptoms of GERD patients were randomly divided into four treatment groups. Efficacy analysis on days 1 and 5 were performed on the four groups which comprised 10 (esomeprazole), 11 (rabeprazole), 10 (lansoprazole), and 10 (pantoprazole) patients. RESULTS: On day 1 of PPI treatment, the mean percentage of time with intragastric Ph>4 were 54%, 58%, 60%, and 35% for the groups, respectively, and on day 5, these values were 67%, 60%, 68%, and 59%, respectively. Esomeprazole, rabeprazole, and lansoprazole were found to be superior to pantoprazole on the first day of treatment. CONCLUSION: Pantoprazole is a less potent proton pump inhibitor than the other PPIs tested on the first day of treatment. When the time needed to raise the intragatric pH to over 4 was evaluated, esomeprazole was found to have the most rapid action, followed by lansoprazole and rabeprazole.

Age-based computer-aided diagnosis approach for pancreatic cancer on endoscopic ultrasound images.

AIM: The aim was to develop a high-performance computer-aided diagnosis (CAD) system with image processing and pattern recognition in diagnosing pancreatic cancer by using endosonography images. MATERIALS AND METHODS: On the images, regions of interest (ROI) of three groups of patients (<40, 40-60 and >60) were extracted by experts; features were obtained from images using three different techniques and were trained separately for each age group with an Artificial Neural Network (ANN) to diagnose cancer. The study was conducted on endosonography images of 202 patients with pancreatic cancer and 130 noncancer patients. RESULTS: 122 features were identified from the 332 endosonography images obtained in the study, and the 20 most appropriate features were selected by using the relief method. Images classified under three age groups (in years; <40, 40-60 and >60) were tested via 200 random tests and the following ratios were obtained in the classification: accuracy: 92%, 88.5%, and 91.7%, respectively; sensitivity: 87.5%, 85.7%, and 93.3%, respectively; and specificity: 94.1%, 91.7%, and 88.9%, respectively. When all the age groups were assessed together, the following values were obtained: accuracy: 87.5%, sensitivity: 83.3%, and specificity: 93.3%. CONCLUSIONS: It was observed that the CAD system developed in the study performed better in diagnosing pancreatic cancer images based on classification by patient age compared to diagnosis without classification. Therefore, it is imperative to take patient age into consideration to ensure higher performance.

Oxidative status and lymphocyte DNA damage in patients with acute pancreatitis and its relationship with severity of acute pancreatitis.

BACKGROUND/AIMS: Acute pancreatitis (AP) is a life-threatening disease with a rising incidence. The aim of this study was to investigate the association between oxidative status, lymphocyte deoxyribonucleic acid (DNA) damage, and acute pancreatitis. MATERIALS AND METHODS: A total of 45 patients with AP and 35 healthy controls were included in the study. We assessed pancreatic enzymes, oxidative stress, and lymphocyte DNA damage. The severity of AP disease was determined by the Harmless Acute Pancreatitis Score (HAPS) and Balthazar scoring systems. RESULTS: In AP patients, lymphocyte DNA damage was significantly higher than in controls [49.84±25.48 arbitrary units (AU) vs. 28.80±13.98 AU, p<0.001]. The plasma total oxidative status (TOS) and oxidative stress index (OSI) were higher in patients than in healthy controls (10.36±5.54 vs. 8.47±2.66, p<0.05; 0.64±0.35 vs. 0.45±0.13 AU, p<0.001, respectively). The plasma total antioxidant status level in patients was lower than in healthy controls (1.66±0.19 vs. 1.86±0.18, p<0.001). Lymphocyte DNA damage was correlated with TOS, OSI, and HAPS and Balthazar scores. CONCLUSION: This study shows that patients with AP have higher lymphocyte DNA damage and more deteriorated oxidative status than healthy controls.

Eltrombopag: How secure in triple therapy of HCV?

Triple therapy of hepatitis C usually leads to some hematological and dermatological side effects. Thrombocytopenia is one of the most common side effects that are encountered during triple therapy. Eltrombopag was approved for the treatment of patients with chronic hepatitis C and thrombocytopenia to allow the initiation and maintenance of interferon based therapies. During eltrombopag therapy, some side effects like headache, abdominal pain, and some complications such as portal vein thrombosis, deep vein thrombosis and arterial thrombosis were observed more frequently than placebo. We described here a patient who developing thrombosis secondary to eltrombopag in receiving triple therapy.

Relationship between Helicobacter pylori Infections in Diabetic Patients and Inflammations, Metabolic Syndrome, and Complications.

Helicobacter pylori infection and diabetes mellitus are two independent common diseases. It is showed that the worsening glycemic and metabolic control increases the rates of Helicobacter pylori infections and Helicobacter pylori is shown as one of the common problems in diabetic patients with complaints of gastrointestinal diseases. In this study, we aimed to investigate the prevalence and eradication rates of Helicobacter pylori in diabetic patients and the relationship of Helicobacter pylori with the risk factors and diabetic complications. In our study, in which we have included 133 patients, we have shown a significant relationship between Helicobacter pylori infections and metabolic syndrome, insulin resistance, inflammations, and diabetic complications.

Role of serum myeloperoxidase, CPK, CK-MB, and cTnI tests in early diagnosis of myocardial ischemia during ERCP.

BACKGROUND/AIMS: Some patients may experience retrosternal pain during ERCP, which may be a pioneer of a serious myocardial problem, and early diagnosis is very important for the prognosis and management. In the study, we aimed to investigate the role of serum cardiac biomarkers, such as myeloperoxidase (MPO), creatine phospokinase (CPK), creatine kinase- myocardial band (CK-MB), and cTnI, on early diagnosis of myocardial ischemia during endoscopic retrograde cholangio pancreaticograpy (ERCP) procedures. MATERIALS AND METHODS: In this prospective observational study, ERCP patients were separated into ischemic cardiac (n:48) and non-ischemic (n:76) groups. Serious cardiac, kidney, and liver disease patients were excluded from the study. Changes in electrocardigrapy (ECG), blood pressure, pulse rate, oxygen saturation, and serum MPO, CPK, CK-MB, and cTnI levels were investigated before and after the ERCP. Results were evaluated statistically (p<0.05). RESULTS: Mean age was 59.76±16.62 (55♀, 69♂). Only one patient had clinically unimportant retrosternal pain (0.8%). ST-elevation was detected in 10.4% (n:5), ST-depression in 12.5% (n:6), and negative-T in 31.3% (n:15) of ischemic patients during ERCP. Systolic and diastolic blood pressure and pulse rates in both groups and oxygen saturations in the ischemic group were reduced after ERCP. Significance was not detected with MPO and CPK tests. CK-MB levels showed an increase after the ERCP in the non-ischemic group (p<0.001). cTnI means were higher among the ischemics when pre- and post-ERCP periods (p:0.001) were compared. CONCLUSION: Clinically unimportant retrosternal pain, T negativity, and ST segment changes as well as reduced systolic, diastolic blood pressure, and heart rates can be seen during ERCP. MPO and CPK levels remain insignificant if myocardial injury does not develop. Increased CK-MB levels in non-ischemic patients and increased cTnI levels in ischemics may be seen.

Roles of serum and biliary CEA, CA19-9, VEGFR3, and TAC in differentiating between malignant and benign biliary obstructions.

BACKGROUND/AIMS: Despite the presence of many diagnostic methods, the differential diagnosis between benign and malignant biliary obstructions is still not easy. We aimed to evaluate the role of serum/biliary carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), vascular endothelial growth factor receptor-3(VEGFR-3), and total antioxidant capacity (TAC) tests in this differential diagnosis. MATERIALS AND METHODS: Patients (n:225; 110♂, 115♀) with diagnosis of malignant (n:96) or benign (n:129) biliary obstruction were included in this cross-sectional study. Serum and biliary CEA, CA 19-9, VEGFR-3, and TAC tests were analyzed, statistics were obtained, and significance was defined as p<0.05. RESULTS: Mean age was 54.9±16.4 for the benign and 54.2±19.6 for the malignant group (p=0.89). Head of pancreas cancer (18.2%), cholangiocarcinoma (11.4%) and choledochal stone (48%) were the most common etiologies. The area under the curve (AUC)s by ROC analysis of serum/biliary CA 19-9, VEGFR-3, and TAC and serum CEA were 0.701/0.616, 0.622/0.663, 0.602/0.581, and 0713, respectively. Serum TAC had higher sensitivity (61.1%) and CEA had lower sensitivity (42.7%), whereas CEA had higher specificity (89.9%) and TAC had lower specificity (60.5%). In biliary tumor markers, CA 19-9 had higher sensitivity (74%) and VEGFR-3 had lower sensitivity (56.2%); however, VEGFR-3 had higher specificity (79.1%) and CA 19-9 had lower specificity (34.1%). Additionally, combination of serum CEA (p<0.001), CA 19-9 (p<0.001), VEGFR-3 (p<0.001), and biliary CA 19-9 (p=0.028) markers achieved 95% estimation probability, and the sensitivity, specificity, and accuracy were 88.5%, 45.7%, and 64%, respectively. CONCLUSION: Serum and biliary CEA, CA 19-9, VEGFR-3, and TAC tests would not be useful in the differentiation between malignant and benign biliary obstructions.

Endoscopic repair of duodenal perforation with over-the-scope clipping system and endoclips: a case report.

Herein, we present an endoscopic repair of iatrogenic duodenal perforation by over-the-scope clipping system (OTSC) and endoclips in an 84-year-old woman that occurred during linear endosonography (EUS) examination. One OTSC and 8 clips were used for repairing the perforation hole. After 3 days in the intensive care unit (ICU) by chest tube and without oral feeding, she was discharged from the hospital at 6. admission day, and she also had an acute coronary attack during 4. hospital day. OTSC and clipping devices are very useful for repair of iatrogenic perforations, especially in older patients who have comorbid diseases and who can not tolerate the surgery.

A randomized controlled trial of home monitoring versus hospitalization for mild non-alcoholic acute interstitial pancreatitis: a pilot study.

BACKGROUND/OBJECTIVES: Acute pancreatitis (AP) is a disease typically requiring in-hospital treatment. We conducted a trial to assess the feasibility of early discharge from the hospital for patients with mild non-alcoholic acute pancreatitis (NAAP). METHODS: Eighty-four patients with mild NAAP were randomized to home or hospital groups after a short hospital stay (≤24 h). AP was defined by the revised Atlanta criteria. Mild AP was defined as an Imrie score≤5 and a harmless acute pancreatitis score (HAPS)≤2 in the first 24-h of presentation. A nurse visited all patients in the home group on the 2nd, 3rd and 5th days. All patients presented for follow-up in clinic on the 7th, 14th, and 30th days. The primary outcome was the time to resolution of pain. Secondary outcomes evaluated included time to resumption of an oral diet, 30 day hospital readmission rate as well as the total costs associated with either approach to care. RESULTS: There was no difference between the groups with regards to demographics, prognostic severity scores, symptoms, and biliary findings. No patients developed organ failure, pancreatic necrosis, or died in either group. Time to the resolution of pain and resumption of solid food intake were similar. Three (3.6%) patients required readmission within 30 days, 1 from home and 2 from the hospital groups. The total cost was significantly less in home group ($139 ± 73 vs. $951 ± 715,p < 0.001). CONCLUSIONS: Mild NAAP can be safely treated at home with regular visits by a nurse under the supervision of a physician. Widespread adoption of this practice may result in large cost savings.

Endoscopic stapling in comparison to laparoscopic fundoplication for the treatment of gastroesophageal reflux disease.

BACKGROUND: The SRS(TM) Endoscopic Stapling System (Medigus Ltd, Omer, Israel) is a novel method for the treatment of gastroesophageal reflux disease (GERD). The present study assessed the safety and efficacy of SRS compared with laparoscopic anti-reflux surgery (LARS). PATIENTS AND METHODS: Of 27 participants, 11 underwent SRS and 16 LARS. Symptoms were assessed using Velanovich GERD-health-related quality of life (GERD-HRQL) scores. The groups were compared in reference to operation time, improvement in GERD-HRQL scores, and postoperative course. Chi-squared and Mann-Whitney-U-tests were used for statistical analysis. RESULTS: Of 16 (59.3%) male and 11 (40.7%) female patients, mean age was 39.6 (range: 24-60) years and mean body mass index was 26.2 kg/m(2) . Both groups were statistically similar. An esophageal perforation observed in the SRS group completely recovered after over-the-scope clipping. Procedure times for SRSand LARS were 89 and 47 min, respectively (P < 0.05). Mean discharge time was longer for SRS than LARS (3 days vs 1.2 days, P < 0.05). However, this difference disappeared with the exclusion of a complicated patient with long hospitalization in the SRS group. During 6 months mean follow up, proton-pump inhibitor use was insignificantly higher in the SRS group (P > 0.05). Mean GERD-HRQL scores dropped in 87% and in 64% of patients (P > 0.05) from 29.3 to 4.1 and from 24.8 to 8.9 (P = 0.016) in LARS and SRS groups, respectively. CONCLUSION: The short-term results of SRS are promising. The forthcoming new-generation devices and increasing experience may further improve efficacy and decrease untoward effects.

The relationship between resistin and ghrelin levels with fibrosis in nonalcoholic fatty liver disease.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease. It is generally accepted that insulin resistance is a pathophysiological factor in the development of NAFLD. In the present study, the aim was to determine the relationship between resistin and ghrelin levels, which were found to be closely related to insulin resistance and fibrosis scores in NAFLD. MATERIALS AND METHODS: A total of 40 (21 male, 19 female) NAFLD patients whose diagnosis was confirmed with biopsy and 40 (18 male, 22 female) healthy controls were included in the study. RESULTS: In the comparison of resistin and ghrelin levels, only resistin values were found to be significantly higher in NAFLD group while there was no significant difference in ghrelin values (respectively P < 0.05; P = 0.078). In according to the fibrosis groups there was no difference about fasting plasma glucose, insulin values, Homeostatic Measurement Assessment-Insulin Resistance measurements and also resistin and ghrelin levels. CONCLUSION: It has been understood that insulin resistance plays an important part in NAFLD. Larger studies are required that investigate the gene expression of hormones influencing insulin resistance, particularly resistin and ghrelin in order to determine their role in NAFLD.

Staging of rectal carcinoma: MDCT, MRI or EUS. Single center experience.

BACKGROUND/AIMS: To retrospectively compare the efficacy of multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) and endosonography (EUS) in the staging of rectal carcinoma. MATERIALS AND METHODS: A total of 50 patients (36 male, 14 female) were included in the study. The data from surgical staging were used as reference for comparing the yield of EUS, MRI, and MDCT in preoperative T and N staging of rectal carcinoma. Comparisons were based on the chi-square test. RESULTS: The mean age+SD of the patients were 60±12 years (range; 28-80). The distribution of rectal tumors according to the T and N staging in surgical pathology was as following: T1 (n:2), T2 (n:15), T3 (n:22), T4 (n:11); N0 (n:22), N1-2 (n:28). The accuracy rate of EUS was statistically higher than that of MDCT (92% vs 64%; p<0.01) and that of MRI (92% vs 72%; p<0.01) for T2 tumors. For T3 tumors, EUS had statistically better accuracy of staging compared to MDCT (90% vs 58%; p<0.01) and MRI (90% vs 60%; p<0.01). As for T4 tumors, the accuracy rate of EUS was higher compared to MRI (98% vs 80%; p<0.01). There was no statistical difference in accuracy rates for detection of lymph nodes across the modalities (EUS, 84%; MDCT 76%; MRI 70%; p=not significant). CONCLUSION: EUS appears more accurate in T staging compared to MDCT and MRI in rectal carcinoma. Regarding nodal staging, performance of EUS, MDCT and MRI are similar.

Gastroenterology cases of cutaneous leukocytoclastic vasculitis.

Rarely, leukocytoclastic vasculitis can result from ischemic colitis, inflammatory bowel disease, and cryoglobulinemia. There is no established standard for the treatment of leukocytoclastic vasculitis associated with gastroenterologic diseases. This paper presents three cases of leukoytoclastic vasculitis, each of which is associated with a different gastroenterologic condition: ischemic colitis, Crohn's disease, and chronic hepatitis C. Each condition went into remission by treatment of leukocytoclastic vasculitis, regardless of the underlying disease.

Diagnosis of tuberculous peritonitis using endoscopic ultrasound-guided fine-needle aspiration biopsy of the peritoneum.

BACKGROUND/AIMS: Tuberculous peritonitis is prevalent in developing countries and its diagnosis is still challenging due to the lack of specific clinical characteristics and the difficulty in obtaining tissue from the peritoneum without laparoscopy. Endoscopic ultrasound - guided fine needle aspiration is emerging as the most effective and safe method for obtaining tissue from the structures surrounding the gut lumen. Our study aimed to elucidate the efficacy of endoscopic ultrasound-fine needle aspiration of the peritoneum in the diagnosis of tuberculous peritonitis. MATERIALS AND METHODS: Three patients (2 male and 1 female; aged 38, 25, and 65 years, respectively) suspected of having tuberculous peritonitis were recruited into the study. Clinical evaluation including computed tomography imaging and analysis of ascitic fluid were performed. Endoscopic ultrasound-fine needle aspiration biopsy of the peritoneum was performed trans-gastrically with a 19-gauge ProCore needle in all patients. At least two different areas of the peritoneum suspected to be involved were sampled and paraffin-embedded cell blocks were prepared for each biopsy specimen. RESULTS: Biopsy specimens were positive for Mycobacterium tuberculosis by polimerase chain reaction in 2 patients and positive for multinucleated giant cells in all patients. Treatment for tuberculosis resulted in the resolution of symptoms and ascites. No procedure- related complications occured. CONCLUSIONS: Endoscopic ultrasound-fine needle aspiration is an efficacious and safe method to obtain tissue from the peritoneum to use in the diagnosis of tuberculous peritonitis.